COVID-19 Vaccine: A Call to Action Expert Q&A

Chicago's South Side community is preparing for widespread distribution of the COVID-19 vaccine. But many community residents still have questions about the vaccine from safety to side effects to whom should receive it and where it is available. Join Dr. Doriane Miller and James Williams, an executive with the Urban Health Initiative coming up right now on At the Forefront Live.

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And as always, we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. And we're going to start off having each of you introduce yourselves to our audience and tell us a little bit about what you do here at UChicago Medicine. And Dr. Miller, we're going to start with you. You're a veteran of the show. But some people probably don't know you. So if you could talk to us a little bit about role here at UChicago Medicine.

Thank you so much, Tim. And welcome to our listeners and viewers today. My name is Dr. Doriane Miller. I'm an associate professor of Medicine at the University of Chicago. I'm the director of the Center for Community Health and Vitality. And I'm a primary care doctor.

Great. And James?

Thank you and welcome. My name is James Williams. I'm the executive director of the Urban Health Initiative and the diversity, inclusion, equity office. And we are responsible for driving an equitable process throughout the organization to create health equity for our patients that we serve and support changing, equity, and advancing equity in the community.

As some of you might recognize Dr. Miller's voice from WVON. I know you do a lot of work over there, which is great. And I also understand that you helped pave the way for WVON's Facebook page to cover this live program, as well. So thanks. And welcome to those folks who might be listening that jumped in from the WVON Facebook page. I think the Urban Health Initiative Facebook page is doing this. Welcome to those folks, as well. And I believe our friends on the University side here at University of Chicago on their Facebook page, they're also carrying this. So we want to welcome all these viewers that are coming from various areas. It's really a pleasure to have you.

And we want to remind those viewers that if you do have questions for our experts on today's program, type them in the comments section, and we'll try to get to as many as possible over the next half hour. Dr. Miller, we're going to start with you. And as a physician and you are also a member of the city's vaccine course, Corps. I actually want to kind of start with what is the Vaccine Corps and what do you all do there?

The Chicago Vaccine Corps is a coalition of Academic Health Centers community health centers, philanthropy, and advocacy organizations that are working to figure out ways in which we can increase not only vaccine awareness, but also vaccine uptake for people who are in the Chicagoland area.

From your perspective, how do you think the overall vaccine effort is going?

It's going well, in some communities. And in other communities, not so well. And I think that there are a number of factors behind that. I had the opportunity to take a look at some data the other day that looked at the matching between the highest rates of COVID-19 versus the location and the higher rates of vaccination to date. And there seems to be a big mismatch between the communities that have been the most impacted by COVID-19, namely communities on the South and West sides of the city and the vaccination uptake rates for those particular communities.

As I mentioned, before multiple factors involved there, which we can get into in our conversation this afternoon. But the vaccine is not necessarily going to the people who need it the most at this point.

I'm going to go off script for a minute. And I want to talk to you a couple of things Dr. Miller because we were discussing this, the three of us, before the program actually started. And you said something that really resonated with me because I think throughout this entire pandemic, there have been-- and I think there are legitimate concerns-- about fiscal impact that some of the actions that had to be taken to mitigate spread have had on particularly small businesses. But you made a really good point. And I want you to share that right off the top of the show because to me, that resonated. And I think it's critical to our way of thinking as we move forward.

We can't have good economic health without having good public health because in particular, this pandemic has affected every single part of our being throughout the country, whether it be the closing of businesses, people who are primarily working in the service sector that have seen their businesses disappear. The restaurant industry, in particular, has been especially hard hit by this. Children who have been learning on Zoom calls, whatever platform is being used in a particular community, has an impact on their parents, who may need to go to work because they may be essential workers and figuring out child care and how to arrange things. And so every segment of our society has been impacted by the COVID-19 pandemic in one way or another. And without having good public health around prevention and also vaccination, it will be a much longer course before we can get back to a state of normal.

James, I want to bring you into this conversation, too. We talked about essential workers. Dr. Miller just mentioned essential workers a moment ago, frontline workers, and how critical they are just to keep the economy going and just for us to do what we do to, make it through every day. And a lot of times, those essential workers tend to be Black or Brown folks. And it seems to be-- I think we see a larger impact within those communities. And those are people that have to come down to a decision in their lives. And it's a tough one. It's actually kind of a cruel decision to make. You either go to work and make money to feed your family pay your mortgage or rent. Or you stay home to try to be safe and you don't have any income and you lose your job. Could you talk to us a little bit about that and the impact on the community and what, from your vantage point, what that means.

I think it's critically important that the Black and Brown community get vaccinated in order to protect their health. When we had-- I had an opportunity to look at some of the CDC centers for Disease Control data. And it revealed that the Black and Brown communities are more likely to be infected. They are also three to four times more likely to be hospitalized as result of an active infection. Very unfortunately, about nearly three times as likely to die.

So we are just on a mission to make sure that we provide information to as many individuals as possible, so that they can make informed decisions and based it on credible information and hopefully, come vaccinated, help us to really stamp out the spread of COVID-19 and the devastation that it is wrecking on the Black and Brown communities.

James, I know that's one thing that your team is working on and just really laser focused on right now is getting the word out and trying to send positive messages to the community to convince people that this is the thing to do because there is some hesitancy in some areas for the vaccine. And this is one of those times where it kind of makes me-- not kind of. It makes me very proud to be part of Chicago Medicine because I think we are trying to step up and do this kind of work. I don't know if you want to talk about that at all. But you mentioned it just a little bit. But I just think it's so critical to talk to our mission.

Absolutely. Our mission is to serve the health needs of the community, as was stated in our mission statement. And we've taken a number of efforts and the Urban Health Initiative, as Dr. Miller alluded to, being involved in the city efforts, being very closely connected to [INAUDIBLE] Department of Public Health and Chicago Department of Public Health to ensure that we identify the areas that are hardest hit, that we are getting the word out, good information, credible information around the efficacy of the vaccine, safety of it and really making ourselves available both inside the organization to our employees, many of which come from the South side of Chicago, as well as the South side of Chicago, in general.

[INAUDIBLE] share some of the work that she's done through community grand rounds. But really just making ourselves visible, making sure that credible sources are getting good information out to absolutely as many people as possible, so that they understand and can make a really good, informed choice around becoming vaccinated. But we're laser focused on this and communicating in virtually every way that we can community grand rounds, this particular show, and making sure that other people will get access to this information.

I just think that's so important. And Dr. Miller, one of the thing that's an obstacle to reaching herd immunity and getting beyond this whole pandemic is folks that are hesitant to take this vaccine. Can you talk to us about some of the reasons that you believe that people are hesitant? And then we'll talk a little bit more about what you're doing along with James' efforts.

Part of the hesitancy around the vaccine is the rapid speed in which the vaccine was developed. And that it's a little bit different in terms of the platform for the vaccine, being something called an mRNA vaccine or messenger RNA vaccine, which is a type of platform that people are not accustomed to receiving. They're a lot more used to receiving a typical seasonal influenza vaccination, where there is a killed virus that is used as a part of that. But it's the whole viral particle, as opposed to the mechanism that's being used for this one.

I also think that, particularly in Black and Brown communities, with the history of not only structural inequities that we see in these communities, but also, issues around ethics and past studies that have been done that have been potentially harmful for these communities, that people are hesitant. And they're concerned. I've had some patients who have said I'm not too sure about this because of Tuskegee. I'm not too sure about this because of Henrietta Lacks.

And so when people start to think about the ethics behind it, they think a little bit about the speed of development. And they also think about the testing of the vaccination and clinical trials to say, well, were people like me represented in these clinical trials for the vaccine. Because in most clinical trials, there isn't a lot of representation from people of color. And so how do I know that if I get this, it's going to work for me. And so as James mentioned just a moment ago, we've been doing a lot of community education around not only prevention of COVID-19 infections, but also the vaccine, and started these activities actually in the spring. And they've been continual.

Community town halls, the way that we're doing them here, broadcast on radio, newsletters that go out on a weekly basis providing people with updates and information and news that they can use around COVID-19 have been a part of our strategy. And if I could just say this for a moment, Tim, we sometimes think of ourselves as being at the forefront of medicine and that we're this referral center for people who have very rare conditions, where we can apply state of the art medicine.

But for people who live on the South side of Chicago, they see us as their community hospital. And so, as their community hospital, we have extended ourselves into the public health space by providing this information for the people that we care for, in the hope that we can prevent them from getting sick with COVID-19, as well as other health conditions that we've talked about on earlier shows.

Dr. Miller, I promised I wouldn't do this to James before the show. So I'm going to keep my word. We do have a couple of questions from viewers that are medical questions. So I want to throw one to you. And this one, first one is I got an itchy hot spot rash on my arm 10 days post first Moderna vaccine. And we got the Pfizer at our place. But this is the Moderna vaccine. It went away after about eight days. Is it OK to get the second dose in the other arm? And how long after can I get a shingles vaccine?

So it is very common for people to develop a little bit of a red itchy rash after receiving the vaccine. We've seen a little bit more of that with Moderna, but we've also seen that with the Pfizer vaccine, as well. It's the one that we have available at the University of Chicago. We're asking people to wait 90 days after receiving their second dose of their vaccine, whether it be the Pfizer or the Moderna, until they get their shingles vaccine. The reason being is because we want to make sure that the body's immune system is focused on developing antibodies or resistance to COVID-19, at this point and also, the question of side effects in that sometimes, people will have the same kind of side effects from the shingles vaccine as we're seeing with those first and second doses of the COVID-19 vaccine. And so for those reasons, we're asking people to wait a bit.

Interesting. Another question from a viewer that we're going to give to you Dr. Miller. I get a monthly Procrit shot. Should there be a time lapse between the giving of the two of those?

Should not be a time lapse in between, but as we stated at the beginning of the show, because people have specific concerns about their particular health needs, it's always a good idea to ask your doctor about whether or not you should get the COVID-19 vaccination, based on your particular health issues.

Interesting. So James, this one's for you. So talk to us about some of the efforts to make sure the vaccine is being provided to the hardest hit communities and in an equitable way? How do you do that? Because I know we're struggling. I think the entire country is struggling with the actual distribution right now. I know there's some lottery systems that are being set up. But I also know we're looking at folks that are probably more susceptible to the disease. How is your team working in that field?

Yeah, So again, we've been working very closely with the Chicago Department of Public Health. And they, in themselves, are also looking at identifying the most hardest hit communities and those individuals that are most vulnerable to the COVID-19 disease. And actually, right now, they have a request for proposal out seeking individuals to help them stand up vaccination centers in the community, close to residents. Also, look at [INAUDIBLE] to provide a mobile vaccination vehicle.

And additionally, I believe they are looking at creating strike teams, so that individuals can go into areas where people are, meet them where they are, provide them with information and opportunity to be vaccinated. And so again, we have been working very closely with these entities, providing any insight that we have because, through our urban Health Initiative, we've understood where the hardest hit areas are. And so we've been supporting them to make sure that it's a coordinated effort across the city to address those individuals that are most at risk.

And James, I imagine your phone's probably been ringing off the hook because I know you're in communication with folks within the community, community leaders, as you try to work through these challenges because it's not easy to roll something like this out to a huge, huge group of folks. And I imagine there are some real challenges in doing that. But I think it's certainly a great effort.

Dr. Miller, one of the reasons that maybe, at least, that I've heard that some people are hesitant to get the vaccine is because they've heard about some of the mutations from other countries. And so they're thinking, well, maybe I want to get this one. Maybe I should wait for another vaccine. That's really not a good idea, is it?

Not at all. And the reason why is because viruses are parasites. They cannot live unless they have the opportunity to infect someone, so that they can reproduce. And one of the ways in which they survive is trying to figure out small ways in which they can make themselves a lot more hearty and viable. And that's exactly what a mutation is. And so in our ability to accelerate the rate of getting vaccines and shots into arms, a virus cannot mutate if it cannot replicate. And so it's one of the reasons why it is so incredibly important to get people as vaccinated as quickly as possible.

Now a follow on to that is, well, if I've been vaccinated and I've had my two shots of the Pfizer or the Moderna, am I safe to start doing things that I did pre-pandemic? Can I start gathering with family members again? Can I start going out to restaurants and going into places and not wearing a mask or worrying about backing up or washing my hands?

But in fact, because we're starting to see these mutations and because there's still some evidence to suggest that the vaccines are not 100%. They're 94% to 95% protective, at their very best. There may be a possibility that you could either spread COVID-19, if you were to become infected, without any symptoms. Or someone else who has one of these variants can spread it to you. So we're going to continue using those public health guidelines of mask up, wash up, and back up for a while now. And for some time to in the future.

Well, I'm glad you brought up that 94, 95% because that number sounds high. But that's also why it's so important that we all need to get vaccinated because you still have that 5, 6%. And that's great. But if we're not all vaccinated, as you just mentioned, there still is that potential to get sick or make other people sick. And we certainly don't want to do that.

It's-- and I don't mean to completely get up on my soapbox now. I'm going to climb up on it just a little bit. We were talking about some incidents before the program. And I just reminded of the fact that a lot of this comes down to common courtesy. If you wear a mask around other people, that's showing that you care about them because primarily, I mean you are protecting yourself to some degree. But you're protecting them or you're trying not to get other people sick. And that's just common courtesy. So remember that when you see somebody with a mask, or if you're thinking about not wearing a mask, let's just be nice to each other. I think it comes down to some of the very basics in life. And I will back down off my soapbox now. But it just-- that's one that just always irritates me a little bit.

So another question from a viewer. And this one is for you, Dr. Miller. I'm a transplant patient. And I'm on transplant meds, so I have a low immune system is it safe to get the vaccine? Great question.

People who are transplant survivors are going to be at increased risk for getting complications and having a serious and complicated course from COVID-19. And so we think that those patients should get the vaccine. But I will recommend to you, based on your particular circumstances, to have that conversation with your doctor. We want to try to do everything that we can in order to protect you from becoming infected. Those public health guidelines that I mentioned just a moment ago are still in play. But again, have the conversation with your doctor. He or she will reach out to you in terms of telling you what is best for you in your particular circumstance.

Dr. Miller, that dovetails very nicely with another question. That's a kind of a more general version of the same question. But basically, people asking if it's safe, in general, for folks with underlying health conditions. And I'd love to get your take on that.

Not only is it safe, but the vaccine has actually been tested in people who have underlying health conditions, both the Pfizer and the Moderna vaccines. As a matter of fact, in Moderna's case, more than 2/3 of the people who were enrolled in that study were over the age of 50. In the case of Pfizer, 45% of people over the age of 50 were enrolled in the clinical trials. And as you think about what kinds of things come up in terms of illnesses for people that are over the age of 50, you think about high blood pressure, you think about diabetes, you think about other chronic health conditions. Those people were not excluded from the vaccine trials. And in fact, the vaccines were found to be both safe and effective for people who have chronic health conditions.

So James, I've got a three-parter for you. I already know the answer to the first part of it, I'm fairly certain. But I want to talk to you a little bit about, first of all, did you get the vaccine. Talk to us about your experience getting the vaccine. And then ultimately, your decision to get it. Why did you do that?

Yes, so you're right. I did get the vaccine.

I know you did.

Really, it's a privilege of working at the University of Chicago Medicine. And I did my experience was really, after the first shot, it was minimal. I barely felt anything other than the needle prick, didn't have any side effects after the first. After the second vaccine-- I took it early in the morning [INAUDIBLE] And I can tell you that by 9 o'clock I really felt wiped out. I was really tired. I had a little bit of body aches, a little bit of a headache, which I used either Tylenol or ibuprofen. And I really just said, I got to go lay down. So I went to bed.

When I woke up on the following morning, which was a Saturday morning, I was fortunate that I didn't have a lot on my schedule. I really just relaxed the whole day because I did have a slight fever. I think it went up to like 99 degrees. I did have a headache. I had some body aches. It didn't feel like-- I've had the flu before. And it really kind of wiped out. It wasn't that intense. But it was definitely something that I felt full body aches. And so I took a little bit of-- I don't know and/or ibuprofen, stayed hydrated, rested most of the days, spent a lot of time. And then after going to sleep on Saturday and waking up on Sunday, I felt fine. I didn't feel any after effects. I didn't have lingering headaches or pain. That was my personal experience. with the Pfizer vaccine.

Yeah, it's great. And I can certainly attest to that. And Dr.-- because I had a little bit of arm pain after the first one. I didn't have much after the second dose. So I counted myself pretty lucky. And Dr. Miller, your experience? I'm just curious.

Very similar experience. After my first dose, a little bit of arm pain. Actually, less arm pain that I've experienced when getting my regular tetanus booster. And then woke up the next morning and had a mild headache that lasted for a very short period of time. When I received my second dose, my response to it was a little bit stronger in that I had a little bit more swelling of my arm at the injection site, which lasted for a few days. But also, experienced about 12-- maybe 12, 16 hours later-- nausea for a brief period of time-- it was fairly mild-- 24 hours afterwards. Similar symptoms to James.

So low grade fever. I think I was at about 100 or so. I had a few chills, muscle, body aches. And my body said, you're really tired. You need to go to bed. And fortunately, it was almost time to go to bed at that point. I went to bed a little bit earlier that night, drank lots of fluids. At about must have been about midnight, 1 o'clock in the morning, I noticed that all of my symptoms were gone. I slept well the rest of the night, got up the next morning, and went to work. I felt completely well.

That's great. Another question from a viewer. And this goes right along with what we were just talking about. They want to ask can one take Tylenol beforehand to lessen the arm pain, pain, or fever side effects of COVID-19 vaccine? So could you do it beforehand or you just-- OK.

Not a good idea. And the reason why is because we don't want our patients to take anything that might blunt or lessen their body's immune response to the vaccination. And there's some evidence to suggest that either Tylenol, also known as acetaminophen, or ibuprofen, sometimes that goes by Advil or Motrin, can actually potentially lessen that immune response. And so we want to make sure that your body really, really gets geared up to mount the best immune response possible to the vaccine when you receive it.

Afterwards, not a problem. Go ahead and take something for your symptoms. But not before.

Wow, that was a great question, then, because I would have I would have not thought that. So I'm glad you gave that piece of advice. That's important. We don't have a lot of time left. I think we've got about a minute and a half left in the show. And a couple of questions I really want to get to. Dr. Miller, who is eligible to receive the vaccine right now?

As of right now, we are in stage 1B in our area, which includes all of the people who are in the 1A category, so health care workers and people who are in chronic care facilities, such as nursing homes. It's been expanded to 1B at this point, which includes people who are considered to be essential or frontline workers and also, people over the age of 65.

So this is where we are as of January 25th. Hopefully, we'll get a lot more vaccine coming in from our federal government partners. And as we look at the decreasing rate in terms of COVID infections, we'll hopefully be able to move into the 1C category fairly soon.

And James, I'm going to let you wrap us up. And this is important information. Where can viewers learn more about the vaccine, including when they will be eligible to receive it and where they can get vaccinated? I know we're also going to put some links in our Facebook comments to help with this. But if you can kind of walk us through that, James, that'd be really helpful, I think, to viewers.

Sure. So the Chicago Department of Public Health website is a source. The Illinois Department of Public Health website is also a source for those that are in this particular region. For more general information, I have gone to the Centers for Disease Control and Prevention site in order to understand what their recommendations are. But those have been the go to basis to understand where, when you are eligible, and then also, where you can be vaccinated if you don't have a health care provider that you can reach out to.

Perfect. And I do want to make a pitch for our website, as well, because we do have some really great videos. This at the Forefront Live will be archived. There are a few others that will be archived there or are archived there. You go to UChicagoMedicine.org. You can find it. And there's a really neat video in the works. It should be coming out here in the next few weeks, about the vaccine the safety of the vaccine in the manufacture of it. There's a few others too that one of our colleagues did that kind of talks about the process of manufacturing vaccine.

So if you're curious and you really want to know how these things come about, those are great resources to learn about it right here on UChicagoMedicine.org. So we are out of time.

James, you're no longer a rookie. You're now one of the veterans on the program. Dr. Miller, you were already there because you've been on multiple times. So really, really appreciate both of you being on the show. You had a lot of great information. And again, this is just something I think we need to continue doing, sharing information about the vaccine and the safety of it. And just trying to make sure that people are safe. So thanks to both of you and all of the wonderful work you do in the community, as well.

Thank you to those of you who watched and participated in the program today. And thanks for the great questions. Remember to check out our Facebook page for our schedule of programs that are coming up in the future. To make an appointment, go online to use UChicagoMedicine.org and also, can find more COVID vaccine information there. Or call 888-824-0200. Thanks again for being with us today. And I hope everybody has a great week.

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