The reason that the United States hasn’t been able to reach higher vaccination rates is because of leadership failures. It’s really hard for leaders to lead transformational change during stable times. It’s infinitely harder to lead in a VUCA (volatility, uncertainty, complexity, and ambiguity)-dynamic world, but not impossible.

It’s the timeless leadership challenge.

How do you help the people you lead get from A to B?

This exchange between Fox Sunday host Chris Wallace and Nebraska Governor Pete Ricketts makes it pretty clear that both Wallace and Ricketts are correct and that each of their responses is rational and appropriate.

Wallace wonders why parents object to getting their children vaccinated for COVID but not other required vaccines needed before attending school? He notes that when he was a child, his parents and many others didn’t hesitate when the polio vaccine first came out. So what Wallace highlights is that vaccine requirements have existed for a while, and in the past, when Americans were faced with debilitating illness and given the choice of a vaccine, people didn’t hesitate.

Ricketts notes that for other vaccines like diphtheria, tetanus and pertussis, polio, measles, mumps, and rubella, hepatitis B and chickenpox, there was a long rollout and familiarity people could see and so they felt comfortable. This feels different and having a federal mandate may actually decrease trust. “This is a process that’s going to take time to bring people along, and that’s why it should be a personal choice and not something mandated by the government.”

So, where’s the gap in leadership?

What Wallace correctly implies is that the role of leaders is to lead the people to where they need to go, and in the times of a public health crisis, we need to move more quickly. Rightly he wonders why is it different in times of COVID compared to polio?

Ricketts provides the clues: “People out there who don’t know what to trust and in fact this is really an outcome of what the CDC has done because they flip-flopped on so many issues, whether it’s masking, or whether you have to mask if you’ve been vaccinated and so forth. There’s just a lot of people out there who don’t know who to trust right now.”

This is also where Ricketts falls short of being a leader. Instead of avoiding phrasing loaded with emotion like, “The president has forgotten we live in America. He thinks we live in the Soviet Union, and the hypocrisy of this is just unbelievable,” Ricketts could have said lead with more empathy and understanding about the VUCA world we live in and that scientists and physicians have been facing since the beginning of COVID.

For example, “I understand where President Biden is coming from. There is an urgency to get fellow Americans and Nebraskans vaccinated as soon as possible. These federal mandates however will make my job harder as people already are uncertain what the right thing to do is.”

He could have followed up by also addressing the changing recommendations of the CDC by saying accurately:

“It’s true that people are confused by the multiple changes in CDC guidance. Unlike the past, where the science of various illnesses was well known, like the ones you raised Chris, the American public has been witnessing the scientific discovery, all the stops and starts that come with dealing with a new disease, in full view for all to see, warts and all. As we learn more, we can continue to expect guidance to change periodically. However, I’m confident that over time we will look back at 2021 and mid-2022, we will know how we best protect our children, adults, and elderly as our understanding of the virus continues to evolve and improve.”

To be candid, this would have been an incredible statement by any governor and instead should be coming from public health leaders. Though Dr. Fauci and others have said the same thing with “follow the science,” what public health leaders have failed to do is provide adequate empathy even as the pandemic rolls on to year two, March 2022, even as their own patience, endurance, and mental wellness wears thin. Even as President Biden and business leaders put mandates in to improve overall vaccination rates, those who are truly against vaccines will resent it and find other places to do business or work. Not ideal, but sometimes mandates are needed for a company or organization to survive change and to happen at a faster pace than leaders would like to bring people along.

Although I’ll assume that Governor Ricketts is factually accurate in this statement, “At last year in Nebraska, if you were aged 10-19, you were 26 times more likely to die in a car accident than you were of COVID-19,” in a dynamic VUCA world and a raging COVID pandemic, this sound bite could be wrong a year from now when reflecting on how 2021, went for Nebraska. It’s hard to make predictions about a VUCA world that is increasingly dynamic.

How to close the leadership challenge and end this COVID chapter

It takes a lot of work to be a good empathetic leader and lead the changes necessary for organizations to succeed during normal conditions. The degrees of difficulty are infinitely higher when you have a public health emergency of unknown duration, evolving scientific discovery and treatments, and important and nuanced discussions boiled down into tweets and sound bites. So if we are to protect our friends, neighbors, and communities, leaders need to understand and implement the following.

Invite conversation and set the stage. What are people most worried about? What do they need to make the changes happen?

Set accountability and deadlines. At some point, a leader has to move forward. The president has mandated vaccines. He could also ask governors to have X percent vaccinated by a certain date just like they did for July 4th or that ICU/hospital capacity never falls below X percent.

Understand how to address the four elements that often shoot down good ideas – confusion, fear-mongering, death by delay, and personal attacks. There are plenty of examples available since the COVID pandemic and the discovery and deployment of the vaccine. To add more complexity, because knowledge of the illness is evolving, that understandably will cause even more confusion than in other situations. Note President Biden attempts to address the confusion in his address to the nation.

Scaling this to the finish line will need different strategies and tactics – we are moving from an air war to a ground war. It will be leveraging 1:1 conversations, and President Biden called this out by asking doctors to “reach out to your unvaccinated patients over the next two weeks and make a personal appeal to them to get the shot. America needs your personal involvement in this critical effort.” As one of my colleagues taught me once, it takes repeating things at least 17 times for change and understanding to occur. An address to the nation, a vaccine available in late 2020, and a variety of other programs and roll outs, got us to our vaccination rate today. It will take more 1:1 conversations and more work for all of us to get to the next level.

Ultimately, it’s not about the COVID vaccines alone, as Chris Wallace notes, since schools have mandated vaccines for children to attend school. As Governor Ricketts noted, it shouldn’t be just about vaccination rates alone, it should be whether the health care system can handle both COVID and non-COVID cases.

If the vaccine is the best way to decrease hospitalizations and preventable deaths, that is the best course of action, but people are confused (see changing CDC guidance), scared (see: fear-mongering about the vaccine), death by delay (I’ll wait until there is more data, a mandate, etc.), or personal attacks (directed at the leader leading the changes). In his mind, President Biden’s federal mandate makes Governor Ricketts’ job harder.

But for President Biden, he can’t wait. It’s time to go. Leadership isn’t about leading people when times are easy, but when times are hard, the future uncertain, the data never quite adequate, and you wish you knew more. This is why this change, getting the entire country vaccinated at a rate for all groups, which has never happened before for any other disease, and a scale and speed that is unprecedented has been and will continue to be incredibly hard.

When we look back years from now, it will be commonly accepted that we always wear masks in certain situations, and we always get vaccinated in certain situations. Until then, the leadership challenge has and always will be how do you help the people you lead get from A to B?

Davis Liu is a family physician.   He is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely. He can be reached at his self-titled site, Davis Liu, MD, and on Twitter @DavisLiuMD.

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