This week Fred, Luis, and I review vaccine hesitancy and discuss some strategies for overcoming this that include positive and negative measures. We talk about the EEOC regulations and how they fit into mandates and some of the challenges with verification and tracking of vaccines – what constitutes acceptable proof
We also share review the recently trending news stories around the Johnson and Johnson vaccine and fetal cell lines and separate the facts from hyperbole
Our weekly question and answer session with Fred Goldstein, Dr. Luis Saldana, and Nick van Terheyden, MD on our COVID Insights to Action Discussion webinar that takes place live every Wednesday at 4pm ET You can register here
You can also find our training modules and services available to help businesses, education facilities, and employers get their employees, staff, customers, and students back to work and school safely in the context of COVID19
Raw Transcript
Fred Goldstein
Okay. Hello, everyone, and welcome to this week’s COVID insights to action discussion group. I’m joined again by our two esteemed physicians, Dr. Nick van Terheyden. And Dr. Luis adanya. As always, we’ve got an open discussion here. And thanks so much for joining us. This week, we’re going to be discussing the issues of vaccine hesitancy, the possible use of incentives? And how should employers look at and manage these issues, it’s going to become much bigger as we begin to get more and more vaccine out into the community. And obviously, there’s differing opinions from individuals. So why don’t we start with you, Luis, I know you’ve looked at some of these things. What’s your sense now of where we’re at with vaccine hesitancy?
Luis Saldana
Well, you know, I think vaccine hesitancy while it’s a important consideration, especially for the long term vision, we still have so many short term concerns around demand still is far outstripping the supply or at least it and that’s in the in getting vaccines in arms. I’m not talking about numbers of doses that are out there, but actually gain it into arms. That that I think, right now, it’s really important, it’s an important time for us to position and think about how we will attack this, once we’re at a point where the demand started, the demand starts to drop. And then we’re trying to address or really get to the folks that have been hesitant. Some of that hesitancy may resolve with the sheer numbers, and kind of, quote, peer pressure, potentially, of this. But, you know, I think we’ve seen a lot of a, you know, the disappointing we’ve seen a lot of in health care workers, but they may just again, be waiting for, for for kind of seeing, seeing all of it. Also, it’ll be interesting to see the impact of the j&j single dose kind of vaccine, if that actually changes that as well.
Yeah, I and I think it’s interesting. I
mean, you know, I
Nick van Terheyden
think it’s always incorrect, inappropriate, however, you want to phrase it to discount hesitancy. Everybody has personal reasons, I think it’s important to understand those and address them with science and facts. help people understand, you know, in particular safety, I think one of the things that stood out to me, so first off, you know, from a positive, I would say, based on what I’ve seen, hesitancy has declined, at least from where it has been certainly the numbers that I’ve seen, it was really quite shocking how much pushback there was. So that’s good news. I think what was surprising to me was health care workers, folks that are in the business, who all you know, absolutely on the front line, and I would expect to have confidence in the vaccines, being hesitant. So understanding that, for me is important so that we can start to address that, is that a concern over safety. And as we’ve said on this webinar before, and in other forums, the safety profile of these vaccines, all of them Currently, the data that’s been published a is is excellent, the safety profile is excellent, it continues to be excellent. We continue to accrue data based on shots in arms. And it is not a vaccine that was developed over the course of a year. It’s just not this is years of work and effort. So I think understanding the resistance, and helping people move past that so that they can be confident is really one of the most important elements that we have to sort of address to increase it. But Luis is right. I think peer pressure, it’s very hard, you know, if you’ve ever seen any of those experiments where they you know, put somebody in to a crowd and the crowd is all actually in on it. But there’s one person that isn’t and they do things and the individual just follows along because they’re you know, they’re driven by the crowd crowd effect is very Very powerful.
Fred Goldstein
Let me ask you this, because I really haven’t heard anything. And either one of you please address this. The the the second vaccine particulars I’ve heard with Madonna, you know, you have a pretty big reaction. And that’s got some people concerned sometimes for that 24 hour period or something when they get the second dose? Or are they reporting anything like that with j&j? I haven’t seen it. So I don’t know.
Nick van Terheyden
So because that’s only recently been released in terms of the data, I actually haven’t had an opportunity to review the paper to see what was in there. So I don’t know. But even if it is better, or worse, I think the important thing to remember is that any reaction as long as you know, it’s not severe. And you know, untreatable is far superior to the getting of the disease.
Fred Goldstein
Yeah, absolutely. And I know, you know, some people have said, Oh, my gosh, you know, the SEC, well, maybe I’ll just take the first dose, which obviously is not recommended. And, you know, you think about that, and I’ve, you know, seen people experience it, and it’s a 24 hour, it’s can be rough. And obviously, there are a few, but very miners understand very severe reactions of anaphylactic shock or something like that. So overall, with the millions of doses, it’s really not a major issue. Do you think it’s it’s really maybe early, you brought up Luis, it’s almost maybe too early to worry about that, because you’re still trying to get this out to a very large group of the population that wants to get vaccinated.
Luis Saldana
Yeah, that’s, that’s, that’s, that’s my opinion. And I think it’s something you have to start thinking about. And certainly folks like the CDC and public health officials have to start thinking about how do we put together campaigns to address this? You know, I think, again, I’ve kind of always pointed to the Israel experience, because they’ve gone and, and it’s, I think it’s more the carrot versus stick approach, I would say, and they’ve used incentives. To do that they have what I think it’s called the Green Path. In Israel, if you’ve received both doses of the vaccine, you download and go through on a website and get this green pass, which allows you essentially go to gyms, theaters, restaurants, etc. And so it’s basically, that pass buys you more freedom. So if vaccination equals freedom, then that I think, will will make that you change the the calculation or the calculus of it to where vaccination equals freedom. Yeah. And I think if we can kind of get to that, that that position or sense, I think that’s, that that’s a good way to kind of frame it. I think it’s also important that to use stories, I think stories are always really more important than presenting dry facts and dry, you know, figures, I think, just going to go even with scientific folks, I think it’s important to really speak in, in stories and and real life impact.
Nick van Terheyden
And, Fred, I think it’s important, you’ve looked at this, some of the positive incentives that people are considering include financial based on some of the research and things that you see, right.
Fred Goldstein
Yeah, that really kind of gets into the second topic that you were touching on the waist, which is this idea of one, the EEOC has said you can mandate vaccines at your workplace. But this idea of incenting people and making it a positive instead of a hammer approach may be the better one. So you’re seeing companies come out with and a number of them are doing it, you know, two hours of what will pay you two hours of your time to get a get if you’re vaccinated, we’ll give $150 gift to you if you’re vaccinated. Even one of the hospitals, I think had this program for $500 as a bonus to employees if you’ve also been vaccinated. So I think those ideas around incentives are good ones, you know, we see that always trying to change behavior, it’s always better to get a positive one than a negative one. So it’ll be interesting to see. And interestingly, there now is the first lawsuit out there, I believe in New Mexico, where an individual has sued the company over their mandatory vaccine policy. And not to get too deep in the weeds. But what they’re saying is that the EEOC has allowed you to do that for things that have fully gone through the review process and are fully approved, but not for those with an EU a and that’s why they shouldn’t be allowed to mandate it. So be interesting to see how that goes through the courts. But we do have
Luis Saldana
I think that’s a technicality that we’ll write quite quickly be be kind of tossed out. I think that’s
Nick van Terheyden
fine, but it is inevitable. It’s the American way. I think. I agree with Luis.
Fred Goldstein
Yeah, I think it’ll be interesting to watch. You know, I think more and more Companies will look at the idea of similar to that green pass. It’s an it’s, it’s an incentive a positive for you to get vaccinated to get that done. And we’ll see, hopefully communities then look at that and say, Well, here’s how we can, we can add more to what you can do, because you’ve had a vaccine. Although we’re wondering, you know, again, what’s the I think the CDC is now looking at how they’re going to adjust sort of the guidelines for individuals with vaccinated versus non vaccinated. The other interesting thing, just from an employer perspective, is you can require proof of a vaccine. And you can ask the employees and require them to prove they have it or not. And you can actually keep them from your workplace, if you cannot come up with an appropriate, you know, type of reasonable accommodation for them. If you can’t do a reasonable accommodation, you can say those individuals cannot come to the office. And it’s based upon an interesting thing I looked into, which is called a direct threat in the EEOC as a standard for what is a direct threat. And it’s based on the duration of the risk, the nature and severity of the potential harm to the individuals, the likelihood of potential harm, and the excuse me imminence of potential harm. And they’ve like with influence, they’ve said that the pandemic COVID infection falls under the direct threat protocols, which allows employers to then go further in terms of some of their activities. So if we if we think about it, are there any other ideas? I mean, you mentioned Luis, obviously, this whole communications issue, which is critical, and storytelling instead of just throwing out a bunch of facts. Other places, maybe we were, I don’t know that I’ve necessarily seen people looking at that other than what we’re seeing come out of Israel. And I guess the EU is looking at that as well of allowing people to do more with the vaccine.
Luis Saldana
Yeah, tickets, you’ve probably seen pockets of it, I don’t have any kind of big widescale kind of examples of that yet, because we still are very early in the kind of vaccination process. And certainly, you’re hearing more and more discussions around with airlines and others around this vaccine, passport and things like that, I think, as you see that, for cruise lines are definitely talking about this, the the, you know, the airlines have done something similar by putting you have to kind of prove you don’t have the, the the, the the virus by having negative test. So I think the, you know, all the things are in line for just that kind of approach. Certainly, I think when you I would expect that places in Europe that got hit hard, Italy, Germany, UK, will probably will probably be looking at, at these kinds of things to, you know, to ensure the safety or, or kind of really ensure that we, you know, we don’t see any more major outbreaks.
Fred Goldstein
So let me get to an area where you’re both pretty renowned experts in, and that’s this whole area of digital tech, and proof and the use of apps. What are we seeing around that? And what are some of the potential pitfalls with that approach? Well,
Nick van Terheyden
let me kick off. I mean, I think we’ve already seen, you know, the the initial challenges around this, with fake passes, I think there was at least three instances in three different countries, I want to say the Netherlands, the United Kingdom, and the US, where people were offering and this wasn’t the vaccines, this was the testing, where they were providing fake tests, it was a whole process. I mean, it reminds me a little bit of, you know, applying for a driver’s license to prove you’re 21 for drinking, you know, that potentially that easy. There’s no sort of imagery, or connection to the individual. This is quite a challenging problem. Because if I issue a certificate, even if it’s a digital certificate, you know, people have learned they can copy it, and then Photoshop it. And then I mean, I don’t want to sort of trivialize and finding ways around that. It’s a little bit of a nuclear arms race. You know, once the the the authorities have a better system, there’s an alternative. So I think we really have to think about it. And I always think of it in the context of yellow fever because I lived through that and I had a yellow and it never occurred to me. I was too young really to think about it. I’m sure my parents never thought to falsify the yellow fever because it was about protecting me as much as the people around And I’m hopeful that that’s the case with this vaccine, but maybe I’m wrong.
Luis Saldana
Yeah, I think in terms of the tech here, you know, they this, this just basically raises the sore point that we’ve had in, in, in health IP, of interoperability, and and everybody kind of go in their own way. And then the lack of, of standards, essentially, what what, what you need to execute this? Well, you need to have a way for there to be trust. So trust is is kind of the, the key component of such an app, it you know, and there’s always ways we know, there, there, there are ways to, to verify things. So it’s really kind of a verification, there’s lots of examples where, where the verification is solid, we, you know, we do that when, when, you know, with with different applications, things like that. So, there are ways to do that. But essentially, it’s it’s a matter of right now that you’re seeing that we want to be first to the finish line, that way will be the standard. And that’s what you’re seeing right now. And that’s pretty typical health ID application. So I’d say this is very, very typical. I think at some point in this you will see OMC or somebody which is the opposite of the National Coordinator, it step in and and try and come up with some standards around this that will allow for that trust and interoperability to kind of be overcome.
Fred Goldstein
Yeah, I think what you just raised Louise’s The next question I was gonna get to which is perfect, is this whole concept of it’s it’s typical healthcare approach will fragment and there will be 50 companies out there with one of these apps. And so how do we decide to do that if you’ve got some company that works with 100 different employers using this app that they developed for them, then you’ve got Microsoft and epic off with this app over here? And the others? So do you see it more as the OMC saying, Here’s gonna be the standard you need to do to create interoperability? Or do you see potential, the idea that we’re gonna have one,
Nick van Terheyden
or I’m sorry, I’m gonna jump on many jumps, the idea that we have one pass would just be the complete antithesis of the open market demands requirements. And I, you know, good and bad, there’s always good and bad with these things. I think you can’t sort of focus on that, I think the importance of interoperability that allows for these passes, so that you’re not locked into a single technology platform, and you’re not, I think, more importantly, you’re not excluded. Oh, I’m not on X, therefore I cannot, would not be an acceptable outcome. So let’s hope we do a better job of this than we did with the electronic medical record, and mandate at the beginning, that all of this stuff has to, you know, interoperate. And by the way, worldwide, because that should be the thing. And you know, that can’t be difficult at all to make all the countries agree on how they should talk to each other.
Holy moly, now, my head’s about to explode. So I’m thinking about this thing, and I’m saying to myself,
Fred Goldstein
we should already be done. You know, we’re out there vaccinating people. And we’re still wondering, is the RNC gonna come up with standards? I think they probably will lose, I think you’re on target. That’s the right place to do it. But boy, you gotta get fast and quick on this. Because the other thing you got to consider is, as you talked about, Nick, you can exclude certain groups, how do we make sure it includes all the groups, you know, are certain people, we’re just gonna have to have a paper record?
Nick van Terheyden
You know, what, if you have a flip phone, which people do I mean, and not a smartphone, if it’s tied to that, and how do you do, but I mean, we, we, we have methods to deal with this. I think, you know, this is not an insurmountable problem. It just isn’t. And even if it isn’t, let’s fix it. And then keep adding to it to make sure that we, you know, extend it to those people that are not connected or not able to access it because we didn’t realize or didn’t understand that particular access point. So, just to be the devil’s advocate.
Fred Goldstein
We seem to have tons of non insurmountable problems in healthcare that we haven’t surmounted. Hopefully, this gets a little bit better. I mean, really, it’s like you said, it’s, it’s a technological thing that we could set up standards for, and then people could begin to get those loaded. Obviously, we’re starting to get a lot of vaccine into folks, which is great to see. So it’ll be interesting to see how this rolls through over time to allow us to do those things. Like some of these other countries are considering and begin to reopen the economy even more. So
Nick van Terheyden
that I just want to say, let’s hope we don’t hear COVID-19 like we hear HIPAA as an excuse not to do but rather an excuse to do.
Fred Goldstein
Great point. Great point. And that sort of gets to the next thing. So we’re going to be going through a period where we have vaccinated individuals at the workplace and non vaccinated individuals, and probably given issues around how long immunity lasts and people who don’t get vaccinated or can’t always sort of maybe for a long period, maybe live with those issues. So what should employers be considering as they look at having this dual population of their employees at their workplace?
Luis Saldana
You know, I’m just going to say that I think every situation is going to be very different. And I think it’s going to be an epic ask to be he has to be addressed in some type of business is one thing. What is that? What is the office space look like? Is that an incentive for people to be working remote anyway? And so then in that case, if they’re not going to the opposite way? You know, it’s there’s no incentive for me to do it. And think so. I think, you know, I think that in each case, though, that’s why you need that you need some assistance on is how are we going to address that? What is our goal? Do we need? Do we need people in the office are our people facing customers on a day to day basis, then you might have those, then you look at the mandates, those types of things that you need to have, because, in fact, what you’re doing is keeping your customers safe. And so, you know, you might see that for, quote, essential workers that I’ve no doubt that yeah, I think United Airlines or somebody early on are announced they would they would be requiring, I think all the airlines will be requiring for anybody that probably anybody by their whole employee base, but likely for any, any that base, you know, their customer facing, for sure.
Fred Goldstein
And also, I guess, just beyond, you know, whether you mandate the vaccine or and Senate, you’re still gonna have a need for these non pharmaceutical interventions, right? You’re still gonna say, Hey, we still got a mask issue, we still want to space and those kinds of things, you’ll still be looking at that.
Luis Saldana
Yeah. And to add to what I said about Israel, Israel still requires those things. So they did not. They did not say though that further like theaters and and public spaces, they did not turn off, you know, say no, no, you don’t need masks. Certainly, what if you’re, you know, you know, it vaccinate individuals in their own homes or out, you know, a small gathering that that’s different, but, but they still continued those non pharmaceutical interventions.
Fred Goldstein
Got it? And we’ll get back to this topic. But there was also this question that came in on, you know, speak to the historical and current practice of using material derived from human fetal tissues during preliminary lab testing, and why j&j vaccine actually uses the cells as part of manufacturing. Is there a benefit? Nick, could you address that?
Nick van Terheyden
Yeah, no, absolutely. I think it’s a question. It’s, I certainly saw that raised today. So let’s talk about the differences between the vaccine. So the messenger RNA based vaccines, that’s the donor and Pfizer vaccines are a different platform. We’ve talked about that a lot on this. This is specifically the Johnson and Johnson vaccine, which is based on an ad no virus. And here’s the thing about viruses in general, they inanimate, you know, collection of molecules that do nothing, unless they’re in a cell, they need the cell to grow. So what is it that this is referencing, there are what’s called fetal cell lines, they’ve been used for an extended period of time in history, they go back as far as 1973. And even 1985, a researcher, I believe, out of the Netherlands obtained cells and started what we call a cell line. And then these cell lines have been reproduced. And they use that to insert the Abner virus so that it can grow. So these original fetal cells have been multiplied millions of times creating multiple fetal cell lines, they used in lots of different places. They’ve been using the Baro trees for decades. And to be clear, the same fetal cell lines were also used in the production of hepatitis, a rubella, chickenpox and even the shingles vaccine. So this is not a new issue. And it’s not the cells themselves. We go through this process to allow the growth of that add no virus so I understand some concern around it, but Let me tell, you know, to Louise’s a point of stories, one of the stories that I think is relevant here, that always blows my mind is that everybody on this call has at least some part of Napoleon, Einstein, you name any famous person, at least an atom or two from that individual is in your body somewhere, just based on the way that things happen. We recycle molecules, we recycle all of these atoms. And, you know, that always blows my mind, when you think of this construct of us as human beings. It’s the same with these cell lines. And, you know, for me, what happened in the past, you know, is that that’s the case, but we should benefit from the generation of these fetal cell lines that are essential to some of the scientific work. It’s not going on today, we have some very strict controls. I think people understand that. So I don’t see it any differently. It’s just a different platform, and it has some advantages. I think we just have to accept and move on. But I don’t want to sort of diminish the concern. Yeah,
Luis Saldana
I’ll just say that this is kind of a thing that’s gonna happen to us. Actually, the I think the Vatican spoken to this back in December, that they considered it morally acceptable to receive COVID-19 vaccines that have used the cell lines, in their research and production process. All vaccinations recognized as clinically safe and effective, can be used in good conscience with certain knowledge, with a certain knowledge that the use of such a vaccine does not constitute formal cooperation, blah, blah, blah. So So in other words, the pope himself has spoken on this, you’re seeing some, you know, I think the very conservative American Archbishop, your diocese, kind of speak up on this as, as they often do. And these are probably more political kind of distinctions than anything.
Fred Goldstein
Right. So for the, the less scientifically minded like myself, this is a line that started way back. And they’ve just continued to propagate that line and use it to create the virus. by growing the Edina virus inside those cells that they’ve now created over time.
Nick van Terheyden
It’s like that yogurt strain the yogurt I think you say here that you used to create your youngest you put your milk in and then you put the and the same with I think sourdough that was what I learned. I didn’t even know that about sourdough. Same thing, you take this, you know, this piece of donut keeps replicating. I mean, it’s just fascinating. It just, you know, small pieces, like,
Fred Goldstein
Oh, you got to hit Fisherman’s Wharf in San Francisco and get some of that fine sourdough bread that they’ve been using off those years. I don’t need
Nick van Terheyden
you I can make it in my home now. Because,
Fred Goldstein
yeah, well, we’re sort of coming up on the end of this. I think it’s, it’s really been an interesting discussion. But as you think about this, it’s, I guess, from a vaccine perspective, again, it’s really about all of us trying to help each other by getting ourselves vaccinated. So we can protect others as well as ourselves, because there is some data to show I guess that it’s reducing transmission, potentially.
Nick van Terheyden
Yeah, not only? Well, I think we’re seeing good data, even after the first dose in one of them, I forget which of the two, we’ve seen some studies that show a decrease in transmission, but was showing, you know, effectiveness against any severe disease and death with all of these vaccines. So at the point, as Luis pointed out, right at the beginning, when we have limited availability, we really have to be encouraged to take any option. And you know, I would be grateful for any option that showed up in my arm at any time, and be glad to get it.
Fred Goldstein
Any other final thoughts, Louise?
Luis Saldana
No, I think I think all these thoughts are, are good and relevant. And I appreciate the question.
Fred Goldstein
Yeah. Great. Well, thanks so much for joining us. It looks like we’ve come up on the end of another half hour. If you have any questions or comments or ideas you’d like to get ahold of us, please go to Vedic health comm and we’d be happy to talk with you about your specific issues. So thanks again, Nick and Luis.
