Need to build trust to spur vaccination, says Kentucky’s top doctor

Jennifer Lubell , Contributing News Writer

History shows that vaccines work, bringing diseases such as smallpox, measles, polio and even meningitis in college kids under control. But as COVID-19 cases and hospitalizations spike to an all-time high in his home state of Kentucky, emergency physician Steven J. Stack, MD (@StevenStackMD), knows it will take more than education to beat down the virus.

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Despite a 60% rate of at least one dose of COVID-19 vaccination in Kentucky, a substantial minority continues to resist immunization. "Unfortunately, we're paying the price for that right now," said Dr. Stack, commissioner of the Kentucky Department of Public Health and a former AMA president.

Dr. Stack, who took on his public health post just before COVID-19 hit, offered some strategies for approaching the vaccine hesitant in an episode of "AMA COVID-19 Update."



At this article's deadline, Kentucky saw more than 650,000 total cases of COVID-19 cases and nearly 9,000 deaths, with a test-positivity rate of almost 13%. According to data compiled by The New York Times, six counties in the state rank in the top 10 U.S. counties for new cases per 100,000 people.

Hospitals have surpassed record highs of COVID-19 cases seen this past winter.

"We have hospitals that have extended to 130% or more beyond their normal bed space and to nontraditional areas, places that have converted regular medical floors into ancillary ICU units," said Dr. Stack. In some hospitals, more than 40%–50% of inhabitants are COVID-19 patients. Not enough nurses or physicians are available for hospitals to operate at full capacity, said Dr. Stack.

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Some hospitals have enough extra beds but no qualified health care professionals to operate them, he added.

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Fueled by unvaccinated populations, Delta variant is infecting, and in some cases killing younger people in the state, he continued. People in their thirties are catching COVID and dying from the disease within 5 days. Teenagers are succumbing to COVID as well.

At some point, vaccine doubters may realize that the people getting sick are the ones who didn't get vaccinated. "But until it's that close and real, I'm concerned that we're not going to get this population to come around on it," said Dr. Stack.

Amid rising cases, Kentucky harbors a strong contingency actively working against mitigation measures such as vaccines and mask mandates.

"We're not going to persuade anyone by bludgeoning them with facts" or by arguing with them, said Dr. Stack. They'll just dig their heels in even more and find ways to prove and demonstrate their point of view. "We're going to have to find other ways to help have people hopefully come around on this."

Trust through testimonials is one strategy, he said. "If you find people that others trust and relate to and they tell the story, that's probably more helpful."

This is more about human connection than it is about the science and facts, added Dr. Stack.

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"We all have to practice the best possible self-hygiene we can for ourselves," he added, speaking to physicians and other health professionals. An AMA survey conducted in May found that over 96% of doctors are fully vaccinated against COVID-19.

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