It’s that time of year when we get to reflect on what we learned over the course of this extraordinary year…  

1. We’ve entered The Golden Age of Vaccines.

That was the message from Dr. Scott Hamstra, a man who has spent 30 years working with infectious diseases and with vaccination programs. He added, “We are creating a safer, better world. People can whine about problems, but we are creating a better world, helping people live a healthier, happier lives.”

As evidence of having entered the Golden Age, Dr. Hamstra offered David Bloom’s chart showing the number of new vaccines steadily rising while the introduction of new antibiotics has been declining. The introduction of antibiotics peaked in the 1950s and 60s (the Age of Antibiotics), giving way to vaccines as the preeminent infectious disease tool.

Dr. Scott Hamstra summed up how to think about The Golden Age:

“Yes, there are plenty of deadly pathogens, yet vaccines have been making a leap that is as impressive as going from trains to planes or from wall phones to cell phones. If you aren’t excited, just stop and look at how fast and how far we have come.”

2. We put vaccine hesitancy in perspective.

Vaccine hesitancy derives from rumors and you can’t browbeat them away; rather you redefine your efforts as rumor control. That’s the conclusion we came to after studying Stuck: How Vaccine Rumors Start and Why They Won’t Go Away by Dr. Heidi Larson.

(Photo: Dr. Heidi Larson, from VaccineConfidence.org)

Dr. Larson argues that is there no chance of eliminating anti-vaccine sentiments. For one thing, the concerns are nothing new: “The first anti-vaccine league was founded in the mid-1850s when emotions raged in the United Kingdom against a law making smallpox vaccination compulsory.” And then there’s this overriding conclusion: “One of the key reasons why there will always be vaccine rumors, some more benign than others, is that vaccines will always have risks.”

3. We sent some love to the nation’s pharmacists who became the nation’s vaccinators.

We stopped to recognize the epic accomplishments of the nation’s pharmacies in responding to the COVID-19 crisis.

“There’s still a lot of emphasis on pharmacies to continue to play a strong role in administering vaccine, and over 70% of doses are currently administered through pharmacies.”

Lori Tremmel Freeman

CEO of National Association of County and City Health Officials

Yes, 70% is impressive. And let’s not forget that it has only been since 2009 when the last state (Maine)  gave approval for pharmacists to become vaccinators. Further, it was just last October that the HHS issued its guidance that pharmacy techs would be allowed to administer Covid vaccines, overriding state laws to the contrary.

Given that opportunity, the nation’s pharmacies came through with a stunning success. In doing so, the pharmacy vaccinator corps got built, and that’s great news for the future of vaccination programs. Sandra Leal, President of the American Pharmacists Association, gave us these numbers earlier this year:

“APhA has trained more than 100,000 students, pharmacists, and pharmacy technicians to administer COVID-19 vaccines (and other immunizations) since the start of the pandemic. That’s 80,000 techs, with the remainder being students and pharmacists.”

Jason Briscoe, a pharmacist who is Director of Pharmacy for Discount Drug Mart (DDM), a chain with 76 locations in Ohio said this of his pharmacists and their teams:

“You hear the word ‘hero’ all the time about athletes. I admire their willingness to enter ‘the arena’ for all to see, including critics. But you know what else is heroic? Our pharmacists’ and our technicians’ willingness to enter ‘our arena’ providing invaluable patent care while operating within a pandemic. It’s a lot. But you see the big picture and you’re proud of being able to help your patients and your community. Nobody has tapped out. Nobody has said, ‘It’s too much.’ Nobody.”

4. We felt a little better about how federal funding works.

We turned to a couple of Washington insiders, both working to write and/or influence legislation, Brett Meeks and Jennifer Steger with Horizon Government Affairs (HGA), for their insights.

Photo: Brett Meeks (left) with his old boss, Lamar Alexander

When asked about misconceptions about the work they do, Meeks was quick to point out, “You read that Republicans don’t talk to Democrats, but there are constant negotiations between staffs and things are getting done.”

Jennifer Steger pointed out that a current piece of legislation, HB 550, called the “Immunization Infrastructure Modernization Act of 2021” was introduced by Rep. Ann Kuster, a Democrat from New Hampshire who was joined by Rep. Larry Bucshon of Indiana, an M.D. and a Republican. The bill now has 14 co-sponsors, ten Dems and four Republicans. “Most of the people who went into public service,” Steger asserted, “did so for the right reasons.”

“Our involvement means calling on Republicans and Democrats.”  Meeks added, “People are drawn to public service to serve and they keep at it, trying to right wrongs.”

It’s an appealing picture: earnest and thoughtful staff members working out legislation and implementation while the politicians huff and posture out front.

5. WHAT’S TRENDING? We got advice from the “godfather of influence.”

Dr. Robert Cialdini is often ranked as the country’s leading social psychologist (yes, there are rankings of such things) and his books have sold over three million copies. We talked with Dr. Cialdini, sometimes referred to as “the Godfather of Influence,” earlier this year to get his advice on creating a vaccination program and how to deal with vax hesitancy.

When it comes to persuading those who aren’t sure they want the Covid vaccine, Dr. Cialdini said this:  “The most important recommendation I’d make is to use the word trend. We’re seeing the number of people who don’t want the vaccine is falling. Let’s say that there were 40% who didn’t want the vaccine, and now that number is down to 30%. It would be a mistake to use just those two numbers. That’s because 40 is a statistic, 40 and 30 are a difference, but, if you say, it used to be 40, then 35, and now it’s 30 – that’s a trend.

“There’s magic in a trend because we know that people believe trends will continue and so the trend implies that they should get onboard. It’s what we call social proof. Don’t cite a statistic or a difference — show a trend.”

5. We wanted to be wrong, but…

Back in April of 2021 we pointed out the ugly math of global vaccinations, pointing out that when then President-elect Joe Biden announced the goal of 100 million vaccinations in his first 100 days, it was a dramatic call to action. Then, the goal grew to 200 million. But contrast those targets with the goal of COVAX (an international partnership led by the WHO):  TWO BILLION doses administered this year. Sounds daunting, but there’s still a problem: The global population is approaching EIGHT BILLION.

With those numbers in mind, we turned to our favorite epidemiologist, STChealth’s Dr. Kyle Freese (photo below), to ask just how worried we should be.

He responded, “It depends on how the variants play out and how many people we can actually get immunized. My worry isn’t consistent across geographies. Low and middle-income countries have me worried.” (Let’s pause there to point out that Dr. Freese traveled extensively in South Africa and Zambia for his graduate study research.)

“It worries me for a number of reasons: one, it has a large rural population with limited access to healthcare,” he continued. “Two, there are pockets of vaccine-hesitancy, the underlying reasons for which are not always easily overcome. Three, data collection is limited. Four, vaccine distribution is difficult, both because of the geography and the fact that many vaccines must be kept in certain conditions throughout the supply chain; that is, cold chains.”

Then he added, “It’s places like sub-Saharan Africa that scare me the most because variants could spread quickly and without controls.”

Right. Enough said.

6. And that when we needed uplifting thoughts…

When in a later issue we confessed to Dr. Freese that we were getting disheartened, he said in response:

 “When I get in a glass-half-empty mood, I tell myself this: We don’t have the luxury of thinking small. We have to think globally. Yes, people are exhausted and they have a right to be. But we have to find another gear. I don’t want to raise my kids where it’s normal to live with the threat of underlying disease. What can we do overcome this?

“Think of the tremendous successes we’ve had.  Over the last few decades, we have made tremendous strides in reducing childhood diseases. Think of all we have learned over the last year. And think of a billion vaccinations in just about five months. In public health, we learn as we go. And we’ve learned that we have the ability to do this. And we will. It can’t just be the work of a few scientists; we must have the buy-in of everyone.”

Okay, that’s uplifting. 

7. And, lastly, 2021 was the year the White House called…

STChealth President Todd Watkins remembered STChealth’s first meeting with White House officials: “When you get an email on a Saturday afternoon for a meeting Sunday morning, you know they’re not wanting to just tell you how great a job you’re doing. But we didn’t know the nature of the call. So, we spent the evening prepping and running through possible scenarios. And then Sunday morning I watched the morning news show. There was CDC Director Dr. Walensky talking about vaccinations. Then, a couple of hours later, there she was again – same outfit, same CDC background as I’d just seen on CNN – on the Zoom call with us.”

Also on the call was STChealth VP Tiffany Dent, who recalled this: “What they wanted to talk about was COVID-19 data, of course, and we were soon to learn that they were paying attention to STChealth’s numbers – really paying attention. By that time – this is June of 2021 – a large proportion of the shots were being given at pharmacies and nearly all of that data flows through STChealth’s IMMSlink. Something approaching half of the vaccination records were being sent to us. We’d gotten our success rate up to over 90% and climbing, but what they saw – this was two days after the president announced his July 4^th vaccination goal – was that there were still over 6% of records that were pending or rejected – at that point we were talking about nearly four million records. What I remember best from that first conversation was being asked if we could help the country, and then specifically, ‘Can you get the number to zero?’ And so, we had our challenge.

“So, of course we accepted the challenge – you don’t give STC a challenge and think we’re not going to accept it – and while we didn’t get to zero, within two weeks we are at less than one percent with issues, across the board. We had cleared over three million of the records being held back. We’ve since had half-a-dozen or more meetings with them. The effort has been great and it’s been stressful but it’s what we do. We have been honored to be asked for our recommendations on ways to improve reporting.”

We asked Todd to summarize his thoughts on what it meant to have the White House involved, he said, “There was never any finger-pointing or placing blame. Instead, on every call, they wanted to know how they could help. Whenever we identified a bottleneck, they would ask, ‘Who can we call for you? Can we call the Governor? Can we call the pharmacy chain?’ And they did. There were people who’d been slow walking our requests for change; then, with a little encouragement from the White House, things got done. I truly felt we were on the same team, and they made us feel that we were a critical component in addressing the pandemic.”

We closed the White House issue of the IINews with a quote from a message from STChealth CEO, Mike Popovich, sent to all employees at the end of 2020, just before the COVID-19 vaccines were first being shipped. It turned out to be prophetic for STChealth, but we suspect it applies to you and your work, too.

“There are few times in our life when one can live history. We have been living an era of a pandemic throughout 2020. And so, it will be written in the history books. We all will be able to say we were there. But we were more than just ‘there.’ It is game time… It is show time… It is our time.”

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VAX STATS OF THE MONTH

Who is Your Health Demographic Twin?

By Bill Davenhall, Geomedicine Analyst

Two of the largest Health Referral Regions (HHRs) are demographic “twins” – Can you guess who these twins might be? …Time is up!

Orlando, Florida (#130) and Philadelphia, Pennsylvania (#356) each serve about 4.3 million people with similar demographic characteristics relevant to wellness. One demographic, however, is hugely different — not counting the fact that one is geographically located in the deep south and the other in the Northeast — it’s the number of healthcare professionals that call each region “home”!

Philadelphia has almost one third (32%) more licensed health care professionals (73,224) living in its health referral region than does Orlando (49,531). The Orlando HRR also has 46% fewer primary care physicians (4,242)  and 51 % fewer medical doctors (12,247) to serve its region. How do we know about such health care professional distributions?

Health care professionals are required, by law, to have and maintain unique Federally mandated and assigned NPI (National Provider Identifier) numbers so they can bill any health insurer for services rendered to patients. There are about 4.5 million health care professionals accounted for across the US and just these two health referral Regions (Orlando and Philadelphia) have about 2.7% of all registered health care professionals that the health ecosystem knows about.

Perhaps knowing who is your health demographic “twin” will be something you will want to learn more about. Let us know who you think is your health demographic “twin” and we will send you some interesting data on you and your “twin”!

Make sure you’re comparing apples to apples!

2^nd opinions always appreciated.