In almost two decades working in nursing homes, I've never been through a time as dire as last spring. Facilities like mine, in the greater Boston area, were working with minimal to no protective gear, very little infection-control training, limited laboratory services and constantly changing public-health guidelines. Residents with COVID-19 deteriorated so quickly that they'd crash right in front of me, before we even got their test results.
Staff members got sick, and others stayed home because they were scared to get sick. While many doctors stopped going into nursing homes out of fear for their own safety, my team of physicians and nurse practitioners felt it was our duty to continue seeing patients every day. The need was so great: Units that usually had one certified nursing assistant for every eight to 10 residents suddenly had one person in charge of 30 to 40; we were also short on nurses. People weren't getting their meals or personal care on time; they suffered from dehydration, bedsores and social isolation. It was a heartbreaking time. I lost over a hundred patients.
As we learned more about the virus — treatments, proper infection control — conditions improved. Then the vaccine offered our first real hope that this pandemic would eventually end. I got my shots in January, as soon as I could.
But I soon realized that not everyone shared my enthusiasm. About half the staff in the four facilities where I serve as medical director said they would not take the vaccine. This might seem shocking: We work in the medical field, and we saw some of the worst ravages of this disease up close. And yet, despite the misery we'd witnessed, my colleagues were wary of the one intervention that offered a light at the end of the tunnel.
Health authorities across the country have reported widespread vaccine hesitancy among nursing home staff. Uptake among residents is high. But a national survey of certified nursing assistants late last year found that nearly 72% didn't want to be vaccinated. The governor of Ohio reported in late December that around 60% of his state's nursing home staffers had elected not to take the vaccine yet. Last month, a union representing nursing home staff in Maryland and D.C. estimated that up to 80% of its members opted not to be vaccinated in the first push at their facilities. One Miami health system found that only half its employees wanted to get vaccinated immediately; about 15% said they were not interested in getting vaccinated at all.
Those statistics are much less surprising when you consider who works in nursing homes. A lot of the certified nursing assistants I work with are people of color. Their mistrust has deep roots: The United States has a long, ugly history of doctors experimenting on Black people without regard for their consent or needs. And working with the elderly — another population our society marginalizes and neglects — has done little to shore up my colleagues' faith that the government is acting in their best interests. Nursing homes were among the first and hardest-hit settings in this pandemic, and we never had enough N95 masks or even simple surgical face coverings. So when nursing home employees are informed that they'll be among the first to get the vaccine — that they're in the highest-priority group — they're skeptical. It doesn't help that many of the most widely available educational materials about the vaccine are produced only in English, shutting out my co-workers who primarily speak Spanish or Haitian Creole.
I started running town halls, in person and over video, to talk to the staff in various Massachusetts nursing homes about the vaccine. Some people come with questions about their specific situations: autoimmune conditions, allergies to food or medicine, pregnancy. I've heard more lurid worries, too. Some people thought the shot had a GPS tracker in it that would allow the government to follow their movements. Others claimed that the vaccine changed your DNA and that any future children could inherit the mutation.
No matter how outlandish some fears seem, I can't shrug them off. People's concerns aren't totally random; it's counterproductive to just dismiss them. Instead, I try to figure out where their understanding went wrong and to offer an explanation for that misunderstanding. For example, vaccines definitely don't contain GPS-enabled chips, but the Pfizer boxes carrying the doses do have a tracking device so that we can follow shipments to our facilities. After I show the staff videos of the boxes and their bar codes, that seems to assuage their fears. I also talk about the differences between RNA and DNA — people often confuse the two, I say, but the vaccine won't affect the latter.
Some people have more general concerns: Did some stringent standard fall by the wayside to speed up the development and approval process? A nurse asked me: "So, Dr. Merchant, was there any point in time when you didn't want to take the vaccine? And at what point did that change?" It helped, I think, that I could answer honestly: Yes, I was skeptical, especially in the spring of 2020. It seemed like President Donald Trump was making unrealistic promises about the timeline for a vaccine and the whole development and approval process might be politicized. But as more data emerged about the vaccines' efficacy, and as I read up on their safety, the more I trusted the science behind them.
I also talk about why I took the vaccine: I see COVID-19 patients every day. I got the shot to protect myself, of course, and to protect my family members — especially my parents, who are elderly and live at home with me. I also want to keep my nursing home residents and co-workers safe; I have a responsibility to my community. And, I add, I'm tired of all the precautions that have become life-or-death necessities in the pandemic. We all want normalcy. Vaccine uptake is our ticket there.
These conversations are incredibly time-consuming — hours that I could've used elsewhere, seeing to patients — but they're worth it. Usually, at the end of the town halls, at least a couple of staff members will say they now feel more comfortable with the vaccines. Others say that they'll at least consider taking it, or that they don't want to be the first in line but they'll get the shot the next time it's available to them. When you talk to people, when you take them seriously, you can change their minds. I really believe that. I have to believe it.
Asif Merchant is a geriatrician who serves on the COVID-19 Vaccine Advisory Group for the governor of Massachusetts. This piece was written for The Washington Post.
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