Vaccine Hesitancy and Mission Alignment in the Emergency Services

An Airman assigned to the 911th Airlift Wing receives the COVID-19 vaccine at the Pittsburgh International Airport Air Reserve Station, Pennsylvania, Jan. 28, 2021.
An Airman assigned to the 911th Airlift Wing receives the COVID-19 vaccine at the Pittsburgh International Airport Air Reserve Station, Pennsylvania, Jan. 28, 2021. (U.S. Air Force photo by Joshua J. Seybert)

With the introduction of the Johnson & Johnson product in early March on top of the Moderna and Pfizer mRNA vaccines in use, we are about to see widespread availability to this critical tool in beating back the pandemic that has upended life over the past 12 months. In many places across the country fire and EMS personnel (and even law enforcement in my home state of Georgia) have been included in Phase I distribution of the vaccine.

However, over the past few months there have been numerous articles discussing vaccine hesitancy among some of these emergency responders on the front line of the pandemic. To outside observers, this hesitancy seems counterintuitive. I believe that there is a logical explanation for this hesitancy, but also submit to my public safety coworkers who are not “early adopters” that there is another way to look at this issue that may make more sense to a mission-oriented firefighter or medic than getting vaccinated to protect yourself.  

More from the Author

In a February 28, 2021 article in the Atlantic,1 Derek Thompson points out that vaccine hesitancy is more varied than the caricatures often presented in the social and traditional media. He breaks hesitancy out into four categories: dissent, deliberation, distrust and indifference. Those in the dissent camp are generally concerned about taking vaccines in general, irrespective of the disease it is meant to treat. The deliberation crowd are people who want to wait and see how the vaccine impacts others (e.g. side effects, long-term efficacy) before they take the plunge. Distrust is generally found among those who are skeptical of medical advice coming from the government because of past cultural or community experience with less-than-above-board federal programs such as the Tuskegee experiment. Finally, the indifferent cohort are simply “not concerned at all about COVID-19 in their area.” 

Clearly, these are not hard and fast distinctions, and some may overlap. Additionally, plenty of conspiracy theories and knee jerk political suppositions intertwine themselves throughout the vaccine skeptical portions of the country. From a public health perspective, boiling the argument down to a purely political disagreement a or “science” versus “non-science” binary misses a much more complex issue out there that could have long-term implications for this pandemic.

Emergency services are a slice of the American pie, and we see the same level of hesitancy–if not more–among emergency medical service (EMS) and fire professionals. Articles about the small percentages of fire, EMS, or police departments willing to take the vaccine have become common not only in trade journals, but in the wider national media. It is clear to the American public that getting vaccinated is a rare community safety initiative in which emergency services personnel may not be leading the way.

Why?

Over the past year of this pandemic we may have seen a similar approach to masks. Indifference and skepticism. We are used to wearing personal protective equipment (PPE) on calls—it’s part of the job—but at the station (unless there is a management mandate) or on our off-time we usually don’t approach things the same way. PPE is a work thing, not a personal thing.

I would assert that many fire and EMS services have two things going against them as far as being early adopters of mask usage when not on calls and, now, in taking advantage of being first in line to get the vaccine. The first reason is demographics. The second is organizational culture. 

First for demographics. According to the Centers for Disease Control statistics through February 24, 2021, 20,196 men and women between the ages of 18 and 49 have died2 of COVID-19. In the same age cohort, 11,503,725 have tested positive3 during that time frame. That is a fatality rate of .17 % in this age range. Don’t forget that some studies have found that younger people without comorbidities are also likely to suffer severe illness. Logic dictates that people who aren’t sick (or at least, don’t think they are infected) don’t get tested….so this fatality rate is likely actually lower than .17% for people between 18 and 49. 

Now, think about the average demographic of firefighters, EMS workers, and police officers. Most are young and many are in relatively good physical shape due to hiring and ongoing fitness requirements for the jobs. As a consequence, compared to the rest of the adult population, public safety employees often fall within the 18 to 49 age range and are likely more physically fit than even the average person in that cohort nationally. Anecdotally, while we may read of in the officer down and LODD pages of our brothers and sisters who have died from COVID-19, we have also heard of people who died from rollover accidents in their ambulance or from a structural collapse on a fire. We still get in the apparatus and respond to residential structure fires. 

Statistically speaking, many more emergency service workers have likely experienced the benefits of their demographics of mild to asymptomatic COVID-19 illness than have experienced a close colleague who has died or had their life changed forever by the illness. Sure, we know it happens, but for many (thankfully) it remains something that happens somewhere else.    

For 13 months, many on the front lines of this pandemic may have seen coworkers either 1) not experiencing significant illness or 2) testing positive but being asymptomatic and coming back to work after a 10-day isolation period. This experience may lead some emergency responders to a higher expectation of having mild to no impact should they personally contract COVID-19. This experience may lead to a certain amount of indifference to getting vaccinated.

The second area likely impacting the reticence of some fire and EMS personnel to get a vaccine is organizational culture. There is a mindset in the emergency services—understandably—that we are society’s protectors. Firefighters run into burning buildings to pull the innocent victims out. Paramedics and EMTs practice medicine in a car, upside down in a ditch, in the rain. Police are the sheepdogs protecting the sheep from wolves. Risk-averse people do not usually apply to work in the kind of environments emergency responders find themselves in (and if they do, they often find their way out after their first real confrontation with danger). 

This protector mentality of “risking ours to save yours” (I’ve seen that on a bumper sticker) is reinforced not only though the common experience of being in stressful, dangerous situations together, shift after shift. It is reinforced by out dinner table conversation. It is reinforced by the things we give awards for at our department galas (heroism, lifesaving and even the Purple Heart). 

EMS and firefighters are, by definition, willing to risk personal safety for others. Taking chances (even calculated risks) is a regular occurrence. This mindset is reinforced not only by individual experience, but by the group (shift, department, station) on a regular basis. COVID-19 is just one more risk that we may encounter “out there” in the community. Just like a breathing apparatus for a fire, departments even provide us with N95 masks, gowns, gloves and other protective equipment to protect us. As a consequence, confronting disease and danger are an inherent part of the job that every tenured emergency services professional has accepted. When it comes to COVID-19, it is just one more danger to face at work, like tuberculosis or blood borne pathogens or a burning house. We learn how to mitigate the risk on calls but otherwise move ahead with our daily routines. 

Intuitively, demographics and culture go a long way to explaining a certain amount of indifference to the vaccine. Fire and EMS services are primed for it. (This doesn’t discount that there is some political distrust, wait-and-see deliberation, and even some anti-vax dissent within the fire and EMS professions.) None of this is to say this is the appropriate mindset, but just an attempt to analyze the apparent hesitancy among people on the front lines of the pandemic fight. 

There is another way for vaccine skeptics in the emergency services to look at this, though. COVID-19 is not like the dangers we face on a regular basis. It is not about how badly we or our coworkers could get sick. Rather than looking at it as PPE to keep us safe, getting the vaccine is more like the water in our handlines or the epinephrine in a syringe. It is a way that we can protect the vulnerable people we come in contact with (including in our personal lives). I submit that those who find themselves in the “indifferent” camp should look at taking the vaccine as an opportunity to contribute to the mission. The fewer of us who are vulnerable to coughing and sneezing and thereby unintentionally spreading the SARS-CoV-2 virus, the safer the vulnerable patients we come in contact with will be. As more research is conducted, if it turns out that the vaccine makes it impossible to transmit the virus at all, then the benefit to the COVID-vulnerable people we come in contact with is that much greater.

References 

  1. Thompson, D. (2021, February 28). The Surprising Key to Combatting Vaccine Refusal. Retrieved from The Atlantic: https://www.theatlantic.com/ideas/archive/2021/02/vaccine-hesitancy-isnt-just-one-thing/618164/.
  2. CDC. (2021, March 3). Weekly Updates by Select Demographic and Geographic Characteristics. Retrieved from National Center for Health Statistics: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm.
  3. CDC. (2021, March 3). Demographic Trends of COVID-19 cases and deaths in the US reported to CDC. Retrieved from COVID Data Tracker: https://covid.cdc.gov/covid-data-tracker/#demographics.
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