Editor’s Note: Lucy McBride, MD, is a practicing internist in Washington, DC. She is the author of a Covid-19 newsletter working to increase awareness of the intersection of mental and physical health. Sign up on her website and connect with her on Twitter, Facebook and Instagram. The views expressed in this commentary are her own. View more opinion on CNN.
Every morning I walk into my office, greet my assistant, plop into my desk chair, and promptly take off my mask. I then see my vaccinated patients – those who are comfortable and have normal immune systems – one-on-one, in my exam room. Unmasked. My patients tell me they love it.
Does that surprise you? It shouldn’t.
The real-world data on the Covid-19 vaccines is clear: they are stunningly effective. The vaccines essentially take death and severe disease off the table. They dramatically reduce the risks of getting Covid and transmitting the virus to other people. They are powerful weapons against all of the circulating variants. In short, they are the clear ticket to normality.
Yet that message isn’t getting through. Vaccine hesitancy continues to be an enormous problem in this country. Now that all adults ages 16 and over are eligible for the vaccine in the US and approximately 42% of Americans who want the vaccine have gotten at least one dose, the biggest hurdle to achieving herd immunity – and to resuming normal life – is the ground game of encouraging vaccine uptake among unvaccinated people.
Of course, risk mitigation – masks, distancing, and ventilation – is still critical for unvaccinated people, and for vaccinated people in public indoor spaces, until everyone who wants the vaccine has been offered one. Moreover, no two people’s risk or risk tolerance is exactly alike. But most people understand that health is more than the absence of disease.
In other words: not dying is important – and is essentially guaranteed after vaccination – but what about living?
We need a hard right turn on the narrative about vaccines. People need incentives to take one. We must empower people with facts about vaccine efficacy and shift the media’s bad news bias to one of evidence-based optimism about post-vaccination life. We need visible public confidence in the vaccines’ stunning efficacy and trusted messengers to deliver nuanced advice to vaccine-hesitant folks.
Most people who are skeptical about getting vaccinated aren’t anti-vaxxers; their hesitancy is rooted in misinformation, fear about vaccine side effects, historic abuse by our medical system, denial about their vulnerability to disease or lack of a trusted messenger to deliver nuanced guidance.
The hidden hurdle to ending the pandemic? A boost of confidence about post-vaccination life. This week, another patient said to me, “Why should my family get vaccinated if we still have to wear masks indefinitely?” The truth is, they won’t. Pandemics end; this one will, too. But without trust in the vaccines, it will take a lot longer.
Patients are motivated to get vaccinated when they realize that after vaccination they can liberalize their behaviors, see other vaccinated – and most unvaccinated – people without restrictions or fear, and unmask when appropriate.
People need to know, for example, that the risk of two vaccinated people sickening one another with Covid-19 is vanishingly small. Even the CDC has acknowledged this fact. They should be made aware that vaccinated people are safe to unmask outdoors in non-close-crowd settings – and indoors among low-risk unvaccinated people and other vaccinated people.
Vaccinated grandparents should be reassured, for example, that seeing their unvaccinated grandchildren poses very little risk to themselves and that, in general, the risks of Covid-19 in kids are small.
Vaccination is the key to reclaiming our lives, but taking a vaccine requires trust. Building trust takes time, mutual respect and a lot of listening. Instead of lecturing patients about getting vaccinated, I (like most primary care doctors) try to meet people where they are, understand their concerns, and equip them with medical evidence.
Primary care physicians – along with other trusted messengers like pastors, clergy and local leaders – are the secret weapon for ending the pandemic. We need to model vaccine confidence and advertise the clear benefits of vaccination. When making medical decisions, people are more likely to trust their health care provider (or other trusted leader) more than raw data, public health messages or doctors on TV.
In my 20 years of medical practice, I’ve found that modeling is frequently the best way to persuade people to make healthy decisions. When I take my mask off with my vaccinated patients, I encourage them to tell their friends. I remind them of their new freedoms. Sharing hopeful news can go “viral” just as quickly as the contagion of fear.
I leave my mask on with my unvaccinated and immunocompromised patients. I also leave it on with any vaccinated patients who are still afraid of risk. I keep an extra HEPA filter humming in my exam room for optimal ventilation and to ease patients’ worry. I do my best to replace fear with facts. I can see my patients’ excitement when they realize the clear benefits of vaccination – from travel and indoor dining to hugs and social gatherings. They’re frequently visibly relieved to abandon fear.
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Not everyone will be convinced to take the vaccine, and not everyone goes to a doctor. We also don’t need 100% vaccine uptake to achieve herd immunity. We just need enough people empowered with enough nuanced advice from enough trusted guides to reclaim our collective safety and sanity.
Trust is the currency in medicine. It is hard-won and precious. Doctors need to leverage that trust to empower patients with evidence-based guidance and optimism. When hope is rooted in science, it’s our duty to dispense it.
