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Susan R. Bailey, MD: “Vaccine hesitancy was a huge problem before the pandemic began and has certainly not gotten better since we’ve had COVID and now are looking forward to a COVID-19 vaccine.”
The big news about Pfizer’s breakthrough today perhaps signals that the long-awaited and talked about COVID-19 vaccine will be approved in the not-too-distant future. However, you can lead people to a COVID vaccine, but you can’t make them take it. Susan R. Bailey, MD, the president of the American Medical Association knows this all too well. Bailey tells Infection Control Today® that at least in the hospital setting (as opposed to physician private practices) doctors and infection preventionists should act as vaccine ambassadors to patients and their fellow healthcare workers. “I think that we just have to make sure that we all stick together and work all-hands-on-deck to fight this virus,” says Bailey. “Infection prevention obviously is a huge part of this process. And you know, now more than ever, we need to all have the same message and work together from prevention to treatment to immunization.”
Infection Control Today®: The COVID-19 vaccine: Do you see doctors and infection preventionists working together possibly to try to push the public and their fellow healthcare professionals into getting the vaccine if—and this is a huge if—doctors and IPs are themselves convinced of its effectiveness?
Susan R. Bailey, MD: Unless medically contraindicated, medical professionals I think have a strong duty to accept immunizations when a safe and effective vaccine is available. But they should not be required to accept immunization with a novel agent until and unless there’s a significant body of scientifically well-regarded evidence of safety and efficacy. Now with regard to COVID-19 vaccines, it’s critical that the FDA continuously inform physicians of their plans for vaccine review. Physicians really must be provided with the utmost level of transparency regarding the FDA process for authorization standards for review safety, and efficacy data just as soon as possible. FDA experts continue to assure us that they’ll follow a rigorous, fully transparent evidence-based program to deliver a safe and effective vaccine against COVID-19.
And then we must do what physicians have always done; review the evidence and trust the science. When a safe, effective vaccine is available, physicians have an ethical responsibility to accept immunization. This is especially true if we have a disease that’s highly transmissible. That poses significant risk for vulnerable patients or colleagues. That threatens the availability of the healthcare workforce and has the potential to become a pandemic. And of course, it looks like COVID-19 fits all those categories. There are some medical contraindications, compelling medical reason, which might exempt physicians from receiving a specific vaccine. But if physicians that can’t get a specific vaccine, I think have a responsibility to voluntarily take appropriate action to protect their patients, their fellow healthcare workers and everybody else. They need to adjust their practice activities, which might even include refraining from direct patient contact if necessary.
ICT®: What about the FDA’s emergency use authorization. It means not going through the usual rigors of the FDA approval process. Does that worry you at all? Or if they approve a vaccine using the emergency use authorization, will you tell physicians that “we should jump on it and tell our patients to take it, too.”
Bailey: The emergency use authorization (I call it the EUA-plus guidelines) that have been issued by HHS and FDA for COVID-19 vaccine approval are really very similar to the standard vaccine approval process. I feel good about the process as it has been laid out. Of course, the secret has to be revealed. We need to see what the outcomes are of the safety and efficacy studies. But as the process is laid out right now, I feel comfortable that no corners are being cut.
ICT®: Hospitals are very hierarchical places and physicians are pretty high on the hierarchy. Do physicians, in your experience, work closely with infection preventionists in dealing with trying to prevent infection and monitor what’s going on among, not only patients, but fellow healthcare workers?
Bailey: Well, in a hospital setting, certainly. I think that most hospitals and large health systems have very effective infection prevention teams that work very closely with physicians. That gets tougher the further out into private practice that you get where physicians are pretty much on their own in terms of making their offices free from transmissible infections. But in a hospital setting, that relationship is invaluable.
ICT®: I guess the physician community doesn’t speak as one on anything because in any huge group of people there are going to be disagreements within that group. Do you foresee some physicians just saying no to the COVID-19 vaccine when it comes out and saying something like, “well, let’s wait a year and see what the side effects might be” or “let’s wait a year and see if it’s really effective.”
Bailey: That’s so hard to predict. You know, I think if the data is conclusive, I hope that there will be very high vaccine uptake by physicians, especially those that are on the frontlines and really are going to have a definite interest in being protected against the virus. I think a lot of the vaccine confidence will come with good data, good education, and a clear record of safety and efficacy in the trials.
ICT®: Are you frustrated by the anti-vaccine movement?
Bailey: Oh, gosh, at work, yes. Vaccine hesitancy was a huge problem before the pandemic began and has certainly not gotten better since we’ve had COVID and now are looking forward to a COVID-19 vaccine. One of the more unfortunate aspects of COVID-19 is that it happened in an election year when there’s a highly charged political atmosphere to begin with. And unfortunately, a lot of things about this process have become politicized. I think vaccine hesitancy is something that we have to deal with face to face. And I think really the best way to do that is doctor-to-patient answering questions, being honest, having empathy about a family’s concerns about vaccine safety and efficacy. Because if we’re not 100% convinced of safety and efficacy, we’ll never be able to convince a hesitant patient or their family to take this vaccine. So, communication, understanding that yes, there are many questions, but also realizing that there are times when it’s necessary just to go on and explain that the risk benefit ratio is never perfect.
ICT®: What kind of education do doctors usually do to with their patients regarding vaccines? Doctors always seem to be so rushed.
Bailey: It really depends on the age of the patient. Early childhood vaccines where multiple immunizations are given at a time, that education process can be very challenging. But with repeated doses of vaccine, there’s that reassurance that the patient has done well with the first dose, so there’s much less concern with subsequent doses. As an allergist, immunologist, and private practice doctor, I deal every year with the influence of vaccination with my patients and am amazed at the amount of education that I still have to do every year reassuring patients that they can’t get the flu from the flu vaccine, and reassuring them about other safety and efficacy profiles. It takes time. And it’s quite a challenge. And we all need all of our professional organizations and the media, I think, to help us in this process.
ICT®: As you know, many infection preventionists have a nursing background. And we’ve been looking here at Infection Control Today® at COVID causing or precipitating infection preventionists moving out of hospitals and into other areas, for instance, public health, or schools or businesses. Do you see private practice doctors possibly considering hiring infection preventionists for their staff?
Bailey: The larger the clinic, I think the higher the probability. I think it’s also going to matter what specialty that physician is, what percentage of their practice might be dealing with infectious diseases. To me it’s a novel concept. But I think for very small practices it would be financially very difficult.
ICT®: Any final words of advice that you’d like to give infection preventionists and doctors about the COVID vaccine or anything else?
Bailey: I think that we just have to make sure that we all stick together and work all-hands-on-deck to fight this virus. Infection prevention obviously is a huge part of this process. And you know, now more than ever, we need to all have the same message and work together from prevention to treatment to immunization. And I’m very hopeful that we’ll be able to get past this and get it behind us.
This interview has been edited for clarity and length.