Before the patient spoke, I knew something was amiss, a heaviness in the air, a despondency in the shoulders.
"I thought when we would have the vaccine, things would get better. But nothing’s better. There’s no end in sight."
Many patients have shared the same feelings with me recently in my office in Garden City. Though we all acknowledge the miracle of having vaccines a half decade earlier than expected, the arrival of COVID-19 vaccines has yielded a new anxiety in a minefield of pandemic-related anxieties with which America, and much of the world, finds itself grappling. For those who want it: the anxiety of accessing a vaccine in an agonizingly slow rollout; for those who do not: the anxiety of unknowns of a new vaccine. Many harbor both fears: fearful they will not be able to receive a lifesaving technology whose long-term safety remains to be seen.
Anthropologist Hugh Gusterson examined Americans’ fears in "The Insecure American." Our fears of the other — why we feel safer inside gated communities; our fears of disease, death and dying; our fears of the homeless and our greater fear of joining them; our very real fear of destitution as Americans see real insecurities spiraling upwards along the social ladder — the ever-shrinking middle class is no longer secure.
The pandemic formed a perfect maelstrom of fears — an invisible pathogen that exploits social interactions; a devastating first wave that placed New York at the global epicenter of the worst pandemic in a century; our self-inflicted economic catastrophe which has only expanded in the almost one year since the first person in New York was infected by COVID-19 and hit New York economically harder than anywhere else in America; and now, a new vaccine that poses an impossible decision for many Americans — a real-life, high-stakes game theory gamble:
Should I risk being vaccinated, or should I risk being not?
For two months, I treated patients in the intensive care units at NYU Langone Hospital-Long Island at the height of the first wave — some of the most difficult work I experienced as a doctor in my 30-year career. The number of deaths of patients I confronted still overwhelms. It was therefore unimaginable to me that any physician or medical worker could decline the chance to be vaccinated — yet that is what we are seeing.
I was vaccinated a week or so after the Pfizer-BioNTech vaccine received emergency use authorization. I realized only in that moment how fearful I had been of contracting COVID-19. I count the vaccine as both blessing and an enormous privilege.
But many health professionals and doctors feel differently.
In Los Angeles County, 40% of front-line workers are refusing COVID-19 vaccines; 60% of home health workers in Ohio are refusing. The Kaiser family foundation reports 29% of health care workers demonstrate vaccine hesitancy and even in Britain, where the National Health Service is overwhelmed by the UK strain variant of the coronavirus, 40% of medical care workers are likely to refuse the vaccine.
The medical workforce has the same fears as the general public. But if we can allay our own fears in the front-line medical workforce, we will be better placed to lead all Americans through vaccination into life after the pandemic.
Most fears can be allayed by good communication. And doctors have a disproportionate role in leading the way — we are the most trusted when it comes to health information. When we fear vaccination, fears are magnified in the public.
Certainly, much of the world was skeptical, even frightened by the speed of vaccine development. But the lay public – and much of the medical workforce – doesn’t understand that we already knew the role of the spike protein in human coronavirus infection from decades past. Nor did the public know that the nucleic acid technology platforms used for these vaccines were in advanced research for more than a decade, allowing vaccine candidates to be precisely designed at the molecular level and studied in parallel rather than sequentially, saving years of research, without increasing risks. And that six months later after publishing the virus’s genetic code, all phase-one research had been completed. It usually takes three to nine years. Understanding that speed did not equate to "cutting corners," helps dismantle many fears.
Like many Americans, some health workers believe the natural antibodies they have from a recent COVID-19 infection are protection enough, not realizing while both sets of antibodies last months, the immune protection from the vaccine doesn’t only produce antibodies from B Cells but also activates T memory cells that are much longer lasting. Vaccine-induced immunity probably provides protection to a much greater degree because the body sees the spike protein multiple times in a very short time frame – using a two dose regimen. This "booster effect" is so important, and that is why even those who have resolved COVID-19 infection already are still advised to be vaccinated.
But as we each work to build vaccine confidence and dismantle vaccine hesitancy, we are not acknowledging the most challenging aspect of the mass vaccination – the pervasive myths and misinformation around vaccines that through social media are spreading more rapidly than even the pandemic.
Previously fringe beliefs are now social media-promoted antivaccine propaganda. A patient asked me when I was going to mention the "government microchip" in the vaccine; another wanted to know how the vaccine would "change their DNA;" and a third inquired about the aluminum content of the vaccine that "could cause dementia."
It’s not enough to know medicine and science. I need to know, and debunk, the common themes of misinformation my patients and coworkers are encountering.
Certainly, as New Yorkers, we are allowed to be fearful. Nothing remains normal. And, though we have survived previous devastating blows in New York — the 2000 dot.com bubble, Sept.11, the 2008 economic crash, Superstorm Sandy in 2012 — this pandemic is already orders of magnitude more devastating.
While 9/11 is a poignant comparison – something I recall every day as I treat World Trade Center first responders – New York remained resilient, a heinous act bound us together even more deeply.
In contrast, this pandemic demands social distancing and may be much more detrimental to New York (and many other cities around the world) than the worst manifestations of violent jihadist terrorism. Instead, we are separated by the contagion while we fear contact with others. In a year, COVID-19 has unraveled the fabric of New York life more profoundly than jihadist terrorism.
Courage always demands that we must act despite our fears. That is what makes us brave. As doctors and nurses and other health workers, we must face our fears, overcome them, and empower every New Yorker around us.
Show the way, New York. We can do this – one shot, in one courageous arm, one brave heart at a time.
Qanta A. Ahmed is an attending critical care specialist at NYU-Langone and visiting fellow at the Independent Women's Forum.