How can Fort Worth close its COVID vaccine gap? Start by talking to doctors about it

·8 min read

Government institutions on the national and local level have been at the forefront of COVID-19 vaccine communication, but polling shows those aren’t the sources that Americans turn to when they’re making medical decisions

Americans’ trust in sources like the Centers for Disease Control and Prevention, the Food and Drug Administration, and local health departments depends largely on whether they’ve received the COVID-19 vaccine already or whether they plan to in the future, according to new polling data from the Kaiser Family Foundation.

But there’s one source of information that garners universally high trust, no matter the respondent’s vaccination status: Your personal doctor or your child’s pediatrician.

More than 80% of a nationally representative sample of 1,888 adults told the Kaiser Family Foundation they had either a great deal or a fair amount of trust in either their doctor or their child’s doctor to give them accurate information about the COVID-19 vaccine. Americans said they trusted their doctors more than any government institution, more than President Joe Biden, or their state health officials.

As public health experts and community leaders scramble to find ways to reach people who haven’t yet received the vaccine, this data and previous research indicates that one of the most influential conversations an unvaccinated person can have is with their primary care doctor.

“Vaccine rollouts have focused on large vaccination sites, prioritizing efficiency over all else,” said Dr. Ishani Ganguli, an associate professor of medicine at Harvard Medical School. “The role of the trusted patient-clinician relationship was really sidelined.”

In Tarrant County, local doctors said the non-judgmental conversations they have with their patients have been essential in answering questions and dispelling misinformation about the COVID-19 vaccines.

“As pediatricians, we have had conversations about vaccines and vaccine hesitancy for many years,” said Dr. Christina Robinson, assistant professor in the department of pediatrics and women’s health at UNT Health Science Center. Family doctors “do have deep relationships with a lot of their families, and that is one way that we can rally families to get vaccinated, if we’re able to embed COVID-19 vaccines in primary care settings.”

Less than 50% is fully vaccinated in Tarrant County

Fort Worth and the rest of the country are at a precarious moment in the vaccine rollout. With just 50% of Tarrant County’s eligible population fully vaccinated (or 42% of the county’s total population, according to state data), there are still thousands of county residents with no protection against the virus and any current and future variants.

With so many people unprotected, the SARS-CoV-2 virus can continue to infect new people and mutate, giving the virus the time and space for more infectious or more deadly variants to emerge.

Already, the Delta variant of the virus has become the dominant strain nationwide. The Delta variant spreads from person-to-person more easily than the original version of the virus, and has caused a spike in cases and hospitalizations locally and across the nation.

Dr. Grant Fowler, the chair of JPS Health Network’s family medicine department, said his experiences treating hospitalized COVID-19 patients recently reflect national data: The overwhelming majority of people getting seriously sick and dying from the disease are not fully vaccinated against COVID-19, he said.

A recent patient who was under 65 years old died from the disease despite having no risk factors that would make him more likely to get seriously ill, Fowler said. Another patient, he added, lost her leg after COVID-19 caused a massive blood clot, forcing physicians to amputate her limb, he said.

As officials puzzle over how to encourage Americans to take a vaccine that is free and in ample supply, local doctors and their peers studying vaccine access stressed that there is still a wide swath of the population that is open to receiving the vaccine. Right now, however, they don’t have the right information, easy access, or a person to talk with about their decision.

Talk to your doctor

Robinson, who is also the medical director of UNT HSC Pediatric Mobile Clinic, said she and her peers have decades of practice of talking with parents about vaccines, largely through a tool known as “motivational interviewing.”

“We know realized that vitally important to establishing a deep relationship is allowing (parents) to feel that they are heard,” Robinson said. “Recognizing their concerns and asking their permission to step into the space. Saying, ‘I’m hearing that you have some concerns about the COVID-19 vaccine. May I talk to you a little more about my information about the vaccine?’”

Robinson said conversations about all vaccines, whether it’s the COVID-19 vaccine or others, should start from a place where both doctor and parent recognize they want the best for the child. From there, doctor and parent can discuss how to protect the child and ensure they have a long, healthy life, she said.

But the COVID-19 vaccine does bring specific questions for parents, Robinson said, including some that are specific to patients of color who have experienced systemic racism in the health care system.

Black patients, Robinson said, have been more likely to express concern over historic research that’s abused Black or other vulnerable communities.

“They’re reminded a lot of the instances where true, informed consent wasn’t given to vulnerable populations who were offered a service, especially when the service was free,” Robinson said.

Latino patients, however, have been more likely to ask questions about what information would be recorded and stored about them and their families, she said.

At the North Texas Area Community Health Centers (NTACHC), chief medical officer Dr. Patricia Rodriguez said doctors talk about the COVID-19 vaccine with their patients during every visit, no matter why the patient initially came in. Although she does talk with patients who are dead-set against taking the COVID-19 vaccine, she said there is still a group of patients who want more information.

“Most of the interactions are in the middle of the road,” Rodriguez said. “They’re not opposed, they have questions, they want to talk about it, or they’ve just been a little apathetic. But they’re not against it.”

These conversations, Rodriguez and Robinson said, give patients the space to ask questions about side effects, about COVID-19 itself, or about the vaccine’s development in safe place where they can get accurate information.

And the benefit of having these conversations in a primary care setting is that if patients feel they’re ready to take the COVID-19 vaccine after talking with their doctor, there’s no delay. If a doctor’s office has vaccine on hand, the patient can get vaccinated within minutes of talking the decision over with their doctor.

“My recommendation would be to have the conversation at every appointment,” Rodriguez said.

What if you don’t have a doctor?

The high level of trust that Americans have in their doctors, no matter their vaccination status, indicates that there is a window of opportunity for reaching some unvaccinated Americans.

But that trust can only exist if patients have a personal doctor, which is not a guarantee. Texas has the highest rate of uninsured residents in the country. In Tarrant County, census data shows that almost one in every five adults under 65 doesn’t have health insurance, meaning that they have to pay for the full cost of their healthcare in cash or try to find someplace that can provide free care.

Adults without health insurance are more likely to go without preventive care, and then to ultimately use emergency rooms or urgent clinics when conditions deteriorate.

One of the few places in the county where uninsured residents can get care on a sliding scale is NTACHC, where Rodriguez is chief medical officer. The center, the county’s only Federally Qualified Health Center, treats thousands of uninsured patients each year.

The polling data from Kaiser Family Foundation shows one of the biggest predictors for not having received the vaccine is your insurance status. For people under age 65, 62% of insured adults reported receiving at least one dose of the vaccine, compared to 48% of uninsured adults, according to KFF’s data. The uninsured are the only demographic subgroup where less than half of adults report receiving at least one dose of the vaccine in KFF’s poll.

“I think it’s a really important finding that people who are uninsured are less likely to be getting the vaccine,” said Liz Hamel, KFF’s vice president and director of public opinion and survey research. “It reflects both confusion and lack of access to information, but also that they’re still facing significant access and logistical barriers.”

Other gatekeepers

Focusing on the doctor-patient relationship is not the only solution for increasing vaccine uptake, physicians and experts stressed. But because unvaccinated Americans have a wide range of different reasons and explanations for not taking the COVID-19 vaccine, all paths should be explored.

“There have been missed opportunities to talk about the vaccine” with primary care doctors, said Ganguli, who is also an internal medicine doctor and has researched the declining use of primary care doctors in the U.S.

For those Americans who don’t regularly see a doctor, physicians and experts said relying on trusted members of the community to share information about the COVID-19 vaccine is a key, and largely ignored, tool to increase vaccine uptake. Pastors and faith leaders, directors of community centers, or prominent business owners are all members who should be consulted and worked with when trying to spread accurate information about the vaccine, experts said.

“I do feel like that there were a couple of missteps in our vaccine rollout as a nation, and I think one of those was not using key messengers community gatekeepers to get the word out ahead of the misinformation,” Robinson said. “Now we’re having to do a lot of backtracking to dispel those myths.”

Have you changed your mind about the COVID-19 vaccine? Are you still waiting to decide whether you’ll take it? The Star-Telegram wants to hear from you. Please contact health reporter Ciara McCarthy by calling or texting 817-203-4391 or emailing cmccarthy@star-telegram.com. Nothing you share will be published without your explicit permission.

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