Make Vaccination Easy: Jerome Adams' Call to Health Care Workers This Flu, COVID-19 Season

Jerome Adams, MD, MPH, FASA, executive director of health equity at Purdue University and the 20th surgeon general of the United States, discussed the urgent need for health care personnel (HCPs) to receive their recommended influenza (flu) and COVID-19 vaccines in an interview with Pharmacy Times®.

The discussion comes as new CDC data indicates that less than 1 in 6 health care workers in nursing homes and hospitals reported getting COVID-19 boosters during the 2023-2024 respiratory season, with an additional swath also not receiving flu vaccines. Additionally, a CDC survey found that health workers expressed little confidence in the safety, effectiveness, and benefit of COVID-19 vaccines, despite many believing that the virus remains a threat.^1,2

Adams spoke to the proven efficacy of the immunizations, explaining that HCPs getting their own shots will not only lower their elevated risk of severe disease but also provide an example to colleagues and patients to receive vaccines of their own to protect themselves and their community.

Pharmacy Times: Why is it important that HCPs remain up to date on influenza and COVID-19 vaccinations?

Jerome Adams, MD, MPH, FASA: It's critically important that health care workers remain up to date on COVID-19 vaccinations, including the most up to date boosters, and with their flu shots, because health care workers are on the front lines of caring for our most vulnerable patients. Unfortunately, recent data shows shockingly low COVID-19 booster uptake amongst this critical group, my own colleagues.

Pharmacy Times: What can explain the resistance of HCPs towards receiving these vaccines, particularly the COVID-19 vaccine, as indicated in recent CDC data?

Adams: Well, we know that health care workers recognize COVID-19 is a serious health threat, but they've also expressed low confidence in the vaccines’ effectiveness, safety and benefits, and in that way, they're not unlike the general public. A couple of things lead into this specifically for health care workers. I think, first of all, there's complacency and pandemic fatigue. You've got to remember that health care workers typically have already received multiple doses of the vaccine. And because they're health care workers, they've also, in many cases, been infected multiple times. So, there's a complacency, I think, that health care workers are even more predisposed to have. There's misinformation and confusion, and again, that's for health care workers and the general public, about efficacy, the need for boosters, and about safety, particularly for populations like young males or for women who are of child-bearing age. There's a lack of trust in recommendations; we have to acknowledge that that the CDC and others have confused people with constantly changing and evolving vaccine guidance. And there's workplace culture and peer influence. I've seen this happen in my own in my own hospital. I still practice clinically, and in many cases, if one person is expressing doubt or saying I'm not getting it, then there's that that peer pressure to conform. Accessibility and convenience, I think, are key. This may not be intuitive to folks, because we're around health care systems all the time, but logistical issues may still pose a barrier. We have flu clinics at my own hospital, but we haven't had a COVID-19 booster clinic at my hospital, and for me to get my booster, I have to take time off work or find personal time, which can be hard to come by for health care workers. Those are just some of the concerns. I think another important thing to consider is that many health care workers, again, like much of the public, falsely see themselves at low risk. You have younger people, in particular, when you think about pharmacists, nurses, doctors, and they don't see themselves as being in that high-risk category for bad outcomes if they get COVID.

Pharmacy Times: What are some strategies to encourage more HCPs to receive flu and COVID-19 shots?

Adams: I think it's important that we have tailored messaging addressing specific concerns that health care workers have. We need to have clear communication of the benefits of the booster shot—not just for personal protection, but because we have an obligation to protect patients. Many different employers have experimented with incentives and recognition, public recognition for people who've gotten their vaccinations, and peer-led campaigns—not just do it because the CDC says, but using colleagues and peers as example, showing that your colleague or someone who you look up to got it, and so you should get it too. As I mentioned, there are logistical barriers, so having workplace vaccination clinics can help increase some uptake. We need our leaders to lead by example. Having hospital leadership publicly getting their COVID and flu vaccines, I think, will help other people understand the importance of getting them, again, as I mentioned, not just for yourself, but because we have an obligation to protect our patients.

Pharmacy Times: Could these strategies be translated to the public at-large to increase vaccine uptake?

Adams: It's important that we really focus in on getting health care workers vaccinated and up to date with COVID-19 shots, because they then, in turn, are examples for their patients and for people in the communities in which they live, learn, work, play, and pray. So, the strategies that will help increase health care provider uptake will also, in turn, indirectly increase uptake in the broader community. But conversely, if we can't even get pharmacists, doctors, nurses to get vaccinated, then we're going to continue to struggle to get people in the general public vaccinated. And it's why this is critical. It's why this recent CDC report is so troubling.

Pharmacy Times: Could you explain why the traditional holiday season often leads to surges in respiratory diseases?

Adams: Well, we know that respiratory diseases like COVID and flu surge during the holiday season for several reasons. First, it's getting colder. We had a big snowstorm where I am, in Indiana, just yesterday, and that tends to drive people inside, so you're starting to have more ventilation issues and more concentration of people in one space, which we know makes it easier for a respiratory virus to spread. We also know that people are often traveling for the holiday season, so they're going back and forth through airports and bus stations and train stations. They're crowded together in department stores, doing holiday shopping. All of these are environments where the virus can easily jump from someone you may not know to someone who is part of your family and allows you to bring it home or bring it into your workplace. Those are just a few of the reasons, and it becomes even more of a risk during the holiday season, because that's when we are often visiting people who are at higher risk. You're visiting grandma, you're visiting people in a nursing home more frequently than what you would any other time of the year, and it's all the more important that we protect ourselves and that we protect those who we love by getting an updated COVID-19 shot.

Pharmacy Times: How can pharmacists and other treatment providers counsel fellow colleagues regarding flu and COVID-19 vaccination?

Adams: Well, I think it's important that we have open discussions. At one of the hospitals where I worked, I actually led a Q&A session with several of our nurses. And these are, again, people of childbearing age. Some of them have heard the misinformation about COVID-19 vaccines affecting your fertility. Having that open discussion allowed people to get their questions out, allowed me, a recognized expert, to answer their questions and answer them empathetically and honestly, sharing what we know and what we don't know. And then finally, I would always close with: I got vaccinated. My wife got vaccinated. My kids have been vaccinated. So again, leading by example. I think having an open conversation, giving people a chance to air their concerns and get their questions answered. And then finally, helping use that peer support system to demonstrate positive behaviors so that then people feel more enabled to take action themselves.

Pharmacy Times: Is there anything else that you would like to add?

Adams: The only thing I'd add is that I really do think we need to be respectful of people's questions, because there is a lot of misinformation out there. We shouldn't shame or blame people for not being vaccinated or up to date on their vaccines, but we also shouldn't be afraid to engage and figure out what their concerns are. Open conversation is important. I think making the right choice the easy choice, is important. Employers and hospital systems need to have vaccination clinics so that folks can easily get their booster shot in the cafeteria at lunch, on their break, before or after work. We also need to look at giving folks paid time off for their vaccines. One other thing that we don't talk about enough is that there's still legitimate concern from people about the post-vaccination malaise that many people feel, particularly after a COVID-19 shot. Many people feel headache, feel fatigued, feel mild flu-like symptoms for up to 24 hours afterwards. So, if that happens, people need to know that they can have paid time off from work to recover from that vaccine, or else they're going to choose not to get that booster. If we create a culture of vaccination, where peers and leaders are literally walking the talk in terms of getting vaccinated, and where we make vaccination the easy choice instead of the hard choice for people, then I'm convinced that we can increase health care provider uptake.

I always tell folks, talk to your trusted health care provider about which vaccines you and your loved ones need to stay healthy. I think that's important. We assume that because people are health care providers themselves, that they know it all, but they have their own doctors, their own nurses and their own pharmacists that they trust. I encourage them to talk to those individuals and not just listen to some podcast or what they hear on social media. For questions, you can go to vaccines.gov, or to search specifically for a Moderna vaccine, folks can go to disease.education\finder. Again, it's my goal to make the healthy choice the easy choice for everyone.

REFERENCES

1. Meghani M, Garacci Zm Razzaghi H, et al. Influenza and COVID-19 vaccination coverage among health care personnel--United States, 2023-24 influenza season. CDC. Released October 2, 2024. Accessed December 3, 2024. https://www.cdc.gov/fluvaxview/coverage-by-season/health-care-personnel-coverage-2023-24.html#cdc_report_pub_study_section_6-authors

2. Bell J, Meng L, Barbre K, et al. Influenza and COVID-19 vaccination coverage among health care personnel -- National Healthcare Safety Network, United States, 2023-2024 respiratory virus season. MMWR Morb Mortal Wkly Rep. 2024;73:966-972. doi:10.15585/mmwr.mm7343a2