Vaccine Confidence: Where We Are Now and Where We Are Headed

At the Core of Care

Published: March 6, 2023

SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and health-care needs of patients, families and communities.

I’m Sarah Hexem Hubbard with the Pennsylvania Action Coalition and the Executive Director of the National Nurse-Led Care Consortium.

As we enter the third year of the COVID-19 pandemic, we’re going to spend the next four episodes taking stock of the latest vaccine confidence trends and some of the lessons learned so far during this public health emergency.

Joining us for this conversation is Melody Butler.

Melody is a member of the National Vaccine Advisory Committee as well as a member of NNCC’s Vaccine Confidence Advisory Committee. More than a decade ago, she founded and still runs Nurses Who Vaccinate. She’s also a registered nurse and infection preventionist on Long Island in New York.

Melody, welcome back to At the Core of Care.

MELODY: Thank you. I'm very happy to be here.

SARAH: So, Melody we last spoke about two years ago in 2021 when we kicked off our COVID-19 vaccine confidence coverage. Clearly, a lot has happened since then. There's now even a word we didn't have two years ago: tripledemic. From your perspective, how would you describe where we are now?

MELODY: Well, we've learned a lot since 2021, and we have a lot more tools in our toolbox to protect ourselves against all of these respiratory diseases that we're concerned about. When you talk about the tripledemic. So flu, COVID, RSV, we know how to bring the rates of infection down and we know what we need to do in order to protect the most vulnerable in our communities.

Unfortunately, not much has changed in regards to vaccination rates. Last we spoke, the vaccination rates for United States at the end of 2021, we were about 73% for people having had received at least one dose of the COVID vaccine. And here we are in 2023 and we're at a whopping 81% of people having at least one vaccine dose.

So, I'm very disappointed to see where we are right now. The fact that we have not hit at least a good 90, 95%,  like we have with other vaccines,  unfortunately. So that goes to show you that there is so much work that needs to be done.

We have hit a couple of walls. The public's confidence in the vaccines and in boosters have taken a hit due to variants and surges.

And the data that I really want to highlight throughout this talk, especially when we talk about the COVID vaccine, is how, while it may not protect you from getting sick, you may still catch COVID, despite being vaccinated but it's going to do an amazing job keeping you out of the hospital. It's going to keep you from developing severe illness, complications that could follow had you not been vaccinated.

SARAH: Hard to pinpoint exactly. But it seems like people are sicker than before with the flu going around, COVID, the common cold. Do you agree with that?

MELODY: I do. In fact, we're in a very rough flu season. To date, today is January 24th. For this flu season, we've had a total of 85 pediatric deaths. That's awful. Last year, for the flu season of 2021 to 2022, there were 45. We haven't even hit February yet, which is normally our peak for flu season, and we have more than doubled the pediatric death rate from last year. I really do fear because usually, what we saw before when we had a bunch of Flu A. And what tends to follow Flu A is Flu B and that's going to be rearing its very ugly head very soon.

Now the thing with flu is there's no in between for flu. Either you have the flu or you don't. There's no, Hmm, I might have the flu. If you have the flu, you're knocked out, you're sick at home. However, you're contagious for about two days before you can show symptoms sometimes. So think of all the people you come in contact with in two days.

And I do worry though, because now thankfully the flu cases are coming down, but Flu B is known to piggyback on top of Flu A. So, a really important message that, uh, we need to get out there to the public is that even if you have had flu earlier this flu season, you are, um, even more at risk for complications should you catch an additional flu strain later in this season.

SARAH: And what have you been hearing and seeing in response to the new COVID-19 bivalent booster? How's it being received? What are the risk calculation conversations sounding like?

MELODY: The rollout of the COVID booster, the bivalent booster, has been very tricky and there's still lots of confusion surrounding it. And unfortunately, a lot of people still don't know that they are a candidate for it when they very much are. There's really four reasons. One is they don't realize that they should be getting it. Maybe they got a vaccinated earlier this year with one of the earlier boosters, and they don't realize that they're a candidate for this current one. Number two is they're too busy. Unfortunately, access of the booster is not as easy as it had been earlier in the pandemic. Some locations only have the booster being given out certain times and certain days of the week. I know that even doctor's offices don't always carry the booster. You go to the doctor's office for a physical and then they say go to the pharmacy to go get your booster. And people aren't making that second trip; which then leads us to number three. People are forgetting that they need the booster. Then, number four, people are worrying about side effects.

SARAH: And also side effects that can make it difficult to work. I mean, combining that, with being busy. If you know that you're someone who's going to be sick for a day or two after you get your booster, sometimes that's extra hard to schedule in.

MELODY: Of course. And we know we don't have that leeway that we once had with the original COVID vaccines, where there was even days allotted by some businesses that if you got the COVID vaccine, if you developed a fever the next day, you were not penalized. And it was okay. It was recommended that you actually stay home and recover from getting the vaccine because they realized how important it was to get vaccinated. And it kind of seems that we've gotten away from that. It's an all hands on deck and we learned in the early days of the pandemic how to work all hands on deck.

SARAH: I think you touched on several things that were really important there, but kind of what stood out to me was that frustration. And, and it touches on a little bit of what we talked about in some of the past seasons too, about the burnout, the burn down, the fatigue. Like how could this have gone? And what do you say to your colleagues who are struggling, who are frustrated, you know, who are feeling alone?

MELODY: We all need pep talks. No matter where you are, no matter how you're working in this field, whether you're doing frontline nursing care, quality work, data reporting, public health, public education.  Seeing the statistics, knowing your loved ones are getting sick, seeing family members refuse to get vaccinated then develop complications. All around, it can be frustrating and we always need to help support each other. So when we keep that in mind, we need to really make sure that we're building upon all the resources that we need to have laying out there for us, because we never know when we're going to need to step back and then tag in our  partner to kind of go in there for us to kind of take over the education or take over the patient care. It’s something we need to make sure that we do a better job, relying on one another and using all the different skills that we have. I really want to say going forward, for the next winter, like let's say we know that this is going to happen again, we need to have more resources for nurses to have downtime, for doctors to have more flexibility of sick time, right?

We had even healthcare workers getting very sick during this last surge, and they were doing everything they can to protect themselves. Unfortunately, sometimes you're still exposed at home or in the community and making sure people know that they don't and shouldn't go to work sick. Making sure that we're really reinforcing and encouraging and highly encouraging self-care. So if we take away anything from this most recent winter, it's the continued need of taking care of each other, taking care of ourselves, because we're in this for the long run.

This is our new normal. And as much as I hate that expression this is it. This is what we have to really kind of focus on and come up with a good game plan in dealing with.

SARAH: And clearly, you've talked about the impact of illness on kids that we're seeing. So, looking at vaccination, I think specifically COVID-19 vaccination, how's that looking for kids? Especially under the age of five.

MELODY: So as of January 2023, the American Academy of Pediatrics continues to recommend the COVID-19 vaccine for all children and adolescents six months of age and older. As long as they don't have any other contraindication to vaccines. With that being said, right now, we have about 1.9 million children, six months to four years, who have received at least one dose. 1.9 sounds like a lot. Unfortunately, that represents only 11% of that age population.

So that means there are 15.2 million children between six months and four years to receive their first COVID-19 vaccine. And what's interesting is that vaccination rates really do vary from state to state. You have some states that are at 2% and you have some states that are at 40%. So there is a lot of work to be done. And when we talk about COVID-19 vaccine for the children under five, it's really important to stress to the parents when we're educating them, making the recommendations, is how safe the vaccine is, how we continue to monitor the vaccine for any type of adverse reactions or safety issues and whatnot.

SARAH: So thinking again about kind of where we are now and where we've been, access has been a barrier throughout the COVID-19 vaccine rollout. So, to what extent is vaccine access still an issue? Really, access to both vaccines and testing? And how do you see that changing as the public health emergency declarations are starting to expire?

MELODY: So, I've come to learn that, you know, I live in New York where everything's pretty much centralized. We have pretty good access here, and it's very easy to forget how rural some parts of the country can be. Well, a lot of the parts of the country are. And in talking to colleagues around the country, I know that it can be very difficult right now as we stand to get boosters, to make appointments, to have that availability to drive an hour or so to a vaccination site to get vaccinated. So, when we talk about the emergency declaration ending, I'm really concerned. There's going to be major changes that are going to occur. The COVID-19 federal emergency declaration provided free testing. It provided free vaccines and even free treatments such as some of the antibody treatments that people were receiving. What's important to know is not all of these items will go away, but a lot of them will no longer be free. So people, if you don't have insurance, they'll no longer be a pathway through Medicaid for free COVID testing, vaccines or treatments. And then for Medicare beneficiaries, there is going to be a cost sharing requirement. Hospitals are going to be affected by this. Hospitals will no longer receive the 20% payment increase for discharges of patients diagnosed with. when this expires. And we know that when you have a COVID-19 patient, it's complicated. So, to lose that funding that can help provide for additional nursing care, that's very troublesome. It's something we should be worried about. And, you know, I mean that's just a small snippet of the concerns that I have when this does expire.

SARAH: So, as we're forecasting out, you know, what are the things to be paying attention to, what might we expect to see in terms of vaccine confidence trends? You know, the next six months, the next year, what do you see coming?

MELODY: I foresee us in the healthcare community having to continue this uphill battle. We are continuing to push against misinformation. We have to push against this adversity to mandates. And also we have to push against hopelessness that we see in our patients. People are very disappointed that the COVID vaccine does not prevent illness. We have to stress how amazing it is that the vaccine keeps you out of the hospital just like the flu shot. The vaccine prevents severe complications and it prevents death. It does a great job at keeping you alive, and that's such an important point that we need to stress to the public, to our patients, to our communities. But we need to do a better job at that. And we need to continue to push back even harder against misinformation. The misinformation and the anti-vaccine movement organizations, they're only getting stronger. Social media has its ebbs and flows in regards to how it regulates and how it decides what's acceptable and what's not acceptable. And unfortunately, right now we are dealing with really, really serious conspiracy theories. And it's very damaging to the public's confidence. So, we need to have a more collaborative effort in pushing back against these very negative narratives and sharing stories of how safe it is and how important it's to be vaccinated. And how being vaccinated is one of many of the tools we have to protect ourselves. Hands, hygiene, washing your hands, wearing a mask. Being aware of your surroundings in a crowded area. I, myself, when I go to shows and if I'm like, you know, attending a, a musical or a play, or even a concert, like my kids' concerts, sometimes those auditoriums can be very packed and you’re right on top of each other. I put a mask on because I know I'm going to be in this one spot for a good two and a half hours.

I hear the person behind me coughing and sneezing, you know what? I don't want it. I don't care what they have. It could even be a mild cold. I don't have time to get sick. I'm going to utilize all these tips and tricks that I have, you know, using Purell. I'll carry Purell with me and wash my hands.

So, we need to continue to really educate the public. We need to really work together and to continue to encourage one another to be vocal advocates whenever we can.

And if you yourself don't know the answers, at least know where to direct people to go. At NNCC, there are many resources that people can utilize in regards to updating themself, webinars, and other educational pieces they can use to stay up to date.

The CDC has a great reference. They're called the COCA Calls where they put out on a monthly basis keeping everyone up to date on the effectiveness of vaccines. And the latest outbreaks and important information the healthcare providers need to know. Vaccinate Your Family is another great resource that we direct people to go to. They have a lot of information that's easy for the common lay person to read. You don't have to be in the medical field to understand the information they put out there. And if you're looking for like-minded people who are vaccine advocates, who appreciate the science, maybe don't have a huge scientific background, but you want to do your part. There's an organization called Voices for Vaccines that I'm also a part of that we work really hard to just encourage the regular person to be a science advocate.

SARAH: Can you tell us a little bit about Nurses Who Vaccinate? What's going on with that right now?

MELODY: Thank you for asking about Nurses Who Vaccinate. We are sharing some very important information on our social media pages, making sure that our members and our followers are staying up-to-date on what they need to know about COVID and flu, RSV, Monkeypox. We continue to be a reference point for nurses and healthcare workers to collaborate to come up with ideas and a game plan in regards to education and advocacy, whether it's in their own workplaces, in the community, in the nursing field. We're working with organizations to host some events that are up and coming, so stay tuned with that. We're looking forward to hosting HPV vaccine awareness events. We're going to be looking to partner with one of our partners Shot at Life for an upcoming summit, where that’s going to be involving our members going out in the real world, doing face-to-face advocacy with some of our legislators and educating, them on what they need to know about vaccines and making sure they're up to speed on the up updates and evidence-based information. And we'll be working with our members to continue to provide that support that's very much needed, especially those who are vocal vaccine advocates. Sometimes it could be a very lonely world out there for those who are passionate about vaccines. And it's important that they know that they're not alone. And we are here as a resource, as a safe place for them to come up with great ideas that continue that momentum and get the information out there to the public and to renew their sense of service.

SARAH: So, before we come to an end, any final thoughts you want leave with our listeners?

MELODY: What I would like everyone to walk away with are three points. One, it is not too late to get vaccinated and it's not too late to convince your loved ones and family members to get vaccinated. Persistence is key and continue to be their source of information to be that place they can go to ask questions in a safe venue. Two, don't give up. Sometimes it can be very frustrating. That was our common theme of the night. But don't let the frustration keep you from doing good work. Continue to fight the good fight. We need to protect ourselves, our colleagues, our patients, and our community from these preventable diseases. And that's what they are. Number three, they're preventable and that we can only prevent them if we use all the tools in our toolbox. So, remember, it's not just about vaccines. It's about wearing a mask. It's about staying home when you're sick. It's about washing your hands. The simplest of simple things. I want to make sure that people understand all these things do add up and they can play a huge part. Making sure good ventilation systems. Oh, we could talk an hour about that. Even more than that, right? I wish we had the time. But working together to put all the pieces of the puzzle together, and hopefully maybe next winter, we won't see the crazy surges that we saw, and we won't have 80 kids dying from the flu.

SARAH: Thank you so much for everything that you're doing to keep this movement strong and the contributions that you're making personally and and professionally. And of course, thank you for making time to join us on At the Core of Care.

MELODY: My pleasure. I hope to see everyone out there. Stay safe and stay healthy.


SARAH: Our special Vaccine Confidence series was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention or CDC.

The CDC is an agency within the Department of Health and Human Services also known as HHS. The contents of this resource do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.

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At the Core of Care is produced by Stephanie Marudas of Kouvenda Media and mixed by Brad Linder.

I’m Sarah Hexem Hubbard of the Pennsylvania Action Coalition.

Thanks for joining us.