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June 29, 2021

Vaccines and Our Complex New Normal

As I write this, I am still feeling the exuberance of something one might hardly think of as exhilarating – we had our first in-person ACEP Board Meeting in more than 18 months! What a joy it was to finally meet so many people I’ve grown close to, virtually, over the past year. What a humbling moment of gratitude it was when we took time to share both lighthearted and tough memories of the past year.

There is also no question that this meeting and our return to somewhat-normal social interactions would not have been possible without the COVID-19 vaccines. The ACEP HQ building protocol we established meant that only vaccinated individuals could participate in the meeting in person. That allowed us to accommodate those who could not attend via video conference while letting those in attendance do all of the things we’ve missed – we hugged, we laughed, we sat close to each other, we shared meals.

It almost felt like things were normal.

Yet, the headline in our EM Today the very next day starkly reminded me that much work remains to be done before the pandemic is over, noting, “Nearly All COVID-19 Fatalities in US Among Unvaccinated Patients.” The data, which are now becoming more clear, stated that “only about 150 of the more than 18,000 COVID-19” fatalities in the US last month “were in fully vaccinated people,” representing “a staggering demonstration of how effective the shots have been and an indication that deaths per day – now down to under 300 – could be practically zero if everyone eligible got the vaccine.”

This is the kind of headline that is hard to digest and feels even harder to do something about.

An individual’s decision to vaccinate can be complex. Options may be curtailed for health reasons. Hesitancy may come from personal views influenced by a myriad of current and historical factors. Access can limit availability.

I recently picked up a copy of Stuck, by Heidi Larson, PhD. A professor at both the University of Washington and the London School of Hygiene and Tropical Medicine, Dr. Larson is Director of the Vaccine Confidence Project and has built her career researching risk and rumor in global health. In the prologue, she explains that her final manuscript for the book moved to production just two days before the World Health Organization declared the novel coronavirus a public health emergency of international concern. Maybe that’s what makes the book so intriguing to me. While it sheds light on the history of vaccine hesitancy, it also delves into the staying power of rumors. She asserts that, while rumors can act as “collective problem solving and a means to manage uncertainty,” hostile and purposefully disruptive rumors will spread like a contagious virus, then hibernate until they find new fertile ground to re-emerge.

She goes on to note that the disease of misinformation has no cure. The ability for social networks and rumors to stick more than facts and science has always been there – it’s just not been as accessible as it is in our connected age.

And so ACEP continues to do what we do best: advance policy and outreach for systemic action.

Since the beginning of this year, we have worked with the White House, CDC and others to make vaccines accessible in ED. ACEP President Dr. Mark Rosenberg was invited to participate in a White House Town Hall talking about their experience in Patterson, NJ, an area that largely falls into the CDC’s assessment of socially vulnerable communities. Their success, giving more than 50% of their FEMA allocated vaccines to those at-risk and often hesitant residents, occurred because it was a coordinated effort of access, community engagement and physician leadership.

ACEP’s website was recently updated to give you the tools you need to set up a vaccination program in your ED. We know that providing emergent care may not always leave resources to address general public health needs, but there is opportunity to educate, if not vaccinate, the patients you see. That’s why we’ve provided both resources to develop a program as well as to help overcome vaccine hesitancy.

Thanks to the outstanding work of the Diversity, Inclusion & Health Equity Section, you can view a March 2021 webinar, “This Is Our Shot,” which lays a strong foundation for understanding the historical and contemporary elements of unequal access, including abuses that have led to modern-day distrust issues. Recognizing the important trust patients place in you, we have gone beyond the FAQs to address concerns and misconceptions, both in a message to the public on our website and in downloadable flyers you can use in your EDs.

There is no question we seek to build on what we learned from this pandemic. The new normal will find us thinking more about readiness, resiliency and action. Yet, the fears and emotions that drive behaviors still stick. Let’s be part of the good rumor that emergency medicine changed the ecosystem of public health at a time when we needed it the most.

Now, let’s get into the updates:

ICYMI: Annals of Emergency Medicine has curated a special issue of articles on Equity in Healthcare. These articles, all currently available without a subscription, showcase the important research being done to address equity in patient care, support a diverse workforce and foster diversity in research. At a time when some journals are struggling to advance the conversation about racism as a fundamental driver of racial and ethnic health equities, Annals has more strong articles in the pipeline that will be published in the next few months and is actively seeking research that discusses eliminating health equity gaps.

NOW: Our Workforce efforts continue. We have released three “Workforce Minute” videos to keep you updated on the latest efforts, focusing on the five pillars of the Workforce Considerations illustrated in this helpful graphic. If you’re attending the Leadership & Advocacy Conference in a few weeks, we’ll be hosting a town hall focused on workforce where you can ask our leaders any questions you may have.  

NEXT: Speaking of LAC21, we look forward to hosting our first in-person event for our members since the pandemic. As mentioned in this recent ACEP Now article about the event, LAC holds the unique distinction of being the first event we had to move to virtual back in March 2020, and now it’s the first event where we’ll be bringing members back together again. It's also a reminder that life is not completely normal yet, since we are unable to conduct in-person Hill visits with legislators due to security concerns stemming from the Jan. 6 attack on the Capitol. And though we can't come to them, we do have legislators coming to us: Reps. Josh Gottheimer and Brian Fitzpatrick will be speak about their work as co-Chairs of the co-chairs of the Problem Solvers Caucus, and Sen. Tim Kaine will come speak about the Dr. Lorna Breen Health Care Provider Protection Act. Our dine-around fundraisers will also include members of Congress, and more legislators will be stopping by the closing reception. 

In these complex new circumstances, more than a year into the pandemic, we are left to celebrate normalcy where we can find it and embrace pivots when they are needed. 

I’m looking forward to seeing both our established and up-and-coming leaders in emergency medicine in the same room and on shared screens, working together to address challenges and opportunities. I am confident that whether you're participating in person or attending virtually, LAC will give us a boost of energy and optimism about what we can accomplish when we unite behind a common cause.

Sue’s Shout-outs

ACEP has more than 35 committees and task forces working on issues such as ethics, emergency medicine practice, pediatric emergency care, disaster medicine and more. Huge thank you to all of the committee chairs who recently met to update objectives for the coming year and to appoint new team members.

Thank you to all of the ACEP members who represented ACEP so well during the recent AMA meeting:

Delegates

  • Stephen Epstein, MD, MPP, FACEP, Chair
  • Nancy Auer, MD, FACEP
  • Michael Bishop, MD, FACEP
  • Brooks Bock, MD, FACEP
  • Erick Eiting, MD, FACEP
  • Stephen Epstein, MD, MPP, FACEP
  • Hilary Fairbrother, MD, MPH, FACEP
  • John Moorhead, MD, MS, FACEP
  • Ashley Norse, MD, FACEP

Alternates

  • Marc Mendelsohn, MD, MPH, FACEP
  • Reid Orth, MD, PhD, MPH, FACEP
  • Debra G. Perina, MD, FACEP
  • Mark Rosenberg, DO, MBA, FACEP

Young Physicians Section (YPS) Representatives

  • Jordan Warchol, MD, MPH
  • Erik Blutinger, MD, MSc

Residents and Fellows Section (RFS) Representatives

  • Ashley Tarchione, MD – Delegate
  • Maggie Moran, MD – Alternate Delegate
  • Angela Cai, MD, MBA – Additional Delegate
  • Moudi Hubeishy – Additional Delegate
  • Anna Yap, MD – Additional Delegate
  • Angela Wu, MD – Additional Delegate
  • Sophia Spadafore, MD, RFS Vice Speaker – Additional Delegate

Medical Students Section (MSS) Representatives

  • Alysa Edwards -Delegate
  • Spencer Bayless – Alternate Delegate

Thanks for reading.

Sue

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