If you’re reading this, odds are you are a user of IIS (Immunization Information Systems) and their data. And if you’ve been paying attention, you’ve noticed how the systems have been evolving – becoming ever more useful, especially thanks to the emphasis given to them during Covid. But now, with the pandemic officially declared “over”, and with budget cutbacks, what’s to become of the evolution: Will the systems evolve, be stagnate or maybe even devolve?

This raises the question, Would it be possible to help educate key members of Congress on immunization intelligence and what it is and, more importantly, could be? STChealth decided to jump in and do their part in that mission, having begun visits to D.C. to take meetings with the people writing legislation and drafting budgets. We sat down with some of those who made the most recent Capitol Hill trip to find out just how optimistic or pessimistic we should be.

Before reporting on what they learned about the future of the IIS, we also wanted to share the inside story of just what it’s like to go to D.C. to call on Congress. (If you’ve been yourself or aren’t interested in that side of the visit, just jump to the next section.)

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THE INSIDE STORY OF CALLING ON CONGRESS

The point person for STChealth’s efforts is Kristal Shearin. She got asked to take on that role  after many years at STChealth and before that, working for Surescripts. But she also has unique experience in dealing with government agencies and specifically, fighting budget cuts: “I worked for the State of North Carolina,” she explained, “handling public health programs and the health information exchange. The effort was financed by Tobacco Master Settlement dollars and the legislature in North Carolina was constantly trying to take the funding.”

So, as for the recent visit to D.C., we asked Kristal to take us on a vicarious visit to Congress, starting with getting in the front door. Here’s what she told us, along with a few of her photos.

“As you get close to the Hill, it hits you: this is an amazing place where the laws of our country have been made! You can feel the history. Going into the legislative office buildings, you enter through a security entrance with guards and metal detectors – just like an airport but a little more relaxed. Inside it’s beautiful, there are marble walls and staircases where you can actually feel the indentations of footsteps from others who’ve come before me.

“The Capitol is a little city within itself connected by underground tunnels with banks, stores, coffee shops and plenty of places to eat. There are the two sides of the Hill. The Senate office building has a huge atrium with a contemporary art installation in the lobby. Senators hold longer terms so there are fewer of them, and each office has plenty of space with a lobby area and a conference room for meetings. There are way more House members, so that side of office buildings feels more crowded and, with an army of staffers in cramped spaces, a lot of meetings take place in the hallways or in obscure corners.”

 (That’s Kristal in two of the halls, the brick lined one is a connecting tunnel.)

Finally, when we asked Kristal if she had any advice for anyone visiting Capitol Hill, she said, “Wear comfortable shoes. You end up walking miles a day just going from meeting to meeting.”  (There was one person who has yet to take the sensible shoes advice: “We did see Nancy Pelosi walk past and she was in her trademark stilettoes.”)

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BUT HOW WORRIED SHOULD WE BE ABOUT THE FUTURE OF IIS?

Kristal made the most recent trip to D.C. with three others from STChealth: (left to right) epidemiologist Dr. Kyle Freese, pharmacy veteran Dr. Jason Briscoe, and Chief Growth Officer Tom Groom.

Dr. Freese summed up the mission: “Our primary goal was to educate lawmakers that public-private partnerships are essential for robust public health infrastructure.” As for the meetings, he said, “There’s an army of staffers and we got paired with specialists for health care. Many of them were familiar with IIS… very familiar.”

The visit was made more productive by the team having an ongoing relationship with a lobbying firm who does the research to identify the members of Congress who are critical for healthcare policy. We asked Kristal if there are thought-leaders, members who everyone – or everyone in each party — looks to as “the authority” on immunizations. She sighed and said, “Sadly, no. There are not experts everyone looks to.”

Still, everyone on the team found the staffers receptive. As Dr. Briscoe put it, “Some people would assume that you’d eventually run into people with their heels dug in — but that didn’t happen. We didn’t see any hesitation to hear our message. Whether they’re from a blue state or a red state, the staffers have an eye on public health and want to do right by their citizen’s health.” Dr. Freese added, “The reality is that while there are indeed politics and negotiations, people are reasonable and willing to listen.”

THE OUTCOME?

The most recent visit to Capitol Hill was mid-summer and the CDC had just given notice of funding cuts to the IIS jurisdictions. Naturally, this was a key topic for discussion. And while many of the staffers had not yet investigated those cuts, they did offer concern and support. Kristal summed it up by saying, “They understood the major role IISs played in the pandemic and were concerned about funding going forward. We asked them to use any policy levers they have available to mitigate the current impacts and prevent these types of cuts in the future.”

Dr. Freese added, “Overall, I left encouraged. No matter what side of the aisle, they all have reasons to support vaccinations, especially when it comes to protecting kids.”

Further, Dr. Briscoe felt he heard in those conversations a willingness to support future progress in IIS: “When speaking of cuts,” he recalled, “the term ‘surgical’ came up more than once, including from an office that’s represented on the committee that negotiated the cuts. To a staffer, they did not recall any funding for IIS being part of cuts.”

BUT…

There was one issue where the staff wasn’t offering support. Kristal explained: “Members from both the House and Senate have introduced bills about increasing CDC’s blanket authority to demand data. If you aren’t familiar, CDC had a clause in its CDC Authority bill last year that CDC could request any health data from partners in any form, at any time, as long as there was a public health emergency going on. The ongoing opioid emergency would count. This bill didn’t get any traction last year but has been reintroduced this year on both sides of the Hill.”

She went on to explain that as one of the data partners, STChealth has foreseen issues with implementation and so their team has concerns of its own about the legislation.  Kristal added, “At this time, there doesn’t seem to be much support or consensus for either of these bills; but we will continue to track them. STC agrees that the CDC should have access to data, but we advocate that they leverage the knowledge from immunization experts that have been in the field for years to make prudent and intentional decisions about these programs.“ As Kyle put it, “There were doubts about the bill. Everybody wants the CDC to do its job and they need data for that, but we found that nearly everyone we met with believes there should be bounds on what they can require.”

SUMMING UP

So, after all the walking and all the talking, the team left encouraged, feeling that, at least for now, the folks on Capitol Hill appreciate and support accessing and utilizing  immunization data because, as Dr. Kyle put it, “No matter what side of the aisle, they all have reasons to support vaccinations.”

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STATS OF THE MONTH

 Participant-Observation:

A Better Research Tool for Immunization Strategy?

By Bill Davenhall, Geomedicine Analyst

Participant-Observation? Let’s take a closer look! It’s a survey research technique that been around for many decades (actually since 1934), long before there were the massive databases filled with “snippets” of socio/economic/geo-demographic information about people’s likes, dislikes, and specifically, their immunization beliefs and behaviors.  Of course, there are those who will say the technique is not very “scientific,” but immunization behavior might just be the one issue where it might contribute a great deal of useful and practical insights to those whose job it is to protect the nation’s health. Think here about the research of Margaret Mead or Jane Goodall – where their participant-observation methods became riveting “models” for “deep learning” about unknown and strange behaviors of people in Mead’s case and chimp society in Goodall’s.

(For readers who what a quick “what is this?” here is what Wikipedia says about participant-observation: “Its aim is to gain a close and intimate familiarity with a given group of individuals (such as a religious, occupational, youth group, or a particular community) and their practices through an intensive involvement with people in their cultural environment, usually over an extended period of time.”)

In reading the CDC report – (Vaccine National Strategic Plan 2021-2025) – which sets forth goals for 2025 and 2030 for vaccine uptake, I keep thinking about how much greater complexity has entered the immunization arena in recent years. There still appear to be significant issues regarding the willingness to believe in the value of vaccines, and, most importantly, the understanding of the informational needs and behavioral patterns of those who are willing and receptive to immunize both on a regular basis and periodic basis — from birth to death. That is where the research methods of a participant-observer become almost a required approach to find solutions for a complex set of issues, concerns, and behaviors. There are several types of participant-observation, ranging from passive participation to total immersion among the group that is under study. There are clear indications that certain groups of persons, in different geographic locations, have aversion to vaccines and to the entire immunization value proposition as compared to those in different areas that make it a habit to be immunized and accept the best science of  immunology.

So here is one indication what 2028 could look like for those that are assigned the job of keeping the American population from the dangers of spreading infectious disease:  The map shows regions of the US and one measure of having different “pools” that can affect the choice to remain unvaccinated (for various reasons not clearly understood). I have used the population Diversity Index*  here as a proxy indicator of the level of potential complexity of “local” society. It’s a sobering look from my perspective, as someone who looks at national demographic data at very small geographical areas with their ebb and flow of daily life. Immunization experts already have a good idea who will likely be the hardest populations to get immunized, but they seldom have enough contextual information about their specific “reluctance” to have practical insights into what might be some very nuanced approaches to immunizations. My assessment would suggest that a “silver bullet” will be elusive until the immunization ecosystem invests more deeply in some of the more contextual research that only something like a participant-observation method could possibly provide. It will take longer to get the data they will need, so the sooner they get around to this approach the better!

As always, 2^nd Opinions welcomed!

* Census Bureau Diversity Index tells us how likely two people chosen at random will be from different race and ethnicity groups. For example, in 2010, there was a 54.9% chance that two people chosen at random would be from different racial and ethnic groups, while in 2020 there was a 61.1% chance.