1/ As an epidemiologist, I’m immensely grateful for anyone systematically documenting those refusing #COVID19 vaccination in health care and #LTC...and asking & recording their reasons why... https://twitter.com/latimes/status/1344648353397702657

2/ Vaccine hesitancy is a major barrier to US achieving enough immunization to avoid rolling waves of #COVID19 outbreaks for years. It is *so* important to take it seriously and craft effective responses & strategies (feds should have started months ago, but that’s past)...

3/ It’s critical to watch this closely in this first round of vaccinations in #LTC longterm care/nursing homes and healthcare bc we have the benefit of a denominator in these settings...

4/ the only reason anyone can put a number on the vaccine refusals (20-30%, etc) is because these are defined populations. There’s a roster of employees you know you’re targeting. This is a “denominator” in #epitwitter speak. It’s a core principle in epidemiology.

5/ it’s crucially important to take advantage of the data in this stage bc, the way US is doing vaccine rollout, there are *not* clear denominators in the next stages...

6/ when vaccination moves out to general public, there’s no roster, no master list, there’s no clear denominator (we can pull from census, housing, public health risk assessments, etc to approximate local denominators but that takes local staff time - in short supply rn)...

7/ (Other countries have denominators and are proactively contacting and tracking people bc they have national universal health care and social safety net systems to build from. Also also they probably spent 2020 planning for & funding their #COVID19 vaccination rollouts)

8/ In the next stage (we see a preview in states like FL), we’ll see the disastrous shortages of vaccine & vaccination infrastructure, but we won’t see who is missing. Without knowing who we are missing, the US will walk into yet another totally predictable #COVID19 disaster...

9/ We will get to June or July and see vaccination rates dropping off. But we will have all this extra supply and wonder why. We will be scratching our heads wondering what happened. We were so focused on getting it out faster, we didn’t think about who we were missing...

10/ and then we will realize the implications of having so much of the population non-vaccinated & we will get panicked and then more panicked when we realize that the non-vaccinated folks are not randomly distributed throughout the country...

11/ that they are in socially networked pockets throughout the country...so much so that we remain at risk of frequent outbreaks, also these folks are the people who work in the service industry, in schools, in health care, in your stores, on your airplanes...

12/ then another scramble to address a foreseeable problem that public health folks (especially equity-trained folks) had been warning about for months and months and months. The US’s repeated failures to consider longterm consequences are exhausting.

13/ I don’t like the admonishing tone that some leaders & news accounts take towards health care and #LTC workers refusing vaccine in this round

They are the canary in the coal mine

You don’t get mad at the canary

You’re grateful for its lesson, and you heed its warning