Infection Preventionists Must Teach Value of COVID Vaccines

Getting vaccinated against coronavirus disease 2019 (COVID-19) will not become a mandated requirement for health care workers anytime soon, says infection prevention expert Sharon Ward-Fore, MS, MT(ASCP), CIC. “It took us 10 years to be able to mandate flu vaccine in health care,” says Ward-Fore, a member of Infection Control Today®’s Editorial Advisory Board. “And there are still some exceptions. I think it will be a long time coming before we’re able to mandate it.” In the meantime, Ward-Fore says infection preventionists will need to educate those inside and outside of the health care community about the value of getting the COVID-19 vaccine. Ward-Fore says that she considers IPs to be “a force to provide education on the necessity of the vaccine, and to help other health care providers understand the importance of getting vaccinated. There’s a lot of fear around the vaccine. And it’s actually quite a bit among health care providers, those frontline first responders.” Also, while this tug of war goes on, IPs need to remind everybody of the importance of social distancing, and wearing a mask. Also: “Don’t forget your hand hygiene. That’s our number one way to protect ourselves.”

Infection Control Today®: So please help us make sense of everything that’s going on with the vaccination rollout and with the variance.

Sharon Ward-Fore, MS, MT(ASCP), CIC: Let’s talk about the variant. I think one thing we need to keep in mind right now, as we get further into this, we will probably learn more about this variant. But right now, I think people need to understand that the importance of masking and social distancing really, really, really is important right now, because of the contagiousness of this new variant. People should not let their guards down even with vaccination happening. People still need to remain vigilant.

ICT®: It’s been kind of grim news lately. Do you see anything that might be hopeful? I guess the vaccines is a big hopeful story, right?

Ward-Fore: Right, the vaccine is hope. It’s on the horizon. But again, we’re nowhere near where we should be with percentage of people vaccinated in the United States. We really, really need to ramp up vaccinations so that now people can sort of, I won’t say relax, but be a little more comfortable with the fact that eventually we will not have to mask and socially distant. And that now is the time with vaccinations we can begin to start loosening restrictions, and maybe opening up restaurants for dining and trying to get some semblance of normality. But again, we’re a long way from being there just yet, so people need to be patient.

ICT®: Where do infection preventionists fit in all of this? I know in some hospitals they oversee flu vaccination efforts. Do you see them overseeing COVID-19 vaccination efforts at hospitals?

Ward-Fore: I don’t really see that at this point, because the vaccine is not mandated. But I see them as a force to provide education on the necessity of the vaccine, and to help other health care providers understand the importance of getting vaccinated. There’s a lot of fear around the vaccine. And it’s actually quite a bit among health care providers, those frontline first responders.

Sharon Ward-Fore, MS, MT(ASCP), CIC

And those are really the folks you want to protect first and foremost, because we don’t want them to get COVID. There is a lot of information on the efficacy of the vaccine. And although there are some side effects, they are very, very rare and very few and far between. I think health care workers should look to the IPs to answer questions about it. And IPs need to be armed with current information about what’s happening in other parts of the world that have been giving the vaccine for quite a bit longer than we have in the United States and provide that information to health care providers to help ease some of their concerns.

ICT®: What parts of the world are we talking about? I imagine you might be talking about the United Kingdom?

Ward-Fore: Right, the UK. And the UK has been vaccinating for a while. They’ve seen very few reactions, just a couple severe reactions. But when you think about the number of people they vaccinated, you’re going to see vaccine reactions with any vaccine. I think knowing that it’s been successful in the UK, that the United States needs to look to those folks to provide information to us and IPs need to take that information to the frontlines and say, “Hey, they vaccinated X number of thousands of people here.” And actually, in the United States, there’s quite a bit of people that have received the first vaccine. You can look to those first vaccine folks and say, “You know, I got it. I didn’t have any side effects.” And now we see the second wave of people getting their second vaccine with very little side effects. I think as more and more people are vaccinated, I hope health care will look at that information and step up and get vaccinated themselves.

ICT®: I have to ask you this. Did you get the vaccine yet? Do you intend to get the vaccine when you’re able to get the vaccine?

Ward-Fore: I do intend to get it I don’t qualify right now, believe it or not. I’m not old enough. And I don’t have any comorbidities that I’m aware of. But I will say that my husband, he works in health care, also. He did receive both sets of vaccine with no side effects whatsoever. You know, injection site pain. That’s really about it. He’s had both doses. He’s had the Pfizer, I believe, and he said, no problems with it whatsoever. If I could get it right now, I absolutely would. No questions about it.

ICT®: Do you see COVID-19 vaccinations becoming a yearly or every other year thing in hospitals?

Ward-Fore: From what I’ve read, it seems as if we’re going to be dealing with COVID-19, like we do with some strains of the flu. And I think the dream is to eventually include it in our flu vaccine. It’s kind of like, you know, a twofer. When you get vaccinated, you’ll be vaccinated against flu and COVID-19. So, according to what I’ve read, we will be dealing with COVID-19 for some time as a seasonal strain. You know, sometimes we see SARS and we’ll see MERS kind of circulate through. It’ll be that kind of thing. But I don’t believe it will be on the same scope of what we see now. And I hope not because eventually, once we have everyone vaccinated, or at least a good percentage, we’ll have that herd immunity necessary to keep it from becoming another pandemic.

ICT®: Rates of infection seem to be going down in most states. Are you worried that that might lead to complacency?

Ward-Fore: Absolutely. I’m in Chicago. And right now, our positivity rate is about 8%. So now, our mayor is looking to open indoor dining. Although I understand the need for it, I think we can do it and do it safely. As long as people continue to mask up, continue to socially distance and try and avoid indoor dining as much as possible. I mean, any time you’re in a place and you have to remove your mask, it really puts you at risk and anyone else in the room that’s unmasked. Even people who are masked, because we know that masks are only 65% effective. So, I think I’m a little worried. But I’m hopeful that people will continue to do the right thing. And it will give them just enough leeway to feel more comfortable and continue to follow these restrictions because they’ll feel a little less restrictive.

ICT®: What I’ve heard from people who are angry about the lockdowns is they’ll say something like, “Well, you’ll notice that everybody who’s pushing for lockdowns, they all have guaranteed paychecks.” There is real economic harm being done because of the lockdowns. Has that line been thrown at you and how do you respond?

Ward-Fore: I agree there’s a huge range of disparity regarding health care and accessibility. And you’re right, those of us who have been able to work from home, this has been not such a bad thing. But when you’re out in the frontlines…. Say you’re working in the grocery store. And I’m hoping that you’ve been given the best information to help keep yourself safe. But I will say, I was at the grocery store not too long ago. And it was the grocery store workers who are not complying with wearing masks, putting them at risk. And maybe it’s because they’re there eight hours a day, and they’re wearing that mask all day long. I think even with education, there's just fatigue. Think about it. Only those of us in health care are used to wearing masks for extended periods of time. I understand why, you know, the layperson struggles to wear it. But there’s been education about the necessity of it. I think just some people don’t get it or they think it won’t be me.

ICT®: The CDC’s Advisory Committee on Immunization Practices announced that they’re going to meet January 27 to talk about everything vaccine related, like what’s going on with the rollout, what’s going on with efficacy, what’s going on with the willingness of people in general and health care workers to get the vaccine? Would you like to be a fly on the wall at that meeting?

Ward-Fore: I would love to be a fly on the wall. One of the things I’ve been doing during the pandemic is I’ve been volunteering with the City of Chicago to do contact tracing. And some of the discussions we have had and the frustration that’s been felt with the anti-mask movement is very palpable. I think those same kinds of things will be discussed during this meeting. I don’t think a lot of people understand that public health isn’t just about me. It’s about you and everyone else. And for some reason, we’ve lost that. I think there’ll be frustration that the reason we’re where we are today is because we didn’t get it right in the beginning. I think they’ll talk about lessons learned. I think the mask mandate may be something that’s coming. I know it’s coming for federal employees, which is a good start. Maybe if we can get that done, and they discuss something like that, that will help rein in this more contagious strain, because it is a more contagious strain, which can continue to put a strain on our health care system. I think they’re going to need to address those kinds of things. Vaccine rollout is really, really important. For those vaccines that are sitting on the shelf in the hospital that health care workers don’t wish to take, I think it’s time to put them in the arms of those who do wish to take. And we’ve got to move mountains to get vaccine into arms to be able to get everybody safe and our economy opened up. I think there’ll be a lot of discussion about what’s going to be the fastest way to get this done.

ICT®: When the infection preventionist wakes up in the morning, what should she do in terms of where they’re getting information from? Should they go to the Johns Hopkins Coronavirus Resource Center? Should go to the COVID Tracking Project? There’s a very good tracking project at Washington State University. Is there a certain source that you look for as soon as you wake up?

Ward-Fore: I start locally, because you know, every place is different, every demographic is different. I’ll start with the City of Chicago, the Department of Public Health website for my local information, to see what’s happening in my neighborhood. And then, they receive their guidance. It all comes from the top-down. The CDC and WHO and then it all flows down. But I think it’s in your best interest wherever you’re located to see what your local departments of public health and officials are recommending. And we’re actually held accountable for the strictest regulations. So, if those are the strictest regulations, and they’re giving you guidance, that’s who you follow. I’ve looked at them for information. That’s why I know today, Chicago, is it 8% positivity, and we were at 10% last week. Things are headed in the right direction in Chicago. Follow your local guidance.

ICT®: I’m going to put you on the spot here, but mandated COVID-19 vaccination for health care workers: Are you for or against?

Ward-Fore: I’m actually for it, but I understand the reticence. It’s a new technology. It took us 10 years to be able to mandate flu vaccine in health care. And there are still some exceptions. I think it will be a long time coming before we’re able to mandate it. But I think just like measles, mumps, rubella, all of those vaccines, I think it’s something that we should think about mandating in the future. And it’ll be based on really more long-term data on it, and the efficacy and the safety of it. And once we have that I think more health care workers will decide they want to get it. And then hospitals will be able to mandate it because they’ll have a lot of data behind it. The safety of it, which is the main concern.

ICT®: Is there something that I didn’t ask you that you think is important for your fellow infection preventionists to know about either about the variants or the vaccination effort?

Ward-Fore: No, I think you covered it all. But one thing I want to remind IPs is have them remind everyone they interact with to continue to be vigilant. To wear your mask appropriately up on the bridge of your nose so that it’s a nice tight seal on your face and pull it under your chin. Make sure you’re wearing some kind of eye protection. If you’re face to face with people and you’re within that six-foot radius and continue to socially distance, I always say six feet is the minimum and I stand quite a bit farther away. And hand hygiene. Don’t forget your hand hygiene. That’s our number one way to protect ourselves. Infection preventionists need to remind people to be vigilant both in health care and outside of health care. Because we’re not done with this yet. We have a long way to go before we’re fully protected.

This interview has been edited for clarity and length.