[Senate Hearing 117-192]
[From the U.S. Government Publishing Office]
S. Hrg. 117-192
VACCINES: AMERICA'S SHOT
AT ENDING THE COVID-19
PANDEMIC
=======================================================================
HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
ON
EXAMINING VACCINES, FOCUSING ON AMERICA'S SHOT AT ENDING
THE COVID-19 PANDEMIC
__________
JUNE 22, 2021
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
46-772 PDF WASHINGTON : 2023
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
PATTY MURRAY, Washington, Chair
BERNIE SANDERS (I), Vermont RICHARD BURR, North Carolina,
ROBERT P. CASEY, JR., Pennsylvania Ranking Member
TAMMY BALDWIN, Wisconsin RAND PAUL, M.D., Kentucky
CHRISTOPHER S. MURPHY, Connecticut SUSAN M. COLLINS, Maine
TIM KAINE, Virginia BILL CASSIDY, M.D., Louisiana
MAGGIE HASSAN, New Hampshire LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota MIKE BRAUN, Indiana
JACKY ROSEN, Nevada ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico TIM SCOTT, South Carolina
JOHN HICKENLOOPER, Colorado MITT ROMNEY, Utah
TOMMY TUBERVILLE, Alabama
JERRY MORAN, Kansas
Evan T. Schatz, Staff Director
David P. Cleary, Republican Staff Director
John Righter, Deputy Staff Director
C O N T E N T S
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STATEMENTS
TUESDAY, JUNE 22, 2021
Page
Committee Members
Murray, Hon. Patty, Chair, Committee on Health, Education, Labor,
and Pensions, Opening statement................................ 1
Burr, Hon. Richard, Ranking Member, a U.S. Senator from the State
of North Carolina, Opening statement........................... 3
Witnesses
Bailey, Susan, M.D., Immediate Past President, American Medical
Association, Fort Worth, TX.................................... 6
Prepared statement........................................... 7
Summary statement............................................ 12
Nichols, Michelle, M.D., M.S., Associate Dean of Clinical
Affairs, Morehouse School of Medicine, Atlanta, GA............. 13
Prepared statement........................................... 14
Summary statement............................................ 16
Chang, Curtis, Consulting Professor, Duke Divinity School, San
Jose, CA....................................................... 17
Prepared statement........................................... 18
Summary statement............................................ 20
Betancourt, Jeanette, Ed.D, Senior Vice President for U.S. Social
Impact, Sesame Workshop, New York, NY.......................... 21
Prepared statement........................................... 22
Summary statement............................................ 25
VACCINES: AMERICA'S SHOT
AT ENDING THE COVID-19 PANDEMIC
----------
Tuesday, June 22, 2021
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The Committee met, pursuant to notice, at 9:58 a.m., in
room 430, Dirksen Senate Office Building, Hon. Patty Murray,
Chair of the Committee, presiding.
Present: Senators Murray [presiding], Casey, Baldwin,
Murphy, Kaine, Hassan, Smith, Rosen, Hickenlooper, Burr, Paul,
Cassidy, Braun, Marshall, and Tuberville.
OPENING STATEMENT OF SENATOR MURRAY
The Chair. Good morning. Senate Health, Education, Labor,
and Pensions Committee will please come to order.
Today, we are holding a hearing on how to get people the
information and encouragement they need to get vaccinated so we
can end the COVID-19 pandemic.
Ranking Member Burr and I will each have an opening
statement, and then we will introduce today's witnesses. After
the witnesses give their testimony, Senators will each have 5
minutes for a round of questions.
While we remain unable to have this hearing fully open to
the public or media for in-person attendance, live video is
available on our Committee website at help.senate.gov. And, if
you are in need of accommodations, including closed captioning,
you can reach out to the Committee or the Office of
Congressional Accessibility Services.
President Biden has declared June a month of action as we
near his goal of having 70 percent of adults vaccinated with
their first dose by the 4th of July. We have made incredible
progress toward that goal. In fact, several states, including
my home State of Washington, have already reached it. But,
nationally, we are still short. Only 65 percent of adults have
received their first dose.
While the progress we have made so far is promising, it has
not been consistent. Some states may have vaccinated over 70
percent of adults with one dose, but some have not even reached
50. And even in states like mine, there are areas, especially
in rural communities, that are falling behind. In some rural
counties in our state, the rate of adults who are partially
vaccinated is below 40 percent. We are also continuing to see
huge inequities when it comes to the rate of vaccination,
including in Black and Latino communities.
It is so important that we keep pushing because, as the
rapid spread of the Delta variant in India is showing, this
pandemic is not over, and the threat it poses is still very
real. The new Delta variant of COVID-19 is more contagious,
more likely to send people to the hospital, and it is already
here. Researchers in Washington State have identified 170 cases
in my state, and the Centers for Disease Control and Prevention
says it now accounts for 10 percent of COVID cases across the
Country.
In the United Kingdom, the Delta variant has already
delayed efforts to reopen and surged among youth aged 12 to 20.
That should be a red flag, especially as CDC recently found,
even as cases across the Country have been trending down,
hospitalizations for adolescents due to COVID increased in
April.
We have to stop this pandemic. We need to do it soon. And,
we know vaccines are the best shot we have, which is why,
starting in January and February 2020, I worked with then-
Chairman Alexander and other Members of this Committee to fund
and scale up COVID-19 vaccination efforts throughout our
response bills.
Working together, we made historic investments that allowed
experts to create a remarkable system to speed up the
manufacturing and development of COVID-19 vaccines and that I
believe will be seen as the cornerstone of our efforts to beat
COVID-19 here in the United States and around the world.
Throughout our work, I also pushed to make sure we focused
on how we distribute and administer vaccines quickly and
equitably, and how we promote confidence and fight
misinformation. And, I'm pleased the Biden administration is
prioritizing vaccination both domestically and internationally
by providing millions of excess doses to fight this pandemic
globally.
We managed to administer over 200 million vaccines in the
U.S. during President Biden's first 100 days in office. But, in
the past few weeks, our vaccination rate has dropped down to
where it was in January, less than a million vaccinations a
day.
As remarkable as the last few months have been, everyone in
this room knows, even with our system to develop, distribute,
and deploy COVID-19 vaccines, we will not reach the goals in
many states and communities if we do not continue to address
the hesitancy, misinformation, and other issues holding back
Americans from getting vaccinated.
We have to continue increasing access and addressing
barriers, which make it hard for people to get vaccines,
especially for people of color, people with disabilities, and
people who live in rural areas. As we tear down those barriers,
we also have to tell people they can get vaccinated quickly,
close to home, and at absolutely no cost.
We are also still seeing an alarming number of people say
they do not trust vaccines and do not intend to get vaccinated.
People want to make the right decisions for their family's
health, but too many people with genuine concerns are being
misled by false information. We need to address the
misinformation and make sure people with questions are getting
reliable answers. Facts, science, and experts are a central
part of that work. But, encouraging people to get vaccinated is
not just about getting the facts right; it is about trust. That
is why we need to make sure we have messages that resonate with
people and address their unique concerns, delivered by
messengers they know and trust.
We need to work with healthcare providers, as well as
advocates and leaders from every background, people of
different races and religions, different geographies and
generations, and yes, even different political parties.
I am glad we are having this bipartisan hearing today to
talk with experts from different backgrounds about how we meet
people where they are when it comes to trust in vaccines, what
messages are most effective in reaching people, where people
are getting their information, and who are the voices they
trust the most.
I hope our discussion will provide helpful answers to
anyone listening who might have concerns about getting
vaccinated themselves. People are not sure how to productively
discuss those issues with others in their life, and leaders and
communities across the Country.
At the end of the day, we need people to understand
choosing not to get vaccinated does not just put themselves at
risk. It puts at risk the people around them, including people
who are fighting cancer and are immunocompromised, and kids who
are not yet eligible for vaccines.
Getting vaccinated also does not just help you stay safe;
it helps us get back to school and work and concerts and sport
games and family gatherings without people having to fear
getting sick with this virus, which has now killed over 600,000
people in this Country.
I look forward to hearing from our witnesses today. Thank
you all for being with us. We want to hear from you about how
we get these messages out, how we get vaccines in arms, and
finally get through this pandemic.
With that, I will turn it over to Ranking Member Burr for
his opening remarks.
OPENING STATEMENT OF SENATOR BURR
Senator Burr. Thank you, Madam Chair. I am glad we are able
to hold this important hearing together today.
The COVID-19 vaccine is the fastest way for our Country to
recover from this pandemic. We all have to do our part in
encouraging Americans to take this safe and effective vaccine.
I have experienced the hesitancy of some Americans to take the
first shot firsthand with friends, family members wondering
whether the vaccine is safe enough for their families. The
answer is absolutely yes.
I got the vaccine. So did my wife. So did my children. When
the FDA authorizes the vaccine for children under 12, I will
encourage my children to vaccinate my grandchildren. The staff
in this hearing room have gotten vaccinated. My Senate
colleagues have either gotten vaccinated or had COVID
themselves, which provides a natural immunity.
Clinical trial data shows that Moderna and Pfizer vaccines
are 100 percent effective in preventing hospitalization and
death, and the Johnson & Johnson vaccine is 85 percent
effective for preventing hospitalization and death from the
virus.
A year ago, when we were in the darkest days of the
pandemic, I thought people would line up for miles to get a
vaccine that kept you out of the hospital and prevented you
from dying from COVID-19. I still believe that, which is why
this hearing, I believe, is so important. We have experienced
much loss in this Country over the last year, and now we have a
tool--the vaccine--to end this and to return to normal. Let's
use it.
The efforts of Operation Warp Speed brought our Country and
the world three vaccines to protect against COVID. They are
safe, and they are effective. Operation Warp Speed is a
testament to American innovation and ingenuity, and shows that
the framework we designed and the statute actually worked.
The vaccines we have for COVID are safe, and they do work.
Pfizer is 95 percent effective, Moderna is 94 percent
effective, Johnson & Johnson, 67 percent effective in
preventing COVID-19.
Today, over 177 million people have received at least one
dose.
Fifty-five percent of adults in America are fully
vaccinated.
Over 87 percent of seniors, those most vulnerable to the
effects of the virus, have received at least one dose of the
shot.
At least 10 percent of the Americans have had COVID-19, so
there is also a number of people who have some natural immunity
to the virus.
Even with all this progress, there is so much more work to
be done. I said during our last COVID-19 Task Force hearing
with the Administration that we would reach a point where we
have more shots than we do arms. This moment has arrived in the
United States, and we cannot be complacent.
Israel showed us the roadmap for what to expect where
vaccination rates began to level off as roughly 60 percent of
the population became vaccinated.
Reports out of India and the U.K. of the Delta variant are
evidence of the importance of protecting Americans now and
encouraging everyone who still needs to get vaccinated to get
it.
The number of doses administered in the United States per
day is falling. Earlier this month, the rate dropped below one
million doses per day for the first time since January. That is
compared to a peak of 3.3 million doses per day in April.
Of the 328 million Americans, almost 284 are 12 or older,
making them eligible today for vaccine. Nearly 177 million
people so far have received at least one dose, which means
about 106 million are still eligible. Clearly, we still have a
lot of ways to go to get all eligible people vaccinated and put
this pandemic firmly behind us.
We also cannot forget about the importance of global health
security. If we do not help other countries access the vaccine,
we will not see the end of the pandemic. The way to help other
countries access vaccines to protect against COVID-19 is
through the extremely successful public/private partnerships
that have developed and manufactured the vaccines we have
today. As I have said before, removing the intellectual
property protection only ensures that we do not have the
vaccines we need when the next pandemic occurs.
Americans that have not yet gotten the COVID-19 vaccine
need to know the benefits that come along with it. The most
compelling case to me is that the shot keeps you out of the
hospital. It also gets you back to work and helps keep people
who you work with safe.
Senator Kaine--he is not here this morning--said at the
last hearing earlier this year that he wore a mask so the
grocery clerks felt safe. Getting a vaccination helps keep you
safe, it helps keep your family safe, and it keeps those around
you safe. It also helps Americans return to the things they
enjoy, like concerts, movies, baseball games, or watching the
Panthers in Charlotte play.
Over the next few months, important outreach efforts will
continue to focus on younger people. Schools are reopening in
the fall, and one of the vaccines is already available for
children 12 and up. In-person learning is critical, and our
efforts over the summer should be to focus on getting kids the
shot, protecting them from the virus. As a grandparent, I look
forward to the day when the vaccine is available to young
children, as well.
I am pleased to have representatives from Sesame Street
here today to talk about the information families need as we
prepare for that round of vaccinations. Our efforts should be
focused on reaching communities that have questions.
I look forward to hearing from each of our witnesses today
about the partnerships and programs that you have underway to
meet America where they are, answer questions, dispel myths
about safe and effective vaccines, and get more shots in arms.
Before I yield back, Madam Chair, let me just say, it is
hard for me to believe that the best example of innovation in
this Country seems to be the thing that makes individuals
hesitant about being vaccinated. It happened too quickly. Well,
let me assure my colleagues, let me assure the American people
what I think the witnesses know. These vaccines went through
the most exhaustive clinical trials of any medication that we
have ever approved for this market. We have not shortcut
anything in any area of Government. But, we did set up a
pathway for accelerated consideration that was taken advantage
of.
As I think Dr. Cassidy would agree, it is the science that
you follow. And when the clinical trials come back and prove
safe and effective, then you should feel comfortable taking
this vaccine.
I thank the Chair.
The Chair. Thank you so much, Senator Burr.
With that, we will now introduce today's witnesses. I will
start with Dr. Susan Bailey. She is a pediatric allergist and
immunologist from Fort Worth, Texas; a distinguished fellow of
the American College of Allergy, Asthma and Immunology; and,
she recently finished her tenure as President of the American
Medical Association.
Dr. Bailey, thank you for joining us today.
Our next witness is Dr. Michelle Nichols. Dr. Nichols is an
Associate Professor of Family Medicine and Associate Dean of
Clinical Affairs at Morehouse School of Medicine. She has led
the historically Black university's community vaccination
efforts and research focused on community engagement, health
disparities, preventive health, and COVID-19.
Thank you for joining us today, Dr. Nichols.
With that, I am going to turn it over to Senator Burr to
introduce our next witness, Curtis Chang.
Senator Burr. Thank you, Madam Chair. As the son of a
minister, I am privileged to be able to do this.
Mr. Chang is the cofounder of Christians and the Vaccine, a
group that aims to promote vaccine confidence among evangelical
Christians. To conduct this outreach, Christians and the
Vaccine has partnered with the Ad Council, National Association
of Evangelicals, COVID Collaborative, and The Values
Partnership.
In addition to his faculty appointment at Duke Divinity
School, Mr. Chang is a senior fellow at the Fuller Theological
Seminary. His ministry experience includes serving as Senior
Pastor of an Evangelical Covenant Church in California, and as
a campus minister with the Intervarsity Christian Fellowship.
He has also done mission work in South Africa and is the
founder of an award-winning, non-profit consulting firm.
Mr. Chang earned his Bachelor's degree at Harvard
University and is a former Rockefeller Fellow.
Mr. Chang, thank you for being here with us today.
The Chair. Thank you. And finally, our last witness is
brought to us by the Letter S for Sesame Street. (Laughter.)
Dr. Jeanette Betancourt is the Senior Vice President for
U.S. Social Impact at Sesame Workshop. She is a licensed,
bilingual education therapist and leads Sesame Street's
community initiatives to improve the health and well-being of
children and families.
Dr. Betancourt, thank you for joining us today.
With that, we will begin our testimony with Dr. Bailey.
STATEMENT OF SUSAN BAILEY, M.D., IMMEDIATE PAST PRESIDENT,
AMERICAN MEDICAL ASSOCIATION, FORT WORTH, TX
Dr. Bailey. Good morning, Chair Murray, Ranking Member
Burr, and Members of the Committee. The American Medical
Association commends you for holding this hearing today, and I
thank you for the opportunity to testify.
I am Dr. Susan Bailey, and I am the Immediate Past
President of the American Medical Association. I am also a
practicing allergist/immunologist in Fort Worth, Texas. And
those two roles have given me a unique perspective on the
COVID-19 pandemic and its impact on our patients, on our
physician community, and on our Nation's health.
COVID-19 is a watershed moment in our Nation's history. It
is both an epic tragedy and one of the greatest scientific
achievements in our lifetimes, thanks to the courageous efforts
of physicians, nurses, scientists, researchers, and the
tireless efforts of so many working in government.
The AMA has been committed from the beginning of the
pandemic to making sure that physicians have the information
and the resources they need to take care of COVID patients, to
keep their offices safe, and to answer all of the questions
that patients and physicians have about COVID-19 vaccine
development.
COVID-19 remains a very serious threat for certain high-
risk groups and for those that have not been vaccinated. But,
much has changed in the last few months to give us hope that
the worst of the pandemic may be behind us. The good news--and
I think it is good news--that more than 55 percent of adults
are fully vaccinated, and 65 percent have received at least one
vaccine shot. And, while there are racial and ethnic
differences in vaccination, as well as regional differences,
attitudes are shifting in most groups. To maintain this
momentum, however, and finally bring an end to this pandemic,
we need to work to get as many people as possible vaccinated
against this virus.
Many individuals are hesitant to receive the shot for
personal, religious, or political reasons. The speed with which
the vaccines have been developed and the politicization of the
pandemic has naturally led to concern among the public about
safety and efficacy.
Physicians play a critical role as vaccine Ambassadors for
our patients. Experience has shown us that our patients place
great faith in a strong, positive recommendation from their
physicians; and that the information and education provided by
physicians and other healthcare professionals results in higher
vaccine acceptance rates. So, the responsibility falls to us to
answer their questions honestly, to address their concerns, and
to be firm and encouraging them to receive the vaccine. This is
our surest way through the pandemic.
Regardless of the reason, though, we need to engage these
vaccine-hesitant individuals and find ways to reach a common
understanding of why these vaccines are important and safe, not
only for the health of individuals and their families, but for
the health of our Country.
We have to lead with the science. To do this well,
physicians need to be part empathetic counselors, part research
scientists, and part myth busters. Obviously, our messages may
differ depending on the reason for our patients' hesitancy or
refusal, but that personal relationship and trust, built in
many cases over years, can make all the difference.
That is why we have advocated for distributing the vaccines
to physicians' offices. It is a lot easier to get shots in arms
when your patients are actually in your office and the vaccines
are in your office.
We are also working with partners, including the Ad Council
and the COVID Collaborative, which are leading a massive
communications effort to educate the American public and build
confidence around COVID-19 vaccines.
We have a lot more work to do to convince as many people as
possible to get vaccinated. It will take all of us working
together.
Thank you, and I look forward to answering your questions.
[The prepared statement of Dr. Bailey follows:]
prepared statement of susan bailey
The American Medical Association (AMA) appreciates the opportunity
to provide testimony to the U.S. Senate Committee on Health, Education,
Labor, and Pensions as part of its June 22, 2021 hearing entitled,
``Vaccines: America's Shot at Ending the COVID-19 Pandemic.'' As the
largest professional association for physicians and medical students,
and the umbrella organization for state and national specialty medical
societies, the AMA and our members have been, and continue to be,
strongly engaged and committed to confronting and ending the
unprecedented COVID-19 pandemic and ensuring that as many people as
possible are vaccinated against COVID-19 (SARS-CoV-2). We commend the
Committee for holding this important hearing to examine barriers to a
successful vaccination campaign and how to overcome them, as well as
lessons learned from this pandemic that will better prepare us for
future vaccination activities related to COVID-19 and other public
health threats.
Introduction
The United States is at a critical juncture in its battle against
the COVID-19 pandemic. While there has been a sharp decline in new
infections and deaths, over 600,000 Americans are known to have died
from COVID-19, and people are still dying from the virus and related
complications, particularly in certain parts of the country and among
certain population groups. COVID-19 remains a very serious threat, yet
much has changed in the last few months to give us hope that the worst
of the pandemic may be behind us. According to the most recent data
from the Centers for Disease Control and Prevention (CDC), more than 55
percent of the adult (age 18 or over) population is fully vaccinated
and 65 percent have received at least one vaccine shot, although there
are stark racial and ethnic inequities in rates of vaccination as well
as regional differences. But, in order to maintain this momentum and
finally bring an end to this pandemic, we need to work to get as many
people as possible vaccinated against the virus. Physicians play a
critical role as vaccine ambassadors for their patients, and surveys
show that even when people have a general distrust of medicine at-
large, they tend to trust their personal physicians.
Large numbers of the population remain unvaccinated and are
hesitant to receive the shot for personal, religious, or political
reasons or due to vaccine access issues. The supply of vaccine is now
outpacing demand in many areas of the U.S., particularly in the South
and Midwest, even with the Administration's push to vaccinate at least
70 percent of adults by July 4. While at one point in mid-April more
than three million people received a vaccine every day, vaccinations
had decreased to only about 1.2 million daily as of early June. Enough
Americans are reluctant to get the vaccine that it may be difficult to
reach a level of immunity in certain communities, which would prevent
illness and death from being limited and from such communities being
able to fully move on from COVID-era restrictions. This is especially
the concerning given the continued spread of variants, such as the
highly transmissible ``Delta'' variant first identified in India. The
Delta variant is quickly becoming the predominant variant in many
countries and now makes up at least 19 percent of all cases in the
U.S.; as an illustration of how quickly it is spreading, on May 22, the
variant made up only 2.7 percent of cases. The CDC also now designated
Delta as a variant of concern, which means the agency officially
recognizes that the variant may carry a risk of more severe illness and
transmissibility. In addition to Delta, the CDC has noted five other
variants of concern.
The rapid rise of the Delta variant in the United Kingdom--where it
now accounts for 90 percent of cases--has slowed that nation's
reopening efforts by four or five weeks and should serve as a warning
to other countries. At the same time, other parts of the world are
experiencing their worst COVID-19 surges yet, and in addition to issues
accessing COVID-19 vaccines in many countries, a recent Gallup poll
showed that 1.3 billion people or 32 percent of adults worldwide are
unwilling to get vaccinated. Until more people in the U.S. and around
the world are fully vaccinated, especially as international travel
increases this summer, the global pandemic will be far from over.
Vaccine Hesitancy and Refusal
Unfortunately, there has been increasing vaccine refusal and
hesitancy over the past several years in the U.S. In many cases, this
lack of confidence has surrounded established vaccines despite long
track records of safe and effective use in the population. With vaccine
hesitancy on the rise, as well as the ongoing spread of medical
misinformation and disinformation related to COVID-19, it should not be
surprising that there has been, and continues to be, even greater
concern regarding the safety and efficacy of a vaccine developed
through ``Operation Warp Speed'' in a much shorter timeframe than has
usually been the case for past vaccines.
Moreover, trust in scientific institutions, public health, and
health professionals has been seriously eroded, especially throughout
the course of the pandemic, and this has spilled over to fear of the
vaccines and potential side effects. There are a several reasons for
this, including the spread of misinformation and disinformation and
conspiracy theories, particularly by social media, and the
politicization of COVID-19 and COVID-19 vaccines. Black Americans, for
example, report lower levels of trust in the health care system, a
result of historical abuses such as the Tuskegee study (in which Black
people were experimented on without their consent), but also day-to-day
discrimination they often experience during health care encounters.
However, vaccine confidence has grown since February among Black
adults, with about 14 percent more saying in May that they already had
been vaccinated or planned on being vaccinated.
Among the most challenging issues to address is that the highly
partisan nature of the Nation's politics has spread to many aspects of
interpersonal discourse, including the highly politicized debate over
COVID-19 vaccines. According to the Kaiser Family Foundation, hesitancy
is the highest among some Republicans, specifically men, who have
questioned the severity of the COVID-19 pandemic and have significant
doubts and concerns about vaccination, and who have expressed unease
about government mandates of vaccines and personal liberties/freedoms.
In addition, White evangelicals, who have similar concerns and doubts
but also are concerned about regarding rumors of the use of fetal
tissue in vaccines, are among the most reluctant; a March poll by the
nonprofit Public Religion Research Institute found that White
evangelicals ranked highest among those who are religious and refusing
to get vaccinated. Only 45 percent of White evangelicals said they
would get the vaccine, the second-lowest acceptance of any religious
affiliation behind Latino Protestant groups. Another reluctant group is
young adults, who do not believe they are susceptible to COVID-19 or
that it poses a risk to them and are the most likely group to engage in
behaviors that result in high rates of transmission. With the rise in
the Delta variant, it is critical that this group is vaccinated. Women
in this group are also more susceptible to false information regarding
vaccine impact on menstruation and fertility, as well as concerns
regarding pediatric vaccinations.
While it is beyond the scope of this hearing and not the intent of
the AMA to engage in a First Amendment debate, the role of social media
in allowing misinformation/disinformation to spread rapidly and
unchecked must be acknowledged. This allows medical misinformation to
be conveyed as real news. While social media has the potential to help
provide accurate, evidence-informed health information, during the
pandemic it has contributed significantly to vaccine hesitancy with
very little being done, until recently, to combat the spread of
blatantly false information. This has done tremendous damage to vaccine
confidence in certain groups, such as women of child-bearing years--for
example, rumors about vaccines impacting fertility have been rampant
and difficult to overcome. In December 2020, the AMA wrote to the chief
executive officers of leading technology companies, urging them to
guard against disinformation that could derail the vaccination campaign
and to remain vigilant against the proliferation of unintentional
misinformation and purposeful disinformation on their platforms. The
AMA further stressed how important it is for social media platforms to
share timely, transparent, and accurate information about COVID-19
vaccines from public health institutions like the U.S. Food and Drug
Administration (FDA) and the CDC that are rooted in science and
evidence.
At the AMA's policy meeting last week, the AMA adopted new policy
to address misinformation on social media. The House of Delegates
directed the AMA to:
Encourage social media companies and organizations to
further strengthen their content-moderation policies related to
medical and public health misinformation, including enhanced
content monitoring, augmentation of recommendation engines
focused on false information, and stronger integration of
verified health information.
Encourage social media companies and organizations to
recognize the spread of medical and public health
misinformation over dissemination networks and collaborate with
relevant stakeholders to address this problem as appropriate,
including but not limited to altering underlying network
dynamics or redesigning platform algorithms.
Support the dissemination of accurate medical and
public health information by public health organizations and
health-policy experts.
Work with public health agencies in an effort to
establish relationships with journalists and news agencies to
enhance the public reach in disseminating accurate medical and
public health information.
Delegates also modified existing policy that calls on the AMA to
support COVID-19 vaccination and information programs. According to the
amended policy, the AMA will educate the public about up-to-date,
evidence-based information regarding COVID-19 and associated
infections, as well as the safety and efficacy of COVID-19 vaccines, by
countering misinformation and building public confidence. Moreover, the
AMA will educate physicians and other health care professionals on ways
to disseminate accurate information and methods to combat medical
misinformation online.
Vaccine Access Issues
Concern over access, especially equitable distribution and
availability, to the COVID-19 vaccines has been a top AMA concern since
the vaccines received FDA emergency use approvals. Preventing racial
disparities in the uptake of COVID-19 vaccines has been, and continues
to be, critical to mitigate the disproportionate impacts of the virus
for people of color and prevent widening racial health disparities
going forward. According to Thomas R. Frieden, MD, MPH, former director
of the CDC during the Obama administration, the biggest impediment to
getting more people fully vaccinated for COVID-19 is access, not
vaccine hesitancy. During an episode of the ``AMA COVID-19 Update''
examining vaccine hesitancy and the role of politics at the end of May,
Dr. Frieden stated, ``Most of the people who are not yet vaccinated
aren't strongly opposed to being vaccinated. They just haven't had the
vaccine be as convenient as it should be.'' He stressed that providing
easier access to vaccines ``means walk-in hours. That means easy
locations, easy hours, supporting transportation and setting up pop-up
sites outside of everywhere, from ball games to bars to bowling alleys
to shopping centers. We need to make it the default choice, basically,
to get a vaccine.'' The AMA strongly agrees. We must ensure that
communities struggling with access are met where they are. These
communities need local solutions and partnerships with local leaders to
find the best possible strategies to bringing vaccinations to
communities struggling with access.
Some communities have been falsely accused of driving vaccine
hesitancy, when easy access to vaccines, lack of transportation to
vaccine sites, and concerns about issues such as unpaid time off for
vaccination are driving lower rates of vaccination. Health care
services are not as easily accessible in many communities of color.
These communities also struggle with being able to find time to both
get vaccinated and recover from any potential side-effects of the
vaccine. Taking time off work to get vaccinated can result in lost jobs
or pay for many, which makes getting vaccinated difficult and has led
to many individuals deciding not to get vaccinated. According to a
recent issue brief, ``Latest Data on COVID-19 Vaccinations by Race/
Ethnicity,'' by the Kaiser Family Foundation, Black and Hispanic people
have received smaller shares of vaccinations compared to their shares
of cases and compared to their shares of the total population in most
states. The share of vaccinations received by Black people also
continues to be smaller than their share of deaths in most states and
the share of vaccinations received by Hispanic people is similar to or
higher than their share of deaths in most reporting states, although in
some states it continues to be lower. For example, in California, only
29 percent of vaccinations have gone to Hispanic people, while they
account for 63 percent of cases, 48 percent of deaths, and 40 percent
of the total population in the state. Similarly, in the District of
Columbia, Black people have received 41percent of vaccinations, while
they make up 56 percent of cases, 71 percent of deaths, and 46 percent
of the total population.
Rural communities also lag behind urban areas in vaccination rates.
These communities frequently lack easy access to health care. Since
they have higher proportions of uninsured and those with comorbidities,
leading to higher risks of morbidity and mortality from COVID-19, it is
essential to ensure they are vaccinated. Rural areas in the Southern
U.S. are particularly at risk, especially since the Delta variant is
about 12 to 14 percent of cases in the South, higher than the national
average.
AMA Activities to Encourage Vaccination
The AMA and its physician and medical student members, as well as
its partners in medical specialty and state societies, have worked
tirelessly during the pandemic to educate physicians, their patients,
and the public about the safety of the COVID-19 vaccines, dispelling
myths and misinformation about the vaccines, and building confidence in
patients' willingness to get a vaccination. Physicians remain one of
the most trusted sources of information for patients on COVID-19
vaccines and it is critical to continue to involve physicians in this
work and ensure physicians are able to vaccinate potentially hesitant
patients. It makes a big difference to be able to talk to patients
face-to-face about their vaccine concerns and answer questions and be
able to vaccinate them while they are onsite in the office for an
appointment. That is why we have urged, and continue to urge, that
vaccines be distributed to physician offices. Physicians are leading by
example, with a recent survey among practicing physicians conducted by
the AMA showing that more than 96 percent of surveyed U.S. physicians
have been fully vaccinated for COVID-19, with no significant difference
in vaccination rates across regions. Of the physicians who are not yet
vaccinated, an additional 45 percent do plan to get vaccinated.
More specifically, the AMA has developed dozens of resources free
on our website, including the flagship Journal of the American Medical
Association (JAMA) website to ensure physicians have a clear
understanding of the COVID-19 vaccines, including the development
process and the safety and efficacy data underlying them so they are
prepared to discuss this with their patients. The AMA also strongly
encouraged Federal officials to be as transparent as possible
throughout the vaccine development process, to explain the key steps,
and to share the vaccine trial data, and we continue to provide updates
on a regular basis, including through the COVID-19 (2019 novel
coronavirus) Resource Center for Physicians on the AMA website. We also
developed extensive frequently-asked-questions documents on COVID-19
vaccination covering safety, allocation and distribution,
administration and more. There are three FAQs documents, one designed
to answer patients' questions, another to address physicians' COVID-19
vaccine questions and a third to address physicians' clinical concerns.
The AMA also launched a free AMA webinar series specifically for
physicians called What Physicians Need to Know that aims to gain fact-
based insights from the Nation's highest-ranking subject matter
experts, including from the FDA and CDC. The most recent episode
focused on vaccine misinformation. The AMA recently joined other
leading organizations and corporations in a national campaign with the
Ad Council and the COVID Collaborative, which are leading a massive
communications effort to educate the American public and build
confidence around the COVID-19 vaccines. The COVID-19 Vaccine Education
Initiative is designed to reach different audiences, including
communities of color who have been disproportionately affected by
COVID-19.
The AMA is also encouraging all state and medical specialty members
to help involve their members in efforts to increase COVID-19
vaccination rates and ensure COVID-19 vaccination is equitable. The AMA
has partnered with Made to Save, a national organizing campaign working
closely with the Biden administration to help increase vaccine equity
and access in communities of color. Made to Save has identified
individuals most likely not to be vaccinated and is asking for
assistance in reaching those people through a number of events for
health care providers. These upcoming events include ``Housecalls,'' a
phone banking opportunity where physicians and other health care
providers are invited to call people in key communities to listen to
their concerns, answer any questions, and help them get their shots.
Made to Save is also sponsoring ``Ask Me Anything about COVID-19,''
where physicians and health care providers participate in one-on-one
conversations in their community about vaccination.
Lessons Learned
There have been many lessons learned throughout the pandemic,
especially about the importance of open communication, information
sharing, and targeted messaging, particularly focused on specific
populations and communities. Whether for medical, political, religious,
or other personal reasons, all vaccine-hesitant groups need to be
engaged to reach a common understanding of why these vaccines are
important--not only for the health of individuals and their families,
but for the health of the country. Physicians have more work to do to
reach all communities with a clear and consistent message: that the
vaccines for COVID-19 are safe, they are effective, and that they have
followed the same rigorous scientific process that every vaccine does
before it reaches the public. In addition, specific messages and
initiatives need to be geared to different populations and communities:
what works for one individual or in one community may not work for a
different individual or in another community. Physicians have played a
critical role throughout the COVID-19 vaccination campaign and will
continue to have a leading role as vaccine ambassadors in educating and
their patients and communities about why they should get vaccinated.
The AMA believes the following lessons learned are critical to move
beyond this pandemic and be able to address the next one:
Transparency and early information sharing from
government officials is critical, based upon evidence and
science rather than politics.
Trust must be restored in science, scientists, and
public health professionals--public health officials need to be
empowered to communicate clear, consistent, and credible
evidence-based public health information to the public.
The spread of misinformation and disinformation,
especially from online sources, must be addressed.
Private physicians need to be involved as partners
early in all phases of a vaccination campaign, including
planning and implementation.
Increased Federal, state, and local funding is needed
to modernize the Nation's public health data systems to improve
the quality and timeliness of data and support electronic case
reporting, which alleviates the burden of case reporting on
physicians through the automatic generation and transmission of
case reports from electronic health records to public health
agencies for review and action in accordance with applicable
health care privacy and public health reporting laws.
Public health preparedness and response must be
bolstered, including surveillance systems, preparedness and
response efforts, and leadership capabilities of public health
agencies. Public health agencies will need considerable support
to maintain core public health activities: detecting and
investigating cases, identifying underlying causes and
etiologies, assessing the needs of vulnerable communities,
communicating with the public, collecting data and developing
comprehensive plans with stakeholders to enact actions for
mitigation, preparedness, response, and recovery.
Communities of color and underserved communities
should receive early intervention in any future pandemic and
vaccination campaign, given their disproportionate lack of
access to health care.
Conclusion
The United States is emerging from the most serious public health
crisis we have faced in a century, but much work remains to be done
before the pandemic can be declared over or no longer a threat. It will
take all of us--government, physicians and other health care
professionals, communities, individuals--working together to get as
many people vaccinated as soon as possible. Widespread access to
accurate, evidence-based information that is grounded in science is key
to our success. The AMA and our members are strongly committed to
ending this global pandemic and to fighting medical misinformation. The
AMA looks forward to working with Members of this Committee and your
colleagues to advance these critical goals.
______
[summary statement of susan bailey]
The American Medical Association (AMA) appreciates the opportunity
to provide testimony to the HELP Committee as part of its June 22, 2021
hearing entitled ``Vaccines: America's Shot at Ending the COVID-19
Pandemic.'' the AMA and our members have been, and continue to be,
strongly engaged and committed to confronting and ending the
unprecedented COVID-19 pandemic and ensuring that as many people as
possible are vaccinated against COVID-19 (SARS-CoV-2). Physicians have
a critical role as trusted Ambassadors in the current vaccination
campaign, and the AMA has helped prepare our members to be ready and
able to educate their patients and the public to reduce vaccine
hesitancy and refusal.
The United States is at a critical juncture in its battle against
the COVID-19 pandemic. While there has been a sharp decline in new
infections and deaths, over 600,000 Americans are known to have died
from COVID-19, and people are still dying from the virus and related
complications, particularly in certain parts of the country and among
certain population groups. COVID-19 remains a very serious threat, yet
much has changed in the last few months to give us hope that the worst
of the pandemic may be behind us. Large numbers of the population
remain unvaccinated and are hesitant to receive the shot for personal,
religious, or political reasons or due to vaccine access issues.
Unfortunately, there has been increasing vaccine refusal and
hesitancy over the past several years in the U.S.. With vaccine
hesitancy on the rise, as well as the ongoing spread of medical
misinformation and disinformation related to COVID-19, it should not be
surprising that there has been, and continues to be, even greater
concern regarding the safety and efficacy of a vaccine. Moreover, trust
in scientific institutions, public health, and health professionals has
been seriously eroded, especially throughout the course of the
pandemic, and this has spilled over to fear of the vaccines and
potential side effects. While it is beyond the scope of this hearing
and not the intent of the AMA to engage in a First Amendment debate,
the role of social media in allowing misinformation/disinformation to
spread rapidly and unchecked must be acknowledged. This allows medical
misinformation to be conveyed as real news. While social media has the
potential to help provide accurate, evidence-informed health
information, during the pandemic it has contributed significantly to
vaccine hesitancy with very little being done, until recently, to
combat the spread of blatantly false information.
Concern over access, especially equitable distribution and
availability, to the COVID-19 vaccines has been a top AMA concern since
the vaccines received FDA emergency use approvals. Preventing racial
disparities in the uptake of COVID-19 vaccines has been, and continues
to be, critical to mitigate the disproportionate impacts of the virus
for people of color and prevent widening racial health disparities
going forward. There have been many lessons learned throughout the
pandemic, especially about the importance of open communication,
information sharing, and targeted messaging, particularly focused on
specific populations and communities. Whether for medical, political,
religious, or other personal reasons, all vaccine-hesitant groups need
to be engaged to reach a common understanding of why these vaccines are
important--not only for the health of individuals and their families,
but for the health of the country. It will take all of us--government,
physicians and other health care professionals, communities,
individuals--working together to get as many people vaccinated as soon
as possible. Widespread access to accurate, evidence-based information
that is grounded in science is key to our success. The AMA and our
members are strongly committed to ending this global pandemic and to
fighting medical misinformation. The AMA looks forward to working with
Members of this Committee and your colleagues to advance these critical
goals.
______
The Chair. Thank you very much.
Dr. Nichols.
STATEMENT OF MICHELLE NICHOLS, M.D., M.S., ASSOCIATE DEAN OF
CLINICAL AFFAIRS, MOREHOUSE SCHOOL OF MEDICINE, ATLANTA, GA
Dr. Nichols. Good morning, Chair Murray, Ranking Member
Burr, and Members of the Committee on Health, Education, Labor,
and Pensions. Thank you very much for convening this important
hearing on Vaccines: America's Shot at Ending COVID-19
Pandemic.
I am Dr. Michelle Nichols, and I am presenting testimony on
behalf of Morehouse School of Medicine, and I bring you
greetings from President and Dean, Dr. Valerie Montgomery Rice.
I am a family physician, and I am the Medical Director of our
COVID-19 Community Vaccination program, as well as the
Associate Dean for Clinical Affairs.
According to the CDC, the COVID-19 pandemic has brought
social and racial injustice and inequity to the forefront of
public health, and that has applied to vaccines, as well. We
were an early adopter in becoming a COVID-19 community
vaccinator, vaccine provider. Based on our commitment to health
equity and being a trusted entity within the African-American
community in both healthcare and research, we knew that we must
tackle the hesitancy, mistrust, misinformation, and myths. We
knew what we had to do to tackle this virus.
When vaccinations were first offered to the 75 years and
older population in early January, we did a kickoff event and
invited legendary civil rights leaders to become vaccinated
because we wanted to build confidence and trust in the
community. As we were vaccinating, we were concurrently doing
educational programs, doing weekly town halls, panel
discussions, and community outreach programs.
Lessons learned from our first couple of months of the
vaccinations led us to applying for and receiving grant funding
to reach beyond Atlanta, Georgia via our traveling vaccination
mobile program. Since we are a trusted entity within the
communities of color, over 75 percent of our vaccine recipients
have been African-American, compared to only approximately 9.9
percent nationally, based on yesterday's CDC data.
To help expand vaccinations in our Hispanic community, we
started engaging and partnering with Latino organizations and
the consulate, and particularly the Mexican Consulate, because
patients tend to trust people who look like them, talk like
them, and have similar backgrounds in education and
experiences, which resulted in our current Latino vaccination
rate being 13 percent, which has positively impacted the
Hispanic population rate, vaccination rate, in Georgia.
At Morehouse School of Medicine, with our community
outreach and focus on decreasing health disparities,
vaccinations for Black and Brown people and communities of
color represent approximately 88 percent of our vaccinations.
Lessons learned over the last 6 months are to impact trust
by engaging the community and being part of the community, as
well as having vaccinators who look like, sound like, and have
similar experiences. Also, providing information and education
to dispel myths and misinformation and to educate and make sure
that material is multilingual, also multimedia, and also with
the appropriate educational level, and to meet people where
they are in their vaccine journey, and to know that we are
ready to vaccinate whenever they are.
As far as our adolescents, we want to engage and educate
both the parents and the children and plan back-to-school
vaccine events with incentives, such as book bags and supplies.
And, at the same time, doing school physicals, preventive
health reviews, and health checks. And when people come to get
tested for COVID-19, we need to vaccinate them at the same
time. We need to travel where the vaccine recipients are and
make it as convenient as possible. And finally, we do not want
to politicize this. We need to stay focused on the goal and
educate and meet people where they are in their vaccine
journey.
Thank you for the opportunity to share our views with you.
I am pleased to respond to any questions. Thank you.
[The prepared statement of Dr. Nichols follows:]
prepared statement of michelle nichols
Chair Murray, Ranking Member Burr, and Members of the Committee on
Health, Education, Labor, and Pensions, thank you very much for
convening this important hearing on ``Vaccines: America's Shot at
Ending the COVID-19 Pandemic.''
I am Michelle Nichols, MD, MS and am presenting testimony on behalf
of Morehouse School of Medicine (MSM). I bring greetings to you from
our President and Dean, Dr. Valerie Montgomery Rice. At Morehouse
School of Medicine, I serve as associate professor of family medicine,
medical director of Morehouse Healthcare (MHC) which is our faculty
practice plan, medical director of MSM/MHC Community COVID-19
Vaccination Program, and Associate Dean for Clinical Affairs.
According to the CDC, the COVID-19 pandemic has brought social and
racial injustice and inequity to the forefront of public health.
Unfortunately, it has highlighted that health equity is far from being
a reality since COVID-19 has unequally impacted many racial and ethnic
minority groups, putting them at greater risk for infections,
hospitalizations, death, and access to vaccinations. These findings
were not a surprise to us at Morehouse School of Medicine since we are
on the front lines in leading the creation and advancement of health
equity by engaging, educating, serving, and providing healthcare and
research in communities of color.
When the opportunity presented itself in December to become a
community vaccine provider, Morehouse School of Medicine became an
early adopter. Based on our commitment to health equity and being a
trusted entity within the African American community in both healthcare
and research, we knew that we must tackle the hesitancy, mistrust,
misinformation, and myths associated with not only the vaccine but also
the novel coronavirus in general. When vaccinations were first offered
to those 75 years and older in early January, we did a kick-off vaccine
event and invited and vaccinated Atlanta's prominent civil rights,
church, and community leaders, legendary icons and role models, all
whom were >75 years old such as former Ambassador and civil rights
leader Reverend Andrew Young, former HHS secretary Dr. Louis Sullivan
and other prominent >75 year old Atlanta legends, whom all consented to
publicly be vaccinated so they can impact trust and to serve as role
models (like they had done earlier as trail blazers in the civil rights
movement and their careers) as we rolled out vaccinations for the
seniors. Within days after that event, we set up a drive through
vaccine event on our campus doing the first week in January and
continued these events for 2 months. Since we are an academic health
center, we engaged our students to not only vaccinate (vaccinators for
medical students and PA students) but also to provide preventive health
information (navigators for MPH and graduate students) during the
observation period. This was very important because the pandemic
resulted in many people missing on several preventive health services
such as mammograms and colonoscopies and we wanted to encourage people
to resume their in-person healthcare and procedures. We also helped
vaccine recipients complete paperwork and register for CDC V-safe while
waiting. As we were vaccinating, we were concurrently doing educational
programs through weekly town halls, panel discussions, community
outreach programs, Public Service Announcements, and social media.
Lessons learned from the first 2 months of vaccinations were that
the keys to success were community engagement, education,
accessibility, and outreach. This led to us applying for and receiving
grants to expand our reach beyond Atlanta, through our mobile unit for
the traveling vaccination program that started in April.
Since Morehouse School of Medicine is one of the four HBCU medical
schools, we are a trusted entity in the community. This has resulted in
over 75 percent of our vaccine recipients being African American
compared to only approximately 9 percent nationally based on recent CDC
data tracker from June 18, 2021. Additionally, starting in March as the
vaccine supplies increased, we expanded our vaccination outreach and
review of other vulnerable populations, and the DPH data on vaccination
rate within the Hispanic community stood out as being low in Georgia.
To help expand vaccination in the Hispanic community, we started
engaging and forming partnership with Latino organizations and the
Mexican consulate. Additional keys to success in impacting trust in the
Latino community were through the consulates and traveling to the
consulate facilities to vaccinate. Patients tend to trust people who
look like them and have similar backgrounds and experiences. For these
events, we also added and engaged our bilingual Spanish speaking
students, nurses, and providers to vaccinate and educate. Currently, as
we expand on our traveling vaccination program, we have started to
engage with other Latino consulates as we go into rural migrant
agricultural areas. From this we have learned that other languages and
educational materials must be done besides English and Spanish. For
example, as a result of engaging the other consulates-consents, videos,
and educational materials were developed using the Mayan language.
Because of these efforts, we are reaching more communities of color. At
MSM, our current Latino vaccination rate is 13 percent which has
positively impacted the Hispanic vaccination rate in Georgia. At MSM,
with our community outreach and focus on decreasing health disparities,
vaccinations for communities of color represent approximately 88
percent of our vaccinations.
Lessons learned over the last 6 months are:
(1). Impact trust by engaging the community and being a part of
the community as well as having vaccine providers who look
like, sound like, or have similar experiences and backgrounds
to the vaccine recipients. Define the community (church, civic
organization, consulates, ethnic organizations, HBCUs, schools,
sports, etc.) and determine who are the best spokespersons
(civic rights or community leaders, athletes, people that look
like them and speaks their language, etc).
(2). Provide information and education to dispel myths and
misinformation and to educate on vaccines through panel
discussion, town halls, media, PSAs, social media, Q&As,
pamphlets. Ensure material is multi-lingual, multi-media, and
at appropriate educational levels. Do not make assumptions. Do
not stereotype.
(3). Meet people where they are in their vaccine journey.
Realize that not everyone is ready to be vaccinated. Do not
judge. Let potential vaccine recipients know that we are ready
to vaccinate them whenever they are ready.
(4). As for adolescents, engage and educate both the parents
and children (12-17 year olds) so that our schools can resume a
sense of normalcy again, plan back-to-school vaccine events
with incentives (book bags, school supplies, etc.) while at the
same time doing sports physicals, preventive health reviews,
and health checks.
(5). When people come for testing because of potential fear of
exposure, offer vaccinations at the same time. Never waste an
opportunity to educate and vaccinate.
(6). Travel to where the vaccine recipient is and make it
convenient (go to school/college, work, home for the homebound
and senior communities, sporting events, fitness centers, rural
areas, etc.)
(7). Do not politicize. Stay focused on the goal, educate, and
meet people where they are and vaccinate.
Morehouse School of Medicine because of its mission is uniquely
positioned to help boost vaccination rates because we are viewed as a
trusted source of COVID-19 help, health, and vaccine information within
communities of color.
Thank you for the opportunity to share our views with you. I am
pleased to respond to any questions.
______
[summary statement of michelle nichols]
I am Michelle Nichols, MD, MS and am presenting testimony on behalf
of Morehouse School of Medicine (MSM). At MSM, I serve as associate
professor of family medicine, Medical Director of Morehouse Healthcare
(MHC) which is our faculty practice plan, Medical Director of MSM/MHC
Community COVID-19 Vaccination Program, and Associate Dean for Clinical
Affairs.
Beginning in December 2020, based on our commitment to health
equity and being a trusted entity within the community in both
healthcare and research, Morehouse School of Medicine endeavored to
serve as a community vaccine provider and to tackle the hesitancy,
mistrust, misinformation, and myths associated with not only the
vaccine but also the novel coronavirus in general.
To date, over 75 percent of our vaccine recipients have been
African American, compared to only approximately 9 percent nationally,
based on recent CDC data tracker from June 18, 2021. Given our
intentional efforts to reach more communities of color, our current
Latino vaccination rate is 13 percent which has positively impacted the
Hispanic vaccination rate in Georgia.
In our efforts to continue to advance health equity by providing
vaccinations to our community, we have learned several critical
lessons. These lessons learned will be expanded upon in my testimony,
but can be best summarized as:
(1). The keys to success are in community engagement,
education, accessibility, and outreach.
(2). Impact trust by engaging the community and being a part of
the community as well as having vaccine providers who look
like, sound like, or have similar experiences and backgrounds
to the vaccine recipients. Define the community (church, civic
organization, consulates, ethnic organizations, HBCUs, schools,
sports, etc) and determine who are the best spokespersons
(civic rights or community leaders, athletes, people that look
like them and speak their language, etc).
(3). Provide information and education to dispel myths and
misinformation and to educate on vaccines through panel
discussion, townhalls, media, PSAs, social media, Q&A's,
pamphlets. Ensure material is multi-lingual, multi-media, and
at appropriate educational levels. Do not make assumptions. Do
not stereotype.
(4). Meet people where they are in their vaccine journey.
Realize that not everyone is ready to be vaccinated. Do not
judge. Let potential vaccine recipients know that we are ready
to vaccinate them whenever they are ready.
(5). As for adolescents, engage and educate both the parents
and children (12-17 yo) so that our schools can resume a sense
of normalcy again, plan back-to-school vaccine events with
incentives (bookbags, school supplies, etc) while at the same
time doing sports physicals, preventive health reviews, and
health checks.
(6). When people come for testing because of potential fear of
exposure, offer vaccinations at the same time. Never waste an
opportunity to educate and vaccinate.
(7). Travel to where the vaccine recipient is and make it
convenient (go to school/college, work, home for the homebound
and senior communities, sporting events, fitness centers, rural
areas, etc.).
(8). Do not politicize. Stay focused on the goal, educate, and
meet people where they are and vaccinate.
______
The Chair. Thank you.
Mr. Chang.
STATEMENT OF CURTIS CHANG, CONSULTING PROFESSOR, DUKE DIVINITY
SCHOOL, SAN JOSE, CA
Mr. Chang. Senators, the road to ending the pandemic runs
through the evangelical church, especially the White
evangelical church. At the national level, White evangelicals
comprise the single largest vaccine-hesitant demographic in the
Country, with almost half signaling that they will not get
vaccinated.
At the state level, if you took a map of the least-
vaccinated states, it corresponds very tightly to a map of the
Bible Belt, with some states not reaching even one-third
vaccination rates.
At the global level, American evangelical culture is highly
influential in parts of Asia and Africa. We are already
exporting our misinformation and fears to the rest of the
world, especially via social media.
Reaching every demographic in our Country matters, but we
are not ending the pandemic unless we convince more White
evangelicals to get vaccinated. And this is why I, along with
Chris Carter, who is here today, founded Christians and the
Vaccine. It is a partnership with the Ad Council, COVID
Collaborative, the National Association of Evangelicals, and
Values Partnerships. We have produced and distributed a range
of online video content to equip the evangelical community to
address vaccine hesitancy in our own community.
Why are White evangelicals so hesitant? Well, vaccine trust
is essentially a proxy for institutional trust. Every one of us
only takes the vaccine to the extent we trust the FDA, the CDC,
pharmaceutical companies, and public health. Unfortunately, the
level of distrust among White evangelicals with large
institutions is at an all-time high.
Now, there's complex and longstanding reasons for this
growing distrust. Our own communities' vulnerability to
misinformation is certainly a big factor. But, in the context
of the vaccine, this tendency toward distrust has been
exacerbated by public health's inattention and overlooking this
particular community. While there has been hammering about
evangelical attitudes in the mainline media, there has been
little targeted outreach from public health. As one state
health official admitted to us, she said, we have spent maybe 2
minutes thinking about White evangelicals.
To the extent that the public health has engaged with faith
communities, it has overwhelmingly been with minority faith
communities, where it has succeeded with remarkable effect,
driving a 10-point jump in vaccine acceptance among Black
Protestants in just a few months of outreach.
Now, this racial equity emphasis has been absolutely
necessary, given historical inequities and current barriers of
access. However, this focus has not been matched by attention
to the largest and most vaccine-hesitant community. And this
inattention is simply counterproductive in a national pandemic
where we are all connected. As a person of color, I need public
health to focus on White evangelicals because what they decide
affects my community.
As our work has gained prominence, we did have the
opportunity to speak with several key national public health
institutions, all of whom showed great interest. However, they
had no available pathway to partner with us to expand our
efforts. Again, a key reason given was the fact that our focus
did not fit the minority-focused communities.
Another issue was that the vast majority of Federal funding
on vaccine outreach simply gets distributed to state public
health agencies, meaning there is no efficient pathway for the
Federal Government to partner with us on a coordinated national
outreach.
But, it is not too late. It is not too late to persuade the
White evangelical community. Faith-based efforts do work as
demonstrated by the success reaching Black Christians. And one
very recent study by PRRI showed that 44 percent of vaccine-
hesitant evangelicals say that they would still be influenced
by faith-based efforts.
The key recipe is a partnership between public health and
faith leaders in the evangelical community. The message and the
voice have to come from the faith leaders themselves because
they are the trusted voices. But, public health can make a big
difference by convening the faith leaders, by providing
resources to amplify their voices, and then especially by
taking cues from those faith leaders on which public health
efforts will work in their communities.
The last point about taking cues from faith leaders is
critical because there is no one-size-fits-all approach. For
instance, what works in the Black church, such as having
churches host vaccination sites, often does not work in the
White evangelical church context.
I respectfully submit the following two requests to this
Committee for consideration. First, please consider
supplementing the current state-focused approach with
additional resources and national coordinated outreach. A
state-by-state approach may be effective in some health issues,
but in pandemic, we need coordination.
Then, finally, please direct Federal outreach to pay
attention to White evangelicals. This community requires a
specific type of outreach, and failure to do so puts all
communities at risk.
[The prepared statement of Mr. Chang follows:]
prepared statement of curtis chang
The pathway to ending the pandemic runs through the evangelical
church. Almost half of all white evangelicals are resistant to getting
vaccinated. The sheer size of this population nationally and within
concentrated regions mean evangelicals could make or break the
vaccine's potential to restore life to normal in communities across the
country. Yet for many outside the evangelical world, this resistance
seems incomprehensible.
As life-long evangelicals, we worry about how our people could
become a barrier for recovery from the pandemic. But as insiders, we
also have an understanding of how we got here. Evangelical resistance
to the vaccine is driven by larger forces that have reshaped our
tribe's relationship with the broader secular world. Vaccine outreach
efforts to our community must account for these deeper dynamics, and
should partner with evangelical leaders who know best how to navigate
this altered landscape.
For everyone--evangelical or not--the decision to take the vaccine
is essentially a decision to trust institutions. Few of us are equipped
to understand the vaccines' scientific complexities. We only take the
vaccine when we decide to trust ``Them:'' the constellation of
scientific, government, and media institutions assuring everyone that
the vaccine is truly safe, effective, and necessary.
But what happens when this trust in ``Them'' is thoroughly
undermined within a particular community?
American evangelicals are historically prone to ambivalence toward
the dominant secular institutions of the day. In fact, a posture of
critical evaluation is built into the fabric of our faith. Evangelicals
interpret Jesus' teaching that his followers are in the world but not
``of the world'' (John 17:16) to mean we should engage with the world's
secular institutions with a certain measure of caution. In proper
doses, a certain amount of caution is healthy for all communities--not
just evangelicals. No institution is infallible, and critical thinking
can be a civic virtue.
Unfortunately, in recent years, the evangelical posture of critical
engagement with secular institutions has mutated from caution into
outright fear and hostility. Reminders to be on guard while engaging
``Them'' have turned into a belief that ``They are out to get us!''
Many social forces--both internal and external to our community--caused
this, but three current forces have especially exploited our built-in
ambivalence toward secular institutions.
First, conservative media have mastered the art of sowing
evangelical suspicion of ``the Establishment'' to attract our eyeballs
and grow their ratings. Second, politicians--some Christian and some
not--have mastered the art of leveraging fear of elite institutions to
gain our votes. Third, online conspiracy movements such as QAnon and
the anti-vaxxers--which are thoroughly secular in their origins--have
mastered the art of creating fictional enemies that are out to destroy
our values, and in the case of the vaccine, our actual bodies. All of
these forces now actively shape how large segments of our community
perceive the vaccine.
In our vaccine outreach with evangelicals, we hear a variety of
reasons for suspicion, ranging from common fears that the vaccine was
rushed to conspiracy theories that the vaccine contains tracking chips
or is the ``the mark of the beast''. But underneath all of those
diverse reasons is the sharply intensified reflex of institutional
distrust.
This reflex has taken root so rapidly that an alarming gap has
opened up between evangelical pastors and the people in their pews. One
survey from the National Association of Evangelicals conducted in
January showed that 95 percent of leaders were planning to take the
vaccine themselves, a marked contrast to other surveys that show 45
percent to 55 percent of evangelicals continuing to be reluctant on the
vaccine. This gap follows a well-researched trend of pastors feeling
afraid to speak on public issues for fear of alienating some portion of
their members.
Even so, there is a path forward. A just-released study from Public
Religion Research Institute and Interfaith Youth Core (PRRI/IFYC)
reveals two key encouraging truths. First, there still exists a large
``moveable middle'' even among vaccine-hesitant evangelicals. Second,
faith-based appeals--distinguished from secular public health appeals--
are an effective strategy. Among vaccine-hesitant white evangelicals,
47 percent said that more faith-based outreach would encourage them to
get the shot.
Several high-profile evangelical leaders have already begun faith-
based outreach. NIH Director Francis Collins, a well-known evangelical,
has worked tirelessly to promote the vaccine. BioLogos, a Christian
nonprofit that promotes the integration of faith and science, has
rallied other evangelical scientists for the cause. Russell Moore, head
of the Southern Baptist Convention's Ethics & Religious Liberty
Commission, has provided important guidance to the country's largest
Protestant denomination. Even Donald Trump-supporting conservatives
like Franklin Graham and Dr. Robert Jeffress have come out strongly in
favor of the vaccines, willingly enduring hostile reactions from their
base.
These national voices are important, but we are now at a pivotal
moment: the ground game phase of vaccination outreach. The PRRI/IFYC
study spotlighted that the remaining vaccine-hesitant evangelicals will
be most persuaded by a mixture of subtle, local and highly relational
efforts: e.g. people learning that their pastor or fellow church member
got vaccinated, or getting help from their church in scheduling a
vaccination appointment.
Evangelicals on the ground must take the lead in implementing these
efforts because the underlying problem is our community's distrust of
secular institutions. Resistance won't be overcome by more well-
intended PSAs from the Biden administration; it can only happen via
millions of granular exchanges like that between a pro-vaccine
evangelical and a vaccine-hesitant friend who attends the same church.
While evangelicals are best-equipped to reach evangelicals, secular
institutions still have a critical role to play, particularly to
achieve the scale of outreach necessary in this crucial moment.
Philanthropy, social media platforms, public health all can
meaningfully accelerate this ground game phase--if those institutions
are willing to partner with evangelicals.
American evangelicals must help our own community find their way
out of the thicket of vaccine confusion and distrust. But we still need
the partnership of secular institutions. The pandemic has provided this
Nation many lessons in humility, perhaps none greater than the
realization that none of us--and no sub-community--ever stands fully
alone.
______
[summary statement of curtis chang]
The road to ending the pandemic runs through the evangelical
church. At the national level, white evangelicals comprise the single
largest vaccine hesitant demographic. At the state level, a map of the
states with the lowest vaccination rates corresponds tightly with a map
of the Bible Belt. And at the global level, US evangelical culture is
already exporting our misinformation and fears to the rest of the
world, especially via social media.
Evangelicals are prone to vaccine distrust because vaccine trust is
essentially a proxy for institutional trust. Every one of us will take
the vaccine only to the extent that we trust the FDA, the CDC, public
health, pharmaceutical companies, and others. Unfortunately, white
evangelical distrust of institutions is at an all time high.
There are complex and longstanding reasons for this distrust. But
in the context of the vaccine, this distrust has been exacerbated by
public health overlooking the need to reach out to white evangelicals.
There has simply been little targeted outreach efforts from public
health.
To the extent that public health has engaged faith communities, it
has overwhelmingly been with minority faith communities, where it has
succeeded with remarkable effect, driving a 10 point jump in vaccine
acceptance among Black Protestants in just a few months of outreach.
The racial equity emphasis has been necessary, but it unfortunately has
excluded attention to the largest and most hesitant population, which
is counter-productive in a nationwide pandemic. Because of this
exclusive focus on minority communities, there has been no available
pathway to partner with the government to expand our efforts. Moreover,
the vast majority of Federal funding on vaccine outreach was simply
distributed to the state level, meaning there was no efficient pathway
for the Federal Government to partner with us on national outreach.
It is critical that faith based outreach increases for white
evangelicals with the COVID vaccine, and for future public health
crises. This is because studies show that faith based public health
outreach works. One study by PRRI showed that 44 percent of vaccine
hesitant evangelicals say that they would be influenced by faith based
efforts.
The key recipe is a partnership between faith leaders and public
health. The message and voice has to come most directly from trusted
voices within the faith community, but public health can make a big
difference in convening faith leaders, providing resources to amplify
those faith voices, and taking cues from those leaders on what public
health efforts work best in their particular communities. This last
point about taking cues from faith leaders is critical, because there
is no one-size-fits all approach.
We respectfully submit the following two requests to this Committee
for consideration: (1) Please direct Federal outreach efforts on the
vaccine and future public health crises to pay attention to white
evangelicals, in addition to minority faith communities; and (2) Please
direct public health funds on the vaccine to include coordinated
national outreach efforts.
______
The Chair. Thank you very much.
Dr. Betancourt.
STATEMENT OF JEANETTE BETANCOURT, Ed.D., SENIOR VICE PRESIDENT
FOR U.S. SOCIAL IMPACT, SESAME WORKSHOP, NEW YORK, NY
Dr. Betancourt. Thank you very much. Thank you, Senator
Murray, Senator Burr, and all of the Committee in terms of
HELP.
First of all, what I would love to do is introduce our
process that we have engaged in throughout the pandemic because
one of the things I am hoping to leave you with is the idea of
looking at young children's perspective, along with parenting.
At Sesame Workshop, which is the non-profit, global
organization whose mission is to help all children grow
smarter, stronger, and kinder, we continually, not only through
our programming, but through our social impact work, tackle the
toughest topics. We have dealt with parental addiction, foster
care, family homelessness. And throughout the process of the
pandemic, we have actually structured this to meet the stages
that families and children are engaged in throughout the
pandemic.
When the pandemic first hit, we called that stage the ``For
Now Normal.'' Suddenly, young children and their families were
in shelter-in-place. All the safety routines that are so
typical for young children were lost. They no longer had the
physical contact and routines that they generally have.
The next stage, that we are in now, is the ``Different But
Before Normal.'' In other words, we are transitioning back, but
it is in steps. And additionally, we are preparing children to
adjust, along with their families, to those steps.
However, they have had quite a bit of crisis. It is the
focus on our young children's and their families' mental health
that we need to look at as we are making decisions around
vaccination, as well.
We also look at our third stage as ``Long-Term
Consequences,'' what is the mental health of now this young
COVID generation.
Tying all those pieces together now, we have also
partnered, like many of the colleagues here, with the Ad
Council and the COVID Collaborative around messaging on
improving and informing parents with young children that they
should be vaccinated. There, the approach that we took is, how
do you return to those safety moments, those things that you
have missed before, that relevance to family life, and, also,
the relevance to young children's well-being in their safety
routines.
In addition to that, we created all of these resources
bilingually, in English and Spanish, in different formats. Not
only in terms of video, audio, and also digital resources that
can be posted, whether it is posters specific for the Latino
community, or the African-American Black community, or the
immigrant community. Again, using the trusted power of our
Muppets as a trusted source for parents and caregivers and
children.
Now, as we are reaching this next vital stage, we believe
very strongly of the idea of creating a circle of care, a
circle of safety, when we get to the stage of now encouraging
parents to vaccinate their young children.
But, I also ask you to look at the way we have messaged
thus far. Our role, many times, is, how do we message in a
friendly way for children and families and the adults who
influence them so that they are making the decisions for the
well-being of their children.
However, throughout the pandemic, and rightly so, we have
mentioned the young children are the least influenced or
impacted by the pandemic. Again, it is not adverse; it is true.
They are also very much likely the first to have returned to,
quote, school, early childhood programs, whether it is through
family, friend, and neighbor care, through center-based
programs, or family childcare.
From a parent's point of view, children, young children
especially below five, are Okay. The decision on vaccination
will be a little harder because, along the way, they have been
sort of told they are doing Okay. It is the priority on
children, on youth, and adults.
We are here to work with all of you, to partner, to also
continue our messaging. And we believe that the next stage of
convincing young parents in terms of vaccinating their young
children is the idea of forming a circle of safety. I do it. My
family does it. I include my children. But, also, the idea of
bringing back those valuable routines to young children's well-
being in which all of us, as a Nation, should be invested in.
Thank you very much for this opportunity, and I look
forward to your questions.
[The prepared statement of Dr. Betancourt follows:]
prepared statement of jeanette betancourt
Introduction
Good morning Chair Murray, Ranking Member Burr, and other
distinguished Members of the Committee on Health, Education, Labor, and
Pensions.
I am Jeanette Betancourt, Ed. D., Senior Vice President of U.S.
Social Impact at Sesame Workshop. I wish to thank all of you for the
opportunity to share Sesame Workshop's response to the COVID-19
pandemic, especially in meeting the sudden and evolving needs of young
children and, most recently, our focus on encouraging parents and
caregivers to get vaccinated as an important part of the whole family's
well-being. If I can leave you with only one major takeaway, apart from
the joy of sharing a few special moments with our Sesame Street
Muppets, it is the importance of considering the child's perspective
and of recognizing what children and families have experienced over the
past 18 months and how that has informed their decision-making process
regarding vaccination.
Who We Are
Sesame Workshop is the nonprofit global organization with a mission
to help children around the world grow smarter, stronger, and kinder.
We do so through a wide range of media, formal education, and
philanthropically funded social impact programs. Our iconic and beloved
Sesame Street premiered at the height of the Civil Rights movement with
the first racially integrated cast on children's television, and it has
remained a place where humans and Muppets of all shapes, sizes, and
skin (or fur!) colors model diversity, equity, inclusion, and mutual
respect and understanding. While our efforts are made on behalf of all
children--and all children stand to benefit from them--our primary aim
from the outset has been to improve outcomes and well-being among the
most marginalized children and their families, who are so often
impacted by the effects of poverty, trauma, and racial injustice.
Sesame Workshop's U.S. Social Impact team develops
philanthropically supported initiatives that address critical
challenges impacting children, parents, and caregivers as well as the
community providers who support them. Our initiatives are research-
driven, proven, and innovative, especially the wide-ranging and ever-
growing Sesame Street in Communities (SSIC), which creates and delivers
free bilingual resources in response to widespread issues such as:
trauma, food insecurity, a parent's incarceration, family homelessness,
divorce, school readiness, health and well-being, and other important
early childhood topics. These initiatives model parent and caregiver
strategies that are vital to ensuring that every child--especially
those most at risk--can succeed in school and in life. The success of
our initiatives is rooted in our approach, which ties together
curriculum, research, and accountability for achieving results. We are
also extremely nimble, with the ability to respond immediately to
crises or plan out for the longer term.
Our COVID-19 Response: Caring for Each Other
The COVID-19 pandemic prompted unprecedented disruption and
uncertainty in the lives of young children and their families. We knew
immediately that we had a responsibility to respond and that, having
built a half-century's worth of trust and dependability among parents,
we were uniquely positioned to explain for children the many changes
that were so dramatically altering family life, while offering
responses to their questions and concerns. Sesame Workshop acted
quickly. To help young children feel a sense of comfort, engage in
playful learning away from school, and maintain a more hopeful outlook,
we created our Caring for Each Other (CFEO) initiative and the SSIC
Health Emergencies topic page and brought families clarity, comfort,
and moments of joy through televised specials such as Sesame Street:
Elmo's Playdate and a series of CNN Town Halls.
Foreseeing the ongoing impact of constant change in children's
lives, we developed a phased approach to meeting the needs of
families--as always, from the child's perspective. We grouped our
efforts into three stages, creating bilingual CFEO resources for each,
aligned with the progression of change as the COVID-19 pandemic
evolved.
For Now Normal: Initially, families and their young
children found themselves dealing with a complete halt to their
everyday routines, the need to shelter-in-place, and facing
questions about a deadly virus that did not have a child-
friendly explanation. As families settled into a ``for now
normal,'' CFEO offered ways to support children's emotional ups
and downs, including challenges such as missing friends, coping
with sickness, and grieving the death of a loved one. As the
urgent reliance upon essential workers became more prevalent,
we offered special support, encouragement, and gratitude to
frontline workers and their families while helping them explain
to children why sometimes-lengthy separations were unavoidable.
Before But Different Normal: This is our current
stage. As children and families transition back to pre-pandemic
routines, CFEO continues to provide resources across a broad
variety of experiences, from understanding mask wearing
(including resources for autistic children) and other safety
precautions, to managing separation anxiety, building
mindfulness and fortitude, and, for many, returning to school.
As guidelines and mandates for in-school learning have shifted,
parents and caregivers have had to prepare children for changes
to school as they had known it, while staying flexible to
handle fluctuations between in-school and at-home learning.
Community providers, especially early childhood educators, have
had to learn to connect with children while wearing PPE and
staying physically distant. They must also understand
children's emotions during these constant changes, find new
ways to nurture them, and maintain open lines of communication
with parents/caregivers.
Longer-Term Consequences: Often there is a tendency
to assume young children are resilient and that they can easily
and/or quickly recover from (and even forget) challenging
situations. Although children do possess a certain resiliency,
recovery from the longer-term consequences of the pandemic will
likely take time and consideration, due to the traumatic
disruption of their established routines and sense of safety.
In many marginalized communities, which have been the hardest
hit, children are expressing stress, anxiety, and major effects
on their mental health and well-being. Furthermore, we must
acknowledge that parents, caregivers, and community providers
have been deeply affected as well, and what they model will
ultimately reflect upon young children.
Our approach has proven effective. During the first phase of our
work, we executed a pre-and post-survey \1\ with parents of young
children after they used the CFEO Health Emergencies resources. Results
indicated that parents who used the strategies (e.g., belly breathing)
helped their child cope with the challenges and stress of COVID-19 more
successfully than before exposure to the resources. Parents also rated
themselves as significantly more confident in helping their children
manage difficult emotions, feel physically safe, and have a greater
sense of hope during sheltering-in-place, especially due to their
children's connection to Sesame Street characters as they modeled
behaviors. ``My son was so interested in the video and activities, and
would be talking to the characters. I saw relief on his face as he saw
his character friends discuss things I didn't realize he was worried
about.''
--Parent of 4-year-old boy responding to the survey.
---------------------------------------------------------------------------
\1\ Sesame Street Health Emergencies: COVID-19 Parent Survey.
MediaKidz Research & Consulting. July 2020.
---------------------------------------------------------------------------
COVID-19 Vaccination
Continuing CFEO's nimble response, we partnered with the Ad
Council, COVID Collaborative, and CDC, and launched a series of public
service announcements and resources in English and Spanish to guide
parents and caregivers about the importance of COVID-19 vaccines.
Featuring Elmo, Elmo's dad Louie, and the Sesame Street Muppets, the
PSAs highlight that COVID-19 vaccines for adults are here and that
getting vaccinated can help lead to sunnier days ahead.
I'll Be Seeing U: I'll Be Seeing You Song (60'sec).
This take on Billie Holiday's ``I'll Be Seeing You'' is sung by
the Letter U and shows what families miss and want to return
to.
Healthy Family with Elmo and Louie: Elmo's Daddy Gets
Vaccinated (60'sec). Here, Elmo's dad, Louie, responds to
Elmo's curiosity and explains why he got vaccinated--so he can
stay healthy and keep everyone safe.
An additional bilingual digital toolkit includes printable
activities, posters, and FAQ that take children's perspectives and
build on their curiosity, explaining why grownups are getting
vaccinated, answering common questions in age-appropriate ways, and
reminding children to practice other healthy behaviors like
handwashing. It also customizes messaging to different communities,
i.e., Black/African American, Latino, and Immigrant.
Our Learning and Recommendations
We continue to observe that young children are curious about the
ongoing transition to recovery, however many are experiencing
challenging feelings and/or are unsure how to express their concerns.
Parents and caregivers are also struggling. Many are still managing
their children's hybrid learning or transitioning back to school;
coping with possible ongoing economic hardships; and/or are not
considering self-care as a priority. Vaccination and other transitional
practices are allowing our collective return to the ``before but
different normal,'' bringing greater hope for the future. Yet vaccine
hesitancy remains pervasive and, as we approach the phase when young
children will be afforded vaccination access, we recommend the
following considerations:
Acknowledge that, for the youngest children and their
parents and caregivers, there will be confusion in messaging.
Throughout the pandemic, the overall messaging was that young
children were less vulnerable to contracting COVID-19 or
experiencing ill effects.
Vaccine hesitancy might be prompted by the fact that
young children returned to in-person childcare settings
(family, friend, and neighbor care; family childcare, or
center-based) much earlier than other ``students,'' and most
are doing ``fine'' as perceived by parents or caregivers.
Parents and caregivers are likely to be more hesitant
of the longer-term effects of a new vaccine the younger their
child is.
There is a critical relationship between the mental
health and overall well-being of parents and caregivers and
their openness to considering what may seem to be challenging
decisions. Many parents and caregivers are still experiencing
high levels of stress, anxiety, coping with loss, economic
hardships, and/or feelings of isolation.
Although young children, parents, and caregivers do rely
on the health care community as a trusted source, many may have lost
their connection to a consistent medical provider.
Next Steps
Sesame Workshop's CFEO will partner with the Ad Council, the COVID
Collaborative, and the CDC (and possibly other partners) to create
specific resources to encourage vaccination for our youngest citizens.
We are in the process of determining the most effective messaging, but
we know we will once again rely upon the power of our beloved Sesame
Street Muppets and our long held trust with parents, caregivers, and
providers to continue to make a difference in the well-being of our
youngest citizens.
______
[summary statement of jeanette betancourt]
Sesame Workshop's response to the COVID-19 pandemic
has focused on meeting the evolving needs of young children as
well as encouraging parents and caregivers to get vaccinated as
an important part of the whole family's well-being.
We must consider the child's perspective and
recognize that what children and families have experienced over
the past 18 months impacts their decisions regarding
vaccination.
The COVID-19 pandemic has prompted unprecedented
disruption and uncertainty in the lives of young children and
their families. In response, Sesame Workshop has developed a
three-phased approach--For Now Normal; Before, But Different
Normal; and Longer-Term Consequences--to provide resources that
bring families clarity, comfort, and moments of joy aligned
with the progression of change as the COVID-19 pandemic
evolved.
For COVID-19 vaccinations, Sesame Workshop partnered
with the Ad Council, COVID Collaborative, and CDC to launch a
series of public service announcements and resources in English
and Spanish to guide parents and caregivers about the
importance of COVID-19 vaccines.
The PSAs feature Elmo, Elmo's dad Louie, and the
Sesame Street Muppets and highlight that getting vaccinated can
help lead to sunnier days ahead. An additional bilingual
digital toolkit is customized for different communities to help
explain why grownups are getting vaccinated, and answers common
questions in age-appropriate ways.
Our Learning and Recommendations
Young children are curious about the ongoing
transition to recovery, however many are unsure how to express
their concerns. Parents and caregivers are also struggling.
Vaccination and other transitional practices are
bringing greater hope for the future. Yet vaccine hesitancy
remains pervasive and, as we approach the phase when young
children will be afforded vaccination access, we recommend the
following considerations:
Y Acknowledge that, for the youngest children and
their parents and caregivers, there will be confusion
in messaging. The overall messaging has been that young
children were less vulnerable to contracting COVID-19.
Y Vaccine hesitancy might be prompted by young
children returning to in-person childcare settings much
earlier than other ``students,'' and most are doing
``fine.''
Y Parents and caregivers are likely to be more
hesitant of the longer-term effects of a new vaccine
the younger their child is.
Y There is a critical relationship between the overall
well-being of parents and caregivers and their openness
to consider challenging decisions.
Y Although families do rely on the health care
community as a trusted source, many may have lost their
connection to a consistent medical provider.
Looking ahead, Sesame Workshop will collaborate with
the Ad Council, the COVID Collaborative, and the CDC to create
specific resources to encourage vaccination for our youngest
citizens. We are in the process of determining the most
effective messaging.
______
The Chair. Thank you very much to all of our witnesses. We
really appreciate your testimony this morning and find it
invaluable. So, thank you.
Dr. Betancourt. Sorry.
The Chair. Yes.
Dr. Betancourt. I forgot to mention that we have actually a
PSA. I could not forget that.
The Chair. Okay.
Dr. Betancourt. We have--sorry. I bring my Elmo friend and
also a PSA that we wanted to demonstrate. So sorry.
The Chair. Okay.
Dr. Betancourt. Demonstrate how we have messaged. And this
is Elmo and his daddy, looking ahead.
Oh, we do not have volume.
What we can do is actually send this to you. All Elmo and
Daddy are exploring is really why he got vaccinated, and it is
that hope for the future and return to routines. So, thank you.
The Chair. Okay. Thank you very much.
Dr. Betancourt. Sorry.
The Chair. I think all of us probably know what they are
saying just by having the question----
Dr. Betancourt. Yes. And you can imagine. Yes. Children's
curiosity.
[Laughter.]
[Video presentation.]
The Chair. Can we start it over at the beginning?
[Video presentation.]
Dr. Betancourt. Thank you.
The Chair. Thank you so much. As a former preschool
teacher, I now feel I can start my day.
[Laughter.]
The Chair. Thank you.
We will now begin a round of 5-minute questions of our
witnesses, and I ask all of our colleagues to please keep track
of your clocks, stay within those 5 minutes.
Let me start. We know that the best way to reach people and
address their concerns about vaccines is to actually tailor the
message to their specific background and concerns. We also know
the same kind of outreach will not work for everyone. Different
communities may prefer to receive information in different
settings, different messengers.
Let me start with Dr. Nichols and Mr. Chang. You frequently
talk to people who have not received COVID-19 vaccines. What
are effective ways to customize outreach on vaccines to the
person or community at hand?
Dr. Nichols, let me start with you.
Dr. Nichols. Thank you for the question. So, I am a family
physician, so one of the things that I do is, I started back in
January a modeling, telling people that I had completed my
vaccine series, and I told them what the effects were.
The other thing is, I always say go where--reach people
where they are in their journey. So, if people are hesitant, I
give them the information, I give them the data, I give them
the science, to say that these vaccines are safe.
Also, it is important to go where they are, so I go to
their locations. I have actually gone to the various
communities and had conversations with them. Preplan--pre now
opening up to a sense of normalcy, I also went to--I did Zoom
presentations.
Also, when I go toward my adolescents and my younger
people, I talk to them about the importance of getting back to
normalcy, of going back to playing their sports events, not
worrying if they are going to be quarantined because some
member of their team is--now has COVID-19. So, I talk about
that.
I talk to parents about the opportunities so that their
kids can get back to school and learn because we all know that
what happened was that we often saw there are--kids were far
behind. They were getting behind. And, so, I said, let's do
what we can to get it back to normalcy.
When I talk to my patients, I say, let's try--don't you
look for the opportunity that you could now hug your grandkids?
I have a lot of older patients. So, I said, don't you wish that
you had the opportunity to hug your grandkids? I say the same
thing to my patients about seeing their parents. I was able to
see my parents for the first time in February, and I was very
thrilled to have the opportunity of seeing them in over a year,
and they are in their 80's.
I talk to people about those things and those family
gatherings. So, I talk to people about what is important to
them.
Finally, one of the things that I did that was very
important is that we engaged people who look like and talk like
them. Because I found that in our other communities, that if
you had someone who was similar to you, this helped. When we
looked at some of our other immigrants, such as those that were
from Ecuador and different people, we found out that the--that
Spanish nor English were the right language for them. And, so,
we did videos that were in the Mayan language so that you can
reach and help people to understand.
That is the important thing. Just meet people where they
are. And if they are not ready, I say, that is Okay, because I
am here and we are here to vaccinate you whenever you are
ready.
Thank you for your question.
The Chair. Mr. Chang.
Mr. Chang. I think, given that there is institutional
mistrust, the key is providing information and content to
friends and family who vaccine-hesitant folks will trust,
people in their own social networks. This is why we created
short, sharable videos to put in the hands of evangelicals to
share with their neighbors, fellow church members, friends and
family, and so forth.
The key here, I think, is actually social media. Because,
in the pandemic, how we are sharing and influencing each other
is significantly mediated through social media. And this is
where I would encourage efforts by the government to fund more
outreach through social media, through generating content,
through targeted advertising, because that is the battlefield
right now for the vaccine trust efforts.
The Chair. Thank you very much.
Many of you mentioned misinformation in your testimony and
the concern about that. These efforts seem to be growing and
undermining all of your work and our work. We hear about
constituents who are getting misinformation or spreading false
information via Facebook, Twitter, other platforms.
Let me just quickly ask Dr. Bailey and Dr. Betancourt. What
would you tell all of us that we should be doing to stop the
spread of false and misleading information on these platforms?
Dr. Bailey.
Dr. Bailey. Social media is certainly a double-edged sword.
It can be a great venue for spreading good information, but
also spreading misinformation. We--the AMA believes that social
media networks need to have some responsibility for spreading
false information that they know not to be true. And, we need
to be able to counter that with factual information from
trusted sources, as my colleagues have said.
If we completely bow out of social media and do not
participate, then we are ceding that territory to those who are
willing to spread misinformation. And, I think it is important
to understand that folks that are spreading misinformation are
often doing so because they may have a book to sell. They may
have a site they want you to go see. They may have something
that they are trying to buildup, and, so, it might not
necessarily be in your best interest that this misinformation
is being spread. I think it is important to know the source and
to go to trusted sources.
The Chair. Thank you.
Dr. Betancourt.
Dr. Betancourt. Thank you for the opportunity. I would say
that for our role, it is not directly dealing with
misinformation, but how do we provide information that is
relevant, valued, research-based for parents, caregivers, and
we do so because we do an incredible amount of research in the
way we are messaging. Our hope is that we are counteracting
that misinformation.
But, the other factor is, how do we deliver this
information so that it is relevant to the everyday moments of
families and children; that it is also relevant to the key
influencers in their lives, whether it is the healthcare
community, the social work community, any--the early childhood
community.
The other way that we address, as a trusted source now over
50 years, is how do we use--and the reaction that you had--our
trusted Muppets and, again, presenting from the child's
perspective. Often, because this is viewed as such a grownup
issue, we lose the fact of how our young children can be
advocates, as well. And that means looking at young children,
having information on what helps them keep safe, on what helps
their parents keep safe, and how we can do that collectively.
Thank you.
The Chair. Thank you very much. I am well over my time. I
will turn it over to Senator Burr.
Senator Burr. Thank you, Madam Chair.
It is remarkable to me that our whole national campaign
from the start, and continues today, is all about TV. The only
thing consistent with 30 years ago is Sesame Street, so it is a
tremendous avenue for a particular population. The rest of
America tunes out ads. I do not care if they are on COVID or
something else. And it is remarkable how much money we have
injected into this.
But, where we have seen success, Dr. Nichols, is when you
have gone into those African-American churches; Mr. Chang, when
you have focused on White evangelicals; Dr. Bailey, when you
have said the family doctor, the physician, we totally took out
of the loop. Some of the reasons were the unique requirements
for vaccines, and we really did not have an explosion in
vaccinations until we actually penetrated the retail
pharmacies.
Here is my question, Dr. Bailey, just real quick. How much
of the challenges behind vaccination is transportation?
Dr. Bailey. Transportation of the vaccine is a challenge.
Transportation of patients----
Senator Burr. Transportation of somebody getting there.
Dr. Bailey [continuing]. Is a challenge. There--the initial
phase of our mass vaccination efforts were to bring patients to
the vaccines. That phase is over, and we knew that it would not
last forever. We knew that there was a lot of pent-up demand.
But, now that patients that have been wanting to be vaccinated
are vaccinated, now we are reaching individuals that are more
hesitant. Many do not have transportation. Many may have
transportation but it is limited. It has been said that over 90
percent of Americans have vaccines available within 5 miles of
their home, but that leaves 10 percent out. And 5 miles can be
a long way if you do not have a vehicle and if----
Senator Burr. It is a long walk.
Dr. Bailey [continuing]. You have to walk.
Senator Burr. It is a long walk.
Mr. Chang, should we have anticipated the White evangelical
resistance?
Mr. Chang. Absolutely. The reason we started this campaign
as early as end of December, even before vaccines were
released, was because I think the masking controversy told us
where this was headed; that the commonsense public health
effort got politicized, got polarized, got used by folks trying
to gain attention and trying to divide our Country and our
evangelical community. And we saw that same thing was likely
going to happen with the vaccine.
I would say that overall, from where I sit, the public
health efforts have been amazing in terms of the logistics and
the development of the vaccine. It has been slow and a little
bit late in messaging. That is where I would encourage, for the
rest of this campaign and for future public health efforts, to
prioritize messaging as important of an investment to make as
you do in the research and development of the actual vaccine
itself, because a vaccine sitting on a shelf is not doing any
good to anyone.
Senator Burr. Dr. Betancourt, I commend what you guys have
done and, more importantly, the fact that you are thinking in
the future because we will be in a situation where we vaccinate
one- to 12-year olds. I am convinced of it. We have got to.
Dr. Betancourt. Yes.
Senator Burr. I am more curious about how in your
organization, in the Workshop, you addressed this change in the
life of young people in the Country.
Dr. Betancourt. Yes.
Senator Burr. They no longer saw their grandparents.
Dr. Betancourt. Yes.
Senator Burr. They no longer went to school. They no longer
could go play with a friend. How did the Workshop try to
present that to this population?
Dr. Betancourt. It was really a--we are very nimble, and we
took advantage of taking the perspective of our child
development and also parenting information.
We actually addressed it in phases. The first phase that we
called was the ``For Now Normal.'' And bringing two factors--
how do you normalize something that is now totally changed?
And, so, we helped parents establish routines while still
working and learning from home.
We also started to bring the factor of joy and hopefulness,
because suddenly, everything was shut down. And from a parent,
and especially a child's point of view, I no longer get to see
my grandparents, my friends, and suddenly, all of those
connections are lost.
We used the power of our trusted Muppets in different ways,
not only through our programming, but what we also do, like my
colleagues here, is work with national and local partnerships
to integrate these resources, so as they are connecting in the
community, we are so doing, as well.
Last one is really the second phase that we are in now. It
is the ``Different But Before Normal.'' And we love these terms
because they are very practical. They sort of reflect the stage
that we are in. How do you adjust to what were before routines
but are now very different in certain circumstances? We use
animation. We use interactives. We use what we call printables,
posters, to deliver consistent messages that fit into everyday
moments.
Senator Burr. What I have learned is that kids are quite
resilient, and adults very----
The Chair. Not.
[Laughter.]
Senator Burr. Very counter-resilient. But, let me just say,
everything that you guys have shared with us is important, and
the challenge is, for me, why are we not doing it all? Why are
we not in every Black church that we can find on Sunday with
somebody with vaccines and needles? Why are we not in White
evangelical churches? Why are we not promoting as much to the
generational mix out there? Why have we not got the full
complement of doctors with vaccines in their office ready to
inoculate folks?
I might add, why are we not pushing the envelope and trying
to figure out how to do microneedle patches where we are not
relying on a nurse that comes in and draws a vaccine, sticks
you in the arm; where you could sit at church and pop these on
people's arms and, for 72 hours, they get their first dose and
then they come back and get a second dose?
From a technology standpoint, that is available to us, but
the bandwidth of how much can you do at the same time as you
are innovating? We have also got to look at the communications
and the parallel delivery systems if we want to capture as much
as we can.
Thank you, Madam Chair.
The Chair. Thank you.
Senator Hassan.
Senator Hassan. Well, thank you, Madam Chair and Ranking
Member Burr, and to all of our witnesses. Thank you so much not
only for being here today, but for what you do every day.
Dr. Nichols, I want to start with a question for you. As
you know, Congress has provided funding to ensure that COVID-19
vaccines are available to all individuals at no cost. However,
there remains a perception among some that they will be
required to pay a copay or they are going to receive a bill if
they go get the vaccine. What can we be doing at the Federal
level to ensure that people know that the COVID-19 vaccine is
available at no cost?
Dr. Nichols. One--thank you for your question. So, one of
the things is--I think that message is starting to get out--is
to do ads that say, Go for your free COVID-19----
Senator Hassan. Right.
Dr. Nichols [continuing]. Vaccine. And, so, another thing,
that is the important thing, is just keep emphasizing the word
that this is free.
Senator Hassan. Yes.
Dr. Nichols. The other things besides, social media is just
overwhelming.
Senator Hassan. Yes.
Dr. Nichols. That is again where you have to go, is go into
social media and keep emphasizing those words, that this--there
is no cost to this; that this is our gift to you. Because so
many people have lost loved ones, and, so, let people know that
our gift, we are giving you a free vaccine. Thank you.
Senator Hassan. Well, thank you. I want to follow-up, too,
on a point that Senator Burr began to make because for many,
there are related financial barriers associated with taking the
vaccine. We talked about transportation a couple of minutes
ago. There is childcare expenses, and some people are concerned
if they have a reaction to the vaccine, there might be lost
wages involved.
How do we most effectively acknowledge and work to address
these barriers so that they do not limit the ability of
individuals and families to access COVID-19 vaccines?
Dr. Nichols. One of the things that is important is for
employers to give people the opportunity; to stress the
importance that you get--if you have side effects, we give you,
well, both. One, the time to go and get your vaccine.
Senator Hassan. Right.
Dr. Nichols. No. 2, that we give you the opportunity that
if you are having side effects, that is a paid leave; that you
have the opportunity to be paid. So, that is important.
If we are going toward mandatory requirements, which many
employers are doing, that those are things that you must do.
So, I think, again, it is just getting the word out through
whatever means necessary to let us know that we are going to
support you and also your childcare issues and your child--and
your transportation.
Senator Hassan. Anecdotally, I am hearing, for instance,
from some workers in long-term care facilities that they do not
want to risk losing wages. When you are living paycheck to
paycheck, this is a real issue. So, thank you for that answer.
I want to follow-up to both Professor Chang and Dr.
Nichols. We have talked a little bit about this. You both have
learned from your work and the work of countless individuals
across the Country that the most effective way to improve trust
in the vaccines is to meet people where they are--you have used
that term several times--and engage respectfully about the
safety and effectiveness of these vaccines.
The American Rescue Plan included funding to expand access
to COVID-19 vaccines. So, is there anything that you have not
said about how you believe we can effectively use these
resources to continue and expand on your work? Just talk a
little bit about what specifically you think we could use--the
Federal Government could be using these dollars to do?
Mr. Chang. Yes. I will repeat again that I think the fact
that much of these faith-based outreach has been directed to
minority communities, which again----
Senator Hassan. Yes.
Mr. Chang [continuing]. Is critical.
Senator Hassan. Right.
Mr. Chang. But, to--I would encourage you to redirect some
of that attention and resources to the White evangelical
community.
Then, second, I do think the fact that the general
channeling of these resources to the state level is proving to
be ineffective to reaching this particular community. I think a
national outreach coordinated at a national level will be your
most effective bang for their buck here.
Senator Hassan. Okay. Dr. Nichols, anything to add to that?
Dr. Nichols. I echo what Dr. Chang said, that what you
really want to do is a national outreach to make sure that--and
like I said, do not politicize this.
Senator Hassan. Yes.
Dr. Nichols. That is an important key, is that we are all
working toward the same goal of decreasing deaths, decreasing
hospitalization, and getting our world back to normalcy again.
Senator Hassan. Thank you. Dr. Bailey, I want to turn to
kind of a related topic. But, as you know, we have seen a
concerning drop in routine pediatric vaccinations during the
COVID-19 pandemic. A year ago, I sent a letter to the CDC
requesting that they provide additional support to states and
healthcare workers in order to reverse this trend. And, while
progress is being made, many children remain behind on their
routine vaccination schedule.
How do we work to catch children up on routine
vaccinations?
Dr. Bailey. I agree, it is incredibly important that we get
our children up to speed on vaccinations. And there have now
been advisories issued that COVID vaccines can be given at the
same time as routine childhood vaccines, and, so, I think that
will be very helpful in trying to get as much done in as short
a period of time as possible.
Senator Hassan. Okay. Thank you.
Thank you, Madam Chair.
The Chair. Thank you.
Senator Marshall.
Senator Marshall. Thank you, Madam Chair and Ranking
Member. My first question would be for Dr. Nichols.
Dr. Nichols, one of my biggest frustrations was that we had
a system in place where we would give three million flu
vaccinations a day across this Country, and that system
consisted of community pharmacies, health departments, and
doctors' offices. And, all long, we knew we would hit this
wall, that if those people were not involved with this process,
we would have not good compliance with getting the vaccine.
And, so, we were the last ones to get the vaccine,
unfortunately.
Has that been your experience, as well, that doctors were
the last ones to get the vaccine? And now, do the doctors have
access to it?
Dr. Nichols. That is true. So, one of the things is that
before, we were really--it was very important that we get the
vaccines into the doctors' offices. Majority of the physicians
are vaccinated. About 96 percent or so say that they are
vaccinated. But, it is important to get it into the offices.
Because I was fortunate. I was one of the people who was an
early adopter. And, so, we go into our clinic, and that is part
of the routine questions. I ask everyone, Have you been
vaccinated? So, we give vaccines while people are in the
office, as well, besides going out.
It is important that you give the access to the doctors and
get it into their offices so that they can vaccinate during
those routine visits. For the pediatricians, during those
routine health checks, that you give them their vaccines, when
you go to just any other facility. So, that is key getting it
into the doctors' offices because often your physician is your
most trusted person that people have.
Senator Marshall. You bet. Thank you.
Dr. Bailey, I will go to you. Your life and my life has
been centered around giving advice to patients, and we
typically talk about the benefits and the risk of what we are
prescribing. And for me, it was, should you have a surgery?
Should you have a C-section? You prescribe treatments that can
cause anaphylaxis and you have to weigh that risk-benefit with
everybody.
When we started out with this process, no one worked harder
than we did to make sure every American adult had the
opportunity to get the vaccine. And when we sat down with
people over the age of 60, it was a slam dunk, that the
benefits outweighed the risk.
Now we are talking about people under the age of 21 and the
benefits and the risk of the vaccine. The risk of the virus to
a person less than 21, pretty small. More and more, we are
seeing some concern about complications and risk to the
vaccine, as well.
As you advise parents or young adults, do you feel like you
have the data, the science, that you can actually have a great
conversation discussing the benefits and the risk of the
vaccine to give them advice?
Dr. Bailey. Yes, I do. These vaccines have been thoroughly
studied in adolescents, and we are now studying them in
children. And, yes, the benefits and the risks discussion is
something that definitely needs to be had. But, I think there
is a general misconception among the population that children
are at no risk or that the risk is so small that it is less
than the risk of getting the vaccine, and that is simply not
true. Children do get COVID. Children get long COVID after
having----
Senator Marshall. You see the science side by side that
would say here is the risk of a serious complication to a
person under the age of 21 versus the risk associated with this
vaccine? You have seen that side by side? Because I have not
seen it.
Dr. Bailey. Well, we will be happy to share the data that
we do have. But, the risks of side effects in adolescents
appears to be very, very small, but we know that the risks of
long COVID in children can be quite significant.
Senator Marshall. Okay. Dr. Bailey, would a T cell test be
a benefit to you as you are sitting there considering a person,
a young adult especially, that has already had the virus? Would
that be a benefit to you in making--in that decision making
process?
Dr. Bailey. I think it would be helpful, but we still do
not have the perfect package of laboratory tests that we can
run on someone to say, You are immune, you are not immune.
Senator Marshall. Right, but if we had a T cell test, it
would be very helpful, I think, for most doctors in giving
advice.
Dr. Bailey. It would add to our armamentarium.
Senator Marshall. Right.
Dr. Betancourt, as we watched, I assume--was that Elmo?
Dr. Betancourt. That was Elmo and Elmo's daddy.
Senator Marshall. Elmo's dad. One of the things I noticed
is that neither one of them had a mask on, and I assume there
is a reason for that because----
Dr. Betancourt. There was.
Senator Marshall [continuing]. Kids do not trust adults
with--or trust people with masks on. Have you all looked into
the mental impact on children by making them wear masks and
adults around them wearing masks?
Dr. Betancourt. Yes. Actually--well, we had also PSAs on
mask wearing, and particularly for children, to ease that
process. And, also, we used our other character, Julia, who is
an autistic Muppet who is 4 years old, and also guided mask
wearing at that time.
What we do is, in this case, with the PSA, it was focused
on vaccine. It was indoors, and it was, again, parent, child,
so the use of--mask wearing in that context would not be the
modeling that we would use. The focus was on the vaccination.
Then last, also in that case with the PSAs and
transparency, with any Muppet speaking and with the mask over
it, it is going to be a little harder in voicing. But,
regardless, in that situation, mask wearing was not necessary.
But, we have advocated for, again, the process of easing
mask wearing when it was necessary, and how to take that
child's perspective to do so. But, also, now what we are
dealing with is also how do you transition into the stages
where you are not having to do mask wearing. So, we are
tackling both. Our focus is how do we ease transitions in a
child-appropriate way.
Senator Marshall. Okay. Thank you. I yield back.
The Chair. Thank you.
Senator Casey.
Senator Casey. Thank you, Chair Murray. I want to thank the
panel for their presence here today and the message you are
delivering. Just your presence and your testimony today and the
answers to your question is helping to get the word out.
I will start with Dr. Nichols and, of course, would open
this up to others, as well. But, I want to talk to you about
people with disabilities as a particular community.
You have great personal experience with family medicine and
providing healthcare access across a number of communities. One
of them--one of the communities that is often neglected during
not only this public health crisis, but others, is people with
disabilities as a community. Because of their primary
disability or secondary health conditions, they are often at
greater risks than others. In fact, during the height of the
pandemic, people with developmental disabilities, such as
Down's Syndrome, had the highest mortality rate, other than
those 75 and older.
Communicating the importance of becoming vaccinated in
people with disabilities is, of course, complex. Communication
methods needed to take into account including accessible video
with sign language interpretation and plain language documents
so that someone needing kind of jargon-free descriptions can
understand information. You mentioned, and others have, as
well, and we cannot say it enough, meeting people where they
are, as you have said, on their vaccine journey.
The question I have is, how should we be communicating with
this particular community, which is diverse, the disability
community, and ensure they receive the information that is
necessary about vaccinations?
Dr. Nichols. Again, thank you for the question. You hit on
a great topic as far as getting to people with disabilities.
One of the things is, again, through the physician's office is
to ensure that the vaccines are available in the physician's
office so you can reach the disabilities. Also, going in, too,
if there are places--like we go into our senior homes. So, I am
going Wednesday to go and vaccinate within the senior
community. So, also going.
We have also--I believe in making it easy as possible. Not
everyone can get in a car. And, so, that is something that you
have to do as far as going to them. That is what our mobile
program is about.
Also, you touched on a great area. Make sure you have the
information in multiple languages. Multiple languages, also
sign languages, to make sure that people understand. And that
is why with the face masks--so, that is a good thing because
people who are deaf, they cannot--they do not know what you are
saying. So, before, it was important to use the clear masks,
but now, since most people are vaccinated that are providing
the vaccines, is to make sure that you make it easy for them to
read your lips, and also to have the ability to have the sign
language available, as well.
But, I think the key is going into the physicians' offices
so that they--because they are the ones with the direct
interaction with the patients.
Senator Casey. Anybody else on this question from the
panel?
I was going to move to Dr. Betancourt on children--of
course, that is your area of expertise--and hesitancy. We have
also seen major disparities in the vaccination rollout to date,
and particularly when it comes to vulnerable children getting
left behind as more children become eligible for the vaccine.
We have to address, of course, the concerns of parents who
are hesitant to get their children vaccinated, and we have to
do that, as you and others have talked about, through
thoughtful and culturally appropriate community engagement.
What are your thoughts on how we can best engage families,
particularly families that have lots of challenges, to help
parents make informed decisions?
Dr. Betancourt. Yes, it is a couple of things in terms of
more marginalized communities, and we always address that as we
are developing any of the content that we have discussed.
It is two ways. One, it is looking at the other trusted
sources. We have discussed a lot in terms of the medical or
healthcare community and its diversity, whether it is the
pediatric community, whether it is public health clinics, and
making those connections. But, it is also the messaging.
As we have said, for younger children, it is going to be a
little bit of a challenge. As we discussed, many times that
perception is that they are fine. And, again, it is twisting
the messaging a little bit.
How do you, again, try to leverage what we are calling a
circle of care, a circle of safety in that care? How do we
encourage not only the vaccination, but I think returning to a
medical home? Most marginalized families, and many families,
have been separated from their medical home.
How do we unite what we call the key influencers in young
children's lives? So, it is the healthcare community. It is
also the early childhood community. It is the faith-based
community.
Our belief is, to make a difference, you need to message
with similar messaging across all those groups where they are,
but with similar approaches. Use social media or use posters.
Use a variety of elements. Use audio, as well. Radio. We have
created our PSAs so that they are available also in audio
formats. We also close caption, both in terms of visual and
auditory, to make sure that everything is also accessible as
much as possible.
Last, version it as much as we can into a variety of
languages that are culturally relevant.
Senator Casey. Thank you.
The Chair. Thank you.
Senator Paul.
Senator Paul. Dr. Bailey, I agree with you that
misinformation is leading to vaccine hesitancy, and I think
probably the largest area of misinformation is actually coming
from the government regarding natural immunity. There is
actually dozens and dozens of peer-reviewed articles on natural
immunity. The natural immunity is robust.
A study from Washington University School of Medicine just
recently says, Mild infection with SARS-CoV-2 induces a robust
antigen-specific, long-lived humoral immune memory in humans.
Cleveland Clinic study, 50,000 employees showed that those
who had the disease previously had the same, if not better
immunity than those who have been vaccinated.
If we deny this and we say, stick your head in the sand,
everybody be vaccinated, do not worry your pretty little head
about whether you have had it or not. We do not do any testing.
We have lots of ways of testing for immunity. Guess what? The
government--the people are going to have hesitancy because they
think you are not telling them the truth, which is true. That
is not the truth. We do know that you get robust immunity from
this.
We also know that, even taking conservative estimates from
the CDC, that about 100 million people have had this. How do we
know that? Thirty-four million people have tested positive.
But, even the most conservative antibody surveys show that at
least two people for every one that got it, also had it. That
is 100 million people.
If we discount that, we say, oh, we are never getting to
herd immunity. You have all these articles saying we will never
make it, we will never make it, we do not have enough people
vaccinated. But, then we say, oh, we have to go harder. Now we
are going to have to go for the 10-year old, then the 5-year
old. Then we are going to go for the 2-year old. Then we are
going to say, oh, you cannot leave the hospital until you are
vaccinated.
People are going to be hesitant because they do not believe
you and they do not believe that the risk of the disease in
children anywhere equates to adults. Over 65, it is at least a
thousand times more dangerous. The death rate under 25? About
one in a million.
If you combine natural immunity with vaccine immunity, Dr.
Makary of Johns Hopkins estimates that 80 to 85 percent of
adults have immunity and that we have reached herd immunity.
Yet, the government insists on discounting or really not
counting at all the millions of individuals who have acquired
natural immunity. This scientific error causes the government
to believe that we have not gotten there, that we have to go
harder and harder and harder.
There are reports of myocarditis. It is not decided yet. We
are in the means of talking about this. And, if we just say
blithely, go take your vaccine, do not think about this, that
is not good medicine. We should think about it.
I do not know what the risk is. It may turn out that it is
one in 10 million, and then, by all means, I would say go. If
you are over 65, I would say without question, the vaccine is
way safer than the disease. But, I cannot say that with
assurety for a 10-year old. I really cannot say that.
I also cannot say that we have not reached herd immunity,
and that we are pushing so hard on the kids that we might do
damage to children with this. It is an unknown question. The
science is not completely done on children. They are discussing
it this week.
How frequent is myocarditis? We do not know that. If it is
one in 100,000 and the chance of myocarditis in the normal
population is one in a million, I would probably say you ought
to think twice about it.
But, another way to do it is, we could test the children.
We could test the adults. If they have antibodies let them make
a choice. Let them make an intelligent choice. Some people will
still choose to be vaccinated. But, we are so adamant, get the
vaccine, do not think about it, that leads to hesitancy because
people do not think we are following the science or that people
who give that advice are following the science.
My question is, should previous infection not be considered
in the effort to push vaccination on our children?
Dr. Bailey. Yes, I think previous infection should be
considered. I also think that we need to understand that a
previous infection is not as robust in protecting against new
variants as----
Senator Paul. We actually do not know that.
Dr. Bailey [continuing]. The vaccines seem to be.
Senator Paul. We actually do not know that. All of the
testing on natural immunity and the vaccinated has shown that
we have great immunity both with the vaccine and with natural
immunity.
The Delta variant that everybody is talking about, the
vaccine is very good for it. So, you see hysteria on TV. We are
driving--we are still driving this debate by the hysteria of
the Delta variant.
If you get vaccinated, there is a 96 percent chance you
will not be hospitalized. The numbers are very similar for
natural immunity, too. This what if, what if, what if has been
played, but it is just not true and we are scaring people
needlessly. We should study it honestly in a rational fashion
and give people advice, but we should not be pushing people, do
not think about it, just take a vaccine.
Dr. Bailey, failure to acknowledge natural immunity has led
to the policy of indiscriminate vaccination. So, when we do
this, we divert the vaccine from those who truly need it.
In India, getting to herd immunity may take a couple of
years. Six thousand people are dying a day recently, and they
are taking the advice of the government experts in our Country
that they should vaccinate everybody indiscriminately. In doing
so, tens of thousands, if not millions of Indians will die
because you are going to have millions of people who have
already had it. If you could get the vaccine to those who need
it more, you will save lives. It is the same way with diverting
it to those over 65. In my community, in this Country, we are
giving it to young, healthy 28-year old volunteer firemen. That
makes no sense at all.
Do you think in countries like India we should take into
account whether you have had it to try to make the vaccine go
farther so we could save lives?
Dr. Bailey. I cannot comment on vaccine administration
strategies in other countries. I do know that----
Senator Paul. It is the same as ours.
Dr. Bailey [continuing]. We need to be a good part of the
global community and provide as many vaccines as we are able to
make--after we have taken care of our own population, which we
have plenty of vaccine for.
The Chair. Thank you.
Senator Baldwin.
Senator Baldwin. Thank you, Madam Chair.
Last fall, a green bean canning plant in Wisconsin
experienced a COVID-19 outbreak that killed at least 11 migrant
workers. COVID outbreaks hit food-processing facilities in my
home state especially hard. And I am increasingly concerned
that many workers, who often live and work in crowded settings,
have not been vaccinated.
Dr. Nichols, can you describe the specific barriers that
wage workers, particularly workers of color, face when it comes
to getting vaccinated? And what should employers do to make it
easier for workers, including seasonal or temporary workers, to
get vaccinated?
Dr. Nichols. Senator Baldwin, thank you for your question.
You bring up a great point. One of the things that we are doing
is going out to the agricultural migrant, agricultural workers
to get vaccinated, and we are taking our mobile unit out to
them so that they can get vaccinated. So, I think that is one
of the important things that partnership. So, you can partner
with the various companies to vaccinate their workers.
We have also talked to other companies and vaccinating like
the grocery store workers, the people that work at the
different organizations, such as the food services, and said
that we are here, and if you want a partnership, we will be
willing. So, that is one of the things that the employers need
to partner with those who have the vaccine.
We have an abundance of vaccines now. We are looking to put
shots in people's arms. So, I think that is something that we
need to do, is go out to the different organizations, the
different companies, so that you can get those essential
workers vaccinated, and make it convenient. Because you have to
go to them. They cannot necessarily get off to come to us, so
you have to go to them. And, so, I think that has been the key.
Thank you.
Senator Baldwin. Thank you. I appreciate that response.
As my colleagues on this Committee know, throughout the
pandemic, I have called for the Occupational Safety and Health
Administration to issue an emergency temporary standard to
protect our Nation's workers. The Trump administration failed,
did not work on this at all. And while the Biden administration
has finally issued a standard, it really does not protect all
workers, including those in food processing. The lack of a
comprehensive workplace safety standard for all of our Nation's
workers and lagging vaccination rates should concern us, and we
really must do more.
I am now going to turn to a pervasive problem of
misinformation in Wisconsin. While 45 percent of Wisconsinites
are now fully vaccinated, this figure is only 29 percent for
Hispanic individuals in my state. One of the factors that has
been cited by the Wisconsin-based group, Forward Latino, is--as
contributing to this hesitancy is a widespread concern that a
state-issued ID is a requirement to receive the vaccine, which
it is not.
Dr. Nichols, how can we combat vaccine hesitancy in
underserved communities, particularly when that is based on
misinformation and fear, widespread rumors like this one that I
describe? And further, how can the Federal Government best
support communities in addressing the vaccination disparities
and other public health challenges?
Dr. Nichols. Thank you for the question. I think that is a
really good point. We engage the consulates because one of the
things that we found, that they are--people are most trusting
of going into the place, and we actually went to the locations.
So, we have been going weekly to the Mexican consulate, and now
we are going to others. So, it is important that you go to the
location. We partner with them and you go out so that people go
to a trusted entity.
That is the key, because unless they trust you, they will
not come, and they will think that it is a conspiracy or that
there are other things that are waiting there. So, you cannot
just say come to this vaccination site.
We also tell people we do not require your ID. We just--if
you are going to do the two-shot vaccine, we are just saying
that whatever name you give right now, make sure it is the same
one so we can document it. But, we do not require that they
give ID because that will--that is a limiting factor for a lot
of people. So, we rest assure and we make sure there are
translators that are available so that they can speak the
language and tell them that this is free, that this is safe,
and that no one will come after you because of your status.
Thank you.
Senator Baldwin. Thank you.
The Chair. Senator Tuberville.
Senator Tuberville. Thank you. Thank you all for being here
today, and I would like to say thank you for your commonsense
approach. We have not had a lot of that up here since this
pandemic. And I will say this, too, that when we put politics
into this, which we have--it has been heated up with politics,
this whole pandemic. People back in Alabama, where I come from,
do not trust a lot of things that are going on because they do
not understand because they have been told so many different
things from CDC and everybody that works for the CDC, and it
just has not been a commonsense approach. But, thank you all
for being here today and doing this.
We are trying to get everybody to take the vaccine, and
everybody in here over 50 should have taken the shingles
vaccine. Everybody in here. I have not taken it. I am much over
50, and I have seen people with shingles and, my God, we just
keep putting it off, and that is something Americans do. They
think that they are not vulnerable to something like this, but
they are.
Ms. Bailey, let me ask you this. Back in April, we--J & J,
they had a 10-day pause. Now people back in Alabama ask me,
Coach, why should I take this vaccine, this J & J? They stopped
it. They are scared to death of it. I do not know why we--did
you agree with them making the pause to that?
Dr. Bailey. I believe that the pause that was taken with
the J & J vaccine was a sign that our system of detecting what
we call safety signals or adverse effects is working. And, I
think it was a serious enough issue of having blood clots in
the brain that we really needed to look very carefully at what
was going on before we decided to go forward out of an
abundance of caution. I think it was a reasonable thing to do,
but I agree that it planted some seeds of hesitancy in some
folks.
But, the fact of the matter is, is that all vaccines have
had some reported side effects, but we have always felt that
the benefits of the vaccine outweighed the risks. And the
beauty is that if someone is of this certain age group that is
affected by the J & J vaccine issue with blood clots,
especially women of a certain age group, they have choices. The
mRNA vaccines are not associated with those types of blood
clots and, so, if someone is concerned about that particular
vaccine, they have a couple of great choices.
Senator Tuberville. In Alabama, we have only had 30 percent
of the people that are fully vaccinated, and one reason why we
got hammered early with the COVID. A lot of people had it.
And--but, they see all this information on television. If you
have had it you really do not need the vaccine. What would you
tell these people?
Dr. Bailey. Well, I would tell them that they do need the
vaccine because I am a belt and suspenders kind of person. I
believe that COVID is a bad enough disease that it is worth
doing everything you possibly can to keep from getting it and
to keep from spreading it to someone else that you love, which
you can do with an inapparent infection. And, so, I believe
people--and I agree with the authorities, that people that have
been diagnosed with COVID should be vaccinated. They should get
the second shot if appropriate, and should do everything
humanly possible to stop this pandemic in its tracks.
Senator Tuberville. We hear of a booster getting ready to
come out for the fall. How are we going to sell that?
Dr. Bailey. Well, we will have to kind of wait and see what
happens. I think we need to have the data to show folks that it
really does make enough of a difference to justify getting all
these folks in to give it to them. But, I certainly would not
do, personally, a big booster campaign until we had gotten the
first batch of folks vaccinated in the first place. I think our
emphasis should be on complete vaccination for the first time
around of the general population before we start worrying too
much about boosters.
Senator Tuberville. Thank you.
Thank you, Madam Chair.
The Chair. Senator Hickenlooper.
Senator Hickenlooper. First, I want to thank all of you for
your--not just for your time here today, but for your efforts
and your public service. And this has got to be one of the
hardest things that we, as a Country, have gone through going
back all the way probably to the Second World War.
I was in Aurora, Colorado last week with Secretary Becerra,
Senator Bennet, Governor Polis, members of the entire
congressional delegation, and looking at these same issues that
you are getting questions on and asking. We were touring--
looking at a--getting a tour of a bus, as you guys have
described, but a bus that goes to those communities that we are
having the most trouble getting people vaccinated.
I think maybe I will start with Dr. Nichols, if that is all
right. I think it is critical that what we have learned about
the health disparities from this pandemic that we use that to
better inform our healthcare efforts to communities of color
and any community where we see these inequities. You talked a
little bit about robust public education as being part of the
major lesson learned.
How can we, at the Federal level, boost public health
education efforts starting now so that we can--what
specifically should you be telling us to make sure we are ready
for the next pandemic, which, whether we like it or not, we
know is going to come?
Dr. Nichols. Thank you for the question. So, one of the
things that we really can do to boost this through public
education is to do targeted campaigns. There are a lot of
lessons learned, and we need to let people know that these are
the lessons learned from this pandemic because there might be
another one. There most likely will be.
With that in place, then what we need to do is say lessons
learned is, one, is that as soon as you--this, any type of
virus or infection hits us that you hit it hard and you hit it
fast and you hit it as soon as it occurs.
No. 2, that one of the things that you need to do is that--
meet people where they are.
I keep saying you cannot politicize this. This is an effort
that is affecting all of us. It does not matter if you are
Republican, Democrat, or Independent. This is going to--or
Black or Brown or whatever. This is something that has affected
all of us.
What we want to do is to say our goal, as a Nation, is to
protect our citizens. And, so, that is what I think we need to
get out there, is the importance of protecting our citizens and
getting people, meeting them where they are, and educating them
through every avenue possible, and in every language. Thank
you.
Senator Hickenlooper. Great. And Mr. Chang, I will ask you
just to comment on that, as well, just from the outside of
government. Obviously, the--and there is, I think, a
significant amount of evidence that it is not politics that
are--as a major reason why many people are choosing not to be
vaccinated. It is more in that framework of their own autonomy
and who they do trust. Do you want to maybe address that in
terms of preparing for the next pandemic?
Mr. Chang. I think one of the things that the Federal
Government should think about and putting in its toolkit to
prepare for the next pandemic is to develop a roster of trusted
faith leaders they can convene very quickly and early on to
bring them together to have a unified message.
If you look at what happened with White evangelicals, what
happened was individual leaders had to take the position at
different times to speak out on this, and then it got slammed
by the opposition. So, Franklin Graham did that, got killed on
social media. He withdrew and went quiet for a while. J.D.
Greear, the former president of the Southern Baptist
Convention, then stepped up. He got slammed on social media.
This was one by one, they were coming forward, and all of
you, know what that is like, to be the lone target out there.
And, so, if the Federal Government had enough foresight to
actually do the convening work of bringing leaders together,
because unfortunately, the evangelical church does not convene
itself very easily. It is a very, by design, a sort of
decentralized movement, so it requires an outside body, like
the Federal Government, to convene these folks together, let
them present a united front. They were there. They just could
not bring themselves together to form a united voice. They
needed the government to help them.
Senator Hickenlooper. Absolutely. I think that is a good
point.
Dr. Bailey, the numbers from the United Kingdom on the
Delta variant are obviously very concerning to all of us. It
now accounts for 90 percent of new infections there, and
obviously, whether it is 10 percent or 15 percent now in the
United States, who knows how rapidly that is going to grow.
Clearly, it is going to spread rapidly.
Given our current rate of vaccination, do you think that we
will get to a similar impact from the Delta variation, similar
to what we are seeing in Great Britain?
Dr. Bailey. I certainly hope not. We have been in a
footrace with variants from the very beginning, and right now I
think we are outpacing them because we have had good vaccine
uptake.
But, I think it is important to understand that the vaccine
strategy in the U.K. was very different, in the vaccine
strategy there. And the U.K. decided to delay the second
vaccine in patients in order to get the first vaccine in as
many people as possible. And we realize now that is not the
best way to fight variants, that you need to get as many people
vaccinated on time, with both doses, if you are--if that is the
vaccine that you are dealing with, which is the best way to
fight the variants.
I think we are better prepared to fight the variants.
Senator Hickenlooper. Great. Well, I appreciate that. I
hope you are right.
I yield back. Thank you all.
The Chair. Thank you. Senator Smith.
Senator Smith. Thank you so much, Chair Murray and Ranking
Member Burr. I really appreciate this hearing. It gives us all
an opportunity to kind of dive into where people are on the
spectrum of acceptance versus I am not really sure to sort of a
hell-no mentality.
As of yesterday, 54 percent of Minnesotans have received at
least one dose of COVID-19; 51 percent have been fully
vaccinated. And we are making good progress in Minnesota, but
we have a ways to go to get to where the Governor has said is
our goal in the state of 70 percent.
I have a few questions that I hope can kind of clarify some
of the misinformation that is out there, and also help us
understand what more we need to do.
Let me just start, if you do not mind, Dr. Bailey. I just
want to start with you because Senator Paul interrupted your
comments regarding the efficacy of the vaccines compared to
immunity when people are exposed to a new variant, like the
Delta variant. I just wanted to give you an opportunity to
finish your thought.
Dr. Bailey. Oh, well, thank you, Senator. I appreciate
that. And my interpretation of the literature--and it is vast,
and there are so many thousands of studies that are available
now for review. We have to be able to put them together. But my
understanding is that adequate vaccination with both mRNA
vaccines or the Johnson & Johnson vaccine gives you better
protection against variants than natural immunity does.
Senator Smith. Okay. All right. Thank you. And, so, the
COVID-19 vaccines do protect against the Delta variant is what
the science tells us right now?
Dr. Bailey. Yes.
Senator Smith. Okay. Thank you. That is very helpful.
Dr. Nichols, can you just quickly sort of say, what do you
think are the biggest structural barriers? Meaning there are
reasons that people do not get the vaccine not because they do
not want to, but just because they cannot--they cannot make
their lives work to get the vaccine. What are the biggest
structural barriers?
Dr. Nichols. Transportation is one, so that is why I say it
is important to go where people are.
Senator Smith. Right.
Dr. Nichols. The other one is hours. Some people work two,
three jobs.
Senator Smith. Right.
Dr. Nichols. You have to make sure that the availability is
there at all hours. And I really appreciate now the pharmacies
and some of the grocery stores are extending those hours for up
to 24 hours.
Senator Smith. Yes.
Dr. Nichols. You have to make sure that--those are the main
ones.
Also, before structural barriers happened to be internet
and computers, so that is why it is important to make sure that
when people were making appointments that you made it easy. So,
now people do not have to make an appointment. You can just
walk up.
I think that those are things that we are seeing are true
that were barriers before that we are helping to overcome. But,
the main thing is making sure that you are there and make it
very convenient for everyone.
Senator Smith. You are going where people are. You are
help--you are just--you are not assuming that everybody has
the, has the wherewithal if they are working three jobs to get
someplace.
What do you hear are the kind of the most common myths,
just the flat out, not true but get repeated, that you hear
about why people are thinking the--why not? Why not get the
vaccine, the most----
Dr. Nichols. My young people, my early 20-something people,
a lot of them are talking about infertility.
Senator Smith. Yes.
Dr. Nichols. I told them that is absolute--that does not go
with the science. That is a very common one that--that is
probably the most common.
Another one is the myth that people say, oh, I already had
COVID-19, so therefore, I do not need to be vaccinated. But,
there are people getting the--getting COVID for the second time
around, and there are variants out there.
Those are the really big two myths. And then the whole
thing with Johnson & Johnson. People say, Remember talc powder,
so I have to then remind them that this is a very safe vaccine;
that this is a vaccine that has gone through all the rigors and
the science and everywhere else. So, those are--I just hit them
with the facts and the data and the science.
Senator Smith. Very helpful. Dr. Bailey, are there other
myths that you have heard repeated frequently that are
different from what Dr. Nichols just laid out?
Dr. Bailey. There is a common, almost an existential,
concern that something that we do not know about is going to
happen down the road; that, well, how do I know that if I get
this vaccine today that I am--something is not going to happen
to me in 5 or 10 years.
We have decades of experience with dozens of different
types of vaccines, and we have never seen a vaccine cause a
distant side effect past about 6 weeks of administration. So,
we feel very comfortable about that. There is no reason why
COVID vaccines should be any different. But granted, the
farther you are from getting the vaccine, it is going to be to
correlate an event to that vaccine. But, so many events that
have been reported are coincidences and not causal, and it is
hard to explain to folks that just because something happened
near the time of the event does not mean the vaccine made it
happen.
Senator Smith. I know I am out of time, but that--is that
data essentially also true when you are talking about vaccines
for young people as well as older people? So, it is not like
there is some sort of a different set of data for a young
person?
Dr. Bailey. That is true, Senator.
Senator Smith. I think that is very helpful, just to remind
people that we do have science and facts and data that back up
what we are doing. And it is good to help to speak out against
these myths that get repeated over and over again.
Thank you. Thank you, Senator.
The Chair. Thank you.
Senator Murphy.
Senator Murphy. Thank you very much, Madam Chair. Thank you
all for your testimony. I have been listening to a lot of it
from my office.
Dr. Nichols, I had a really interesting conversation
yesterday--I put it up on my social media channels--with the
Student Body President at the University of Connecticut,
talking about the specific challenges around vaccinating
students. And I wanted to sort of ask for your opinion about
how we build out best practices to make sure that college
students are ready to get back to school in the fall.
Data suggests that less than 40 percent of 18 to 29 year
olds have received one or more doses, and there seems to be
some differences with respect to how colleges are treating this
issue. In Connecticut, for instance, our flagship university
says everybody has to be vaccinated and have proof of
vaccination in by the end of July, but our state university
systems have not made a decision yet. And, so, it is confusing
to students because some may have a requirement to get a
vaccine, but other students may not. In addition, the
requirement seems to be that a lot of the proof come in during
the summer, which means students may not get to do this while
they are on campus.
I know you have been leading a lot of Morehouse's efforts
in this regard. What do we know about the specific challenges
related to getting students vaccinated, and what can we
recommend as a Committee to schools and to school associations
to make sure that there is some degree of uniformity in terms
of what we expect of kids to get back onto campus?
Dr. Nichols. Thank you for the question. So, it is very
important that we, again, provide the data and the information
to the students and to the administrators on vaccines.
Also, doing town halls and panels--I have one coming up on
Thursday--where you talk to them, to the parents of the
students about vaccine safety.
Right now, over 500 colleges and universities have made it
mandatory. I think that--I personally think that is the right
thing, but not everyone is ready to get vaccinated. And there
are ways--some people have religious reasons that they feel
that they cannot be vaccinated. Other people are medical
reasons. So, you do give that option.
But, I think the important thing is to talk about so you
can get back to normalcy. Many of the people that are now
college-age kids, they did not have a normal experience. They
were not able to have proms when they--if they were in high
school, or even to have normal graduations. So, I think that
one of the things that you have to explain to that age group,
which is a very difficult group to talk to, is--because they
are young, and they think they are invincible. So, it is to say
that this is your opportunity to get back to normalcy, not to
wear a face mask, to be able to get out toward your friends.
But, also, to give them the data, because these are college
kids. So, to make sure that they have the data and the science
to show the safety and the rigors that were involved with this
vaccination process.
I think that we are on the right path, but I think that we,
as an institution, must talk to all the colleges at the
administrative level, to the parents of those students, and to
the students themselves. Thank you.
Senator Murphy. Just food for thought. One of the things
that the student body president wanted to make clear is that
there needs to be safe space for questions to get answered, and
sometimes there is a feeling that students are maybe going to
be looked down upon when they sort of ask some basic questions
about the vaccine. They are always a little careful, right, in
not wanting to sort of look foolish or look like they do not--
are not as plugged in. We need to make sure that nobody feels
bad about asking questions because we have answers. That is the
good news.
Dr. Nichols. I tell everyone there is never a stupid
question. So, I always tell the students, I really want you to
ask those questions, and we need to answer it in ways that can
relate to them. And social media is very important in that age
range, as well.
Senator Murphy. I know we have a bunch of people that want
to ask questions and we are going to have votes, so I am just
going to submit a question for the record to you, Dr. Bailey.
I am really interested in some of the comments you made in
your opening statement about the dangers of misinformation. And
I am working on legislation right now with the American Medical
Association that would set up an interagency effort housed
within the U.S. Department of Health and Human Services to try
to bring together both government agencies, think tanks,
academic institutions to both track and evaluate
misinformation. Sometimes it is difficult to sort of know what
to label as misinformation. And I look forward to working with
you and others as we try to work through that legislation.
Dr. Bailey. Thank you.
Senator Murphy. Great. Thank you, Madam Chair.
The Chair. Thank you.
Senator Kaine.
Senator Kaine. Thank you, Chair Murray, and thanks to the
witnesses. This is fascinating.
A couple of quick research questions. So, as I am trying to
make the case to my constituents to get vaccinated--and
yesterday, our Governor announced that Virginia has just
crossed the 70 percent mark on at least one vaccination, which
is great--I point out it is effective in stopping COVID if you
have not had it. But, there is also two other benefits that I
cite based on some initial studies, but I wonder if I am on
solid ground in talking about this.
The vaccine is not 100 percent effective, so someone can
get the vaccine and still get COVID. But, it does seem like
that there is some evidence that if you have been vaccinated
and you get COVID, your symptoms might be lesser. Is that a
fair statement of the kind of early evidence that is emerging,
when people get vaccinated and then get COVID, it tends to be
less serious cases?
Dr. Bailey. That is true, and people who are vaccinated are
very unlikely to be hospitalized, and in some situations, it
prevents death entirely.
Senator Kaine. That is very, very powerful because
obviously, some--I had COVID. I was not hospitalized. The
difference between not being hospitalized and being
hospitalized, and being hospitalized on a ventilator, serious
issues, is very stark, so that is a good piece of evidence for
being vaccinated.
Second, there is also some suggestion that people who have
had COVID and are suffering long COVID symptoms, which might be
15 to 20 percent of people who get COVID, there is some, again,
articles suggesting that some of the long COVID symptoms
disappear upon vaccination. And, again, I have seen that
reported in media. I do not know if there has been enough
research on it to kind of validate it. But, what is the current
state of play on that?
Dr. Bailey. Senator, I have heard the same things that you
have, and there have been some case reports of patients with
long COVID whose symptoms have improved after vaccination. That
is still under study. We do not really know enough about long
COVID itself to understand what makes it better or what makes
it worse. But, the few case reports are encouraging.
Senator Kaine. That is also positive. So, I think there is
multiple reasons to get it.
Dr. Bailey, I have focused some significant attention upon
vaccination of pregnant women and wanted to make sure, A, that
it is safe; B, that they have access and that there is an
effective take-up rate among vaccines. So, what are you able to
tell us, again, based upon kind of the initial experience--and
I will open this up to anyone--about the safety of receiving
COVID-19 vaccinations during pregnancy?
Dr. Bailey. There were a number of women in the clinical
trials, who became pregnant after they had received the COVID
vaccine, and did well. There was one pregnancy loss, but that
turned out to be in the placebo group, not among the group that
received vaccines. There are--the American College of
Obstetricians and Gynecologists now recommends that pregnant
women get the vaccine. We know that pregnancy is a somewhat
immunocompromised state in and of itself, and pregnant women
are susceptible to more severe disease if they contract COVID-
19, so we believe it is important to immunize pregnant women.
And, those antibodies will transfer to the baby, and, so, the
baby will have some degree of protection, as well.
Senator Kaine. Excellent. Thank you.
Mr. Chang, I found your testimony fascinating. I read the
written version of it because I was not here during your
opening. I was at an Armed Services Committee hearing. You
point out that a path to greater vaccination is through the
White evangelical church. You have two kind of recommendations,
one of which just seems unassailable--find trusted leaders,
evangelical leaders, and gather them together so that when
there are messages about vaccination, people are hearing them
from the folks that they most trust. And I think you have all
sort of testified to this--you have to meet people where they
are rather than expect people to come to where you are. So,
whether that is outreach in minority communities, evangelical
communities, that sounds like a really good strategy.
But, the other sort of half of what you said is that sort
of a mistrust among evangelicals for sort of governmental
authority. And over the course of my public life, that has
puzzled me. I had a pivotal experience of living in a military
dictatorship in Honduras when I was young, 1983, 1984. So, I
guess I saw what a really bad government can do, and it gave me
a perspective that our government here, our small-d democracy,
certainly is not perfect, but I can--I see how it is elsewhere.
So, while I never hesitated to criticize authority, I have a
sort of deep appreciation for how lucky we have it compared to
elsewhere.
What are strategies that we ought to be embracing to try to
bring down that mistrust? In addition to using trusted
messengers, what are things that we, as officials, could do to
start to tear down slowly that mistrust?
Mr. Chang. That is a great question. And I think one of the
things that I have been trying to do is to actually teach my
fellow Christians that institutions are people, too.
Institutions are comprised of people, that they are human.
These are human institutions, and therefore, they are going to
be flawed. And I think part of the problem is--for evangelical
Christians is we are in some ways hyper-individualistic. It is
probably built into our faith. It is sort of me and God.
Senator Kaine. Personal relationship.
Mr. Chang. Personal relationship. And the idea that
actually, also, human beings also comprise institutions is
something that is not very strongly taught in the evangelical
community. But, it is critical because if we do not think of
institutions as human, then when they do change their mind, we
think those institutions are just--cannot be trusted, whereas
we are Okay with individuals changing their mind. We somehow
are not Okay with institutions changing their mind.
A lot of when we say, well I am hearing so many different
things from the CDC, it is because the CDC is made up of
scientists, who are human beings, who are responding to new
information and new data and are changing their mind and may
not get it right from the first time.
I think certainly within the evangelical community to
humanize institutions is critical. And, then, from the vantage
point of public institutions, the more you can present a human
face behind the institutions, the more that I think that sense
of humanity can come through.
Senator Kaine. Thank you very much.
Thanks, Chair Murray.
The Chair. Thank you.
Senator Braun.
Senator Braun. Thank you, Madam Chair.
My first question will be for Dr. Betancourt. Back in
Indiana recently, Indiana University, flagship institution,
required students and faculty to be vaccinated before they
could return. I have a simple question. Do you believe that
American citizens have a right to privacy about their own
healthcare?
Dr. Betancourt. In--I would think so, absolutely. And from
a Sesame Workshop point of view, we do focus on our youngest
children and the grownups who make decisions for them, and we
know that in terms of privacy or any--that is extremely
relevant to their questions and also their information
gathering.
Senator Braun. Do you think that would also apply to adult
college students and faculty, as well?
Dr. Betancourt. From a Sesame Workshop point of view, I
would say that is a little higher, but I would say that our
experiences many times on what applies to young parents making
decisions about their children also applies to, again, older
college--college-age students or youth.
Senator Braun. To zero in on, then, do you think that you
need to have a proof of vaccination as a condition for
enrollment?
Dr. Betancourt. That is beyond--I am going to be honest.
That is going to be beyond our Sesame Workshop decision-making.
Our focus is basically how do we promote the awareness of
vaccination as being something for not only in the moment, but
also for your future. So, what I would take into context is
that college students come from families, and our message is
that, as a family, you are making a decision for safety, for
also hopefulness for the future, and that there is advantages
if you do that holistically. Regardless of whether you are a
college student or you are an essential worker or anything like
that. So, our messaging is more in that context, and hopefully
it is creating what we have often called that circle of care.
Senator Braun. Thank you. Next question is for Dr. Bailey.
Clearly, I think the biggest variable that has gotten this
in the rearview mirror was the speed at which the vaccine was
developed. I remember interviewing Dr. Fauci and Dr. Collins
and Redfield back then, and there was kind of a wrestling match
in terms of which bureaucracy was going to lead the dynamic. I
think had that gone according to normal procedure, we could
still be wrestling with having that vaccination being done. And
it was a tribute to the entrepreneurialism in the industry and
the agility, I think, of the Administration at the time.
Do you think that, when it comes to something as simple as
trying to get people comfortable with vaccinations, that maybe
time spent better by the Biden administration to where it would
have educated folks on the vaccine instead of still weighing in
on mandates and shutdowns and things maybe not directly related
to what was going to probably be the only thing close to a
silver bullet of getting this in the rearview mirror? Did we
waste time?
Dr. Bailey. That is a difficult question to answer. And I
do believe that one of the issues that my patients have concern
with is that they feel that the vaccine was rushed, that it was
made too quickly. They need more information about that. And I
always take great pains to explain to them that the beauty of
Operation Warp Speed was that no corners were cut. No
scientific rigor was left on the table; that the companies were
given the financial security to be able to do this very quickly
because there were a whole lot of real smart people and a lot
of money involved, and they were able to get it done in an
amazingly short period of time.
We can never stop talking about the importance of reviewing
vaccine safety and efficacy and how these vaccines have gone
through incredible clinical testing and is, I think, one of the
greatest scientific achievements in our lifetime.
Senator Braun. Well, very good. I think that is well said.
How about going forward? We are seeing now variants. I watched
something over the weekend where they were talking about using
mRNA technology to maybe apply it toward fighting cancer in a
particular way. And, also, to where it might end up playing
into going about contriving, creating therapeutics versus just
vaccinations because it looks like this could be repeating
itself through variants, maybe get to where it is in a rhythm
similar to how we wrestle with the common flu. Where does
emphasis on therapeutics fit in to the long-term journey of how
we deal with and live with the coronavirus?
Dr. Bailey. I believe that is an incredibly important area
to pursue because I think all of us acknowledge that, although
we want to get as many people vaccinated as possible to get
past the pandemic, that COVID is probably always going to be
with us in some way, shape, or form. And we need to learn
better how to treat COVID at early stages, to keep it from
progressing to hospitalization and death in someone that hasn't
been immunized, or in a new variant that may be resistant to
vaccination. And mRNA technology in and of itself is absolutely
mind boggling in its potential across all specialties of
medicine. And, so, I think that it is important for us to make
sure that we continue to focus on research for therapeutics,
research for diagnosis, research for care, for vaccination, and
for long-term complications.
Senator Braun. That is good to hear that you think that
might make sense because it seems like that is going to have to
play into the formula in the long run. Thank you.
The Chair. Thank you.
Senator Burr, do you have any additional comments?
Senator Burr. Just two quick ones, Madam Chair.
Dr. Bailey, if a patient diagnosed with pancreatic cancer
was provided a cure delivered on a mRNA platform today, do you
think they would be as reluctant to take it as they are a
vaccine on an mRNA platform?
Dr. Bailey. I am not a cancer specialist, but my experience
is that when patients are really desperate for help, they will
take risks that they might not take otherwise.
Senator Burr. Isn't part of the problem that we have is
that some people believe that this is not as bad as what we
have suggested?
Dr. Bailey. The disease of COVID is not as bad----
Senator Burr. Right.
Dr. Bailey [continuing]. As we have suggested? I believe--I
worry about that going forward as the huge numbers of
hospitalizations and deaths seem to fade into the rearview
mirror that we will have some collective amnesia about how bad
it really was.
COVID-19 infection is a devastating disease. It is a tricky
virus unlike anything we have ever seen before, and we must
never underestimate its potential to wreak havoc and cause
death. And, I think that someone who still doubts the existence
of COVID, gosh, we need to put them in--hopefully--I wish we
had time travel so they could back and safely walk through a
hospital ward where every patient was on a ventilator. They
were unable to speak to their loved ones and had to say their
goodbyes over an iPad, surrounded by people that they could not
see because they had so much PPE on. I hope we never have
anything like this again, and we must always remain vigilant to
make it so.
Senator Burr. We would agree with you. And I think if you
could take everything that this Committee, the Committee
Members have said throughout this process, and sort of add them
together, it would have addressed the mental health for
children. It would address the physical challenges that are
presented, the employment challenges, the society challenges.
Hopefully, our memories will not be as short as we have proven
in the past.
Last thing. I have said to the Administration, because I
think we are destined for a booster, based upon the science.
When, nobody knows. But, I have made it perfectly clear that we
better have a strategy when we get ready for the booster
period, meaning that we are out selling it long before we start
it.
I agree with you. We ought to inoculate as many folks as we
possibly can in the first round, but you cannot start too early
at educating what that booster can mean based upon what we do
not know, not necessarily based upon what we do know.
It may be that all three vaccines that are currently
approved are sufficient for Delta. Does it mean it is
sufficient for what we are seeing in South America today? And I
cannot remember what the name that we are calling it, but it is
devastating South America. So, the one thing we know about
viruses, they continue to mutate as long as they exist. This
one will continue to do it. And if the booster provides us a
better defense, then I hope we will sell it so that the
American people will aggressively take it.
Thank you, Madam Chair.
The Chair. Thank you very much. Thank you, Senator Burr.
Well stated.
That will end our hearing today. And I do want to thank all
of my colleagues for such a thoughtful discussion, and I want
to really thank all of our witnesses today--Dr. Bailey, Dr.
Nichols, Dr. Chang, and Dr. Betancourt. Thank you. Mr. Chang,
Dr. Betancourt. Thank you so much for sharing your experience
and expertise. It was very, very helpful.
For any Senators who wish to ask additional questions,
questions for the record will be due in 10 business days, July
7th, 5 p.m. The hearing record will remain open until then for
Members who wish to submit additional materials for the record.
With that, the Committee stands adjourned.
[Whereupon, the hearing was adjourned at 11:56 a.m.]
[all]