“Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.” 

From Ferris Bueller’s Day Off (1986)

“If you can dodge a wrench, you can dodge a ball.” Dodgeball (2004)

“Picture this,” Mike Popovich of STChealth said to us: “You’re a 25 year-old who started a career in health services back in 2000, maybe working for a state health agency or maybe you’re a pharmacist. Think of what you’ve already seen, and then think about what you are likely to see before you reach retirement.”

You in? Let’s give it a shot…

Let’s begin by setting the stage with what was going on that year back in 2000. The first day of a new century came and went, as did the feared Y2K and, whaddya know? computers did not have meltdowns and planes didn’t fall from the sky.  After that, it was, like all years, on and off; but, for you, it was also the beginning of a career of continual surprises, some of which actually became health emergencies in the USA, but most were just events that created public doubts and fears, or at least conversations.  Here’s a few events…

2000 Mad Cow disease – the disease was first identified in 1986, but outbreaks recurred multiple times in the 2000s, including several hundred human deaths,  and leading to declines in beef consumption

2001 SARS identified in Southern China—the first SARS-related coronavirus—with about 8500 cases and an 11% case fatality rate.

2001 Estimates published in 2001 put AIDS/HIV infections at 40 million worldwide

2005 Hurricane Katrina killed nearly 1400 people and caused major relocations of residents out of the New Orleans area (and led to the first sharing of vaccination data among states, developed by STChealth)

2005 Bird Flu, later known as Avian Flu, made another appearance, one of several in the 2000s – A UN spokesperson warned that a worldwide outbreak could kill 5 to 150 million people, but prevention measures, killing the culling of tens of millions of birds (16 million in Iowa alone, during the 2022-23 outbreak) helped prevent significant numbers of human deaths.

2006 The first HPV vaccine introduced

2006 Two e-Coli outbreaks affect hundreds in the US

2009  H1N1, known as Swine Flu, declared a global pandemic by the WHO

2012 First case of MERS is identified in Saudia Arabia (one study put the fatality rate at 34%)

2014 Polio returns: the WHO declares a public health emergency due to an increase in cases

2014 EBOLA found in Guinea, Liberia, and Sierra Leone

2015 Cases of dengue spike (perhaps as many as 400 million annually), in part because of the work of the Gates Foundation to improve reporting

2015 Cases of Zika soar in Brazil, becoming an international health emergency within a year

2019 Covid appears in Wuhan, China

2019 The first Ebola vaccine is approved

2020 First Covid vaccine approved (in December)

So, here you are (our imaginary health worker), more than halfway into your 40-year career. If you’ll retire at 65, you’re looking at another 20+ years in health. What’s coming?

NOW WHAT?

We’ve seen advances in vaccines and we know what appears to be in the pipeline: New RNA and vector vaccines, a universal flu vaccine, and personalized vaccines. 

Beyond the pipeline, we put that “what’s coming?” question to some big-brain colleagues, starting with STChealth’s medical advisor, Dr. Scott Hamstra, who told us he’d learned from a lecture by Neil deGrasse Tyson not to even try to make predictions. The argument is that we predict change by thinking of linear progression; however, change is really exponential and occurs in unexpected leaps or maybe just lumps.

Dr. Hamstra sent along a link to Tyson’s video : “Living in Times of Exponential Growth.” In it, Tyson says of predictions about the middle of this century, “you can guarantee that every one of them will fail.” Nevertheless, he can’t help himself and declares that it’s “time to make a future fool of myself,” and offers some thoughts about what we might see, including these:

Thanks to advances in brain research,  mental illness will be cured

Antiviral serums that cure cancer will be perfected

Medicines tailored to DNA will leave no side effects

We will be able to grow lost limbs and failing organs

(And one more, one with only a slight connection to health services but we couldn’t resist:

Tyson suggests the day is coming when,  “If you want to be nostalgic and drive a car… as opposed to a self-driving vehicle… you’ll go to special car track, rather like the horseback trails of today.”)

We next passed the crystal ball to STChealth’s Chief Scientific Officer, Dr. Kyle Freese, and he surprised us by predicting that the effects of change on public perceptions could be as important as the technology breakthroughs pushing those changes: “I started my career in public health in 2010,” Dr. Freese said as he ruminated on the future, “so not that far off from the person you’re describing. And what strikes me is not just that the pace of technology is increasing, but that the speed of change itself impacts perceptions of the technology. With the Covid vaccine, the benefits were enormous, but there was so much coming so fast from pharma and governments that it began to breed mistrust.”

This makes sense: the human mind, conscious and sub-, knows that speed increases dangers and the speed of change would itself increase the fear surrounding it. We asked Dr. Freese if this meant new medical advances create fears the way, say, the introduction of the cell phone led to rumors about brain cancer. “Yes,” he agreed, “except that someone not using a cellphone isn’t dangerous; not getting a vaccine is.”

He added, “There is a lagging effect of unintended consequences, and declining vaccine confidence could be one of those consequences. That’s why we need to train people to be able to work across disciplines. Even when technology makes tasks simpler, humans are still complex. We know are going to get better technology, what’s less certain is if those of us working in public health can get better at bringing it to the public.”

“YOUR PHONE WILL RING”

Mike Popovich, STChealth CEO, the one who started this exercise, summed up a career in health services by writing this:

If you are “lucky” enough to have taken on the fight against disease as a career path, you can be assured the following will happen:

Old vaccine-preventable diseases will re-emerge.

New diseases will emerge from (?), ones that have no vaccines at that time.

Every disease will impact communities, families, and individuals as populations increase and shift and demographics change.

That means…

At some point your phone will ring. You will be called upon to step up and help minimize the impact of a crisis, starting today. You will know the caller also meant to say, “and tomorrow when everyone else has moved on and forgotten.”  

If you’re lucky enough to have picked this career path, you will have picked up the phone. You will have taken on the challenge, and you will have achieved what others could only imagine. You’ll do it because you could look back at the past two decades and know what to expect in the next two decades — you already had a plan prepared and have put in place practices with everyday events that can scale for any new future event.  

How many other career paths can say that?

What will the family dinner stories be like that you are able to tell, 20 years from now?

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STATS OF THE MONTH

The Demographics of Doubt

By Bill Davenhall, Geomedicine Analyst

Much research ink has flowed during post-pandemic times and yet it’s highly likely that much more is yet to come. There is still much to learn and understand about the dynamics of vaccine hesitancy and the culture of immunization.  A recent study undertaken by the National Center for Immunization and Respiratory Diseases (NCIRD) sampled more than four thousand individuals though the Omnibus surveys that were conducted as recently as October 2023. Two things stand out in this research – it’s extremely timely and is well supported by statistical processes.  What caught my attention was the usefulness of  the wide range of familiar demographic characteristics used by its authors to elucidate the reader — its illustrative bar charts are exceptionally well done.

As you might expect, vaccine hesitancy (or as I like to call it “immunization doubt”) begins among  a complex set of understandings, beliefs, and observations that people accumulate or learn from their participation in society. Demographics often become the surrogates for describing these complexities. The NCIRD report illustrates this complexity and attempts to help readers grasp the wide variety of factors that influence doubt, such as education, poverty, access to services, race, religion, and geography. To my surprise, this report did not demonstrate that geography per-se, had a great deal of explanatory reasons for the “source” of the doubt – but when you examined all the other sampled factors, you can’t but wonder the role geography  could play in geographically targeting the opportunities to reduce the  doubt about vaccine safety.

Nationally, about 11% of the sample said that they were “not sure” about vaccines’ safety, yet when looking over the list of 30 “demographic factors” they segmented  in their national sample, you will spot characteristics of these 11% that varied widely, such as educational attainment, rurality, access to insurance, and income – all of which in most other national samples explain a great deal of the population’s variability. 

A quick glance at this report would suggest some areas where more attention probably needs to be focused, including non-white races,  Hispanics, populations with greater proportions of people with only high school attainment, and  those living in poverty with poor or with very limited access to health insurance. The table below would suggest that doubt is not a  small nor a simple “problem” to solve.

Demographic Factor	% in “Doubt”	Population 18+	% over National Average
Ages 18-49	12.5	16,347,991	1.5
Female Population	12.7	8,384,000	1.7
Hispanic Population	15.5	9,671,365	4.5
High School (None or Only) Attainment	16.0	13,695,613	5.0
Rural Population	15.9	6,900,000	4.9
Family Households with  Income < $24,999	21.0	4,135,148	10.0
Southern States Population	14.1	4,291,470	3.1
People Having Some Religious Beliefs	14.0	18,309,708	3.0
People Having No Health Insurance Access	22.5	29,471, 317	11.5

Source: NCIRD, US Census, Scan\US, 2023 Data.

Note: Table above represent mutually exclusive categories and are not sub-sets of any other category.

As you can see, this is not a small number of people carrying around doubts about the “safety” of annual “flu” vaccine. Pick your favorite demographic.  I would suggest greater caution when “simple” solutions are offered to reduce the population’s doubts – but accelerate your thoughts about ways to resolve some of the underlying problems that appear to “feed”  the doubt.  I would suggest you take a closer look at this timely research.

As always, I appreciate 2^nd opinions.