Why Health Workers Must Lead Campaign Against Vaccine Hesitancy – Tometi

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Pharm. ‘Kunle Tometi

In this exclusive interview with Pharmanews, Pharm. ‘Kunle Tometi, CEO and pharmacist-in-charge of Total Pharmacy, Dallas, Texas, USA, highlights the need for pharmacists and other healthcare workers to be at the forefront of vaccine advocacy to enlighten the general public on the importance of vaccination. Tometi, a Fellow of the Nigerian Association of Pharmacists and Pharmaceutical Scientists in the Americas (NAPPSA), also shares his experience after having recently received the second dose of the COVID-19 vaccine. Excerpts:

Why health workers must lead campaign against vaccine hesitancy – Tometi

I was born in Lagos but grew up in northern Nigeria (Kaduna), where I attended primary and secondary schools. I attended Army Children School, 44 Comilla Barracks (from 1974 to 1979) and Government College, Kaduna (from 1979 to 1984), respectively. I received my B.Pharm. from University of Ife (now Obafemi Awolowo University), Ile-Ife, Nigeria, in 1988 and graduated with PharmD. at Howard University College of Pharmacy (HUCOP), Washington, D.C., USA, in 2020.

I had my NYSC at Holy Rosary Hospital, Emekuku, Owerri, in 1989, where I met and married Ms Angela Ngozi Opara in 1993, and we are blessed with three sons and a daughter. I speak Hausa, Yoruba and Igbo, having lived in all parts of the country.

I practised Pharmacy as a salesman for Glaxo Nigeria Limited in eastern Nigeria, from 1990 to 1994, under the tutelage of Dr U.N.O. Uwaga. I later ran my consulting and business company, Remington Nigeria Limited, where we worked as drug vendors to some oil service firms, including Schlumberger (onshore and offshore), NNPC (chemicals and laboratory reagents and tools vendor), and many other consumer products in the Niger Delta Area.

My family emigrated to the United States of America in May 1998 and have been domiciled in Dallas, Texas, since then. My work experience here has been in retail pharmacy, leadership and operations at a Fortune 10 company (CVS Caremark), and also an independent pharmacy business owner and operator.  I enjoy helping to bring satisfaction to my customers – patients, caregivers, family, staff, prescribers, payors and regulators.

I joined Eckerd Drugs as a cashier in 1998 and obtained, by examination, my Texas pharmacy licence in May 2000. Thereafter, I was promoted to staff pharmacist, a role I handled, until I was promoted to leadership and mid-management in August 2002 as assistant district pharmacy manager/peer review consultant. I later assumed the district pharmacy manager position in August 2003. During this time, I led my team through the acquisition and transition into CVS Pharmacies in June 2004.

I resigned from CVS at the end of 2007 and started our family business, Total Pharmacy, on 1 January, 2008, exactly 10 years from when I joined my previous company, to fulfil a challenge and desire of mine of going independent on my 10-year mark.

I am very committed to pharmacists’ empowerment. I also participate in advocacy wherever and whenever necessary to advance the practice of Pharmacy. To this end, I sit on two councils (Public Policy Council and Financial Affairs Council). I am also one of the three members of the Audit Committee at the Texas Pharmacy Association (TPA) since 2018.

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I am very proud of the membership and leadership roles I’ve been privileged to play at NAPPSA where I previously served two terms on its Board of Trustees. I currently serve on the programme committee and the mentorship committee. I am also a member of the B2B (Business to Business) group of the association.

I was invited to the National Executive Council of the Pharmaceutical Society of Nigeria (PSN), in 2019 where I sit in Council, representing Nigerian pharmacists in the diaspora. I work collaboratively with all PSN interest groups to help facilitate knowledge and skills transfer and exchange of ideas on best practices on both sides of the pond.

You recently received the first and second doses of the COVID-19 vaccine. Please, share with us your feelings on this.

Vaccines have brought many benefits to the human race, chief amongst them being their ability to prevent diseases and save lives. And with the current management of the pandemic with very little or few therapeutic options available, it is only proper that vaccines are the best way to control and beat this COVID-19 pandemic.

Most people will experience very little, if any, side-effects upon receiving the vaccine. These may include injection site pain, fatigue, headache, chills, and fever (usually mild to moderate in intensity and will subside in a few days).

Fortunately, I was unremarkable after my first and second doses of the vaccine. Some people may experience more serious side effects with the second dose of the vaccine. This is not unusual as they are exhibiting a secondary immune response to the recognised antigen.

I am thankful to science and I feel very great and encouraged that, very soon, everyone who needs the vaccine will be able to get it and be protected from this pandemic of COVID-19.

Several conspiracy theories were postulated especially by some doctors in the USA, Australia and other countries against the effectiveness of the vaccine; why did you go ahead to take it.

Firstly, I am a scientist and also a pharmacist and we are one of the most educated scientists in the new curricular leading to the award of the Pharm.D degree. We are taught the core sciences, as well as therapeutics, pathophysiology, immunology, epidemiology and many other courses appertaining to a rounded pharmacy education.

I educated myself and understand the science of the vaccines and remain convinced of their safety and efficacy. As of today (25 February 2021) over 65,032,083 doses of the vaccine have been given to patients in the USA and the percentages of people experiencing side or adverse effects are quite minimal.

Also, as leaders in our communities, it is important that we step up and lead – showing the way forward to our people, dispelling untruths and rumours about the vaccines and also help curb vaccine hesitancy by showing and letting our people know one has taken the vaccine. At NAPPSA, we encourage each member who has taken any vaccine to post a picture on our chat group to help encourage everyone to take their shots.

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Of all the vaccines given in the USA, 60 per cent of people who have taken the vaccines are white; 11.5 per cent are Hispanic or Latino; 6 per cent are Asian; and just 5.4 per cent are black. So, we have a lot of education to do in our communities – churches, village meetings, professional associations, and so on. Stepping out and encouraging people to take their vaccines when it’s their turn is a great service to our people.

Which of the vaccines did you opt for and why?

I didn’t have a choice in which vaccine to take, I was assigned to take the Pfizer-Biotech. However, both the Pfizer-Biotech and the Moderna vaccines are in the 95 per cent efficacy range. The Johnson and Johnson (soon to have its EUA Emergency Use Authorization) comes in at 65 per cent efficacy for mild to moderate case of COVID-19, and at 85 per cent effective overall in preventing hospitalisation and death.

At this time, I would advise anyone to take any of the vaccine complements that is made available. They are all very effective vaccines for COVID-19.

What has been the general disposition of citizens to the vaccine?

Vaccine hesitancy is still a big opportunity even here in the US. But, generally, most people are taking their vaccines when their time comes up in the queue. Pharmacists and physicians are readily available to help counsel and answer all questions people have about the vaccine.

Have there been cases of patients who got infected after being vaccinated?

Though I have not encountered a patient contracting the disease after vaccination, it is not unusual that one may, even though one has taken a vaccine.

What the vaccine does is to expose the human body to a challenge of the antigen (herein COVID-19), which will orchestrate an immune response  and also help the body to recognise the antigen, due to immunological memory, the next time it shows up. It can help to prevent disease, but more importantly, should one contract the disease or get infected after being vaccinated, it will help the body to fight the infection; and, as such, one does not fall very ill at all, or one may be asymptomatic (but one can still transmit the disease), or experience very mild symptoms, certainly reducing the chances of severe disease and hospitalisation.

Also, it is very important to understand the science of the vaccine and the timelines of activities. Although one gets vaccinated, appreciable quantities of antibodies do not begin to form until 14 days later; and a second dose (in a two-dose vaccine) four weeks later only then confers immunity in the 95th percentile.

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So patients are advised to continue to follow all recommended public policy advice.

Following certain negative speculations about the vaccines, some Nigerian healthcare workers have determined not to accept it. How would you advise this set of people?

Public health enlightenment and education will be the best way to advise any persons not willing to take the vaccine. Some people have expressed concerns about the science of the first two vaccines, Pfizer-Biotech and Moderna – both being mRNA vaccines – that they may alter people’s DNA. This is not true and the mRNA only challenges the human cell and instructs it to produce spike proteins to which antibodies are then formed.

All this process takes place between the cell wall and cytoplasm of the cell. It does not penetrate the nucleus where our DNA is kept.

For people concerned about this science, thankfully, the Johnson and Johnson vaccine is here and the science is based on a viral vector pathway – where a viral vector, Adenovirus 26, which is a common cold virus, is used to carry genetic material into human cells, tricking them into making pieces of coronavirus spike protein, to which the immune system then reacts. So, people who remain concerned and unconvinced about the science of mRNA can opt to take this one.

It is also noteworthy to mention that drug companies practise market integrity and price protection to safeguard their markets. Therefore, it may be possible to see vaccines designated for delivery in Africa bearing signs or labels reading “to be sold in Nigeria, or in Africa or in India only”. This does not mean the vaccine is inferior and really does not speak to the integrity of the vaccine but rather market integrity protection by the manufacturers.

Infection rates in the US, as well as death rates, have decreased by 67 per cent since we started vaccinating people a month ago.

Are there any guidelines health workers and patients need to keep  before and after receiving the jab?

Yes.  Protection from vaccine is not immediate. Vaccine is a two-dose series (for Pfizer-Biotech and Moderna) and it will take, at least, from 14 days after the shot to start getting any protection and one to two weeks following the second dose to achieve 94 to 95 per cent efficacy and be considered as fully vaccinated. For a one-dose Johnson and Johnson vaccine, protection starts about 14 days after vaccination (72 per cent in the USA) leading into full protection at 28 days.

Therefore, we need to continue to adhere to public health advice: Wear a mask, stay at least 6 feet away from others, avoid crowds, wash hands often, follow all travel guidelines,  and follow quarantine guidance after exposure.

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