December 21, 2020

Rounds: A Holiday Gift

Against the noisy background of masking debates, surges, flattening curves, warp speed initiatives, conflicting messages and misinformation, political controversies, not to mention a revolutionary mRNA technology, millions of people are deciding whether to take the COVID-19 vaccine.


Against the noisy background of masking debates, surges, flattening curves, warp speed initiatives, conflicting messages and misinformation, political controversies, not to mention a revolutionary mRNA technology, millions of people are deciding whether to take the COVID-19 vaccine.

Jeff Balser, MD, PhD

This, however, is clear: In Tennessee, more than 6,000 people have died from COVID-19, often more than 100 people dying each day. Vanderbilt University Medical Center, like other hospitals and health systems in our region, is experiencing what promises to be a long and very dark winter.

As much as we all might wish, the ills of 2020 will not vanish at the stroke of midnight as we welcome 2021. The next year will be ushered in with record numbers of people still becoming ill and requiring hospitalization — and the death toll will keep spiking.

Today we are vaccinating those at greatest risk: our patient-facing personnel. But soon there will be sufficient vaccine supplies to begin the much-anticipated process of vaccinating patients. And with them, the millions of people living and working throughout Middle Tennessee.

Yet finding that light at the end of the tunnel requires much more than giving two doses to everyone who wants to be vaccinated. As if the most ambitious vaccination effort in human history isn’t enough of a challenge, conquering COVID-19 means we need to build a cocoon of safety for those we can’t effectively immunize — our young children and our loved ones with conditions that suppress their immune systems — all the people who cannot be safeguarded by taking the vaccine themselves, either because it isn’t yet available to them, or because their immune systems won’t respond even if they do take it.

This is why we so desperately need to achieve so called “herd immunity.” An often-discussed term, it’s when a sufficient number of us are immune to COVID-19 that indirect protection is provided to those who are not actually immune to the disease. Essentially, it’s when so many people are immune that the virus can’t spread through the population. Achieving herd immunity for COVID-19 is a huge challenge. Unlike the flu, where many of us have some level of immunity from years of exposure to similar flu strains, this is a new virus for all of us, so the projections show we need literally 70-90% of the population to be vaccinated in order to protect those for whom we care but cannot protect themselves.

Given the COVID-19 vaccines are more than 90% effective, it is understandable that many people will take the vaccine to protect themselves. But we also know that many people — up to half of all Americans in some surveys — are considering not taking it. The reasons range from concerns about the newness of the vaccine and its safety, to general mistrust of research stemming from historical abuses such as the Tuskegee syphilis study, to skepticism about whether COVID-19 is even a serious problem.

So, if the only rationale to take the vaccine is “I will be protected,” then how do we convince those already reluctant to get vaccinated, especially when their personal risk of becoming seriously ill with COVID-19 may be small?

Just as Lincoln opined in his first inaugural address, this is a time for us to express “the better angels of our nature.” Beyond protecting ourselves directly, taking the vaccine to help achieve herd immunity isn’t an abstraction of epidemiology and science — it is a work of compassion. For those healthy and young, it’s a selfless act: “I’m doing this for you, even more than for me.” It’s an expression of concern for someone requiring immunosuppressants after an organ transplant whom we don’t even know. It’s an expression of care for someone who has been unemployed since the pandemic began, now struggling with food insecurity and homelessness.

It is this compassion for all in the face of measured uncertainty that we are asking everyone in our country to embrace. During World War II many of our citizens sent their family members overseas to fight in a war that threatened our way of life. Of the 16 million Americans who served in our military forces during the war more than 400,000 died, so the chances of dying were in retrospect about 3%. That’s not much different than the average risk of dying, across all ages and conditions, when someone has been diagnosed with COVID-19 in the U.S. Wouldn’t we agree the pandemic threatens our way of life today, causing the most unemployment since the Great Depression and more than 318,000 deaths so far?

Compassion flows from understanding, and we need to build that understanding with our neighbors, friends and family. And we need to listen.

Many people have fears about taking this vaccine. It is comforting that it has been tested exhaustively in many thousands of people, with clinical trials that are even larger and more diverse than those we have used for vaccines in the past. But it is still the case that the technology is new and we completed the work in record time — and for some, that’s unsettling. And there is always an element of faith when people take a new treatment, including a vaccine.

However, what feels to many of us like the “sudden” appearance of two remarkably effective RNA-based vaccines isn’t very surprising at all. It’s the result of decades of public investment in government-funded research, alongside investments by industry and foundations, coupled with painstaking work by thousands of researchers over decades. This is no different than landing on the moon or sequencing the genome. Much to celebrate, but also based on our history of swift scientific innovation in this country, practically inevitable.

We also need to engage our community by singing, not shouting. Most people are not looking for a lecture. Instead, people want us to listen and to hear what they’re not saying: is it the nitty gritty science they want, or is it validation that it’s OK to be apprehensive? Are they looking for someone who empathizes and understands they’re afraid — a fear that may be more agonizing to them than COVID-19?

This is one of those communication challenges where we need to harmonize like a chorus. The beauty of a chorus is that while everyone is singing from the same musical composition, the notes are not the same for each member. The full range of tones, with varied pitches, intensities, and timbres, all create the resonating mixture of sound that attracts us to listen and holds our attention. Our diversity at Vanderbilt provides that complex range of singing voices, with varied communication styles and personal experiences — all influenced by our races, ages, gender identity, and social and political backgrounds. Our chorus of perspectives is essential to making the case for immunization to the richly diverse community of Middle Tennessee.

And finally — what better message at the holiday season? Before we can all remove our masks and be confident that we are truly caring for our neighbor, we need to give everyone a gift — including many people we don’t even know. The gift of vaccinating ourselves.


Jeff Balser, MD, PhD

President and CEO, Vanderbilt University Medical Center and Dean of Vanderbilt University School of Medicine