A Shot in the Arm
Date Published: March 2, 2021
Yvette Calderon, MD, MS, understands why vaccine hesitancy remains stubbornly high in communities of color. Growing up in New York City public housing, she heard stories of forced sterilization in Puerto Rico and saw the medical system put other families first. Now Dr. Calderon finds herself on the flip side of the coin, trying to persuade reluctant colleagues and community members to take the COVID-19 vaccines. With the United States passing 500,000 pandemic deaths, including her father, Dr. Calderon argues that the vaccines are key to our resilience and shares advice for confronting hesitancy with compassion, enthusiasm, and science. Dr. Calderon is Chair of Emergency Medicine at Mount Sinai Beth Israel.
Also in this episode: Justine Sarkodie, 17, talks about how COVID-19 transformed her West Bronx community and what she's learned about neighbors' attitudes toward the vaccines. Ms. Sarkodie is a senior at the High School for Health Professions and Human Services.
Justine Sarkodie: 00:00
My neighborhood is really diverse. There's a lot of Hispanic, Latino, and African-Americans over here. It's really loud. A lot of people hang out outside. They play dominoes. Music is always playing. And then all of a sudden it's just silent and nobody's outside and everybody's home. I never knew how much I appreciated that, or enjoy people just being around. And it just completely shifted as COVID came in.
Justine Sarkodie is 17 years old. She lives in the West Bronx, which like many communities of color has been hit especially hard by the pandemic. And now in another cruel reminder of health disparities, it lags behind many wealthier, whiter neighborhoods in terms of vaccinations. Recently, Justine and some classmates set out to explore why. They're focusing on one factor in particular—vaccine hesitancy. Because while enthusiasm for the vaccines is up across racial groups, surveys show Black and Latino adults are still among the most hesitant to take them. Working with mentors from Mount Sinai, the students put together an online survey asking neighbors how they feel about the vaccines. What did you expect to find when you started out?
Justine Sarkodie: 01:09
I expected a lot of people to have a concern that the COVID-19 vaccine was developed way too quickly. I also expected some misconceptions coming from social media. I know there was a huge one about the COVID-19 vaccine having a microchip. And I was just like, social media is pretty influential. So I'm guessing that a lot of people would believe that, especially because I'm a teenager and I'm in high school and that's where most of my network is, like high school students. I was just like, hmm, we have pretty impressionable minds. So I feel like people would think that as well.
What goes through your mind when you hear something like that?
Justine Sarkodie: 01:49
I'm surprised. Some of them are really like–I related to them, but some of them were very bizarre. I feel like that's the word for it, because I wonder why they think that the government would want to track us or put microchips. It just showed me that a lot of people have mistrust in our government. I understood that in some aspects, but I never really knew how much people had mistrust about the government.
And you found that in the survey results as well, I assume?
Justine Sarkodie: 02:17
Yeah, I did.
Are there people in your life who are still hesitant?
Justine Sarkodie: 02:22
Yeah, there are. A couple of my friends and then also a little bit of my family members.
How do you deal with that? Do you try to convince them? And if so, how do you bring them around?
Justine Sarkodie: 02:33
So first I let them know that their feelings and thoughts are valid, because I feel like if you immediately say, "Oh, that's wrong," the person won't want to have a conversation with you. Because if you're not understanding them, how do you expect them to understand you? So first up, making sure that their feelings are valid. And then the second step, along with the articles, I do it with them. Like, I'm saying, "Oh, I'm learning with you. So let's learn together. Let's go on this website and let's watch these together and get an idea and talk about it." I feel like if you're learning with them and you're showing them that, "I'm willing to understand your side, if you're willing to understand mine." I feel like that helps the conversation.
Do you have anybody that you've convinced?
Justine Sarkodie: 03:15
Yeah, I do. One of my close friends. Because like he was expressing all these different concerns, and I'm like, "Okay, I have an article for that. I have an article for this." So I felt really confident about that. Because I'm just like, okay, great. Because I feel like the worst part is when people have concerns and then you don't know what to say. You're just like, "I don't really know how to address your concern. I don't have an answer for you." But luckily the concerns that she had were some that were really common. So I was able to find articles on those and send them to her.
If I had to put you on the spot and be like–there are people listening to this, what's your pitch to them if they're a little bit hesitant about the vaccine? Do you have a 30-second pitch?
Justine Sarkodie: 03:52
I can think of one. Okay. So I feel like we've all been saying, "When things go back to normal, we want things to go back to normal." And at first that just sounded like a saying, like, we're just saying it. But I feel like with this vaccine, that can turn into a reality. Things can actually go back to normal. If everybody just takes a leap of faith and just takes the vaccine. Things can finally go back to normal. That imagination can turn into a reality.
What are you most looking forward to doing once things go back to normal?
Justine Sarkodie: 04:23
Hanging out with my friends, hanging out with groups again. And I'm also going to college. So I want the college experience, getting to meet different people. I'm really, really excited about that. So yeah, fingers crossed that happens soon.
That was Justine Sarkodie. She's a senior at the High School for Health Professions and Human Services. From the Mount Sinai Health System, this is Road to Resilience. I'm Jon Earle. Today on the podcast, vaccine hesitancy. Why, on a podcast about resilience? Well, resilience is about bouncing back from adversity. And if we're going to bounce back from COVID-19, we need to use what my next guest calls the best tool in our toolkit. Dr. Yvette Calderon: understands the science as well as anybody. She leads the Emergency Department at Mount Sinai Beth Israel. But she also understands hesitancy at its roots and she has advice for how to meet it with compassion, enthusiasm, and science. Dr. Calderon, welcome to Road to Resilience.
Dr. Yvette Calderon: 05:23
Thanks for having me.
Tell me about where you grew up.
Dr. Yvette Calderon: 05:26
So I grew up in New York, in Manhattan. I started out in the Chelsea projects way back when, and then in my teenage years, my family moved up to Hell's Kitchen. So I've been a Manhattan girl for a long time.
And how would you describe the community in which you grew up?
Dr. Yvette Calderon: 05:45
A very poor community. My mother and father came from Puerto Rico. They were born and raised there. And my father came from an area in Puerto Rico called Fajardo, and my mom came from Santurce. You know, pretty humble background.
How did growing up in that community sensitize you to some of the issues faced by underserved communities when it comes to health care?
Dr. Yvette Calderon: 06:12
Such a great question. I mean, whenever I interacted with the health care system with my parents, I would see how we were treated differently.
What did you notice?
Dr. Yvette Calderon: 06:22
I noticed that we were basically kept waiting for a very long time. I remember this distinctly because my father had horrible back pain. He worked in a factory and part of his job, it was textile, it was carrying heavy, heavy stuff. And I remember this one time my mom and I took him to the emergency department, and we waited, and I saw him in pain for such a long time and couldn't understand, until finally my mom had to say something because my father was actually crying in pain. And I thought to myself, "That's not how this works, right?" When I see it on television, people run over to you and help you. And so that was one of the first times that I really understood that perhaps the care that we were receiving was slightly different from the others that were in the emergency department at that point in time.
I read something that you said in an interview that I really loved. You said that one of the reasons you went into emergency medicine is because it's the front door to the community. Can you expand on that thought a little bit?
Dr. Yvette Calderon: 07:27
Emergency medicine is like no other place in medicine. We are really the first part of health care that you will see when you need health care the most. And so to me, that's the most important place to be right now. And when I was in medical school, I loved a lot of parts of medicine, but knowing that I could be there at the moment where a patient is most vulnerable, to me, that's an honor, an honor to be there for that patient and to help them. And so yeah, we are the closest to the community.
Do I have it correct that you've done work related to HIV/AIDS, is that right?
Dr. Yvette Calderon: 08:07
Yeah, a ton.
Yeah. Since we're going to be talking about disparities in health, I think HIV/AIDS showed those disparities very clearly. These are not new. And I was wondering if working on HIV/AIDS helped to sharpen your understanding of who gets what in the health care system and who gets left out?
Dr. Yvette Calderon: 08:26
Oh, absolutely. I mean, I must've been within my first 10 years of being an attending and I decided actually to go back to get my master's in clinical research because I wanted to be able to build programs and interventions that could help the patient population we were taking care of in the Bronx at that time, help them identify HIV faster. So I went back to school and I had a fabulous partner who ran the HIV clinic over at Jacobi [Medical Center]. And we just started to build programs and show the success of the programs, bring in those patients much earlier, keep them healthy, keep them safe. And so I firmly believe that you need to speak to the community. You need to ask them what are their needs and not presume to know their needs.
How have those lessons played out during COVID? How have they affected the way that you're working during this time?
Dr. Yvette Calderon: 09:28
Yeah, that's a great question. I think more than anything what struck me during COVID was how fast patients would really decompensate within the emergency department. And at the time we had a policy of patients would have to come in without their loved ones. So you didn't have a visitor. And that was done to protect the patient, the staff, as well as the family members. But that was probably the hardest decision. And when I recognized that my parents both had COVID and that I couldn't get to my father and I couldn't care for him, then it became so personal. You can sometimes see things and it really has an impact on you, but when you have to actually go through that journey–that journey is incredibly painful. And that is why I want everyone to get vaccinated. No one should have to go through that, really. And if you don't have to then just get vaccinated. Do the right thing. Make sure that you can be with your family.
As we know that message has been resonating to varying degrees. How have you seen that message be received in different ways?
Dr. Yvette Calderon: 10:48
You know, when I see some of the staff say, "No, I'm going to wait." I try very hard to go and find them every day, every other day and just go, "Hey, any good news yet? Have you taken the vaccine yet? I'm here to answer your questions." And I think the first thing I have to say is, I get it. I get the mistrust. Totally. I mean, I grew up hearing about my great aunt in Puerto Rico during a time where they were sterilizing women and not telling them. And if you look at history that happened in Mississippi, it's not just Tuskegee. And so people have to understand that that hesitation is because medicine has not always been the best place to go to. And so I start from there, I get it. I start from that point of view and then I make my arguments as to why it's different now. And what makes it different.
What makes it different?
Dr. Yvette Calderon: 11:51
The science. It's understanding the science. It's the transparency of the science. I don't think that we do such a great job sometimes conveying that. We think we're doing a great job, but we don't. And I think it's important to be able to dissect things apart, like when I hear from family, friends, "Well, the vaccine rolled out so quickly. I mean, is it safe? I don't think it's safe. It can't be safe, right? How could it be safe? It takes two years to create a vaccine." And then you have to go back and go, "Wait, first of all, it is safe. And, yes, it came out quickly and you should be going "hooray!" because that means we have made such strides. We have come so far to be able to create a vaccine that works, and that works in an extraordinary way. And then you have to understand that this is not a new technology. MRNA is not a new technology. It's been studied for decades. So it's not new. It's been used with Ebola. It's been used with Zika. People have studied this technology. And if you look at the trials and you read the articles, and this is what I say to my nurses, and, honestly, I did. And that's why I felt very comfortable. You know I keep up on the science because it's emerging. And that's the part that is so hard for people. If I come and tell you today one thing, and then tomorrow it changes, it's hard to believe that the science–is this really the science? But when you're in medicine you know that that's how it goes. And COVID was like, one minute we were doing this, and the next minute we were doing that. It was rolling so quickly. And every day we got new information. And so we had to tweak our policies and how we were doing things and even how we were taking care of patients. But that evolved, and that evolved quickly. So for me, I tell people, this is like that moment where you should be extremely proud of medicine and science and where we've gotten to.
What was it like for you–I'm assuming you've been vaccinated–what was it like for you to get that shot?
Dr. Yvette Calderon: 14:00
I can tell you this. And I laugh at it now. The first list came out of the department. They randomized the list. And when I was told that I was on the list, I ran, I didn't walk. I ran upstairs. I'm like, "I want to put my name–I'm on that list, and I want my vaccine." And they all started laughing because I was the first one there that went up. Everyone was taking their time, and I was just like, "No, I want my vaccine!" So maybe I'm a little crazy—.
Why were you the first one up there?
Dr. Yvette Calderon: 14:37
Well, it was clear. I saw my father–I didn't see him pass away, but he left abruptly. And I have a daughter and I have a dog. So you know what, they need me. And there's just no way I want this disease. There's just no way. I have a brother, a sister-in-law, a niece. I mean, my family, my friends, they mean the world to me. I have a lot of life to go. I needed to get this vaccine. But the real truth is–when you see so much death, and you understand the science and you understand the medicine, it was so easy for me to say, "I'll be the first one taking that shot." I did not have any hesitance about it.
I heard you say in an interview in September–so before the vaccines–that you hoped that the communities that had been hardest hit would be the first vaccinated. How would you rate our performance as a society on that metric?
Dr. Yvette Calderon: 15:40
It's complicated because that's the same community that has the hesitancy of vaccination. And so that's why it's so important to go and talk to the community, get them ready for when they are eligible to get the vaccine, they go and they get it. I think that's the part we left out. We just assumed everyone was going to get the vaccine when they became eligible, they were all going to go and get the vaccine. And I think the hesitancy piece was something that a lot of the physicians and certainly the scientists did not expect, and the public health world did not expect. And that's why now I continually go out there and whenever someone asks me to go and do a talk or answer questions, it's more than my pleasure, I feel it's kind of like my duty to go out there and do that.
Do you have a 30-second pitch?
Dr. Yvette Calderon: 16:37
Well, no, I go, "Okay. So tell me, what's the question? You have to have questions and I can answer them for you." And then when they shrug their shoulders, I go, "Look, I took it! I don't have two heads. No, seriously. I mean it went as I expected, and I am extremely happy that I took my vaccine and that I'm protected. And recently my niece called me, she's pregnant, and we were having this conversation because she was hearing the hesitancy and social media and a lot of people saying negative things. And we had a great conversation, and then I led her to–there's a great talk by one of the physician scientists that actually reviewed all of the data for the Pfizer vaccine. And I sent that to her so she could hear it. And they talked about being pregnant and having the vaccine and the science behind it. And what was really clear to her was, "If I don't take this vaccine and I get COVID, now that I'm in my second trimester, so to be in the third trimester, if I get COVID, my baby's going to suffer." And that's all she needed to hear. And that made the difference. But you have to hear the science, you have to hear how others have gone through things that you don't want to go through. And I also say this, "Listen, I have never seen a trial, an actual research study, looking at these vaccines so quickly enrolled. I mean, these people enrolled–40,000 for Pfizer, 30,000 plus for Moderna. That just doesn't happen. So, you know what I know? People were putting their lives out there and going, "I want to be a part of the solution." And for me not to be a part of the solution I feel is–that can't be. We all should be part of the solution.
Since this is Road to Resilience, we're talking about resilience. And I think we've been referring to it in many different ways throughout this conversation. And I'm wondering if you could just connect the idea of resilience–bouncing back as individuals, as a community–to vaccination.
Dr. Yvette Calderon: 18:52
Yeah. If you asked me what one word really exemplified last year, 2020, throughout the whole pandemic, it was "resilience." And saw it in my staff. I saw it in my family. I saw it in myself. And so that resilience can carry you through. And it's based on your faith for some people, your community or your family for others. Whatever that is you have to put it together to go forward. And because we're seeing so much positive stuff right now, I think that just reinforces the fact that this strength that has gotten us through will get us through to the end. That's how I look at it.
And vaccination is a part of that?
Dr. Yvette Calderon: 19:40
Well, vaccination is the part, the biggest part of the toolkit. I mean when we talk about how do you keep yourself safe? The first thing on the list is when you're eligible and you can get a vaccine, get the vaccine. Do what Dr. Calderon did–run upstairs, sign up for it, and just get it, alright? I promise you you will feel better about it.
Fantastic. I think that's a great note to end on. Dr. Calderon, thank you so much for coming on the podcast.
Dr. Yvette Calderon: 20:05
Thanks for having me.
It's been a pleasure talking with you. Thank you, Justine and Dr. Calderon, for coming on the podcast. And a big thank you, also, to Dr. Ugo Ezenkwele, Dinah Jacobson, Dr. Bruce Levinson, and Donna LoPiccolo for their help with this episode. We want to know what you think about the podcast and what topics you'd like us to cover. If you've got five minutes, please take our listener survey at www.mountsinai.org/rtrsurvey. There's also a link in the show notes, which is probably easier to use, but again, that URL is www.mountsinai.org/rtrsurvey. Thank you. Road to Resilience is a production of the Mount Sinai Health System in New York City. It's produced by Nicci Cheatham, me, Jon Earle, and Lucia Lee. From all of us here, thanks for listening. We'll see you next time.