An Interview with Mike Popovich by Dale Dauten,
Special for the IINews

Mike Popovich, CEO of STChealth has been working with vaccination data for 33 years, since STChealth’s founding in 1988. He’s worked with dozens of federal and state agencies and has even been repeatedly called upon by the White House’s tasked health officials. And because he began his career in engineering, he has that engineer’s need to figure out how to make things work and how to make them better. So, who better to talk to about the future of vaccination information and about its role in public health?

DD: You’ve been running a private business working with public health for decades, how are you feeling about the state of public health after these pandemic years?

MP: My thoughts keep coming back to this: it is the individual users of health care that matter, as they are the ones who validate just how good the public health response to the pandemic has been. Individual users are the ones that create the trust in public health.

DD: But aren’t they mightily influenced by the media?

MP: Trust rises up. It is not the news media, social media, bloggers, or the political players that create trust; in fact, it is not even the WHO, national, state or local public health agencies, NGOs, or private businesses in the vaccine disease prevention space. All these folks are just doing their job the best they can. The trust in what they do will actually arise from people as they hold the public health folks accountable.

DD: I think I understand your point. I trust, not because anyone told me to trust it, but because I have direct individual experience. And, a better example, come to think of it: I trust the Postal Service, even though for years now I have often heard it criticized. So where does that leave us? You have several hundred million people to persuade, one at a time?

MP: That’s right. We have the technology and the data to do just that. One good way is by empowering every individual to have access to their immunization records in the public health IIS (immunization information systems) of each state. You empower individuals to hold public health accountable to provide their accurate immunization records, and to provide them notifications of what and when they are next due for any vaccine-preventable disease. This allows people to travel, attend events, restaurants and enjoy areas where vaccine proof is required. It allows them to enroll their kids in school, summer camp, play sports, and so on.

If an individual has easy access to secure information, and their immunization records presented to them match the shots and dates they received them, they trust the data, along with the health information system and the organizations that provided this information. Individuals trust their clinical providers, pharmacists or clinics to provide them with the right immunizations. But because, over time, they can receive new immunizations in many locations, they cannot count on an accurate record from anyone of the past vaccinators, or for that matter, their health plans. But all their “shot records” end up being reported by each and every one of the providers to public health — and public health becomes the only source for a consolidated history of an individual’s immunization records that range across a lifetime. Empower individuals with this information and it’s like your example, when it matters the most.

People will expect their immunization providers to report all their immunizations to their state public health information system. They will expect public health to provide this information to them on demand and keep them advised when they are due for their next immunization, just like their car maintenance program, a trip to the dental hygienist or annual pet veterinarian visit.

DD: All those places send out what they call a “friendly reminder” and that’s just how it comes across – helpful and friendly.

MP: Exactly. People will trust public health as a health partner not as just another government organization telling them what to do. In turn, public health must become 100% accountable to the individual, first and foremost, and second to the clinical communities and the remainder of the vaccine ecosystem. This has not been the case. But the pandemic has begun to shift and change the mindset of public health officials who understand how much easier it is to do their jobs when the people are behind them. This ground-up approach begins with the state public health programs but also pushes up to the federal level and CDC. Remember that it was the CDC that had the vision, nearly 30 years ago , to empower state public health agencies to develop and implement immunization information systems. They have had the vision and offered dollars and support to states to create, grow and expand these systems initially focusing on school age kids but now everyone. And thank God they did.

Having lived and worked in this area for years prior to this Covid pandemic, back with H1N1, Zika or the smaller outbreaks, public health agencies catered mostly to provider communities and were accountable to their peers and federal agencies like the CDC. Very few in the health industry understood or used the information in these systems to the extent that was demanded in this current pandemic. When you’re accountable to your peers, trust is only to this level; but, if your accountable to every individual that has a record in the IIS, you can go to a whole new level of trust.

DD: So how do you see vaccine data — or, as I know you prefer to call it, immunization intelligence — making a difference going forward?

MP: The number-one lesson learned from every outbreak has been the public demand from government for accurate, timely, and transparent communication. And the number-one action individuals can take to reduce their risk of a vaccine preventable disease is to get and maintain their immunizations. So, the question is, how can we get there fastest?

A good news story to come out of the pandemic is that we have started to empower individuals: This is occurring as we speak. National pharmacy chains provide services to 90% of the U.S. population and all are providing immunization services. Many independents pharmacies are new immunization providers help close gaps with many of the hard to reach populations across the country. All are providing trusted and direct lines of communication to individuals while at the same time reporting their immunizations to IIS with their jurisdictional public health agencies. This information is reported daily to public health. It is accurate and timely, allowing public health’s technology solutions to combine patient histories within their records. All this is occurring across a national pharmacy and clinical provider communication network. The individual now knows they do not need to ask “where is my data?”; they now can ask, “how can I get a copy?” and know what is needed and when. Public health has done a good job collecting and storing the information; now, they need to provide this immunization intelligence quickly and on demand to all of us.

DD: One thing became clear over the past two years, that pharmacies have the knowledge and wherewithal to undertake massive efforts. We all acknowledge the sacrifices of hospital staffs, but we have to add pharmacists to the list of heroes.

MP: And we can tap that expertise and energy to get ready for the next pandemic.

DD: I see you smiling. Good thoughts to end with?

MP: I was just reminded of an idea I had the other day. It was about what I would do if I were the director of CDC for one day. And I would want all 300+ million people to contact me and tell me if their information was correct, in the immunizations systems our vision created some 30 years ago. Was it easy to retrieve and useful? And, if not, how I could make it better? [Laughs.] It’s a lot of calls, but what could be a day better spent?

Giving Future Voters a Safe Start!

By Bill Davenhall, Geomedicine Analyst

“When you have kids – well, that’s all you have!” So remarked a speaker at an economic conference many decades ago, early in my professional life. I laughed then, but soon understood what the speaker really meant, learning from my own economic experience with having children. Nonetheless, kids are where future wellness practices really get started. Having a better understanding of where the kids of the future will grow up and receive preparation prior to voting age, would be useful.

In 2026, there will be over 73 million kids (persons under 18 years of age) in the United States, spread across the country in various geographic clusters in which approximately 145,000 kid’s physicians – pediatricians and obstetricians – also live. That’s not as many medical doctors as you might expect. In reality, taking into consideration retirements and administrative positions, probably there will less than less than 135,000 in active practice across the United States.

The map below illustrates where 80% of under 18-year old’s will likely grow up and receive most of their health education and health care before they get the right to vote! Of the 306 Health Referral Regions (HRR’s) in the US, only 45 (15%) of those referral areas will account for 80% of all those under 18 years of age. It also might suggest that generalizing about physician supply for children can be deceptive. Local communities that lie within the dark green geographies will certainly have their hands full!

This picture suggests to me that we may have to look at our healthcare delivery system a bit differently. As we increasingly experience “seamless and borderless communications,” the delivery of and the statistics about many health care services, constrained by traditional administrative geographies, may be inadequate. My own health practices today are a good illustration of what we face: I have a collection of nine different county health departments across six state health departments, with no less than 30 individual physicians practicing in those 15 public health jurisdictions. The phrase “patchwork quilt” comes immediately to my mind.

2nd opinions always appreciated.

Notes: HRR’s by Dartmouth Clinical Evaluative Institute based on Medicare Patient Origin Data 2018; Physician Specialty Counts (NPI, NEPPS, and Medicare), Scan\US, 2021; Population Projections for 2026 by Scan\US LLC and US Census Bureau (2020); map narrative and illustration by author (2022).