Susan Bailey was elected president of the American Medical Association in June 2020. (Courtesy American Medical Association)
Bailey said taking on the role in the middle of the unprecedented pandemic was “analogous to being a wartime president.” But she said her original plan as AMA president of reducing administrative burdens for physicians so they could focus on patients has not changed.
“It was just through a very different lens,” she said.
AMA’s goal during the pandemic has been to ensure physicians had the supplies and information needed to care for patients as well as resources to help keep practices open, Bailey said. As the pandemic progressed, she said the AMA became focused on vaccine transparency and distribution.
“We knew that vaccine hesitancy was at an all-time high before the pandemic began,” she said. “We had to make sure that physicians were thoroughly informed about COVID vaccines, because if they were completely confident about the safety and efficacy of the vaccines, then we’d be able to convince our patients to be confident of the vaccines.”
Founded in 1847, the AMA is the country’s largest physician membership organization, which represents doctors with a focus on practice sustainability, medical education and controlling chronic illnesses, Bailey said.
Bailey visited with Community Impact Newspaper for an interview April 21. This interview has been edited for length and clarity.
Given how recently COVID-19 first made landfall in the U.S. and how little we knew about the virus at that time, how would you say the nation, the states and the health care community has done in terms of vaccine creation and distribution?
The public-private partnership in vaccine development was unprecedented, and I think has been phenomenally successful. You know it was entitled … Operation Warp Speed, which was an unfortunate name in some respects, because it solely focused on the speed but didn’t focus on the safety and efficacy. And the good news is that we got all three.
We feel very confident that no corners were cut during the manufacturing process. A lot of red tape was cut, and a lot of financial risk was cut for the vaccine manufacturers so they were able to overlap phases of the research and do some things simultaneously. And thank goodness the mRNA vaccines turned out to be phenomenally safe and effective.
… The mRNA vaccines were approved right before the holidays, and so the initial rollout was a little bumpy, not surprisingly. We’d never tried to do anything like this before, much less during the holiday season, much less in the middle of a raging pandemic.
And when President Biden was inaugurated in January and set the goal of administering 100 million vaccines the first 100 days, many of us that that was totally unrealistic and aspirational. And it turns out we haven’t reached the 100-day mark yet, and we have reached 200 million vaccine[s] administered. And so I think it’s been a tremendous achievement.
What do you see as the biggest challenges to vaccine distribution moving forward?
We predicted this in the beginning that initially there would be a big rush of people that wanted the vaccine, and the demand would far outpace the supply. Eventually those two would meet up. And now we are entering the phase where most folks who desperately wanted to get the vaccine have had that opportunity or have at least signed up for it.
And now, the task is to, you know, help increase vaccine confidence in those individuals that haven’t been sure they … wanted to get it. … So we’re going to see a transition from mass-vaccination events … to smaller, more local events. And one thing AMA has been advocating for since the vaccines were authorized is to get them into more physicians’ offices, because physicians have always been vaccines’ greatest ambassadors.
… When a patient has a difficult decision to make about their health, they turn to their physician and they trust their physician, and the physician’s guidance is very, very strong in influencing the patient’s decision-making process. … We also, in more cases, are going to need to bring the vaccines to people rather than asking people to come to the vaccines. Patients in marginalized communities without the transportation, without good internet access, maybe even without a primary care physician or health clinic to go to—we are going to need to get vaccines into those communities.
… We’ve been working with the Ad Council and with the White House’s effort to help get the message to community leaders that people trust, because trust is a key component to agreeing to take a new … vaccine. And so we’re working with faith leaders; we’re working with community organizations; we’re working with just, you know, helping get that message out. The message needs to be consistent, but the messenger doesn’t have to be the same one every time.
What is herd immunity, and how do we reach it?
The concept of herd immunity is that if you get enough individuals vaccinated, that the few that aren’t vaccinated will still be protected because there’s not enough disease in the community anymore to spread. And so numbers vary. You know, at one point we said 70% need to be vaccinated; at one point we said 80%.
You know, I don’t focus on those numbers that much anymore because we know that there is some degree—we don’t know how much and we don’t know how good it is—of immunity among people that have been recently infected. And we know that it’ll be a while before we’re able to immunize children who comprise, what, 20% of the population? So I think we need to strive for, you know, 80% of the adult population, but realizing that it’s not a switch that’s going to get flipped. … It’s a journey. It’s not a destination.
We just are going to have to keep trying, and right now we are in a race with emerging variants. Right now, all of the vaccines that are available, including the Johnson & Johnson vaccine—assuming we get that one back online—are effective against the variants that have so far been discovered in the United States. … But the more people that are vaccinated and the greater the level of immunity in the population is, the less viral replication is taking place where a variant can develop. … If we can get ahead of the variants by getting folks vaccinated, we’re going to be in great shape. But there’s no question we’re in a foot race.
Is there a concern that additional variants could arise the vaccines are not effective against?
It’s a definite concern, and that’s why we’re in a race with the vaccine to make sure that we can get the level of disease spread in the community so low that the odds of a more infectious, more dangerous variant are much less. But that possibility exists and is one of the reasons why we recommend that even after people get vaccinated that they continue to wear masks, to physically distance, to wash their hands, to avoid crowded indoor gatherings. Because those promote the spread of the virus, and our basic public health recommendations work.
We know masks work. We know avoiding crowded indoor gatherings works. So until we have suppressed the virus to—we’ll probably never get rid of it completely; I think COVID is here to stay—but get it to a low enough level in every community that we can lighten up on some of those public health measures.
The distribution of the Johnson & Johnson vaccine was temporarily stalled due to some health concerns. Should those who received that vaccine worry about health care risks? What health care risks are there with these vaccines in general?
Well … with, you know, 180 some-odd million vaccine doses of the mRNA vaccine doses being given, we are not seeing significant side effects from those vaccines aside from the flu-like feeling that a number of people get right after they get their shot. A remarkable safety record. We now have six-month reports on both the Pfizer and Moderna vaccines. The immunity level remains high, and we’re just not seeing any new, what we call ‘safety signals’ that some side effects are coming out.
Now since there has been such incredible monitoring of our population after they’ve gotten vaccines. When the FDA had received the six reports about episodes of clotting disorders … they all happened within about six to 15 to 20 days after getting the Johnson & Johnson vaccine.
All these patients in particular just happened to be women. But in these patients that were having these blood clots, their platelet levels were actually very low—what we call thrombocytopenia. And platelets are what make blood clot—one of the things that make blood clot—and so you would think if you had low platelets, you wouldn’t clot at all. But the opposite is happening because there seems to be immune response to the platelets, and we think that’s what’s going on.
… It’s very rare, and it’s less than 1 case per million doses of the Johnson & Johnson vaccine being given. And this seems to be similar to what has been reported with the AstraZeneca vaccine in Europe. The same type of clotting syndrome. Both the Johnson & Johnson and the AstraZeneca vaccine are what we call viral vector vaccines. It’s an inactivated virus that the human immune system type has seen before, and they attach the information to make that famous spike protein, … which is where the COVID vaccine attaches to the human cell and where all the current vaccines are aiming at. … So we don’t know if it’s that viral vector technology, which is inducing this immune response, but it’s being investigated.
… And we have to remember that if you get COVID, your risk of having a clotting episode is 20%—1 in 5. So, pulmonary embolism, clots in the legs, strokes, heart attacks. … There is something about the COVID virus that, you know, encourages our bodies to make blood clots. We haven’t figured that out yet. So the risk of getting COVID and getting a blood clot because of COVID is far greater than the risk—if it is related—of clotting with the J & J vaccine.
How long will the vaccines be effective? Will those who have been vaccinated be scheduling shots every year?
We would all like to know the answer to that. We’re all going to have to wait and see. You know, as I mentioned earlier, we know that the mRNA [vaccines] give us at least six months, hopefully much longer than that. But it’s just going to take time to keep following patients, you know, very closely to see how … long their immunity lasts. The manufacturers—Pfzier and Moderna—have both come out in the last week saying they’re thinking that we may need boosters eventually, but we really don’t know.
Another reason that we might need a booster shot is if new variants develop that aren’t covered by the current vaccines so that they can update the vaccines and we’ll need a booster of that one. So if we do need boosters, hopefully it would only be like once a year at the most, but we’re just going to have to wait and see.
How much of a challenge is misinformation and the myths about vaccines to the vaccine distribution process?
Vaccine misinformation and deliberate disinformation are definitely out there and are risks to vaccine confidence. There are, you know, patients that … just don’t understand how the vaccines work. They’re afraid they might get COVID from the vaccine, which you can’t. There’s no live viruses in the vaccine. They’re afraid of, you know, what else might be in the vaccine that they don’t know about.
… I think the most common misinformation is just that feeling that “Well, it can’t happen to me.” And, yes, it can happen to you. … It’s so important to have those conversations and help patients that have questions about vaccines to understand that it’s normal to have questions. We expect you to have questions. And we want to answer your questions.
Very often, when you just have that conversation … and reassure them that they can’t get COVID from the vaccine, that they’re really very safe. They’re very effective. No, they weren’t rushed. They were done in a hurry because a lot of money was put into the manufacture, and a lot of incredible people worked really hard to make sure that we had vaccines. But, no … steps were skipped.
Once you take an empathetic approach to discussing this with your patient, … very often, they’ll say, ‘OK. Well, I feel much better. That sounds good.’ We’re not going to convince 100%. But, you know, an empathetic conversation that encourages questions from someone that you can trust can be incredibly powerful in increasing vaccine confidence.
Is there anything else you would like to add regarding vaccinations or anything else we discussed?
I’m excited. You know, there are more vaccines on the horizon. … Many of them have different mechanisms than either the mRNA vaccines or the viral vector vaccines. And so I think we’re going to have a number of choices going forward. I am convinced we will beat COVID. We will win this fight. But we’re all in it together, and we’re all going to have to pull our weight.