How SGIM Can Use Our History to Create a Better Future: COVID-19 & Vaccine Hesitancy

I spent the early part of this summer considering how we would work together to readapt our lives, practices, trainees, peers, and society from the disheartening reality of the COVID-19 pandemic to the “new normal.” There were many glimmers of hope of normalcy as we proceeded into the summer solstice. Many of us were excited to pursue time for respite in old and familiar vacation locations despite varying levels of restriction. Our practices were transitioning back to face-to-face visits with telemedicine as adjunctive and hopefully as a tool to enable our focus on equity. Our academic hospitalists were making systemic changes in their environments to rejuvenate and combat burnout given they often bore the brunt of high-intensity clinical care over the past year. Those involved in research were excited to learn of the new federal research priorities focused on eliminating structural racism within the NIH as well efforts dedicated to enhancing primary care research. We read the Forum last month seeking strength, renewal, and lessons learned to improve mental health. The SGIM’s Council, Board of Regional Leaders, ACLGIM, as well as the Program Committee were reviewing budgets, executing a new program year, and planning for face-to-face meetings. With a new wave of hope, SGIM had set the date of December 2021 to transition back to face-to-face meetings.

And then, two national holidays—Juneteenth and July 4th—arrived. Since those landmark days, we have witnessed increasing cases of the Delta variant of SARS-CoV-2 nationally. The surge has been uneven and likely attributable to low vaccination rates and vaccine hesitancy.

Now that the academic year is in full swing, we are all again working overtime to keep the hospitals, schools, and the economy open. Given the current situation, I am now rethinking the fall and looking to the past for answers. I keep returning to the aphorism “Those who cannot remember the past are condemned to repeat it” as stated by Spanish philosopher George Santayana and later paraphrased by Prime Minister Winston Churchill. This phrase helps us examine history to understand the future.

Those who know the history of the Spanish Influenza (1918-20)¹ pandemic might have thought our technological advancements, most notably the rapid development of the vaccines, would have allowed us to short cycle the natural history of another pandemic. Nonetheless, we must ask ourselves: What can we do to mitigate this lingering public health dilemma, confront vaccine hesitancy, and prepare for difficult conversations about the vaccine?

As general internists and those in training we must heed the following:

• Arm ourselves with evidence-based information. Read the literature, locate, and, at times, develop the evidence; consult with both basic science and subspecialty colleagues. Dr. Robert Centor (@medrants, SGIM president 2005-06) would remind us that as generalists we must do this in our daily clinical practice.
• Use effective communication skills to articulate the benefits and risks of the vaccine with our patients and the public in ways that encourage understanding. Dr. Michael Barry (SGIM president 2004-05) also demonstrated this expertise in the field of medical decision making.
• Listen to our patients empathetically and remain open to their questions. Dr. Thomas Inui (SGIM president 1987-88) reminded us to excel at the social context of medicine and the humanities.
• Separate public health from politics as Dr. JudyAnn Bigby (SGIM president 2003-04) reminded us so eloquently almost 20 years ago.²
• Work with communities both collectively and individually to strengthen our trustworthiness as physicians and health care institutions, as clearly articulated by Dr. Bigby.³ Bigby and former SGIM presidents Dr. Marshall Chin (@MarshallChinMD, SGIM president 2015-16) and Dr. Giselle Corbie-Smith (@gcsmd, SGIM president 2018-19), have long role-modeled ways to work both as trusted brokers and with trusted brokers within our communities.
• Continue to advocate at the federal level as Dr. William Moran (SGIM president 2014-15) has long demonstrated on health policy to ensure that COVID-19 vaccines remain 100% free for every individual living in the United States and that COVID-19 services for the uninsured or undocumented are billed to the federal government.
• Demand that our local leaders make access to the vaccine easy in the outpatient and inpatient settings as well as in the community.
• Amplify the voices of our patients and support the institutional structures needed to improve health not only regarding COVID-19 but also those related to the underlying structural inequalities and racism. These are necessary steps to realize “a just system of care in which all people can achieve optimal health.” Dr. Karen DeSalvo (@KBDeSalvo, SGIM president 2019-20) called this to our attention.⁴
• Use social media to collectively amplify each other and the public health message needed to combat this virus on the big screen of the world wide web (see @medrants). Accept that it is here and can serve as a tool to combat misinformation.

As fall transitions into winter, the SGIM community must continue to learn from history, especially the wisdom of our former presidents so that we can change our future for the better.