Karen E Lasser: Vaccine hesitancy—finding common ground

In the early 2000s, I had occasion to visit the spa town of Baden-Baden, in Southern Germany. In addition to taking the spa waters, I visited Casino Baden-Baden. I do not consider myself a gambler, and have generally avoided the seedy, smoke-filled casinos in the US. However, this casino was different—“the most beautiful casino in the world,” according to Marlene Dietrich. My husband, a Russian literature professor, was eager for us to visit the Casino as Dostoevsky had gambled there. I played roulette that night in Dostoevsky Hall, winning several hundred dollars and immediately spending it on a lavish, multi-course meal with my husband. I remember feeling a rush of euphoria when I won, and I thought to myself, “I understand how gambling can be addictive.”

Yesterday, twenty years later, I re-experienced a winning gambler’s euphoria. No, I have not been gambling online during the pandemic. I received an e-mail entitled “You are eligible for a covid-19 vaccine” from “COVIDVax.” At first, I thought the e-mail was spam, a cruel hoax.  However, I realized the e-mail came from my institutional e-mail address. The vaccine has just become available in the US this week, in Boston, and I had assumed it would be weeks to months before I received it. I am a primary care doctor for adults. I treat patients in-person two weeks each month and I work semi-monthly shifts at Boston Medical Center’s “influenza-like illness” clinic. I know hospital staff who work in the emergency department and the inpatient units will take the vaccine before me. I am ready to accept the risk of a hastily developed experimental vaccine. I think about being able to get on a plane to Seattle, Washington to see my 77-year-old mother whom I have not seen in months.

In my primary care telehealth sessions this week, I have begun discussing the covid-19 vaccine with my patients. Reflecting national trends, about half of my patients expressed “vaccine hesitancy.” One patient, an older African-American woman, whom I have been seeing for many years, has always declined the flu shot, preferring alternative remedies. Did they work? I don’t know, but she has never contracted the flu. When I broached the topic of the covid-19 vaccine, she expressed her concerns about the newness and the experimental nature of the vaccine. She alluded to the history of experimentation on “my people” in this country. I tried to respond empathically and noted in her chart “wants to wait re coronavirus vaccine. She is mistrustful of it.” I also told her that after I have had the vaccine, I will share my experience with her, and that we could continue our conversation. 

Perhaps it was because I was running behind, or because of my introverted nature. What I did not tell her is that I am also a health disparities researcher, and that sitting on my bedside table is Harriet Washington’s comprehensive history, “Medical Apartheid: the Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.” Research suggests that race concordance between healthcare providers and patients can build trust and improve healthcare experiences for members of ethnic minority groups. I wondered if I should ask one of my African-American colleagues to discuss the coronavirus vaccine with this patient when it becomes available to her. I also wondered how much I should disclose about myself to this patient. Could I tell her that my father was a Holocaust survivor, and that Nazi doctors had experimented upon “my people” as well?  

Today, on the drive into the hospital, through snow-filled streets and shimmering sunlight, I felt hopeful and lucky. As I entered the area of the hospital where staff were administering the vaccine, I noticed a flyer on the wall: “Post a photo of yourself on social media answering the question: Why is getting the covid vaccine important to you?” I posted a photo on Facebook and Twitter, captioned “Getting the covid vaccine is important to me because I want to bring an end to this pandemic. I also want my patients, friends, and family to know that the risk of side effects from getting the vaccine is lower than the risk of getting ill from covid-19.”  My daughters each posted my photo on their Instagram accounts, and my daughter Tatiana proudly informed me that her post has already garnered 161 views. I think it is quite unlikely my patient will read these posts. I hope that a trusted person from her community will share a similar message.

Would it be crazy for me to print out a copy of this article and mail it to my patient’s home? Extraordinary problems may benefit from extraordinary solutions. Perhaps it is worth the gamble…

Karen E Lasser, is a primary care physician and Professor of Medicine and Public Health at Boston University Schools of Medicine and Public Health.

Twitter: @lasser_karen

Competing interests: none declared