Transcription:
Shots, Jabs, or Immunizations: Words Matter

Dr. John Lantos (Host):    Hi everybody. This is John Lantos. Welcome back to the Peds Ethics Podcast coming to you from Children's Mercy Hospital and Children's Mercy Bioethics Center in Kansas City, Missouri. We are thrilled today to have with us, Dr. Brian Carter. He is the Chair of the Department of Medical Humanities, and Bioethics at the University of Missouri, Kansas City School of Medicine, as well as holding the Marjorie and William Sirridge Endowed Professorship at UMKC. He's a nationally recognized Neonatologist and Editor of the Handbook of Perinatal and the Neonatal Palliative Care. He's also the Editor in Chief of the Journal Clinical Pediatrics. And earlier this year wrote an editorial about a very interesting issue related to COVID vaccines. Welcome to the podcast, Brian.

Brian Carter, MD (Guest): Good morning, John. Thanks for having me.

Host: You were thinking about COVID vaccines and had some concerns about the language they use. Could you tell us a little bit about those concerns?

Dr. Carter: Sure. It happened to be a convergence of a number of experiences and things that I heard over mainstream media, and saw in the press, that being; experts, infectious disease experts and epidemiologists and others advocating for improved and anxious for more vaccines to become available using the term shot. Sometimes people would say, we need to get vaccines in arms and others would say, yeah, we need to give more shots. Everybody should come get a shot. And given the social unrest, the milieu of social injustice and racism, that has been prevalent in the past year; it just struck me that we use a term shot to describe the administration of a vaccine or to provide an immunization. And to be honest, as I understand it, infectious disease specialists are trying to determine which is the better nomenclature, vaccine or immunization and I'll leave that to them. But I thought it was peculiar to hear this from experts on mainstream media, in the same news program in which people were describing police shooting into crowds. Or another child was the victim of a random violence gunshot. Being a pediatrician, I was sensitive to these things and perhaps my involvement in ethics made my ears perk up as well.

Host: So, one of the things you say in your editorial is that pediatricians are uniquely attuned to issues related to gun violence. Is that something that you've talked to your colleagues about or that's come up in your own practice?

Dr. Carter: Well, as you know, John, my practice has been principally in neonatology and follow up of NICU graduates. I don't in everyday practice have conversations with general pediatricians, who I see as to be on the forefront taking care of people. But I have colleagues as do you, friends indeed, that work in the pediatric ICU, who in fact, take care of children who are victims of gun violence. And as pediatricians, the notion of vaccination and immunization, is part and parcel of everyday practice, health promotion and disease prevention.

It's a big piece of general pediatrics in the first few years that children accomplish primary vaccination against so many illnesses, some of them, which can be life-threatening and then superimpose on that the COVID-19 experience and awaiting a new vaccination. So, I think pediatricians are just perhaps more attuned than their adult primary care colleagues, but I don't want to misspeak. I, don't have data to that effect.

Host: And what language do you think would be better than calling the administration of vaccine a shot?

Dr. Carter: Well, again, I think frankly, we can use the term vaccination or immunization, but those are multi-syllabic large, somewhat medical terms that perhaps the everyday citizen doesn't want to have to contend with. Our colleagues across the pond in the UK use jab. In fact, I have a sister-in-law who's from Wales, and she readily told me just recently that she got her first jab of the vaccines and I, thought, well, there you have it. It's common nomenclature in the UK and throughout Europe. The term shot is not characteristically used and I have a hard time finding the origin of where immunizations became shots. In fact, if you look up the origin of the word shot, in any dictionary, it pertains to gunfire, an explosive device propelled from a gun.

Host: So, you note that the Centers for Disease Control and Prevention use vaccine and shot interchangeably, are you suggesting that they should change that on their public information, websites and literature?

Dr. Carter: I certainly do. I think we should dispense of the term shot in the nomenclature of medicine. Medicine, as you know, is oriented towards healing, towards prevention, as I mentioned earlier, but certainly not towards anything that could be misconstrued with violence and the language of shot does in fact, get misconstrued. I've encountered some international colleagues who've come to America and were perplexed when they were asked to provide their shot record.

And they looked inquisitively and said, what? I've never been shot. And then the health officer would say, Oh, well, I mean your immunization or vaccine records. Oh, here it is. No problem. So, that confusing entity exists. And then if shots come from guns, it's intriguing that we have thermometers that look like guns.

Host: Yeah. Tell us about your concern there.

Dr. Carter: Well, children have no reason to fear receipt of an immunization or vaccine, but I actually witnessed at our hospital, a father who was holding his two or three-year-old son. The father having already had his temperature taken before entering the hospital and answering the requisite questions about exposure to COVID, symptoms of COVID, et cetera. And the two or three year old was wrestling away from his father trying to wiggle out of his arms and saying, no, no, no, I don't want to get shot. And I thought, oh my goodness, this is a child who recognizes that thermometer that looks like a handgun and is just freely expressing his resistance. And I thought, what confusion. I'm certain this isn't the only child who might view that thermometer in such a manner. And yet they've been widely sold, dispensed. Gratefully, there are alternatives. There are now thermometers that you can approach with your face and it will take your temperature. There are thermometers that you can hold your wrist up against, and it will take your temperature. So, there are alternatives.

I suppose, they may be more expensive. I really don't know the details. But that confusion, I think, also factored into my writing this editorial.

Host: So, let me ask you to do just step back from these specific issues about language and think about your role as Chair of a Department of Medical Humanities, and Bioethics. And talk a little bit about how you see the whole national effort to get the population immunized against COVID-19 going. Do you think we're doing a good job? What are your concerns? And when do you think we'll get to herd immunity?

Dr. Carter: Oh, great questions, John. They're on the forefront of a lot of minds in academia and in medical practice. The progress is good. It's not great, but nonetheless, this is as has been described, quite an experiment. We have never, in the history of mankind had to develop a vaccine to immunize the whole world. And here in America where there's over 300 million people, a good 60 to 70 million of those being children, we have a ways to go still before we have acceptance of vaccination as necessary and the provision of the vaccine being viewed as safe. At the same time we have ramping up that continues.

That is the production and distribution of vaccines. It seems to be coming in lumps. Periodically there'll be a few thousand vaccines delivered to a hospital or made available through our health department. And we know this and we see the convening of lots of resources to be able to vaccinate people in efficient manners, the use of athletic stadiums, other things. So I mean, people don't even have to get out of the car. They can roll up their sleeve and have their vaccine and be on their way. But, I think it's a slow process partially by nature and partially by frustration of logistics. And I certainly won't wax political, but through the course of the disease, the pandemic over this past year, there have been some political statements or processes that perhaps delayed the availability of the vaccine.

Nonetheless, to be able to have a vaccine available within a year is record setting. And so the Project Warp Speed, I think was truly remarkable from a scientific perspective. Are we doing well and communicating, I think is the big question. And so communicating this to healthcare professionals, not so much an issue, although there's still a little bit of reticence on the part of healthcare professionals, anywhere from 15 to 25%, in different surveys saying that they're going to wait or they're not going to get it. And herd immunity, as you know, is something that generally speaking requires a 70% or more of the population to be vaccinated or to have experienced the disease. That's true with many diseases, but with measles it's quite different. And measles is one of the most highly contagious viruses known. And it requires 90 to 95% immunity.

Host: Let' hope we don't need to get there with COVID, but we're on our way to 70.

Dr. Carter: Yeah. I think we are based on estimates of numbers that have been infected and real counts of numbers that have been vaccinated.

Host: Well, thank you so much for your leadership as Editor of the Journal, as being carefully attuned to the language we use and some of the problems that might arise, if we invoke violent imagery for either taking temperatures or giving people their COVID vaccines. We've been talking with Dr. Brian Carter, who's Chair of the Department of Medical Humanities and Bioethics, as well as holding the Marjorie and William Sirridge Endowed Professorship at the University of Missouri, Kansas City School of Medicine. He's also the Editor in Chief of the Journal Clinical Pediatrics, and his editorial about changing the language around COVID immunization appeared earlier this year in 2021 in that Journal Clinical Pediatrics. Thanks so much for talking with us this morning, Brian.

Dr. Carter: Thanks for having me John.

Host: And I'm John Lantos. We are the Pediatric Ethics Podcast from the Children's Mercy Bioethics Center in Kansas City.