The Biggest Challenge with COVID-19 Right Now: An Interview with NFID Medical Director Robert Hopkins, Jr, MD

"The greatest challenge, in my mind, is the ongoing, widespread circulation of the virus and what I call a minimal societal response to it."

In a recent interview with Patient Care,^© the National Foundation for Infectious Disease's medical director voiced concern over continued circulation and evolution of the SARS-CoV-2 virus in the context of crippled prevention efforts among public health officials and even among frontline health care providers. In some communities, Hopkins said, clinicians are not stocking the vaccine. Vaccine fatigue and the lingering effects of misinformation campaigns appear to be overpowering any vestiges of concern for the danger of the infection. He discusses these frustrations and others in the short video segment above.

The following transcript has been edited for clarity and length.

Patient Care: What do you see as the biggest challenges with SARS-CoV-2, COVID-19, and vaccine uptake?

Robert Hopkins, Jr, MD: You know, this is a big one. The greatest challenge, in my mind, is the ongoing, widespread circulation of the virus and what I call a minimal societal response to it. This continued spread facilitates the evolution of new variants, persistent infections, and an ongoing risk for severe disease and long COVID across all populations.

If we look at the last couple of years, vaccination rates are dismally low—20% to 30% in adults at the high end and less than 15% in children under 18 nationwide. That leaves far too many people unprotected against severe disease, which could be prevented with vaccination. Compounding this is low vaccine uptake overall.

I don’t want to put people on the defensive, but there have been inadequate recommendations for vaccine use, even among healthcare professionals. In recent weeks, I’ve heard from patients and providers nationwide about difficulties accessing COVID-19 vaccines in many communities, especially for children, since many clinics aren’t offering them. Access for adults outside of pharmacies has also been limited. That should not be happening.

Yes, the vaccines are now commercialized, and yes, practices must purchase them—but we need to address this issue. Vaccine fatigue is also widespread, fueled by persistent disinformation and misinformation about COVID-19 and its vaccines. Many of us are working to counter that, but it remains a major barrier.

Finally, I’m not sure we in healthcare and public health have done enough to convey the importance of COVID-19 prevention. The pandemic is not over. COVID-19 continues to hospitalize tens or hundreds of thousands of people and kill tens of thousands annually. Why is prevention important? Because it prevents severe disease, hospitalizations, and poor outcomes.

And we need to include the story of long COVID in this narrative. Think about the complications we’ve all seen: increased heart attacks, strokes, venous thromboembolic events, and pneumonias—both viral and post-viral—among others. While these vaccines aren’t perfect, they are far safer and more effective than taking the risk of infection and facing these adverse outcomes.

Robert J Hopkins, Jr, MD, is the medical director of the National Foundation for Infectious Diseases and professor of internal medicine and pediatrics and director of the division of General Internal Medicine at the University of Arkansas for Medical Sciences, in Little Rock, AK.