Our Favorite Items from This Year’s IINews

It’s that time of  year when we get to take a look back on what we learned this year…  

1. We got to smile and “THANK A VACCINE”…

Let’s start with the folks at the Wyoming Department of Health. Their fascinating new television spot got us thinking about vax promotion.

Here’s the :30 second version

The ad is surprising, and that’s what makes it clever and sneaky-funny, but it’s also surprising in another way – it didn’t argue or push, didn’t pound the table, merely slipped in its little tagline, “Thank a vaccine.”

Kim Deti, Public Information Officer for the Wyoming Department of Health, also shared with us a print ad being used primarily as a full-page newspaper ad.

2. We got challenged on VFC and got a big offer of help…

Jude Allen of STChealth has made it a personal campaign to increase vaccine access via the VFC (Vaccines For Children) program. “Many states have never done active recruiting for VFC,” Jude explained. “They think it’s not a huge priority because ‘we already have everybody,’ – they’re used to thinking of pediatricians or family practitioners. Then, when it comes to adding pharmacies, I know how scary and intimidating that can be. You don’t want to open the floodgates. You think of all the site visits and how you just don’t have the staff. And that’s why I say, Just do one!”

If you’re thinking of giving it a try, but not sure how to start, Jude offered to guide you through the process, saying, “Together we can bridge the gap between public health and pharmacies and make it happen.” If you want to take up her challenge: [email protected]

3. We got a case of hyper-hyphen phobia…

Bill Davenhall, statistical guru, sent us recent data from the Pew Research Center’s that suggests a trend among American parents:  the hyphenated last name. In a recent 2022 survey,

• Twenty percent (20%) of married women ages 18-49 say they kept their last name, compared to 9% of those ages 50 and older.
• Those women with postgraduate degrees (especially professional degrees) are even more inclined to keep their “maiden” name: 26%, compared to only 13% of those with a bachelor’s degree or 11% with some college or less.
• Then there’s the divide with political “leanings”: Democratic women are twice as likely as Republican women to keep their last name (20% vs. 10%) and women who self-identify as “liberal Democrats” are especially likely (25%).

Why would an immunization program care about this? For starters, keeping accurate immunization records often relies on first and last names correctly identified and associated with the right individuals. Furthermore, simply having more space (longer lines) on data collection forms and screens is now a critical business imperative on many levels.

4. We got a new goal for HPV vax: Can we do better? Yeah…

The CDC latest data showed an impressive increase in the number of teens getting the HPV vaccination – 62% vaccinated at the last survey (2021), up from 43%. But, wait a minute, before we get too pleased with that increase, that still leaves over a third of our teens unvaccinated.

CAN WE DO BETTER? You know when someone asks the rhetorical “Can we do better?” the answer is always “Yes.” In this case we have proof of success and it comes from the IHS, the Indian Health Service. It’s one reason why we’re glad to have Dr. Hamstra with us, a man who devoted his career to working with Native Americans, specifically those in Arizona. Look at these HPV vax rates from 2021 for 1st & 2nd doses for IHS at the National and Local AZ levels, where Dr. Hamstra has been working:

When we asked Dr. Hamstra how they did it, he said, “There’s an openness to vaccines on the reservations. We have built trust over decades.”

That’s something our state health departments and our pharmacists can aspire to. As for the latter, Dr. Hamstra adds, “If anyone has a chance to make a difference, it’s pharmacists. They are much more accessible, convenient, and interactive with patients, seeing them 3-4 times more often than the doctor. When it comes to adults, the pharmacists are the MVP of the vax world. When teens are missing the HPV vaccine, our pharmacists are the ones who can fill that gap and help get that last third vaccinated. Current ACIP recommends HPV vaccines for all adults ages 19-26 (who missed out on their teen recommendation window) and even recommends discussing HPV vaccination for adults ages 27-45. Personally, I’d absolutely offer the vaccine to all.”

5. We got a new contender for cutest vax cartoon ever…

6. We learned how to reinvigorate pharmacy vaccination programs…

Early in the year, when we asked Jason Briscoe about the current state of morale among vaccinators, Jason sighed and said, “Let me start at the end to explain where we’re at. We’ve had great news! We just got the report that the number of flu vaccines in pharmacies is increasing sharply, and that the trend line is moving up on other vaccines, as well. But, at the same time, we just got reports from major pharmacy chains that they are reducing the pharmacy hours. Why? They don’t have the pharmacists or techs they need. So we need to face up to that contradiction. We need to reinvigorate the pharmacy.”

At one level, this isn’t a new conundrum. Jason faced it a decade ago with flu shots, when he led the effort to turn his drugstore chain (now at 77 locations) into what they came to call (and trademark) as “Your immunization destination.”Thus, we wanted to know what he had learned about getting buy-in from pharmacy staff for playing the leading role in adult vaccinations. He explained: “What we didn’t want was for anyone to conclude, ‘This is just corporate being greedy.’ So we started having conversations, agreeing that if we are going to stay relevant as a profession we had to find new ways to provide value. We found an appetite to expand our scope. Vaccinations were a logical extension.”

He added, “There is the blocking and tackling of a community pharmacy, and it couldn’t be, ‘Jason says we need to do vaccinations.’ That’s why, right from the start, it was all about how we could help. I would never provide goals without being there with resources. We set out to eliminate 30 to 40 percent of the routine work in order to free up time for vaccinations. We had three major initiatives: a new pharmacy management system, a call center that took care of most calls, and a central fill pharmacy.”

8. We’re glad it’s after Thanksgiving that we’re recalling this one..

In his book, Pathogenesis, Jonathan Kennedy asks what drives human history and at one point he summarizes thusly:  “The answer is simple: germs, germs, germs.”

For instance, he concludes that the Pilgrims succeeded in settling in New England because they arrived in an area cleared by an epidemic “probably brought by European fishermen or traders,” one that had just wiped out 90% of the native population. Thus, Kennedy can write, always looking to be provocative, “If modern-day Americans want to be historically accurate, then their gratitude at Thanksgiving should be directed to the Old World pathogens that made the settlement of Plymouth Colony possible.” Pass the gravy.

9. We learned the language of leaders who inspire innovation

We got to explore the book Experiments Never Fail: A Guide for the Bored, Underpaid and Unappreciated and learned one way to change a team’s conversation, and hence, its energy…

Most bosses, without thinking about it, guide the organization toward mediocrity. Think about your team’s language. When assigning or evaluating a project, which have you heard more often, the  words of Boss A or Boss B?

Situation #1

Boss A: It doesn’t have to be anything special, just get it out.

Boss B: Let’s come up with three unique approaches, then decide on one.

Situation #2

Boss A: This situation is a lot like the proposal we did last year – just update it.

Boss B: Let’s come up with something truly creative for this one – we can make this great.

Situation #3

Boss A: The timing isn’t right to try something new.

Boss B: We don’t have the budget right now, but let’s find a way to do a pilot — let’s just start.

So, looking at those questions, which boss is going to have more innovation? Which boss would you rather work for?

9. We learned an acronym that we wished didn’t exist…

CBRN. It’s not one of those catchy acronyms. Nothing lovable about it.  That’s because it’s a short list of horrors, the four categories of possible threats to public health: Chemical, Biological, Radiological, Nuclear. The only good news is that the acronym exists because there are smart folks working every day to figure out how to deal with the threats they represent.

We talked with one of those people, Brad Goble, a consultant to organizations dealing with CBRN, including the Global Health Security Initiative. He reported, “After 9/11, we were paying more attention to what the bad actors were doing,” Goble explained, “working to assess the new threats and to coordinate the work of defense departments and health organizations.” Included in that work was the development of plans to deal with terrorist attacks: “We couldn’t assume rational behavior – we have to assume crazy.” And with that came the “A-list pathogens,” the list of the most virulent agents.

Goble added: “We started by bringing defense departments and public health organizations together, but I’ve also been working to bridge the gap to industry and make them true partners. As we work to strengthen the line of defense, we know that health departments play a major role, but one thing we learned from Covid is how pharmacists have a big part to play. We need to strengthen that line of defense more and more. Here in Canada, we are seeing new government proclamations putting pharmacies at  the front lines for more equity of care, and we have an increasing need for conversations on how we can rely on pharmacists.”

10. We got reminded of how much the world, and the family, has changed…

Our favorite statistician, Bill Davenhall, told us how recent publication by the Census Bureau, (FM-1 U.S. Census Bureau, Current Population Survey) provides an interesting glimpse on how families across the United States have been arranging for parenting: 

One parent (un-married) family with at least one child under 18 years of age present- (Includes parents of biological, step, and adopted children)

• 1950 – 7%    (85% Moms; 15%  Dads)
• 2022 – 31%  (75% Moms; 25%  Dads)

Two-parent (married couple) family with at least one child under 18 years of age present – (Includes parents of biological, step, and adopted children)

• 1950 – 93%
• 2022 – 69%

Bill added, “Changing family arrangements for parenting would suggest we need to rethink the communication strategies in immunization, especially for children. It should also stimulate innovations in immunization data collection procedures and program operations.”

And, finally, as a bonus, we found an older Covid-victory cartoon that we just had to share again …

* * * *

VAX STATS OF THE MONTH

Public Assistance and Immunizations:

Where Geography May Matter the Most!

By Bill Davenhall, Geomedicine Analyst

Would fiscal policy changes that affect government-provided public assistance income to family households impact those families’ vaccinations? While the challenges could be considerable in the near term, it’s also obvious that whatever happens from a policy perspective, the geographical impact will be broad and face enormous challenges for family households in many states.  The ability of family households to pay for various immunizations will vary greatly – both for children and adults – and present yet another hurdle for meeting national immunization goals. Here’s why:

Recently released data from 2022 on the subject of household income sources help us understand some of the geographical implications of what we know about the distribution of family households that receive governmentally provided public assistance. According to the Census Bureau’s American Community Survey (ACS), about 3.4% of all households receive public assistance, and it varies widely across the MSAs (Metropolitan Statistical Areas) nationally. The map illustrates the percentage (estimate for 2028) of family households that presently rely on public assistance. The 919 MSAs shown on this map represent the geographical units which encompass most of the United States’ family household’s population. (Note: about 5% of the population lives in areas outside an MSA.) Please keep in mind that 2028 estimates are based on the results (rates/percentage) from the ACS.  The map illustrates the wide geographical differences in rates of family households reporting receiving Public Assistance. Median annual HH incomes across all MSAs ranged from $55,738 to $83,734. 

Time will tell how the uneven geographical pattern of US family households reporting  receipt of public assistance will evolve in the economic and social life of every MSA, but I would suggest getting more accurate data on family household incomes using  the Census Bureau’s ACS data collection methods will become important to those who need to maintain present immunity levels and to those establishing goals across a national immunization “ecosystem.”

As always, I invite your 2^nd opinion!

Percent of Family Households Receiving Public Assistance Income in 2028