Vaccines. Vaccinations. Vaccine hesitancy. These words have become pervasive in today’s lexicon, particularly now as vaccines equipped to battle the novel coronavirus (COVID-19) have been authorized for emergency use.
But where do individual rights fit in when public health is threatened? What roles do psychology, faith, and reasoning play in decision-making about whether to trust or reject science? How do different health professions contribute to vaccine development, research, vaccine distribution, and public health education?
Such are the questions that need to be addressed as the COVID-19 pandemic continues, according to speakers at the University of Maryland, Baltimore's (UMB) Seventh Annual Interprofessional Forum on Ethics and Religion in Health Care. The event explored the topic of vaccines through the lens of bioethics and religion, with perspectives from various health disciplines. (The event took place before the Food and Drug Administration’s emergency use authorization of the Pfizer/BioNTech SARS-CoV-2 vaccine, which University of Maryland Medical System health care workers have started to receive.)
This year’s forum, “Unraveling Vaccine Science, Faith, and Public Discourse,” was held virtually for the first time, in keeping with COVID-19 safety precautions. The program featured religious leaders including Rabbi Shmuel Silber of Suburban Orthodox Congregation Toras Chaim in Pikesville and Bowyer G. Freeman, DMin, senior pastor of New St. Mark Baptist Church in Baltimore, as well as medical, legal, and pharmaceutical experts.
Jane M. Kirschling, PhD, RN, FAAN, dean of the University of Maryland School of Nursing (UMSON) and director of UMB’s Center for Interprofessional Education, offered remarks to kick off the event. “Certainly, virtual events such as this one have become standard operating procedure, but even though we are growing used to them, they are still a potent reminder of the ongoing dislocations caused by the COVID-19 pandemic,” she said.
Throughout the day, panelists led participants through the intricacies of vaccine development, factors that lead to vaccine hesitancy, ethical questions surrounding mandatory vaccinations, and racial injustice in vaccine distribution.
Kirschling said it seemed especially fitting that this year’s forum focused on yet another aspect of the pandemic — the multiple questions surrounding development and distribution of a vaccine to halt or mitigate the spread of the virus.
She cited results of a recent survey of 1,000 U.S. adults, published in the Annals of Internal Medicine, which sought to gauge attitudes toward a potential vaccine. The survey found that approximately 58 percent of respondents intended to be vaccinated, 32 percent were not sure, and 11 percent did not plan to be vaccinated. The reasons given for hesitancy included vaccine-specific concerns, a need for more information, anti-vaccine attitudes or beliefs, and a lack of trust, she said.
“The presentations today and the discussions that you will have are not only timely, but also critically important for addressing the current pandemic and for responding to other public health challenges in the years ahead,” Kirschling said. “Understanding what is driving individual attitudes and how best to respond requires the insight and efforts of a broad array of professional disciplines.”
UMB is composed of a rich configuration of six professional schools — nursing, medicine, pharmacy, dentistry, social work, and law — and the interdisciplinary Graduate School, Kirschling noted. “Collectively, these schools educate the majority of the state’s physicians, graduate nurses, dentists, lawyers, social workers, and pharmacists. We all benefit from interprofessional education and practice. It prepares and supports each of us in addressing complex issues through team-based approaches and ensures that we bring the perspectives of multiple disciplines to bear on problem-solving.”
Moderators included Jason Noel, PharmD, BCPP, associate professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy (UMSOP); Ahleah Gavin, PhD, assistant staff scientist, UMSON; and Anita Tarzian, PhD, RN, assistant professor, UMSON, and program advisor, Maryland Healthcare Ethics Committee Network, University of Maryland Francis King Carey School of Law.
Matthew B. Laurens, MD, MPH, associate professor, opened up the discussion with “A Primer on Vaccine Development for SARS-CoV-2,” an overview of how vaccines are developed and the phases of vaccine trials. He is the director of pediatric infectious diseases fellowship and director of international clinical trials unit, Malaria Research Group in the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine.
“What we also know is that there exist racial and ethnic disparities in COVID-19, such that if we look at the number of cases in whites, compared to American Indians, Asians, Blacks or African Americans, and Hispanics, we see that there is about a three times higher risk of being a case if you are American Indian or Alaska Native, Black or African American, or Hispanic or Latino,” he said.
Deanna Tran, PharmD, BCACP, presented “The Role You Play in Increasing COVID-19 Vaccine Rates.” She is an assistant professor and co-director of Pharmacy Practice Laboratories at UMSOP.
“Most people do not have an intimate knowledge of the clinical process, and especially the changes that have occurred specifically for COVID-19,” Tran said. “Even the term Operation Warp Speed could cause some individuals anxiety because the name itself sounds like we’re talking and going too quickly, and this perpetuates the perception that the process is set up without ensuring safety.” Operation Warp Speed is the name of the public–private partnership initiated by the U.S. government to rapidly develop and distribute COVID-19 vaccines and therapeutics.
Research shows that one of the major reasons an individual does not want to get a COVID-19 vaccine is due to side effect concerns, Tran said, noting all approved vaccines are still monitored for possible rare and severe side effects that were not found during clinical trials. This monitoring includes a vaccine adverse event reporting system, which analyzes adverse drug events reported by patients and health care professionals.
“It’s important to realize that there has always been underlying vaccine hesitancy with vaccines in general,” she added. “It’s important to realize, of course, that race, culture, and social-economic status all play large roles in terms of the differences and attitudes toward vaccines and preventative care. Vaccine hesitancy really could be its own conference and forum.”
A second panel delved into the influence of racial disparities on vaccine hesitancy. The panel included Kenneth A. Berkowitz, MD, FCCP, special advisor, Veterans Affairs National Center for Ethics in Health Care, presenting “Are Vaccine Mandates for Health Care Workers Racially Biased?” and Yolonda Wilson, PhD, fellow, National Humanities Center, presenting “COVID-19 Vaccines and Race in America.”
“We always learn when we think about things together,” said Berkowitz, associate professor, Departments of Medicine and Population Health Ethics, New York University Grossman School of Medicine. “In ethics we speak about a very powerful concept — about the dignity to choose, and to take away someone’s dignity to choose to make their own health choices in the name of public health and utility of the greater good is really a big deal, or it should be. I think this is especially important for vaccinations, since there are clear and well-known variations in flu vaccination rates and pneumonia vaccination rates by race, and public health efforts need to be sensitive to that.”
It can be ethically justifiable to restrict personal choices based on public health concerns, “but there needs to be a very high bar,” Berkowitz said.
Varying religious viewpoints were presented by Silber in his remarks on “Religion, Free Will, and the Balance of Autonomy and the Common Good,” and Freeman, who spoke about “Responding to Faith-Based Vaccine Hesitancy in the Christian Community.”
From a Judaic perspective, Silber said, “Do I believe God brings cancer? God brings COVID-19? Absolutely. But the same God who brings these illnesses in these pandemics is the same God who gives man the ability to understand the science to create the vaccine, to create the remedies. My theological mandate is therefore to go ahead and participate in the scientific process, to participate in these curative effects as well.”
A fundamental pillar of Judaism is that “where there is a tension between the needs of the many and the needs of the individual, the needs of the many always win out,” Silber said.
While Christianity also dictates a sense of doing what is best for the greater good, “people have the right to govern themselves and to have significant say in how things will affect them,” said Freeman, who in addition to being a minister is a principal of the African-American Clergy Medical Research Initiative, which seeks to close longstanding racial disparities in medical research and treatment.
“Trust is going to be very critical as it relates to our discussions around vaccine implementation in the community, in particular as we talk about the Christian community and specifically the African American community, based on the experiential reality that we have already undergone,” Freeman said.
Other speakers included Trudy Henson, JD, law and policy analyst and public health program director, Center for Health and Homeland Security, Francis King Carey School of Law, providing insights on “Vaccines and Public Health: Ethical and Legal Issues.”
Click here to watch a recording of the program.