- Today I am here with Dr. Nnedu,
a senior physician of infectious disease here at Oxford.
Thank you so much for joining us today, Dr. Nnedu.
I'd like to start out and just have you tell everyone
kind of what your role is at Ochsner
and what you practice here?
- Yes, I'm an infectious disease physician here at Ochsner.
I have a couple of roles.
One is in education, I'm the program director
for the infectious disease training program at Ochsner.
I also direct the travel clinic at Ochsner as well.
And then I'm a physician, I see patients.
- So what has your work within the COVID pandemic
been this past year?
- So in addition to seeing patients
with COVID in the hospital,
I was also privileged and fortunate
to serve on a advisory committee
to the COVID prevention network,
specifically as it relates to the vaccine trials
trying to get more minority groups,
African-American people
from the African-American community
to take part in the vaccine trials.
And I was able to sit with a group
of other African-American physicians and scientists
to provide advice, to try to get more people
from the African-American community
to be part of the clinical trials.
And so that work was very rewarding
and also taking care of patients with COVID
has been both rewarding
as well as sometimes depressing as well.
- So in your work doing these vaccine trials,
have you seen some pretty significant disparities
within acceptance of the vaccine
or trust and concerns of the vaccine
across various populations?
And could you tell us a little bit about that?
- Correct.
So, you know, Ochsner served as a trial site
for two of the vaccine candidates
and, you know, we worked really aggressively
to try to reach out to the community,
to get people to participate.
It was really important
that in understanding if these vaccines work,
we have good representation
as far as people involved in the trials.
And of course there was a lot of hesitancy initially
but we were able to reach out particularly to church groups
and kind of go work with them.
And I think one key thing that I learned
is that it's important to identify people
from these communities who are trusted in these communities,
reach out to them, engage with them,
and then reach out to people through them, essentially.
The trials are still ongoing,
individuals who were recruited are still being followed.
Obviously we have preliminary data
showing that the vaccines are safe
and are effective in a short term.
And so the next phase now is actually getting people
to be accepting of getting the vaccine.
- And so, we talk about these vaccine uptake efforts
and I want to read a quote from a survey by the NAACP
that they recently did
and they talk about how critical it is to directly confront
and address the deep historical traumas
that have led to and are continuing to lead to distrust
in the healthcare system among African-Americans.
And I know that unfortunately there is a dark past there.
We look at things like the Tuskegee syphilis experiment
or Henrietta Lacks,
and it's understandable that there are some real concerns,
and having that educational piece and that reassuring piece
I imagine is important as well as transparency.
So as a physician, how do you think healthcare as a system
can best reach these communities with that in mind?
- Yeah, I think, and I just want to say
it's not just the Tuskegee experiments or Henrietta Lacks,
there's multiple incidents in history
where our government has simply
through either actual legislation or through certain actions
has left the African-American community behind.
And I think there is just a general distrust of government
and obviously government has been encouraging this vaccine.
And so I think, one important thing
is to understand the distrust,
not to minimize it, not to downplay it,
understand it, have a conversation with individuals,
make sure that the right information
is getting out to individuals.
But I think really, really key is to not minimize
or downplay or write off the caution that people have,
the distrust that people have of health care,
but rather to respect it
and always offer correct accurate information.
- And I like that you kind of speak
of acknowledging it very upfront
because even outside of COVID
and outside of the vaccine,
I mean, we look at disparities in outcomes
for childbirth among different communities.
And even, again,
I believe the COVID hospitality or mortality rate,
was it double or triple for our black community.
So, you know, I like that the conversation more
is let's acknowledge these things
and be transparent about it
instead of acting like this doesn't exist
because these are valid concerns.
- And for me, it's really important because,
you know, the truth is our community was hit really hard
by COVID just as you mentioned,
both in terms of hospitalizations, in terms of deaths.
That's across the board,
but locally here in Louisiana, in New Orleans,
our community was hit really hard.
I think a lot of us know people
who were impacted by COVID either through death
or through prolonged hospitalization and so forth.
And so it's really important for me
in terms of the work that I do
to reach out to my community,
reach out to the black community, speak to them.
I was very excited when I heard about this podcast
but speak to them about the vaccine
and other prevention mechanisms,
because I think it's really important
that people get correct information about the vaccines,
correct information about its efficacy, about side effects,
and I think it's very important
that people get correct information
about other preventative steps that they can take
to keep themselves safe.
- So what would you say are the top three concerns
that you've seen people have about this vaccine?
- I think all of them
kind of tie into one historic distrust of healthcare.
Some of it relates to how quickly the vaccine came up.
Some of it relates to the fact
that there are other illnesses
that have been around for some time
and we don't have vaccines for them.
How is it that we came up
with a vaccine for COVID as quickly?
There's a feeling that certain steps were skipped,
there's a feeling that we're gonna be used as guinea pigs
and so forth.
And so these are all things that I've heard.
And I always, first of all, I always try to, again,
understand and respect the concerns.
Yes, the vaccine was developed quickly
compared to other vaccines,
but all the steps that a vaccine will take
in order to eventually get approval were followed.
That includes first identifying the need for the vaccine,
second, coming up with appropriate candidate vaccines,
third, testing it in animals first
to make sure that the animals
respond the way you intended them to respond,
make sure it's safe in the animal,
fourth, testing it on a small group of people first
to make sure that it's safe,
then testing it on a slightly larger group of people
to make sure that not just it's safe
but that it triggers the right immune response,
and then thousands and thousands and thousands of people
were recruited in terms of the phase three clinical trial,
giving us a lot of information
in terms of what side effects might be there,
and does it actually work?
And so it essentially followed all of these basic steps
and I try to assure people,
along the way that the data is being presented.
And so, as an infectious disease doctor,
I certainly wouldn't recommend anyone get a vaccine
if it didn't follow the proper steps.
And I certainly won't get the vaccine myself
if it didn't follow the right steps,
and if I didn't believe it to be safe.
- Would you say there was sufficient representation
of minority populations in our trials?
- Correct, there was.
Somewhere around nine to 10% of individuals in the trials
were African-Americans, I can speak to that.
And so, and there was a really strong effort
to recruit African-Americans, Latinos,
and Indigenous Americans,
recognizing that these groups
have been disproportionately hit by the COVID pandemic.
- And healthcare in general.
- And healthcare in general, absolutely.
- So let's talk through how exactly the vaccine works
just to help everyone understand
and really feel like they have a solid knowledge
of what happens to their body when they get the vaccine.
- Correct.
So, you know, we have different vaccine platforms.
The basic trust of what they do
is you want the body to be able
to recognize the coronavirus,
should the body be exposed to it,
and get rid of it really quickly.
That's basically what you want.
You want your immune system to get rid of the virus quickly
or at a minimum to keep you from getting really sick
if the virus were to really kind of enter into your system.
So the first two vaccines that have received FDA approval,
the MRNA vaccines,
I think there's been some concern
that this is new and so forth.
The truth is MRNA has been around for a while
and people have been looking at it for vaccines
for quite some time.
It's not actually that new, and we have safety data on it,
and over the years we we've developed information
on how to store it, how to transport it.
And what these vaccines do,
I think another misconception is that these MRNA vaccines
are somehow gene therapy and it's altering our genome.
I just want to declare that it does not do any such thing.
When the MRNA is injected into the body,
it stays in a very separate compartment from the human DNA.
In that compartment, the basic code is red,
and a protein that is basically very similar
to the COVID virus protein is produced.
Once that happens, the MRNA actually vanishes,
it's destroyed, it doesn't stay in the body.
And so what you're left with is this COVID protein
which the immune system sees, recognizes,
and then the immune system gets rid of that protein.
So both the MRNA and the protein are now gone,
but your immune system has a way of remembering
what it's been exposed to.
So it remembers this protein.
And so, if ever the coronavirus gets into the body,
it would remember the protein on the coronavirus
and then it'll work to keep us safe.
- So we've talked briefly earlier
about the disparities in equity in healthcare
for general things with the mortality,
with the hospitalizations.
What about with the efficacies of this vaccine?
Have they found any differences in efficacies
among different ethnicities?
- It's been proven to be effective across the board.
- So who would you say needs to get this vaccine and why?
Just older people, younger people, pregnant mother,
you know, what would you say who is the person that says,
I will stand up and get this vaccine?
- Well, everyone really needs to get the vaccine.
Right now, in terms of the trials,
we have information for people older than 16,
people older than 18 years of age,
we're in the process of getting information
as far as children.
So certainly, everyone above those ages
should get the vaccine.
Now because of limitations in terms of production and need,
we've started a phase approach
trying to vaccinate high-risk individuals first,
individuals over than 70, 65, healthcare workers,
frontline essential workers.
So we're trying to vaccinate people at high risk of exposure
and people at high risk of severe disease initially.
But I think what we're hearing is probably by late spring,
there's gonna be much more available vaccine,
and I certainly think everyone should try to get it.
- And so when we do have this higher rate of accessibility
and hopefully, again,
the goal is a strong level of information,
education, and transparency.
When people are getting this vaccine,
what can they expect in terms of side effects?
- That's correct.
So what we've seen the most common with the first vaccine
is some pain in the shoulder at the local site,
usually with the first dose.
And we've seen that fairly commonly,
a lot of people have some pain,
maybe a little bit of swelling.
That usually goes away in about one to two days.
That was certainly something that was picked up
in the clinical trials
and we're certainly seeing that
as people are getting vaccinated.
With the second dose, a subset of people may get body aches,
maybe some low grade temperatures.
Again, usually that will last
for no more than one to two days
and then it'll kind of go away on its own.
What we've noticed is that people younger
than 55 years of age are a little bit higher risk
of getting those body aches and low grade fevers.
And those above the age of 55
seem to be a lot less likely to get that.
- And just to really clarify,
why is the body reacting that way?
I know some people could could think like,
"Oh, this vaccine is supposed to be helping me,
why would it make me feel bad?"
If you could just talk a little bit about
is that a normal response from the body?
- It's an immune response,
it means your immune system is responding to the vaccine
and eventually will make that immune memory
that'll keep you safe.
You know, we've seen this with some other vaccines,
certain other vaccines, for instance, the shingles vaccine,
we know causes pain in the shoulders
in a good subset of people that get it.
The flu vaccine,
a small subset of people that get the flu vaccine
get body aches when they get it,
usually lasts no more than one to two days.
So certain vaccines can certainly have some side effects.
Again, these are short term,
usually one, no more than two days,
everything clears away.
- Great.
And as we wrap up,
I just want to kind of ask one last question,
which is in your opinion,
what can we as either a health system, as individuals, do
to help vaccination uptake across our communities,
or if even if you have just a message to those listening?
- Yeah, no, I think my message is that, you know,
the data shows that these vaccines are safe.
There's been a lot of concerns,
not just about short-term side effects,
but about long-term side effects.
And what we know about vaccines
is generally there are no long-term side effects
and we know what the short-term side effects are
with these vaccines.
And so they are safe.
They are effective based on the data we have
in people that have been followed up to this point.
And so it's really, really important,
our communities have been hit really hard,
New Orleans has been hit very hard
directly and indirectly in terms of the fact
that we have to shut down the city
or close down certain things
in order to keep ourselves safe.
And so I'd really encourage everyone,
if you have questions, reach out to your provider,
your provider can certainly reach out to infectious disease
if they have questions.
And we're always happy to answer questions at any time.
- Awesome, well, thank you so much, Dr. Nnedu,
for that important information,
as you all kind of work together
to reach the end of this COVID pandemic,
but certainly,
your message of education and transparency is vital.
So thank you for joining us today.
- Thank you very much.