Q&A: What Infection Preventionists Should Expect From a COVID Vaccine

September 1, 2020

Rebecca Leach, RN, BSN, MPH, CIC: “I’m a very strong vaccine proponent. I do believe in them, and I think they should be mandatory if you’re working in healthcare.”

At first and probably for a couple years after the arrival of a vaccine for coronavirus disease 2019 (COVID-19), it will be business as usual for infection preventionists, says Rebecca Leach, RN, BSN, MPH, CIC. Leach, a member of Infection Control Today®’s Editorial Advisory Board, also points out that a lot of people don’t bother to get the flu vaccine, and that includes many healthcare workers. In fact, hospitals and other healthcare facilities—especially long-term care facilities, which were hit particularly hard by COVID-19—might have to make getting vaccinated against SARS-CoV-2 a prerequisite for employment. Any vaccine will also be just one element in the infection prevention arsenal. It will be “just be another piece that we add into our prevention plan,” says Leach. “We have isolation precautions. We have screening of patients. We have wearing a mask and proper PPE for all encounters. And then we would add onto that with our employee health or occupational health programs, vaccination of staff, and potentially of patients as well, when they come into our facility.”

Infection Control Today®: So the COVID-19 vaccine: Will that change an infection preventionist’s job in any way you think?

Rebecca Leach, RN, BSN, MPH, CIC: I think personally, it won’t change our job right away. Maybe in a few years, or something like that. But right away, we still have a lot of work to do to keep up with what we’re doing to prevent transmission of infection. There are many people who kind of say that in casual conversation, “I can’t wait for the vaccine so life can get back to normal.” But really, the vaccine is not the cure-all and there are a lot of other things that need to be considered on top of just vaccination.

ICT®: And a vaccine isn’t always 100%. In fact, very few are, right?

Leach: Right and especially when you see something like the coronavirus, and from other sort of similar viruses, vaccines—it’s not 100% coverage. If we just look at the flu vaccine, for example, we know that doesn’t provide 100% coverage. There really aren’t any vaccines that provide 100% coverage. So, we know there’s always going to still be some transmission, even with a high vaccination rate. That’s something we have to consider and then if we can’t get a high vaccination rate, then we’re still going to have a lot of people who are susceptible to infection. And that’s probably going to be the situation, especially at first. Then if we’re still rolling it out and trying to administer the vaccine. But then there’s a whole other side of it of people actually willing to get the vaccine.

ICT®:As an infection preventionist, do you monitor how often your fellow healthcare workers get the flu vaccine every year?

Leach: I work in an acute care setting. And that’s one of the things we have to report to CMS is our annual healthcare provider vaccination rate. We’ve monitored that for several years. And it was relatively low, maybe about 70%. But then once we made it a requirement of employment, then it jumped up and it increased into the 90s. But that means you have to make it a requirement of employment. And so that’ll be one of the issues that people want to think about. If we have a COVID vaccine, is this going to be required for employment in health care?

ICT®: Does every hospital make it a requirement for employment, do you know?

Leach: Not every hospital does. I think the majority of them do now because of that CMS requirement. It became required, but not every hospital system has that, and then we have to look at long-term care and other healthcare settings, outpatient settings, and that may not be required in those settings, as well. And thinking about with our coronavirus vaccine, in long-term care and those other settings, that would be just as important as a flu vaccine because those are some of our highest risk patients.

ICT®: Do you think when the COVID-19 vaccine comes that it should be mandatory?

Leach: I think it should be. I’m a very strong vaccine proponent. I do believe in them, and I think they should be mandatory if you’re working in healthcare. That’s not a consistent view across the country. As we know, there are a lot of antivaccine people, and there are a lot of people who struggle with making vaccines mandatory just based on some of those points of view for anti-vaccinations and requiring those kinds of things. But I believe it should be.

ICT®: Before the flu vaccine became mandatory, what were some of the methods that you used to try and talk to your fellow healthcare workers into getting the vaccine? And to what degree did they work or not work?

Leach: It always depends on the person and the reason why they don’t want to get it. For some people, it’s just simply inconvenient. Then you try to set up making sure that they can get the vaccine while at work. Make it easy for them to get it so they don’t have to go someplace else to get it. If it’s other reasons, maybe just not understanding or they say every time I get it, I get sick, then we kind of tried to educate them on it’s not a live vaccine. And it can cause some reactions, but it’s not really making you ill. Part of it is education and trying to provide them with an understanding of how the vaccine works. And then you will have those people who just do not believe in vaccines. And so that’s a group that’s really hard to capture, but it is a minority. If you can get the majority of your staff on board with it, if you can bring it to them, if you can make it easy for them to get it, then you’re going to increase your compliance. But you’re still going to struggle a little bit if it’s not mandatory.

ICT®: And a vaccine from an infection preventionist’s point of view is just one tool, right?

Leach: Right. Exactly.

ICT®: Is there a hierarchy of tools? I guess it depends on how potent the vaccine turns out to be, right?

Leach: That depends on a lot of things. I think it’s not so much a hierarchy, because it’s like you said, it depends on how effective the vaccine is and how widespread the uptake is, how much compliance there is with it. Until you kind of have a broad use of the vaccine, and a lot of population has it, you’re going to have to rely on a lot of other things. And even when we see it, with like flu vaccine, where we look at that every year, vaccine is just one part of the puzzle. You also have to do your respiratory etiquette or your respiratory hygiene. Now, of course, with coronavirus, the masking and staying socially distant and those kinds of things I would imagine would still apply even probably for at least a year if not two after the vaccine is distributed.

ICT®: Your job is not going to change that much except to try and talk people into getting the vaccine.

Leach: Right. I think that that’ll just be another piece that we add into our prevention plan. We have isolation precautions. We have screening of patients. We have wearing a mask and proper PPE for all encounters. And then we would add onto that with our employee health or occupational health programs, vaccination of staff, and potentially of patients as well, when they come into our facility. It’s just another tool in our toolbox against coronavirus.

ICT®: Have people from private industry or government talked to you since this began and asked for pointers on how to handle the situation?

Leach: Not me personally. No. But we work closely with our local health departments. And when something like the COVID vaccine is distributed, I’m sure that we would work closely with our health departments to help plan how are we going to deliver it to our healthcare workers? How are we going to deliver it to our patients and also the community? That would be something I would foresee happening.

ICT®: Are you making systemic plans right now in terms of when the vaccine comes how are you going to distribute it? Who might distribute it? Where are you going to give the vaccine in the hospital? Are you thinking that far ahead at the moment, or just basically trying to get through each day?

Leach: It’s still trying to get through each day. And right now, actually, we’re focusing on the flu season upcoming and we’re looking at making sure we’re prepared for flu season and getting our vaccine early and getting it distributed early and trying to increase our vaccination rates within our patients. But also trying to expand it around potentially to our employees’ families, because we know that if we can vaccinate as many people in the community as possible, that’ll help while we still have COVID ongoing.

ICT®: Data about the flu season so far say that it’s milder than we’ve ever had and one expert I talked to says it’s because people are masking up against COVID. Does that give you hope that you’re not going to be barraged with COVID-slash-flu patients in the fall?

Leach: It does give me hope for that. As long as in all of our communities we maintain the same precautions that we’re doing for COVID and things don’t open up too quickly, which is what we did see here in Arizona, where in May they opened everything up at the same time and them we got a huge surge. Hopefully we’ve learned from that, and we can keep doing what we’re doing. And we will have a mild flu season as well as keep our COVID cases minimal.

ICT®: When the vaccine comes, do you think that will bring us back to the way we were before this? Do you think anything will bring us back to the way we were before this?

Leach: That’s a very philosophical question, but I don’t think so. I don’t think that societies can live through something like this and not have some sort of permanent change. I don’t think the vaccine will be the cure-all. I think it will be a good vaccine, but I don’t think, just based on the virus—not that I’m a biologist; I’m not a vaccine expert—but just kind of looking at what I’ve seen so far, this vaccine won't be 100% effective. They’re thinking maybe 50 percent effective or something like that. You’re still going to have to do a lot of things around social distancing and masking. And I think that masking will be something that we see more often in our society after this and people won’t be as concerned about wearing a mask for protecting others and themselves, when they’re flying or traveling or doing things like that. I think that’ll be more common.

ICT®: Any final words of advice for your fellow infection preventionists and the whole idea of a vaccine and what to do about it when it comes?

Leach: I think we just need to stay vigilant with what we’re doing. I think infection preventionists are probably tired across the country right now. But we need to stay vigilant, keep working and understand the vaccine and we're excited for it but also understand that it’s not going to be the cure-all for this pandemic. We have to keep our voices loud so that people hear what we have to say.

This interview was edited for clarity and length.