Keeping Calm and Carrying On : Reflections on COVID-19 Vaccination

I am by profession a general practitioner, as well as a mother of two grown children. I bear BCG and smallpox vaccine scars on my left arm from immunizations received before my memory, and I can recall receiving hepatitis B vaccination as a medical student, in preparation for the clinical part of the training. I faithfully took my daughters to all their routine childhood vaccinations without any fears of harm as I appreciated the value of these immunizations to not only their health but the health of society in general. I routinely prescribe and give the tetanus vaccine for patients who have sustained penetrating injuries and I have checked countless immunization cards for young people doing school medicals over the years. So the concept of vaccination as a public and personal health promoting measure is something that has been so ingrained in my mind that I take it for granted.

Yet when the news broke in December 2020 that the first COVID-19 vaccines were awaiting approval by the World Health Organization (WHO), and other regulatory bodies, I had concerns that to me felt significant enough to make me not want to take these vaccines as soon as they were approved for public use. My doubts arose from fear that in order to produce vaccines ready for public use so quickly, some corners must have been cut. I did not feel that 8 or 9 months was long enough to do all that was needed to make sure the vaccine was in fact safe. As much as I feared actually getting COVID-19, my fear of getting a rushed and inadequately tested vaccine loomed just as large. My fears regarding the safety of the vaccine were rooted in a deep distrust of pharmaceutical companies specifically and big corporations in general. I would say that those fears were not unfounded given what we now know about how the tobacco industry conducted its business, and how the current opioid crisis originated. There are also confirmed reports of pharmaceutical companies that “cooked” results of drug trials in order to avoid reporting findings that would adversely affect approval of a new drug.

So by the time the WHO gave emergency use approval to the first vaccine on December 31, 2020, I had decided that I would not be the first in line to receive any COVID-19 vaccine. I would wait and see what emerged as large scale vaccinations began and make my own judgement on the safety of the vaccines. I initially thought perhaps that I was in the minority as a physician to take this sort of stance, but as I talked with fellow health care workers I realised that others felt the same way. Meanwhile our government in Jamaica was beginning a campaign to encourage everyone to take the COVID-19 vaccine in preparation for when it became available in our country. Doctors were expected to actively participate in this campaign both by taking the vaccine and encouraging their patients to do the same. This put me in a very awkward situation. My patients trusted me to advise them, and if I did not feel safe taking the vaccine, I could not with any integrity encourage my patients to take it. Up to this point, I had not heard anybody I could trust as having purely a public health interest and no political agenda, addressing my fear that these vaccines were in fact not safe because the testing had been rushed. My decision to wait and see remained, and this is what I shared with anyone who asked my advice.

Then in a COVID-19 update webinar for doctors hosted by the Jamaican Ministry of Health and Wellness, I heard Professor Peter Figueroa speak. A quick online survey done during the webinar had revealed that at least half the doctors in the webinar had “vaccine hesitancy” because of concerns about the safety of the vaccine. So Professor Figueroa proceeded to provide us with an explanation intended to allay some of those fears. He explained that SARS COV-2 which causes COVID-19 is member of the family of coronaviruses that caused the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 and the Middle East Respiratory Syndrome (MERS) outbreak in 2012. He further explained that research into vaccines against these coronaviruses had begun from as early as 2003, but the pace of research had decreased when those outbreaks became controlled. So the search for COVID-19 vaccine simply built on the information and research already done for SARS and MERS and simply adjusted it to fit specific coronavirus SARS COV-2 that was identified as the cause of COVID-19. Thus they were able to move quickly into the clinical trials and they were not really as abbreviated as we might imagine. I knew Professor Figueroa as a public health expert. Based on my knowledge of his work and utterances at other medical meetings I had formed an opinion of him as someone whose only agenda was promoting health. In other words I trusted him to tell the truth. In that webinar I learned that he was also a member of the Technical Advisory Group for the Pan American Health Organization (PAHO). Finally I had found a person I could trust to allay my fears about the safety of these vaccines. Listening to Professor Figueroa’s explanation that day marked a milestone in my vaccination journey. That was when I decided that I would get the vaccine as soon as it became available. By this time, we knew that Jamaica would begin their vaccination program with the Astra Zeneca vaccine.

Having my rational safety concerns about vaccine safety addressed by a trusted health care professional allowed me to make the decision to join the line to be immunised. Yet, as the global vaccination campaign took off and doses were transferred from vial to arm, reports also began to circulate about adverse reactions, almost on a weekly basis. I tried to focus on the scientific rational reports, but could not completely avoid all the sensational personal accounts of some debilitating adverse effects experienced after receiving one of the WHO approved COVID-19 vaccinations. The reports of increased clotting risk associated with the Astra Zeneca vaccine, which we were waiting to receive in Jamaica, created a ball of fear in my stomach even as I appreciated rationally that there is a difference between “being associated with”, and “being caused by”. Knowing that the chance of having a serious adverse reaction to a COVID-19 vaccine was far far less than the chance of dying from COVID-19 did not allay my fears of having a catastrophe befall me because I willingly accepted a vaccine. One in a few million is a small risk, but what if I happen to be the one in the few million that it happens to?

While we waited for our first shipment of Astra Zeneca vaccine to reach Jamaica, these little gnawing fears continued to simmer in my gut. It did not help to hear that there did in fact seem to be a tiny but real risk of abnormal blood clotting issues with the vaccine I had already decided to take. Further reports of non-medical issues related to the production and supply of vaccines rekindled my fear that the drug companies were possibly sacrificing people’s well-being for profit. Although these reports and stories did not cause me to change my decision to get vaccinated, they did foster a sense of fear which I realised I could not resolve with the available scientific information because the fears revolved around unknowable things like how my own body and its chemistry would respond to the vaccine I was consenting to take.

In my 25 plus years working as a physician I have observed that a person’s mental state is an integral contributor to his general state of health and well being. The physical phenomena that we, as physicians, observe and measure in our work are affected profoundly by what an individual is thinking and feeling even if those effects are not yet fully understood or measurable. I have observed on countless occasions how two patients with the same diagnosis, receiving the same treatment have vastly different outcomes. I believe the difference in outcome is related to the mental state and for me addressing this mental state is as important as prescribing the right drug for an illness. Applying this knowledge to myself as I prepared to take the vaccine, I realised that one way I could allay my fears about experiencing rare adverse effects was to achieve a state of calmness which would allow my body to respond to the vaccine in the desired way, that is, to trigger an immune response that would protect me from getting COVID-19. That state of calmness would likely also prevent my vaccine triggered immune response from going overboard and creating adverse effects.

The science and the facts provided to me by Professor Figueroa allowed me to decide on taking the vaccine, but the state of calm that I felt was important to maximise the effectiveness of the vaccine for me, and minimise or eliminate unwanted effects had to come from within me. So I made a conscious decision to stop looking at all the reports of adverse effects because they were only feeding my fear at this point. In looking deeply into myself, I realised that although I had grounds to mistrust the motives of pharmaceutical companies, I could also choose to consider the individuals responsible for the science and research in those companies : that such people may be motivated by the desire to help people rather than profit from their misfortune. If I focused my attention on those individuals, it was easier to generate a sense of gratitude for people who spent their time, energy and talent trying to improve our lives. This change of focus doesn’t deny the questionable motives of one group, but it allows me to choose whether my state of mind is governed from a place of fear and mistrust of that group, or from a place of gratitude for the work of another group driven by altruistic intentions.

Thus it was that on March 12, 2021, dosed with ginger tea, a healing meditation, and armed not only with paracetamol but also a calm state of mind, I received the first dose of the Astra Zeneca vaccine. The side effects were nothing more than the indicators that I had mounted an appropriate immune response (aches and pains and feeling flu-ish for about 36 hours). The sense of relief I felt on receiving protection that went beyond wearing a mask was more than I had expected and that increased even more 2 weeks after the second dose when according to the science I could consider myself fully vaccinated. At this point I have no regrets about getting vaccinated. Having taken not only the vaccine but also the journey from hesitancy to full acceptance, I realise I am also better able to advise my patients from a place of practical lived experience and not just theoretical knowledge of the science.

Based on my experience and journey, there are some useful general steps that could be used to get us to that 70% vaccinated goal with minimum adverse events reported. Those of us who had no hesitancy and were able to be at the head of the line to get vaccinated deserve our gratitude for leading the way. But many of us have hesitancy, even people whose work involves dealing with the very real worst case outcomes of getting COVID-19. Hesitancy exists for a variety of reasons and though some of it can be removed through educating people on the facts and science of the vaccines and how they work, not all the fears can be dispelled by information. Sometimes information feeds the very fears that we are trying to allay. Fear will affect our state of mind which in turn affects our physical health, and potentially the way we respond to a vaccine or any health challenge. It is important to recognise that what we pay attention to can affect our state of mind, and that we do have a choice of what we pay attention to.

The insight gained in my own journey helped me to generate a set of directions that perhaps may help others to navigate the voyage from vaccine hesitancy to accepting all the protection against COVID-19 that is available to you. I offer these directions as part of my contribution to the vaccination campaign specifically but also more generally as a guide to achieving good health. They are as follows:

  1. Get your facts and scientific information from a trusted individual who has the appropriate knowledge and training to provide those facts. For me that person was Professor Figueroa. For you it might be a trusted family doctor, a public health specialist or other appropriately skilled and trained person. It is not advisable to take plumbing advice from an electrician who has no training or experience in plumbing matters. Similarly it is not smart to take health and medical advice from people whose day jobs have nothing to do with healthcare.
  2. Recognise that science is based on the currently knowable, and that there are unknowable things at any given time for which no doctor or scientist can give you a 100% guarantee of the desired outcome. If you fall into the category of people whose fears are stoked by the possibility of an adverse outcome no matter how small the actual probability, then understand that your fear cannot be allayed by searching the internet for more information. Dealing with that fear will require an internal journey of self-reflection.
  3. Recognise that your state of mind plays a vital role in your health and that you need to consciously aim for state of calm and inner peace in order to optimise your physical health.
  4. Recognise that with fear as the driver you will never achieve the state of calm needed to achieve good health. The more you focus on fear, the more it determines your state of mind. Fear is a powerful driver, as anyone who is in the business of providing security or life insurance services will tell you, and in the short term it can keep you from leaping into danger. But in the long run, the effects of constantly living in fear will take a negative toll on your health.
  5. Find a driver that generates the state of calmness and peace that will allow you to function at your best, physically, mentally and emotionally. For me in my vaccine journey, that driver was gratitude for the researchers who made a vaccine a reality. For you it might be the knowledge that your action will protect the vulnerable, or the joy of being able to once again have family dinner with loved ones. To do this effectively, you do need to have some facts, but more importantly you need to recognise that you ultimately have the choice as to which facts you focus your attention on. When you focus on things that bring you inner calm and peace, you are more likely to make the decision that is best for you, and having made that best-for-you decision you are more likely to maintain that state of peace and inner calm. That cycle once activated is likely to keep you in good health.

In a situation such as we have with COVID-19, ultimately I think the decision to get vaccinated should be an individual one. We do need to acknowledge that the vaccines have been approved for emergency use by the WHO because we are indeed in an emergency situation. The emergency use listing does not mean the vaccine is less than safe, but simply acknowledges that due to a time constraint, there are current unknowables which may only become apparent with the passage of time. But we also need to acknowledge, as the numbers unequivocally show, that currently the vaccine causes less harm than actually getting the virus. Fears that people have are real to the people who have them. Some of them have a basis in fact or past experience, while some have basis in ignorance and others in conspiracy theories. It is important to figure out which category a person’s fear falls into so that it can be appropriately addressed.

The fears need to be appropriately addressed in order to reach the 70% vaccination target to halt the pandemic, and we do not have all the time in the world to reach that goal. The more opportunity the virus has to multiply and spread, the more opportunity it has to mutate into a form that overcomes the current vaccine based defence we are trying to erect. Addressing those fears may involve venturing out of the realms of numbers and verifiable scientific facts and into the realms of accepting that state of mind affects health outcomes and understanding how to guide the attainment of a health promoting state of mind. Sometimes that may mean avoiding information overload, and it may mean taking the time to ask non-judgemental probing questions to ascertain the basis of the fear so that it can be appropriately addressed.

When we ask those probing questions we also need to identify people whose minds we cannot change with any of the steps outlined in my map. They will form the 30% that remain unvaccinated and we need to accept that and focus on the people whose minds we can shift and use the road map to guide those people to the destination that ultimately will benefit everyone. Achieving our vaccine target requires the wisdom to appreciate the value of willing participation and working towards getting that participation. To do this we need to engage the easily definable and verifiable facts and figures as well as the more nebulous yet equally important realm of thoughts and emotions that affect our physical state in ways that we may not fully understand. It means applying the WHO definition of health as a “state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” in a very real and practical way to the challenge of vaccine hesitancy and the impact it can have on individual and public health.

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