Episode II: Evaluating Our Region’s Response to COVID-19

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Episode II: Evaluating Our Region's Response to COVID-19

Summary: Dr. Hilary Godwin of the University of Washington, Dr. Chunhuei Chi of Oregon State University, and Dr. David Pate, formerly the President & CEO of St. Luke’s Health System in Boise, joined NPI’s Caya Berndt to discuss the status of our region’s response to SARS-CoV-2, the virus that causes COVID-19, including the disease’s highly contagious delta variant.

Release Date: July 31st, 2021
Recorded: July 11th, 2021


Caya Berndt: Hello and welcome to PNWcurrents, an in-depth podcast from the Northwest Progressive Institute that brings together thinkers from Washington, Oregon, and Idaho to discuss strategies for advancing progressive causes across our region and beyond.

I’m your host, Caya Berndt. Thank you for joining us!

At the Northwest Progressive Institute, we believe that good legislation and good policy don’t pass by accident. Worthy ideas — from increasing the minimum wage to fifteen dollars an hour to Medicare For All to wider availability of rooftop solar — need sound strategies if they are to become a reality. Our team believes research is the key to identifying winning strategies, while advocacy is the key to implementing them. That’s why we’re engaged in both.

You can learn more about our insightful research, imaginative advocacy, and our history by visiting n-w-progressive.org. Again, that’s n-w-progressive.org. I will give you that information again at the end of this podcast.

Our topic for this month’s episode is the status of our region’s response to severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019, which is known as COVID-19 for short.

At the end of last month, Washington and Oregon lifted requirements and restrictions imposed early on during the pandemic, in what has been dubbed a grand reopening. Idaho, meanwhile isn’t far behind from lifting the last of its COVID emergency measures. However, despite the rollback of public health measures, the pandemic continues. Many people, especially in rural communities, remain unvaccinated and thus at great risk of contracting COVID-19’s delta variant, which accounts for a growing share of all COVID cases worldwide.

America has been hard hit by this pandemic, with over half a million lives lost. Many survivors are grappling with the effects of what’s been called “long COVID,” and we’re learning more every day about how harmful those are.

While the Biden-Harris administration has done heroic work to get the virus under control, especially on the vaccination front, much remains to be done, both in the U.S. and abroad. Recently, World Health Organization Director Tedros Adhanom Ghebreyesus warned: “The world is at a perilous point in this pandemic… far too many countries in every region in the world are seeing sharp spikes in cases and hospitalization.”

Joining me to discuss how the Pacific Northwest is doing with its COVID-19 response and what our region needs to do to keep cases down are Dr. David Pate from Idaho, Dr. Chunhuei Chi from Oregon, and Professor Hilary Godwin from Washington. Welcome to all three of you!

Chunhuei Chi: Thank you!

David Pate: Thank you!

Hilary Godwin: Thanks for having us!

Caya Berndt: All right — wonderful! So before we get into our discussion, let’s do some brief introductions so our listeners can get a sense of the expertise and experience that this panel brings to the table. Hilary, would you like to get us started?

Hilary Godwin: Yeah, absolutely. It’s a pleasure to be here today. My name is Hillary Godwin and I’m a professor of environmental health sciences, and also Dean of the University of Washington School of Public Health.

Caya Berndt: All right, thank you. And Chunhuei, over to you.

Chunhuei Chi: Hi, it’s a great pleasure to join you. My name is Chunhuei Chi. I’m a professor in global health and also in health management and policy program at Oregon State University. I’m also the director of Oregon State University’s Center for Global Health.

Caya Berndt: Wonderful. Thank you for that. And finally to you, David.

David Pate: Thank you. It’s good to be with you. My name is David Pate. I’m a general internist by training. Also a healthcare attorney. I am recently retired as the president and CEO of Saint Luke’s Health System, the largest health system in Idaho. And since the beginning of the pandemic, I’ve been serving on the Idaho governor’s Coronavirus Work Group.

Caya Berndt: All right, thank you for that. And I’m Caya, your host. I’m an NPI staff member and undergraduate at Central Washington University, Spokane native and eternal and reckless optimist. I have a passion for ideas and catalyzing productive conversations that can spark long-lasting progressive change. It’s wonderful to have you all here. Let’s start off with a quick rundown of what’s happening across our states. We’ll begin in the Beaver State, which like the region as a whole is seeing fewer cases, tests, hospitalizations, and deaths overall. Still, hotspots along the Columbia River Gorge, including in the Pendleton area, are prompting some concern. Chunhuei, can you summarize the status of Oregon’s pandemic response for our listeners?

Chunhuei Chi: Yes. Oregon, since the beginning of the pandemic, in terms of its overall pandemic control policy and approach, compared with the rest of the states in the nation, I would say it’s in the medium level — not particularly strong and not particularly weak. And there is room for improvement, surely. And similar to Washington State, we have urban versus rural divisions. Whether it’s about the cases or about vaccinations, you can see huge differences between the urban and the rural. And similarly, with the pandemic response, not just as with the government response, but also about the residents’ response. So for example, during this entire time, up till the recent vaccination [efforts], if you went to urban areas whether Portland, Salem, and Eugene, or even where I live, in Corvallis, you [would have seen] the vast majority of people, when they are in any public place, in outdoor space, wearing masks. But then, when you cross the Cascades, or to the South, it’s almost the opposite, with the exception of the Bend area.

And so in terms of the population’s behavior, there’s a huge variation. That variation creates a challenge and difficulty for the governor [Kate Brown] and for the health authorities. Oftentimes, as I observe, the level of stringency of major control is often compromised. So for example, during the early time of the lockdown, we still allowed church [congregations] to gather, which purely from a public health and hygiene point of view, doesn’t really make sense. If you do not allow public gathering, why with the exception [for the] church [congregations]? And so that’s an example of a compromised approach. And with that compromised approach, we are bound to see the differences in how counties — using the county as a unit — how counties fare, in that we continue to see high cases and low vaccination rates in rural counties.

I have been reviewing and following the vaccination rate, and in terms of fully vaccinated, in the urban area, many states are approaching sixty percent or even higher, whereas in the rural area, many county are still below thirty percent. And so it can be misleading if we only look at state statistics, because within states, there’s a huge variation. And I think every state is doing the same thing: trying to provide incentives for those counties that have low vaccination rates. And there has been a mixed result from incentives, which [we can talk about later]. If we have time, we can discuss that.

Caya Berndt: Yeah, we’re definitely going to address that later. So yeah, thank you very much for that summation Chunhuei. And then, moving on to David! Idaho recently advanced to stage four of its reopening strategy. But my understanding is that how officials in the Gem State managed the pandemic has thus far been pretty different from Washington or Oregon. How would you assess Idaho’s pandemic response?

David Pate: Well, it’s very decentralized in our state. Our state has seven public health districts. Those seven public health districts have boards, and certainly some seem stronger than others. We have had board members promoting misinformation and conspiracy theories. It’s quite shocking that you can be on the board of a public health agency and yet have little appreciation or regard for accepted public health principles. In fact, a physician was just removed from our biggest health district because he promoted a mask mandate. So he has now lost his position. We’re waiting to see who will be appointed to that board. We have had those board members who have pushed for as strong preventative measures have been the recipient of overwhelming hate emails, on occasion threats. And on at least a couple of occasions of people actually showing up to their homes to protest.

It’s certainly been a very difficult time. Our state has done surprisingly well, despite this. Oregon and Washington both had forth surges. I certainly expected Idaho to have a fourth surge at the beginning of this year. We didn’t. And I have no idea why we didn’t, and that’s one of the very mysterious things about this virus. In addition, right now, our transmission rates on a relative basis are very low, about five new daily cases per 100,000 statewide. Although, as Dr. Chi was mentioning, [there is] a lot of variation in Idaho. Idaho also has many rural areas, some urban areas. And so we do see differences. Our overall vaccination rate is quite low. I only look at — especially with the Delta variant now — I only look at the completed vaccination rate. I’m not sure what getting one shot means anymore. It used to mean something.

So our completed vaccination rate is only around 44%. And of course one of the things that some of us are worried about, many are not worried at all, is what does this mean for schools coming up? So, right now we’re in a good place. I don’t know why we’re doing as well as we’re doing, but certainly we do see some areas where the infection rate is higher and is increasing. And so I think as we see across the country, with overall growing rates, we’re on the edge of our seats waiting to see what will happen.

Caya Berndt: And, Hilary, Washington’s COVID-19 restrictions recently got lifted to great fanfare. A big crowd showed up for the first game of the Mariners post June 30th home stand at T-Mobile Park. How is the Evergreen State doing with its pandemic response?

Hilary Godwin: Pretty different from what you just heard for Idaho. We have had, since the beginning, a fairly coordinated response across the state with policy being set by the governor who works very closely with the Washington Department of Health, which we refer to as DOH. They’ve collaborated really tightly, and we’ve seen very good alignment in terms of public health recommendations and government response at the statewide level, similar to what you’ve heard for Oregon and Idaho, though, of course, there’s differences between different counties.

And like you see in Idaho and Oregon, much of those differences tend to fall into the urban rural divide. But that being said, I think Washington has been a really great example of how, for instance, we’ve been able to leverage connectivity, not just in public health, but in our health systems across the state. When there was a surge in cases in Yakima and their ERs [emergency rooms] were overloaded, we had people medevaced to the Seattle area for care. I would say [we’ve had] really good statewide coordination, and good success rate in terms of overall the percent of the population that’s vaccinated.

So right now, if you count individuals over the age of sixteen, we are just hovering around seventy percent for the State of Washington. The CDC uses over the age of eighteen, and then we’re way above seventy percent. But as you heard, big variation from county to county, from region to region across the state, in terms of those percentages, with some counties being in the twenties and many being in the thirties, in terms of percent of residents who are vaccinated.

Nonetheless, we have still seen our caseloads have really dropped dramatically, probably because the majority of our residents live in counties where there’s good vaccination rates. So we’re down with the fourteen-day rolling average about three hundred and seventy cases per day [as of early July 2021], which is fantastic. It’s much lower than it’s been in a very long time. In addition to the world disparities, we’re also seeing, I would say big disparities in terms of impact on underserved populations and traditionally excluded populations, and we see different rates of vaccination amongst different populations based upon their healthcare access as well.

Caya Berndt: Thanks for those recaps everybody. I’m sure we’ve all got a lot to talk about, lots of questions. So let’s dive into our discussion. Mike Ryan, the executive director of the WHO’s Health Emergencies Program, said recently, that is “a moment for extreme caution for our countries right now… The idea that everyone is protected and it’s Kumbaya and everything goes back to normal–I think that is a very dangerous assumption anywhere in the world.” So with our COVID-19 restrictions having gone away, my first question to all of you is: to what extent should we continue to mask up and practice physical distancing? If you wouldn’t starting us off, David?

David Pate: It’s a very tough question. It’s certainly very easy with respect to those that are unvaccinated. That’s easy, nothing has changed. Arguably, things have gotten more dangerous for those that are unvaccinated. So the unvaccinated should not be changing any of the practices that we’ve been recommending for the past year. They should be avoiding large groups, they should be wearing masks when they are indoors with people that they don’t reside with. For the unvaccinated it’s quite clear: they’re at elevated risk.

And part of that is just because so many public entities have eliminated their mask requirements once the CDC came out and said that fully vaccinated persons no longer need to mask. So those mask mandates went away, but those mask mandates actually protected the unvaccinated as well, because everybody was masking. Now, unlike what my colleagues here have described, I see in our state only 44% of people are fully vaccinated.

I can tell you, I see very few people masked, and I should be seeing slightly more than half masked when we go out. So I think that is dangerous. The far more difficult question is: what should people that are fully vaccinated be doing at this time? I don’t have the same public health expertise that Professor Godwin and Dr. Chi have, but in my view, I have never thought that this was a “vaccine-or-nothing” strategy until we were at comfortable levels where disease transmission is consistently suppressed, we’re not seeing new variants, and so forth.

I didn’t quite understand why it was a full switch from all these precautions to none if you’re vaccinated. Generally speaking, we would continue to exercise some precautions when there is high levels of disease spread. We certainly have not achieved herd immunity, if that’s even something that’s possible and personally I’m not convinced that it is.

And I hear people say, “Well, let me tell you about the science of the delta variant.” Well, that makes it sound like there’s some point in time where, okay, now we know all about the delta variant. We don’t know all about the delta variant! We are constantly accumulating science and information. And I think for those people that have already made all their conclusions about the delta variant, I certainly don’t take that assurance. Although the vaccines clearly are highly, highly effective and highly protective, they’re not perfect. And therefore, I do think there are certain groups of people that are fully vaccinated that still need to take precautions.

I’m very concerned about people who are immunocompromised, either because they have an underlying immunodeficiency, or they’ve got an immunocompromised situation from medications or medical procedures. I’m still worried about those people. We don’t see such great results of the vaccines in them. It’s important they get vaccinated, but they should not rely on vaccination protecting them. And I think I really put them in the same category as those that are unvaccinated. Their world has just gotten a lot more dangerous since the CDC guidance, frankly.

The other group that is much harder to know about is the older population. We’ve been familiar with this concept of immune senescence, of the fact that older people don’t have as robust immunity as people that are younger. We don’t know to what degree. Frankly, so far in data that’s been made available from these vaccines, it looks pretty good in the elderly. On the other hand, when we do see breakthrough cases — which are to be expected by the way, that’s not a surprise that we have breakthrough cases – -but when we see them, and when we see people that, while most breakthrough cases, people aren’t even aware of, or they’re mild, when we do see severe outcomes, they do tend to be older folks, people with other risks.

So I certainly think it’s not unreasonable for older individuals, and particularly those that have very severe underlying medical conditions, to still take some added precautions at this time, until we do feel like we really do understand what the risks are. There are issues and certainly a lot of debate.

And we just don’t know the answer about whether fully vaccinated people may be playing a role in the transmission of Delta. We didn’t seem to see much evidence of that before, but I think one thing that frustrates me is, as I certainly look at a lot of decision makers that are making decisions based on the virus’s behavior last year.

And I think we have to realize that things are different. They were different with alpha, and they’re different with delta, and they would probably be different with lambda when that gets here. I think we shouldn’t look at this as a steady state. I think we have to constantly be reevaluating. And I think that frankly, for some of those higher risk people that are fully vaccinated, I’m not sure that we can be confident in the guidance and therefore, I urge them to make their own risk assessments, and certainly tell them that there’s nothing wrong with taking some extra precautions until we know better.

On the other hand, young people like you, Caya, that are in great health, you’re fully vaccinated. I don’t know that you have much to worry about, other than the possibility until we know better with delta: could you possibly get it and transmit it to your grandma or grandpa, even though you’re fully vaccinated?

We just don’t know that answer yet. It may be no, but we don’t know that answer. And there’s certainly some reason to be questioning that. So, I wish I could give you a better answer, but that’s the best I got.

Caya Berndt: You make a lot of good points. I do want to turn to you Chunhuei, with the same question. In your assessment, to what extent should we continue to mask up, practice physical distancing for unvaccinated and for vaccinated individuals?

Chunhuei Chi: Yeah. I agree with what David just said. At the same time, even then we still need to accelerate, to push for more vaccination. There’s this delicate balance of messaging, because earlier, I think in April, up to April or in early May, the CDC was facing that challenge, because before the CDC changed guidelines for people who are fully vaccinated, the guidelines remained the same. That raised a major question about those who hesitate to be vaccinated. They asked, “Then what’s the point of getting vaccinated if that doesn’t change our accessibility of activities?”

So we need to bear that in mind in terms of messaging — that is, we still need to encourage people to get vaccinated. While I agree with David’s comment, I just want to supplement [with an observation]: oftentimes people have misinterpretations about those protection rates from the clinical trial. They mistakenly interpret that as saying: if Pfizer has a clinical trial data suggesting ninety-five percent protection from infection or from symptoms, and they interpret that as “If I am fully vaccinated, I have ninety-five percent protection.”

That’s not the correct way to interpret that. Based on the clinical trial data, the correct way to interpret that is: out of every one hundred people who are fully vaccinated, if, say the protection rate is ninety-five percent, that means ninety-five out of one hundred are one hundred percent effective in preventing them from having symptoms. But the other five are not. All we can say for the other five [is that] the protection rate is zero, or close to zero.

And so with that in mind, to the appropriate or correct interpretation of the protection you get from the vaccine, one thing I particularly want to note, as David also alluded to, is people who have immunocompromised, or with severe chronic conditions, particularly cancer. I have reviewed the data. I think almost none of the available vaccine, during the clinical trial, they included cancer patients as their sample.

That means we have very little data on to what extent cancer patients are protected. And that part needs to be investigated. At the same time, they did include a lot of chronic conditions, whether hypertension, or even diabetes. And so the appropriate interpretation of the protection, if you want to be more detailed, is to look back into who were included in those clinical trials? And for those diseases, a patient, like cancer that were not included, you have to take extra caution because we don’t know at this point to what extent [those who] are fully vaccinated are protected.

And in term of masks, again, anyone who is fully vaccinated but has cancer or other chronic conditions, I would advise taking more caution. Continue to wear masks if you’re in the public, indoor places. And of course [when ridng] public transportation. But also, [I want to touch on] one point that people often neglect: we still have our entire population who are twelve and under unvaccinated. I’ve seen many parents who are fully vaccinated, started to take advantage of summer, start to travel, to party, but they neglected to protect their children.

So I would strongly advise the audience that if you have unvaccinated children, when you are doing any social gathering or travel, please remember to protect the children. While children generally are more resilient, they can still, if they’re infected, transmit the virus into your family or other friends.

And again, the vaccine is not one hundred percent protective. We can still be at risk. At the same time, by now we know, David made a very good point in terms of this COVID-19, it’s a new disease. So we continue to learn new knowledge. And oftentimes, our new knowledge we learn always from what we knew last year.

And so one thing we know by now is that the virus will develop new variants in places or populations where they found a rich breeding ground. So one of the big concerns now, besides the regions that’s have less vaccination, is whether, over time, the virus might develop a new variant that is particularly prone to attack the younger population. And that’s why I think the protecting the unvaccinated, especially children, will be very important.

Caya Berndt: Yeah. Thank you very for that Chunhuei, especially the point about children, especially in multi-generational households, where they could expose older folks like David mentioned. Now, before we move on to vaccines, Hilary, I want to get your thoughts on masking and maintaining physical distancing. What are your thoughts on what types of precautions we should be taking?

Hilary Godwin: I agree with what we’ve heard so far, completely, and I guess I would say in addition to people who are most vulnerable taking extra steps to protect themselves — and we know now masking actually is a very effective strategy for protecting individuals — I would say the other place that I would recommend that people really think about masking up again, even if you’re vaccinated, is in situations where you have a high potential for exposure.

So that’s, for instance, the reason that there’s a requirement when you’re on public transportation, that everyone be masked is because you have a lot of people that are in close proximity to each other, and they’re mixing from all different areas, right? And probably the greatest situation for us in the United States is in the airports. With people who are coming literally from all over the world and mixing with large numbers of other people. That’s a high potential for exposure situation, and a situation where everyone should be fully masked.

But likewise, if you’re traveling to a region where a large percentage of the population is still unvaccinated, that’s another situation where there’s high potential for exposure. Or if you’re living in one of those regions, for sure, then you might still want to stay masked when you’re in public places, particularly indoors, if you’re in an area that has very few people vaccinated, a small percentage of the population vaccinated, and a high level of disease transmission. So that could be rural counties in all of our states. But the one that I keep reminding people about is, people were getting excited like, “Woo! We’re open in Washington!” and thinking about international travel again… things are not good in many parts of the world.

We’re so privileged to live here in the United States where we have good access to three fantastic vaccines [Pfizer-BioNTech, Moderna, Johnson & Johnson], and most people in the world don’t have that kind of access. So we’re still seeing really high disease transmission and emergence of new variants in many regions of the world. And I would say, if you need to travel to those areas, absolutely continuing to mask is the WHO’s recommendation, regardless of your vaccination status, it’s really critical. And most importantly, get vaccinated before you travel!

Caya Berndt: Excellent points, Hilary. This would be a great time to start talking about vaccination, as that is still an ongoing challenge. Since the FDA approved vaccines from Pfizer-BioNTech, Moderna, and Johnson & Johnson, the United States and Pacific Northwest have made distributing and administering the vaccines the focus of their pandemic response. The latest data suggests that supermajorities in Washington and Oregon have been vaccinated, but in Idaho, as you mentioned David, only forty percent across all ages have received at least one dose and only thirty-seven percent are fully vaccinated. So that means that the Gem State has the furthest to go in inoculating it’s people. David, what are your thoughts on combating vaccine hesitancy and bolstering Idaho’s vaccination rate?

David Pate: Well, Caya, it’s a very good question, but a very difficult one to answer. I’ve had many, many discussions with people that were vaccine hesitant. I don’t have too many conversations with people that are vaccine resistant because it will just drive you to drink, so I’m careful where I spend my time. But I recently had a meeting with about fifteen parents who were hesitant about getting their teenage daughters vaccinated. So, we had an hour discussion and I’m pleased to say by the end of it all agreed, and I did get confirmation, they all followed up and did get their children vaccinated.

So it is possible to move those who are hesitant, but I would, pardon the pun, be hesitant to put them all into one basket either. They have various different concerns. Certainly there’s been a lot of misinformation. Some people may be concerned because of some of this misinformation. So it may be a matter of straightening that out.

Others are thinking, “Well, I will eventually get my child or myself vaccinated, but there’s not a need to right now because our cases are low. And let me just wait for a while. And plus I’ll learn more about how everybody else is doing.”

So that could be a reason. And I think rather than taking this approach where I’ve got people that are vaccine hesitant and I’m just going to go out and tell them why they should get vaccinated. I think we need to do it in reverse. We need to start out and just ask, “Okay, tell me what you’re concerned about. Tell me what’s holding you back?” Because we don’t need to go on with an hour-long lecture about vaccines if we’re not going to hit what their point is.

So we just need to hear from them: what is it? Hopefully some of those discussions are happening with their personal physicians, hopefully there are people that are influential to them that are able to give them the reassurance, hopefully they can look to good sources to get information, but I do think it’s different for different people. [As for] the incentives… I think it will be interesting once we really can get some data to see, did that really move the dial?

I certainly am not under any illusion that for those that are vaccine resistant, that creating incentives is going to move the dial. Question would be, is it going to move the dial for some of those that are just on the edge? And I don’t know the answer to that. I think another part of it is with people that are hesitant, maybe it’s somebody like you, Caya, that’s young, healthy, “Why do I need to get vaccinated? Even if I get COVID my chances of being sick or being hospitalized or dying are pretty low.”

I think we have to make sure people understand: there are more reasons to get vaccinated than just to keep you from dying. I mean, that’s an important reason to get vaccinated, but it’s not just you. It’s to protect others. And frankly, there are some bad things that can happen to you, even if you survive COVID, and we’re certainly learning more and more about that. Certainly, I’ve talked to people with long COVID and let me tell you, not one of them has told me that if they had it all to do over again, that they wouldn’t have gotten vaccinated to prevent having to go through what they’d gone through.

So we need to help people understand: it’s not just about keeping you from dying. It’s about helping prevent you from infecting other people, it’s about preventing you from getting other kinds of complications from it.

And frankly, what is just causing me to beat my head against the wall is I talked to these parents that: “I want my kids to be in school, I want full school, I want full athletics.” And then you say, “Okay, have you gotten your high schooler vaccinated?” “Oh no.” Well, you don’t get to have your cake and eat it too. And so for those parents of children that are twelve and older, your best chance of keeping school in full attendance every day, with sports and all, get people vaccinated. I think it just takes a lot of different conversations to get there. We’ve got to keep getting good information out.

I think the other thing for the future, we’ve got to try to help people in the future understand how to choose your sources for information. How do you teach people? Because all of us wade through this stuff and we know what are reliable sources, what aren’t, and we need to teach kids and the public: how do you assess the veracity of what you’re being told? How do you assess sources of information that are going to be reliable?

So that we’re not constantly, just constantly doing, whack-a-mole trying to count this misinformation or this conspiracy theory. We got to help people find good sources of information to begin with.

Caya Berndt: Right! Hilary, I want to move on to you. Washington is one of the more vaccinated states, but the campaign to vaccinate Washingtonians is now entering a tougher phase, a phase in which the target population increasingly consists of vaccine skeptics. We’ve tried a lottery and incentives. What else should we be doing?

Hilary Godwin: Well, I think we have some great examples from right here in Seattle and King County of strategies that were super effective, that I hope we see replicated across the state. So for me, one of the frameworks that I find most helpful in terms of thinking about why we have so much vaccine hesitancy is, as David mentioned, thinking about the different types of reasons that people are vaccine hesitant, and The New York Times had a fantastic article, and they have a great interactive thing where you can look at, by state, what percentage of the people who haven’t gotten vaccinated? What reasons they cite for it. And they break them down into four different categories.

So yes, there are the COVID skeptics, and I’m looking right now at Idaho’s data, and you have twenty-three percent [who] are skeptics versus in Washington. For us, we’re down at fourteen percent. So yeah, that is a big barrier.

And given how bifurcated our media is right now, and divided it is, I think reaching those folks is particularly hard. The other group that’s really hard to reach are the group that The New York Times referred to as “system disruptors.”

Those are individuals who feel that the healthcare system doesn’t really treat them fairly. They tend to be a pretty small percentage though. So to me, what I look at are the two groups that I think are pretty low hanging fruit, the groups that are cost anxious and the groups that are watchful, which David also mentioned.

Let’s talk about the cost anxious ones. We keep talking about how the vaccines are free, right? But nonetheless, if you were working an hourly job, you have to take time off of your job to go get vaccinated. And if your employer doesn’t pay you to do that, it is costing you money to go and get vaccinated.

So one of the strategies that we’ve used here in King County, and specifically in the City of Seattle, is to take vaccination sites to the people. Lumen Field was our big vaccination site. That site was chosen because it was so accessible to so many people, it’s right on the light rail line. Even if people are not super excited about taking public transportation, at least they can get to it. We’re not vaccinating there anymore, but for a while, we were doing thousands of people per day at Lumen Field. So that was a big part of how we got to where we are. And then the other strategy that we leverage really heavily here in Seattle were what we call pop-up sites. And those pop-up sites tended to be in collaboration with trusted partners, and often in low income neighborhoods as well. So it really was targeting those individuals, bringing vaccines to them, who otherwise were going to have difficulty getting to a vaccine site. And so that’s a really important group.

Then there’s the watchful group. And I think David emphasized that there are definitely people who are still sitting on the sidelines, waiting to see what’s going on, but they aren’t opposed to getting vaccinated at some point. And so I think continuing to message what we do know about the three vaccines that have been authorized for emergency use in the United States, which is that they’re SO much more effective than any of us would have dared to dream.

So yeah, we’re seeing breakthrough cases, but the vast majority of people are really well protected against severe disease, hospitalization, and death. So like I said, we’re just so lucky to have access to those. And we’re seeing really low side effects. I know there was a lot in the media when there were some blood clotting issues with J&J, and it was literally right after I had gotten the J&J vaccine, and people are texting me, like, “Are you worried?”

I was like, “Nope, I’m not worried because statistically, being unvaccinated, I was more likely to die from COVID-19 than I was to get, once vaccinated with J&J, to get that blood clotting issue.” We’re just, I think continuing to message to people, yeah, we still have a rollercoaster [ride] ahead of us. We’re still watching the variants.

Obviously there may be times when a new variant comes out and that we’re going to need to pull back on some of the freedom that we’ve been enjoying the last couple of weeks, and go back to doing some masking or even some more physical distancing, but we’re doing a lot better job of monitoring what’s going on with those variants, doing sequencing of them, checking what’s going on internationally. Getting vaccinated it’s really the way to go for those people who are sort of like, “Should I, or shouldn’t I?”

And then finally the last strategy that I want to point out that was really heavily leveraged here in King County, that I would love to see taken across not just the State of Washington, but also Oregon and Idaho as well, which is that the city and the county really partnered with our public school system. So they actually got into the public schools and did vaccinations at middle schools and high schools before the school year ended. So right now it’s hard.

All our kids are scattered to the winds and enjoying the freedom of summer. But thinking about having vaccine clinics in our public schools for kids, when they come back by trusted providers are our nurse practitioners that are in the schools. That really is a great way to go and offer free vaccines at the same time to their parents. That would be great.

Caya Berndt: Yeah. That’s fantastic, Hilary. Chunhuei, Oregon is right behind Washington on vaccination rates, but like its northern neighbor, there is an urban/rural divide and incentive based advocacy campaigns have only moved the needle a little. What else should Oregon be doing?

Chunhuei Chi: Well, I agree with what David and Hilary just mentioned. In Oregon, some counties have already done what Hilary mentioned, bringing the vaccine to the job, to the employment [centers]. At the same time in Oregon, besides the rural-urban divide, [we have a concern with] the minority population, especially the Hispanic and African-American [communities]. Their vaccination rates are still way below the general average population.

There’s a mix of factors. [Wages] are one factor. And for the Hispanic [community], many of them are seasonal or migrant workers, and some of them, they don’t have regular places [of employment].

So the next step will be to identify those regions, those farms, and bring the vaccine to those farms. And one particularly tough challenge: I think that, even to this day, there are still Americans who do not believe there’s a such thing as a pandemic [happening right now].

I call them the pandemic deniers, and the estimation is [that they are] somewhere between ten percent to fifteen percent [of the population]. And this will be a very tough sell to ask them because if they don’t believe there’s a pandemic, why should they be vaccinated? And of course they are the ones who will not wear masks because there’s nothing to protect against. I think we have a big hurdle to overcome [with respect to] those pandemic deniers.

My suggestion is, given that we need higher rates of the population to be vaccinated to approach herd immunity, we may need to compensate, to boost up vaccination [rates] among the young people, especially between twelve and eighteen. Currently, their vaccination rates are still lower than the other age groups.

[Again]: In order to achieve greater protection for the entire population, to compensate for that, we need to vaccinate more children. And then when the vaccine becomes available, sometime this fall for children under twelve, again, we need to vaccinate them. And there’s also [been] conflicting messages about the issue of herd immunity, because from federal to state and even local, they’re using different parameters for vaccination rates.

A true herd immunity doesn’t care about your age group. So the rate I have been monitoring is all populations, not just eighteen and above or sixteen and above. We need to aim at [the whole] population, to reach as high [of] a vaccination [rate] as possible. Given that we have a high-resisting group, the pandemic deniers, they will probably never get vaccinated. So we just need to vaccinate our children and younger generations.

Caya Berndt: A follow up question for all of you: Though we’ve all been affected by COVID-19, the pandemic, as many of you have noted, has fallen hardest on communities of color. I know that states are already taking measures to address that. Earlier this year, Washington announced that it would be tracking county vaccination rates by race and ethnicity in an effort to improve vaccine equity. Idaho initiated their own vaccine equity cooperative to address these disparities. So Hilary and David, what is the status of these causes in your states, starting with you, Hilary?

Hilary Godwin: That has been front and center both for Washington Department of Health and also the City of Seattle. Public Health Seattle-King County is really being strategic about making sure that people have access to vaccines. I guess, I would like to just take a step back and say, hopefully everyone who’s listening is aware of this, but the reasons that those communities have been disproportionately affected is because of structural racism. It’s not because of vaccine hesitancy. So we see that those communities of color are disproportionately ones that are working in service sectors, where they have to work in person. And so they’ve had much higher exposures.

Those populations in some cases have much higher rates of disease that makes them susceptible to comorbidities that make them susceptible to more severe impacts, and also are more likely to be living in multi-generational households. That has nothing to do inherently with race, it has to do with the inequities in our society that have occurred along racial lines. So in terms of how to address those, we have to take the same approach in terms of thinking about what are the structural barriers that have created those health disparities.

In terms of access, again, one of the things I was talking about, was really thinking about, is what are the barriers to access that people have, particularly in communities of color? And so, for instance, people who are in hourly jobs, how do we make sure that we are getting vaccines to them and [avoid] making it difficult or costly?

Another one is really recognizing that those communities also have been disproportionately taken advantage of, historically, by our medical and public health systems. And so they understandably have mistrust of whether or not our systems are looking out for them, or that our agencies are looking out for their best interests.

Partnering with trusted partners in those communities has been a really important strategy. For instance, we’ve seen both the City of Seattle and also Public Health Seattle-King County partnering with some of our Black churches to bring vaccines to their congregations. That’s one strategy. One of those things that just makes me smile is looking at how well our Native serving organizations have done in terms of vaccine delivery to those populations, talking to them.

For instance, the Seattle Indian Health Board has done a fantastic job of really thinking about giving vaccines to people before, when we had all these [stipulations] like, “only people this age could get it.

Because they have tribal sovereignty, [they] could do what they wanted. And so they said, “We’re going to give vaccines to anyone who comes to our clinic if they want it.” And that was a great strategy! It worked really well.

So this is definitely one of those cases of it’s going to take multi-pronged strategies and really thinking about what are those systemic contributors to the inequities that we’re seeing.

Caya Berndt: That’s great insight, Hilary. And David in Idaho, what’s the status of Idaho’s own vaccine equity cooperative?

David Pate: Well, we see the same kinds of issues that Professor Godwin has just described. And as you mentioned, Caya, we’re trying to address those. I don’t know that we have enough data yet to judge how successful these efforts were because they’ve only been recently implemented, but I think Professor Godwin brings up a lot of great points.

One is, again, we should not make generalizations about these populations. There’s many different issues. Some may be distrustful and have good reason to be so. There’s others who would love to get vaccinated, but they can’t get off from work, or they may not have transportation. And sometimes those of us that are more affluent, we just assume people, “doesn’t everybody have a car, or doesn’t everybody have a working car?” At one of our clinics, a gentleman drove fifteen miles on a flat tire to come in and get his vaccine.

And we just have to remember that and keep in mind that there’s a lot of obstacles for a lot of these populations, including the fact, you don’t see a whole lot of doctors’ offices in areas of low income.

And so, just as Professor Godwin said, we’ve got to get out to those communities, but we also have to partner with those communities. We need people that they know, they trust, speak their language, that can help tell them when and where they can get vaccinated, answer questions that they have. And so certainly we’re making those efforts now, let’s hope that those are successful, because just as the Professor said, these folks disproportionately bear the morbidity and the mortality of these public health threats. And we need to do something about that.

Caya Berndt: Thank you for that David. And Chunhuei, vaccine data is not yet available by zip code, though the Oregon Health Authority has started to initiate similar programs. How great of a role would you say public health infrastructure plays in managing pandemics like this one?

Chunhuei Chi: This pandemic actually exposed both the strengths and weaknesses of our public health infrastructure, [and] not just [in] Oregon. I think throughout most states when initially, early this year, when the vaccine becomes available and the vaccines roll out, oftentimes there’s a huge lag because the county level public health infrastructures were not able to keep up with the resources required to do mass vaccination.

And this is most likely the first time in over half a century [that] we [have] ever had to do a mass vaccination in such a short time. That put our entire public health infrastructure under stress. And there were, I still remember, in March, [problems]. Even in the metropolitan Portland area, the county health department [in Multnomah County] was not able to provide enough staffing and logistics.

And there were hundreds, even thousands, of doses spoiled because the logistics were not there. Over time, many counties have improved, but that was with a massive mobilization of volunteers. And I think this is a golden opportunity for us to reinspect how well is our public health infrastructure [doing], not just dealing with a pandemic [like this], but in regular day-to-day operations, in promoting [our] population’s health?

And I think this pandemic exposed a lot of that weakness.

Caya Berndt: All right. Thank you very much for that, Chunhuei. We covered a lot of good ground in this episode! But before we wrap up, I just have one final question for all of you. Suppose someone comes up to you and says, “I have a friend, a parent, or loved one, and they just don’t seem interested in getting vaccinated. What can I say to them that would encourage them to get the vaccine?” What would you tell that person, Hilary?

Hilary Godwin: Yeah, that’s a hard one. So that’s your disinterested person. And I think I would focus on two things. One would be how the good data that we have so far that supports both the vaccines that have been authorized in the United States are very safe and also very effective. So it’s a pretty low risk undertaking to get a vaccine with a lot of potential benefit. And then I honestly would share a story of, you know, I lost a younger sibling to cancer, and I’m also a cancer survivor myself. Fortunately, knock on wood, very healthy right now!

But I remember both when I was going through chemo and when my brother was going through chemo, it wasn’t a pandemic, but it was so hard because people just weren’t careful about not spreading diseases, which to them seemed like no big deal, but to me or to my brother could have been life-threatening.

And so I guess I would just ask them to think of those folks in our society, who, through no fault of their own, don’t have the benefit of being able to get protection from a vaccine and who they could be protecting by getting vaccinated. So, pretty low cost to them, low risk to them, huge benefit for really vulnerable members of our society.

Caya Berndt: Thank you. David?

David Pate: Yeah. As I said, my preference would be if I could talk to the person themselves so I can find out exactly why they’re hesitant, but if I had to go through the other person, I probably would just make two points.

Number one, this is not over. And you remain at risk, arguably more risk. And even though the chances may be very good that whoever this person is not going to die if they get infected, I would just point out that we do know the people that are really high risk, we know how to identify them, but everybody else, we really don’t know how to tell whether somebody that is middle-aged for example, if they’re going to do perfectly fine, or if they’re going to be one of the people ending up in the hospital, on the ventilator. And so my first point would just be, don’t have regrets, don’t wait till you get sick and then say, “Oh, I wish I had gotten vaccinated.”

The second thing I would say is, even if you’re not worried about yourself, just realize that as you are trying to get on with your life, you’re probably coming into contact with a lot of other people that are very high risk and you may not know it. And so, do it to protect them, even if you’re not worried about yourself.

Caya Berndt: All right, thank you for that, David. And Chunhuei, what would you tell this person?

Chunhuei Chi: I think both Hilary and David have said the most important things. I fully agree with what both Hilary and David said, and I just wanted to supplement that, as I commented earlier, while we may end the pandemic [sometime in the not-too-distant future], COVID-19 will still be with us for a while. And so it’s important to know, in order for us to never go [bac] into a pandemic mode, at least not with the COVID-19, vaccination is an important way for us to [lead relatively normal lives and go about normal activities]. And also, it’s not just to protect the person in question, but also to protect the family, the friend, or the network or the colleagues. And I can even say, depending on the person’s inclination, to protect our community, protect our schools, our job places, our nations, it’s [an act of] love, [it’s] kind and patriotic to do so.

Caya Berndt: All right. Thank you very much. Wonderfully said. All right, well, panelists, thank you so much for those keen insights. To our listeners, thank you for joining us for our July 2021 episode of PNWcurrents with our guests, Dr. David Pate, Dr.Chunhuei Chi and Professor Hillary Godwin! We hope you enjoyed the discussion and hopefully gained some knowledge that you can apply to your own advocacy. Each one of us can and should be public health leaders in our own communities. We invite you to join us next month when we’ll discuss ideas for electoral reform and strategies for increasing voter turnout! To learn more about the work that NPI does, be sure to check out our website at nwprogressive.org. Again, that is nwprogressive.org. There, you will find a transcript of this episode and the PNWcurrents archive, as well as our poll findings, Statehouse Bill Tracker, Elections Hub, and our publications, like The Cascadia Advocate and In Brief. See you next time! For NPI, I’m Caya Berndt.