Health Literacy, a Pandemic, and the Church

One year ago, a winter wave of COVID-19 cases was starting to surge. The United States had already seen over 250,000 deaths.  The hope of a vaccine was just around the corner. Yet a COVID-19 vaccine misinformation campaign was already well underway.  Now we are approaching a staggering 1 million excess deaths due to COVID-19,  despite having multiple safe and effective vaccines. Why are so many not only not vaccinated against COVID-19,  but angrily opposed only to these particular vaccines against this specific illness?

Also in 2020 – and coincidental to the growing pandemic – UnitedHealth Group issued a report  on health literacy, which is the ability of people to access, understand and use information to promote good health. They noted that health literacy, like other social determinants of health  – social and physical environments, behaviors, access to healthcare, poverty, education, etc. – varies greatly across the country. Maps of health literacy  look similar to maps of county health rankings,  obesity,  heart disease,  poverty,  and education level  – generally worse across the Deep South.

In the paternalistic days of healthcare, health literacy was not even a concept. Patients relied on their physician to make healthcare decisions, trusting that he (almost all doctors were men) had their best interests at heart. Now we “shop” for healthcare as “consumers” in an increasingly transactional relationship. Big Pharma markets directly to the consumer through television, internet, social media, and streaming services. We Google for healthcare information. But are today’s consumer-patients any more educated or more capable of making informed healthcare decisions?

At a very basic level, health literacy must start with actual literacy. Twenty two percent of adults in my county can’t read a newspaper, which is written at around an 11th-grade level.  Add to that the fact that much healthcare information is even more difficult to read and understand, much less process critically. For example, I have otherwise educated patients who cannot tell me the names of the medications they are on and why they were prescribed.

And then along comes a pandemic, a fertile ground for a new, lethal combination of low health literacy and ubiquitous misinformation. A pre-pandemic systematic literature review on the spread of health-related misinformation on social media noted that accurate (often dull) scientific information is easily crowded out by sensationalized news.  The Internet of Everything  promised to help us live an efficient, informed life. Instead, it has produced a far darker reality of unquashable lies and misinformation that, in this perfect storm of pandemic and politics, has resulted in hundreds of thousands of avoidable deaths.  UnitedHealth Group’s report envisioned that increased health literacy might lead to 1 million fewer Medicare hospital visits each year and $25.4 billion in Medicare savings.  No small potatoes. They did not foresee this pandemic, where additional and avoidable COVID-19 hospitalization costs totaled $5.7 billion just from June to August 2021.  

Unfortunately, the evangelical church, of which I am a member, has been on the wrong side of the health literacy discussion, especially as it pertains to the COVID-19 vaccines.  I have written previously about the appalling attempt of many Evangelicals to claim religious exemptions.  Rather than a biblical love your neighbor message, the church – at least the Christian Right version of it – has promoted individual rights and selfishness as the greatest good. Rather than teaching the Beatitudes,  some in the church want to take over the state,  institute a theocracy and claim God’s blessing while doing it. Rather than preaching and being the Good Samaritan  to the pandemic ill, the Christian Right has chosen not only to walk on the other side of the road but to add to the toll of injured.

It is tragically ironic that the self-proclaimed pro-life Christian Right has raged against life-saving vaccination. Ted Cruz, the dominionist darling of the Christian Right,   vilified Big Bird for a “government propaganda” tweet about getting vaccinated.  The church – if it will preach the true pro-life gospel – can’t help but shine a light on this hypocrisy. For so many Evangelicals to fight against protecting and caring for others is not reflective of Christ’s teaching and, at a deeper level, heresy.

When it comes to solving the problem of low literacy and misinformation, avoiding social media and the commentary-based news media is a non-starter. Retracting misinformation is difficult, if not impossible. We have to learn to live with social media and understand that misinformation spreads faster and wider than factual information.  Health care providers must allocate time at every visit to assess what the patient does and does not know and to explain procedures, interventions, and medications in simple, clear language, avoiding jargon, verifying that the patient understands and can repeat back what they were told.  Most importantly, critical thinking should be treated as a core skill in education. We must educate people to be open-minded, to think beyond the noise, to observe and question, to be objective and look for biases, all with humility.

At the end of the day, too many in the Evangelical church allowed fear, misinformation and politics to replace compassion, service, and love. If the COVID-19 pandemic has taught us anything, it should be that loving our neighbors as ourselves is not a hollow commandment;  it saves lives.

The Miracles of Music and Medicine

I grew up in the Friday Night Lights of West Texas in the 60s and 70s, where sports – especially Midland Lee and Odessa Permian football – were king. A preemie who remained anemically skinny all through my school years, I also suffered from an uncorrected lazy eye, which resulted in no central vision in one eye and no functional depth perception. I could not catch a baseball or football to save my life. I truly was the proverbial kid who was picked last for every sports team. Luckily, at the age of seven I was already developing a talent for music. I started taking piano lessons in second grade and have been playing ever since.

Though I excelled academically in high school, I started at Rice University as a music major, though not on piano. I was fortunate to study with the principal clarinetist with the Houston Symphony. Thankfully, I came to several realizations my freshman year: 1) Though I was talented, I was not good enough on clarinet to make the big-league symphony orchestras and make a good living at it; 2) I found playing the same music over and over again a bit boring; and 3) I really wanted to go to medical school. I loved music (and continue to love it, just not playing the clarinet). But I did not want to make music my life’s work. Now, I have the best of both worlds – I have a wonderful career and I get to enjoy music on the side.

The other evening, I was sitting at my piano practicing an arrangement of “O Holy Night.” My daughter, a classically trained soprano, will be singing this at Christmastime and I have the great joy of being able to accompany her. As I was playing – glancing between the written music and my fingers on the keys, listening to the sound fill the room – I had the distinct realization of what a miracle music is. At its most fundamental, the concept that various tones and rhythms can be combined in a non-random fashion and be pleasing to the ear both for the performer and the listener is a mirror of creation. Add to that the genius of the development of various musical instruments and the complexity of composition and performance and you arrive at what can only be described as a spiritual experience where the music and the musician combine in a true act of worship. 

As a pianist, it never ceases to amaze me that I can look at a splotchy group of dots on a page and translate that into an elegant motion of arms, hands, and ten fingers to make music. And when I can make music with others, the amazement and joy is amplified even more.

In 2014, Curt Fenley and I had the pleasure of bringing together the choirs and musicians of New Beginnings Baptist Church, under the musical leadership of Gregg Garcia, and our First Baptist Church for a combined Christmas program. We were without a music director at the time. That Christmas celebration demonstrated another miracle of music – the ability to bring a diverse group of people together for common good and purpose. 

These two churches continue to make music and worship together at Christmas! Under the excellent leadership of First Baptist’s John Lassitter and New Beginnings’ Gregg Garcia, we are practicing for our eighth annual Christmas celebration, to be held on Sunday, December 5th at First Baptist at 6 PM. Our weekly practices together, which can really be described as jam sessions, transport us all away from the daily grind to a place of unity and worship. I hope everyone will plan to attend this impressive Christmas celebration! Canned goods will be gathered in support of CISC as well.

On a more somber note, we are now approaching a staggering 1 million excess deaths due to COVID-19. Nearly 100,000 of those deaths are since vaccines have been widely available. As a cancer physician, it is mind-blowing that COVID-19 is killing more people than cancer. I am heartsick when I hear people I know and love continue to refuse vaccination because of an unrelenting campaign of lies and misinformation, both about the seriousness of COVID and the safety and effectiveness of the vaccines. This paper’s obituary page continues to be filled with tragic and preventable COVID deaths.

In the realm of cancer treatment, hardly a day goes by that patients aren’t clamoring for the latest experimental medicine, desperate to try anything they think will help, regardless of unproven effectiveness and potential harm. How ironic (and senseless) that we have a disease that is killing more people than cancer and people refuse to get a proven safe and effective vaccine. 

I am a rational, logical thinker. That does not mean my heart doesn’t ache when so many are dying for a lie or out of misplaced fear. I tell my reluctant terminal cancer patients who are afraid to take pain medication, once I have counseled them on appropriate use, that there is no virtue and no extra stars in their crown for hurting when they don’t have to. I feel the same way about unnecessary COVID illness and death – there is no virtue there. 

Martin Luther wrote, “My heart, which is so full to overflowing, has often been solaced and refreshed by music when sick and weary.” And so, I sit at my piano, calming my spirit and soothing my weary soul. As we enter the holiday season, I urge everyone to appreciate the miracle of music, yes, but also the miracle of modern medicine. Both have the power to heal. Let us thank God for both.

Happily Ever After

I love fairy tale endings. I am a sucker for the 1997 television version of Rodgers & Hammerstein’s Cinderella featuring Brandy, Whitney Houston, and the incomparable Bernadette Peters. My daughters grew up with that version and we all watched it countless times. Pretty Woman, a different type of fairy tale, has my favorite glamour shopping scene in it. Who doesn’t love Julia Roberts owning Rodeo Drive? And The Princess Bride is simply one of the best movies ever. Apart from a treasure trove of classic quotes – Inconceivable! – the underlying theme of a young couple coming together from different cultures or stations in life and finding true love is heartwarming.

There is nothing like a fairy tale wedding! Remember, though, it really isn’t just the wedding that makes it a fairy tale – it is the promise of living happily ever after! No one sincerely attends a wedding hoping the couple doesn’t make it. Countless books have been written about how to have a successful marriage. Funny, my answer to that is the same general advice I have been giving when dealing with so many pandemic-related controversies: it’s not about you. In marriage, put the needs of your spouse above your own, emotionally, financially, physically. Love in word and deed.

I have been thinking a lot about weddings recently. My oldest is now engaged, and what was a vague prospect of a wedding one day is now an imminent reality. The institution of marriage has changed, though, since I got married.  

Recent data from the US Congress Joint Economic Committee shows that marriage rates hit an all-time low in 2018. Interestingly, the divorce rate actually has fallen by about 30 percent over the last 18 years, speculated to be the result of self-selection out of marriage. According to a 2018 Los Angeles Times article, marriages today have a greater chance of lasting than marriages did 10 years earlier. My generation (baby boomers) married quite young and divorced more (and continue to divorce at higher rates), whereas Generation X and especially millennials are being pickier about whom they marry (or not marrying at all), and tying the knot at older ages when education, careers and finances are on track.

Still, legal, financial, and emotional benefits of marriage – a healthy, lasting marriage, that is – abound. Health insurance benefits, IRA contributions, Social Security benefits, and potential tax advantages often favor marriage. Happily married couples live longer and suffer less from stress and depression.

The Knot Worldwide, self-described as the nation’s leading wedding marketplace and known in the US as www.theknot.com, published the results of a comprehensive survey of Americans married in 2017 that points out many ways marriage has changed over the years. They noted that ceremonies hosted in a religious institution have dropped from 41% in 2009 to 22% in 2017. The same thing holds true in England, where religious ceremonies accounted for 85% of marriages in 1900 but only 49% by the late 1970s and 23% in 2017. The Knot also notes that people are marrying at an older now (around age 30), the number of wedding guests is decreasing (now average 136), and the price per guest is increasing (now average $268/guest). The average wedding cost is now $33,391, excluding the honeymoon!

In our increasingly online society, another trend is notable (and given the sorry state of the US Postal Service, welcome): more couples are creating a personal wedding website (31% in 2017, up from 14% in 2014) and using an online RSVP service (28% in 2017, up from 7% in 2014). During the COVID-19 pandemic, online RSVPs became an essential way of tracking and notifying guests of last-minute venue changes, wedding instructions, or outright cancellations.

As couples are marrying older, the focus of weddings has become more on the guests, making memorable experiences for the attendees and reflecting the personality of the couple. But the fact that weddings are taking place in non-traditional venues does not mean that cultural and religious traditions are not reflected in the ceremonies.

Personally, the move of weddings away from religious buildings doesn’t necessarily bother me. When my wife and I got married, it was every bit the standard Southern Baptist wedding. The afternoon ceremony probably took no more than 20 minutes and we immediately retired to the church parlor for punch and cookies. We had to beg the church not to throw out the Christmas poinsettias until after our ceremony on December 28th because we couldn’t afford other flowers for decoration. There was certainly no sit down dinner, and no dancing or alcohol! Last December, we celebrated our 35th anniversary, so I guess it took. Honestly, hardly a day goes by that Catherine and I don’t tell each other how blessed we are. She truly is my soulmate.

Isn’t that what we want for our children – for them to find a lifelong companion, lover, and friend? Whether my daughters get married in a church or in a barn, at whatever age, I hope and pray they find their soulmate with whom they can grow old together, sharing the ups and downs of life, grateful for the blessing of life and love. The wedding celebration can be whatever they want it to be as long as the significance of the ceremony is not diminished, especially the solemnity of the commitment itself: "To have and to hold from this day forward, for better for worse, for richer for poorer, in sickness and in health, to love and to cherish, till death us do part."

In every generation, the fairy tale magic of love brings people together. That happily ever after part? It may take work, but as Whitney Houston and Brandy sang in Cinderella, “It’s possible!” 

The Deception of Religious Exemptions

 On August 23, the FDA gave full approval to the Pfizer COVID-19 vaccine for individuals 16 years of age and older. This was supposed to be a time of celebration when everyone’s fears and doubts were finally relieved and the lines to vaccination sites extended around the block. After all, more than 200 million doses of the Pfizer vaccine have been administered in the US (not to mention 146 million Moderna doses and 14.5 million J&J doses). Safety and efficacy are proven. Yet only 53% of the population is fully vaccinated and the Delta variant is filling our hospitals and ICUs.

 Incentive payments for vaccination are increasingly common as school districts and colleges encourage vaccination to avoid shutting down in-person learning.   Prominent celebrities and politicians have encouraged vaccination, but others have been vocal opponents. What is apparent is that being nice is not enough to get people vaccinated.

 The FDA’s action lit the fire of vaccine mandates, which were rare when COVID-19 vaccines were under Emergency Use Authorization (most still are). Large hospital systems like Methodist hospital (which mandated vaccines at the end of March) and many major employers from McDonald’s and Walmart to Goldman Sachs have stepped up vaccine requirements. Delta Air Lines will require that employees be vaccinated or pay a $200 a month health insurance surcharge.  Beginning this month, the US military is requiring COVID-19 vaccination to maintain preparedness of our troops, much as they already do for any number of other infectious diseases.

In an article in The Atlantic titled Vaccine Refuser Don’t Get to Dictate Terms Anymore, author Juliette Kayyem says what a lot of vaccinated people are thinking: people who opt out of shots shouldn’t expect their employers, health insurers, and fellow citizens to accommodate them.

 The most vocal demands for accommodation are coming from what historically would have been the least expected place: religious conservatives. Some churches have offered blanket religious exemption letters for those who don’t want to take the COVID-19 vaccination, despite some religious leaders’ prohibitions. One particularly egregious – and frankly, immoral – means to the anti-COVID-19 vaccine end is the use of religious exemptions as a “pro-freedom” political position. This is not the old-style, radical fringe anti-vax movement, which opposes all vaccinations. However, the zeal of these mostly White evangelical Christians is no less extreme. Unfortunately, this segment of the Christian right is a sizable enough minority of the US population that achieving the high rate of vaccination needed to quell this pandemic has become a herculean, if not impossible, task.

True religious exemption requests are based on sincere religious beliefs. It defies credulity that in this era of declining church attendance and doubt that God even exists, sincere religious exemptions are suddenly in vogue. Religious leaders across the spectrum – Pope Francis, the Dalai Lama, the archbishop of Canterbury, the presiding bishop of the Episcopal Church, the leadership of The Church of Jesus Christ of Latter-day Saints, pastors, rabbis, imams, Hindu leaders, Buddhists, Sikhs, even Jehovah’s Witnesses – support vaccination.  Apart from all major religions looking askance at religious exemptions for COVID-19 vaccination, one leading bioethicist commented that most of the purportedly religious opposition to COVID-19 vaccination is not sincere; rather, it is “just a way to get out of having to take a vaccine.”

 Up to 2019 – prior to the pandemic – medical exemptions for vaccinations were rare. For example, the US median non-medical exemption rate among kindergartners was 2.0%. If the COVID-19 religious exemption rate was anticipated to be a mere 2%, we would not be talking about it. No matter the rate, Erwin Chemerinsky, dean of the UC Berkeley School of Law, argues that policies requiring vaccination against COVID-19 need not include, and should not include, exemptions for those who have religious objections to vaccinations. “No one, in practicing his or her religion, has a constitutional right to endanger others,” he writes. United Airlines apparently has taken that to heart, amending their mandatory vaccination policy to say that those granted religious exemptions will be placed on temporary unpaid leave and only allowed to return to work “once the pandemic meaningfully recedes”.

 It should be clear: If you have never refused a vaccination on religious grounds – if you are vaccinated against measles, mumps, rubella, diphtheria, tetanus, shingles, hepatitis, or any other infectious disease – then suddenly in 2021 you decide you don’t want to take the COVID-19 vaccination, that is not your religious belief. It is your political opinion. There is a huge difference, and the latter does not qualify you for exemption. And lest anyone think vaccine mandates are unconstitutional, think again. The US Supreme Court decided for vaccine mandates way back in 1905.

 There is a misplaced rage among too many Christians – yes, rage! – disingenuously cloaked in a dubious religious liberty narrative against safe, proven, life-saving vaccines. As political commentator, attorney, and Christian David French writes, “The very moral framework of millions of our fellow citizens—the way in which they understand the balance between liberty and responsibility—is gravely skewed.” The title of that recent column by French says it well: it’s time to stop rationalizing and enabling evangelical vaccine rejection. Amen to that. “But my freedom!”, some are screaming, as they want to claim vaccine mandates are the (evil) government’s way of suppressing the church. French thoughtfully argues there is no religious liberty interest in refusing the COVID-19 vaccine.

 As if we need reminding, liberties have limits. We are at a point where our “self”-centered society falsely believes that individual rights trump our responsibilities as citizens of our great democratic constitutional republic. All citizens – especially true Christians – should be doing everything in their power to care for the health and safety of others in this pandemic. That includes getting vaccinated. It is our civic and moral duty, if we would acknowledge it. Attempting to claim a religious exemption for the COVID-19 vaccines is, frankly, an egregious example of biblical bad fruit.  Let us all produce good fruit.

Anger in the Time of Coronavirus

What an emotional roller coaster the last year and a half has been! The pandemic and the election have been a double whammy on our mental health. Religious leaders are seeing a lot more anxiety and depression in their congregations. FiveThirtyEight notes that hatred now dominates American politics. Though we are learning more about potential long-term physical consequences of COVID-19 infection, I fear anger may be most damaging and lasting side effect of the pandemic.

I’m generally not an angry person. But there is a pervasive anger I suspect most of us are experiencing. It catches us off guard. By the time we are aware of it, we are about the explode. The triggers may be different for each of us. For some (like me), it is the failure of the country to get behind the greatest vaccine development and distribution effort in the history of the world. For others, it may be the political fallout of a lost election, or the decline of the church, or systemic racism, or immigration. Our anger has been whipped into a frenzy by presidents and politicians, by news organizations and social media. Our collective and individual anger switches are on an ever-shortening fuse. This is not healthy. Anger is tearing us apart from without and within. 

For example, vaccine hesitancy is the lead story in much of the news right now. The phrase vaccine hesitancy is kind. It is a gentle way of referring to the ever-hardening decision by far too many to refuse to save lives – theirs and others. Honestly, hesitancy describes very few now and grossly mischaracterizes the selfish and vehement opposition of too many to getting vaccinated – kamikaze cultism, as this paper called it. Vaccination rates have plummeted. The Delta variant is on the rise as a result. In states with low vaccination rates, more than 99% of COVID-19 deaths over the past six months were among unvaccinated people. Virtually all current COVID-19 hospitalizations and deaths in the United States are preventable.

We continue to give people the benefit of the doubt, hoping that the truly hesitant will step into the light, when the dark void of lies and misinformation has swallowed so many. Fear of the Delta variant may now be convincing some holdouts to get the jab. On the other hand, those falling on the straw man sword of freedom and personal responsibility will get to enjoy the consequences of their choices, which increasingly may mean wearing masks at work, regular nasal swab testing (isn’t that fun!), or even loss of employment. Some will die. Freedom to choose is a wonderful thing.

Does that sound cynical to you? Yes, I am cynical. And, as I said, angry even. As a cancer physician, I have determined that a healthier emotional reaction to the unvaccinated would be more like my compassionate-yet-uncompromising reaction to smokers, who often have a similar “personal rights” reaction to smoking restrictions (and who can be “addicted” not only to smoking, but also to the misinformation and rationalization that misplaces and overrides the very real health dangers that demand a broad societal response). One person I attempted to talk to about getting vaccinated said, “It is scary that we would capitulate to forced mandates. You agree with this one, but may not agree with the next. You may be very thankful later that people like me will stand in the gap regardless of the social stoning we are experiencing.” Yet very few of the anti-COVID-19 vaccine zealots are true libertarians. They are much more likely to view COVID-19 vaccine refusal as a statement of political identity and a test of party loyalty. And that social stoning? Self-inflicted wounds are an affront to the true coronavirus martyrs – those who lost their lives through the inaction of others. 

Don’t get me wrong – every COVID-19 death is tragic, regardless of the circumstances. My anger at the situation must not be seen as a lack of compassion for the person. Our healthcare system and the providers in it will do everything they can to care for those who are suffering and dying from COVID-19. 

The vaccine isn’t of the devil, folks, and it isn’t the mark of the beast, either. Ah, but anger is, including mine. When Jesus sent his apostles out to spread the gospel message – literally the good news – he didn’t tell them to get angry when the message was rejected. They were to shake the dust off their feet and move on. Some people laugh when I suggest it is a Christian duty to get vaccinated to help others, as if the Good Samaritan story has no modern pandemic equivalent. We should be protecting our neighbor, not infecting them. I’ve shaken off a lot of dust lately. Yet, I will continue to spread the good news that vaccines save lives.

Whether vaccines or elections, critical race theory or immigration, politics on the left or the right, we cannot let the sun go down on our anger. The antidote to anger is gratitude and love. It is hard to remain angry when you are counting your blessings and serving others. I’ve said it many times before, but the response of those claiming to be followers of Christ – and I count myself among those – should be to love our neighbor. 

Are you suffering from debilitating anger, anxiety, or depression? Seek help. The Burke Center is here for you. Reach out to them at https://myburke.org or by calling their 24-hour crisis hotline at 1-800-392-8343. 

Cognitive Dissonance, Trust, and COVID-19

Most of us have had our lives disrupted in some way as a result of the COVID-19 pandemic. As difficult as job loss and economic upheaval have been, it is the loss of life that is most tragic. Between March 1, 2020, and January 2, 2021, the US experienced 522,368 excess deaths, an incredible 22.9% more than expected. Though the vast majority of these excess deaths were directly COVID-related, deaths from other causes (heart disease, Alzheimer’s, and diabetes, for example) were also increased. Total COVID-19 deaths have now exceeded 600,000. Yet to hear some talk, you would think the coronavirus was nothing more than an excuse for the government to infringe on individual rights.

As the pandemic surged on, all anyone could talk about was controversy surrounding pandemic-related measures (masking and social distancing), COVID-19 interventions (hydroxychloroquine and bleach come to mind), and ultimately vaccinations. As illness and deaths mounted, an insidious combination of mixed messaging, misinformation and politics perpetrated an ironic and sinister distrust of science and healthcare.

It used to be common to joke about how little we trusted politicians. How is it that now we trust (some of) them more than scientists and doctors, even when it comes to science and medical information? There is cognitive dissonance here: A) Doctors are some of the smartest people around (so I’ve heard), and they are exquisitely skilled at preventing, diagnosing and treating illness; and B) Politicians are self-proclaimed experts at viral transmission, disease severity, drug effectiveness, and vaccine necessity.

Cognitive dissonance – holding on to conflicting or inconsistent positions – is not new in health-related matters. Smokers demonstrate it all the time: A) Smoking is bad for me; and B) I smoke. There is a fundamental conflict between what smokers know or should know (based on scientific facts) and what they do. Smokers resolve this internal conflict by trivializing (smoking is not that bad), rationalizing (at least I eat healthy and exercise), or trying to change or deny the facts (smoking didn’t cause my heart disease, COPD, or cancer). Deflecting blame for bad outcomes is common. The hard road to resolving the cognitive dissonance associated with smoking is to change behavior and quit.

I don’t mean to pick on smokers. Nicotine is addictive and quitting is quite hard. Every time I stop for a Ray’s bacon cheeseburger with onion rings or get an iced cookie from Confections (two of my favorite local eateries), I experience a bit of cognitive dissonance myself. I rationalize, I trivialize, I deny that it may be unhealthy. With diet, however, one can assess whether the hamburger or cookie is an occasional treat or a bad habit. The cognitive dissonance surrounding COVID-19 (and especially vaccines) is more problematic.

As a physician, I often do not know whether my patients believe what I say and will act on what I recommend. I strive to be seen as a trustworthy authority. Lack of trust – in me or the system – has consequences. Healthcare system distrust is associated with lower COVID-19 vaccination rates, especially in minority communities. In my field of oncology, distrust affects outcomes across the breast cancer continuum. Even before COVID-19, trust in doctors had plummeted by 75%. (The internet has turned everyone into an expert.) The odd anti-vaxxer, for example, used to be an easily dismissed anomaly. Now, a crippling vaccine hesitancy risks preventing COVID-19 herd immunity. The consequences could be devastating, as virtually every COVID death going forward is preventable.

Let’s consider: A) COVID-19 vaccines are readily available, wildly effective, very safe, and completely free (all verifiable facts); and B) Less than half of the United States is fully vaccinated. Cognitive dissonance. This isn’t just a problem in the United States. How are people responding to this inconsistency – this disconnect – between what we know (again, scientific facts) and what we do? It is the same playbook we saw earlier with smoking – that of trivialization, rationalization, and flat-out denial. Add in conspiracy theories and “it’s like choosing from which side of the flat Earth we’re going to jump off,” according to an obviously exasperated Dr. Luana Araújo, a Brazilian infectious diseases physician.

The apostle Paul struggled with the inconsistency between beliefs and actions in his letter to the Romans, admitting he doesn’t do the good he wants to do; rather, he does what he knows he shouldn’t do. Can we amen that? Paul even calls himself a wretched man as a result. That’s cognitive dissonance! Paul was instructing on the spiritual condition and the nature of sin and grace. I’m simply trying to get people to use common sense.

Where do you stand with COVID-19 vaccinations, and why? Seek the truth rather than trying to bend the facts to your preference. We have a misinformation pandemic where lies propagate across the internet further and faster than truths. What is the source of your knowledge? Is it science experts and doctors, or politicians promoting their own self-interest and conspiracy theories? Second, be willing to eat a little humble pie. Don’t throw logic and facts out the window in order to cling to pride or party. If you haven’t been vaccinated yet, you are allowed to change your mind! Making the wrong choice about vaccinations during this pandemic (especially with the newer, more virulent Delta variant on the rise) can have deadly consequences.

Hopefully we can get back to trusting the healthcare system and doctors more. Are we perfect? Of course not. We must earn your trust. I know I strive every day to do just that.

Vaccine Passports Are Coming

Like it or not, vaccination passports are coming. Before we go too far, let’s be clear: the federal government has no plan – and really no ability, at this point – to mandate, create, and verify a nationwide passport confirming anyone’s vaccination status. Though privacy issues are cited as the main reason, the more practical reason is that the United States (unlike other countries) does not have a national healthcare system that is responsible for registering people for and administering COVID-19 vaccinations. In other words, the federal government doesn’t know who has been vaccinated. 

A vaccine passport is really nothing more than proof of COVID-19 vaccination. Many businesses, organizations, and even countries are starting to require proof of vaccination as a form of pay to play. Honestly, that is nothing new.

In 1986, I journeyed to rural Thailand to work in a Baptist mission hospital for two months. I was required to get a yellow fever vaccination and carry proof of vaccination with me – a yellow fever vaccine passport, if you will – in order to travel. In 2021, for those ready to visit European Union countries, tourists from “safe” countries will be allowed in – as long as they can show proof of vaccination against COVID-19. Greece is open. France, Spain, Germany, Italy, and Croatia, among other countries, are opening up again soon or have already opened up. Proof of vaccination is the surefire ticket, though entry with a recent negative COVID-19 test or proof of recovery from COVID-19 in the past six months may be possible in some circumstances.

Educational institutions are looking closely at vaccination requirements as well. My alma mater, Rice University in Houston, Texas, recently announced that all members of the Rice community are expected to return in person for the fall semester and all students who come to campus are expected to be fully vaccinated before school starts. The list of colleges and universities following suit grows daily. This really shouldn’t surprise anyone. Colleges have required vaccination against infectious diseases like meningitis, measles, mumps, and rubella for years. Why not against COVID-19 in the middle of a pandemic? The Supreme Court affirmed compulsory vaccination laws way back in 1905 and specifically affirmed proof of vaccination laws for public schoolchildren in 1922, both cases dealing with smallpox. 

Texas Governor Greg Abbott (R) issued a politically motivated executive order on April 6, 2021, “prohibiting state agencies or political subdivisions in Texas from creating a `vaccine passport’ requirement, or otherwise conditioning receipt of services on an individual’s COVID-19 vaccination status.” The order also prohibits organizations that receive public funds from requiring proof of vaccination “in order to receive any service or enter any place”. Abbott’s executive order trying to prohibit vaccine passports is only effective as long as vaccines are administered under an emergency use authorization, and it excludes nursing homes, state supported living centers, assisted living facilities and long term care facilities. 

The question of whether colleges, businesses – anyone – can require COVID-19 vaccination when the vaccines are under emergency use authorization (EUA) status is quickly becoming irrelevant. First, Pfizer is applying for full FDA approval of the Pfizer-BioNTech COVID-19 vaccine. Moderna plans to do the same. Both vaccines are highly effective and safe. Second, the Equal Employment Opportunity Commission (EEOC), announced on May 29, 2021, that U.S. companies can mandate that employees in a workplace must be vaccinated against COVID-19. The Houston Methodist Hospital System, one of the most respected healthcare systems in the world, has mandated their employees get vaccinated or face termination. Ninety-nine percent of their 26,000 employees have been vaccinated, but 117 staff are suing. Based on the aforementioned legal precedent and the EEOC pronouncement, the suit should get thrown out.

Short of mandates, employers can choose to offer incentives to employees to get vaccinated. Dollar General, for example, offers employees an extra four hours of pay if they get vaccinated. Incentives extend to the general public as well. By now, most have heard of the Krispy Kreme reward, where those who can show proof of vaccination can get one free glazed donut a day. My waistline is glad there is no Krispy Kreme store near me. Vaccination incentives, from donuts to lottery tickets to permission to attend in-person, live events, or even raising health insurance premiums for those not vaccinated, are mentioned favorably in respected medical publications like the New England Journal of Medicine. People magazine even came out with an article on how to get promotions, prizes and freebies with a COVID-19 vaccine card. 

Ultimately, the goal is to encourage those who may be sitting on the fence to go ahead and get vaccinated. Some diehards may bristle at the thought of vaccine passports and being required to get vaccinated – “Don’t Tread on Me” and all that. They would do well to remember that rights have limitations and choices have consequences. Those opposing vaccination must ask themselves if it is really worth not being able to fully participate in an open economy, much less risk losing their job, just to forego a highly safe and effective jab. Between mandates and incentives, not to mention basic moral and civic duty, refusing COVID-19 vaccination is an increasingly senseless and expensive hill to die on. As for me, I’ve got my passports – the official one and the COVID-19 card – and am ready to travel again!