Rae Woods:
From Advisory Board, we are bringing you A Radio Advisory. My name is Rachel Woods, you can call me Rae. As researchers, we spend a lot of time tracking Coronavirus news, but lately we've noticed that the tone of some of the latest media narratives are far too negative, maybe even bordering on over-hyped.

Rae Woods:
We want to challenge some of the narratives that are out there, especially some of the myths and misconceptions that might ultimately make vaccine hesitancy even worse. To do that, I brought vaccine expert, Brandi Greenberg, and policy expert, Christopher Kerns. Hey Brandi, hey Christopher.

Christopher Kerns:
Howdy.

Brandi Greenberg:
Hello.

Rae Woods:
What's the wildest COVID conspiracy theory, myth that you're hearing right now?

Brandi Greenberg:
That the vaccine attacks whatever your weakest part is, and that is where you will have your side effects. So if somebody had a bad knee, that their knee would hurt after getting vaccinated.

Rae Woods:
Oh no. That's a problem, because it's within the realm of possibility. It's at least slightly reasonable, compared to others. How about you, Christopher?

Christopher Kerns:
Mine's not nearly as cool as that, just that the virus itself is to distract us from the fact that birds aren't real.

Rae Woods:
I think as an avid bird watcher, Brandi would say that they are in fact real. Can confirm.

Brandi Greenberg:
Yes, but I have many family members that taught me with the whole birds aren't real conspiracy. I'm well aware of it.

Christopher Kerns:
I do like how it tends to coincide with the flat earther phenomenon. So the world is flat and birds aren't real, and COVID was really just created to throw us off the trail.

Rae Woods:
Well, there are obviously tons of myths and misconceptions about the progress of the pandemic, and in vaccine rollout specifically. But we are not going to talk about the crazy stuff today. We're going to talk about some of the real concerns that the three of us have had as we've watched the media address the progress of the pandemic to date.

Rae Woods:
And I feel like one of the biggest moments for us actually happened a couple of weeks ago, when the FDA announced a pause in the J and J vaccine. This is where misinformation could have really gone into a tailspin. What was the biggest thing that you were tracking?

Brandi Greenberg:
For me it was the data on hesitancy. It was how I was tracking any follow-on that would suggest that, because of the pause, that people who were on the fence were starting to recede back. And that, that would then spin out of control and create momentum for hesitancy.

Christopher Kerns:
And the data since then has backed up that fear. It's not been as bad though, as we might have suspected at the very beginning. In that we haven't seen more people become more hesitant, but people who were hesitant have become hardened in that belief.

Rae Woods:
But at the same time, the opposite problem could have happened, right? When that pause was announced, I know that we were also talking about, are there actually enough doses of Pfizer and Moderna to even keep up with demand for immunization? What happened there?

Christopher Kerns:
Well, the good news is that Pfizer and Moderna were able to pick up the slack, and they've certainly increased their production. So we didn't really see a significant disruption in overall supply, at least in the US.

Brandi Greenberg:
The one other thing I want to note here, Rae, was you and I had had a conversation when J and J got authorized, about some of the opportunities that a single-dose vaccine presented. And that there would be certain people who were hesitant about getting the MRNA that may have been more open to either the single-dose or the viral vector platform.

Brandi Greenberg:
And so part of what made me sad was that, for a lot of people where their reason for hesitancy was MRNA, we sort of took that other option away from them, or have to now reassure them all the more that the option that they maybe would've been more inclined to is actually quite safe.

Rae Woods:
And that concern I think is well-founded. Because now that J and J is back on the market, it now has a new warning. The question is, is that warning enough to combat the real, or maybe just perceived, concerns about vaccine safety?

Rae Woods:
Now, we didn't get the kind of label that I think folks see at the end of a drug commercial on TV. Is the label that we got enough?

Brandi Greenberg:
I'll go out and just say yes.

Christopher Kerns:
I'd agree with that.

Brandi Greenberg:
I think it's perfectly fine. It happened the right way. They knew about the risk, they didn't quite know how big it was in the trial. Now that they had then 8 million people, and they found out that it happened a handful of times, it was enough to warrant, basically what you'd call a change in the label. And acknowledging that this is a risk.

Brandi Greenberg:
It is, like you say, no different than other risks for other medicines, both prescribed and over the counter, like aspirin. And we don't talk enough about those risks that we take every day. And so I think there's a proportionality that we have to deal with. But overall, I was perfectly happy with the way they handled the pause.

Rae Woods:
I think you explained to me that these kinds of warnings, these black box warnings, tend to be vague. They aren't the laundry list of examples are said really, really quickly at the end of drug commercials. And that actually was purposeful.

Christopher Kerns:
And that's especially true when the risk levels are this low, in general. So the warning was warranted, but it was purposely vague, and this is not unusual at all. And I think that's important for people to understand that.

Rae Woods:
So we know that the two-dose vaccines were able to cover the demand during that J and J pause, but that brings me to the next thing I've been hearing about in the media. And that's this commentary that 8% of Americans who got the first shot of either Moderna or Pfizer, didn't actually show up in time for their second dose. Are you concerned about that number?

Christopher Kerns:
You're really focusing on the wrong number when you look at that 8%, right? The real number to look at is 92%. ask any physician or nurse, and getting 92% compliance on literally anything is an astounding achievement. 8% is certainly not ideal, we would love it to be 100%. But when we're looking at the overall compliance levels, 92% is actually pretty darn good. When we look at the bigger picture here.

Brandi Greenberg:
And even for the folks that don't come back, or maybe delay. Keep in mind that in the UK, they were actually spreading out the doses a little bit longer, and they're still seeing quite a bit of benefit. So if they do come back, but maybe there's a lag, that's not horrible.

Brandi Greenberg:
And, thank goodness, there's a whole lot of real-world evidence showing that for the folks that don't come back at all, they still get quite a bit of protection out of one dose. I'm not recommending it.

Rae Woods:
Of course.

Brandi Greenberg:
But, again, better than nothing.

Rae Woods:
When it comes to that pause with the J and J vaccine, is there anything that you wish would have happened differently? Or you think could have changed the perception issue that we've been dealing with, and are still dealing with right now?

Christopher Kerns:
I mean, Brandi and I have talked about this a lot, and the FDA did the right thing by everything that we can tell. The one mistake, if you could call it that, that I would probably attribute here is the fact that there was a two hour delay between the time that the FDA announced that there was going to be a pause, and when they described the rationale behind it.

Christopher Kerns:
So that allowed a lot of media outlets to run with the story without any context, which I think created a lot of unnecessary confusion in the marketplace.

Rae Woods:
If I think about misleading headlines, I immediately think about breakthrough cases. Those headlines that say, even though this person was four weeks out from their second dose, look, they still got COVID. How do we actually assess the rate and the risk of breakthrough cases?

Christopher Kerns:
The number of breakthrough cases is extraordinarily small, given the number of people who've been vaccinated. I think the latest numbers that I saw were 9,245 breakthrough cases. And of those people, very few, less than 9% were hospitalized. And even fewer of them have died from COVID.

Christopher Kerns:
The reality is that this is an extraordinarily small number, and it really does map to the clinical trials. We all knew that the vaccine was not 100% effective, but it is mapping to the 90-something percent that we got from the clinical trials for Pfizer and Madrona. That's not unexpected at all.

Rae Woods:
You're also pointing out a really important nuance in tone. That, yes, we expected this to happen. But the world is not ending as a result of this. And Brandi, I can see you nodding your head, because I am normally the pessimist and you are the optimist when we speak. But when I reflect on these headlines, even if the numbers are right, maybe the tone is actually what's off here.

Brandi Greenberg:
Yeah. And, you and I have talked about this at length, right? Same thing with the alarmist nature of the J and J pause, before we have the context. The word breakthrough cases, that suggests that something went wrong and it wasn't supposed to happen. And so you are dialing up the alarmist nature of it. And for a culture that increasingly reads headlines but not articles, especially on social media, that becomes a huge problem, and people end up forwarding the headline and it spirals without reading.

Brandi Greenberg:
Some of the articles actually in paragraph four will say, actually, this is perfectly in line with what the clinical trial data said, and it's actually not so bad. But you've got to get to paragraph four. So I think that we are doing public health, a disservice by trying to get clicks and keep subscriptions going.

Rae Woods:
Because the worst case scenario is we actually convince people that COVID-19 vaccines aren't effective because a handful of people are still testing positive for the virus.

Brandi Greenberg:
Absolutely. Now the one caveat I will point out here that is nuanced is, I think we are learning more about the vaccine's effectiveness in the real world. Because there were certain populations that were excluded from some of those trials, or at least in limited number. And I have a very personal example I will share, which is immunocompromised folks.

Brandi Greenberg:
It turns out that a large percentage of the people that are super vulnerable already, the MRNA vaccines at least are not triggering the level of antibodies in a lot of them. These are cancer survivors, current folks with blood cancers, and some folks transplant patients who are on immuno modulating drugs.

Brandi Greenberg:
My mom has leukemia right now, and we just learned that she has had both vaccines and shows up as having zero antibodies. That, again, is not shocking. We just have to manage it differently. I don't want that to look like a failure, it is just continued learning about the vaccines and the virus.

Rae Woods:
Now let me switch gears and talk about a misconception that I will completely admit I have a personal connection to. And that is this narrative that is out there that, because a disproportionate number of COVID cases are coming from younger people, ages 18 to 50, they must be the ones that are flouting the rules.

Rae Woods:
In fact, I think the narrative is specifically, you damn millennials are now causing all of the problems. As a millennial, please tell me this is not true.

Christopher Kerns:
As a Gen X-er, I can say it with extreme disappointment that this is not millennials' fault. So the reality is that this is just math. When we look at the percentage of the population that has been vaccinated, most of the senior population, or at least a disproportionate level of the senior population, has been vaccinated. So of course the number of cases that are going to be turning up in hospitals are going to be younger, simply because the vaccines are working on the senior populations that have by and large been vaccinated at this point.

Rae Woods:
Again, which is a good thing. We should be celebrating that, rather than focusing on the more negative side of the narrative.

Christopher Kerns:
Let's also remember that while it's certainly not a great thing that younger people are contracting the virus, they are much more likely to survive it.

Rae Woods:
One constant in life is that older generations like to blame the younger generations, and I know I just wanted to get to get out of jail free card for millennials. But should we actually be placing any blame on gen Z? I'm thinking the very young, 12 to 18, who are maybe spending time with friends, going back to school. I've heard things about them actually being the spreaders of the disease. Should we be concerned there?

Brandi Greenberg:
So as the parent of two of those folks, I have a 14 year old and a 17 year old, I would say probably it's not fair to blame them for doing the activities in the safest way that they can do them, that they need to do just to function as kids and teenagers. Which is, go to school. And play sports. And we all saw the huge behavioral health toll that the pandemic has taken. And so I think, very personally as a parent, weighing that trade-off of how to have teenagers be social animals, be learning beings, in a way that still keeps them safe and protected, there will be mishaps.

Brandi Greenberg:
But again, more and more kids 16 and above are now getting vaccinated. They're actually quite excited to do it. I don't think that's getting talked about enough, is the number of kids that I talked to who cannot wait to get their shot. My son, who just is 14, found out yesterday about the Pfizer approval and he wants to be the first in line the first day it's available.

Rae Woods:
Amazing. Yeah. See, we should be celebrating that. And to your point, we want kids to hang out with their friends and play sports and go back to school. So maybe it's wrong to assume that any spread coming from that demographic is coming from bad behavior.

Christopher Kerns:
You know, the reality is that 16 year olds always want to be 25, and as a 44 year old I also would like to be 25, but that's just not going to happen. I also think though, that we should keep in mind that these trade-offs that parents and kids have had to make recently may not have to be as much of a trade-off going forward. We just got FDA approval for use of the vaccine on kids as young as the age of 12. So increasingly, we're going to find that adolescents and teenagers are going to find themselves vaccinated.

Rae Woods:
And potentially even younger age by the fall.

Christopher Kerns:
Quite possibly.

Rae Woods:
I will say, I think part of the concern about age and hospitalization is this underlying fear about the variants. And I think the concern there is, are the new variants more transmissible than classic COVID 19, and are they ultimately more lethal? What are we actually seeing here?

Christopher Kerns:
Well, by definition over time, the variants that survive are going to be the ones that are the most transmissible. So it's not surprising that the variants that we see that are starting to take over are the ones that are the most transmissible. Because by definition they would have to be.

Christopher Kerns:
But I don't think there is much evidence to suggest that most of these variants are more lethal than any of the others. There's also a lot of evidence to suggest that the vaccines that are currently out there do provide some level of protection against even those.

Rae Woods:
Square that for me with the very real concern, and frankly, what we've been talking about at Advisory Board, about pushing for vaccination and trying to get as many shots in arms as possible to stay ahead of variants. How do I weigh the good news about lethality, at least, with the reality we still need to get ahead of the variants?

Christopher Kerns:
Well, it's always possible that variants can mutate over time and become far more resistant to vaccines, so this is one of the things that we are really keeping tabs on with the spread of the virus in India, for example, getting the virus much more time to mutate. But the reality is so far, even when we look at the South African variant, that everyone has been very worried about, it's far more transmissible and it does get into populations faster from what we can see, but even that variant has been thwarted to a certain extent by the vaccine, from what we've been able to see so far.

Brandi Greenberg:
But Rae, to your point about why is that a ... That's not enough to say, okay, well, enough of us are vaccinated, and it covers enough in the vaccines that we can just slow down now. This is basic virus, evolutionary biology, sort of what Christopher was alluding to. They need hosts to survive. As more of us get vaccinated, they have fewer hosts.

Brandi Greenberg:
Their options are to mutate in ways that make it easier to get into hosts. It actually is counter to evolutionary biology to become more lethal, because they don't do a whole lot of good if they kill their host.

Rae Woods:
Oh, interesting. Yeah.

Brandi Greenberg:
My son pointed this out from his biology class to me. But the other thing they can do is you have, it's not only more transmissible, but they're coming up against these antibodies and these blockers. And so it is, again, makes sense with evolutionary biology, and we've seen this with other viruses, other bacteria, they can become resistant to drugs and vaccines. And that is why it is still so important to vaccinate, not just in the US, but also to do what we can to make sure that vaccinations are happening as quickly and effectively as they can around the globe.

Rae Woods:
And to get vaccinations in the arms of folks who maybe weren't really eager, or wanting to go to the front of the line, wanting to be the first person to get that dose as soon as their age group opened up.

Rae Woods:
Now, Brandi, you and I have spent a lot of time on this podcast talking about vaccine hesitancy. And so has Advisory Board. And many other institutions have dedicated a ton of time to helping providers and public health agencies combat vaccine hesitancy, particularly among communities of color. But is that where we're seeing hesitancy play out right now, in practice?

Brandi Greenberg:
I think the short answer is, it's not one story. And what the data ... There was initially a lot of focus on marginalized communities, communities of color. Knowing just past history, medical mistrust. But I think what is happening is that there are pockets of hesitancy, depending on how you slice it, by rural-versus-urban. We're seeing more rural populations a little bit more hesitant. We're seeing still hesitancy in some black and Hispanic communities. It is starting to play out a little bit, demographically. Younger, a little bit more hesitant than older. COVID feels a little bit less threatening, a little bit more distant.

Brandi Greenberg:
And also by political affiliation, I wish it weren't the case, but it is. People identify as Republican, more likely to be hesitant than folks that identify as either independent or Democrat.

Brandi Greenberg:
But something that Christopher has brought up a lot is the idea of, that doesn't mean we need to target and blame one group. It means we actually just need a multifaceted strategy to address and understand the different sources of hesitancies.

Christopher Kerns:
No, definitely. When we look at the one thing that seems to run across a lot of the sources of hesitancy, one thing that comes up over and over again is distrust of government, or mistrust of government. But the reality is that the reasons behind that are very different. So the strategies that you're going to have to employ to convince people to get over their hesitancy, to get past that hesitancy, they're also going to have to be different.

Christopher Kerns:
For example, people may not trust what they see on Facebook. They may not trust what they see coming from the government itself, but they might trust their local PCP. Because these are the people in their neighborhood, the people that they see every day. So we need to have physician offices, PCPs, making it easier to distribute and administer the vaccine. And by and large, primary care physician practices have not been the main administrators of the vaccine. That might need to change.

Christopher Kerns:
And we need to get people within individual communities, people that are trusted leaders within those communities, to be the ones who are taking the vaccine very publicly if we're to expect to get past this wave of misinformation. Because the reality is, we're just not going to be able to overwhelm the misinformation with correct information. It's just too much information for people who are hesitant to really process.

Brandi Greenberg:
The other thing that I have been thinking about when it comes to moving more vaccines into PCP offices, is that PCPs have the opportunity to offer the vaccine when you're already there for something else. And that may sound like not a big deal, but what it does is, it actually changes the equation of how active the person needs to be in seeking out the vaccine.

Brandi Greenberg:
And when you get to issues of mistrust or identity, it may feel uncomfortable, based on who you are and what you believe, to actively seek out an appointment. And go to the mass vaccination site.

Brandi Greenberg:
But if you're at your PCP for your wellness visit and the doctor says, hey, as long as you're there, I've already given four, other of your buddies, the vaccine today, why don't we just do it? It's almost more of a passive opportunity. And I've heard in a couple of conversations this week that that may actually be effective for some of those folks that are more hesitant.

Rae Woods:
Hm. My final misconception that I want to talk to the two of you about has less to do with the here and now, and more to do with the future. And frankly, Brandi, you already alluded to this.

Rae Woods:
As we see COVID cases surge around the globe, I'm starting to hear an argument for vaccine nationalism. Meaning, the US should not give away any doses because we've got to get to this all-important herd immunity. First of all, is herd immunity even the goal anymore?

Christopher Kerns:
Well, given the levels that we see right now in terms of hesitancy, getting to 70%, it's possible, it's mathematically possible for sure. But it's an uphill climb, and we're really having that last mile problem right now. It's just very difficult to get the next set of people vaccinated because it's not just a matter of getting them access, it's a matter of getting them over their hesitancy.

Rae Woods:
But President Biden, I think, thinks that he can get there. At least by July 4th, right? With the new goal of getting 70% of American adults at least one dose by the 4th of July. Which, as you pointed out, gets us actually pretty darn close to herd immunity. Doesn't it?

Christopher Kerns:
It certainly would, but I think this really does showcase a lot of the political tensions that we're feeling right now. I mean, the simple truth is that it is very politically difficult to export vaccines to other countries when there are still un-vaccinated people in the US, and that is a reality that policymakers and politicians have to deal with.

Christopher Kerns:
But it's also true that it is measurably better for the United States, and the developed world in general, to ensure that the virus doesn't rage in developing nations, as it is currently doing in India right now.

Christopher Kerns:
So if we cannot increase the amount of Americans who are vaccinated, there's going to be a strong political pressure to distribute them to the rest of the world. But as long as there are un-vaccinated Americans, there's going to be a strong political pressure to not distribute them to the rest of the world. This is the tension that politicians, policymakers have to navigate right now. And there is no cost-free solution here. And I think we all just need to recognize that.

Brandi Greenberg:
Yeah. And adding complexity to this is a new term I am hearing, which is vaccine diplomacy.

Rae Woods:
Oh, interesting.

Brandi Greenberg:
Which is the idea that countries are offering up their vaccines in the hope that it will change the recipient nations view of them.

Brandi Greenberg:
Perfect example, WHO just authorized China's Sinopharm vaccine. And that is a vehicle for China to make its vaccine available at a time where America is not doing as much. And there are all kinds of political ramifications for that, as if it wasn't a complicated equation already. Just additional things to think about.

Rae Woods:
And I mentioned this on a previous episode, but the truth is that it is in the national interest of the United States to be both local and global, right? To our conversation about variants, that is how we're ultimately going to prevent dangerous variants from emerging that would ultimately hurt the United States as well as the rest of the globe.

Rae Woods:
Well, Christopher, Brandi, when it comes to the media narratives out there, when it comes to the potential myths that we're seeing about this pandemic and about COVID-19 vaccines, is there anything that you really just want to correct about the narrative that's out there?

Christopher Kerns:
I'll take an optimistic view here. I think that the news largely has been good, that when we look at the story of the development of the vaccine, of the distribution of the vaccine here in the US, certainly in Britain, and other countries, the story has been that of success.

Christopher Kerns:
We have made strong progress on getting our citizens vaccinated. We have a long way to go, but we've come a long way. And I think there's a lot to celebrate here. It's true that when we look at the media narratives they're often negative. Media has a negative bias. But in this particular instance, I think there's a lot to celebrate.

Brandi Greenberg:
And I'm going to do something I don't typically do on this podcast, which is take a little bit more of a contrarian view. I don't know if it's negative as much as I'm frustrated. And it was. I'm frustrated at what Christopher said, which is the media tends to take a negative slant.

Brandi Greenberg:
I would like to see public health officials, policy makers, healthcare leaders, hold the media more accountable for the stories that they tell. I think they are, in an effort to report, and sew, and get clicks, they are spinning a more negative narratives than what the facts actually play out. And I think they are hurting their own cause, that they are objective.

Christopher Kerns:
Hear, hear on that.

Brandi Greenberg:
I would like to see a little bit more accountability from the media.

Rae Woods:
And frankly, as researchers, as participants in the engine that is healthcare, it is important for all of us to be correct in our narrative, but to also think about the implications of what we say. Because they clearly have a very real impact on the patients and the communities that we serve.

Rae Woods:
Well, Christopher, Brandi, as always thank you for coming on Radio Advisory.

Christopher Kerns:
Thank you for having us.

Brandi Greenberg:
Thank you.

Rae Woods:
I know that some people have trained themselves not to trust what seems like good news, but Brandi and Christopher are right, there is a lot to be positive about. Yes, we're still dealing with a pandemic, but coronavirus cases are decreasing or steady all across the United States. As a research organization, Advisory Board is committed to sharing accurate and actionable insights. But as participants in the health care engine, and as a person with a platform, I also know that we have a responsibility to think about the implications of what we say. Because they clearly have an impact on patients and on the community. So this week, I want you to feel proud of the work you’ve done. And remember we’re always here to help.