Podcast Transcript:

Dani Bradley: Hi I'm Danny Bradley and I’m the Director of Clinical Services and Evidence here at Ovia Health. Welcome to this week's episode of the via asked podcast.

Today we'll be discussing a very timely and important topic, vaccines. Specifically debunking myths and misconceptions about the COVID vaccines. I am joined by my lovely colleague Elaine Bishop. Hello Elaine, thanks for being here today! Can you tell us a little bit about yourself and your background as a provider.

Elaine: Sure, thanks so much Danny. I'm really happy to be here with you. I started out my career as a nurse in Labor and delivery birth and gynecologic care has always been my main focus career wise. I became a certified nurse midwife and spent several years caring for people in the office setting and attending births and local hospitals.

And then, after having my own children, I wanted to step back a bit and spend more time with them as they grow so, thankfully, I've had a lot of training and healthcare communication and coaching. And so I found this position with Ovia as a digital health coach and I've been loving it ever since.

Dani Bradley: And we've been loving having you so that's fantastic, can you just tell us a little bit about how you got into healthcare in the first place.

Elaine: Oh gosh sure, so I had brain surgery, when I was  years old, and that was my first big experience in healthcare as a patient and I, I really found that, I loved the way I was treated by some people and that really impacted me and then there were others that I didn't so much appreciate their approach to things. It really inspired me to want to be one of those people who offer kind, compassionate, and competent care.

Dani Bradley: Wow, thank you for sharing that story, and I can vouch that you certainly do offer kind, compassionate and empathetic care so we're lucky to have you on the team. And you know, right now, the topic at hand today is covert vaccines and we're really living in a time where vaccines have taken Center stage and most people aren't trained in kind of the science behind vaccines, or how to source reliable information about them as a provider caring for people and and having conversations with patients every day. What do you want to share about vaccines right now?

Elaine: Great question.

One of the most obvious benefits of vaccination is protection against contagious diseases so that's a very individually realized benefit of vaccination but additionally there's this concept of herd immunity where, when enough of a population gets vaccinated, infection rates drop significantly for everyone, even those who are unable to get the vaccine due to certain health conditions.  

And then, in some cases there have even been situations where we've been able to eradicate diseases, all together, for example, smallpox. There's an added bonus to getting vaccinated when pregnant and a great example of this is the TDaP vaccine. 

This is recommended to women when they are pregnant, during every pregnancy, even if they are not ready for their booster shot, because you can pass the immunity that you develop on to your fetus this immunity lasts through some part of the newborn period when they're little immune systems aren't quite ready to fight off significant illness. And in this example, it applies to whooping cough so then once they're older, they can get vaccinated But until then you've provided them with protection through being vaccinated yourself.

So when developing the COVID vaccines, the two initial goals were,

1. Safety 
2. Efficacy 

Developers wanted to create a vaccine that would decrease both the number and the severity of COVID infections. In the clinical trials for these vaccines, there were members of the control or placebo groups (no vaccine) who ended up hospitalized and even died of COVID-19. Whereas amongst those in the experimental groups (who got the vaccines being studied) some did get the infection, they were able to manage the symptoms and recover from COVID.

Dani: So thank you for that Elaine. Adding on to that, we know the pandemic has impacted nearly every aspect of all of our lives, and of course the vaccines, having taken center stage recently.

It has impacted other healthcare decisions that people are making. Can you talk to us a little bit about the impact that the pandemic and this heightened awareness of vaccinations has had on adherence to other life saving vaccines that have been available for a long time?

Elaine: Absolutely, while the stay home orders and the general advice to minimize exposure were meant to keep us all safe from COVID they had the unfortunate effect of decreasing attendance at routine health appointments.

So, for example, young children missed or fell behind on their routine vaccination appointments and this makes them more vulnerable to severe but preventable illnesses. The American Academy of pediatrics is strongly encouraging parents to resume well child visits and get go ahead and get caught up on those childhood vaccinations that they were missing.

Dani: That's so true. We've actually seen in our own research at Ovia. We've been studying the experiences of being a parent during the pandemic and, of course, also being pregnant or trying to conceive during the pandemic. 

Among parents, we've seen that about half of them reported that their children's vaccinations appointments were either delete or cancelled at some point during the pandemic We also learned that about 5% of people believe that avoiding all possible exposure to cove it was more important to them than maintaining the recommended vaccination schedule for their children. So, there's a lot of education and work to be done to make sure that people are sticking to those really important vaccine schedules.

Elaine: Absolutely. It is a lot to juggle and try to figure out what to prioritize but this decrease in childhood vaccinations can be really alarming when you consider that. 

Otherwise, healthy children are now more vulnerable to infectious potentially deadly diseases. And their peers, who may have health conditions that restrict their ability to receive routine vaccinations, are even more vulnerable to exposure. So community spread of preventable disease becomes much more of a concern when larger numbers of individuals don't get vaccinated.

Dani: As one of our own resident health coaches at Ovia, and, of course, a provider who's talking to patients, every day, what are the most common questions that you've been hearing recently about vaccines?

Elaine: Certainly, the most common questions that I have been noticing are: 

• Is it safe to get the vaccine well and trying to conceive or well i'm pregnant or while and breastfeeding?
• Is there a right time in pregnancy, to get the vaccine?
• Should I get both doses of the vaccine?
• I might be thinking of trying to conceive in the coming year, so should I should meet or my partner delay getting the vaccine right now?

There has been a lot of media coverage on the COVID vaccines which fuels a lot of opinion sharing that can appear like facts sharing. And, not everyone has the skills to filter out the opinions and focus on the factual information on the Internet, so it can be tricky to try to answer these questions for yourself and, unfortunately, this has led to many misconceptions about the safety and the necessity of this vaccine.

Dani: So true. We know how pervasive misinformation and vaccine myths have become over the last several years and combining that threat of misinformation with a very common kind of lack of understanding of what the standard clinical trial process is and looks like, how do you address concerns and misperceptions as a provider? I know you recently published a blog on this topic so i'd love to hear your thoughts on that.

Elaine: Of course! A first a great first step is addressing some of the most inflammatory claims out there, like, "Steps were skipped in the development of these vaccines." and "We've never seen them come out this fast before."

And the truth is, we actually had worldwide collaboration to think for very this very fast timeline for the development of these vaccines. Labs across the globe were able to cooperate and run more studies simultaneously than are typically done in vaccine development because we were all cooperating for that greater good. This allowed for the quicker timeline in identifying good candidates for animal studies and clinical trials.

And it's important to know that all available COVID vaccines currently in the US have gone through the standard steps of vaccine development overseen by the FDA including three phase clinical trials to establish safety dosage and efficacious outcomes.

One big fear that I've heard is that children and pregnant and breastfeeding people were not included in the clinical trials for the FDA approval of these vaccines. And that can make people who fall into those groups more reluctant to take the vaccine when it said in the news and on social media, it can kind of seem like a suggestion that this was an intentionally skipped step to expedite the vaccine approval. But, in reality this is the normal course for scientific study.

Healthy individuals with the ability to give consent for treatment so adults are studied first. This is based upon the ethical responsibility of researchers to not subject those who do not yet possess autonomy to experimentation often turned vulnerable populations. So, happily, since the vaccines have become more widespread and their safety has been established studies are now underway that do include younger participants and those who are currently pregnant in breast or chest beating.

In addition, the COVID vaccines are currently enjoying the most rigorous safety monitoring of any vaccine in US history and no adverse pregnancy outcomes, as a result of vaccination have been reported to date. So, it's really important when we are helping individuals decide whether or not to get the COVID vaccine that we have an awareness of the risks and benefits of that individual.

People are not populations, they each come to us with a unique set of circumstances. And, consideration of their perspectives helps us inform their decision making. This is called shared decision making, and it is a very important part of healthcare communication.

Dani: Couldn't agree more. We've talked a lot about the importance of interpretation in science, data, and statistics based on those populations within context. So within the context of a particular patient practicing shared decision making, what are the unique considerations that pregnant people specifically should be taking into account, right now, as it pertains to the COVID vaccine.

Elaine: It's really important for people who are currently pregnant to weigh the impact of getting a COVID vaccine right now versus the potential impact of them getting the COVID illness while pregnant. Research over the past  months has shown pregnant people are at risk of more severe cases of COVID. So severe it sometimes leads to an ICU admission, dependence upon a ventilator, or even death.

Infection with COVID  during pregnancy also increases the risk of premature birth and other poor pregnancy outcomes. Thankfully ,the COVID vaccine has been shown to protect against infection most cases, and in those who do get infected after getting the vaccine, have had milder cases. Studies are underway to investigate if, like the TDaP vaccine, a pregnant person who gets the vaccine can pass that protection on to their fetus.

Another important consideration when trying to decide whether or not to get the vaccine is to get a good understanding of what is the difference between a vaccine adverse effects little.

Dani: One of the things that I hear come up all the time, is a hyper-focus on side effects of the vaccine. I think people often get side effects confused with adverse effects. Can you talk to us a little bit about the difference between those two things?

Elaine: Absolutely, that is a really common confusion. Those two terms get used interchangeably the adverse vaccine effect and side effects, but in fact they're really different.

Side effects of a vaccine are basically evidence that your immune system is responding to the vaccine and doing the work to protect you against the disease. They are fully anticipated, they are usually mild like redness or swelling of the site of an injection of low grade fever and chills body aches headaches things like that.

Alternatively, the adverse vaccine reactions that have been observed, after the COVID vaccines include severe allergic reactions called anaphylaxis that's a life threatening condition. Or, the identified risk associated with the Johnson and Johnson vaccine which is called thrombosis with thrombocytopenia syndrome or TTS.

Both of these adverse events are very, very rare and the risk of getting COVID is much higher than the risk of one of these adverse events. Knowing your potential risk factors remains really important as a part of your decision to get vaccinated or not.

Dani: Thank you so much, that is such a helpful distinction. So, I know a lot of health plans are working on vaccine campaigns right now, and a lot of employers are considering adopting vaccination policies for their own workplaces, especially as they plan to bring people back into the office.

How can it health plans and employers educate themselves and also their employees or members to make these important decisions and, of course, it's an independent decision that each person will make, but what tools and resources are available today to help with that?

Elaine: That's such a great question. One of the first places that I would direct people is to the CDC website.

They have a couple of really helpful sites that we will link on the bottom of this page if you're interested in checking them out. The first is a site that has a list of what you could should consider as an individual when deciding if you should or shouldn't get the vaccine. It'll walk you through the steps step one. 

Here's what I should consider step two. They have another very transparent site called "What we know and what we are still learning about the vaccines," where they lay out with great clarity, what we absolutely know about the vaccine right now and what we need to know more about before drawing a conclusion. So, that can really help people in their decision making and in trying to get a better understanding of what is a vaccine you miss and what is truth, in fact, about the vaccines.

Dani: That's so great, Elaine! I think having that level of transparency is so important, right now, particularly when it seems like this decision about getting vaccinated or not is somewhat polarizing in some communities. So, to have that level of transparency that's really rooted in the facts and what we know, I'm sure is a very helpful asset.

At Ovia we've actually created our own tool which, I know you know you had a hand in creating, but it's really taken a page out of the idea of each person making a decision on their own, but informing their decision with the facts and having really thoughtful conversations with their provider.

And so we formatted it in a way that allows people to kind of walk through what might a conversation about this look like if I were to put my myself in the shoes of a fictional patient who's having conversation with their provider. So, we're really hopeful that that kind of context will help people make a decision about their own vaccine choice. The link to the blog announcing that is at the bottom of this page as well if you want to explore or share with your members or employees. 

So, what can employers do to help right now? We know there are a lot of people who are returning back into the office, and people who have been onsite this whole time. What can employers do to support their employees in both situations?

Elaine: That's a great question, and there are obviously some legal questions and state specific requirements here. Also, each employer needs to decide their policies on the for themselves. 

But, if you want to help make vaccines more accessible here are a few ideas that we have to share so by providing them.

• First, it's really important to provide employees with information that is accessible understandable and relatable and be sure to emphasize that the vaccines are free.
• It's a great idea to make sure that there's an opportunity for your employees to be vaccinated. Remember during a pandemic, you cannot bring family members, along with you too many appointments, including vaccinations. So finding a time when an employee is both off of work and has child care can be a real barrier to vaccination so helping out with that can make a big difference.
• Offer a vaccination access program at work where on a break an employee can get help scheduling a vaccine nearby.
• Provide information about, or access to  ride sharing options to and from the vaccine site. 
• You could even consider giving employees a voucher for the cost of a ride, so they can choose when to get the vaccine in their free time. 
• It’s good to note that some ride sharing companies or even offering free rides to and from vaccinations.
• Lastly, larger employers can overcome some of these logistics, by holding a vaccine clinic on site, like has been done with flu clinics in the past.

Dani: So, we know the concept of shared decision making is so crucial to good healthcare. Like you said, every patient is unique, and the scientific process requires all of us to interpret results with caution and take into account the patient’s context. Can you talk to me about why shared decision making is so important, and how to make sure these conversations are happening?

Elaine: Absolutely, I'm so glad you asked. According to the National Patient Advocate Foundation, only 2% of surveyed individuals stated they prefer for their healthcare provider to make decisions for them. Yet this has historically been how many providers have been trained and continue to operate. If not directly, unintentionally.

The goal with shared-decision-making is to very intentionally involve patients in their own healthcare decisions taking into account their background, learning style, preferences, barriers, and health literacy.

Something important for every individual seeking healthcare to remember is, you matter. You have the right to take up space. You have the right to ask questions. You have the right to receive information you understand and can make decisions with. If you do not have those things, speak up and advocate for yourself. It is your right. That may mean having a frank conversation with your provider to let them know you learn best with visual aids, or you have a monetary barrier to the medical treatment they are suggesting. It's important to let them know how you learn best and what are your barriers to following through with the plan of care that.

Dani: That's so true. And I think sometimes even thinking about who your care team is and making tough choices about maybe seeking other providers to have those conversations so you can get to a place where you can have really fruitful conversations and sharing that decision making. You know, not every relationship will be right all the time, it takes work to find the right person to work with.

We’ve all been in situations where a provider we’re seeing seems incredibly rushed, and you know their schedules are jam packed in between note taking and seeing patients, you know they don't have time for all the questions we wish we could ask. I think sometimes that speed of the visit or the sense that you're asking their time can force a lot of us to not ask the questions we wish we could ask. Or that the speed of the visit is unsettling and makes us forget everything we wanted to ask. Do you have any tips for how to make sure that doesn’t happen? What can they do to make sure that their provider is making time for them?

Elaine: Absolutely! One important step to take prior to your visit is to educate yourself on the info that is available to you regarding the topic you want to discuss. In this case, check out the tools we mentioned earlier to help you get a basic handle on the information.

Then, keep a list of questions on paper or on your phone leading up to the appointment. Most of us think much more clearly before our appointments than during and having your own sort of roadmap or goals for the visit is very helpful. Your provider has goals for the visit, it’s okay for you to as well. And you can start out the appointment saying, “this is what I’d like to make sure we cover today.” Then you can have a conversation about whether or not that’s possible during your appointment, and if not, how can you get everything addressed in a timely manner. It may be that you have a phone call later or make another appointment to discuss in more detail. It may even be that some of your questions are best answered by another provider and the one you’re seeing can make a referral so you speak with the most appropriate person.

Another benefit to bringing your list of questions is the ability to write down what you hear in the appointment. Research has shown that depending upon circumstances of a visit, patients can walk away only remembering 10-25% of the information they heard accurately. Taking notes can be helpful when you recall what you reviewed during your visit.

Dani: That's such a good point. I think I even you know, being in this space, I get halfway there. I come in with a list of things I want to discuss, but then I don't set the stage. I don't start the conversation with, "here's everything," and then we run out of time and I don't get the most important things answered. Or I don't do what you said, which is take notes, while I'm hearing the information, and then I forget what I what I learned the whole time. That's such great great advice for people to really make sure they're getting the most out of their brief time that they do have with providers yeah.

So we've talked a lot about kind of the challenges that we're all facing right now, particularly as it relates to the pandemic and the way that we all receive health care at this time. But what are the silver linings? There's there's always got to be a silver lining, what would you say they are here?

Elaine: Absolutely, I think the overwhelming public awareness of this situation and how much it has impacted each one of our lives, has really empowered us all to seek information for ourselves.  It's exposing more of the general population to sources of information, which as we've talked about can be challenging finding what's accurate and what isn't. It's an opportunity for all of us to learn where are we getting our information from, where can we find information that we can trust, and how do we make these decisions for ourselves.

And that leads us into our appointments with our providers using that shared decision making model. It's really allowing more people to become active participants in their own healthcare, instead of just letting healthcare happen to you.

Dani: That's so true I think another thing that I've noticed at least over the last several months is the uptick in access to telemedicine and the ability to have phone calls or video consults with providers. That ability to get a little bit more face-time, or have a scheduled visit just for the purpose of talking and discussing your concerns is something new.

From what I've experienced, usually you'll go into a visit and there was a lot of kind of the physical exam component and not enough of the talking about what's going on. So, I think there might be an opportunity here to to really use telemedicine to our advantage and fill in those gaps that we've been experiencing for a long time.

So, Elaine, is there anything else that you'd like to leave everyone with today - the general population, our listeners, employees, employers, health plans - that you didn't mention during this conversation yet?

Elaine: I don't think so Dani. I think I would just summarize with a couple key points that we've covered: 

• Question what you hear make sure that you're getting factual information before accepting it as truth
• Find trusted sources of information, like the CDC website, like the Ovia Vaccine Guide
• Advocate for yourself as a patient, you are worth it.

Dani: That's great. Thank you so much Elaine for all your time and your insight and your expertise on this really important topic. We know vaccines are center stage as we've discussed and you've offered so many useful tools for everybody to take with them to really become active participants in their health care and make the choices that are right for them. If anyone has any questions or would like to get in touch with Ovia, please email us. And stay tuned for our next episode.