Combatting COVID-19 vaccination hesitancy: An interview with Dr Renuka Ananth Kalyan Kadali

Dr Renuka Ananth Kalyan Kadali is an internal medicine physician within the Harnett Health System and an assistant professor at Campbell University in North Carolina, US. Alongside his medical practice, he has published widely on topics ranging from sickle cell disease to sleep apnea. More recently, his published work has studied the COVID-19 vaccine, with a particular focus on self-reported side effects. His vital work aims to combat vaccine hesitancy to ensure that every demographic is protected from the virus.
Global news headlines throughout 2021 were dominated by the mass rollout of the COVID-19 vaccines, and the vaccine rapidly became integral to most government’s anti-virus strategy. In the UK, the first jab was administered on 8 December 2020, while in the US the first publicly administered shot took place on 14 December. At the time of writing, approximately 71% of the adult population in the UK have received both doses of their vaccine, while 54% have received their ‘booster’ top-up, in an attempt to combat the Omicron strain of the virus. By most accounts, this is a remarkable success story. There are of course sobering counterpoints to this success however, as figures show that only 9.5% of people in low-income countries have received their first dose.

While this global vaccine inequality is a matter of grave concern, even within wealthier nations where vaccines are widely accessible, a sizeable and often vocal percentage of the population have been unwilling to receive their jab. For some, this is born out of a wilful objection to the science, often ostensibly motivated by political ideology. For others, however, vaccine hesitancy has arisen out of a genuine concern or confusion about the possibility of side effects.

To combat this hesitancy, Dr Renuka Ananth Kalyan Kadali has undertaken numerous cross-sectional surveys to study the self-reported side effects, and to ensure that those who may feel cautious or confused are reliably reassured of the safety of the vaccine. In addition to his inpatient clinical management and research efforts toward COVID-19, Dr Kadali has also delivered relentless humanitarian work through his leadership initiatives to combat the second wave of the COVID-19 pandemic, which greatly benefitted two states in India during the time of an oxygen supplement shortage.

Volunteering as an executive lead in the ‘Physicians for American Health Care Access’ non-profit organisation, on behalf of nearly 15,000 international medical graduates/physicians trained in the US, Dr Kadali has played a key role in developing, proposing, executing and maintaining legal advocacy methods and strategies to promote bipartisan Senate and House legislations. These include ‘Conrad State 30 and Physician Access Reauthorization Act (S.1810/ H.R.3541)’ and ‘Healthcare Workforce Resilience Act (S.1024/ H.R.2255)’ during the 116th and 117th (present) Congress to improve Americans’ access to physicians. These bipartisan legislations are vital in strengthening the country’s healthcare workforce, helping after-effects of the pandemic by mobilising the healthcare workforce in the required areas, and overcoming potential future healthcare workforce challenges. His research, recently published in Cureus, provides an insight into the significant physician shortages in areas of the country where they are much needed, and the simultaneous immigration challenges experienced by practicing physicians, especially during the COVID-19 pandemic.

“This research provides information on the safety of vaccines that is very important in combatting vaccine hesitancy.”

As hospital numbers continue to grow among the unvaccinated population, it is vital that we accurately convey the safety of new COVID-19 vaccines to ensure the protection of the population at large. Research Features was fortunate to interview Dr Kadali about his work, and about his hopes for the future.

Could you introduce us to your research background in internal medicine?

Apart from my active role within the diagnosis and management of acute and chronic illnesses among the adult population, I have dedicated myself to research activities that advance the knowledge base of the field through scholarly work and scientific publications. While balancing the challenges of my clinical caseload, for years I was able to find some time and energy to contribute to research in the internal medicine field. My prior work in research projects on sickle cell disease, pulmonary hypertension, lung inflammation and obesity, obstructive sleep apnoea and sarcoidosis, were applied in clinical practice by other physicians and clinical investigators – and were helpful in the development of guidelines for the management of those related conditions. Our prior research was published in well-reputed journals such as Clinical Cardiology, Annals of Hematology, Journal of Clinical Sleep Medicine, Chest journal, and many others. Recently, I have spearheaded multiple cross-sectional survey studies related to COVID-19 and the vaccine, and have published in American Journal of Infection Control, International Journal of Infectious Diseases, Journal of Medical Virology, and American Journal of Obstetrics & Gynecology. This recent research provides information on the safety of vaccines that is very important in combatting vaccine hesitancy.

You recently conducted an important study on healthcare workers and the self-reported side effects of the Pfizer-BioNtech and Moderna vaccines. What motivated you to undertake this study?

Healthcare workers form an essential part of an effective response to the COVID-19 pandemic. Emerging threats of infectious diseases, such as COVID-19, demand much more than just that healthcare workers continue to work as normal. This group of workers has a critical role in diagnosis, containment and treatment, and they have high commitment in managing patients despite increased personal risks. The pandemic crisis at times necessitates longer hours (and correspondingly increased exposure to the virus), potential quarantines and assignments outside one’s normal specialty. In this COVID-19 pandemic, healthcare workers are subject to risk of illness, risk of death, fatigue from extended hours, and moral distress.

The new COVID-19 vaccines have an eye-opening mRNA technology, and were made available to healthcare workers during the initial phase of the vaccination programme. But then a lot of concerns and apprehensions were posted about the side effects in their network groups. The idea of the study was to find the facts, and break vaccine hesitancy in the public by showing that healthcare professionals were in fact at the forefront of vaccine acceptance.

Could you explain a little about the methodology used in your vaccine studies?

The first phase of the vaccination programme was primarily focused on healthcare workers worldwide. Our cross-sectional study was conducted by circulating an independent online survey questionnaire (pertinent to demographic data and symptomatology upon detailed review of systems) through an internet-based survey platform (Survey Monkey), which further gathered responses from healthcare workers from verified healthcare worker groups from various parts of the country during the early phase of COVID-19 vaccination. The online questionnaire was also distributed to healthcare workers through coordinators of healthcare institutions. Informed consent was obtained at the beginning of the survey. Participants who voluntarily agreed and consented to proceed and who chose receipt of one of the two mRNA-based COVID-19 vaccines were allowed to move forward to answer the questionnaire. Only the complete responses were included in the final analysis of our study.

Do you feel that these reported side effects might affect vaccine uptake amongst certain demographics?

Absolutely not. Most of the side effects reported from multiple independent studies, including ours, are non-life-threatening. Only a very small fraction of recipients reported considerable symptoms. A significant number of recipients reported feelings of joy or relief or gratitude after the vaccination – highly encouraging for future vaccine recipients. Some respondents may have incorrectly blamed the vaccine for several side effects that they developed soon after vaccination, although symptoms of their pre-existing chronic medical problems or an unfortunate coincidence from new underlying medical problems that were not related to the vaccine may also have contributed to these side effects.

Side effects, from the immune response that gets generated with any vaccine, are to be expected. After reviewing the data obtained, the whole idea of writing the manuscripts and publishing them was to break that hesitancy among the public, and to show how well the vaccine (even the second dose) has been accepted by healthcare professionals (who were among the first to receive this vaccine). Our study reports may alleviate some of the potential anxiety about these side effects.

Our published research has received a great deal of attention, not only from the medical community but also from researchers and the general public worldwide, as part of COVID-19 prevention strategies by encouraging the general population to take the COVID-19 vaccine. Our studies were also used and cited in ‘Philippine COVID-19 Living Clinical Practice Guidelines’, in ‘Clinical guidance on use of COVID-19 vaccine in Australia in 2021’, and in the extended version of the Pfizer-BioNTech COVID-19 vaccine document, published by Pan American Health Organization.

“Healthcare workers form an essential part of an effective response to the COVID-19 pandemic.”

Our research was positively discussed in German media (FOCUS Online) with the title ‘High acceptance of the BioNTech vaccine despite vaccination reactions’.

Based on the above, it is evident that our published research has been well regarded by others in the field and has received national and international acclaim. Our studies have yielded positive impacts and helped in promoting vaccine uptake among anti-vaccinators, and subsequent studies were developed by other investigators about vaccine hesitancy.

Your vaccine studies have importantly focused upon demographics who may have particular susceptibilities to new vaccines, such as pregnant women. Do you feel concerned that some sections of society might slip through the net when it comes to vaccine trials?

Although pregnant individuals were not part of the initial vaccine trials, pregnancy-related adverse events were very rarely reported during the post-vaccination phase. Also, the side-effect profile obtained from a detailed systematic review of organ systems among pregnant women, who received either of the mRNA vaccines in the immediate or early post-vaccination period, were non-life threatening. They appeared to be similar – with no significant statistical difference when compared with non-pregnant women. There is high acceptance of the second vaccine dose, which is an encouraging aspect for future pregnant vaccine recipients.

Do you feel optimistic about the future development of safe mRNA vaccines?

With all the non-life-threatening experiences that the world has seen with the highly innovative messenger RNA technology, I am very confident about the development of safe mRNA vaccines in the future.

Aside from vaccine-related research, what projects are you currently undertaking?

I am working on gathering more information and data to develop strategies about how we can be more successful with the COVID-19 vaccination programme. While the vaccination programme continues globally, future COVID-19 related legislation in countries implementing vaccination among employees, along with the provision of incentives, may help to promote higher compliance and acceptance of the vaccination.

What direction do you hope your future research will take?

The research and clinical experiences that I have gained so far are motivating me to step forward further with a wider scope and take part in future trials related to vaccine and/or drug development technologies, and get involved in patient screening and safety protocols in the future.

Combatting COVID-19 vaccination hesitancy: An interview with Dr Renuka Ananth Kalyan Kadali