As COVID-19 cases rise and vaccination rates in Mississippi remain among the lowest in the U.S., Dr. James E. Keeton, vice chancellor emeritus of health affairs and former dean of University of Mississippi Medical Center School of Medicine sat down with The Dispatch to talk about the safety of the vaccine and encourage the public to receive it. A Columbus native, Keeton, 81, earned biology and psychology degrees from Ole Miss and graduated from UMMC in 1965. He practiced pediatric urology for years, with stints in private practice and with Blair Batson Children’s Hospital in Jackson, before leading the medical school from 2009 to 2016. This interview is presented in question and answer format and is edited for length and clarity.
Dispatch: The rate of people fully vaccinated in Mississippi is still lagging below 40 percent. There is a lot of anti-vaccination rhetoric out there and vaccination hesitancy, combined with mask wearing hesitancy. Where does that come from?
Keeton: It would be nice if there was one thing we could identify as far as why people aren’t vaccinated. If it was just one, maybe we could focus on that and fix it. As I see it, having even some of my family members who are not vaccinated, it could be, ‘You’re not going to tell me what to do.’ We have a history of that mindset in the South, of the big ol’ bad government telling you what to do. There certainly can be a religious aspect to it: ‘I’m scared of this. I don’t think you have checked it out well enough. I’m God-fearing, so everything will be OK.’ Among the Black community, there’s an understandable reason with Tuskegee and some things that were done there and some research that would give them some worry. Sadly, people take all that and make conspiracy theories out of it. Some people don’t believe the virus is a problem, not any worse than the flu. But those people don’t see what I see and what others see — the people in the ICUs and the people dying — unless it hits their family, or how hard health care people are working to save these people’s lives.
Dispatch: You mentioned people continuing to say COVID-19 is no different from the flu. Can you explain how the two are different?
Keeton: This particular variant, the Delta variant, is different from the first (COVID-19 virus) because it is so infectious. It’s got this whole fertile ground of unvaccinated people to where it can mutate and get better at what it does. It’s whole deal is to find somewhere to live at the right temperature. Of course, it’s spread by breath, in effect, mainly by coughing. It’s not spread by your hands, really. It mainly comes from the respiratory system. We all talk, we like to gather and we put ourselves close together, so this virus is in heaven. Now, we get that with the flu, but this particular virus just went crazy and in a very rapid fashion. As it has mutated, it’s done it even better. The spike protein has changed, it’s adapted to where it can get in the cells in your throat and your lungs better. It’s an interesting thing that in the beginning the people who were dying were the old people, people my age. But my people — about 70 percent of them — went and got vaccinated. What’s happened now is the virus is affecting young people more, and some of them are not only getting it asymptomatically, but some of them are dying. We’re not having the death numbers we were, because we are treating it better, but we’re seeing an enormous amount of sick people. Here’s what really got some people worried: What if we don’t get all these people vaccinated, or enough to where the virus doesn’t have a place to grow, and it mutates against the vaccine? We are in big trouble then.
Dispatch: We know medical professionals in this community who say they are not vaccinated and don’t intend to get vaccinated. They say many of their colleagues in the medical field believe the same way. Have you encountered much of that in the medical community and to what do you attribute that?
Keeton: I’m embarrassed. That’s what I am. I can’t imagine, but we have it. To (current UMMC head) Dr. LouAnn Woodward’s credit, her system — there are four hospitals in the medical center — is you either have to be vaccinated or wear a mask. As soon as we get off that emergency use (and the vaccine receives full FDA approval), you’re going to have to be vaccinated. Just like the military and the VA is doing now. So those people you are talking about that say they don’t want to be vaccinated, they are going to run into not having a job. There are not enough hospitals saying that yet, but I suspect that soon they will have to. UMMC has about 10,000 employees and 3,000 students at the medical center, and about 30 percent of them didn’t get vaccinated. They are getting vaccinated now because if they aren’t and don’t wear a mask they lose their jobs. The medical center has required all along that employees get a flu shot or they can’t work there. This is even scarier than the flu. It kills more people than the flu, so there would be more reason to require the vaccine. I do not understand why a health care worker could say they won’t get vaccinated. One of the problems is not necessarily you getting it, but you could be carrying that virus around with a huge viral load and spreading it to everybody and it not affect you. So, what do you think about your fellow person when you could get a vaccine?
Dispatch: This particular vaccine is possibly one of man’s greatest achievements in terms of efficacy and speed to market. From the beginning of the pandemic, the messaging has been poor from the top down. There hasn’t been clear, united messaging of what we’re facing, the fact that it’s a changing virus. Do you agree with that? And if so, where did that messaging go wrong?
Keeton: This is an amazing vaccine. We’ve never had one like this. When I was head of the medical center, every six months we would practice disasters — tornado, hurricane, school bus wrecks, everything. My last year, the last one we practiced was pandemic. And I told the group, our disaster team, ‘This will happen.’ Now this was 2016. What we didn’t do, even though we were preparing for it on the medical level, we didn’t let the public know that these sorts of things were super dangerous. It got out that, ‘These things happen in China’ or like Ebola, ‘It happens in Africa.’ People would say, ‘That happens somewhere else and it would never happen in the United States.’ So there was denial. Then it happened at a hugely political time in this country. Once it became political, it made it very difficult for science to say, ‘Put the politics aside.’ The virus doesn’t care what party you belong to or what you believe. That’s where we messed up. People started blaming other people based on what they believe, and it put us in this place of awful partisanship about something we ought to all be on the same team about. Hopefully, that’s changing now.
Dispatch: How did we get this vaccine so quickly?
Keeton: The fact we got a vaccine this quick that can save your life is unbelievable. (In the past with other vaccines), you were using the virus itself. This one works on an RNA/DNA system. They don’t have virus in the COVID vaccine. It knocks out the virus based on its genetic makeup. That is the biggest breakthrough ever. Sadly, since it was touted as a novel vaccine, some people said, ‘Well, I’m not sure I want to take it because they don’t know. There could be some long-term effects.’ What I’m hearing now is the long-term effects are far more likely with the virus than with the vaccine.
Dispatch: What is the difference between a breakthrough infection and the virus ‘working against the vaccine’?
Keeton: A breakthrough infection means you’ve had the vaccine and you get COVID. Remember the vaccine is about 95 percent effective. So you have a 5 percent chance you’ll get the virus. The good news is that if you get it in that 5-percent group, the vaccine is going to call forth all the wonderful things in your body to kill it. But it most likely won’t kill you. It might make you sick, but by and large you’re pretty well protected. As far as the virus mutating to the point it works against the vaccine, I don’t know if that will happen. But I imagine that would bother the heck out of me if I were a virologist or an infectious disease guy that the virus could keep mutating and doing some crazy stuff. This Delta variant is already doing crazy stuff. It’s just one more step for it to become more pathological, as they say, and cause more deaths.
Dispatch: What are some other effects on health care of COVID case numbers spiking again?
Keeton: The more immediate problem: a couple of weeks ago, all our beds were full — ICU, NICU everything — and we had 68 patients in the emergency room who had been admitted but there were no beds. They were on stretchers, squirreled away in some little room. So what’s happening is the everyday medical requirements that every hospital in the nation has is magnified because the COVID infected, particularly the unvaccinated, are filling up the hospitals, and we don’t have the flexibility to take care of other needs. So right now, there’s no elective surgery that stays overnight, meaning people who have been waiting on procedures are being put off. So not only are unvaccinated people hurting the immediacy of what’s happening in the emergency room, they have an effect down the line. The delivery of health care right now is very hazardous.
Dispatch: You said you have people in your own family who haven’t been vaccinated. What do you say to them and have you had any success getting through to them?
Keeton: No, I haven’t had success. They made their decision based on the reasons I’ve told you. Some of it is religious and some of it is, ‘I just don’t think it’s going to happen to me.’ I don’t agree with them. Just thinking you won’t get COVID doesn’t mean you won’t get it.
Dispatch: What about vaccination incentives, or company level mandates for employees even outside the medical field once the vaccines are fully FDA approved?
Keeton: I think mandates really will make a difference. The last I saw, Dr. Fauci is expecting (full FDA approval) for Pfizer by the end of this month. Moderna is about a month behind them. When they release that, I think the big companies will jump in there.
Dispatch Publisher Peter Imes and Managing Editor Zack Plair conducted the interview. Plair transcribed the interview.
The Dispatch Editorial Board is made up of publisher Peter Imes, columnist Slim Smith, managing editor Zack Plair and senior newsroom staff.