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May 7, 2021

In this episode of The Campfire Jeremy talks with CGU epidemiologist Nicole Gatto about her ongoing research into the development and distribution of COVID-19 vaccines. Vaccines interact with our immune system in highly complex ways, as do vaccinated individuals with society at large. Discussion around viruses and vaccines has suddenly become part of a larger conversation about the shared risks and rewards of public life as the country slowly transitions to a state of post-COVID normalcy.

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Jeremy Byrum: Hi everybody, and thank you for joining us from wherever you may be. It's a
little chilly out there, so welcome to The Campfire. I'm your host Jeremy Byrum,
and today I'm excited to be joined by our very special guest CGU's very own
Nicole Gatto. Dr. Gatto is an associate professor in the School of Community &
Global Health at CGU, is the director of the PhD program in Health Promotion
Sciences, and the interim chair of the IRB. She earned a Master of Public Health
from the Fielding School of Public Health at UCLA, and a PhD in epidemiology
from the Department of Preventative Medicine at USC'S Keck School of
Medicine. With experience in communicable disease control and prevention
with entities such as the LA County Department of Public Health, she focuses
her research predominantly on environmental, genetic and lifestyle risk, and
protective factors for chronic diseases. In the last year, she has lent her
expertise to work on COVID-19 including a recent collaboration on vaccine
hesitancy research with Riverside University Health System. Dr. Gatto is looking
forward to traveling to Iceland later this year as a Fulbright scholar now that the
previous pandemic restrictions to the program have been lifted. Nicole, thank
you so much for joining the show.
Dr. Nicole Gatt...: Jeremy, thank you so much for having me. It's great to have an opportunity to
speak with you.
Jeremy Byrum: Of course, and it's always great to talk to a public health expert and someone
with your expertise, especially now that we're in the later stages, I'll say, of the
pandemic, although it's crazy that we've experienced it now over the last year. I
felt like the year went by, well depending on who you ask, either fast or very
Dr. Nicole Gatt...: I agree with that.
Jeremy Byrum: Thank you for taking the time.
Dr. Nicole Gatt...: You're welcome.
Jeremy Byrum: So let's get started a little bit with a brief overview of your background, maybe a
little bit on epidemiology for those who aren't aware of what epidemiology
entails. So can you go over some of what you do?
Dr. Nicole Gatt...: Sure, absolutely. So Jeremy, I think that probably before a year ago, most
people had not even heard of epidemiology. And I can say this because when I
would introduce myself as an epidemiologist, most people would ask me if I
worked with bugs, I think they were thinking entomology, or second I would get
if I worked with skin, so I think they were thinking epidermis. But
epidemiologists are health scientists, we study diseases in human populations. I
often say that we bridge public health and medicine, and essentially
epidemiologists our goal is to understand risk factors, so things that make you
more likely to get a disease, as well as protective factors, so things that make
you less likely to get a disease. We then use our research, and others use our
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research really as the basis to make recommendations to prevent disease from
occurring in the first place, so there's the reference to preventive medicine.
So epidemiology, I think, as now most people appreciate, is a data-driven
science, so we do depend on data from human populations to be able to do our
work. So in doing our work, there's really two parts to it, so usually we begin by
observation. So we observe, we characterize, we summarize, so this is what I
usually tell my students is the who, what, when and where. We then use our
data to ask research questions, so this is where we're asking the why. We want
to know what are the explanations for the patterns that we observe in the data,
so we go about designing epidemiologic studies to be able to attempt to answer
these questions. And as far as my background, epidemiologists usually
characterize ourselves either as chronic disease epidemiologists or infectious
disease epidemiologists. And my expertise is predominantly in chronic disease
epi, but I do have experience in infectious disease when I conducted
surveillance of influenza and other respiratory viruses as an epidemiologist for
the Los Angeles County Department of Public Health.
And I would say because of the nature of this pandemic, I would liken it to all
hands on deck moment for epidemiologists. So even those of us who may not
have as much of a background in infectious disease epi, I think have been
prompted to do what we can to contribute to solving a piece of this puzzle. I've
consulted with organizations on developing protocols for safely returning to
work, I've provided media commentaries and I've also been active in a number
of research projects. So I published an article with Henry Schellhorn from
Mathematics on Optimal Control with Uncertainty, so this was using
mathematical modeling to predict conditions that are relevant to this pandemic.
I also published another article with Wallace Chipidza from Information Systems
on Early Media Coverage of the Pandemic, and pointed out opportunities for
public health communication. I have a current project with one of our
community partners, Pomona Valley Hospital and Medical Center, they were
examining predictors of hospital mortality among patients who have been
hospitalized with COVID. The project that I'd like to speak about today,
addresses a very important issue and an issue that I think essentially relates to
us being able to get out of this pandemic, and that is vaccine acceptance.
Jeremy Byrum: Yeah. And that's really interesting. And I'm along with that public group of
people who honestly didn't know what epidemiology was prior to COVID, so it
was one of those new... And I think it was one of those search terms too,
probably that when Google compiled the most searched terms in 2020, I'm sure
epidemiology was one of them.
Dr. Nicole Gatt...: And in the past I would say, well, epidemiology is from the root word epidemics.
And so we are scientists who study disease in population, and I think because
we hadn't had very many pandemics in our recent history that were of the scale
and magnitude of COVID, I would then have to explain, well, there are
epidemiologists who study other diseases like chronic diseases like myself.
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Jeremy Byrum: Yeah. And I think it was interesting what you said too in terms of infectious
diseases, you said that you did have some experience in studying influenza. So
when COVID started, I guess, when it came into the picture and it was compared
a lot with the Spanish influenza pandemic of, I think 1918, how and why, I guess
did... When you started learning about COVID, did it come into your radar?
Dr. Nicole Gatt...: Yeah. Okay. Yeah. So I remember quite vividly in January of last year, when I first
heard of the reports that were coming out of China of a series of cases of
pneumonia of unknown etiology, and when we hear the words unknown
etiology, usually that's when our antennas come up. And I remember at the
time my attention was definitely peaked, but I also remember feeling quite
worried. And that was in part because epidemiologists and public health
professionals have really anticipated for many years, the potential for a global
infectious disease pandemic like COVID-19. To your point of influenza, I think
many folks thought it might be an influenza pandemic, but it was not, it was a
coronavirus pandemic. Some of the reasons why we've been anticipating this
sort of pandemic, have to do with the increased globalization of trade and
travel. So really there's many more people mixing around the world, both
people and goods than ever before in our history.
I would also include the changing climate and our impact on the environment,
particularly our continuing encroachment on animal habitat. So really we have
the potential nowadays to come in contact with unknown pathogens like we
have not had before. So these are some of the ingredients that are there to
bring about these conditions for there to be a pandemic on this scale. And I can
really remember those first few months of the pandemic, the stay at home
order had been issued and I was stuck at home, and I really felt a sense of
helplessness, I really wanted to be out there helping however I could. And so
even though I have more of a background of chronic disease, I did take this as a
personal call to action to do what I could from my training and experience to try
to contribute to solving some piece of the problem.
Jeremy Byrum: Yeah. You mentioned a little bit on your training when COVID happened, right?
You basically had to shift your mindset from chronic to infectious diseases. So
what are some of the logistical elements of that? Like, of course in the
mainstream we've heard a lot about social distancing, mask wearing, and then
now vaccines, which again, we'll get to, but how did some of that inform your
consulting that you've been doing with these different entities?
Dr. Nicole Gatt...: That's a great question. So one of the main differences between infectious
disease epi and chronic disease epi is usually when we're talking about known
infectious diseases, epidemiologists will shift their focus to understanding other
aspects of how disease spreads. So we might try to understand more about
transmission, we might try to understand more about factors on the individual
level that might protect people, but in this case, when we're talking about an
unknown pathogen, one of the biggest challenges is the unknown. So you've
probably heard a number of scientists saying that we're learning to fly the plane
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as we're flying it, right? So there's a lot of information that we're learning as
we're going along that's influencing our recommendations, what we know and
understand about the virus. And it can be very challenging to be trying to issue
what I would call real time advice and guidance while you're going along and
learning about it. So, I mean, if you think about it, we've only really known
about this disease for a year. And I like to remind folks that some
epidemiologists, some scientists, in fact many, may spend their entire career
studying a disease. And in the larger scope of things, we really have not had that
much of experience with this particular virus and the disease that it causes.
Jeremy Byrum: Where does the history of vaccines come into play when it intersects with the
history of infectious disease and, I mean, by extension pandemics?
Dr. Nicole Gatt...: Yes. So from a public health perspective, the reality is that vaccines are one of
our interventions that are credited with contributing to significant declines in
infectious diseases during the 20th century and the accompanying increases in
life expectancy. So in the year 1900, the average person lived to be 47 years old,
in the year 2000, the average person lived to about 78 years in the United
States. So that's a 30 year increase in life expectancy that in part is due to our
control of infectious diseases, and one way that we've done that is through
vaccinations. So perhaps it might be a good idea to talk first about how modern
vaccines work and then cover a brief history of vaccine hesitancy. So to start
with, it's really important to know that our immune system is very smart. It can
sensitively discriminate between subtle differences for a huge number of
pathogens, so not only viruses, but bacteria, fungi, et cetera. And our immune
system learns the identity of pathogens when we're naturally exposed to them
and we get sick. It fights back against the pathogen by mounting an immune
defense to get us back on our feet, but the reality is that this takes time.
So as part of this response, our immune system remembers the pathogen, so
the next time we're exposed, it will respond more quickly and more intensely to
prevent us from getting sick. So what do vaccines do? So vaccines are really
teaching our immune system to recognize a pathogen without our having to be
exposed. So this effectively bypasses the time that's involved with the natural
learning process. So vaccination results in our immune system being able to
mount an immune response the first time we're exposed, preventing us from
getting sick in the first place. And there's many different types of modern
vaccines; there's inactivated, live attenuated, recombinant, viral vector, mRNA,
but they're all essentially working off that same premise that I just described.
There's a second way that modern vaccines "work", so in addition to protecting
the individual, modern vaccines work also by protecting the community, and
this we refer to as herd immunity. So essentially the concept is that when
enough people in a population are vaccinated to a disease and therefore
immune, if that disease were to enter the population, persons within the
population who are not vaccinated and not immune are indirectly protected by
those who are. So this I think is really important to why we all need to be
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vaccinated. Vaccines are protecting persons who are not choosing to be
vaccinated, so persons who are not choosing to be vaccinated are really being
able to enjoy the benefits from those of us who are. And I think it's also
important that we not lose sight of the fact that we're all members of a society,
we share a common environment, and we're really interdependent on each
other. So when we talk about the reasons why people may be hesitant to be
vaccinated, I think it's important to keep in mind some of the risks, which
hopefully we'll also be able to talk about, but as a punchline, as members of
communities, we really need to remember that we're sharing both the benefits
and the risks. And if we all do our part, we're going to be able to maximize the
rewards that we'll all share.
Jeremy Byrum: Right. And I think too, you mentioned in your talk a little bit outlining that
community as well, and also how the development of vaccines or I should say
the history of not only your anti-vaxxers, but also your vaccine hesitancy has
been around as long as the actual vaccines have. So can you go into a little bit of
that history as well and where some of that public hesitancy comes from?
Dr. Nicole Gatt...: Yeah. So in working on this project, I wanted to understand more about the
history of vaccine hesitancy. And I found that it's not a recent phenomenon. So
in fact, as I mentioned that health and medical scholars describe vaccination as
one of our achievements from a public health perspective, the opposition to
vaccination has almost existed as long as vaccination itself. And so some of this
has to do with the early inoculation practices dating back to the 1800s, so it was
not particularly painless, safe or sanitary to get vaccinated then. Governments
in the United States and in Britain imposed steep fines to people who didn't get
vaccinated or have their children vaccinated, so it was actually quite a punitive
system, it was costly to people who were working then. So fortunately since
then, public health has evolved away from these quite heavy-handed
approaches to prioritize and favor educational interventions.
But in modern times, anti-vaccination movements can be traced back to the
1970s when there was an international controversy over the safety of a
particular immunization called the DTP, or diptheria, tetanus, and pertussis
vaccination. There was a report from London, from a children's hospital at the
time, which claimed that 36 children suffered neurological conditions following
the DTP immunization. The opposition to the vaccination was fueled by
television documentaries and newspaper reports, a parent advocacy group, and
even some members of the medical profession. And unfortunately the
controversy affected vaccination rates even though advisory committees
reformed and confirmed the safety of that particular immunization. More
recently, if we look to the late 1990s, probably a better known controversy is
that over the MMR vaccine, so this is the measles, mumps, and rubella vaccine.
There was a British doctor in 1998 who published quite a well-known study that
suggested a possible relationship between the MMR vaccine and autism.
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So this was published in a well-known journal, the media picked up on it,
igniting public fear. There was confusion over the safety of the vaccine. As it
turns out that doctor was later investigated by the British Medical Council and
he eventually lost his license, this was because they identified some quite
serious violations, including a conflict of interest. There were issues with
consent in the study, and he even had falsified some data. The journal
eventually retracted the paper over 10 years later, but the damage
unfortunately had been done. There was an anti-vax movement, which had
grown out of this, it was credited as playing a role in the re-emergence of
measles in the United States and other countries. And this was even though
there had been a large number of studies which later confirmed that that
vaccine was safe, and none of them by the way, found a link between vaccine
and autism.
So if we look at the history, there are really three major themes that relate to
acceptance of vaccines, and I think we can see their roots historically. So the
first is governmental authority versus individual liberties. So here, right? The
concept is that people have a right to control their own bodies and those of
their children and not the government. The second major theme is that from
religious objections, so here is the belief that my body is pure, and vaccines are
unclean or unchristian, in part because of some of the animal roots of
vaccinations. And then third, relates to concerns about safety and the potential
harm caused by vaccines and especially to children. So these are themes that
are even true today, in people who feel hesitant about being vaccinated.
Jeremy Byrum: Right. And I think you said something interesting too, when it comes to the
damage already being done. I think probably a modern analog to that is the
recent reports of the single dose Johnson and Johnson vaccine, which had a
pause, and then now I believe doesn't have a pause. So I can imagine why that
still plays into today's society, where one report like that comes out and it has a
ripple effect into the community.
Dr. Nicole Gatt...: Yeah. I think people are probably coming in with some level of skittishness.
Unfortunately there's been a lot of misinformation which has been propelled
through social media, which I think is different than in the past. So information
is more readily available and so is misinformation. And the Johnson and Johnson
vaccine being paused, actually I think is a testament to our system working. So
we do have, and we can talk a little bit more about this later, we do have a
system that reviews vaccines before they're approved for use. That same
system also monitors the use of vaccines once they are being used in the
population. And it's set up to monitor potential adverse events in persons, and
then take a step back and confirm whether or not those are related to the
vaccine itself. So that I think is a bit more of a testament of our system working
the way that it should.
Jeremy Byrum: Right. And also about that system, so maybe we can go from there and then
transition that into some of the work you're doing in vaccine hesitancy research.
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Now with this vaccine particular, I know that there's several COVID vaccines,
and I think for emergency authorization in the US, there's at least several that
are available now, probably the two most popular are Pfizer and Moderna. Can
you speak to how that process worked and how we were able to get a vaccine
so quickly, and perhaps how that might lead to some of the hesitancy among
the public?
Dr. Nicole Gatt...: Sure, absolutely. So what's going on behind the scenes, which I think may not be
quite as much in the public consciousness is that, these vaccines or their
platforms have been in development for years. So for example, the mRNA
vaccines, the Pfizer and Moderna vaccines, even though they are a new
technology in terms of a vaccine that we're using now, those have actually been
in development for a decade. So even though they are new, the research that
has contributed to building the foundation has actually been around for quite a
long time. So before a vaccine can be used in the United States, it has to go
through a series of rigorous studies. So these begin in the lab, they continue in
animals, and then they progress into humans. And folks hear about clinical
trials, so there's actually three rounds of clinical trials in humans that must be
conducted before a vaccine or actually any drug, can be approved by the FDA
for use in the United States.
Emergency use authorization is a designation which can move along more
quickly the release of the medication or the vaccine to the public, but it has not
shortcut all of that work that I just described that goes into the development of
the therapeutic or the vaccine. So there are a team of scientists and medical
doctors at the FDA who are reviewing all of the data from those studies, they're
looking for safety, they're looking for effectiveness, and that essentially is what
goes into the approval process. And then as I mentioned, the FDA is also
involved in ensuring the safety of vaccines after they've been approved. So they
check vaccine manufacturing sites, they inspect them to make sure that they're
following good manufacturing procedures, they also monitor the use of the
vaccine in the general population. So clinical trials are large, but they're
enrolling on the order of tens of thousands of people. Once the vaccine is used
by the public, we're talking about millions of people who now are taking them,
so the FDA is monitoring the population for the occurrence of more rare
adverse events that we may not have detected in clinical trials. And their work is
focused on looking to see whether those potential adverse events may actually
be linked to the vaccine or not.
And think about it this way, the reality is that when we're talking about millions
of people, there is the potential for us to see the occurrence of rare events, just
because we have so many people that we're following that the potential is
greater. So it could be by chance alone, that we're detecting these adverse
events. So think about it this way, it may be that even if those people had not
been vaccinated, they still may have experienced that adverse event like a blood
clot. So the task of scientists involved in this type of work is to review medical
records and try to determine whether there's a link between that medical event
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and the vaccination, it could just be a coincidence. And so far, the rare side
effects that have been detected are the severe allergic reactions, so the
anaphylaxis, and this has been recorded to occur at an extremely low rate. So I
think it's five cases per 1,000,000 doses for Pfizer and three cases per 1,000,000
doses of Moderna, so that's extremely rare. And it seems that this has mainly
occurred in women and people with a history of allergies.
And one of the ways that we take steps to keep an eye on folks is, what
happened after you got vaccinated? Well, you are to wait for 15 minutes. So
wait in the vaccine site for 15 minutes, and this is because we want to check to
make sure that folks don't have an allergic reaction. If they did, there would be
these steps taken to help them, medical care would be called and we would
take steps to treat them for that. The second, which is the reports that have
come out for the Johnson and Johnson vaccine, this is the rare occurrence of
brain blood clots. And the most recent statistics are showing 15 confirmed cases
among nearly 8 million doses, so this is also extremely rare. And we're talking
about less than one in a million or thereabouts of these different adverse events
for both the Pfizer, Moderna and the Johnson and Johnson vaccine. So if you put
this into perspective, the lifetime risk of dying from a motor vehicle accident is
one in 107 in the United States but we're still driving, right?
There's a background risk that's just associated with living and the different
things that we do as part of our life, so there's a risk associated with driving, but
yet we all still drive, right? If you're interested in the risk of winning the lottery,
in the California super lottery, a jackpot of 41 million, your odds are one in 41
million of winning that. So actually putting this in perspective, the risks
associated with these vaccines are extremely low. And scientist's part of the
task is to adjudicate whether the benefit is outweighed by the risks, and
scientists looking at the Johnson and Johnson vaccine, their conclusion is that
the benefits do outweigh the risk of vaccination with that particular vaccine
Jeremy Byrum: A calculated risk, right? Okay. So how does that play into some of the research
you're doing now in vaccine hesitancy with particularly Riverside University
Health System, where does that research come into play?
Dr. Nicole Gatt...: Yeah. Good question. So coming back to our project with Riverside University
Health System, so this is an integrated health network in Riverside County. It's
one of our community partners here at CGU. Riverside University Health System
serves about 2.3 million residents of Riverside County. So we had a couple of
goals for this particular project, and why would we be even interested in
studying this issue in the health system? Well, so first of all, Riverside University
Health System frontline workers, so there are doctors, nurses, physician
assistants, et cetera, who work there. This was the first group to be vaccinated
in California, as well as nationally. These are folks who interact with patients so
certainly there is the potential there for them to be exposed and protection
from vaccination is important. And also there's the secondary issue, may they
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have an influence on patients? So in other words, could their personal opinion
about vaccines matter when they interact with patients?
Riverside University Health System is also a large employer in Riverside County,
so not only are we studying frontline workers, but the employees likely
represent a cross section of the Riverside County population. So there's the
factors that make this an important group to study. There's two important
factors also to keep in mind as we talk about this work, the first is that the
vaccine is offered at the workplace at RUHS. So in other words, folks who work
there do not have to sign up on that My Turn site like the public does, so this
greatly facilitates the administration of the vaccine. The second thing is that
persons who are working at RUHS are likely to still be employed, so unlike other
sectors or employers who laid off their employees, that was for the most part,
not the case with Riverside.
So we had a couple of objectives of this project, the first was to assess levels of
vaccine hesitancy in employees of Riverside University Health System. We
wanted to really understand what could be some of the driving factors or the
determinants that influenced their decision to either accept vaccination, to
refuse it, or to be hesitant about it. And the reason why we were interested in
that is because we are a program of health promotion, so the idea is that we
may be able to develop targeted interventions that could address those factors.
Also, from my review of the literature, this is the most comprehensive survey
among healthcare workers and health system employees to date. So there had
been another study conducted by UCLA, but this was previous to vaccines even
being released. So going back to September and October of last year, UCLA
surveyed its employees and found that there was some apprehension over
adverse events associated with vaccines.
There was a recent Kaiser Family Foundation, Washington Post survey in March
of healthcare workers, which also showed that a percentage of them were
hesitant. Americans also have some level of hesitancy, and it seems that there's
about a 10% to 15% stubborn group over time, I mean, that that number is
stubbornly not changing over time who say that they won't get vaccinated. So it
is important again, going back to herd immunity, that we maximize the number
of people who receive a vaccination because this is going to offer the larger
society protection from COVID.
Jeremy Byrum: Now what's some of the inferences we can make from the data you've collected
so far? Given this is a new project, I'm sure it'll be ongoing. And with how
comprehensive it is, I'm sure you're getting a lot of responses for sure.
Dr. Nicole Gatt...: Yeah. So we developed a survey, this was a collaborative effort between CGU
and Riverside University Health System. They have a research center there that
we worked with. We didn't reinvent the wheel, so we did model our survey
after a previous published survey, so the WHO has worked quite a bit in this
area. We included different questions, we wanted to understand demographic
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factors, we wanted to understand person's knowledge and experience with
COVID, their hesitancy with vaccines, we also wanted to collect data on a
number of different influences that might be shaping their opinion. So these
were contextual influences, individual and group influences, and then vaccine
specific issues. So we started administering the survey, March 15th, we closed it
this past Monday on April 26th. We sent it out to about 2,500 Riverside
University Health System employees, we heard back from 714 of them, so that's
about a 29% response rate. A large proportion of the people who answered the
survey were nurses or had administrative positions.
We asked them about their weekly level of exposure, and some of them had no
exposure, some of them had minimal, moderate or high exposure. So that was
relatively equally distributed among the persons who responded. There was a
significant percentage of them who reported having underlying health
conditions like hypertension, like asthma, like diabetes, and overall probably no
surprise because of the health system employees, they were very
knowledgeable of COVID symptoms and disease. So at the time of the survey,
83% of the persons who responded had received either one or two doses of
COVID vaccine, so 17% had not been vaccinated yet. So we continued to ask
that 17% additional questions, we wanted to know when the opportunity arises
for them to be vaccinated, will they be? And 12% said they would, 50% said they
would not, and about 40%, so 38% said they were unsure.
So we continued to probe them with a question of whether they would be
vaccinated at a later date, and 19% of them said, yes, we had a proportion who
said they were unsure, and we had some that said, no. So overall we have about
7% of the people who we surveyed who said they were hesitant, and about 6%
who said they refused. So these percentages are lower than what we find in the
US population and other surveys of healthcare workers, but it still does reflect
an important 12% of the employees who we may be able to target with
Jeremy Byrum: And I think that, sorry, I didn't mean to interrupt, I was just going to say, I think
that's really interesting when you were mentioning about the public perspective
versus the expertise perspective of not only diseases, but also vaccines. I think
that's an interesting statistic given that these are healthcare workers.
Dr. Nicole Gatt...: Correct. Now we do have to keep in mind that this reflects people who
responded, so we are missing out on the opinions of persons who didn't
respond. And it could be that because such a large proportion of people who
are vaccinated responded, this data may not necessarily reflect everybody's
perspective within Riverside University Health, but we are going to continue to
look at that more closely. We wanted to understand the determinants of
vaccine acceptance, hesitancy, and refusal, so we asked all of the people who
responded a set of questions to try to understand the reasons that might
influence their decision to get vaccinated. So we gave them 17 reasons, we
asked them to rate these reasons using a Likert scale, so whether these reasons
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definitely would, definitely would not, probably would, or probably would not,
influence their decision. And we also had a category for not sure.
So we asked them questions like, would getting paid time off influence your
decision, would an influential religious leader, would assurances that the
vaccine was safe, what about if the vaccine was a requirement to attend social
or sporting events? So we asked them these set of questions and asked them to
rate the importance that they would give to these different reasons. So among
the persons who were vaccinated, and this is I think really interesting data so
far, among the persons who had been vaccinated, there were some themes that
came out in the responses. So these were people who we felt were relatively
altruistic. So scanning the reasons that they gave, they were not motivated by
money, paid time off, other incentives, but they did report being influenced by
knowing somebody who got sick from COVID, or receiving encouragement from
a family member to get vaccinated.
We also saw themes that related to professional motivations and an indication
that they rely on knowledge of medicine and science in their responses. Now,
this was different than the group who were hesitant. So among those who said
they were unsure, looking at their responses, the responses concentrated really
squarely in the middle of the Likert scale. So regardless of the reason that we
asked, these folks reported that they were not sure. So the theme that emerges
here is a level of uncertainty and indecision across the board. In the third group,
those who refused to be vaccinated, it was interesting. So again, looking at
where the response is concentrated, regardless of what we asked these folks,
they said it definitely would not influence them. So a theme that emerged here,
was that nothing may sway these folks. So we really need to take this into
consideration when we think about, okay, if we want to develop educational
interventions, how are we going to reach both our folks who refuse to be
vaccinated and our folks who report being hesitant? So this helps us think about
different strategies that we could use with either group.
Jeremy Byrum: Now, as a bit of I guess some parting words from your perspective as an
epidemiologist, earlier you mentioned that your field bridges the medical
sciences and the public health side, how can a study like this inform the public
health response for, as you said, getting out, I think is the words you used, of
this pandemic or any kind of pandemic or public health issue we may face in the
Dr. Nicole Gatt...: Yeah. So I think that by looking at the responses, we may be able to develop
educational interventions that assure people of the safety and efficacy of
vaccines. So if they're hesitant because they're worried about, for example, you
brought up, why was it that these vaccines were released so quickly? Well,
perhaps if we explain the context and provide greater information that, well,
even though it appears that they were released quickly, there was actually years
of research that went into the development of these vaccines. And we can look
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at some of the other responses as well, to see where we may be able to reach
other groups that report being either hesitant or refusing a vaccine.
Jeremy Byrum: All right. Well, thank you so much, Nicole, your breadth of knowledge, it just
seems very... You definitely have the expertise in this field, and I'm glad we
were able to talk to you to get some of that perspective for those who might not
know again, what epidemiology is. So we really appreciate it. Where can we find
your work particularly on COVID, but just in general and what you're doing right
Dr. Nicole Gatt...: Yeah. Well, thank you again for having me. It was great to have an opportunity
to talk about the work that we're doing at CGU, with our community partners,
with our students. So if you're interested in finding more about my work, you
can check out my website, which is There you'll be able
to find copies of my published articles and some of the other areas of research
that I'm interested in.
Jeremy Byrum: Perfect. And is there anybody else you wanted to shout out in terms of
collaborators that helped make a lot of this work possible?
Dr. Nicole Gatt...: Certainly, I can mention by name, let me get my page here so I don't forget.
Certainly, so I can acknowledge we have a great team at CGU, Debbie Freund is
my colleague on this project, a number of students that are working with us,
both in public health and economics. Also, our collaborators at Riverside
University Health System, Doctor Anthony Firek and Judi Nightingale, as well as
a number of their employees and volunteers who, without them, this work
would really not be possible.
Jeremy Byrum: Fantastic. Well, thank you to them and thank you to you, Nicole, for your
expertise and for coming on today.
Dr. Nicole Gatt...: Thank you for having me, Jeremy.
Jeremy Byrum: From Studio B3 at Claremont Graduate University, you've been listening to The
Campfire. We'll see you next time.