After months of declining case numbers, Nevada is seeing an increase in COVID-19 cases.

Health experts say getting vaccinated is the best way out of the pandemic, so why are so many people reluctant to get the shot?

That's this week on Nevada Week.

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt and additional supporting sponsors.

(Kipp Ortenburger) When the coronavirus vaccine rolled out in December, people stood in long lines to get the shot, but now vaccination rates have waned significantly.

As the new delta variant spreads, health experts say time is of the essence to listen to Nevadans who are hesitant to take the vaccine and address their concerns.

Joining us to answer questions about the vaccine's safety and importance are Dr. Marc Kahn, dean of the Kirk Kerkorian School of Medicine at UNLV; Dr. Cindy Duke, a virologist and fertility expert; Christina Madison, associate professor of pharmacy practice with Roseman University of Health Sciences, and Brian Labus, epidemiologist and assistant professor at UNLV's School of Public Health.

We thank our viewership very much for joining us for this very special discussion here, and we thank our panel as well.

Brian, I want to go to you first.

I mean, if you've been following any of the news now, we've got two very concerning trends.

One is test positivity is just skyrocketing, a four-point increase in the month of June alone.

On the other side, we have vaccination rates that are decreasing.

We had a high point of 25,000 vaccinations per day in Clark County in April, now we're at about 6,000 a day.

How are those two trends related?

(Brian Labus) Well, vaccine is the thing that's going to take us out of this pandemic.

If we don't have enough people vaccinated in our community, we're going to see more transmission.

It's the way we stop it.

When you add that people aren't wearing masks on top of that, we have a lot of people who are susceptible to the virus and as a result, we're seeing an increase in transmission and that test positivity rate is increasing.

-Now, we're hearing a lot about the delta variant, the delta variant potentially being more admissible, I guess.

Is that a big factor here too?

-It's definitely a factor.

We are seeing higher rates of the delta variant in the community, we're seeing a greater percentage of our cases being a result of that, and it spreads more easily.

If we have a variant that spreads more easily than the one before, the pandemic has that potential to take off again because we have a new virus that spreads easily between people.

-Christina, we had this benchmark of 70% of our population to reach or to get the vaccine.

As our rate has gone down, of course it seems like the line of when we might get to that seems to be more and more extended.

Now I believe it's August, potentially September.

If it stays the way it is, what kind of impact could this have on our local community?

(Christina Madison) Yes.

I mean, I think the biggest thing is unfortunately, we're going to see more cases and potentially more deaths.

I mean, really right now, the issue here is we're at a race, right?

So as much as we think the virus is something that we may want to be done with, the virus is not done with us.

And as we continue to have this pot of people who remain unvaccinated, they remain susceptible.

And those individuals, we know that 99.8% of people that are hospitalized and are dying from this virus were unvaccinated, which means that these deaths are all preventable which to me just seems uncanny, you know, that we're at this point that these individuals are dying needlessly.

So I think that's really where we're at right now is looking at this from the standpoint of people who we love that potentially could succumb to this virus.

So the longer it takes for us to get to that quote, unquote, herd immunity or community immunity, the more people are going to potentially have complications associated with this virus.

So it's not even the fact that people may die.

It's the long-term complications associated with this infection as well: Cardiovascular disease, we now know that it's been associated with new diabetes diagnoses, you know, clotting disorders.

There's so many things that this virus we know touches that we don't even know, you know, all of the potential long-term complications if you become infected with this virus versus if you are vaccinated.

We know that even if you do become infected, your likelihood of having severe complications and death is much less.

-Dr. Kahn-- I'm sorry to interrupt-- death and complications, two huge impacts.

Are there other ones that we need to be concerned about as well?

(Dr. Marc Kahn) You know, we're learning more about this virus, you know, as time goes along.

I think, you know, I'm a hematologist by training, a blood doctor, so some of the blood complications are rare but fascinating.

We also are now seeing some long-term pulmonary complications.

There's clear data on cardiovascular complications, so this is a bad virus.

You don't want to get this virus, and again, as we've been saying, the best way to prevent this is to get vaccinated.

But let me just say one thing.

Vaccination really does two things: It protects you, but also it protects other people.

So when you get vaccinated, you're helping others because then you're not transmitting the virus to people who may in fact get more sick than you with an infection.

-Dr. Duke, I want to come to you.

Let's talk a little bit about we hear this sometimes, of mutation of something as well, too, especially if we haven't reached whatever herd immunity tolerance is.

I mean, we see that maybe with the delta variant, I don't know if that's considered a mutation.

Is that a big concern as well?

(Dr. Cindy Duke) Absolutely, and the delta variant is a mutation.

I think what people need to know is every unvaccinated person who gets infected has the potential to become the new source of a new variant.

So I know many people are very worried about what about other variants?

Well, if you're unvaccinated, that's you.

You're the potential new source for a mutation that leads to a new variant that can ravage your community.

So that's where I think we need to talk more about that community responsibility and how the individual can help their own community because many people are scared of variants, but they think variants happen in far-flung places.

Variants are going to happen right here amongst us if we don't get vaccinated.

-Brian, the most obvious question here is why have our vaccination rates gone down?

I want to give our entire panel the chance to share their perspectives here.

What are some of the main reasons?

-I wish there were a simple answer.

It's a number of different things.

If we had a simple answer, we could target that and we could get the vaccination rates up.

We've gotten past that initial group of people who really wanted to get the vaccine, and now we're into the rest of the community who has a number of different reasons for not getting vaccinated.

Some people are concerned about the health effects of it.

There's a lot of misinformation about the safety of the vaccine and the long-term consequences of being vaccinated.

And then there's different groups that have been historically mistreated in our community that don't trust the government and don't trust these vaccine campaigns.

Every one of the people that are not getting vaccinated have their own personal reasons, and that's the challenge.

We kind of have to go almost door to door and deal with them on an individual level to figure out why they don't want to get vaccinated and do something about it.

-I think there's really two things.

I think one thing is, you know, we have to bring medicine to the community, not the community to healthcare.

So as Brian said, we need to get into the communities to vaccinate people.

The other thing is I think social media has really been, unfortunately, problematic with vaccination.

With social media anybody can become an expert, and there's really a lot of misinformation.

This is a safe and effective vaccine.

That's the bottom line.

As Brian said earlier, the only way to get to the other side of this pandemic is with widespread vaccination.

-Christina, let's quell some of those concerns.

Let's talk about the safety of the vaccine itself.

-Yes, absolutely.

I mean, obviously the social media aspect is huge, and I think unfortunately, when it comes to public health messaging, we did have some challenges at the federal level with getting that information communicated out, you know, to the public.

Part of our kind of decline, our precipitous decline in the number of individuals wanting to get vaccinated, came from when we had the pause at the Johnson & Johnson vaccine, right?

So those individuals who maybe were on the fence about getting vaccinated, it gave them a reason to say hey, look.

That vaccine?

Look, it's causing blood clots.

I'm not going to get it, right?

So it kind of gave them license because we took that pause, and even though it was in an abundance of caution and they are still extremely rare, it caused people to have that reason and that seed of doubt.

So again, when we go back and look at all of the vaccines that are currently authorized, they are all extremely effective and safe.

And even now that we're seeing-- you know, ACIP just came out with another statement talking about the newer cases of myocarditis and that potentially being associated with young males being vaccinated with the messenger RNA vaccine.

They've come out time and time again saying benefits far outweigh this risk, and again we want them to know these potential side effects are extremely rare and you getting this virus is much more detrimental than you having potential side effects associated with the vaccine.

Safe, effective, all of the different vaccine presentations that we have right now, almost 100% effective at preventing hospitalization and death.

-Preventing hospitalization and death.

Dr. Duke, I want to go to you and talk about something Christina mentioned.

The RNA factor of this is something that raises a lot of eyebrows.

It's a big concern.

It's something that's new for a lot of us to hear.

Can you walk us through exactly what that is and give us some assurance of why that is a safe method of vaccines.

-Well, I think the first thing that people need to understand is the mRNA technology has actually been around for well over a decade.

So while we keep using the word "new," it's not new to the world of science, nor is it new in the context of vaccines or therapeutics.

So we have been testing and have actually already authorized vaccines using mRNA technology for things like Ebola-- remember that scary one that we all think about?

There's a vaccine that's mRNA based.

The other thing is mRNA is actually utilizing what we know about normal human cell biology.

It's actually really amazing in terms of the concept, but most importantly it doesn't stay around in your body very long.

It is safe, it does not integrate with your DNA because it doesn't even go into the part of your cell where your DNA is, and it's very important that people hear that.

I think the other thing people need to hear is usually we say risk versus benefit, but we don't really explain what risk is, and I think that leads to a lot of fear that is actually very unfounded, but understandable if you don't explain it.

So for example if we take the Johnson & Johnson example with the blood clots, when people heard that, no one countered by saying let's talk about the blood clots that COVID-19 infection causes and just how many we see.

And let me tell you, it's blood clots that can lead even to sexual dysfunction; blood clots that lead to amputations; blood clots that can lead to heart attack, stroke, kidney compromise in very high rates.

But people weren't hearing that part, nor were people understanding the pause, for example, on Johnson & Johnson was really a part of our safety mechanism.

It shows just how much you can trust the process of vaccine, clinical trials, and that all of our stops and checks and balances are in place, and that's really what that was.

It wasn't that something scary was happening or that we should stop vaccinations altogether.

-Yes, it's a great point, the comparable risk is not something that we definitely get in the media.

Brian, I want to come to you.

Let's talk about where we can get the best information.

Of course we are all struggling to find the right information, and a lot of times that falls on our own shoulders to find it on our own.

Give us some reference points, or what are some good resources for us to reach out to?

-The place I always look to first is the CDC.

They have the best public health information.

They have the latest science.

They have stuff that's been verified.

It's not something that's just being spread on social media by a friend of yours who saw something and posted some misinformation.

Basically, those trusted people.

Beyond that, it's the physicians in your community.

It's your doctor, it's people you trust to get health information.

You know, if you're making a major decision about your healthcare, you should probably listen to your doctor before somebody who put a video on YouTube or Instagram or something like that.

So those those commonly trusted sources are the best places to go for information.

It's going to be the most accurate, and it's actually verified by real scientists and not somebody just trying to get "likes" on their social media feed.

-And for those that are a little bit hesitant on the government side of this, the distrust of government here, are there non-governmental agencies that are really good resources maybe to look to?

-We have a lot of different agencies in our community that are working right now to vaccinate people in our community.

Immunize Nevada is leading the charge here and providing good information.

It's a non-governmental organization that's heavily involved in this.

They know the same sort of things that the rest of us do.

They base it on the science, and organizations like that are able to provide good accurate information that will not just discuss the positives but the risks as well.

We don't want to just paint it as something that's absolutely perfect, because there are risks involved in anything that you do.

But really, it's that comparison of the risks that matters.

You have to look at what's the risk of dying if I get vaccinated versus what's the risk of dying if I get the disease, and the risk of dying from the disease is way larger than anything negative that's going to happen from the vaccine, and that's what we want people to think about and not treat those things as equal.

That's kind of been a big challenge.

It's hard to get people to compare risks accurately.

The way I always describe it is every time the Powerball jackpot spikes, everyone drives to California to buy a ticket thinking they're going to win, and nobody thinks they're going to get in a car accident and be injured or die on the way there, but that car accident is much more likely.

We're just not very good at making comparisons of risks.

We know things like getting struck by lightning is rare, but beyond that, we're not very good at making those comparisons.

So that's why we have to look at accurate information from places like those government agencies and healthcare providers.

-And the comparison piece of this is so important.

We want to talk a little bit more about the research side of things.

Coca-Cola managed to market a drink that is not considered very healthy to the American public, but a shot that could potentially save lives has struggled.

The Nevada Week team spoke to an expert in marketing about why.

On a warm July morning at the Southern Nevada Health District, Texas Lopez had a very good reason for getting his coronavirus vaccine.

I just felt like it would be cool and I didn't want my friends or me to get sick when I went to see them.

And so does his dad, Felipe Lopez, who got his shot as soon as possible but didn't hesitate to get his kids vaccinated.

We did have some other views coming in, but no, I mean, I think it's the right thing to do.

Alexandra Lark wasn't sure at first, but changed her mind about the vaccine.

I had a few concerns because I did hear things especially with women and reproductive issues, so I just wanted to wait a little bit and see how people were reacting.

Now she's fully vaccinated and happy to go without a mask.

My sister's about to get married, so it'll be nice to be maskless for that.

Professor Angela Christian studies marketing at UNLV.

She says getting people to want the vaccine is different from trying to get them to want a car or a new phone.

You get the phone, you feel like you've got this immediate coolness, right?

So how do you create that same effect with something that is not ultimately going to give people that feeling of trendiness and coolness?

Christian said people who are undecided about the vaccine may be persuaded with an effective appeal, and for something like a vaccine, that can be fear.

We don't need a fear appeal for a car, right?

We have beautiful cars, right?

Guess what we need a fear appeal for?

Insurance, right?

What sells car insurance?

You see these ads where, you know, it's a wrecked car and people are crying.

Same thing with medical insurance or life insurance.

Those kinds of appeals, those kind of fear appeals are very effective when it's basically an unwanted thing.

She said another way to appeal to people is through a positive approach, giving them something positive and the vaccine at the same time.

Instead of saying if you don't do this, you will face this consequence, which is the fear campaign, and it can work; we also can in parallel try to do as many of those "if you do this, we'll give you this."

As an example, she said a community could hold a food festival and offer vaccines as part of the event.

Christian also recommends that any ad campaign for the vaccine include people who look like the communities being targeted.

We've got to get more representation in these ads because otherwise again, you're not going to get those different diverse groups that are not represented.

She said research shows if people see themselves in an ad, they're more likely to respond to it.

Another angle is knowledge.

She said simply teaching people about the vaccine can help.

We can't assume intent, you know.

We can't assume that because somebody is not getting vaccinated, they're a mean person or they have some negative intent.

It could very well be they just flat-out don't know.

She said consumer education can go a long way towards people making better choices.

Overall, Christian said the vaccine sits in a place between private and public needs, making it a difficult message to get across.

It's just like insurance.

I mean, I can compare it to car insurance because you need to pay for it individually.

But if you don't have car insurance, right, it's a problem for society too because now you're running around, you know, potentially creating problems.

She said an effective campaign needs to hit on a lot of different values from cost, by reminding people of the expense of going to the hospital to be treated for COVID-19, to functionality, conveying the message that it is a good product that people need.

For Nevada Week, I'm Heather Caputo.

Thank you, Heather, we appreciate it.

Brian, I want to go to you.

Let's talk a little bit about this middle that Angela was talking about.

We have those that have been vaccinated, those that probably are never going to be vaccinated, but we do have a population here that potentially could.

Do we have an idea of what that population is, demographically speaking, here in Southern Nevada?

-For certain factors we know, but I don't think we have the best picture of exactly why every single person doesn't want to get vaccinated.

It's really an individual issue, so even if you look at those community trends and say this is the big picture, we still have to look at the individual and why they're not getting vaccinated.

There are campaigns that we may say it may work for this group that they're part of, but as an individual, they'll be resistant to it because that's not their exact reason.

So it's not a simple thing of saying here's what it is at the community level.

It's really that individual approach that we have to take pretty much to convince people because they have individual reasons for not getting vaccinated.

-And Dr. Khan, let's get your perspective too.

We've already talked about knocking on doors.

It really seems like that might be where we are at.

Is that the right strategy for us?

-Again, I think any way that we can get vaccine to people is what we need to do.

Again, we want to make vaccine administration as convenient as possible.

As you said, you know, there are people who aren't going to get vaccinated.

We can continue to try to change opinion, but we have to-- and then there are people who have already been vaccinated.

It's that middle group that you talk about, and really access, we don't want access to be the issue for why people aren't getting vaccinated.

We know in countries like Japan where there's actually not enough vaccine supply, that there are problems that have even led to no spectators at the Olympics this year.

Fortunately in the United States, we have vaccine available.

We just need to get it to people and into their arms.

-Access is a great piece of this.

Christina, you've been on the frontlines here administering vaccines.

We talked about events at the end of that clip, and you've done this, right?

You've incentivized it with some things there.

I mean, is this an access-- is this an access barrier at all?

-Yes.

I think, you know, we need to meet people where they are, right?

And especially those high-risk individuals, communities of color, marginalized communities like the LGBTQ population.

You know, those are some of the places that I particularly wanted to go in and try to see if we can incentivize and help, you know, doing things like having live entertainment, having giveaways, right?

So Immunize Nevada, they have all of these great little tchotchkes that they'll send you for free, you know, little buttons and masks that say "I got vaccinated."

So that and then also with our youth, it really is about that no-trust factor, right?

So if someone in their peer group gets vaccinated and talks about them having a positive experience, they're more likely to want to get vaccinated.

So I think when we talk about the movable middle, right, that's what we need to go to, and how are we getting those individuals that are on the fence?

How do we incentivize them?

Then how are we looking at their peer groups and looking at what is their "why," right?

It was really easy when we had our grandparents that wanted to go see their grandkids, right?

It was really easy when we had these people with chronic medical conditions.

They were lining up, right?

But now this population that doesn't think they're going to get that sick if they get it, there's not really this push that they think they need to get vaccinated.

So it needs to be part of their peer group.

It needs to be part of their "why."

-There isn't the push, and I want to talk, Dr. Duke, about one of the big concerns for this movable middle population.

Let's go to the 20-29 and the 30-39 demographics are also disproportionately low, and fertility comes into the conversation a lot.

Talk a little bit about that.

-I think it's important to talk about fertility development because those are some of the big ones we hear people cite when they reference not wanting the vaccine is well, what about the development in teenagers and 20-something year-olds?

We're concerned that this may permanently impact their hormonal development, or is it going to permanently negatively impact their ability to conceive?

So it's important to first highlight that that is a falsehood, a complete falsehood.

These vaccines, not one of the three vaccines that are authorized in the United States will lead to hormonal changes that are in any way permanent or negative in anyone.

Secondly, when it comes to the question of fertility, and many people are citing the reports we're seeing regarding periods, right, which that is a clear sign.

The truth is we actually see period changes with any inflammatory change in our bodies, and most people who are menstruators, meaning people who have periods, will admit that when they've had a cold or if they've ever had an infection, they actually noticed a change with their period.

Well, the same thing happens when we give you a vaccine because we're actually amplifying your immune response to prepare it if it sees the perpetrator the next time around with a spike protein to know what to do.

So usually when that happens, you'll see that someone's period, depending on where they were in their cycle, it might be a little bit longer, a little bit heavier.

Some people will even notice it's shorter, but it's very temporary.

One or two months, depending on whether you're doing a one-dose vaccine like the J&J vaccine, or if you're doing two doses, like Moderna and Pfizer.

As for ability to get pregnant, it doesn't negatively impact pregnancies; in fact, if you got COVID-19, your risk of pregnancy loss is significantly higher.

Similarly, the risk to the baby that's born is higher and to the pregnant person.

-There may be an effect of COVID also on male fertility.

So if you get COVID, that may actually lead to infertility.

Again vaccines, you know, there's no data as you said that the vaccines cause infertility in any way, shape or form.

-And we should mention on the male side, that's a concern.

That's been a vaccine concern, to have infertility as well.

-Yes, no data.

And in fact, some data that act of infection can actually affect fertility counts to drop.

-It causes sperm counts to drop but also it can lead to erectile dysfunction because of the clotting.

-Again, the risk comparison is so important here.

We've got about a minute left, and Brian, I want to go to you.

If you have a loved one and you're in a situation where maybe they haven't been vaccinated and they have some of the concerns we've been talking about here, give us some suggestions on how we can approach them.

-Well, I think the biggest thing is to listen to them and find out why they don't want to get vaccinated.

What exactly are their reasons because then you can deal with those individual reasons.

Some people are concerned about the safety of it, and you can provide that safety information.

You can explain to people how many people have been vaccinated worldwide.

We've given out billions of doses, and if we had major problems, we would have seen those things by now.

If it's a number of conspiracy theories or falsehoods or things that are out there on social media, you can start to talk about those and why they're not correct.

And then as Dr. Khan said, it's also not just for them, it's for the community.

If you get vaccinated, you're not just protecting yourself, you're protecting your family as well.

-Well, thank you so much.

We're out of time, but we really appreciate this conversation.

And thank you, as always, for joining us this week on Nevada Week.

For any of the resources discussed on the show today, please visit our website at vegaspbs.com-- I'm sorry, vegaspbs.org/nevada-week.

You can also find us on social media at @nevadaweek.

Thanks again, and we'll see you next week.

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