Q&A: Infection Preventionists Might Become Vaccine Cops

Healthcare workers should be in the front of the line when the long-awaited vaccine against coronavirus disease 2019 (COVID-19) finally arrives. Thus says Jason Tetro, the host of the popular podcast show the Super Awesome Science Show and the author of The Germ Code and The Germ Files. Tetro tells Infection Control Today® that infection preventionists (IPs) might be drafted by those in the C-suite to encourage their fellow healthcare workers to get the COVID-19 vaccine. History tells us that not all healthcare workers are on board when it comes to being vaccinated. Many do not get the flu vaccine. “I believe that infection preventionists will be working with the C-suiters to be able to identify ways to be able to mitigate those individuals who are choosing to not follow the vaccination route,” says Tetro.

Infection Control Today®: When the COVID-19 vaccine comes, should infection preventionists and other healthcare workers get it first?

Jason Tetro: It would make most sense. Think about it. When we talk about rollouts for any kind of vaccine, especially ones that are new, we’re going to look at the people who are going to be at the highest risk as being at the front of the line. And as we’ve learned, not just from COVID-19, but also from SARS, and MERS and other respiratory agents, healthcare workers do, unfortunately, essentially make up the highest of risks. So, they really should be at the front of the line when a vaccine becomes available.

ICT®:And what’s going on with testing as far as healthcare workers are concerned?

Tetro: Well, I mean, ongoing testing is always a very good thing, regardless of what you’re dealing with. But when you’re talking about healthcare workers, again, because of that high risk, you need to be making sure that there are tests in place to be able to monitor them over time. It’s one of those few examples where you’re having consistent exposure, basically from day to day to day, simply because people are coming into the hospitals, to healthcare facilities, nursing homes, and their status is unfortunately unknown. And as a result of that the risk for a healthcare worker is at the highest. When we actually had the flu pandemic, back in 2009, 2010, the vaccine came out. And while we may have seen on the news lineups that looked like people were trying to get into a U2 concert, at the end of the day, the uptake was only about 30% to 40%. There really is a resistance to vaccination, and healthcare workers are not excluded from those individuals. Some do it for reasons outside of science. Some do it because they’re not exactly sure whether or not the vaccine is going to help them. It really doesn’t matter. We do know that there is going to be resistance within the healthcare community. And there has been a huge debate over whether or not mandatory is going to be the option to go or if you go like British Columbia, one of the provinces here in Canada, where they said you either get vaccinated against the flu or you wear a mask every time you walk into a healthcare facility. And since we’re already in a stage now where everybody’s wearing a mask, that may also be a fairly OK alternative. If you’re not going to choose the vaccine, then you should constantly be wearing a mask. Absolutely.

ICT®: When the vaccine comes out, there may be a lot of people who won’t want to be guinea pigs, for want of a better phrase, and they may include healthcare workers. This is all uncharted territory. How can those kinds of fears be alleviated?

Tetro: Well, there is a way and that is to let the phase 3 trials do their thing. And then when you’re finally finished with the phase 3, look at the results. And if the results say it’s safe and effective, then you roll it out. The problem is that because of the seriousness of COVID, and also because essentially, we have this so-called race to be first, what we’re seeing are several countries, and possibly the United States, forgo the phase 3 process and instead provide emergency or even just general approval, and hope to goodness that we don’t have a huge level of adverse events, or that the effectiveness actually isn’t all that poor. When you think about it, it makes no sense from a scientific perspective. But from a public, social, and political perspective, it makes perfect sense. So honestly, if I’m talking with someone who says, Look, I don’t want to get vaccine A, because it was approved after phase 2. I’m going to wait for vaccine B, which is going through the full phase 3 process. I kind of have to support that. But if someone is going to say, Well, I don't care if it’s gone through all the phases, it didn’t meet the criteria I personally have as an individual, well, then we might have to have a chat.

ICT®: Do you think there will be a pecking order among healthcare professionals in terms of who will get vaccinated first?

Tetro: When you look at the area, the geographic area, you find that there are different individuals with different professions within the healthcare environment that are highest of risk. So, it may be nursing homes in some areas of the world. It may be hospitals in other areas of the world. It really all depends. And every country is going to have to do their own risk assessment to be able to identify which healthcare workers are probably at the highest risk and need to have that vaccine first. Is it going to be a race to the front of the line? I want to say yes, but based on experiences that we’ve already seen, I don’t think that’s going to happen. It’ll just simply be people are going to do their thing: wear their masks, perform the hand hygiene, make sure they work with the isolation and adopt the precautions as necessary. And then one day they’re going to get a call or they’re going to get mail, maybe during one of their nursing huddles. They’re going to hear that the vaccine’s available. I honestly believe that’s the way it’s going to be approached.

ICT®: The vaccine is not going to be a cure-all, but how effective is it going to be?

Tetro: Well, what we’re hoping for is that it’s going to essentially stimulate memory in both arms of the immune system. So, we have the innate or humoral system, which are the antibodies which everybody talks about. And then there’s the cellular adaptive immunity, which is where we have the T cells, and that in itself could create a memory that is very, very long lasting. Now here’s the thing, when you look at people who are coming down with the COVID-19 infection, and then you look at their immune responses, it relies less on the innate immunity. In other words, the antibodies are not as important as that T cell immunity when it comes to being able to prevent severe infection. What we’re hoping for is that T cell adaptive cellular immunity is going to be very, very, very strong with one or several of these particular vaccine options. So, that down the road as we’re facing new and subsequent waves of this particular virus—and remember, we’re going to find waves for H1N1, that pandemic that we had 10 years ago, we’re on the 11th wave. There are going to be COVID-19 waves every year. What we hope is that that vaccine is going to be able to help us to be able to have that protection whenever those waves are hitting us.

ICT®: You’re familiar with the administrative structure of hospitals. Is there any chance that infection preventionists might be drafted into becoming vaccine police?

Tetro: Honestly, we are at a point now where the people who want the vaccine are going to get it. But people who don’t want the vaccine are not going to get it. And even though we haven’t even seen the approval for a COVID vaccine yet, we can pretty much identify who is going to fit into which one of those categories. And so, as a result of that, I believe that infection preventionists will be working with the C-suiters to be able to identify ways to be able to mitigate those individuals who are choosing to not follow the vaccination route. And depending on the decisions that they make, it may simply be bringing them back so that they’re not part of the front of the lines. They may end up doing less threatening or less severe wards. It really comes down to how do you manage these particular people. So, you don’t really look at them as being a risk that you have to mitigate. But that they’re just another part of your populace of workers who you have to essentially manage. And you know, the old joke is management sucks. And this is one of those situations where, yeah, it’s really a hard choice no matter what direction you take.

ICT®: Any final words for all infection preventionists or other health care professionals?

Tetro: When it comes to a vaccine, you have to realize one thing: It is a tool. And it is a tool that is to help us be able to reduce the chances of that infection spreading within a community. That is not going to stop people from getting sick. That is not going to stop COVID-19 from spreading, and we’re at least a year away before the pandemic that we’re in probably disappears. So, in the time being, maintain what you’re doing. Keep up that vigilance. It’s hard, it’s draining. You’re to have to take time for yourself. That burnout is incredible. So, make sure that you’re taking care of yourself as well as taking care of other people. And whether that vaccine comes in November, December or sometime next year: Again, it’s going to help to reduce the load. But as a healthcare worker, you know that that load is always going to be there. It’s just for the last six months, it’s been focused on one thing, and it hopefully will give us that wake-up call that everybody really does need to take time for themselves, so that they can get the rest and recuperation that they need.

This interview has been edited for clarity and length.