It’s that time when we get to take a look back on what we learned over the past months. But, before we dive in, we discovered it’s the ten-year anniversary of the original publication of one of our all-time favorite cartoons:

1. We learned that the key to selling ideas to those making funding decisions is to “stop selling”… wait, what?…

Our favorite marketing expert, Alan Quarry, explained his philosophy of selling ideas to decision-makers: “If you spend time with people in large organizations you understand that risk-reduction is the key to making decisions.That’s the thing that data — turned into information, turned into knowledge — can give you: reduced risk.”

So, we then wondered, does that mean the key to selling ideas is simply to offering them like they are the equivalent of a weighted blanket and a nice cup of tea? “No,” Alan insisted, “the key is to STOP SELLING and START HELPING PEOPLE BUY. The first thing to do is to make sure you’re not seen as selling – do that and a barricade goes up. Instead, risk-reduction is figuring out how to help.”

How could we apply this logic to getting a policymaker to approve a new immunization campaign? Instead of talking about how wonderful the outcome could be, the risk reduction approach might sound more like this: “We have such detailed data available, down to the neighborhood level, that we could do small, inexpensive tests of different campaign ideas. We could then project the outcomes to the wider population and estimate the health benefits against the cost estimates. Our odds of having a successful campaign go way up.”

2. We learned that former NFL players are standing by to help with immunization programs…

Tom Groom , an advisor to the NFL Alumni and to STChealth, explained that it was in 2021 that the CDC turned to the NFL Alumni to help increase Covid vaccination rates. “Given the historical lack of trust in the African-American community, these athletes were in a position to go into the churches and the barbershops and get out the message: you need to be informed for you, for your family, and for your neighborhood.”

The NFL Alumni Association is now making a new push to improve health, including vaccinations. That takes us to the Symposium in Canton, Ohio where former ESPN anchor, Sage Steele (photo below with Michelle Bonjour of STChealth), moderated discussions with Hall of Famers like Emmitt Smith (shown with Tom).

Michelle said of the event in Canton, “These are people who can leverage who they are and what they have done to make a difference, especially with diseases that hit minority communities hard. They further leverage that background when they partner with other organizations that do events.”  If your reading this and thinking, “Wait a minute — we do events,” then you should know that there are 40 chapters of the NFL Alumni around the country, and they are looking for teammates to improve health awareness. Inquiries can be made via Tom Groom at [email protected].

3a. We wandered in the “pharmacy desert” hoping it wasn’t taking us to a “vaccination desert”…

We’ve all heard plenty about vaccine hesitancy… but, what happens when the professionals giving the shots start getting their own form of vaccine hesitancy, as in, “Do I really want to be in the vax business?” Or, maybe it’s a new form of vaccine fatigue, as in, “Do I really want to keep promoting vaccines so hard?”

Those thoughts came to mind as we talked with Laura Cranston, the founder and former CEO of PQA (Pharmacy Quality Alliance) where she devoted much of her work to increasing the role of pharmacists in healthcare. She told us, “There is a great deal of burnout and stress on the frontlines of care, and pharmacies are no exception. Independent pharmacies, faced with challenges like reimbursements that have gone sideways, are going out of business and chains are closing stores. We are seeing an increase in pharmacy deserts.”

At, Laura’s urging, we sought out one of the pioneers of the pharmacy vaccination movement, John Beckner, now with the National Community Pharmacists Association (NCPA), and asked about the specter of “pharmacy deserts.” He replied, “There are deserts right now. Chains are closing stores and nobody is going into that space.” As for the independents John works with, he said, “It’s certainly a challenging time. We frequently survey our members, and we’ve seen that a majority of owners are worried about staying in business. In 2023, there was an average of one closure per day.”

3b. But we found some hope in the desert….

Given what we learned above, we asked John Beckner, Are pharmacies backing off from giving vaccinations? His answer was clear: “No. I have not heard of anybody deciding not to offer vaccinations anymore. Maybe it’s happened somewhere, but I have not heard of it. After all, if you label your pharmacy as a ‘health and wellness destination’ it’s very hard to backtrack.”

What else would help? John offered some possibilities:

1. He reports that he’s optimistic about legislation that will help with reimbursement, saying, “We’ve shined a bright light on the egregious practices of PBMs, and reform is now a bipartisan issue. The finish line is in sight – we just need Congress to act.”
2. Meanwhile, there’s help available on getting paid: the NPCA has published a Vaccine Billing Guide.
3. More states are allowing more vaccinations to be administered by pharmacy techs, thus making vaccine programs more profitable, especially when pharmacies are offering offsite vaccinations to employer groups.
4. Given the renewed interest in foreign travel, some pharmacies are offering “travel clinics” – a consulting service for not only vaccinations, but also advice on medications and supplies helpful when visiting various countries/regions.
5. Lastly, John is seeing an opportunity for pharmacies to increase their vax programs with adolescents and children, saying “rates are alarmingly low” and “if a pharmacy wanted to add a target group to close gaps, that would be the group.”

4. We learned an important fact about implementing AI…

We sought out the big brains of STChealth’s Analytics team to talk about how AI is changing vax programs. We mostly discovered that AI is not replacing human work, but rather, boosting productivity. However, as John Mendez, STChealth’s Director of Software Engineering pointed out, one thing AI is NOT taking over is responsibility; that, as John explained, is still an entirely human endeavor: “I hear people say, ‘The AI got it wrong.’ No. It’s still up to you.”

5. We got schooled on the “Demographics of Doubt,” finding groups with the most vax hesitation…

Stats guru Bill Davenhall told us of a national survey where about 11% said that they were “not sure” about vaccines’ safety. He added, “Yet, when looking over the list of 30 “demographic factors” the Census Bureau segmented  in their national sample, you will spot characteristics of these 11% that varied widely. 

“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.”

6. We found someone willing to open the immunization “can of worms”…

“Primary care is overwhelmed. Do they have time to do a comprehensive vaccination screening? Probably not. The vaccinations guidelines have changed so much that it’s hard to keep up with them, and now patients have opinions about vaccines – do you want to open that can of worms?”

That quote is from pharmacist Bianca Daisy-Bell, someone working to close vax gaps, and one of her solutions was involving community healthcare workers (CHWs) in the conversation, saying “They provide a different kind of voice compared to a person in a white coat.”

That led us to seek out Cindy Litterest, who was working as a Pharmacy Tech when she went back for CHW training and took on a new combo-role in the pharmacy and that meant that, as she explained, “I became the hub for connecting resources. I have a whole binder full of resources. So everyone in the pharmacy knows that if they hear someone say, ‘I can’t pay my bills, so I can’t get my medicine,’ they think, ‘Wait, we have a CHW’ and they send that person to me and we’ll figure out how to get them help.” That’s led her to this conclusion: “Every pharmacy should have one.”

7. We knew living arrangements were changing, but this?…

Stats guru Bill Davenhall dug into Census data to look at how/where 18-24 year-olds are living:

“Some aspects of our desired or preferred individual living arrangements probably began early in our life while others not so predictable – but you need to look at the change America has undergone over the last 57 years  for yourself. You may also wonder what your kids and the children they might have will undertake in the future.

“While families might still prefer to live in ‘traditional households,’ the data suggests that our definition of ‘family household’ is evolving before our very eyes.”

8. We first heard the term “flu floppers”…

We got surprising data from STChealth about “flu-floppers,” the people who get a flu shot some years but not others. In one analysis of six years of data across a large data set,

THE PERCENTAGE OF THOSE WHO GOT A FLU SHOT

THREE YEARS IN A ROW = 30%

FOUR YEARS IN A ROW = 20%

9.  We got to play with a simulation model that could change how immunization programs get approved…

The folks on STChealth’s Analytics team have created a simulation program, and to demonstrate its use, they showed what might happen if the percentage of people who get flu shots every year could be boosted. First, they looked at how flu outbreaks might progress across five flu seasons, using a population of one million, with typical assumptions about the disease and with typical vaccination rates. The numbers in the blue boxes are the number of new infections each week. (In the first season, we see about a thousand new cases each week at the peak.)

For the second run, they looked at what happened if a campaign succeeded in converting some “flu-floppers,” the 15% who get flu shots semi-annually, into regulars.

OK. But it’s a not a giant surprise that more people getting flu shots results in few cases of flu. So what’s so useful about this simulation tool?

First, as Sam McGee of STChealth explained, what’s appealing about this particular run of the model is that that it shows what can happen when a program focuses solely on “flu-floppers”: the drop in flu cases over time didn’t require the converting of any anti-vaxxers; rather, this scenario merely got some of those people in the middle, the ones open to getting flu shots, to be more consistent.

Likewise, a team choosing among potential immunization campaigns can run a series of simulations to assess the potential outcomes and the potential payoff in terms of reduced disease and the cost savings that come with it. As Sam put it, discussing the five-year simulation, “You don’t see immediate results – the payoff is in years four and five. Go to someone making funding decisions and say, ‘It’ll take four or five years to see results, but, trust me, it’ll pay off.’ That’s a hard sell. Not everyone has the vision and the budget to wait five years. But if you can show them the data up front, it’s an easier sell.”

10. We were asked to reflect on a career in health services and offered an uplifting vision… 

“YOUR PHONE WILL RING”

Mike Popovich, STChealth CEO, 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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VAX STATS OF THE MONTH

Fertility Rates: What’s Up With That?

By Bill Davenhall, Geomedicine Analyst

Fertility trends are seldom the main topic of everyday conversation, yet for organizations that deal with emerging groups of people that require different kinds of health services from birth forward, it’s a topic of increasing concern. The US Census Bureau, the Centers of Disease Controls Vital Statistics units, and USAFacts help us better understand what might require our attention downstream. Here are some useful analytics:

• The nation’s fertility rate overall has declined since 1957 — a 50%+ drop in 66 years.
• Only three  states experienced a relative stable fertility rate since 2005 – Kentucky, North Dakota, and Louisiana.
• Not all states have falling fertility rates – in 2022, three saw fertility rates increase (South Dakota, Alaska, Nebraska).
• American women are having children later in life – fertility rates are up for mothers over 35 years of age.

For any readers who think immunization strategies are etched in stone, they will probably be faced with very different challenges. Falling fertility rates are not simply a coincidence in birth record analytics, but likely due to social, economic, and cultural norms and realities. Will the value and acceptance of immunization to a smaller cohort of the population make a “come back”? Or will there be a further retreat? Will the downstream value of better preventative healthcare of fewer newborns and children raised by older mothers  seek a “higher standard” of acceptance to help protect  their offspring?  Will all of America’s children be better cared for in their earlier years because of these trends?

Many components of the US economy have traditionally  hinged on sustained natural growth – generally higher fertility rates and greater numbers of newborns to mothers of younger ages. Families’ economic status at all income levels are likely to be intrinsically involved in health-seeking behaviors. I suggest that there are many different explanations for the trends you might observe in the state where you find yourself today. There are still many geographical places in every state where we have applied little analytical knowledge about how the changing fertility rate shifts will impact local healthcare activities. 

My analysis of these reported trends would suggest that historical fertility and birth rate data collection programs have provided an excellent foundation for generating more geographically granular fertility data, and this could support smarter community immunization goal-setting in every state over the next several decades. In 2025, I will begin to describe some of the ways we might go about improving and stabilizing desirable immunization rates – stay tuned!

As always, I encourage 2nd opinions!

You got your pro-vax and your anti-vax people, right? You got Anthony Fauci and RFK Jr. But what all those in between, the folks who don’t really give thought to vaccinations? Ask them how they feel about the subject and they’ll just shrug. Perhaps these people could make the difference in the success of immunization programs, the way Undecideds end up deciding elections. Said another way, we might need to care most about those who care least.

What got us thinking about the middles was hearing some surprising data from STChealth about “flu-floppers,” the people who get a flu shot some years but not others. Check this out: In one analysis of six years of data across a large data set,

THE PERCENTAGE OF THOSE WHO GOT A FLU SHOT
THREE YEARS IN A ROW = 30%
FOUR YEARS IN A ROW = 20%

We sat down with Dr. Sam McGee, one of the big brains of STChealth’s Analytics team, to discuss these results and he explained the immunization breakdown that their data suggests:  20-30% of the population can be counted on to routinely get a flu shot and 40-50% can be counted out, being highly unlikely to get one. So, using the mid-points of 25% of a population on one side and 45% on the other, that leaves 30% in the middle, our “flu-floppers.” 

Dr. Sam McGee

Further, Sam explained, when they did some recent modeling of vax program outcomes, they sub-divided the flu-floppers into those who tend to get a flu shot about half of the flu seasons and those who do so only occasionally. Thus, they used four groups:

25% regulars
15% semi-annual
15% infrequent
45% never

These data become highly useful when put into a new program that can simulate what might happen if some of those numbers could be changed. Sam explained that this is modeling uses ABM or agent-based modeling, which creates a population of individual “agents” who are sent out into their statistical world (with dozens or hundreds of variables we get to choose) then we sit back and watch what happens, something like Madden NFL but the opposing team is the flu.

So, using the new simulation software, let’s get back to our flu-floppers and see what happens if we can get them on Team Regular.

First, let’s look at how flu outbreaks might progress across five flu seasons, using a population of one million, with typical assumptions about the disease and with typical vaccination rates. The numbers in the blue boxes are the number of new infections each week. (In the first season, we see about a thousand new cases each week at the peak.)

Now, let’s change the assumptions. For the second run, let’s say that we were able to implement a campaign that succeeded in converting our “flu-floppers,” the 15% who get flu shots semi-annually, into regulars. Nothing else changed: while we now had 40% getting shots every year, we still had 15% in the “infrequent” group and 45% still “nevers.” Here’s how that scenario plays out:

OK. But it’s a not a giant surprise that more people getting flu shots results in few cases of flu. So what’s so useful about this simulation tool?

First, as Sam explained, what’s appealing about this particular run of the model is that that it shows what can happen when a program focuses solely on “flu-floppers”: the drop in flu cases over time didn’t require the converting of any anti-vaxxers; rather, this scenario merely got some of those people in the middle, the ones open to getting flu shots, to be more consistent.

Likewise, a team choosing among potential immunization campaigns can run a series of simulations to assess the potential outcomes and the potential payoff in terms of reduced disease and the cost savings that come with it. As Sam put it, discussing the five-year simulation, “You don’t see immediate results – the payoff is in years four and five. Go to someone making funding decisions and say, ‘It’ll take four or five years to see results, but, trust me, it’ll pay off.’ That’s a hard sell. Not everyone has the vision and the budget to wait five years. But if you can show them the data up front, it’s an easier sell.”

PLAYING AROUND WITH SIMULATIONS

Speaking of easy sells: Sam offered us the chance to play with the simulation program and we took him up on it by going back to something we wrote about recently, what might have been the world’s first pandemic, the Roman Plague. That one was likely some early version of smallpox and might have had a mortality rate as high as 30%. 

We played around with a few variables, but there was one that we wish we could go back in time and offer to the guy in charge at that time: Marcus Aurelius. First, the model told us that if the Romans did nothing, a population of a million people faced with something as deadly as smallpox could expect the death rate to peak 47 weeks into the outbreak, with 1800 deaths a week. However, if Marcus had been able to impose a strict stay-at-home order, with only essential workers being out among the public, the disease would peak in week 23, at about 70 deaths a week. I suspect that, given that the ancient Romans did not have stay-at-home options of Zoom meetings and Amazon deliveries, Marcus might have asked, “What else have you got?” And the model would offer hundreds of options, from cancelling certain holidays to different levels of masking to options on vaccine uptake and effectiveness.

We’ve read that the ancient Romans were said to use the eating habits of “sacred chickens” as auguries. We’re not sure  if Marcus Aurelius had chickens, but you have to think he would have welcomed the chance to test out a simulation model.

WHAT’S NEXT?

We asked Sam where the team sees this going. He replied,  “That might be up to us here in the middle; we know that we’d like to see more people get a flu vaccine annually, but we’re not the ones who need to start taking them annually (or maybe some of us are). But now we have a tool to help us observe the power of even a little more consistency, repeated again and again. With it, we might change our approach for where we put our energy and resources each flu season, so that we can protect more of our communities first and get folks onboard consistently, and then start working with more challenging groups. Any way we go, we’re going to need to do it together, and if you’d like to hear more about or collaborate on this project, contact the STChealth Analytics team at [email protected].”

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STATS OF THE MONTH

Do Birds of a Feather Flock Together?

By Bill Davenhall, Geospatial Advocate

“Birds of a feather flock together” is an saying suggesting that people who are similar in some way tend to associate with each other. The exact origin of the saying, while uncertain, has been traced back to ancient Greek times and was first recorded in English in 1545. So, what does it have to do with immunizations?

Most products and services have unique “mini” markets, essentially more specific and targeted segments. For example, a product might target “affluent, tech-savvy urban millennials” or “middle-aged suburban families with young children.” There is hardly a successful national product or service that has not been “segmented” by using customer-centric data, including geographic, psychographic, behavioral, and demographic. In recent decades, several huge consumer marketing research organizations have constructed statistically robust population or household segmentation models to target products or services better. It’s not magic, but a series of data fusion processes that are more accurate in identifying “flocks” and figuring out how they find and track the flock.

Market research organizations essentially meld this data together into statistical clusters or segments that more accurately identify the various “flocks” and put it into a geographical context – in other words, where can we find the many other flocks out there in terms of their size and geographical location, and can we more accurately describe their consuming behaviors? Most marketing segmentation algorithms over the last several decades have identified  65+ statistically unique clusters or, as we like to call them, “flocks.” Still with me?

Immunization is both a product and a service. The vaccine is one part of the product, as are the tools for administering the product. The services that health providers provide include immunization registration, vaccine administration, long-term data storage (the official repository) of the vaccine administered, and other personal contact information.

The map below illustrates one particular segment, identified by a popular market segmentation methodology of one of 72 identified consumer “flocks” representing 4.6 million households (out of 131.2 million nationwide). The segment is described as those “Influenced by Influencers”; that is, “an ambitious flock of hard workers who want to advance as quickly as possible, and while they don’t have much free time, but still find ways to support the liberal-leaning cause, are not likely registered to vote but are willing to volunteer for a good cause or a worthy protest if an issue moves them.”

Hopefully, you can quickly see, geographically,  the value of this type of research for those organizations involved in vaccine administration – as a way to help deliver an immunization product and service to various “flocks” with the best messages and promotions. The remaining 126.7 million “birds” that are out there flying in the remaining 71  different “flocks” are the new delivery challenge in a highly mobile and segmented society  – staying in touch with your customer forever!

As always, I appreciate  2^nd opinions!