COVID-19 vaccines: Channeling the 7 habits to get from vaccines to vaccinations [PODCAST]

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“As we get excited about vaccine news and results, we need to evaluate our messaging and how we can get to high enough COVID-19 vaccination rates to achieve herd immunity. This requires broad and frequent education on the safety and efficacy of the vaccines. It also requires active listening to address concerns so people can make informed decisions. The 7 Habits of Highly Effective People by Stephen Covey are relevant to the task ahead of us to combat COVID-19.”

Toyin M. Falusi is an infectious disease physician.

She shares her story and discusses her KevinMD article, “COVID-19 vaccines: Channeling the 7 habits to get from vaccines to vaccinations.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Toyin Falusi. She’s an infectious disease physician, and she wrote the KevinMD article “COVID-19 vaccines: Channeling the 7 habits to get from vaccines to vaccinations.” Toyin, welcome to the show.

Toyin M. Falusi: Thank you, Kevin, for having me on the show. I admire your work.

Kevin Pho: Oh, thank you so much for being here. Thank you so much for your contributions, and we’ll get into your article a little bit, but first off, can you share your story and your journey to where you are today?

Toyin M. Falusi: Great. So my story: I am Nigerian American, born in the U.S., grew up in Nigeria, and then back in the U.S. for residency training post-medical school. I’ve been in Chicago the last 26 years, so residency, fellowship in infectious disease, and I stayed on faculty at the county hospital and medical center. And so I really have been in HIV care, doing primarily HIV care, clinical care, research, viral hepatitis, and then more recently transitioned, after 20 years in the clinic and the hospitals, to pharma. And so I’m working as a medical director in medical affairs and clinical development in pharma, and I’m still able to kind of channel the things I enjoy around teaching and education in the field of HIV. So that’s my journey.

And my interest in writing, you know, we all have to write for academic jobs, but writing without p-values, writing just free thoughts and associations, I started to do that a couple of years ago, and I really enjoyed that. So I enjoy writing, including contributing to your site, and this is my most recent of quite a few now that I’ve sent to you. So it’s a great way to connect, and I enjoy writing.

Kevin Pho: Yeah, so I always ask physicians who transition to a nonclinical role, what is the biggest challenge when making that move?

Toyin M. Falusi: Yeah, so for me, and my first article contribution to you was kind of how I felt in that transition, I made the decision in December, with the start date in April of this year. And right when I made that decision, COVID wasn’t a thing. And so to then start in April in pharma, when we were in the middle of COVID in Chicago, there was a lot of guilt and anxiety around that. But I was really figuring out that you can still do work around talking about prevention, educating the public, and supporting your colleagues, so there are things you can still do.

But I think the biggest transition is the learning curve. It’s very different; it’s a steep learning curve. But that transition is also an opportunity, because a lot of times we like to be perfect and at the top of our game. And sometimes there’s teamwork, which we’re good at, but knowing that the physician is not always the head of the team, because you’re working with people in commercial, in marketing, and in strategy. So that transition is interesting, but I find it very exciting, learning new things. And then especially not being around your colleagues all the time and clinical cases, and not seeing patients as often, is a challenge if you’ve done that.

But again, I think it’s just been fantastic being able to channel all of those things that we get in medical school and in training and in practice around cross-disciplinary work, working with people across different parts of the health care system. I’ve been able to teach. I’ve been able to get your points across. There are a lot of similarities, but it’s also a very different field, and so it brings out parts of you that you may not have had to use in the past. So I’m enjoying it, but I can see that the transition can be challenging.

Kevin Pho: Yeah. So let’s get into that KevinMD article that you recently wrote, “COVID-19 vaccines: Channeling the 7 habits to get from vaccines to vaccinations.” Now, for those who haven’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Toyin M. Falusi: It’s been a long year, to say the least, and we know that we’re in the middle of this next surge and wave. The cases are going up. My colleagues are exhausted on the front lines. People are burnt out. But then there’s exciting news, and there’s exciting news about the two vaccines. There’s more in process. But just like everything else, I mean, we all know how hard it is to get people to get their flu shots. I’m infectious disease, every year, and normal vax and all that. And just really understanding very well how clear the disparities have been in health care, and the disparities in who’s been impacted, it becomes really important that this exciting data goes from vaccines in the freezer, in this case, to the arms of the people who need them.

And so it was written as kind of my free thought, kind of like, how do we improve on what we already have, and how do we step to that part, to make sure that for the populations that are most hard-impacted, we get past our 40, 50 percent flu vaccination rates and really get vaccines to the people who need it the most, which is all of us, to be able to get to that herd immunity that we need? Because the polls have suggested that there’s a lot of mistrust and there’s skepticism. There’s vaccine hesitancy. There’s a lot of “I’ll wait.” There’s a lot of “I need the first 200 people to go.” There’s a lot of “Why did this happen so fast? I don’t trust it.” So that is kind of why I wrote the article. That was my impetus to write it.

And The 7 Habits of Highly Effective People by Stephen Covey, I’ve read four times, and every time I read it, it means something else to me. And I use those seven habits as much as I can in everything. I wrote a book about divorce a couple of years ago, and I talked about channeling the seven habits as you’re going through a divorce. I’ve talked about channeling the seven habits in anything: in your clinical work, the seven habits in your content placing, empty nesting, or menopause, whatever it is. You really can’t channel that.

So I said, well, if we look at it, about getting vaccines from the freezer to the people, looking at those seven habits: To be proactive is the first habit of Stephen Covey’s book. Second is to begin with the end in mind. Third is to really put first things first, right? Those are what he calls personal victories; that’s kind of behind the scenes, working on that. And then the next four: Think win-win is habit four. Habit five is seek first to understand, then be understood. Habit six is synergy. Those are public victories, because now you’re talking about interfacing. And then habit seven is renewal, or sharpening the saw, which is when you get to whatever ideas you’re trying to do, and you’re kind of like, “Ah, how do we do it?”

So I said, if we do that with the vaccine, let’s think about it. Being proactive: Pre-approval, pre-vaccination season is going to start very soon in the hospitals, and eventually for everybody else, so we need to be proactive about the messaging, really figuring out how we talk to the community and listen actively. Not going in with “It’s 95, what else is there to say?” but really listening actively to whatever those barriers are, whatever the issues of trust are. What is it that people are concerned about? Because that’s going to affect how we do our messaging.

People are concerned about the rapid timeline, and like, “Warp Speed just means I ain’t doing it.” Well, we have to say, well, it was fast because the reason why vaccine development usually takes longer is because either there are funding issues, these are very expensive, or you have such a low prevalence of what you’re trying to prevent, so it takes more people, or you have people who are not volunteers. But this time, you had tons of volunteers, in the thousands and tens of thousands of people who volunteered. There was supplemental funding, so the companies could go ahead. And you had such a high prevalence of the disease, so you could reach your endpoint. So once you tell people, “Yeah, vaccine development usually takes six to seven years, and many fail, but no, these are the reasons, and we don’t have that.”

Or who’s doing the messaging? Who are the key opinion leaders? We have to be proactive. How do we break down complex messages to simple things that people can understand? How do we have an open dialogue? So really being proactive. And I see that that’s happening already. People are going to show that they’re getting the vaccination on TV. They’re going to figure out key opinion leaders. Dr. Fauci was on BlackDoctor.org yesterday, with tens of thousands of viewers, really talking about COVID and the Black community. So really figuring out how we do that; we have to be proactive.

The second is to actually begin with the end in mind. Beginning with the end in mind is to have a conversation with your audience that allows them to make an informed decision. So if you go in there thinking that the end is the audience, and making sure that you get your information across and you’re listening to them, that helps how you frame the discussion, knowing that with every piece of information, there are going to be early adopters who will just try anything new. There are going to be those natural skeptics at the end, right, who are never going to. But the vast majority of the population will be in a bell-shaped curve, where you give them the right information and they make an informed decision to do what works for them.

So beginning with that end in mind means that the third habit, which is connected to the second one, is putting the first thing first. The first thing is the person across from you, the one-on-one in your exam room, the audience you’ve been asked to talk to, the webinar you have to do about vaccine safety, which a lot of us have been asked to do. If the first thing is about the audience, then you’re less likely to be defensive or dismissive if they say, “Well, I don’t trust this,” or “What if I get a.” Then you can explain things, if you put that person, or the audience, as that.

The fourth habit, think win-win, is really just thinking, you know what, if I’m able to have a dialogue, that is a win. Because whether or not they say, “Yes, sign me up for the vaccine trial of the vaccine,” you’re not going to talk about vaccination without talking about what works right now: the public health measures of hand washing, wearing a mask in public, and social distancing. So that’s a win, having that discussion in the context of a vaccine discussion. And then habit five, seek first to understand, is really just listening actively, understanding first where people are coming from, and then you’re more likely to be understood in that case.

And then the last two are synergy and renewal. Synergy is going to be very important, where we share our best practices. Something works, and I hope that happens when the vaccines are rolled out. If states and jurisdictions or communities see that this type of messaging works, let’s reproduce that. Let’s not reinvent the wheel. Let’s share best practices. Let’s find community ambassadors who are willing to go do the speaking. Let’s use social media and TikTok. Let’s do whatever it takes, and let’s synergize.

And the last one is just renewal, right? I mean, when was the time, I’ve been imagining? I mean, I guess HPV vaccines came recently, but most of the vaccines that we use have been around from before me, right? But when is there a time that a new disease, a disease which is a year old this December, we know enough, not all, but we know a lot about the disease, we have a vaccine for it, and we actually have time to inform the public about the safety and the efficacy and address concerns before the first vaccination gets out there? That’s pretty impressive.

And so this is that time where, if we figure out how we do the messaging, who’s doing the messaging, how it was received, what worked, what didn’t work, and what were the best practices, we cannot learn those things, right? That’s where we celebrate our successes. We apply that for the next set of vaccines or therapeutics; we apply that for other things. But we also figure out what didn’t work and how we need to work on that from the health care community, in terms of broadening who our messengers are, not just us, but who works with us in the community. So I just felt like those seven habits are concrete, and you can apply them to anything. Literally, I wrote a whole thing about menopause and the seven habits.

Kevin Pho: So we’re now talking in the middle of December, and right now there are three vaccine candidates. There’s the Pfizer vaccine, the Moderna vaccine, and the AstraZeneca. Now, what do you anticipate to be the points of pushback the public is going to have when we have these vaccination rollouts?

Toyin M. Falusi: Yeah, I think the biggest ones are still going to be concerns around, I don’t think anyone doubts efficacy. I think there are few people who are saying, “Well, you know what, if a lot of people are going to recover anyway from it, I’ll take my chances.” No, I think most people want to resume the way things are. So I think the efficacy, people are good with. I think it’s the safety concerns, and the safety concerns have to do with the timeline, which, if we can break it down, it was accelerated because the usual barriers to vaccine development were pretty much eliminated: by having a high prevalence; nothing else, you know, in terms of vaccine, so the placebo arm was what we had; and that there was funding to support these studies.

So I think the biggest pushback is going to be the timeline. Is it safe? People ask about long-term safety data. We don’t know, because the whole disease is a year old, right? So we don’t know the safety data. But what we know is that a large number of people, right, Moderna had 43,000, Pfizer had, you know, tons of people, before this even got to EUA at the FDA. So again, if there were safety signals, there were tens of thousands of people; we haven’t seen that.

And so if we can talk to people, I think, about the timeline and know it is safe, and that there are guardrails in place, people are worried about how politicized it was, that those things are independent, that the FDA is going to review the science and all that stuff, that by the time it gets approved, the safety data has been looked at, that none of those things are on the timeline, it’s like the data in front of them is going to be the science. I think that’s going to be, you know, being able to address that pushback. But being open, when people say, “Well, I worry about this,” to say, “Yeah, that is a valid concern, but here’s why it’ll be OK.”

I think the biggest ones are going to be around the safety. Are we sure? And why are we doing this? And the other thing I say is, “You know what? Health care workers are going first, right?” I don’t think the average doctor, nurse, or anyone in health care wants to take something that would impair their life forever. People are like, “Oh, this RNA is going to get in my system and change my DNA.” It’s like, you know. So I think if you say, “Look, you know what, the people who are going to be taking care of you are the first to get it, and they’re out there getting it,” I think there are lots of things we can do with the messaging that will help people kind of get over their anxiety.

But the rapid timeline just threw people off, even though they wanted it. Everyone’s been like, “We need something,” but then it comes, and it’s kind of like, “Oh, not me.” So I think those models that come up and say, you know, the former presidents are praying, they’re going to look at celebrities. There’s a lot of Dr. Fauci. I mean, the Fauci effect: Medical school applications are up 18 percent this year. So Dr. Fauci getting, you know, there are a lot of people like, “OK, I trust that person.” You know, the Blackstock sisters, people who are doing a lot of work in the community, the trust. And that’s why I think whatever we build on here for renewal and what worked, it’s going to help us for other health conditions and clinical trial participation and all that. We kind of learn things that work this time.

Kevin Pho: What about the fact that the vaccines require two shots, and then after the second shot, there’s a significant side-effect profile where a lot of people have to take time off from work? And if you look back at, say, the shingles vaccine, almost 50 percent of patients almost didn’t get the second shot. What do you think about addressing that issue, and how big of a challenge will that be?

Toyin M. Falusi: That will be, that is a huge one. And we know that at least those first two vaccines are two doses apart. And we know, right, we don’t have, hep B vaccination: How many times do we have to start over with hep B vaccination? Zero, one, and six. Did they come back? You know, all of that stuff. So this is where that innovation is going to be really key, to see what we do with getting people. And so those people who are like the gung-ho people are going to be timing it down to week three and, like, show up. The rest of the population is like, “Yeah, this and that.” So we’re going to have to be very intentional about how we help people with their adherence and their adherence mechanism and the reminders, and where we’re doing the vaccinations. Once it gets past the health care workers and nursing homes and older adults, are there going to be workplaces where they have certain places, and the large freezer? We have to figure that out, because that is going to be a significant one. And if they don’t do prime boost and you have to restart the thing, that’s wastage.

And so there are a lot of things around the logistics, obviously, of storing all of the vaccine, but also after that first injection. And you are right, because it’s a prime boost kind of mechanism. You have those two mRNA vaccines, where the body is now making those spike proteins. You form some antibodies, which is great, because that’s why the first time, it’s kind of your body just putting out some antibodies. When you get that second injection, you naturally have antibodies in your system, and that’s why people have some of the fever, the myalgias, and the soreness, is what they’re reporting after that second injection, because they already have been primed to expect that spike protein, the mRNA. But what we’ve known from what we’ve seen, and again, we haven’t seen all of the data, is that these are usually self-limiting. They usually last less than two days, you know, a couple of hours to days. They usually have responded to just nonsteroidals or anti-inflammatory agents, because it’s really just the body responding to that.

So I think it is important, and I know that people have written about that too: When we prepare patients and we’re open with what to expect, people trust us more, right? I did hepatitis C therapy for a long time with interferon, before we switched to the DAAs, and when you list out all the things to expect, it can be inundating, but then patients know what to expect, so that when it does happen, they don’t think they’re having a life-threatening reaction. So we tell them that with that second dose, you’re more likely to have XYZ, fever stuff. This is what happens with it. You might want to do it on a Friday, so if you don’t work weekends, maybe if they feel a little fevery, achy, you know, so you have to take time off work and that kind of stuff. But prepare patients so that if it doesn’t happen, which doesn’t happen to everyone, they’ll be OK with that.

But I think having very clear patient education material, really being honest, and I say, “Oh, it’s fine. Would you rather get COVID?” I mean, that’s, you know, we need to say you may feel something, but again, it’s a risk-benefit. And this is because, you know, some people have said, “Well, if I get COVID, well, you know, most people respond, most people recover, and I’m young.” Well, we’re starting to report now all these long-term effects that we don’t know. Long term, we’re talking a year; we don’t even know longer. And so even people who recover may have some disabilities that may persist for longer. So it’s a risk-benefit informed decision, being as open and as transparent as we can. And really, I think the innovation that’s going to come, and how we use our technology to help people with reminders, I think will be very, very interesting.

And partnerships with people who are not necessarily in health care but who know how to do these kinds of things. And then when it works in a certain jurisdiction, to have some kind of best practices place, so that somebody in Colorado can say, “Well, this worked in Chicago for this community. This is what they did. We’re just going to import that and do that,” instead of everybody trying to figure things out. That would be great.

Kevin Pho: We’re talking to Toyin Falusi. She is an infectious disease physician, and she wrote the KevinMD article “COVID-19 vaccines: Channeling the 7 habits to get from vaccines to vaccinations.” Toyin, what is your take-home message that you want to share with the KevinMD audience?

Toyin M. Falusi: My take-home message is that as physicians, we have a lot of credibility that sometimes we kind of take for granted. And I’m saying this because of no longer being full-time in clinical medicine. For those of us who are nonclinical at this point, and there is a large and growing number of us, there is still a lot we can do around helping both our colleagues on the front lines and supporting them emotionally and helping them with whatever they’re going through, supporting them how we can, but also educating the public, right? So the vast majority of people, if we can work on the messaging around prevention and wearing your mask, and when we’re asked to talk about vaccines and what we think and how we do that, we still have a role.

So for my nonclinical colleagues, the credibility that comes with our profession, we should not underestimate. And really, when we talk to people and give them information in an open and transparent way, there’s a lot we can do in terms of our contributions to helping with the pandemic. And to my clinical colleagues, we thank them for all that they’re doing, those frontline people, and, you know, to just help in terms of asking for help, and also for those of us who are nonclinical to support them the best way we can. So my thing is that there’s a lot of credibility that we have as physicians, and that we have a part in being that liaison between the community and the complex world of medicine, and being advocates for our patients is a way to do that.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Toyin M. Falusi: Thank you, Kevin.

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