This was a remarkable event, and I’m glad I was there to see it.
For those who may not know or remember; Greeley’s JBS meatpacking plant was the center of Colorado’s first major outbreak of COVID illness, resulting in numerous deaths and hundreds of workers getting sick and hospitalized. Meatpacking requires close quarters, and one infection spread rapidly to many.
I watched on the news with horror as the disease spread, and Greeley, a small town in rural Colorado became national news. Greeley also led the state in COVID illness early in the pandemic.
Public Health Effort
The great news NOW, is that Colorado’s Public Health coordinated a multi-health-system effort to vaccinate the nearly 5000 employees there. When I heard of the opportunity, I dropped everything and headed up there last Friday to be part of the effort.
It would seem an insurmountable task: How do you coordinate nearly 100 volunteers who don’t know each other, in a noisy, unfamiliar plant? How do you incent workers who may have questions about the vaccine, to come discuss and be vaccinated? Will you have enough translators (at least 8 languages are spoken by employees)?
7 health systems coordinated
Soon, however, we got organized into 14 tables of 3 vaccinators, taught how to load vaccine syringes from defrosting Pfizer -70 degree vials, supplies distributed, and employees started rolling in, paper consents in hand.
We vaccinated over 2500 employees on Friday, a great day and smooth operation. See above for the write-up by the Greeley Tribune, among many news organizations on site.
The “Education Room”: Stories NOT Data
Here is where it gets interesting. I found out that I was assigned to the “Education Room” upstairs. Management at JBS was serious about maximizing employee engagement with this big push for vaccination.
- The plant was closed for 2 days.
- All workers would be paid for 4 hours of shift work JUST TO SHOW UP.
- All workers who got vaccinated would receive an additional $100.
- All workers who declined vaccine could sign a paper … AFTER they went to the EDUCATION ROOM where Dr. Lin and other physicians and nurses were waiting
Hmm. I thought I had signed up to vaccinate today …
When I heard this, my life flashed before my eyes. Not really, but I had a rapid sequence of thoughts:
- I hoped they had enough translators (turns out, yes: Somali, Spanish, Amharic/Ethiopian, many more)
- I hoped I had heard most of the rumors and misinformation about the vaccine before and be ready to respond
- I hoped that I could avoid STATISTICS and DATA, since most vaccine-decliners have (mostly misinformed) STORIES. Data never beat a compelling Story. Only Stories have a chance to fight Stories in the battle for feelings and changing minds.
- I thought back to a book I read recently, The Righteous Mind, about values, moral thinking, and how those with liberal values, and those with conservative values see morality with very different lenses. Would I be able to speak a common language to connect with those who saw the world differently?
Reasons why NOT?!?
Yes, it turns out, we only had about 100 people come through for the 6 hours I spend there. Of the 100 we spoke with, I heard a dramatic range of reasons why people were declining the vaccine:
- “Well, it’s not a real disease anyway.”
- “I heard the vaccine kills people.”
- “The vaccine is only 95% effective. So what is the point? Like, it doesn’t even work.”
- “I heard it is made from dead babies.”
- “Only old people have a problem with COVID.”
- “I am healthy. I don’t live with old people. I don’t need it.”
- “My roommates will make fun of me. We are not getting it.”
- “My parents told me not to get it.”
- “Why are WE the guinea pigs, before everyone else?”
- “I’m going to wait and see.”
- “I’m pregnant. I heard it is dangerous for my baby.”
- “I already had COVID. So, I’m immune.”
- “I never get ANY shots, flu, nothing. I don’t need it.” (and more)
This was a daunting task. However, we had a room full of translators for all languages, 3 tables set up with information sheets and 3 cultural ambassadors to explain the importance of the vaccine and WHY JBS managers and leaders thought this was important, and even Union Leaders who would show videos of themselves getting the shot themselves (thank you JBS; very organized!). THEN, if the participant was adamant about their decision, fine, go sign the paper and get paid.
Less Helpful Conversations?
IF they had a question, one of us would get called over, and we could chat. I heard a few discussions in the room. Some less effective approaches:
Employee: “I don’t want the shot. I already got COVID. I’m immune.”
JBS Supervisor: “I haven’t got COVID. I’m not immune. You don’t care about me?”
Employee: “Nah man, stop talking. Where do I sign the paper.”
Employee: “I don’t want the shot. I’m healthy.”
Medical advisor: “You know, the shot is 95% effective. Even though it doesn’t protect everybody, the data shows that almost everyone gets immunity. Even if you DO get the infection, it is likely milder and you won’t have symptoms.”
(Data-heavy, confusing, and not addressing the issue)
Employee: “It is not a real disease.”
Medical advisor: “Yes it is. People die all the time. Here are 5 reasons the shot is safe and the evidence that it works…”
(Not enough reflective listening, eliciting thoughts, trying to find common ground, and too much talking)
Whew. I could see myself falling into each one of these traps. I set myself a goal to find STORIES to match and counter their STORIES and to suppress temptation to exhibit my command of the DATA (sooo hard).
Here are some of the better ones we came up with. Importantly, ALWAYS begin with “What questions do you have?” and “Tell me more about what you understand.” and “Anything else?” and “I like that you are trying to get good information before making a decision. This can be very confusing and scary. I would like to help.”
Employee: “I’m pregnant. I’m afraid for my baby.”
Me: “Yes, there is less information from the vaccine tests about pregnant women. HOWEVER, MOST of the women doctors and nurses at University Hospital who are pregnant have gotten the shot. And we are confident it is safe for the mom and baby.” (result: agreed to shot)
Employee: “I heard the shot makes you sick.”
Me: “Well, most people do not get sick. If they do, some get a sore arm, or a headache or fever, like getting the flu. Tylenol helps. For me, I had a fever for about 3 hours overnight.” (result: agreed to consider it later)
Employee: “Why are we the guinea pigs and getting it early?”
Medical advisor: “Actually, the doctors and nurses were the guinea pigs; they got the shot back in December and January. We are all healthy and staying safe, with no major side effects. We want YOU to be protected too.”
Employee: “I just don’t want to do it.” (unable to state a clearer reason)
Me: “I hope you see all the doctors and nurses in this room. We are all volunteers, took a day off to come here, because we WORRY about you and your community. You are Essential workers. Last year, many of your co-workers got sick and died, and we did not protect you. We don’t want this to happen again.” (result: thanked us for volunteering, and promised to consider vaccination)
Of 100 people, about 20 agreed to the shot during our session, about a 20% conversion rate. Is this normal? I have no idea. One of my colleagues noted:
“Compared to vaccinating, this is soul-crushing. To do your best explaining why a crucial vaccine would save lives IN THIS PLANT, and not to connect. So hard.”Nurse Practitioner in the Education Room at JBS
At the same time, we all agreed that many of the decliners also said they would think about it some more, and would consider getting it later. In motivational interviewing lingo, perhaps they were moving from “pre-contemplative” to “contemplative.” Even a mild attitude shift like that, is a win.
Some of the more effective strategies:
- Listening more than talking
- Finding common values: “The Broncos!” or “Protecting elderly parents”
- Telling a personal story of COVID or getting vaccinated and how it felt
- Talking about “looking out for each other” “protecting our community” “making Colorado safe” “keeping Covid out of your family”
- Using metaphors: “Which vaccine? Its like, Dodge, Ford, Chevy. Just get in the car. We will all get there.”
Dr. Steve Hoffenberg, Emergency Medicine Physician, coordinated the vaccine efforts at JBS. Thank you, Steve.
FINALLY: Will you look over this document with me? I wrote a ONE PAGE summary of what I thought were the BEST STORIES to fight misinformation about COVID Vaccine. What do you think?
CMIO’s take? Wow, there is a lot more to vaccine work than “give shot, call next patient.” Coordinating a public health effort: massive. Focusing on high risk populations: important. Listening, connecting and changing minds: some of the hardest work of all. In the coming months, THIS will be the conversation.