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Robin Kish (Host): The push is on for all eligible Americans to get vaccinated against COVID-19. In Palm Beach County, Florida, like most of the nation, the availability of COVID-19 vaccines is high, but demand is low. Why are so many reluctant to get immunized at a time when COVID-19 variants are spreading? Palm Beach County's top health official separates fact from fiction, as we break down the fear factor behind vaccine hesitancy on this edition of Here For Your Health. Welcome to the Health Care District of Palm Beach County's podcast Here For Your Health. I'm your host, Robin Kish. Our guest today is Dr. Alina Alonso, Director of the Florida Department of Health for Palm Beach County. Dr. Alonzo, thanks for being here.

Alina Alonso, MD (Guest): My pleasure. Thank you for having me.

Host: Dr. Alonso, since the onset of the Coronavirus pandemic, you've stressed publicly the goal of achieving herd immunity and that the primary way to achieve this is through mass vaccination. What does herd immunity mean? And how close is the county to reaching that goal?

Dr. Alonso: Herd immunity is just the notion that if you vaccinate enough people to be protected, it then protects those who are not vaccinated. The virus needs to jump from person to person in order to spread. So, if enough people in a room are vaccinated, the virus can't spread. So, in Palm Beach County, right now, the number of people that have received two doses is about 39%. Nowhere near the mass vaccinations that we need to have the herd immunity. It is estimated that we need about 80% of the total population for that to occur.

Host: What are some of the obstacles to achieving herd immunity?

Dr. Alonso: There are several obstacles. And I think you mentioned part of it in your introduction. We have some people who simply are never going to get vaccinated. That's a fact. And then there are others who still have questions, doubts, fears, and a lot of misinformation out in especially the internet and those types of media that people are constantly reading.

Host: Let's back up a little bit. You've said from the onset of the pandemic, that there are three phases of vaccination here in Palm Beach County. Can you describe those phases and where we are now?

Dr. Alonso: Absolutely. The first phase is when something has occurred and we are in emergency mode, in other words, crisis mode. You declare the declaration that you have a pandemic worldwide. And so everything starts churning. So, in that first phase in Palm Beach County, what we were concentrating on was two tools that we have at the beginning of a pandemic. One is contact tracing to keep people isolated from those who are gotten the virus so that they don't spread it. And the second one is the mask. The mask has been used for centuries and centuries to stop people from spreading the virus. So, that's phase one. Also in phase one, you also start getting a little bit of the vaccine, and that's what we saw when the governor decided to go 65 and above to start vaccinating. And it's usually a targeted group. Now, the 65 and older caused a little bit of a problem for us because we have a very large population that's 65 and over. That's over 24% of our population. So, we had a very large group with a lot of demand and very little supply, so that causes people to get very nervous.

We had certain problems such as phone systems being overloaded. The commissioners were getting calls left and right, our offices were all getting calls. So, that's that crisis mode that you began at that point. A little bit later on, you get into phase two where you start having a little bit more vaccine available. You may increase the number of people that you're now vaccinating. So, you change your criteria, but there's still a lot of demand and a lot of nervousness, right? And then finally you get into phase three. This usually takes normally six months. And actually that's pretty much what we have seen in spite of this being a crazy pandemic and very unusual.

So the phase three is when you're out of that crisis mode, there's enough vaccine available. The general population starts getting tested and you see exactly what has occurred here, a decrease in demand for the vaccine, and then you have those hesitancy groups and those people that simply are never going to get vaccinated.

So, now you switch from emergency mode. We go back to our normal quote, unquote normal, working conditions, and you rely on the public sector, your pharmacies, your walk in box retail stores that will be giving the vaccine and away from the emergencies of like the state run sites, the federal sites and so forth.

So all of those things will start coming down and people will rely on their physicians to give them the vaccine and the Publix, the CVSs, the Walgreens, all the boxes.

Host: There's so much information and misinformation about the COVID-19 vaccines, it's hard to separate fact from fiction. Dr. Alonso, what are some of the facts you can share to some of those who may fear the vaccine could affect their fertility, for example, or think they may be getting a chip implant?

Dr. Alonso: Let's start with the easy one. There's no chips in the vaccine. Okay. I don't even like to talk about that cause we were kind of promulgating the misconception. So there's no chips in, ,in the vaccine. Secondly, the issue of infertility is completely false. All vaccines were tested on animals. Of course we do testing on animals, not on people. And they were all tested. There's no evidence of infertility in any of the vaccines that we have out, nor the ones that are being still waiting to get, ,approval. The, the, the third piece in terms of, which vaccine is better, which vaccine is worse. They're all pretty much the same. The, they, all the vaccines are safe. We have safeguards as we saw in the Johnson and Johnson. I think that's a good example to show how serious we are about making sure that these are safe for people. We are trying to get the truth out as much as possible. And what I recommend people is they go to trusted sites such as the cdc.gov.

And then just look up COVID under the CDC. If you just search COVID, in the internet, you're going to get all kinds of all different sites. You're going to get crazy information and you're just doing yourself a disservice, not to mention how much time you're going to spend looking for, for the right answers.

Host: Are there any myths that you'd like to dispel that you've heard?

Dr. Alonso: Probably, the one of that the vaccine was made rushed, under warp speed. There's no warp speed about this. That title should never been used for something that's medically being used. The vaccine, the whole issue of the messenger RNA is a revolutionary method for the vaccine, precisely because the viruses creates mutations. And so the idea of the messenger RNA would be that in spite of those mutations or variants, that we call them, the vaccine will still be effective. And indeed, we're showing that the vaccine is effective in spite of the changes that we're seeing in the mutations, in those variants. So, that's very important that people know that the vaccine will protect you against the variants also.

Host: Dr. Alonso, let's go back to something you just mentioned. In late April, the Centers for Disease Control and Prevention lifted it's temporary pause on the single dose Johnson and Johnson Janssen vaccine after reviewing an extremely rare risk of a condition that causes serious blood clots. What are your thoughts on the single dose J and J vaccine?

Dr. Alonso: The vaccine is safe, after the review, which I believe was a very good indication that we take this very seriously and that the CDC and those people that are in charge of looking at all the adverse effects are actually looking at it. And they paused in an abundance of caution so that they could take a look at all of it. They ended up with 15 cases that actually had formed these clots after the vaccine. So, what is now required that everybody that received, any woman that receives it under the age of 50, that they are warned that this risk exists, but the benefits outweigh the risks of even these clots. They're very rare, 15 out of 6.8 million doses of the vaccine. So you can see it's something very, very rare.

Host: So,d when someone asks, which of the vaccines is best, I've heard several physicians say the best answer is whichever you can get first. Do you agree with that response?

Dr. Alonso: I agree. And actually I practiced what I preach. So, I did get the Moderna vaccine because that was the first one that was available. And I would have gotten any one of them. Now for people that are afraid of needles, I recommend the Johnson and Johnson's cause it's just that one shot.

Host: Earlier, you said the COVID-19 vaccines will protect you against the variants. What are the variants that exist and how protective are the vaccines against them as things change?

Dr. Alonso: An answer to that question, the vaccine are protective against all the variants at this point. There are many variants and there's a lot more variants out there than the ones that we're measuring. In South Florida, we know that we have about six, over 600 variants that we have recorded in Palm Beach County.

Florida has one of the largest variants, we're over 10,000. So, there are a lot of variants and there will be more because this is natural for viruses to develop mutations. That's what a variant is and it's common. And that's one of the reasons that this new way of making the vaccine is so effective because they make your body do antibodies against the protein spike of the virus, as opposed to putting a virus in that, then you have to react to, so this is much more effective. That's why it's a revolutionary new way of doing vaccines that are going to be very helpful in the future.

Host: I've heard you mentioned in news interviews that these variants are different from the initial strain of Coronavirus.

Dr. Alonso: They are slight mutations. The virus does that. It's very smart and it wants to keep infecting people. So, it tries to change just a little bit to keep being able to jump from person to person.

Host: Are they as serious?

Dr. Alonso: Well, it, it could become a problem where the vaccine no longer is effective. That's what it's trying to do. And that's why we don't want to keep those variants from jumping from person to person. We want to do the vaccinations quickly. So, we don't have one of these variants become the predominant virus.

Host: How long do the COVID-19 vaccines last?

Dr. Alonso: Well, we don't know, because we've only studied them for six months. So, for right now, we know they're good for six months. I expect that they will last at least a year. H1N1 is in the flu vaccine that we get every year and we have to get that booster every year. But because of the new technology with the messenger RNA and this new technology that we're using, it could be that these vaccines last more than a year, that would be really wonderful. But we have to wait and see and continue to test the vaccine. Right now, we know they're good for at least six months.

Host: It seems like messaging often changes on what is and is not safe to do. How do you reassure those who are wary about trusting the vaccines as we're learning along the way?

Dr. Alonso: Well, we're learning, but nothing about the vaccines have changed. It's been consistent that we know that the vaccine protects against the virus and that the vaccines are doing what we want them to do. There's very little breakthrough. The vaccines are 95% effective and we have seen even less breakthrough. That means somebody who's fully vaccinated with at least two vaccines, wait, 14 days later, some people have gotten the virus. Some people have gotten the virus before they get the vaccine.

They think they got it after the vaccine. But, so far those messages all are consistent and they continue to be true. So, we will continue to study and learn more, not only as we test it here in the United States, but globally. Remember these vaccines are being given all over the world. There's a lot still to learn. But it's all very positive and it's doing exactly what we want it to do.

Host: Yes. There was a New England Journal of Medicine article that said it may be helpful in terms of messaging to say, what is known about the vaccine is more important than what isn't.

Dr. Alonso: That's a very good message.

Host: Dr. Alonso early on in the pandemic, it was thought that the young may not be as vulnerable to COVID-19 as seniors. Now we know COVID can indeed cause some long-term issues for young adults, teens, and children. Can you elaborate on that?

Dr. Alonso: Sure. The, the idea of being vulnerable has to do how many co-morbidities you have. So, what we saw was a very high mortality rate in the very beginning, we had over 5% of our over 65 dying. Well, most people over the age of 65 have comorbidities. In the young, you don't see as much comorbidity, so less people die, less people are hospitalized. And that is normal. However, what we are seeing are those longterm consequences. And so we're seeing everything from loss of taste to long-term migraines.

So, in other words, the youth will get the COVID and maybe go about, have a couple of days or a week that they don't feel good, kind of like the flu and they brush it off. But then they start having those consequences, including targeting organs, such as the kidneys and the heart and other organs. Also psychological problems. Anxiety is very high on the list, loss of taste. And like I mentioned, the migraine. So, those consequences are worse than the actual infection that they got from the COVID. So, this is not your regular flu at all.

Host: Currently anyone is young as the age of 12 can receive the Pfizer vaccine and for the Pfizer and Moderna vaccines, patients need to return for their second dose in order for it to be fully effective. What do you think of those who are reluctant or choose not to come back for their second shot?

Dr. Alonso: Yeah. For those who are concerned about getting the second shot, don't be afraid of the shot. You're cheating yourself out of protection that the vaccine offers, 95% is a very, very high efficacy for this vaccine. So, don't be afraid of the needle. And go ahead and get your second shot the way that you should.

Host: Dr. Alonso, what do you say to those who are on the fence about getting vaccinated?

Dr. Alonso: Hop off the fence. Come on. Usually it's questions that you may have or doubts that you may have. Again, go to a reliable source, such as a CDC. They've got tons of frequently asked questions that you can get answers from. You can call us, you can call your trusted clergy or, you know, whatever resources you need to answer those final questions. Come to some of the Zoom events that we're having to help in different community sections, where we're, we're getting together and talking on Zoom, whatever it is that you need to do to finally get over that question or that hesitancy that you have. We would be very happy to help you with that. It's so important that we all do this, not only for yourselves, but for your family and the community.

Host: Thank you, Dr. Alonso for your time and expertise on this topic. To learn more about the healthcare district's free walk up mobile COVID-19 vaccination clinics, visit www.HCDpvc.org, and click the blue COVID-19 information center button. If you find this podcast helpful, please share it on your social channel and check out our full podcast library for topics of interest to you at healthcaredistrictpodcast.org. Let us know what you think. Your review helps us reach more people just like you. Today's podcast is brought to you by the Health Care District of Palm Beach County. The Health Care District is a unique safety net healthcare system located in South Florida and provides county residents access to primary care, skilled nursing and hospital care, registered nurses in nearly all of the county's public schools and oversight of the county's trauma system, which includes operating two life-saving trauma Hawk air ambulances. Learn more by visiting HCDpbc.org.