My social media feeds have been dominated with “vaxxies” – the newest selfie photo trend. Paramedics, EMTs and other healthcare workers mug for the camera while receiving or just after receiving the Moderna or Pfizer mRNA COVID-19 vaccine. Their facial expressions (presumably because they are universally wearing a face mask) are jubilant, but occasionally, a few tears flow from the emotional release of this triumphant moment in the now yearlong pandemic.
Vaxxies – the term coined by actor and public health advocate Alan Alda – are repromoted by individuals and organizations like the National Association of EMS Physicians, as well as the American Ambulance Association’s #EMSVax social media campaign to increase the number of public safety providers who will get vaccinated. First-person testimonials are social proof that people in our group or sub-culture are participating. Peer pressure is being used as a tool for good to encourage others to join the vaccine movement.
https://twitter.com/NAEMSP/status/1346593570409558016
Unfortunately, the anecdotal vaxxies in my public safety-heavy social feeds are counterweighted by the facts that the vaccine program rollout has been slow, vaccine availability and vaccination delivery is well below predicted rates, and case counts are rising in many places.
Even as the pandemic worsens and dozens of cops, firefighters, paramedics and EMTs have lost their lives to COVID-19, the reluctance of public safety providers to receive the COVID-19 vaccine is regularly reported. Only 38% of law enforcement respondents to a December 2020 Police1 survey said yes to getting the vaccine when it is available to them. Only 28% of respondents to a September 2020 EMS1 survey said they would get vaccinated.
Rewards for vaccination
Hospitals in Southern California are at or beyond capacity. The booming COVID-19 patient population led the Los Angeles EMS Authority to issue memos directing providers to conserve oxygen and that treatment in place for less severe patients is preferable to emergency department transport. The memos also reminded EMS providers to not transport patients with non-traumatic out-of-hospital cardiac arrest who remain pulseless after prolonged on-scene resuscitation efforts. EMS providers know that unless patients achieve ROSC on scene, they should not be transported, but the news of this common protocol went viral this week, just like the same protocol in New York City went viral last spring.
Vaccination, along with continuing vigilance for mask wearing and social distancing, is the clearest path to end the pandemic. But hospitals and public safety are using gimmicks, prizes and gamification to increase vaccination participation.
The LAFD has nearly 4,000 uniformed firefighters and non-sworn personnel. The Los Angeles Times reported that more than “670 city firefighters have tested positive thus far, a dozen have been hospitalized and two have died, most recently Capt. George Roque, 57, a 22-year veteran.”
To increase voluntary vaccination rates, the Los Angeles Fire Department is offering firefighters and paramedics the chance to win prizes, like gift cards, sporting goods and electronics, by receiving the department provided COVID-19 vaccine. The prize drawing, funded by the LAFD Foundation, a nonprofit organization that raises money to support the department, was announced by the fire chief and union leaders to encourage vaccination in a department, city and region that is being overwhelmed by infected patients.
A Texas hospital system is offering its 26,000 employees a cash incentive. Eligibility for the $500 Hope Bonus includes COVID-19 vaccination.
While the already willing will appreciate the cash or incentives, there is a chance that the unsure or unwilling may perceive the risk of vaccination as higher when it is accompanied by a monetary reward. If your organization is considering a prize or incentive program, be sure you are rewarding the behavior you hope to award and understand the motivations of your personnel as they might be quite a bit different than firefighters in Los Angeles or doctors in Houston.
Unvaccinated? Gambling with your health
Public safety providers who are choosing against vaccination are also entering a lottery with undesirable prizes, like severe illness, hospitalization and mechanical ventilation, that no one wants to win.
There is a lot we know about COVID-19. Some of those knowns include:
- Professional affiliation or licensure confers no immunity to COVID-19;
- The risk of infection, because of the work environment and type of work, is increased for public safety providers;
- Thousands of public safety personal have been infected, some of them have become severely ill and hundreds of police officers, firefighters, EMTs, paramedics and corrections officers have died from COVID; and
- The chance of death from COVID-19 is higher for EMS providers compared to other healthcare providers.
Medical professionals are learning that for some COVID-19 survivors, the impact of infection can linger for weeks or months. We won’t know for years if the impact of COVID-19 infection, like World Trade Center-related illness, will persist and eventually be the cause of premature death for previously healthy, vigorous public safety professionals.
Instead of gambling with your short-term and long-term health, as well as your family and close friends, change the odds by getting vaccinated.
Improve public safety provider vaccination rates
The free text comments in the Police1 and EMS1 vaccination surveys and analysis point to three primary reasons behind the decision to pass on a vaccine:
- Concern about short-term and long-term vaccine side effects
- A lack of understanding about how an mRNA vaccine works
- Disinformation circulating on social media
Each of these groups – “Yes,” “Not sure,” “No” – requires a different approach. The “Yes” group doesn’t need prizes or cash. They are already sold and motivated by a combination of self-interest (“I don’t want to get sick”) and altruism (“I don’t want to bring COVID-19 home to my family”). Vaxxie Facebook likes is enough reward for this group.
The “Not sure” group is likely reluctant because of concerns about side effects or wanting to better understand the science behind the development and testing of the vaccines. Prizes and cash bonuses might slightly increase participation in the “Not sure” group and the similarly minded “No” groups, but my sense is purposeful, group-specific messaging and addressing concerns will lead to the biggest gains in vaccination. This Changing the COVID Conversation Communications Cheat Sheet is a good reminder about how much words matter. After reviewing:
- Provide information from trusted sources, such as peers, company officers, chief officers and medical directors. Casey Patrick, MD, FAEMS, encourages us to “meet doubts with data” and John M. Williams, Sr., MD, MPH, who is also a reserve deputy sheriff, views the COVID-19 vaccine as “another risk mitigation tool, like internal body armor.”
- Deliver or share continuing education presentations about how mRNA vaccines work, how they were developed and tested, and why experts are so confident the vaccines are safe and effective. See below for three training videos.
- Encourage and recognize acts of service and sacrifice. Public safety personnel consistently report a top reason for their career choice is to serve their community and care for others. Celebrate vaccination, a selfless act of service to the community.
The odds are against convincing the personnel who believe the disinformation and conspiracy theories circulating on Facebook, YouTube and Reddit. Instead, your energy might be best spent ensuring that the anti-vaxxers aren’t spreading dangerous information on department computers, networks or during formal gatherings or even informal, workplace socializing.
Thanks and learn more
If you’ve already been vaccinated, thanks. If you are still unsure, check out these resources to increase your knowledge and comfort with safe and effective vaccines.
- Video: COVID-19 vaccine update for prehospital care providers from the University of Washington EMS Fellowship Grand Rounds
- EMS Physician Virtual Town Hall: COVID Vaccines – Your questions answered in an event co-sponsored by NAEMT, NAEMSP and NASEMSO
- COVID-19 vaccine informational webinar for EMS by Dr. Peter Antevy
