How Pediatrician Rachel Pearson Brings Along Vaccine-Hesitant Parents

; Abraham Verghese, MD; Rachel Pearson, MD, PhD


November 01, 2021

This transcript has been edited for clarity.

Eric J. Topol, MD: Hello. I'm Eric Topol for Medicine and the Machine, here with my co-host Dr Abraham Verghese. Today is a special and remarkably coincident day because we have Dr Rachel Pearson with us on the day that the US Food and Drug Administration (FDA) is about to approve vaccinations for children aged 5-11 years. Dr Pearson is a physician, scientist, and author who is at the Center for Medical Humanities and Ethics at the University of Texas, San Antonio, and a pediatrician on the faculty of UT San Antonio Long School of Medicine — an amazing background and an amazing author. You may know her book from 2017, No Apparent Distress. She also has written many pieces in recent months for publications like The New Yorker, The Washington Post, and many others. It's hard to keep up. She is a gifted writer, an extraordinary pediatrician, and I would say humanitarian. Welcome, Rachel.

Rachel Pearson, MD, PhD: Thank you so much. It's an absolute pleasure to be here.

Topol: I didn't realize that Abraham and you share some common threads.

Abraham Verghese, MD: It's such a delight to get to talk to Rachel, because as you might remember, Eric, I ran the Center for Medical Humanities from 2002 to 2007. In fact, I was the founding director and had the great pleasure seeing it grow. I didn't get to meet Rachel because she came after my time. But I've been hearing so much about you, Rachel, that it's a great honor and privilege to read your writing and now to meet you in person, so to speak. Welcome to our program.

Pearson: Thank you so much. I've been reading your writings since I was in pre-med and have such respect for the work that you do in the world. To get to follow in your footsteps at the Center for Medical Humanities and Ethics is definitely amazing. Someday, I hope I'll be the writer that you are.

Verghese: You already are. We have so much to talk to you about. I'm going to let Eric take the lead.

Topol: You've obviously put much thinking into the whole children and COVID narrative. You have a young child, so you have primary experience. Why don't you start off what you've been thinking about lately on this?

Pearson: You're right. My son Sam is 15 months old today, so he is one of the little Americans who's not yet eligible for the COVID vaccine. Since becoming a mother, my practice as a pediatrician has been interpolated so much through my love and my care for him. It's brought me a lot closer to the concerns of other parents. Lots of great pediatricians don't have kids, and before I had a kid, I used to say, "Oh, I only like kids when they're seriously or critically ill." But that's not true. I'm delighted to have my own.

When it comes to COVID, kids have been spared a lot of the severe effects of infection itself, largely speaking. I think public health has tried to strike a balance between reassuring parents that any individual child is unlikely to suffer severe illness or die of COVID, while at the same time keeping in people's minds and in the minds of physicians and school officials that some kids do get really sick from COVID. More than 600 kids in this country have died of COVID. To be on the threshold of another large group of children becoming eligible for the vaccine is an incredibly exciting moment.

A lot of what I'm thinking about lately is, how do we harness this potential? How do we work with our communities? How do we work with the families we care for to ensure that the kids can benefit from this vaccine and that the families can benefit from their kids getting vaccinated? A lot of it will come down to effective communication on our parts.

Verghese: Rachel, you live in a progressive city, but in a state that many believe embodies the resistance to the vaccine and to science. You've had to walk a fine line. But I think you've been approaching this wonderfully in terms of trying to understand what the people who are resistant to this are thinking. Tell us about your strategy and about conversing with mothers about the vaccine and the need for it and so on.

Pearson: I am in the great state of Texas, where I'm from. I'm a fifth-generation Texan on my father's side, so I'm very emotionally embedded in this place. I think that there is a bit of a breach between the popular perception of vaccine-hesitant people and what you actually encounter in the hospital or in your office as a pediatrician. If you look only at social media, you'd imagine that most unvaccinated people or vaccine-hesitant people are conspiracy theorists who believe that the vaccine will magnetize you. What I actually experience the vast majority of the time is parents who have concerns about the vaccine and are trying to make the best choice for their specific child.

That's not to say that the political milieu in Texas and other states that have actively resisted sensible public health measures doesn't make a difference. It does. It makes a huge difference when your governor opposes masking, and when your governor isn't allowing local officials and school officials to make reasonable, safe health decisions for our communities. That leaves parents in a hard situation because they feel like all the responsibility is on them to protect their kids from COVID when in fact, to protect anyone from an infectious disease, we need the effort of individuals, families, community organizations, and health systems. We truly are all in this together, as you know.

What Parents Fear About the COVID Vaccine

Topol: Could you talk more about the decision that parents will be confronting? They already have faced this for teenagers, and they will soon have to for children aged 5-11. We know the risks for death or hospitalization from COVID are relatively low, although they still occur. But what seems to have been missed largely is not just the long COVID story, which we know does occur in children and teens — not the same likelihood as with adults, but certainly it does occur — but also the transmission chain. How are we ever going to get over this virus or get on top of it if we don't vaccinate the vast majority of the population?

On the other hand, in teens, the main issue of concern has been myocarditis, which we know is rare and usually mild and isn't something that is of a serious nature. But it is a concern to parents of teens. Then, we have these two trials from Pfizer and Moderna of 2000-4000 people. It's not 50,000 participants for the children. A lot of parents will say, there's just not enough data, we don't know enough. How do you convey the risk-benefit balance to provide the confidence factor for parents?

Pearson: As a physician mom, I think about whether I want to expose my toddler to the COVID vaccine or to COVID — those feel like the choices. Given the high prevalence of infection, I absolutely hope that he is vaccinated before he is ever infected. That's because, as you say, long COVID is not as common in kids as it is in adults, but for small children, subtle symptoms can be hard to pick up. And we won't know for years whether there are developmental effects of COVID infection in the preschool years or infancy. It's going to take us a long time to get those data.

Lots of parents are worried about the vaccine somehow having a delayed long-term effect. They think you're going to get the vaccine and then 10 years later, something's going to pop up and we're all going to regret having vaccinated our kids for COVID. But that's not something we see with vaccines. There's no reason to expect that will happen with the COVID vaccine, based on our decades and decades of experience. As a pediatrician, postviral infection complications, such as neurologic problems, are something we see commonly in the hospital setting. I care for kids who get acute disseminated encephalomyelitis, probably related to a previous viral infection; kids who have postinfectious arthritis or postinfectious symptoms from viruses. We don't see much of that from vaccines.

The Benefits Message

So, do I want my kid to get a single, very specific, vaccine-generated antibody that will protect him? Or do I want him to have a natural infection and develop a whole panoply of antibodies that may or may not have effects in the long term? I think to build confidence, we need to focus on kids' and families' reasons to get the vaccine. Get to the reason why you want it. If you're talking to a teenager, what do you think the vaccine would help you be able to do? Kids care about stuff like not having to stay home from school in quarantine, being able to play on their sports teams, being able to go to those big family gatherings without worrying. In general, kids like being engaged in the world and they are often willing to take a step to protect other people, whether that's masking or vaccinating. So I think part of it is to focus on the potential benefits of vaccination.

When it comes to risks like myocarditis, I think parents need to know that we take those seriously. I agree with you, my interpretation of the data is absolutely that myocarditis from an mRNA vaccine is an extremely rare event, and it's usually quite treatable with NSAIDs. We do need more data, following the kids who do get myocarditis over time, and we will be getting those data. But parents need to know that if they bring up that risk, we are taking it seriously and we're glad we know that it's out there. That way, we can be keeping an eye on their kid.

Verghese: There are data — and I only know this because I keep up with Eric's Twitter feed — that show that the risk for myocarditis with natural infection is also pretty significant and probably more than there is from the vaccine, which is also a useful argument.

Taking Flak for Speaking Out

Verghese: I must say, you've been quite brave, speaking out about many issues you believe in. I imagine that you get flak from time to time. This is a hot-button issue. How have you been able to weather the storm of pushback? We don't necessarily see it, but I could predict that there's been pushback. How has it been?

Pearson: I will say that I look to the physician advocates I admire, and Dr Eric Topol is one of them: people who consistently put their voices into the public sphere and stand up for what matters for families. I try to take the example of these leaders. From the outside, it looks like the flak just rolls off your back, like water off a duck's back. I can't imagine that there's not some emotional toll.

After my most recent Washington Post article on talking with parents about the COVID vaccine, I stayed off Twitter for a few days after getting a lot of negative messages from anti-vaxxers. What keeps me in the conversation is the sense that it's my — the word in Spanish is papel – it's my role as a writer who is a pediatrician who has access to the platforms I have access to, and who is trying to write from Texas in a way that confers the right amount of dignity and humanity on poor and working-class Texans. The families I care for.

I'm not a person who ought to back out of the public discourse, even though it does get very uncomfortable. I'm actually kind of shy by nature. There's a reason I'm a writer and not a TV personality. I like the solitary work of writing, but in this day and age, that means engaging with the public in a pretty rapid-fire way.

Topol: On that note, I learned yesterday that a neo-Nazi website posted all the addresses and phone numbers of members of the VRBPAC group, the advisory committee reviewing the pediatric vaccine, and bombarded each of them with threats over the past week since this advisory committee met. So we're in a very serious antivaccine, antiscience time, while acknowledging your important point earlier, Rachel, about how most of the people out there who are deliberating are not in that group. But this small, vociferous, and sick disinformation campaign is attacking people ad hominem. It's unimaginable, unthinkable.

Physicians Who Write

Topol: I'm curious about you as a writer. Tell us about what got you into writing. I think you wrote your first book as a medical student or resident. How did you get into this? You found a niche that compliments your background. It's extraordinary.

Pearson: I have always been a writer, since I was 6 years old and I published my first story in the newspaper. I still have a clipping of it. Writing has always been my best way of thinking and reasoning about the world. When I write, I feel calm.

I set out to be a professional writer. After undergrad, I started a master's in fine arts in creative writing at Columbia University. By chance, the summer before I left for Columbia, I had a job as a patient advocate at Whole Woman's Health, which is a women's health clinic in Austin that also provides abortions and has been in the news a lot lately. I took that job because it was well-remunerated for a college grad without any relevant experience. That job introduced me to healthcare. Hearing the stories of women in the clinical space was so profound and interesting. In the clinical space, people tell you stuff they have never told anyone. If you're able to listen in a compassionate way, you're invited into someone's life and story in a way — Abraham writes about this all the time in a deeply special way.

After being in that clinical space, the life I saw for myself as a writer of fiction stopped making sense. I'm also from a very small town in Texas. My father is a carpenter, my brother is a commercial fisherman, my mom's a teacher. So I also wanted to do something that felt concrete and meaningful in the way that their work does. I was drawn into medicine. I initially thought, Oh, I'm an artist, I'm not going to write about medicine, but those stories kept bringing me back every single time. The stories we hear, the situations our patients find themselves in, and the way we have a lens on how injustice affects the body — it became impossible to not write about medicine. I've been lucky to be able to bring the two together, and I do feel like I'm doing the work I'm supposed to be doing in the world.

Verghese: You were fortunate to attend the UT Medical Branch at Galveston, which is the oldest medical school in Texas. Long before medical humanities programs became almost commonplace in medical schools, they started the first institute for medical humanities. I remember looking to them and to their history as we started the medical humanities center at UT San Antonio. Talk a bit about that tradition of medical humanities that Galveston put on the map. Your PhD is from there, if I remember correctly.

Pearson: That's correct. I became an MD-PhD because I discovered that the medical humanities existed. It seemed quite obvious that those were my people and I needed to go be with them, and the way to do that was to get a PhD along with my MD. The Institute for the Medical Humanities is a truly special place. When I was there, most of the faculty were PhD scholars in the humanities disciplines — philosophers, historians, social scientists, people who had dedicated their lives to considering problems in medicine through these rigorous means of reasoning in the tradition of the humanities. As you know, the humanities as a set of modes of reasoning predates the scientific method by thousands of years. So basically, the Institute for the Medical Humanities is where I got woke. It also gave me the tools to interrogate my own education and training, to interrogate the systems affecting our patients, and to try to build a moral foundation for my own work and contribute to the moral foundation of our profession. It was and still is a special place.

Taking Care of Neighbors

Topol: In your book, No Apparent Distress, you focused on the underrepresented, which was a precursor to what has been happening in the pandemic. Can you tell us a bit more about your own personal experiences that led to that book?

Pearson: The book focuses on a free clinic in Galveston, St Vincent's, where I trained as a medical student. I started med school in 2009, and if you recall, that's when the Affordable Care Act was being debated. We were all looking forward to its implementation. We genuinely thought the need for free clinics was going to go away because everyone would have access to funded medical care. But then, during the years I was there, we saw how the Affordable Care Act was eroded. Texas did not expand Medicaid, so even today, 11% of Texas kids lack access to medical care, and around 19% or 20% of Texas adults.

We haven't seen the advances we had hoped for from that legislation. What that meant on the ground was that at the free clinic, we could diagnose people with complex processes because at a free clinic, you can do something like get a biopsy and have a pathologist read it. In many cases, we would diagnose cancer. We diagnosed endometrial cancer, and head and neck cancers. But at a free clinic, you cannot give chemotherapy and you certainly can't do surgery. So we were often diagnosing people with serious problems but found ourselves unable to secure access to treatment through my same university, through the hospitals in Houston. We watched people deteriorate and, in some cases, die of conditions that we knew were treatable if they were funded.

That was very personal for me, of course, because I'm a Texan. These are my neighbors. But also, my family includes people who are uninsured. I grew up with imperfect access to insurance coverage. So it was people I recognized on an intimate level. That was a formative experience for me. I had to recognize myself as involved in a system that was allowing poor people to die of treatable conditions. At the free clinic, I learned so much. I benefited so much from being able to work with those families and with my education being funded by the state of Texas, I was in many ways a beneficiary of those same systems that were allowing the patients I loved to suffer. That moral question of how we speak with them and how we become agents for justice within an unjust system that benefits us animates a lot of my work to this day. I never try to position myself as the good doctor or the person who has it all figured out. I'm always somebody who is herself catching up and trying to do her best.

Verghese: It's remarkable what you've already accomplished. What are your plans as you look ahead? Where do you see yourself taking this? I hope you'll continue to be a wonderful public advocate for common sense and public health. But do you have any plans you'd like to share with us?

Pearson: I'm starting my third year at the Center for Medical Humanities and Ethics at UT Health San Antonio, so I feel like I'm beginning to learn how to be a good attending. I'm beginning to get my feet under me. Right now, I think I'm in the right place. San Antonio is such a beautiful, diverse city. It's a city that welcomes immigrants and a city whose spirit is animated by working-class people supporting each other. I feel like here I'm able to do the work I ought to be doing, especially as a bilingual pediatrician. I hope to write beautifully about the issues facing Texans. If I have a body of work in my life when it comes to the writing, I hope that overall, it reflects the complexity, the intelligence, the dignity, and the humanity of ordinary Texans, ordinary people who are struggling to live their lives. So I have a vision for the writing work. As for what comes next in terms of advocacy and my clinical life, we'll have to see.

Verghese: I have a friend who is a banker in Texas, and his expression when talking about people having very different opinions or even conflicts is that you have to "bring them along." It seems to me that that's what you have to do: You have to bring people along patiently and with the same reasonable tone that you've been using. I think you're onto something; just keep bringing them along.

Topol: A friend of mine, Abraham Verghese, back about 5 years ago, was at the White House, recognized by President Obama with the National Humanities Medal for his work. My prediction, even though I know that's not your motivation at all, is that you'll follow in Dr Verghese's footsteps. You have the talent. You're an extraordinary person. We're lucky to have this time with you today. But a little boy in the street could predict this one. What you've already done in the very short span of your career is impressive, Rachel.

Thank you so much for joining us. Your writing inspires us. I read your Washington Post opinion when I didn't know you. But I wanted to meet you; I wanted to know you. I wanted to read everything you've written. Now The New Yorker has figured out who you are, and who knows what's next. We're lucky to have a physician author of your caliber.

Verghese: Rachel, thank you. I can't improve on Eric's words. You have made me proud to have been associated with the Center for Medical Humanities and Ethics. Keep up the good work. You should take inspiration from Eric, my co-host. He never seems to think twice about what he has to say, as long as what he has to say is backed by reason and by science, and by the good intentions that we have for the public we serve. That is our fiduciary responsibility to the public. If you keep that in mind, then everything that comes with it is no different than duty hours and the long obligations in the hospital. I see it as all part of the same coin. We're very proud of you. Thank you for joining us. I'm sure that this is an episode our listeners will truly enjoy.

Pearson: Thank you both for all you are doing in the world and for the light and the truth that you bring to every conversation. It's really been an honor.

Topol: For anyone who is listening, if you haven't been reading Dr Pearson's writings, you're missing out. They're extraordinary. Thanks, and we'll look forward to following your career.

This podcast is intended for US healthcare professionals only.

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