When media and politics run a pandemic response

Recently, a friend of mine made a comment that went something like this: “We really need to step back and evaluate how social media and political motivations have shaped our pandemic response.” My response was one of general agreement because even though I have been trying to shield myself from the social media and political COVID-19 frenzy, I realized that the reason I made that choice in the first place was because there was just too much of it. I was reminded of this comment the other day when I was talking to a patient and her partner about their decision to not get the COVID-19 vaccine. As a locum physician, it can be a challenge to swoop into the middle of a patient’s care journey for one appointment, knowing little about their condition, their care, and their goals for treatment. Sometimes, though, it can be a blessing-in-disguise for the patient and their usual care provider when a new face and a new voice come in to offer a new perspective. As the nurse I was working with came out of the clinic room after getting the patient situated, she expressed her frustration with the couple—a pregnant woman and her husband who were both unvaccinated and were “refusing” to listen to any recommendation that they should get vaccinated. I tried not to let her irritation overflow into my mental sphere as I perused the patient’s chart. In rural Alberta, where vaccination rates are low and case numbers are increasing again, I have probably talked to every second patient I’ve seen about the importance of getting vaccinated. Most of the patients ask me before I have a chance to ask them, and I have been pleasantly surprised by the number of people who take my advice to get the vaccine once they’ve asked me about it. I’ve also come to realize, though, that there are some people who will never be convinced, no matter what I say. And, as bad as it sounds, I don’t have the mental or emotional energy at this point in our pandemic journey to change everyone’s mind. So if a patient becomes defensive about their “right to choose,” after “doing their research,” I smile politely and move on to the next issue at hand. When I went in to meet this patient and her partner, I hadn’t even finished introducing myself to her when she burst into tears. On questioning, she said she was just so lost and scared about what to do about COVID. She expressed her real fear of getting COVID-19, fully acknowledging that even outside of pregnancy, her multiple medical comorbidities place her in one of the highest risk groups for severe illness from COVID. I agreed with her on that, and then I let her continue explaining her fear. She continued to tell me about how everything she is seeing on social media makes her even more scared to get the vaccine, dreading the potential negative effects on her and on her baby. At this point, her partner, also someone who would fall into a high-risk group for severe COVID infection, cut in to give his interpretation of the harms that could come to them by getting the vaccine. As he spoke, I could hear his tone of voice becoming more pressured and urgent, until he concluded by saying how violated he felt that his movements are restricted, and his rights taken away because he is choosing not to get the vaccine. Before I could get a word in edgewise, he continued to say, “I’m not an anti-vaxxer, and I really want to do what’s right for us, but I don’t like being forced into doing something that I’m not comfortable with. I can’t get any real information from anywhere.” And so, since I wasn’t behind, and I had the time, I asked them what specific questions they had that I could answer for them. “How is it safe for a company to come up with a brand-new vaccination in such a short period of time?” “Why is it OK for a pregnant person to get the vaccine but it’s not OK for children and babies to get the vaccine?” “If the vaccine isn’t safe for kids, why is it safe for adults?” “It seems like the vaccine isn’t even working, so why are they still forcing us to get it?” I tackled each question, which I was very comfortable answering, slowly, deliberately, and without judgement in my voice. We talked about the science behind vaccine development, that coronavirus vaccines have been researched for many years before now, and how clinical trials work. We talked about how phases for clinical trials vary depending on the population being studied (children vs. adults), and the difference between absolute and relative risks, and the weighing of risk and benefits in different populations. I explained active and passive immunity, the effectiveness of the placenta, and how even though the baby is “part” of the mother’s body, it is actually a very separate entity. We talked about the different ways we can measure the effectiveness of an intervention, and that stopping the spread of the virus is not the only way we measure the vaccine’s success. And of course, I explained that regardless of pre-existing risk factors, pregnancy puts any woman at increased risk of severe illness from any respiratory virus, which is why we always recommend the flu shot in pregnancy. They listened attentively, they asked followup questions, and they asked me what I thought, overall, of getting the vaccine. I acknowledged their concerns, their fears, and their frustrations. And I told them what I tell every patient who asks me: “We may not have all the answers, but we do know that the vaccine can minimize the chance of severe illness, and to me, that is a success.” Before my eyes, the patient relaxed. When they had no more COVID-related questions, we moved on to the prenatal part of the visit and the mood of our conversation relaxed. As I measured her belly and watched the baby bouncing around on the ultrasound screen beside me, the patient’s partner thanked me for taking the time to answer their questions. He said that talking with me was the first meaningful and informative conversation he has had since the vaccine was introduced. This last comment really made me wonder, how much of the vaccine hesitancy and COVID conspiracy-theory propagation we see comes from the fact that most people don’t feel like they have reliable, trustworthy sources for their information? How would our pandemic response look different if social media and political favour were not at the helm of propagating public information? At the end of the appointment, the patient said she was leaving and going straight to find a place to get her first dose. Her partner nodded along emphatically and pulled out his phone to find an available walk-in vaccine center nearby. As we walked out of the exam room together, the nurse was passing in the hallway. The couple was excited to tell her that they had decided to get vaccinated and were going right away. I couldn’t help but notice the combined look of shock and relief on the nurse’s face. If I did only one good thing that day, it was taking the time to answer this couple’s questions.

When media and politics run a pandemic response

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