ATX Together

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Just ahead on ATX Together - In theory, we can vaccinate our way out of this epidemic if we can fully vaccinate the American people.

- We need to continue to work tirelessly as a community to ensure all have reliable information from trusted resources and equitable access to vaccines.

- Individuals sometimes have to see people that they know, they love and that they trust get the vaccine.

(gentle music) - Hello, I'm Judy Maggio and this is ATX Together.

Vaccinations are the most powerful weapon we have to combat and eventually conquer COVID-19.

For the next half hour, we'll take a closer look at this light at the end of the coronavirus tunnel and why it's not shining very brightly on some of the groups hardest hit by the pandemic.

But we begin with renowned vaccine expert, Dr. Peter Hotez.

He is the Dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and co-director of the Center for Vaccine Development at Texas Children's Hospital.

Thank you for being with us, Dr. Hotez.

My first question deals with the new variants of COVID-19 that seems to be the big concern now and there's worry that we could see more resurgences.

With the sheer number of people being vaccinated now, do you think that's enough to stave off a resurgence?

- Yeah.

Well, thanks, Judy.

This is the question I'm being asked a lot now because we're right at the tipping point where things could go either way.

So we have forces working for us and forces working against us.

The forces working for us, of course, is we're starting to vaccinate the American people, about a quarter of U.S population now has received a single dose of the vaccine.

We're lacking a bit in Texas because we've not quite recovered from our collapse in the power grid and some other factors around our size and that sort of thing.

So we are starting to slowly vaccinate, which is great.

But we've got some things working against us.

And we've all been hearing about the B.1.1.7 variant that came out of southern England.

And that seems to be is going to be the dominant variant from now I think for the rest of our epidemic, at least for 2021.

This is accelerating, it's pretty bad in Texas as well as Georgia and California.

And we have percentages of the virus isolates that are this B.1.1.7 variant coming from Houston Methodist and county and state health departments and it's quite high.

And the reason we have to be concerned about it is there's very strong evidence now that this B.1.1.7 variant is much more highly transmissible, about 60% more highly transmissible.

And now, papers coming out of the UK are showing in Denmark showing higher hospitalization rates and higher death rates.

So that gives us pause for concern.

Then we have the fact that we're lifting mask restrictions and social distancing restrictions in some states where the B.1.1.7 variant is predominant like in Texas.

And so we don't really know how this is gonna go.

If you look at the numbers, it's gone from 250,000 new confirmed cases a day across the country down to around 50,000.

So the good news is that's an 80% decline and the bad news is that's still a pretty high level.

That's about the level we were at last summer when everyone was looking at those numbers aghast.

We've just gotten so used to this high level back in January that we've become complacent but those numbers are quite worrisome.

The good news is by the summer, I think we're gonna be in great shape.

As we approach fully vaccinating the American people, we now know from the performance features of these vaccines that they're not only halting symptomatic illness but the list from studies in Scotland and Israel, they're also dramatically reducing the amount of virus shed from our nose and mouth, so they're stopping asymptomatic transmission.

So that says, in theory, we can vaccinate our way out of this epidemic if we can fully vaccinate the American people.

So I think as we move into the summer, we're potentially looking at a tremendous quality of life and a much safer school year in the fall.

The hard part is gonna be between now and then, you know, for the month of April and May before we're still working to accelerate vaccinations and the B.1.1.7 variant continues to dominate, I think a lot of people, unfortunately, across the country and in Texas will lose their lives from COVID-19.

So it's a matter of just kinda keeping this under wraps for a couple of more months, then we'll be looking at something much better.

So it's a mixed picture, to say the least.

- Final question for you.

There have been certain groups very hard hit by COVID-19, people of color, people who have various disabilities.

They haven't necessarily had the most accessibility to the vaccine, haven't really been prioritized.

Talk about that.

Does that bother you as someone who has done a lot of research in those areas?

- Well, I think that everyone in the State of Texas is working hard to try to ensure some level of equity.

Certainly here in Houston and Harris County, where I'm based, there's been a real commitment to that.

And now what we're starting to see is liberalization of restrictions now that we've gone through 1A and some form of 1B, 1C.

The plan now, according to the State Health Department, is to open it up to any adults, anyone over the age of 16 who wants to get a vaccine, should be able to get a vaccine.

And I actually think it's not a bad idea because if we're gonna get ahead of this B.1.1.7 variant, we have to make it easy breezy to get vaccinated.

And even though the CDC guidelines coming out of ACIP were well-intentioned, I think they wound up confusing a lot of people that were a barrier to restriction.

So I think it's great we're gonna open up to all adults but we have to be able to ensure that equity and that's not easy.

And because our system that's been in place, the way Operation Warp Speed was designed last year, we were gonna rely very heavily on the pharmacy chains and the hospital chains.

And the pharmacy chains actually have done a pretty good job.

It's just that in many low-income neighborhoods those are pharmacy deserts.

So how do we provide access?

So a number, especially in the big urban areas, there's been an effort to create those vaccination hubs and that's gonna be critical.

We still have the problem of groups saying they're not going to get vaccinated or very hesitant about getting vaccinated and I'm doing what I can to address that.

The good news is we've seen some decline in vaccine hesitancy among-- In Black and Brown communities, there was a lot of resistance early on, it's still there, but it's going down.

So I've been going on a lot of talk radio shows and programming and podcasts that reach Black and Brown audiences, I hope that's been helpful.

The one group that's still really dug in so far, according to three polls now from the PBS NewsHour, we did a poll led by a group at Texas A&M, Tim Callahan's group and then also the Kaiser Family Foundation.

So three different methods all came to the same group, the same conclusion, which is that Republicans or white Republicans are the most vaccine hesitant group.

And this kind of started around 2015 when in order to energized the anti-vaccine movement had glommed itself onto the Republican Tea Party and somehow has convinced the Republican Party that this is a mainstream platform.

And it shouldn't be but it's caused a lot of damage and those same groups have been protesting against masks and social distancing.

So there's a lot of advocacy we're gonna have to do with the conservative community.

I've been going on a lot of conservative talk radio shows and cable news outlets and trying to understand their concerns.

And a lot of it is around forced mandates which I think is a bit of a straw man.

Nobody's really talking about mandates at this point.

So we have our work to do, and that's gonna be really important because with this B.1.1.7 variant, what it means is the more transmissible a virus is, the higher percentage of people need to be vaccinated to stop transmission.

So early on, we did studies with a group of (inaudible), University of New York, using the original lineages saying we needed about 65 to 75% of the population vaccinated.

The B.1.1.7 variant unfortunately has raised the bar and now we probably have to get the 80, 85%.

That means just about all the adults and probably adolescents as well.

So we have a lot of good news ahead.

I think we're gonna be looking at much better quality of life by the summer.

I'm worried about the next few weeks and I'm worried about getting to that 85% benchmark.

- Well, we certainly appreciate all the work you're doing to educate the public on the efficacy of vaccination and the vaccination process.

Thank you so much, Dr. Peter Hotez.

He is the Dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children's Hospital Center for Vaccine Development.

Now we want to narrow our focus and take a look at Central Texas and what's working and what's not to get our community vaccinated.

For our progress report on local vaccinations, we turn to three people on the front lines playing an integral role in ensuring our community gets vaccinated against COVID-19.

Please welcome Stephanie Hayden-Howard, the Director of Austin Public Health, Dr. Kimberly Avila Edwards, a pediatrician and Director of Advocacy and External Affairs at Dell Children's Medical Center and Beth Stalvey, Executive Director of the Texas Council for Developmental Disabilities.

Thank you all for joining us today.

I want to start with you, Stephanie.

All adults in Texas, as Dr. Hotez just mentioned, are going to be eligible for vaccines as of March the 29th.

How is Austin Public Health ramping up to meet this added demand?

And what lessons have you learned so far throughout the vaccination process?

- Well, first of all, thank you for the opportunity to be here today.

We, like others, have to acknowledge that we have not completed all of the individuals that are eligible, that fit into the 1A, 1B and 1C criteria.

So one of the things that the state has signaled to us in their communications is that we can continue to prioritize those populations.

We've looked at our system and we know we have several individuals that are 80 years of age and older.

And so we are proactively reaching out to them this week and for the next several weeks working to be able to get our seniors in so we can provide that vaccine to them.

We know that that is an area where severe disease and death occur, so we have to be certain to be able to get our seniors in.

In addition to that, as most of you may be aware is that Austin Public Health during this time, we were receiving facts about individuals that were positive.

And so we built this system in the middle of this pandemic.

Initially put together for the testing results and set up our testing and then we shifted and added the additional ability for vaccines.

And so definitely a lot of lessons learned from a technological perspective.

Our team is always making improvements.

One of the things that we recently added was the ability for individuals to be queued.

Because what we were finding is is since we are a hub that is able to provide vaccines in a short amount of time, but also not to just Central Texas.

We are responsible across the State of Texas to anyone to be able to register to use our system.

And so that queuing aspect has definitely helped us quite a bit.

And so, we continue to learn lessons.

Our goal is excellence.

We are sure that perfection is not something that we can achieve but we can really strive for excellence.

We will continue to work with our partners because our partnerships are very, very important to our efforts throughout the pandemic response.

- And Dr. Avila Edwards, I know that Ascension Seton has been in some amazing partnerships and this has helped reach also some of the communities of color who have been hardest hit during this pandemic.

Nearly half of the COVID-related deaths in our community are among the Latinx population.

Talk about what you all are doing to erase some of this inequity in the vaccination process at Ascension Seton.

- We recognized early on that identifying and successfully vaccinating our most vulnerable and most hesitant populations would require above all a robust data and appropriate analysis.

So to reach these individuals, we know who and where they are.

That is one of the most important things we need to know.

So from the outset of the process, we endeavor to identify who among our clinicians, patients and community members were most vulnerable, were most susceptible to COVID-19 and were most likely to be hesitant about getting the vaccine.

And we took a close look at our associate and patient populations as well as the broader communities in which operate and then reached out directly to many of these individuals to learn from them, learn about root causes of vaccine hesitancy and understand how we might address their concerns.

When our vaccination efforts began and when you asked about gaps, data on our vaccinated patients' race and ethnicity was probably and largely inadequate.

So we began using our data science resources to fill the gaps necessary to locate, reach out and vaccinate those vulnerable population.

We used the CDC's social vulnerability index as a proxy way to help us identify community members who likely face social barriers to equitable vaccine access.

And though not a perfect proxy, it really has served as a tool to help us assess our success in equitably reaching community members who are likely facing social risk factors, including poverty, crowded housing and lack of transportation amongst others.

So on February 4th, when Texas began requiring collection of race and ethnicity data, we were thrilled because this helps us ensure vaccines are reaching those who might need the most support in obtaining access.

And I've personally had the privilege of working directly on our community vaccination efforts here in Texas because we've partnered with a bipartisan group of county governments, healthcare providers and community partners across the Travis County metropolitan statistical area to equitably vaccinate our community members.

And since January 9th, we started and last Sunday was our 12th vaccine drive-thru clinic where we vaccinated almost 40,000 Central Texas community members.

And the vaccine recipients at these clinics beginning with our pilots were largely people of color from some of the hardest hit parts of Travis County.

And I'm so proud to say that last weekend, we were able, through this partnership, to vaccinate our adolescents with the highest risk medical conditions including complex medical care conditions, as well as multiple others to protect this highly vulnerable community.

- So we're making some progress.

And I want to talk to Beth now about these vulnerable communities and accessibility to vaccines because accessibility is even more pointed when it comes to people with disabilities.

There're many different types of accessibility challenges there.

We're talking about technology, cognitive skills, communication skills, transportation.

In this pandemic I'm learning it's had a disproportionate impact on people with disability.

So explain why you think, Beth, people with disabilities weren't really prioritized at the start of all of this when we started vaccinating people.

- First, I want to acknowledge that since there are people with disabilities who also live in communities of color and are also part of other populations that have been discussed that of these efforts and progress that we're making should also benefit people with disabilities.

But we know that the risk among this population is further complicated.

A recent study actually evaluated 64 million patient records from about 547 healthcare organizations last year and the results showed that individuals with intellectual disabilities were two and a half times more likely to contract COVID-19 and were about six times more likely to die from the infection than the general population.

So that is staggering.

We are pleased to see that the state is working to increase vaccine opportunities for those with intellectual disabilities but we are still hearing stories of individuals who are having greater difficulty accessing vaccines.

So I'll share a story of a woman with an intellectual disability who was attempting to get a vaccine this weekend and was told that she could not receive the vaccine without documentation of her intellectual disability and a prescription from her doctor.

Now, we are a bit surprised by these stories because we know that other individuals who are with chronic conditions are not being asked for similar documentation.

So it may be that there is simply a limited understanding within our healthcare system about the unique needs of individuals with intellectual disabilities.

Or it could be that barriers such as these are the result of underlying stigmas and ongoing difficulty in accessing our healthcare system.

People with disabilities have been at the forefront of conversations the entire past year of COVID.

Questions raised such as whether individuals with intellectual disabilities and other disabilities should receive scarce resources such as an ICU bed or a ventilator and now whether there is access to vaccines and whether individuals should be prioritized.

So I don't know that it's necessarily that individuals are forgotten in the priority groups or purposely omitted, I think it might be more likely about the value that our society places on their quality of life.

- Well, hopefully now that the vaccination process is open to all adult Texans, this will improve and make things more accessible.

Before we get to our call to action though, I'd like for any of you to comment on this vaccine hesitancy.

Dr. Hotez mentioned it at the start of the program.

I know you all have faced it in your individual communities.

What are you seeing as keys to fighting vaccine hesitancy?

Is it education?

Is it making sure that these vaccination facilities are in places where they are easily accessible?

Or is it going into churches and places where people do trust and perhaps feel more comfortable getting a vaccination?

Anything that any of you are seeing that's working, I'd love to know.

I know we don't have too much time left but... Stephanie, are you seeing some things generally in Central Texas that are helping?

- Yes, we are definitely seeing some things that are working.

You know, one of the things is key is that whatever program you're going to, whether it's vaccines or any other program, you definitely lead with equity.

You think about how you're going to put the program in place.

But partnerships are key.

Early on in January, we established an equity line that is working with grassroots organizations, and these are trusted individuals in Austin and Travis County.

And so they are proactively reaching out to folks and they are referring them to our equity line and we are scheduling them.

So they are out there.

They're having conversations.

They are providing information that we share with them.

The information must be culturally and linguistically appropriate.

In addition to that, we're using places where most folks will call them non-traditional, they are traditional in the lens of equity.

Individuals sometimes have to see people that they know, they love and that they trust get the vaccine.

So we know we have ways to go, but what we are willing and committed to address hesitancy in our community.

- Before we do our call to action, Kim or Beth, do you want to add anything quickly about this this mistrust and fighting vaccine hesitancy?

- As a pediatrician, it's bread and butter to vaccinate, the most important message that I say is meet individuals where they're at.

Listen to their stories, listen to the reasons they are hesitant and then leverage that information and partner with subject matter experts, trusted partners in the community, influencers, such as physicians, healthcare workers, faith and business leaders, public servants, to authentically, culturally sensitively, and like Stephanie said, linguistically appropriate message to counter those vaccine hesitant populations.

- I'll just add to that.

I think that those components of education and messaging are so important.

And I'll add that other factors such as communication barriers, needing sign language interpreters or needing things that are not in print format and then addressing some of the other issues related to intellectual disabilities and the way that we present information in print format with pictures, or making sure that the appropriate grade level information is available so that people can truly make an informed decision.

- We always end our program with a call to action.

I'd like for each of you to tell all of us ways can help get more Central Texans vaccinated and help combat some of these barriers and inequities in the vaccination process.

Beth, I'll begin with you for our call to action.

- I would say first, I challenge Austinites to get to know their neighbors.

I guarantee that there is someone with an intellectual disability that lives next door to you or down the street from you in your community.

Offer to help someone get registered for an appointment if they have issues with online programs or not really understanding where to find the appropriate links, perhaps even offering a ride to a clinic.

We do know that there are lots of folks that do have transportation barriers.

If you really wanna get involved, I would say talk to some of your elected officials, either locally, or even at the state level and participate in community groups that actually provide some direct clinic assistance.

And if you find yourself at a vaccine clinic, perhaps you can just ask, what are some of the accessibility features that this clinic offers for those with physical disabilities, communication issues, sensory and cognitive disabilities?

I truly believe that it is our obligation to continue these conversations and to keep the conversation going so that we can ensure that this population is not forgotten and that the next person who shows up to get a vaccine can get one much easier.

- Dr. Avila Edwards.

- Beth, I couldn't agree with you more.

And my call to action was be intentional.

Let's be intentional in reaching those experiencing poverty, those who are vulnerable, those who are hesitant to get vaccinated.

The path forward on immunization is really gonna be an all-out effort requiring strong private, public partnerships and we need to continue to work tirelessly as a community to ensure all have reliable information from trusted resources and equitable access to vaccines.

I'm so grateful for the collaborative engagement we've experienced to-date with our state and local health departments, local elected leaders, as well as our community service partner and fellow healthcare providers and look forward to continuing this in our communities.

But I think it's gonna be and require that we are all intentional in contributing and continuing these efforts.

- Thank you.

Stephanie.

- I am going to challenge everyone to be patient.

I know you continue to hear that.

We do know at this time we're continuing to see more vaccine come into our community.

And I ask you if you have a neighbor that is an elderly neighbor, if you can assist them to let them go ahead of the line in front of you, please do so.

If you have received the vaccine and you're a person of influence, and influence does not mean you have influence over a lot of people, it could just be the people that you are friends with.

Please encourage them to get the vaccine.

Answer any questions from your own personal experience.

Because what we see that works is that my dear friend got it.

She went first.

Now I'm ready to go.

And so we've got to get as many people this vaccine because we want to be able to move to our new normal.

So that is my challenge.

Is that not wanting to be the first person in line if you have the ability to wait and be patient.

- Thank you.

Stephanie Hayden-Howard, Dr. Kimberly Avila Edwards and Beth Stalvey for giving us a clearer picture of where we are with COVID-19 vaccinations in Central Texas and where we need to be in the coming months.

If you'd like more resources on COVID-19 vaccinations, simply go to the Austin PBS website and click on ATX Together to find more links.

Another way to keep the conversation going is to join the ATX Together Facebook group or on Twitter, use the hashtag #atxtogether.

Thank you for watching and join us next time for another vital discussion on ATX Together.

(gentle music) - [Female Announcer] ATX Together is made possible by Texas Mutual Insurance Company, workman's compensation insurance for Texas.

And by Roxanne Elder and Scott Borders.

(flute music)