Vaccine Hesitancy

In this episode we speak with Kathleen Shannon Dorcy about vaccines. Shannon Dorcy is an Associate Teaching Professor at UW Tacoma. She’s also the Director of Research, Education and Clinical Practice at the Seattle Cancer Care Alliance as well as a staff scientist at the Fred Hutchinson Cancer Research Center. Shannon Dorcy discusses how vaccines work including how they work once inside the body. She also talks about the FDA approval process and why/how the COVID vaccines were developed so quickly. Finally, Shannon Dorcy addresses some of the concerns expressed by those who are on the fence about getting vaccinated. 

Transcript

Dr. Kathleen Shannon Dorcy:

The reason to get a vaccine is for your own life, but it's also so you don't affect others and cause mortality and morbidity in the people you love, in people you work with. The transmission of the disease may not always have a high death rate, yet it has a much higher death rate than almost any virus we've seen for 100 years. And it isn't just in the elderly, frail, or the immune compromised.

Speaker 2:

From UW Tacoma, this is Paw'd Defiance.

Eric Wilson-Edge:

Welcome to Paw'd Defiance, where we don't lecture, but we do educate. I'm Eric Wilson-Edge. Today on the Paw'd, understanding the COVID 19 vaccines with Dr. Kathleen Shannon Dorcy. Shannon Dorcy is an associate teaching professor at UW Tacoma. She's also the director of research, education and clinical practice at the Seattle Cancer Care Alliance, as well as a staff scientist for the Fred Hutchinson Cancer Research Center. Shannon Dorcy will talk about the COVID-19 vaccines, including how they do and do not work. She'll also discuss the Food and Drug Administration's process for approving new vaccines, as well as how these particular vaccines were developed so quickly. Dr. Kathleen Shannon Dorcy, thank you for joining us today on Paw'd Defiance.

Dr. Kathleen Shannon Dorcy:

Thank you so much for inviting me. I am very happy to be here with you.

Eric Wilson-Edge:

So let's get to my first question. We hear the word vaccine a lot right now for obvious reasons, but I don't know that many of us myself included have actually stopped to think about what a vaccine is. There's all kinds of vaccines, but I can't actually tell you just at a fundamental level, what is a vaccine?

Dr. Kathleen Shannon Dorcy:

That's actually a very good question. And the vaccine basically encompasses many different ways in which we use cultivated, basically different methods to treat disease, to prevent it. It creates immunity. A vaccine is something that if we go back to some of the earliest ones like when they had a worldwide smallpox, vaccines were created to keep people from suffering the morbidity and mortality that was happening, that's such a terrible disease. We find ways in which the immune system, both our T cells and B cells can work to fight against disease. We work in different kind of modes of those kinds of transmissions and virus, and create wonderful ways in which we reduce how sick people will become or prevent altogether the diseases that are caused by viruses. It's a very important way in which we boost the immune system of our human bodies.

Eric Wilson-Edge:

Now, I think this is true of the COVID vaccines, but I know with like the flu vaccine, there is the flu virus is in there, it's not necessarily a live version of it. But I wonder if you could talk a little bit about how that idea within the vaccine works.

Dr. Kathleen Shannon Dorcy:

Yeah. That's an important way in which we understand that viruses can be factors in that way we use the virus to create the immune response. So you're right, like polio was a live virus often given to babies in order to prevent it. We don't get that anymore. But when we used to have a live virus, it was enough of an attenuated dose of the virus to boost the body's ability to create immunity against that virus which is why we have flu shots every year. Viruses mutate and become able to infect people because of the very fact they adapt to the environment. In order to get ahead of certain viruses, such as in the influenzas of all the years that we've had and now coronavirus, you find what are the characteristics of that specific makeup of that virus and then we treat. We cultivate and treat with the vaccines ways to generate a response, an immune response against that.

Dr. Kathleen Shannon Dorcy:

It's like getting your body ready to be a little ammunition against foreign invaders. So it's sort of like in the olden days or games that people had that certain kinds of organisms and other things, not Pokemon, but Pac-Man where they would eat up something. So if you want to think about it, when we make a vaccine, it's rather like a very complicated Lego set where the exact form of the virus is replicated. And then we create another Lego piece to go over top of it, to cap it off and keep it from continuing to grow and to inhibit the disease. So the vaccine is a Lego piece that goes on to another piece that actually works against the disease becoming very dangerous or deadly.

Eric Wilson-Edge:

Those are really good illustrations of how this works. So from what I'm understanding, basically we get injected with a little bit of the virus so our body develops a response to it and then quashes it down. So we've got the mechanism then to defend ourselves within our body.

Dr. Kathleen Shannon Dorcy:

Yeah. It's not only just the virus itself, but it's where we have attenuated the virus and created antibodies. This shot gives you the ability to create the antibodies against that virus. It's not like you're drinking kind of a virus, A, or B or C, it's like you're being able to be given something that was built around that specific shape and genetic kind of floor plan of that and then you were able to be treated to continue... Your body is starting mass production of those antibodies that say, "You're out of here. You're out of here." So they're the little shovels that keep the disease from taking over the rest of your system.

Eric Wilson-Edge:

That is very interesting. Thank you for making it so clear. I think a lot of us have been reading material over the last year and some of it makes more sense than others. And I think that made a lot of sense. So thank you. So there seems to be a lot of concern out there in which the speed in which these vaccines were developed. And from my understanding, the reason this has happened because it's been just a build up of knowledge and technology over the years, including research into mRNA-

Dr. Kathleen Shannon Dorcy:

Right.

Eric Wilson-Edge:

The way I come to understand it is the reason this happens so fast is because we had been working for years for this kind of scenario. Is that a good way to think of it?

Dr. Kathleen Shannon Dorcy:

Well, it's a very important... Excuse me, a very important way to think about it. I'm going to read you just a little thing here first. I'm going to answer about the mRNA, and then I'm going to talk about the speed so that we have kind of two pieces here. So it's kind of a new way to make a vaccine. And so that's what a lot of people have reacted against because there have been other mRNA vaccines, but really to have them so broadly utilized and created across an immediate need situation, it does seem different. So it's basically a teacher that the mRNA night vaccine teaches ourselves how to make a protein or even just a piece of a protein that actually goes out and gets what I was talking about before, triggers that immune response, gets those shovels to get rid of the disease. And it's not at all like getting the disease as much as getting it to learn how to build a response against that specific protein.

Dr. Kathleen Shannon Dorcy:

And by producing the antibodies in our body, then we're able to create this shield against those viruses coming in and attacking our lungs, our body, and making us very ill or perhaps taking our life. Now, the speed was a very important point that you raised and the use of these viruses and, excuse me, the use of the mRNA vaccine against these viruses was made as an EUA made to the FDA to allow these drugs to be used. Most research in our country goes through early phase, phase one, phase two, phase three, occasionally phase four, but phase four is really post-marketing on medications. Phase one and two are safety and dosing. So they're saying, "Are these safe in human subjects?" And then as they continue to do it in larger numbers, "What is the appropriate best dosing?" Phase three which is head to head randomized clinical trials can take up to 10 years.

Dr. Kathleen Shannon Dorcy:

So one of the reasons that this drug, these vaccines were approved under the EUA was because the threat of illness was so severe and the cost of life so great that the FDA looking at the toxicities and safety across all of the trials, which they were very, very many people across different populations around the world tested said, "This is a much better scenario for people to take the vaccine and avoid getting COVID rather than waiting for the five to six years of when we could get to an approved status, which would have been fully approved."

Dr. Kathleen Shannon Dorcy:

When people think that it was fast it's because we have never had such collaboration across companies, across the government agencies to bring something forward this quickly, because the threat was so deadly, what's been a hundred years since we had a pandemic of this caliber that took us many lives globally. So the risk far exceeded what the risk would have been if we didn't vaccinate or improve at that level, it would have been much more deadly for the world. So the safety and best possible efficacy was judged to use it at that level.

Eric Wilson-Edge:

So it almost sounds like maybe this is an over-simplification. We've been in a pandemic for 14-15 months now. And in this country we've lost, I think about 600,000 people, globally I think we're up to about 4 million now. So it sounds like we had a choice. We could wait five or six years and those numbers could be wherever those numbers could be. That could be a very high number.

Dr. Kathleen Shannon Dorcy:

Astronomical.

Eric Wilson-Edge:

Or we could maybe accept a little bit of risk with the vaccine, not maybe having a more complete picture, we have a pretty full picture, but maybe not as complete as we had if we waited five years and then the trade-off is being, we would maybe save a lot of lives. Is that the way to think about it?

Dr. Kathleen Shannon Dorcy:

That's a very good way to think about it. I think one of the pieces that's important to remember also is that the virus as we've heard has mutants and starts to mutate and changes, we would have lost a lot of people and would not have developed any kind of similar immunities against the disease had we not started the vaccination. We know too that our numbers are not representative because a lot of people have died without being tested and we can't attribute cause of death. And poor and low and middle income countries there are not a lot of mechanisms for testing for the disease.

Dr. Kathleen Shannon Dorcy:

So the global burden of this is really, really alarming. So as you look at the deaths in India, you look across the world, we really have a global accountability for saying, "How do we control a disease in a world that is so connected? How do we help? How do we build this from the consideration of protection of populations and all of people as opposed to only individuals?" So this is a really big shift for us as a global community to think together on how to best support the stopping of a disease that we can't even quite comprehend how to measure it at this point.

Eric Wilson-Edge:

Yeah. Thank you for that point about the number of people who have died and been infected. Most likely that number is not accurate. It's an undercount. So thank you for that. If you're looking to get vaccinated and are not sure about where to start, consider visiting vaccine.gov. Here, you can search to find vaccine availability in your area. You can also call +1 800-232-0233, or text your zip code to 438829. So at this point, millions of people around the world have been vaccinated. Are we seeing any side effects, like large numbers of them? And do we know long-term is this changing our DNA to where we're going to become some sort of mutants, X-Men or something. That's sort of a joke, but there's a lot of worry about there because we moved up the timeline from when we would mass distribute. What if there's something sinister lurking in our body that in a few years is going to cause us something, something's going to happen?

Dr. Kathleen Shannon Dorcy:

Well, the fear of the unknown as always something that can cause us to be anxious and wonder about the future. Now, I can absolutely of course say that there won't be. But the important thing to notice this doesn't change our DNA, what it does change is our T cell ability, our immune system's ability to resist disease. I grew up in an era where people aren't dying of polio because the generation before mine was vaccinated and able to stop that where every summer young people were dying and losing the ability to walk. There were all those worries at that time as well about the self vaccine. But in fact, if we look ahead it isn't like invaders from Mars who are coming into our body and will render us new beings of different physiologic capabilities.

Dr. Kathleen Shannon Dorcy:

Really what a vaccine does is give us the chance to continue to avoid severe illness and death by the attack of that organism. Now, there will be coming I think the reality within the next two years that because the virus mutates and changes, just like we have known about the flu shot every year, we will need to have probably some kind of a vaccine booster because the viruses are so scientifically smart and able to move around what we can build in immunity, which is why these continue to evolve into deadly risks to people.

Eric Wilson-Edge:

So one of the things I see a lot and part of my job is managing the university social media, which can be kind of sad sometimes when you have to look at the larger conversation in the world. And I've seen a lot of people saying that, "I'm not going to get vaccinated because the survivability rate is 90 something percent. Why would I subject my body to this unknown when I'm very likely going to survive it?" Or even the idea that getting vaccinated doesn't necessarily mean you won't still get COVID. We've seen that. And I think that comes to a fundamental misunderstanding of what the vaccine is, which I think you kind of clarified. So taking all this in, why is it important for people to get vaccinated?

Dr. Kathleen Shannon Dorcy:

And that's a really important question. One of the issues we have when we hear vaccine reluctance of people who are unwilling, I think we have to unpack it a little bit because just because people's first response is not to get vaccinated does not mean that there might not be an engaged reaction if they were able to speak to people in a way that answered questions that they hold. The reason to get a vaccine is for your own life but it's also so you don't infect others and cause mortality and morbidity in the people you love and people you work with. The transmission of the disease may not always have a high death rate, yet it has a much higher death rate than almost any virus we've seen for 100 years. And it isn't just in the elderly, frail, or the immune compromised, it's in healthy young couples whose bodies basically get affected.

Dr. Kathleen Shannon Dorcy:

And we don't understand why some people's bodies are so much more adversely affected by the virus. I think also, we have such a polarized country right now that thinking about the politics of what it means to say you don't want to get vaccinated often creates an allegiance with a group of people. And I think we want to be able to create unifying allegiances between people of saying, "Let's talk about this. Why don't you want to get a vaccine?" In some cases, one of the things I would would bring forward is that we have a cultural bias and implicit bias of how we think about healthcare. And when we were working with Hispanic cultures looking at trying to get early screening for colon cancer, the whole thought of talking about stool specimens and getting things captured so we could understand and save lives didn't make any difference.

Dr. Kathleen Shannon Dorcy:

The threat of death was not what they needed to hear. They needed to have a way to explore what it meant to have screening and look at what the implications were for living with their families in a different way. So we think there's a singular way to deliver the information of how important it is, but the threat of death is not always the only way to bring that forward, but really the sense of protecting our children, our grandchildren, our elderly grandparents, how do we live in a world with a different motivation of living in proximity and how do we let people explore these without a single response to say, "I'm not going to get vaccinated," it's not a declarative statement of forever, as much the need to let people engage in dialogue.

Dr. Kathleen Shannon Dorcy:

And then there will be people who philosophically will be opposed. And those are risks that a society that allows for freedom of choice embraces, and it poses risks for public health. But on the other hand, I think it's the risk we have to hear. But I do believe one of our fundamental issues we have is learning to listen to how can people understand what it, a vaccine is and what it means to take it as a protective gift to the world of health for themselves and for other people.

Eric Wilson-Edge:

There's a lot of chatter especially online about these vaccines with some folks thinking that someone like Bill Gates put a tracking device inside the vaccine. Looking at these posts, a lot of these folks seem to be of pretty sound, mind, and body, and yet I'm not sure what we do with that level of skepticism. You want to be able to hear people out and understand where they're coming from, but that idea just feels far-fetched, I guess. So what do we do as a society and for those in the healthcare profession, to talk to these folks and see what their concerns are, and maybe getting them vaccinated?

Dr. Kathleen Shannon Dorcy:

Your question is really well unstated in terms of what do we do when there is apparent total dichotomy between what we understand as true scientific process of what could be happening. And the idea that Bill Gates or anybody could put something in that would actually connect us to the international networks so they could read the inside of our thinking and brain. Now, for me, I am amazed with that concept. And yet, it comes from somewhere is trust and a lack of community in our world. And basically a structural bias against really thinking, "What would that serve for anybody?" I think we can't let people be dismissed for how they think, but at the same time we have to make a stand against what is the most just and equitable healthcare actions that we can do. When it becomes a political or a statement of affiliation only, we're not at the heart of what the vaccine is about because the vaccine is meant to promote health and to equitably protect a world that could suffer from the consequences of not being protected against coronavirus.

Dr. Kathleen Shannon Dorcy:

But when we hear people speak of things that seem so outlandish, part of what we have to do is pause and say, "What's at the root of that?" It's clear there's not an argument possible to counter that. And yet if we don't step away and say, "Well, I think that's not a risk that we can support with the data." We give into emotional sparring. And I think that that is not going to get us anywhere. I think people need to be able to hold on to whatever their beliefs are, because those are beliefs and not necessarily grounded in data. But if we can find a way to engage around the issue of health promotion, as opposed to the political [inaudible 00:23:14] we say the political void, because it's not something that I want to give credit to being anything more than a void, our lack of being able to speak across groups. We're going to have to find a way to unify and listen to people that we don't agree with and find a way to come to what is at the heart of the matter.

Dr. Kathleen Shannon Dorcy:

And the heart of the matter is preserving the health and the wellbeing equitably of the people of our world.

Eric Wilson-Edge:

So within the same vein, I guess, I don't know if it's the same vein, maybe the same arm within the veins in the arm, the medical community and this is with an acknowledgement that medicine for a long time was, "We're going to cure you by draining your blood." It's not what medicine looks like today. So the term medicine is, a doctor has gone through a lot of strange, interesting history, but wrapped in that is some pretty heavy duty medical racism against the BIPOC community. Everyone, not everyone, most people know what the Tuskegee, what happened there, but that's just the most obvious most well well-known form of medical racism in this country and in the world at large. But we also know that BIPOC communities are among some of the hardest hits right now, but also have some hesitation when it comes to getting vaccinated for reasons that make sense to me, if there's been a history of using medicine as an instrument of destruction and pain, and why would you trust it now? So how do we approach that? How do we try to reach out to that community and get them vaccinated?

Dr. Kathleen Shannon Dorcy:

That's such a wonderful point. The actual blatant racism and structural racism across all of healthcare and even our government is something we have to acknowledge. There is good reason not to trust healthcare for what we have done as organizations. Back in smallpox they used to give soldiers blankets contaminated with smallpox so that they thought they could develop immunity. People died. Tuskegee, we have a terrible atrocity of an observation trial that went on and let people die over many years because they were in science and in fact it was a blatant, not science and blatantly racist and not value-driven work.

Dr. Kathleen Shannon Dorcy:

Additionally, I think right now if we talk about the communities, our Hispanic Pacific Islanders here in the Northwest had that strongest, the highest morbidity and mortality here in the Northwest has been in our Pacific Islander Asian community, our Hispanic community, African-Americans as well, when we homogenize our data and look at what death rate is and don't look at it or incidents by racial populations, we actually diminish the value of the people and what that its real experience of the illness and possible healing can be. The other piece is we always think in health care about people coming to us. The example of Henrietta Lacks, the Tuskegee, people put their trust in the medical establishment only to be betrayed.

Dr. Kathleen Shannon Dorcy:

So that is a fundamental thing that we will have to work long and hard to overcome. So not trusting us for that reason is absolutely right. But at times we think that people of color, people of different ethnic and racial populations should come to us in the healthcare, the place on the hill, instead of us working with communities and finding ways for people in their own communities to find answers and become vaccinated. Us leaving the ivory tower is a really super important part of this, becoming a part of a real world and working with communities where they are and where we can actually help build trust and consideration for moving ahead with the vaccine. But we in science have a very terrible record with BIPOC communities, with real people whose lives were deeply, deeply affected by atrocities that we committed.

Eric Wilson-Edge:

So let's talk for a second about the work you're doing right now with helping or overseeing students who are actually helping to get folks vaccinated.

Dr. Kathleen Shannon Dorcy:

Thank you, Eric. That's been such a wonderful privilege because in this year of COVID where we were taking care of... As we said in the beginning, I work in clinical oncology here at Fred Hutch Cancer Care Alliance and I also teach at the UW. But the past 14 months delivery of care, patient care delivery, teaching what students were able to do was thrown into an uproar. How could we get clinical hours where we couldn't let people be and very much concentration in clinical sites? So one of the most wonderful things that's happened is during the COVID screening time in the fall when we started that, we brought on Seattle Pacific University students to help with screening. They would have actual engagement with real patients coming into the clinic and how we would show to people how could we do all the things we needed to do to meet the challenges of giving the best quality care to people with cancer.

Dr. Kathleen Shannon Dorcy:

And we needed to really think beyond what we had ever done before. So we brought in wonderful 32 students rotated through care and worked with us in the fall term from Seattle Pacific University. Then in winter term as vaccines became available, we had university of Washington Tacoma graduate students who needed to have clinical rotation hours and internships. So we teamed them with our undergraduate students from Seattle Pacific University and have them work on teaching vaccines, them how to watch and monitor for anaphylactic reactions, how to take care of the vasovagal responses. So the students from both the University of Washington Tacoma graduate program and the undergraduate at SPU became this wonderful energy of helping us bring forward the vaccine to lots of people from the very elderly at the beginning, and now to our 12 to 15 year olds who just a week ago became eligible for this. So it's been a wonderful partnership and a rethinking of how do we work together as institutions and academic organizations.

Speaker 2:

Thank you to our guests and thank you for listening. Be sure to like and subscribe. You can find us on Spotify, Google Podcasts, Pocket Casts, Stitcher, and Apple podcasts.