Stakeholders Perspective

Dr. Kuo Interview: Full Transcription

June 14, 2021

Interview Lead: Julie Grassian [JG]

Interviewee: Dr. Alice Kuo, Needle Anxiety Program [AK]

Transcription:

START OF INTERVIEW

JG (0:00-1:00): Hi Dr. Kuo, I’m Julie, as you know and I’m working on the COVID Vaccine confidence grant as well as Michelle, Laila, and Lucia who are all also on this call. First, I’ll just introduce Dr. Kuo. Dr. Kuo is a professor of internal medicine and pediatrics at the DGSOM at UCLA, and of health policy and managment at the Fielding UCLA School of Public Health. She’s also the chief of medicine/pediatrics at UCLA. Her research interests include access to and delivery of developmental services, cognitive and language development in young minority children, and services for children and adults with autism and other neurodevelopmental disabilities.

So, we’re going to talk with you today about the Needle Anxiety Program (NAP) at UCLA and we’re interested in learning about the program generally and what you’ve learned about needle anxiety in the ND and disability community during the pandemic. That’s kind of what we want to touch on in this interview.

AK (1:00-02): Sure, no problem

JG (1:03-1:13): So, I’ll just go ahead and jump into the questions. So the first question we have is: how do you explain what needle anxiety is to your patients and their family members?.

AK (1:14-2:20): Well, so I take care of both patients with disabilities and without, and I think needle anxiety cuts across all populations. In the general population, it is up to 10% of patients who have needle anxiety of some form or fashion, which would actually lead to some change in health behavior. Having an anxiety about needles or procedures to the point where you avoid or delay scheduling a follow up appointment or a particular procedure or things like that. So studies have shown that’s up to 10% of the population. I have not yet seen this studied in disabled population, but I suspect it is higher. 10% in the GP is already significant. So I think having a solution, a way or strategy, to approach decreasing the anxiety around a procedure that involves needles would help everyone with this concern and not just disabled populations.

JG (2:21-2:28): Great, thank you. And the next question is: why is it important to discuss needle anxiety with your patients in respect to COVID-19?

AK (2:30-3:15): Well, I think that because COVID-19 is a new vaccine, there are lots of concerns and hesitancies and anxieties surrounding that particular vaccine in the first place. And so, as we’re seeing across the country trying to immunize as many people eligible patients against COVID-19, we are seeing efforts stall due to some of these hesitancies, concerns, and anxieties. So, if needle anxiety is contributing to people not getting the COVID-19 vaccine, I think we definitely want to address that one because that is perhaps a little bit easier than some of the other concerns that people might have around this vaccine. 

JG (3:16-3:24): Okay, and are there specific groups of people who tend to have needle anxiety, and if so, what are the main reasons that they usually give for why they have needle anxiety?

AK (3:25-5:03): I don’t know that they know exactly which people tend to have needle anxiety, but in my clinical experience I do think that it is patients who tend to be anxious in the first place. So, a number of my patients are being treated for anxiety and it’s not surprising that some of them have a specific phobia or fear of needs. But I will say that I also have patients that have no history of anxiety but just have a single sort of fear of needles. So I’m not sure who they know is exactly at risk for having needle anxiety, but as I’ve mentioned it’s pretty common. I see in particular in association with the 11 y/o vaccine for all children, so there at the 11 y/o child visit, there are a couple of booster shots and vaccines that have to be introduced. And that’s where, all of a sudden, you’ll see both boys and girls with needle anxiety that will come more evident. I think at this age group, not …. You know, in this age group in particular, we don’t want to restrain the child as we may have when they were 4 years old. What’s interesting is that I’ll have parents that are surprised when their 11 y/o has needle phobia because they don’t remember that in the 0-4 y/o age group that there were problems with giving vaccines at that time.

JG (5:05-5:11): Okay. And, how would you describe needle anxiety within the disability community and neurodivergent community?

AK (5:12-5:43): Yeah, so I think in this population it’s a little bit different because we know that individuals with neurodevelopmental disabilities may have sensory concerns, and so because the vaccination involves a needle that does puncture the skin. And on top of the anxiety of neurosensory issues this population may have increased challenges with receiving a vaccination or getting blood drawn.

JG (5:44-5:53): Alright thank you, and now I’m just going to ask more specific questions to the NAP, can you just give us a general overview of what the program is?

AK (5:55-9:52):Yeah, so about 3 years ago now, I have been caring for predominantly disabled population of patients in my practice, getting routine blood work or giving vaccinations was becoming more and more of an issue. And I went around and I tried to explore places that my patients could get these procedures done that would not be compromising their regular healthcare. So I think again it all comes down to the fear needles to the point where they’re not getting the care they’re supposed to be getting. And that, to me, leads to a service disparity. So if we look at vaccination rates for disabled children, they are likely to be lower than the general population and needle anxiety could be contributing to that. So that’s the disparity that I wanted to address. As similarly, getting blood drawn in overweight, disabled patients with diabetes in the general population you typically do this every 3 months. But in talking to other PCPs, if patients have needle phobia or are not easy to get blood from, the provider is okay with not getting the blood drawn every 3 months and so that is a deviation from standard of care that I’m not that comfortable with. 

So I reached out to the Emergency Department who routinely gets blood from disabled patients and they have a number of methods of doing that and asked if we had these types of patients, would they be able to go to the ED to get their blood drawn. And the ED said no don’t send them to us because they will have to wait and we…. In the priority something like this would be very low priority so they would likely have to wait a long time, which is not great for a disabled patient or neurodevelopmental patients who might be overly stimulated or overwhelmed with a lot of noise and having to wait. 

So then I went to the outpatient surgery centers and I talked to the anesthesiologists and I said well, would it be possible to have them do it with an anesthesiologists because they’re so skilled and they could do a little light sedation. And the answer there was well, if we did that, the patient’s family or the patient would be charged for the OR time in the same day surgery center. And then insurance wouldn’t necessarily cover it. Which means the patient would be stuck with a bill of several hundred dollars just to get their blood drawn or a vaccine administered. So that didn’t seem like a viable option either. 

And so basically it came down to our evaluation and treatment centers which are sort of.. More advanced urgent care centers with an RN staffing and the ability to give IV fluids and IV medication. And so we started exploring the possibility of doing these …… (cuts out here).. We have 3 of them and they have extended hours which is nice because they are open 8am-9pm on weekdays and 9am-5pm on every weekend and holiday. So they are open 365 days a year which is great access. And then, going through the protocol took us probably 2.5 years to get it approved by all the different entities at UCLA that would need to approve our administration of an inhaled benzodiazepine in the urgent care sites.

JG (9:54-9:56): What would you say is the main purpose of the program?

AK (9:58-12:26): Well the main purpose is to be able to provide strategies for patients with needle anxiety or trypanophobia, which is the official DSM-5 term, to be able to receive basic vaccination and blood draws for lab tests. So you know, most patients routinely receive these interventions in the routine care that they receive in the primary care office. And so, maybe 90% of the patients have little to no difficulties receiving these procedures. But for the 10% that experience difficulty by being in the needle anxiety program, we can for example, provide numbing cream, like emla, and topical local anesthetic that can help numb the skin. We also have devices called the buzzy bee, which is a device imagined by a pediatrician that you put in the freezer, and so its cold but it vibrates. And You place that on the skin of the patient near where you’re going to be giving the injection or drawing the blood and it keeps it numb. And if none of those strategies work, then we resort to a light sedative which is delivered through the nose via a nose spray. So it’s called inhale midazolam or [didn’t get]. And when we have to do this, what’s nice about midazolam is that it’s short acting, and so once you are able to spray it in the patient’s nose, within 10-15 minutes they are lightly sedated. They completely breathe on their own and they even respond to questions, but they’re just not as anxious and we’re able to do the procedure. And then the anesthetic wears off in about 15 minutes, so it’s sort of ideal for this sort of situation. They’re in the clinic so they are completely monitored. It gives the patient the dignity and the ability to undergo these procedures without a severe anxiety reaction.

JG (12:27-12:33): And are these interventions for any patient with needle anxiety or is it for a specific different communities of people?

AK (12:35-13:28): It’s for anybody with needle anxiety over the age of 7. So we have had non-disabled patients be in the needle anxiety program as well. In fact our very first patient was a 30 year old female with no disability who just had never … has always had needle phobia. And then, even this past clinic, Friday, I had a 16 year old that needed blood work drawn, and she does have ADHD but no sensory issues and no other neurodevelopmental conditions and as soon as I mentioned the blood draw she just broke down in tears in the clinic and was adamant that she would not be able to give blood without some sort of intervention and that’s when I explained to hear about the needle anxiety program which she will use later this summer to get her blood test.

JG (13:31-13:39): Okay great, and for the different patients you have used these interventions on, were there overall successes? Can you explain a little more about that and the successes of the program?

AK (13:41-15:40): Yeah so I would say we’ve done it on about 20 patients since we started the program last August, and Kendall will give you a better idea of the successes. From my understanding from having a couple of them is that it works well when the parents are .. or the family member who brings in the patient also supportive and calm and understands exactly what’s going to happen and is well coordinated. We do our best to reduce the anxiety in other ways without necessarily using the inhale midazolam if necessary. So sometimes parents are comfortable giving a small oral sedative before they come and we .. you know the parent is convinced that we’re going to need the inhale midazolam but because this is such a controlled environment and our staff are so amazing that the mild oral sedative that they take an hour before they come to our clinic is often enough, and then we don’t even actually end up giving the inhaled midazolam. I think what’s really nice and maybe even just symbolic about the needle anxiety program is that we restored the dignity back to the patients, and that the parents are amazed that the experience can be different from what they’ve had in the past. We’ve had patients drive as far as 2 hours to participate in this program, and for their adult child who is you know, 6 foot 4 and 200 something pounds, and the thought of getting enough adults to hold that individual down to be able to draw blood or administer a vaccine is really undignified, and they are just really amazed that this can be done in such a calm setting. And I think this restores that patient dignity.

JG (15:42-15:51): That’s great and if any patient comes in that is under 7, is there somewhere you can refer them to, or what happens for those patients who have needle anxiety but they are under 7?

AK (15:52-16:41): Well, so I think that the challenge is that, for children under 7, we understand that developmentally, many children don’t like to get shots or needles or have their blood drawn. In general, again those children are a little bit smaller and so restraining or talking them through or having them sit in their mom’s lap or parent’s lap is often enough for us to be able to do the procedure. If not then the inhaled midazolam comes without any risk, but I think when we talk about the risk/benefit, it’s greater in a child over the age of 7 and under the age of 7 I would say we would have to evaluate on a case by case basis. But honestly I think that the practice in pediatrics for younger children is to restrain by the parent in a loving way, you know through a hug or a bear hug or something like that.

JG (16:52-16:58): Alright, thank you. And how can patients learn more about UCLA’s needle anxiety program or access more services?

AK (17:00-17:41): Well we’re developing all of those materials now so we hope to be able to share resources to other institutions interested in implementing a similar program at their institutions and their health system. Here at UCLA we also are planning to let other primary care providers know of this service. I think, sort of, providers who take care of many disabled patients already know because we get those referrals. But, you know, we haven’t yet advertised widely until we develop those materials this summer.

JG (17:42-17:53): Okay, and as you’re developing those materials, are there any recommendations you would provide to other providers to assist with their own patients who have needle anxiety outside of this program?

AK (17:54-19:30): Yeah I mean I think one thing that we have tried to do through ambulatory nursing is to train all the medical assistants to acknowledge patient’s anxieties around procedures. What we’ve heard from patients is that it doesn’t help to hear a nurse say, it’s not going to hurt when it is going to hurt. And it also doesn’t help to have a nurse rush through the procedure and not even acknowledge a patient’s distress around getting their blood drawn or the needle. And so we have implemented some training to have our medical assistants take a smidgeon longer with some of these anxious patients because maybe that’s all they need. So really our model is sort of a pyramid model, where we’re hopeful that 85-90% of patients don’t really need any special accommodations. Training ….(didn’t hear)…. to be a little more compassionate will help everyone. And then the remaining 10% who are needle phobic, hopefully some of them will benefit from having a nurse or medical assistant who is just a little more compassionate. If we need to do the numbing cream or the buzzing bee that’s available in almost all of our primary care clinics that give vaccines. And then, hopefully a smaller 1-5% who may even need to be referred to the official needle anxiety program and receive even more intervention

JG (19:31-19:43): Okay thank you for that information. So that’s all the questions that I have, but I do want to ask you, is there anything that I haven’t asked that you think would be important to share with the neurodivergent community or just anything about the program in general?

AK (19:44-20:50): I would say that you know, because this protocol has been vetted by so many entities, we had to get approval from ambulatory nursing, from the emergency department, from the anesthesiology department, and all of our entities that oversee our urgent care, this protocol has been looked at by so many eyes. You know, I want to say that it’s safe and that many people have considered alternatives to doing this. But in the end, I think ultimately our goal is to not deviate from standard of care for any group of patients, and so if this intervention is what is needed in order to do that, then I hope patients will take advantage of it and that it’s safe and that the benefits far outweigh the risk of using an inhaled sedative in order to be able to have the procedure done.

JG (20:51-20:55): Great, thank you. Well that’s all my questions for you unless you have anything else to add.

AK (20:57-20:58): No, I think that’s about it.

JG (20:59-20:55): Perfect, well thank you so much for taking the time to talk to us about this program.

END OF INTERVIEW

Dr. Curcio Interview 6.21.21

Wed, 6/23 1:03PM • 29:39

SUMMARY KEYWORDS

patients, anxiety, people, vaccines, phobias, needle, procedure, child, support, hear, important, program, bit, distraction techniques, parents, disabilities, reassure, community, nervous, ucla

 

00:03

So we’ll go ahead and get started. Hello, Dr. Kersey. Oh, we’re really excited to welcome you in to interview for our program to discuss the needle anxiety program at UCLA and just learn a little bit more about needle anxiety and what you’ve learned about it specifically within the context of the neurodivergent community and the disability community as well during the covid 19 pandemic. So I’m My name is Laila and I’ll be interviewing you today along with LUCIA JUAREZ, Julie grassy and and Nicholas Shaw, who are also working on this program. And we’re specifically interested in learning about your perspective as a physician working on the needle anxiety program and what we can learn from this program as we try to increase vaccine confidence in the disability community. Before we get started, for anyone who’s watching this video, I would just like to introduce you. So Dr. Eric crucio, is a primary care physician and he specializes in internal medicine and pediatrics right here at UCLA health. He received his medical degree from New Jersey medical school, and he completed his residency at UCLA School of Medicine. So with that being said, Are you ready to get started? Dr. Chris, you? Absolutely. Thank you. All right. Wonderful. So first, we would just like to hear a little bit more about the needle anxiety program. Could you tell us a little bit more about the goals of the program in particular?

 

01:16

Yeah, absolutely. So this, you know, this was a project that we had kind of really a problem that we knew that we needed a better solution for for years now. And it probably was about two years in the making between when we first envisioned it. And it kind of serves as a multi pronged approach, really, we knew that basically, we could be doing a better job with procedures for everybody really, you know, there’s so much anxiety that doesn’t get talked about, and probably a common reason why people maybe skip out on those physicals or missing appointments, people who have, you know, serious, deep seated phobias, or needles. Now, there’s certain groups, particularly disadvantaged by this, I think what we saw that really prompted us to find this was a lot of clothes and myself, take care of patients with a variety of medical conditions, a lot of developmental delays for diversity. And those patients in particular, we’re really getting yourself out to collect medical treatments for these kids, adults, medication that they need to be monitored, every test that you’d look back, and you can see years have gone by, and none of these tests have been done. And when you look at the billets, who would always be you know, unable to get unable to get blood. Because you know, those those patients are, you know, particularly high risk or not being able to explain or understand the procedures. And it was really a problem that we had, what would have been done beforehand would be this sort of wait until they needed something major that required like Asia, so maybe they were going in for major dental work or something. And when they went in for that you can quickly do their blood vaccines and everything else. But that’s a district as you might wait years. For that sort of second tier of the program, you know, the first year was really just coming up with ways everybody to have our nurses trained better to training procedures, patient control and how they wanted to play on wanting to distraction, they wanted us things like that, we came up with the second of our program, which include things like the buzzy for children and other distraction techniques, there will be one of our colleges to be involved in kind of do the type of the whole things. And then the area that’s probably gotten the most attention, or which are the most challenging case, most of the reviews for vocational development really couldn’t understand. And that’s doing it as a base case of anxiety medicine that can be done right before the procedure and really have a calming effect. For everybody, for sure. We have had quite a bit of success, new Alto, I think kind of came up with the ideas behind it and identify the need and then I do a lot of work more on the implementation operation. So, you know, we did a fair amount of literature searching to see how other health systems had handled this. There’s a ton out there, you know, we kind of base our model with a few things we found from dental literature for doing sort of mid level procedures for patients with dental phobias or developmental issues. There are a couple of case studies of pediatric echocardiograms used for set, but we couldn’t really find much of anybody. We used it for this specific but it’s logical as they will translate. supports those protocols were able to find and then almost a year ago started doing our first Three August last year. Okay, so after about two years of figuring out all the processes getting anesthesia, ambulatory nursing and everyone else is, first and foremost, we needed to save safely, we needed to have emergency plans in place. But what we found and what we all spread in the literature is done right. And protocols followed it really is. We haven’t had any negative attraction. Yeah, that’s a little bit at the back.

 

05:34

Yeah, it seems like you’ve developed a really comprehensive program that caters to the needs of a lot of different types of patients. I’m curious, kind of, in your experience working with these patients, what are some of the underlying reasons that patients have provided surrounding their needle anxiety?

 

05:53

Probably when you ask most people who have that the needle anxiety most can’t give you a good reason why they have it. There’s just a subset of people out there that have these phobias, they might have had a bad experience, they you know, there’s a subset of people about what we hear of somebody who every time they get their blood drawn has a fairly high chance of passing now. It’s beyond their control. It’s not an anxiety issue. It’s just a visceral response their bodies have where all their heart rate and blood pressure. But like many phobias, so people really know why they have, it’s not usually a bad experience from memory, but probably something maybe dating back to childhood maybe years that they can’t even remember. So the phobia side, probably about half of the patients that we see are more in that group as you’ve been putting off, putting off drugs because of that. And then the other half is really more than the the neurodevelopmental disabilities, these are patients that can’t understand necessarily what’s happening, or maybe have already VHD or other hyperactivity kind of conditions, particularly a lot of different things. And then that group, it really is just trying to make your hands as pleasant as possible as productive experience for them. Because once they learn that this place is associated with pain, or this place is that scary place where people come in and hold me down aggressively or something like that. It’s really hard to undo that kind of damage. And now they’re going to have this you’re probably walking into every medical office, because they all kind of look the same young, potentially for the rest of your life. So we want to do what we can not pretty more phobias, inadvertently from negative experiences, if we do hear that a lot of parents that the last time you had blood drawn, we had such a setback in their anxiety levels spiked so much, because yeah, they went, where were they had a bunch of people grab them and hold them down? And wait, no, that’s great.

 

07:55

Yeah, thank you. And I’m curious to hear for you, the other providers or for anyone listening? What is kind of something important to know regarding working with families or patients with disabilities regarding needle phobia, while still promoting vaccinations and inoculations?

 

08:15

Yeah, I mean, for starters, I’d say the most important thing is nobody likes surprises. As much as in development, well, the patient in mind, the more we can explain up front, maybe you walk through the scenario, talk through how it’s going to go. I think, you know, a lot of times parents do the opposite sometimes, or caregivers will do the opposite, where oh, I don’t want to upset so we’ll just get on them last night. Nobody likes that, right? It just breeds this just make that phobia that much worse. You know, there are books about this pamphlet, there are online resources out there that you can use to really talk through how this is going to talk about if it’s a play that we’re going to do. We’re gonna feel a little spritz of fluid in your nose, maybe try that at home with a nasal spray over the counter just to kind of really build that confidence of knowing what to expect. So I think we found that the cases go fast, when when patients know sort of what’s coming. They’ve talked about it before they’ve walked through it as much as they can. So that honesty is definitely an important step. We also want our families to know that this is not a cure, all right. But if there’s somebody who’s so extremely anxious, this one one dose of anxiety analysis, that we tend to repeat doses, because that gets more into the safety side of things. So it’s not going to work for everybody. But we figure if this work for you know, half two thirds of cases, that will still have to figure out that other case, probably working with those right now.

 

09:54

Wonderful, thank you very much. And just to kind of elaborate from that question, can you tell A little bit more about how you communicate with patients directly surrounding their needles anxiety or getting shots in particular.

 

10:07

Yeah, absolutely. So, you know, this might be a lengthy process, it might just be at the time of the visit, if it was sort of an unexpected thing. But you know, a lot of times people will either directly voice concerns or caregiver or family might, but a lot of times it’s more in the subtleties of you say blood and you see the kind of recoil or say, Oh, can we do it another day or something like that? Get this going on? And then just try to have an honest conversation. You know, I see maybe a little bit nervous about about the vaccines you have a bad experience before? Did you have your, because like you felt the need, or maybe it’s just about vaccines in general, or about medications or something else, you kind of need to know, if it is about measles, I think it really is referring to a lot of patients, families know that this is something that we’re just rushed off or eyes and say, Oh, really critical. But no, this is something that we identify the problem with common kinds of scenarios, we built this program around it. And I think a lot of times, knowing that are nurses trained in this, this is taking you off, you passed out once paid, we’re gonna have, we’re gonna have you lie down, we’re going to watch for a while afterwards, just those kinds of things alone that we’re going to, we’re going to take it to her, I think, again, if it’s something that’s going to be more of a planned thing, where we’re going to bring them back now for that we’ll talk about, you know, why we do this, how it works, what to expect. It’s a funny feeling, getting this, we should create into those what we’re hearing, burn is quite the right word, but it’s an odd sensation, I think. So making sure patients go to expect that. And, you know, encouraging them to, you know, whatever is going to help calm them down the most might be something like a buzzer, or distraction technique, or kid this may be accepted on the videos, whatever else helps them calm down. Maybe there’s a buddy who really liked us. And with headphones on and distraction that way. Maybe that’d be what kind of gets.

 

12:17

It’s kind of like anything else. I come up with a plan that everyone comfortable with.

 

12:26

I see and has this sort of communication or this sort of approach changed when you’re talking in context of the COVID-19 vaccine or just in the pandemic times in general. Yeah, I mean, COVID certainly heightens everything a fair bit more, when you look at the rate of young people who are passed out after vaccines is not almost certainly related to the actual vaccine itself. It’s more related to both knees and everything, the rates much higher for this, I think it just speaks to that extra level of anxiety. But everyone really has about COVID. You know, there’s a lot of information on where money news is often not that accurate. political issues and other things, it’s really just left people are undecided extra nervous. They’ve heard that somebody they know how to really bad reaction to the second dose, and now they’re extra nervous about it. But you know, we look what’s happening here now that we finally sit down and allowed reopenings No, that’s pretty much thrown out. So people at the same time know it’s important. So it creates this kind of dissonance, I think where they know they need to do it. But they’re also extremely nervous about getting it is a good opportunity. I think he just talked about all these different features of comfort, reassurance. Even more for that I hate to have no fear of needles being are the reason why somebody chooses not to get a COVID back. If there’s things that we could easily do that would probably make a pretty, pretty benign. What we often hear from patients, you know, there’s sort of mental image of them, you know, walk themselves through this in their mind of how horrible it might be, when they actually do the procedure, especially with respect to filming now, they said maybe, you know, whatever else is going to help them. The end result oftentimes is Oh, it wasn’t that bad. And it turns out the vast majority of patients, ie your patients as well as very diverse developments, patient, the best journey don’t ever get to that theory but don’t end up needing the anxiety medication, really just behavioral approaches can take care of most. But COVID has definitely shifted the spotlight I think on all the founding teams

 

14:52

and kind of um he’s you know, many interactions I’m sure you had. Do you have any particular anecdotes or particular Patient interactions through this program that you would be comfortable sharing with us and with the neurodivergent community.

 

15:06

Yeah, absolutely. I from last recap, one have a 14 year old with a rare genetic condition that was part of it has a developmental disability component to it. But had had to go before with vaccines, whatever, we had actually talked about maybe getting too much history. But we ended up bringing him in with that there for support with distraction techniques, but you know, the iPhone out and favorite videos playing on Tick tock, if I remember, right, and, you know, dealt with those distraction techniques or numbing medicine, he had a completely pleasant experience, barely even notice that he had gotten the vaccine by the time was done, and left her you know, with a smile on his face, not having that negative association. And that’s gonna make our lives much easier next time, he needs a boost for vaccine. But I think, for the family to kind of see that, you know, with these interventions, having supported president holding down a restraining, or those kind of things, that we were able to do it safely, that we were able to get it done and not in any sort of stressful or more anxiety ways. But I think we all if you ask the other doctors, I think we’ve all got examples of these. If you think or one of our politics was the passion project, we did a lot of training with the nurses, the medical assistants, in our office, office across.

 

16:48

Ya know, it seems really important to build an environment in which you’re not provoking further anxiety, but helping to ease the patient while also providing them with with quality care and getting them all the procedures and all their occupations that they need. And so when it comes to context of younger or for neurodiverse patients in particular, how do you as a physician weigh the benefits and the risks of the COVID-19 vaccine for those patients that may have needle anxiety?

 

17:14

Yeah, I mean, well, we know the benefits are potentially huge, right? We know that, you know, patients with autism patient with developmental delays, we’re seeing worse outcomes with COVID. pretty consistently, they were getting diagnosed later, they were getting tested later. And we wonder why that is. I mean, it could be it might even be anxiety that’s kind of playing in on patients, or parents or or caregiver who’s now even more afraid to bring them in, because now they’re gonna get this nasal swab that we know is comfortable, oh my god, they’re gonna go into the hospital, we know how disruptive that can be to their routine, because disruptive to anybody, and especially somebody who maybe can completely understand what’s happening or something like that. It’s weird. But, you know, what’s the end result is that, you know, we’re hiring to death batteries, ventilator use in patients with those types of disabilities. So, you know, the benefits, and the risks of not getting it early, or the risk of not getting the vaccine and for COVID risk road are huge. So I think it’s a hurdle that needs to be overcome and taken seriously to build that support. But, I mean, it’s so important, I think that, you know, patients not put off, you know, important medical procedures out of fear of something that we’ve done, right, probably shouldn’t be all that fear provoking, at least most people.

 

18:41

Thank you very much. And we’ve discussed kind of the context of younger patients and neurodiverse patients, but I’m sure you work with patients across a kind of all age groups. And so how does your approach to discussing middle anxiety and more broadly, their care as well, along with the ramifications of any sort of procedure vary depending on the age of the patient?

 

19:04

Right. I mean, there’s, you know, obviously, everything you do has to be developmentally appropriate for whoever you’re talking to. I think, you know, it highlights the need for family centered approach a lot of times for bc it’s a very different discussion group talking about their newborn. who, you know, we’re a couple of months old means x y&z Oh, that’s reassuring Mom, it’s going to be maybe letting mom nurse right after the procedure to calm down maybe letting her hold the child on her lap rather than you know, being on this table or something more intimidating or mom feel more removed from the situation. And then the discussion is going to be different with a school aged kid where maybe we can encourage them to tell the child ahead of time because now the child knows is asking that question you never want to ride on the building. It’s just there. And maybe if the if we know this as a child as a major issue with vaccines Trying to get prep them ahead of time use those that are out there. If it is a an older patient with a neurodevelopmental disability or something like that it really is meeting them where at the level they’re at with the understanding, they have giving them a chance to answer any questions that they have, and get those concerns addressed. And still being there to support the families, because oftentimes, they’re equally as nervous about the whole situation. But we see needle anxiety through the entire age spectrum, we have plenty of patients, they’re young 70s 80s, who also still hate needles, doesn’t go anywhere. For most people, if you’re one of those people that are affected by a disease probably be there, you know, maybe you have to deal with your whole life.

 

20:47

Right? Yeah, thank you very much. And you mentioned, particularly for children, kind of incorporating their parents into that procedure, or just building an environment in which they’re more comfortable. I’m curious if you have any other advice specifically for a parent or a caregiver, to assist their children that have needle anxiety, either at home or at the clinic?

 

21:10

Yeah, I mean, it’s, you know, family is important part, probably, regardless of age to for a lot of people have a support person, there can be huge. at any level. Again, I think it’s just time to think about, what could we do that would put, you know, this patient that they’re most comfortable, and maybe it’s going to be bringing a support object, or if we have a favorite toy, or if we have something that we can bring in a younger kid that we can have with us for support. On occasion, we’ve had people bring their emotional support animals, if that’s like, that kind of helps. Great, you know, whatever it’s gonna be. And it does have to be customized by the points because everyone’s going to have different distraction. That is that they were people want to meditate, some people have a really tough time doing that. And now more and more we go more with music or something else, there’s no kind of one size fits all approach, I would say.

 

22:15

Right, and I’m just gonna move a little bit more broader and just hear from kind of your experience working with patients. What are some kind of comments, questions or factors about needle anxiety, that, in your opinion, are the most important when it comes to raising awareness, either about the issue that needle anxiety itself, or just to the fact that there are resources for people who have needle anxiety amongst the community? If you have any thoughts or opinions on that?

 

22:42

Yeah, I mean, it’s, it’s tough, because one of the hallmarks of phobias, I think, in general is not wanting to talk about it, right, we tend to avoid things we’re afraid of. So a lot of times people really voice voice screamed, patients, just occurred around like anything else, just to be open and honest, you know, with, with your medical team, with the doctors, nurses taking care of you compared to they want to do what’s best for you, and they want to do it in a way that’s gonna make you most comfortable. And on the other side, I think providers, you might know, somebody didn’t know, oh, this is the third time you’re back, you spoken, get that blood work done. You know, and taking that step back to try to dig into why you might be surprised to find us. We’re just, we need help on the search for scientific transportation or get support or something like that. Or maybe it will uncover that bad experience that happened before or if you’re have one of these deep in phobias are that bad experience that happens as a kid or whatever it might be? Just people really kind of keep communication open both ways. Be aware that it’s a combination, to be aware that it’s a common cause why people are getting multiple health care. And then just

 

23:59

and then just based off of your experiences, what are some of the kind of biggest myths or stigmas surrounding the intersection between vaccine hesitancy and neurodiversity that should be broken?

 

24:11

Yeah, I mean, probably not so much related to the needle side of things. But we all know, there was a lot of air and fear put in by studies that were, you know, later discredited, specifically around the MMR vaccine and autism, and that kind of got broadened out to many other vaccines and things like that. And despite, you know, countless studies and excellent research, looking at huge groups, populations, this proving that, you know, beyond the shadow of a doubt, and you know, that study having its own, you know, ethical concerns and being recalled and retracted you that are still out there. And then the last thing any parent wants to do is do something that could possibly hurt their child or even the slightest stress. And I think because there’s misinformation on the web, Now for the people who can’t get any media on your site. And then you don’t see so much of polio and things like that, because Luckily, they’ve done their job and really low, it puts these tough positions where they see a lot of negatives. And the positives are quite as obvious. I think, you know, again, it’s having that dialogue it’s trying to get to the root of a person CERN’s was a good article they read was it’s being their friend told them is there some better direction, we could point them to give them some good information that is out there and give them you know, the things that reassure us as physicians that what we’re doing is, and I think a lot of times, you know, as parents read into that more, that can help reassure them, it’s scary. I mean, you know, nobody, when it comes, especially to taking care of family members, children, I think we’re even more more nervous. Anything that could cause harm, but every parent you’re at the end of the day wants to do what’s best for your child may have just put a navigate to the information that’s out there. And I think we should remember that and just try to move that dialogue further. That’s going to have the best outcomes given people. We think about vaccines to you, they are hesitant to maybe come up with a plan or take them one by one and look at the research data out there. And when most people see the real data there, it is pretty reassuring to hear the medical community is as confident as they are.

 

26:26

Right. And I just have one more kind of broader a specific question for you. I was curious to see if you had any advice for providers or other health care professionals who may not have a formal needle anxiety program on how to approach or communicate with patients who have disabilities and who have some sort of needle phobia?

 

26:49

Yeah, it’s tough. I think the lesson is that you don’t really need a very informal type program to do probably 80% of the work. They’re they’re quick skills that we already have. Time is one of the biggest things. And I think that’s something that all physicians with your you have, you should arrange your appointment times that are often dictated by the health system. And you know, when you’re rushing these things, first to go that taking that extra minute or two to really get to the root of a problem. But at the same time, we know, that’s what a lot of health disparities and for groups that, you know, are diverse disabilities. So you’re being thoughtful that you know, this needs to be addressed and maybe revisit periodically to check in is important, maybe scheduling those patients are a little bit of extra time, maybe doing that prep work ahead of time during email or something like that. A lot of the words pretty dumb for him be huge. But I think all of us are trying to provide the most equitable care that we can. And this is part of that duty, really.

 

27:58

Thank you very much. That’s really great advice. And hopefully, we’ll be able to, or the this type of program or this type of approach will be able to be implemented across the nation and be able to help people who have needle phobias. And then, yeah, and then just last thing, I was wondering if there is anything that I haven’t asked you or that we haven’t discussed today that you think would be important to share with the neurodiverse community? Um,

 

28:24

yeah, I mean, I think we touched on kind of a lot of the highlights. But again, I think the most important thing is just communication, right? You know, and this is, could be generalized to many, many things beyond this, but patients are often hesitant to have these conversations with doctors, probably fear of judgment or a negative experience that they had with another health care provider before but, you know, to get the best you can, the most important thing by far is to just have that open communication with your physician to be able to talk about the awkward things about the things that are inherently, you know, anxiety provoking, as tough as it is, knowing that, you know, nobody’s making any judgments everybody is working towards this goal is probably the most will help you get the most out of healthcare and in any setting, really.

 

29:15

Thank you very much, Dr. crucio. That was the final question that we have for you. But otherwise, we really appreciate you taking the time out to come talk to us and to our community as well about middle phobias and the program at UCLA and hopefully, more and more people will be able to take advantage of the program.

 

29:32

be great. Thanks so much. Let me know if there’s anything else I can help with. Wonderful, thank you. Bye now.

Fri, 6/18 7:29PM • 1:04:39

SUMMARY KEYWORDS

people, community, vaccine, impacted, important, medicine, vaccination, access, support, talking, frankly, families, reality, black, acknowledge, folks, person, louisville, vaccinated, medical

00:04

Hi everybody. My name is Lucia Juarez. I’m part of the COVID-19 vaccine hesitancy interview team and today I have the pleasure of interviewing Dr. Khendra Peay and Dr. Quintin Chipley. Welcome whether you’re free so I’ll first begin by introducing Dr. Khendra Peay, she is a child and adolescent psychiatrist in Washington DC. She obtained her BA in psychology from Wellesley College, where she also completed her pre medical education track, and an MD from Virginia Commonwealth University School of Medicine, Dr. Peay is an assembly representative for the Greater Washington region of the American Academy of Child and Adolescent Psychiatry. She has also practice in outpatient and inpatient clinical settings and consults for clinical training and community education programs. She directs mental health programming at hood medicine and works on the steering committee to improve access to access to Sorry, no problem. Mental health care, mental health care. Thank you. Dr. Quintin Chipley is retired is a retired psychologist who formerly served as the counseling coordinator for the University of Louisville Health Sciences Center. He earned a BA at Rice University and also holds a Master’s of divinity from South Eastern Theological Seminary. He earned his master’s in clinical psychology, his medical degree and his PhD from the University of Louisville. His passion is focused on abstinence based peer support recovery, communities and transitional living for those in recovery from addiction. He currently serves on the board for beacon house, a local sober transitional living facility in Louisville, Kentucky, he steers mental health policy and programming initiatives for Hood Medicine. Thank you both. Thank you both for being here. So I’ll be beginning I’ll jump into the questions. Either of you feel free to answer the questions. Thank you. Can you give a brief overview of what Hood Medicine is and what the goals of the program of your program and describe how your work with the disability and neurodivergent community?

 

02:56

Well, I will defer first if you don’t mind to Doctor Peay, mainly because she has a longer track record of history with some of the people who began but it’s a shame that we don’t have Dr. Sidney Hudson on because she has a patter spiel on this, which is really quite safe and very funny in some respects. But as she says, it’s the assembly of scientists, geeks and physicians and hackers, who are committed to bringing greater equity and health care to the underserved populations, particularly within the black and indigenous populations and Pacific Islanders. That was their typic navigate nation. And it was brought, I guess you’d say sparked, of course, by the COVID-19 crisis, because those communities were disproportionately affected both with morbidity and mortality. And also for having, they were disproportionately affected by the mental health issues which were secondary both to the direct impact of the disease and the disruption of social structures along the way, such as schooling and personal and work relationships. So there was a strong Nexus evidently of the organizers who all knew each other from times at MIT, or in  the Boston Cambridge area score. That’s about what I know about it Dr. Pay off interview.

 

04:57

I am new to work with Hood Medicine. But like Dr. Chipley said, I’ve known the organizers for years. But I was attracted to their work because of what they’ve been doing to increase education, awareness of comorbidities, and different health issues that are affecting communities that are underserved communities that typically don’t have the same access to care that we might see just otherwise, just from a societal standpoint. So my role outside of Hood Medicine is completely working with child and adolescent populations, and also psychiatric neuropsychiatric and no developmental disability. So their work in particular in targeting education and really getting awareness for there being more services, more awareness for the health needs being met for populations that otherwise don’t necessarily get acknowledged as being needing to be met with something that really drew me to to enjoy working with them.

 

05:58

Your team is made up of a variety of experts, including hackers. How would you say that holistic approach contributes to your mission and Hood Medicine?

 

06:08

I could say for myself, because I’m definitely not a hacker. I appreciate the global picture of the group. So I feel like it really mirrors what society looks like. And when we’re talking about treatment. And talking about community resources, in general, it’s really takes into account that it takes a community of different different strengths, different backgrounds, different things that we can all bring to the table for the same goal of really trying to improve our communities in general. And when I say committee, it’s like all of our communities.

 

06:39

I would say what I have observed and I too, and definitely, I’m way too old to be called a hacker. Okay, I do well to get my password correct and get into a program. But what I’ve observed is that the members and their friends, if they’ve recruited bring a fluency, with social media techniques. And with graphics, with the power of naming, of reading names that are going to be effective. They have, they have their finger on the pulse of a rising generation, which I only wish that I knew as well as I do. And so that’s, that’s been very important. But they really do understand that the digital arena that just saturate the population at this point, and I think that is one of the greatest strengths. As far as a holistic approach, because they see how those particular digital tendrils actually move into each one of this.

 

07:56

How will these expertise work together to accomplish this school?

 

08:04

From my enough to like, it really is because we’re all coming from such different backgrounds, we’re able to work in a congruent way, which is amazing. But we all come from really different backgrounds. I mean, my background is purely medical. So I don’t have a lot of when it comes to technology. And when it comes to marketing or when it comes to just a lot of the other areas that are even when it comes to me in their aspects of public health that have to do with just direct medicine I’m aware of but then we have people who are purely that is all they do is public health. So it’s exciting to work with people who we all have different training different backgrounds, which allow us to come in with different strengths, but to be able to work together. And really just with the same focus in mind of wanting to see better health, better health for our communities, better health for the country, just better health in general. And overall, not just mental health.

 

08:55

Yeah, I think that that is true. It’s the fact that there is strong representation from the very identified communities, the black communities, indigenous men, garner support. I personally am honored that I was asked to be part but because I don’t fit in those categories at all. And but it is, I do think quite frankly, that I one strength that I bring in and I hope that this comes across well. I am because I am from where time I was born, which was 1956 and where I was born in Memphis, Tennessee. I am inevitably a white privileged racist. Now I am also by choice and by exposure, a person who has chosen to become anti racist but that does not erase Your origin, it just means that I am able to recognize it and to help where I can within my community to say, look, we have our work to do. And this is not the bipac community’s job, it’s not their job to fix us. It’s our job to fix ourselves in this regard, and, and I can learn from the community of it within Hood, where my blind spots are along the way. And then we can also discover where there is a commonality where none of the origins actually matter where they are. And that’s, quite frankly, when you finally get down to the, to the, the methods and statistical analysis and the conclusions of the scientific study, it’s kind of like when you get down to the point where the numbers speak, then we all we can say, Okay, this is, you know, this is the common language, it’s almost like finding music, the common language to find the common language, in science. And so, but the, the variety is very important. So, I won’t belabor the point, but I think that is important. I do think it is very critical to have both the public health perspective and the, the medical practitioner perspective, because as much as we try to see each other’s world, we always have a slightly different focus, my focus is going to be on the person in the room with me. And the public health person is on the huge, large world beyond their walls, constantly. And so we can each bring to each other, that particular perspective, which helps remind us that not one perspective is going to encompass everything, that there is a parallax view, that must be in both in order to understand the greater trades that are happening.

 

12:22

Definitely

 

12:24

what has learned from you and your patients experiences from the covid 19 pandemic, in general, but also, particularly with respect to the neurodivergent community.

 

12:38

So I’d say the biggest piece of that really an appreciation, and no, just acceptance of the fact that this is truly has been a global pandemic. And that every, every person has been affected. And so when we talk about anything that is either challenging or things that affect what my relationship or what my interaction with the world is, that would have been impacted, just, of course, that inside the pandemic, but it being something across across socioeconomic status, across gender, across race, just in all areas. So that was the biggest piece of them first acknowledging that, that everybody’s affected no matter what, but then going into whatever disparities were happening before, whether it be a disparity in access to care, access to knowledge about care, those things were amplified to in terms of there being just a bigger, a bigger gap in terms of access to that information and access to that here, which led to as we saw a lot of disparities in terms of who was primarily impacted by the global pandemic, also, SAP the biggest, and that then goes on when we’re talking about divergent communities also impacted just the same as everyone else was impacted. But being when we’re talking about having any type of health condition, then it’s going to be an even greater impact. When you have something that now is another insult basically from from an immunological standpoint, but also just in terms of how it affected everything else, our access to socialization or access to support or access to coping skills that previously people would have had been able to easily move into. So an even bigger impact in that sense.

 

14:32

Well, first of all, when it comes to specific patients, by simple quirk of the calendar, I literally retired in January, about a month and a half before the pandemic was properly acknowledged and before restriction set in. So the reality is that I was already out of the clinical setting, so I didn’t have any Patient myself, I will say what I’ve observed is an interesting fact that and the second thing is I really have no specific experience with neuro divergence, I have thought a lot about the issue. And what is the impact of talking about vaccine after the wake of wake, you know, and all of the trope of equating vaccination, quote, causing autism. And it’s, it’s, you know, there, there are so many different ways in which that was wrong. First of all, it was it was fraudulent, fabricated, that’s been now proven. Secondly, if we had to really ask ourselves the question of, what do we mean by quote causing autism? What is it, people think that autism deserves, quote, a cause for I will say, my own experience as a human, it. I am a member of a community that has had struggles I’m a self identified gay man, although masculine by the patient, he can, etc. But I’m also familiar with the whole notions of the this mothering mother notions of causing gayness, which, of course, was completely ridiculous. You know, and, first of all, what, it’s not a cause it’s kind of like talking about any kind of characteristic of, you know, what caused me to be steps, but one, I don’t know. It’s like, and so I getting back to the main point of neurodivergent. And I suppose quite frankly, 1/5, consider sexual orientation to be a version of neurodivergent. Pregnancy, things are centered in the brain. There’s no doubt about that. So it strikes me that much of the neurodivergent community is burdened at this point, with this whole notion, whether they’re aware of it consciously or not, they’re going to be burdened with this notion of vaccine and identity. Whether it was right or earned are proper is a whole different matter. And it’s kind of interesting when you start thinking about the not exactly parallel, but with the black community having to struggle with the whole issue of medical apartheid. And in the history of knighted states practice of medicine, whether it’s a spectrum of gynecology, and the herb rendus experimentations, without Anastasia on non consenting, black women, or when you talk about the problems with SP gay, and even then later on the transference of that to the brown people down and Central America. It’s like so you have situations in which people have been hurt by medical malpractice. And now they’re faced with a situation where they’re having to gain trust. And, ay, ay ay, ay ay ay statement of medical rescue, medical health. And, and that’s, that’s quite a conundrum. It has been interesting to watch the fact that quite frankly,

 

19:13

within the black community in particular, they have proven themselves to be malleable and and changeable. But when you address the realities of what we know about this, these particular vaccines now for COVID, which are proven to be safe and effective, and and countering the issues about what really had happened to them and their community, or reality thing, not a not a conspiracy theory thing, you can move a person from, from an experience of true reality into true reality much more easily than you can move people from conspiracy theories into true reality. And that’s what’s been interesting to watch with the resistant, hyper conservative, white community, they are not moving very rapidly. But because we’re not arguing against saying, this is, you know this Yes, you’re right. That’s what the fact in the past and now, this is the fact of the President, it was a bad fact of the past, it’s a good fact, in the present, you’re having to take on the full argument of what your thinking is not founded in truth. And if odd, it sets up the conundrum? Well, I’ve always had did have the experience, one of the things that we were always taught was, you don’t confront a patient’s delusions directly. You just don’t. And so it’s very difficult to confront the delusions, and so we’ve had more success in actually confronting, and the neuro diverse community may find it to be similar, that you can acknowledge the state your this was an abuse of your identity in the past. And it is acknowledged as an abuse. And now we can move into a real reality now, which would be a benefit for your identity in the present. But that’s just a thought, that’s a hypothesis and it’s totally untested, it would be great if your, if your project can take that forward, and actually operationalize that, and put forward a testable hypothesis, one

 

21:38

COVID standpoint to is having to also take a step back and think about how scary it was for everybody. Like this was new to every single person. And as the medical community and public health, we’re trying to even figure out what this is what’s going on, how do we treat this who’s being impacted, this is all still impacting people simultaneously. So for anyone, this would have been anxiety producing for every single person, this was anxiety producing. So even if there wasn’t a prior diagnosis of anxiety, or a prior diagnosis of, let’s say, depression, this is something that elicited responses that were really natural responses, but work, again, we didn’t have access, because of the nature of this disease, we didn’t have access to things that would, for any community be able to at least decrease necessarily the severity of symptoms. So this was all something I’d say going on simultaneously to separate from the fact of how it was impacting some communities more than that just means we’re talking an amplified effect for communities who already had pre existing it concerns pre existing illnesses. And also we talked about, again, bipoc community, there being already an established disparity in access to health care and access to information about that health care, while the entire country and world is undergoing this novel situation as a body producing for every single person.

 

23:06

So that the, what you mentioned about folks who already had experienced disparities, and now you have this COVID vaccine coming out a lot of programs and organizations having to pivot to go online full mode, without maybe not necessarily having the tools or the know how to how to do it. But yet, here we are, right in June 2021, in a completely different remote world, where we’re able to have this conversation on zoom on different time settings. So there there are some really good things coming out of it. And in some ways, but also I hear what you’re saying about treating people with dignity and validating their experiences, right that like, yes, it’s true, this is what actually happened, and not making it seem like it didn’t happen or that those things are in the past. Like, no, they’re very real. And I think that starting from that perspective really helps establish that trust and that connection that you’re going to need to move from the potential hesitancy that they may be experiencing to further like, so what does that look like? And how, as a medical professional, can I support you work through those questions that you have?

 

24:11

This is exactly because it is valid. It’s a valid worry. And on my end, in my specialty, my goal is to make sure that things like anxiety, depression, ADHD don’t basically become the decision maker like that is not the thing that impacts the decision for different things. I always want to encourage families to have an active communication, ask all questions of their primary care providers. But on my end, I want to make sure that at least the anxiety is not the thing that’s making the decision for them, as opposed to a truly being an informed decision. Because there’s a lot of reason for anxiety to basically come to the forefront and be something that could make decisions.

 

24:52

I have told patients before science before that, particularly ones with depression One of the things that we know about depression is that one of the first symptoms is it takes away your ability to take pleasure, and, or to have motivation in the things that you normally would. So if I tell them I said, your favorite thing in the world could jump up off the floor and stop you in the face, and you wouldn’t know it, you wouldn’t know what’s happening. So. So remember, get some people to help you with your thinking in this regard. You know, don’t consider yourself invalid. But don’t, don’t hesitate to reach out to help others to do reality testing with other people along the way, because your your, you know, your disease, can can actually cripple you. One of the things that’s a little bit of a paradoxical treatment is to basically say, you know, what, that’s the medical system, failed your people in the past royally. Don’t let that happen to you twice. This time grab hold of what’s being offered to you, that’s actually real and helpful. Don’t let the Don’t let the past by to twice, it bits you wants, don’t let the past bite you, again, don’t let the past block you, from what should be rightfully yours, which is the openness to a safe and healthy. And that can sometimes muster up a little bit of, you know, you’re right. You know, it’s, I can’t let them, you know, they knocked us down, but we can’t let them keep us down. We have to move forward. I think that’s

 

26:50

the that’s not the word goodness, that they acknowledge that they bring it to the forefront. And they provide folks with the tools to advocate for themselves where ever they are at. So what are some reasons that you think have facilitated individuals or families who choose to receive the COVID-19 vaccine? I know, you mentioned that depression could act as a potential barrier, or that other folks could have developed different mental health conditions that could potentially fog, you know, the reasons why they may or may not get the COVID-19 vaccine. What are some reasons that you have seen that folks do get the COVID-19 vaccine?

 

27:32

I would say those are actually also some of the same reasons that people have been getting the vaccine is really an awareness of anytime we’re talking about having any comorbid diagnosis diagnoses, that puts you at a higher risk of how significant and how severe the impact is, from COVID-19. So I spend a large decision maker for a lot of people is that piece, and then the other piece also of wanting to get to a life of some degree of normalcy, and doing anything to move in that direction. But initially, I’d say a lot of it was also just knowing there were other medical issues and other things. And that playing a part or so in terms of how people were impacted from the from just how COVID-19 led to further health issues, even for the families who were able to survive it.

 

28:24

Yeah, and now I don’t have any direct experience in doing this. I will borrow from a pediatrician from Indianapolis, who was speaking with us a couple of weeks ago. And, and he will tell, and he’s had success with, as he said, with his families who were resistant, because they were afraid of the side effects of the vaccine. And he would say, well, dude, do Pampers. Now, of course, Pampers is the brand brand name, the trade name for the disposable diapers, if they do Pampers cause brain cancer and toddlers. And the parents will say, well, that’s ridiculous. And then it’s a well, he says, All these all these kids who are three years old who are diagnosed with brain cancer. Were were in Pampers when they were infants. And they will say, well, that just you know, and then they can start thinking for themselves, the way that we think about covariance artistics, about the fact that everybody wore Pampers. And that there was that just because there was temporality involved. There wasn’t causality involved, and that people can start seeing that. And, but he only goes at that after acknowledging the fact that he understands that they have strong concerns about the long term safety and They’re the health of the children. He understands that and to affirm that, and the parent is particularly important to say, you know, I’m not going to diss your your concern for your kids, you know. But now let’s think about how we can actually visualize this and think about that in the in the best terms possible. And the pediatrician reporting that he can gain their trust quite well, because he’s, he’s, he was quite often he is himself a black man. And he’s his population, and he population is primarily black. And so he has a rapport that that afforded to him, that probably wouldn’t come off as well, if I were to try the same thing. And so having the right person say the right thing at the right time is going to be very important. And I can’t assume that just because I’m right about something that I’m the right one, say it.

 

31:01

Your representation matters and delivery of the message matters. Something you mentioned earlier was how folks have a lot of hesitancy around vaccinations, making either assumptions or correlations or causation arguments between autism and vaccines. And that’s one example of a barrier, right? What are some other additional reasons that folks or families may not receive the COVID-19 vaccine that you all have seen or have observed as colleagues or with your own patients?

 

31:38

merely fear. It’s new, and it’s unknown, which I understand. One thing I’m going to add to in terms of things that reasons as to why people happen. Getting the vaccine also is for family and for community, people wanting to make sure that they didn’t increase the risk of elder members in their family being infected, elder members of their community being infected, or individuals with increased health vulnerabilities being infected. So that actually being another reason as to why people have really been open to getting the vaccine, really thinking about other people that they did not want to be infected. But no primary reason fear. Now, in terms of like medical providers, we’ve been quicker to get it in terms of physicians, because that is the place we’re coming from is that we want to make sure that we don’t put ourselves in position that we would get anyone else sick, or get anyone else infected. And that’s where you had so many health providers who weren’t seeing their families for extended periods of time, during really the thick of the pandemic or you know, just not being able to be around other people outside of who was ever in the bubble, similar to what we’re talking, you know, just for everybody, that just also from in terms of immediate people because of not wanting to infect, but fears really been the biggest it is it’s an it was an unknown. And it took a while for there to be enough information disseminated for people to really understand what not only the virus truly was, but also what we were talking in terms of the vaccine, and that this wasn’t something that had just now been developed, really, it being something that had been in the works for decades, prior to it being something that then this was now just now we had a time to basically quickly get use of it. But it was not a novel development. But that took a long time for people. And then there’s still people who don’t necessarily know that which again, goes to, you know, just access to information and dissemination of information and making sure when people are making informed decisions, that they’re truly making fully informed decision.

 

33:43

I would say that, well, first of all, I’m in Louisville, Kentucky, and surprisingly enough, Kentucky had a very progressive and advanced response with provision of vaccine opportunities compared to what you would find some of our neighboring states, particularly when you compare it to this was early, it was organized better. It was a top down organization that enlisted local bodies. Well. So that was that was very good. So what that meant was that opportunity for vaccination actually was read pretty quickly within our communities in particular around Louisville quite well, very quickly, but that that’s not uniform across all avoidable. There are certain sections of loibl that are particularly underrepresented. Of course, if this is not a matter of providers offices, this is because these vaccines were not being distributed in providers offices. They were being distributed either in municipal centers are in pharmacy locations. But there is definitely there are neighborhoods here that are pharmacy deserts. Where and, and those are also the same neighborhoods where people don’t have independent vehicles, individual vehicles, the way they are, you know, they’re quite dependent upon bus lines and the bus lines are mediocre at best. You also have people who were, they did not have the flexibility for the most part of working from home, if they were working. And so they were, they were having to negotiate other kinds of realities. And by the time you take all of these different variables in the regression equation, and knew, you know, then and then also match the variable with the appropriate coefficient along the way, you’re going to, you’re going to strike the y axis as a slightly different place, and you are for the, for our privileged Easton community. And so some didn’t have the ease of being able to get onto the internet and to book their appointments very quickly, when they were first available. And, and they didn’t have the ease of being able to take off from work to and to have their own car because these were mostly drive thru vaccinations. So you had to be able to drive through, so you had to have someone fake, you didn’t own a car, or you had to borrow somebody’s car, if you could, or things like this, it wasn’t like you could walk up, it’s almost like, people tried to do walk up to ATMs at banks, and they actually get punished for it. Along the way, they’re not supposed to do that, you know, you’re supposed to be in a car, kind of thing. And so and so there were there were other socio economic variables that were at play. I will say that, quite frankly, we are at a point right now. Where if someone decides that they want a vaccine, they can pretty much get it with without a huge number of barriers in front of them here in the middle of June, that things have loosened up over the last six to eight weeks, considerably in that regard. But this is not true for all of our regions. Not true for all of our states.

 

37:40

We hit on such a great point that there’s a lot of fire preexisting condition conditions that are structural, like folks not being able to take time off from work not having transportation, not having a, you know, the it like internet or something fascinating that you mentioned was pharmacy deserts write that they don’t even have access to proper medical, not necessarily medical care, but the the medicine themselves to cure them. So now you’re talking about another added layer of health with this COVID-19 that vaccine that we’re all shifting and pivoting to try to figure out how we can support all populations, but also the most vulnerable folks. So in what ways Would you say that, as physicians you have, or as just individuals in the medical field, you have supported families in assisting to receive the vaccine. So you mentioned that now it’s a little bit more easier. How, for example, for folks who have limited access to make an appointment, in what ways have those barriers been mitigated or ameliorated to support access to that vaccine.

 

38:51

For me, just making sure that it that they have access to information as to where they can obtain and where might be a place local. At the end of the day, I still leave it to the family, it’s their individual decision while I’m getting it. So I still encourage just them having information so that they’re making an informed decision on you know, if this would be a benefit, and why this would be a benefit, but increasing that trust in their primary care. But once we’re at that place, just making sure that they’re aware of the places that can and it’s just like Dr. trip we said there’s access added benefit of being in an area that it has a lot of access. Now. There was not that access last year so much but in terms of there being mobile vaccine clinics, even not just the pharmacies, but literally who kind of go down most streets and get it the health departments have set up a lot of different locations. So there’s there is more access now. Especially now that they’ve opened it up to children well to teenagers. There’s even more at is available then there even was when it was just adult. So just making sure to at least they’re aware of those places and options, but families are finding it.

 

40:09

Yes. And around loibl I know that there was that the health department in conjunction with some of the large hospital corporations really work together. Well, they did some pop up, drive throughs pop up walk in trailer vaccination in some of the more poorly acts, access communities, the black communities, the brown communities, I believe now, don’t I, I’m going to go out on a limb and say this, I think they even set up one at the Churchill Downs of the back backside of the track, because that’s a, that’s a heavy with tenex. population. The track workers are, you know, they were able to, to meet the community where they were found. And so and using that the traditional black churches was one of the strong avenues from here, although even the black church leaders would say, Well, yes, we can get the old people. But the young people don’t come to church. We don’t know how to get them, you know, and so but they, they were, you know, we, we did see that to be an effective way to help, it’s still not quite the same thing. It’s having the Kroger pharmacy, or having the CVS and the Walgreens, which right now all have the signs up saying walk in, you know, COVID vaccinations are available, the problem is you got to be able to get to that location to walk in, and they’re all more than two miles away from most people’s home. So that there is still the hope. It’s, it’s, I mean, the modeling of the math modeling of that is the modeling that goes along with fluid dynamics, that you’re always going to find greater flow along the easiest path. And, and so therefore, you’re privileged, it gets privilege, unfortunately, without any consciousness to it. It’s just simply a privilege to get the privilege.

 

42:29

One thing that’s nice that and this speaks to what Dr. ship was saying, there’s been a nice shift to access to areas that are known to everybody. So before it was at a point where it was like you had to figure out where this place was or where this person is, there’s really been a shift to it now being available, where you can get the vaccine at a massive like a mass area that everyone knows to the public transport, transportations able to get to put locations that everybody knows. So that that increases the chance in likelihood of more people having access to getting vaccinated.

 

43:04

I definitely hear what you’re saying it’s visibility establishment and the partnership with well known organizations that already have the trust of the community and leveraging that to support the COVID-19 rollout. You also mentioned information and I’m wondering, what methods do you use to provide correct information or facts regarding the COVID-19 vaccine?

 

43:26

I do like this bill refer to the tried and true CDC because they are technically dictating our steps. So I do reference there but also reference other organizations like NIH, just places that I know, you know, we’re doing either research in different areas. But the first place I always recommend families to go to is and I know I said it, but it’s true. I recommend that their primary care because at the end of the day that their central person who’s managing just from a central aspect, their care specialist, we come in and we support and we do everything we can do to make sure that health is in a good place. But there’s still that central person for them too. So that’s always my primary that I refer them to go back to the CDC. Yeah, because right now that’s that’s what that’s where we’re all getting our information and who Yeah, but not Cz.

 

44:19

Yeah, and now click medicine initiative in particular. Of course, it’s its website, as a very important source for both posting sources outside but also posting its own infographics. And they’ve done I think, quite frankly, a very good job of they are very simplified, but they are accurate infographics about both the pathophysiology of the disease, the thing and also trying to dispel myths about the vaccination Even the do a little preaching here and there about, you know what to watch out where you go for the clubs and stuff of this nature. So that’s been important now. And they also will repost interviews, which that they participate in from the serious news broadcast that’s hosted out of Los Angeles, the name now is blanking on but it’s tremendous theory, Sirius radio broadcasts. They’ve been on, I think three times now that they, but it’s been enabled, they have a strong YouTube presence. With the interviews with forthwith even with Dr. Peter Hotez and others that’s been very important. You know, and bringing up up to the minute is as much as possible accurate information. And when things are ambiguous, allowing that to be a staple thing, you know, this is not exactly certain right now. And not trying to gloss over that. And, and also to not gloss over the fact that science sometimes has to change on a time when when data comes across different. Now move to a different thing here locally, in the in the the traditional black neighborhood areas of Louisville, they are billboarding probax vaccination signs, and this is not that Madison’s doing this, and I’m not exactly sure which organization is funding this, I think it’s coming out of the health department or grant, they’ve got to deal with this. But it is specifically targeting those neighborhoods, really encouraging vaccination and saying things such as herd immunity needs you. You know, sort of, you know, herd immunity for the hood, you are important and showing an almost tantalizing people with pictures of basketball arenas, we have a very important big basketball arena here, which quite often use now for the Final Four, and they’ll show it full and it’s basically kind of like saying, you know, you need to be vaccinated with the idea that if we all get vaccinated, we can get back to here. And you can you can bait a lot of people with basketball and Kentucky, let me tell you that’s, that’s like religion here. So it’s, it’s, I’ve been quite impressed with the fact that they really have, you know, been targeting targeting the underserved communities in this regard. Yeah, absolutely.

 

48:12

What you mentioned about following CDC guidelines is really important, because as we’ve seen throughout the year, things have been changing, sometimes from day to day, week to week, month to month, and it’s just a lot of change. And often for people, I mean, just change can be really hard to move with, however, knowing that there is a trusted website, like the CDC, or I think you mentioned the NIH, that that those are trusted sources that folks could go to. But I think that Hood medicine does such a great job, like you mentioned of creating infographics that are attractive, that are digestible, because sometimes these websites can have very lengthy language that may be just, you know, just regular people who just want to see a quick and fast won’t be able to access or understand. And it’s and it’s Yeah, and so the job or that the workup had medicine is really impactful in that way. I also I wanted to ask you, in what ways would you say you counsel our support patients of color folks who, from the disabled communities who are hesitant about receiving the COVID-19 vaccine, what has worked best and what hasn’t worked as well

 

49:22

as start from where they’re coming from? So no, you know, what is the core? What’s the core behind your decision and your fear and your thoughts? Because even when we’re talking about you know, what bipap community is still going to be individual decision at the end of the day also. So it’s really starting with Okay, what is it for you as an individual that makes you hesitant? What is it for you that makes you feel like this is not something that you can trust and then we work from there to see what parts of that are based in science, what parts are based on information, what parts are based in actual reality, what parts are Based in my anxiety is just purely and I have no I’m not basing it on any information or anything that I’ve read or heard. It’s just purely based on fear. So then once we determine what’s really behind that thought and that hesitancy, then that’s when we’re able to get to, okay, let’s, let’s take the layers down, so that we can truly make sure it’s a well informed decision. Because if it is something, let’s say not based on truly being informed, and we, then we work on getting informed, so that it can truly be a decision. That’s okay. Now, if I am deciding this, then at least I’ve taken to account all these other things. Or if I’m getting information, am I getting information from appropriate sources? Or am I getting information from opinion pieces, because that is not necessarily going to be fact base? So that’s the other piece too. And then making sure our is the information, we’re getting fact based information? Because I definitely work from a world effects. And but then also, if it is anxiety, and that being the primary or depression or something like that, then we work to reduce those symptoms, because then that wouldn’t just be impacting that decision. It’s impacting all decision making,

 

51:10

right? It’s correct. Yeah. And I would say to that, um, well, I don’t, once again, I’m not going to say that I have direct experience, or any measure of experience of what worked, what didn’t, I have heard some anecdotes from the people. We, for instance, Hood Medicine did have an interview in which we had a woman who is PhD, MD, faculty, black epidemiologist, and one of the nice things was that she talked about her initial hesitancy when they were starting to roll out the vaccine in the fall. And because, and quite frankly, I, I’m one who was known for this, too. I kept saying last year in August, I said, I will believe it when I say it, because I said I know a little bit about coronaviruses, and they don’t behave well. And, and of course, my training and in neurology was is ancient, it was in the middle 90s. And there was no knowledge of mRNA technology. At that time, everything was it’s going to be a protein attachment face. And, and so I just put like, very, very skeptical, at first, about all of this. And But getting back to the main point, this particular scientist was able to say that she was skeptical. And so what did she do, she went and downloaded all the articles. Now, she wasn’t saying to the patient, that they need to go read all those articles. She’s basically saying, I know how to read all those articles. And I read them all. And she says, I was amazed. She says this was good stuff, you know. And then they went in, and she was able to talk about Yes, like this came about quickly. But that’s because they put the money in it to allow it to be quick, they didn’t have to wait for this lag time between phase one, phase two and phase three, they had enough money that you could just have them be seamless, moving one to another, you could start planning the logistics for phase three, even while you were doing phase one, which is not something that’s normally available for any kind of vaccine development. So she was able to lay it out there saying, I was convinced I had this training. I am a black person, I understand our history. And I was able to go into this and I was able to become convinced. And I think that that is the thing that is going to be most persuasive is to be able to say no. And and to not to not tell people that they are silly or foolish for being reticent to say I understand exactly where your reticence coming from

 

54:06

Yes. To what you’re describing, also with her experience that really speaks to how you’re going to have different individuals that are going to respond to different things really is going to have to be that they have to get all of the facts and all of that information and really feel like okay, this is coming from an informed place may have other people who it needs to be that they see more people they know getting the vaccine, yes, they were fine and that they did okay. And that being something that gives them enough reassurance. And then for other people seeing people that they respect, even if it’s not someone they know personally, people they respect or hearing someone that they trust what their words are to be someone who’s saying, look, this is I was okay or this was okay. But it really has to be for that person really determining what is what is it for them that would be something to reduce their particular hesitancy

 

54:58

sharing our own personal stories. Whether it be from a famous basketball player to your neighbor, or some important family member, teacher, community figure who can really support lessen the vaccine hesitancy, I also heard you say agency support, like validating, again, a lot of validation of a lot of supporting the person’s on decision that they can or cannot and when they’re ready, as opposed to imposing something on on a person. And I, I also heard you say that people should be making the most informed decision. And that’s it through making the most informed decision, they can better just decide for themselves. And I think with a lot of, I know, what put me at medicine puts out information on YouTube. But I also know that YouTube is a platform for so many people and organizations to put out whatever information they want. And that’s the other really scary I think sometimes it’s Flipside to that, that we do live in a world where there’s a lot of access to resources, and those resources may not always be vetted. I’m wondering in what way do you all help your patients feel more confident or empowered in getting vaccinated give him that there’s so many different just ways of perceiving that information? Or just with the lot of like changes that are happening? How do you ensure that your patients who are getting the vaccine feel that it’s safe and effective for them?

 

56:34

So for me, I just encourage transparency, and I encourage them to know that every time we talk if an honest place and an honest space to be able to talk about any concerns, questions, any doubts, any fears, any of those things. And even if it’s not something that I would address from a my specialty standpoint, then it’s at least something where I can make sure who what professional do they need to speak to, to provide more reassurance in that area. But it being something really just making sure that they have a space where they can be heard, in terms of any of those fears, and thoughts and worries and hesitancy because I think to just pretend that there are no hesitancies or worries are not validated. That’s when it just builds up and builds up and turns into its own thing, as opposed to acknowledging it, respecting it, but then working on it.

 

57:24

And I would also, I mean, this sounds a little trivial, but I think it’s very important to acknowledge the normal side effects of the vaccinations, particularly on the second dose, if there was a two dose regimen. And to let people you don’t have we don’t have to overplay that. But say, yes, you’re probably going to feel kind of lousy for a day or two. And that’s all right. That’s, that means it’s working. Now, not everyone does. And that doesn’t mean it’s not working for them. But say, you know, that’s, that’s just what we expect, you know, along the way. You know, and to contextualize it. In that regard. Most people don’t realize that they’re, you know, when they get the childhood vaccinations, the kid probably felt lousy. You know, it’s just that they, all they knew I had to do was pray about it quite a bit, you know, but so, just being truthful about that, and saying that, that’s okay. That’s just one of the things that happens along the way. And you’ll get over it, and you’ll be better for it. My personal experience was at the shingrix vaccination, particularly the second shot was a whole lot more debilitating, than the second chatter. The merge journal was part of me. But I knew that in advance, you know, I kind of scheduled a weekend off and, you know, that was, that was gonna be it.

 

59:08

I definitely hear what you’re saying about normalizing not only the fear around getting the COVID-19 vaccine, but also the side effects of getting the COVID-19 vaccine and with that, supporting the person, the individual is able to create a plan for themselves, like maybe have their own snacks or their own self care kit that they know they can get through the next one or two days or three days for some folks. Right. So I think that absolutely normalizing that fear and the aftercare that you’re going to need because it is it is a vaccine that may or may not impact your body in a different way. But creating that plan can really support individuals prepare ahead of time to know what can potentially happen and maybe in that way, so lessening that fear that comes with getting something new, an injection of vaccine in your body. So thank you so much. Thank you both for you. Time. There’s one last question, is there anything that I haven’t asked that you would, that you think is important to share that you would like to share with the neurodivergent? community?

 

1:00:12

Amazing questions. Just I can feel, the only thing from my end is just that I mean, we’re all every single person is experiencing this, every single person, we’re all experiencing this together, and everyone is going to have a different experience with it. And then includes when we’re talking about having a divergence, like there’s going to be just because we are all individually, there’s going to be different experiences with this. But this is a really important time to make sure that all health is managed during this time. So that means anything that was a concern prior to the pandemic, to make sure that that is taken care of during this time also, but also making sure like any decisions on the vaccine are back base and informed and really making sure you’re coming at the decision from a place of truly thinking of the consequences of not getting the vaccine awesome, because a lot of times we the fear can be of what’s going to happen in that immediate time of the vaccine. But there’s the reason the vaccine is even a discussion Peters because of the reality of what can happen long term. And what can happen even in months out without the vaccine. So really, that being a part of decision making to what do I want my life to look like, in five years? One year, one month?

 

1:01:30

Yeah, I would say to, to the neurodivergent community is claim your heroes. Quite frankly, I would not have the life that I have right now. If it were not for Alan Turing out who was the person who created the actually this human mechanized computational machine that broke the Enigma code, which allowed, quite frankly, the Allied forces to defeat the Nazis in World War Two. And not only was he a gay man, and partly mistreated for that part by by his own country later, but but he was neurodivergent. Probably represented on the spectrum. And the reality is, he’s saved millions and millions of lives and save at least a partially just way of trying to live in the world. I won’t say completely just right when we’re not there yet. But he definitely. So claim, claim your heroes, and know that when you choose to be vaccinated, to put yourself into a position, perhaps being the next hearing.

 

1:03:01

Thank you. So both of you for your time, we really appreciate you taking the time out of your days to speak with us a little bit more about COVID-19 vaccine hesitancy, the amazing work that Hood Medicine is doing, and just how we could all better support the neurodivergent communities. You now have access to the COVID vaccine and beyond. So thank you so much. Thank you both for your time. Thank you. Best of luck with the project.

 

1:03:34

Thank you so much for your time. This was wonderful. We really appreciate it. Thank you.

 

1:03:39

Thanks for having us. These were great questions. This was exciting. A wonderful job. Thank you. All right. Well,

 

1:03:49

thank you so much. And we will we will definitely be in touch with you about some of our next steps for the project. And we’d love to kind of continue to keep an open dialogue about how we can maximize our impact. Yeah, so

 

1:04:01

I will be looking forward to you guys being the ones who get the real data. I’m, I’m sort of, for lack of a better word, data flat. I really want you to know, and you will be able to listen science behind things which I hope are correct opinions. Anyway, thank you.

 

1:04:28

All right. Well, have a great night. I know it’s late for you on the east coast. Thank you so much. Thank you. Thank you. Bye.

Dr. Bottazzi’s responses: 

We’ve all had the misconception that the vaccine was developed rather fast and that steps have not been followed. I am someone who has been working on a program aimed at tackling coronaviruses for over a decade. 

 

It’s a benefit that Covid 19 is in the family of Corona viruses since we had been working for over a decade in fighting this virus.  

 

Another thing that we have to acknowledge is that it was not only a small group of scientists working on vaccines, it was hundreds of scientists working towards the same goal.

 

The myth that the vaccine was made too fast and that steps have been skipped is totally false. 

 

We see the evidence in the hundreds of millions of people who have been vaccinated and we have seen it work.   6:25-6:35

 

If you’re doubting getting the vaccine, look at those around you who have been vaccinated.

 

It’s crucial to get the vaccine as new variants are arising. People who are unvaccinated are at a higher risk of getting the new forms of Coronavirus variants. And people who are vaccinated do not get as sick as those who do are unvaccinated. 6:49-7:13

 

There are many myths that seem out of science fiction, there are those who believe that the vaccine contains chips or tracking devices for population control.  As a manufacturer we have the responsibility to be transparent with every single step. The vaccine is highly regulated and validated.  7:27-8:17

 

On the topic of the vaccine causing infertility we have conducted various studies, studies in determining the safety of the vaccine and the studies have shown no evidence in causing damage to reproductive health. 

 

There are also myths that the COVID-19 vaccine may alter a person’s genetic makeup. But the truth is RNA vaccines do not alter your DNA or RNA. RNA does not enter the nucleus or alter your DNA. The probability that the vaccine will have an impact on your genetic makeup is highly improbable. 

 

There is also a myth that the vaccine has the virus, or that the vaccine could cause COVID-19 but that is also not true. It is there to prevent Coronavirus or if you are infected with Coronavirus it does not cause you any medical repercussions. 

 

The vaccine prevents any medical repercussions, it does not infect the person with the disease.  

 

For those who are involved in the scientific community, we have to make sure that the sources of information that we are consuming are legitimate sources, having these kinds of discussions help clarify any misconceptions. 

 

To continue supporting vaccine confidence, there is a huge need for better communication between scientists and the general population is crucial in stopping misinformation. 

 

Who can you go to for support? 

We have to rely on public health officials, primary physicians, government agencies, universities, you are at UCLA and I’m in Texas and we are putting the information out there. 

 

In Texas the immunization partnership is specific to the state of Texas but every state has their own version where people can share their experiences 

 

Folks have to be cautious with where they are getting their information and ensure that they are validated sites that are scientific. 

 

New information that is being put out by officials and scientists changes daily, and it is important to stay up to date with verified sources. 

 

Individuals who are neurodiverse, have disabilities or have other at-risk factors can look to organizations that they closely work with in order to be better informed on how the vaccine may affect them specifically.  There’s a variety of associations for specific conditions, and they are there to support, especially because there are people who may be impacted by the vaccine in varied ways. They can help to address concerns, provide important information, and ensure that the information you received is valid and verified. Knowing that you have the information from a valid resources can also support you in speaking with others about the Vaccine.  18:05-19:24 

 

It is essential to get vaccinated, not just covid-19 vaccines but all the vaccines that have been prescribed by physicians. We have to get vaccinated. We cannot let fear prevent us from getting vaccinated. 

 

Don’t be afraid of the side effects after the vaccine, headaches and fever is normal after the vaccine, it is a natural reaction that your body is having. 

 

The vaccine does not work 100 percent but it lowers the risk of having a severe reaction to covid 19 and helps lower the spread of the disease. 

 

Let’s get vaccinated and continue to wear face masks and practise social distancing and keeping good hygiene practices. 

 

The virus looks for those who are weak, those who are not vaccinated, we are seeing new variants that are changing in order to spread easily.

 

If you’re not sure of something, ask, use the verified sites of information.