How to Talk About The Bonus Value of Vaccinations

You’ve probably been seeing reports that vaccinations do more than just prevent the disease they were designed to counter: flu, RSV, shingles, Covid, and other vaccines are being shown to have important extra protective benefits. So, how is the medical community doing in passing along the good news? Well…sigh.

Here’s how a New York Times article introduced the topic:

“But other reasons for older people to be vaccinated are also emerging. They are known, in doctor-speak, as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert.”

“Off-target” benefits? Who lines up to get “off-target” anything? Clearly, we can improve on that language. Let’s start by recalling the “wisdom” of the infomercial. Say what you might about those ads, but they evolved by getting immediate feedback on what communication works and what doesn’t. And what they learned back in the 1970’s is that people respond to what came to be known as “value stacking.” This is where you promote the main item, then keep adding products/benefits, adding what’s known as “the sweeteners.” Thus, the classic line, “But wait, there’s more…”

(The first use of that line is thought to be in an infomercial for Ginsu knives, the work of marketing legend Ed Valenti.

The ad sold you on the knife itself, then kept adding more pieces to the package.)

The “but wait” line was planned to land near your decision point, to prevent drop-off and to make the offer increasingly generous until it feels like you’re losing out should you decide to not join in.

Sadly, we haven’t heard of anyone working on infomercials on vaccinations. So we turned to a man known for his ability to make medical issues clear and convincing — entertaining, even — Dr. Scott Hamstra, and asked for his help in preparing us all to talk more persuasively about vaccinations.

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Dr. Scott Hamstra, Captain (retired), pediatrician, served Arizona Native American communities as a US Public Health Service Officer for 24 years before retiring from Active Duty in 2014. Since then, as Medical Advisor to the STChealth, he shifted focus to expanding the impact of vaccination to the USA and the world. Living in Tucson, he continues to offer medical expertise to Native Americans.

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When we brought up the subject of being more persuasive about immunizations, Dr. Hamstra’s first thought was this:

I’ve long used the metaphor that vaccines are like seatbelts—they don’t prevent the car crash; they prevent you from being hurt during the car crash. I have found this helps many people understand vaccines. In hindsight, we may have been wise to promote this metaphor during COVID.  People were very upset when they got infected by COVID after getting the COVID vaccine, discounting how it helped them stay out of the hospital or the graveyard.

Over time, I have found that vaccines might offer more than simple seatbelt protection. Perhaps akin to new car technology that helps us avoid crashes (automatic braking, airbags, adaptive cruise control, blind spot detection), vaccines might keep us from damaging other internal structures by avoiding hitting the windshield or steering wheel.

Let’s start with measles. In preparing to talk with you, I read an article in Nature where they argued that having measles casts a “shadow” for years.  By “shadow,” they meant that it sufficiently damaged the immune system that it took years to recover.

Measles could be compared to the California fires – as it burns, it wipes out a lot of your natural biology. Then when the rains follow … oops… you don’t have your normal vegetation, and you suffer from flooding and mudslides.

Measles has long known to put us at risk for other infections. Measles “amnesia” describes how battling the virus erases the immune system’s memory, leaving the body vulnerable to other diseases for years afterward. Let’s use a war analogy. During the winning fight against measles, we used up lots of our defense resources, losing a lot of trained Army, Navy, Air Force, and Marine troops, equipment, and supplies.  

I love that analogy, and it’s important because there are plenty of Americans who recall having the measles and, looking back, take measles lightly. For instance, a New Yorker article wrote that RFK Jr. recalled it going through his large family and joking that it was a “great week” of watching ‘Sea Hunt’ on television while treating the flu with chicken soup and Vitamin A. 

Measles could be compared to fighting World War II; during the battles, there’s a lot of damage that takes time and effort to rebuild. For a while, two-to-three years post-measles, you’re susceptible to another invasion or another attack. More bad news, even after the war ends, sometimes there’s some ongoing battles in remote areas that seem unaware of the ceasefire or surrender. While most kids who make it through the acute measles fight seem ok, a few will go on to suffer progressive brain dysfunction, sclerosing panencephalitis. These kids die five or ten years later from this progressive brain disease, that starts as behavior change or intellectual problems, before seizures, blindness, and eventual death. For these parents who felt initial relief, “Oh, thank goodness my kid survived,” it turns into a nightmare experience years later.

So, we have the idea of preventing the mudslides by preventing the fire, but there’s more to this idea of “off-target” benefits than just measles, right?

Yes, vaccines are designed to stop the infection. Beyond this, we have made other observations, like the flu vaccine preventing heart attacks.  Turns out that a single flu vaccine has the same heart attack prevention power as taking a beta blocker every day for a year. That’s good news! Ask the question, Which is easier? 

That’s exactly the kind of description we need to turn the unhelpful term “off target benefit” into something motivational.

There’s more about the influenza vaccine. Sure, it prevents getting an infection, pneumonia, and hospitalization, and “there’s more!” The flu vaccine prevents the first crash that could turn into a chain reaction multi-car crash in your brain or heart, causing a stroke, a heart attack, or even dementia. Wait, what? How does it do that? Well, the mechanisms aren’t super clear, but you can easily imagine collateral damage from this little flu microbe attack. The fighting puts strain on your heart and on the delivery of oxygen to your brain, causing life-altering events.

And this system damage can be true for other vaccine-preventable diseases, right?

Indeed, more and more evidence is accumulating. Looking at people who got:

• pneumococcal vaccine; observing fewer heart attacks and living longer.
• flu vaccine; fewer heart attacks, and over 4 years, less dementia.
• shingles vaccine;  over seven years, less dementia.

COVID-19 vaccine benefits might surprise people. COVID-19 is a nasty disease. It shook up the whole world and killed a million Americans! It was a brand-new disease to us in 2020; it’s only been five years, and still we’re learning more about its short-term and long-term effects. All this is complicated by the social media and political landscape, with lots of information, misinformation, and disinformation about both the disease and the vaccines.

Turns out there’s some good news – similar to the flu vaccine, observing fewer heart attacks and strokes after the first shot, and even further reduction after a second dose.

So, again, that’s not why you chose vaccination – you didn’t get the shot to get rid of strokes and heart attacks — and yet it makes sense given how COVID infection damages your blood vessel lining, leading to more blood clots. And, when clots lodge in your brain vessels, they can cause strokes; and, lodging in your coronary arteries, can cause heart attacks.

Going into our discussion, I was assuming that vaccinations provided extra benefits because each vaccination was like a trip to the immune gym, a workout that made your body—in this case, your immune system—a bit stronger each time. But that doesn’t seem to be the mechanism in play here.

Good point. There are two main parts to our defenses, Innate and Acquired. We are all born with a built-in “Innate” immune system, our ability to notice “self” versus “non-self,” and then when it’s “non-self,” to question, “Are you a friend or a foe?”  In any population, there’s a spectrum of innate immunity, with some able to survive better than others. In truth, humans would have lost the war to microbes long ago if we didn’t have some variation in our natural immunity to fight them.

“Acquired” immune system is like going to the working out in the gym, practicing piano, or learning to swim. Vaccines are a way to learn, to practice, to get stronger, so when faced with the real-life situation, we do better. That’s the measure that we like to use in public health. How can we create stronger people and a safer community? How do we protect everyone, including the weaker ones in our community, and not just watch the roulette wheel spin to see who is lucky and will survive?

SUMMING UP

So, looking back at our goal, to get better at talking persuasively about immunizations, let’s review the options Dr. Hamstra has given us.

Seat belts.

Dr Hamstra has long used the “Vaccinations are like seat belts.”  Seatbelts don’t prevent accidents; they prevent injury from accidents. But now he suggests can take it a bit further, as evidence mounts that can even prevent some accidents. So, along with wearing a seat belt, you’re adding an accident-avoidance system.

Heart attack “accident” prevention

In promoting the flu vaccine, Dr. Hamstra points out that a single vaccine has heart attack prevention effectiveness similar to daily blood pressure medication. So what’s easier to do?

Once a year flu vaccine or daily beta blocker pill every day for a year?

Forest fires and War

Dr Hamstra used the wildfire and war analogies for measles, but they work more broadly.

“Measles infection can be compared to California fires — it just wipes out a lot of your natural biology, leaving you vulnerable when the rains come – your vegetation is missing, rains now cause floods and mud slides, things that wouldn’t have happened if the fires hadn’t burned everything down.”

“The measles infection can be compared to fighting a war. The fighting used up defense resources and caused a lot of damage. It takes time and effort to rebuild. For a while, you’re vulnerable, susceptible to another invasion or another attack.”

What we see is that vaccines aren’t just disease prevention; they’re damage prevention.

Going back to where we started, we aren’t advertising salesmen adding “off-target benefits,” but promoting a healthy lifestyle that includes vaccines, and we’re become increasingly aware of evidence of “value stacking” –  “but wait, there’s more” – more protection from heart attacks, from strokes, from dementia – and possibly more, more and more. Maybe there’s a place for immunization infomercials, after all.

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STATS OF THE MONTH

Immunization Serendipity:

The Changing American Family’s Living Arrangements

By Bill Davenhall, Geomedicine Analyst

The US Census Bureau recently released data on the American Household. While the Census Bureau counts people, one of the significant units of analysis is households, which contain most of the nation’s population.

The most recent data highlight the drastic swing in the living arrangements within households over the past half-century:

• In 1957, women married at 21.1 years vs 28.4 today; men married at 23.1 years, and now it’s 30.8.
• Fifty years ago, most couples (66%) in a household got married; today, only 47% do so.
• For families, 54% had their own children under 18 years of age in the household; now, only 39 live that way.
• Living alone in a household is now about 20%; in 1957, was 30%.

The bottom line is that there are more intergenerational relationships living in the same household than ever before. Surprised?

Multi-generation households are increasing, according to the US Census Bureau, and grandparents are more likely to be living in households occupied by other generational members. Many more adult children (18-24) remain living in the family household for more years than in 1975. Certain populations, like Asian and Hispanic families, bring different cultural norms into households that maintain “shared responsibilities” of the household regardless of the reasons for those arrangements (i.e., economic, cultural, and childcare).

Where then is the serendipity for immunization rates in all of this change?

Multigeneration households have stronger bonds across several generations, and grandparents are respected for their opinions on many issues. Very high percentages (79%) of multi-generational households claim strong family bonds, such as traditions and experiences that impact and boost household strengths. (The one place that appears not to be as supportive of multi-generation family living remains in the more rural areas of the nation – areas that already also have higher vaccine-hesitancy levels.) Despite the family economic structural issues that have created a more supportive immunization household environment, immunization advocates need to be alert to opportunities that generational and multicultural households present.

My takeaway here is this: be alert to the household “structural changes” that both culture, economics, and generational changes will have on the formation and growth of multigenerational households. As they say, “read the room” (community) you serve closely and experiment with ways to leverage the “serendipity” that the Census Bureau data suggests.

As always, I appreciate your 2nd opinions

It’s time for our annual review of the highlights from a wild ride of a year….

1. We learned that all that data you send to registries is doing more good work than you might have thought.

Mike Popovich, co-Founder of STChealth, offered us some encouraging words on the actual usage of registry data:

“When we look at all the immunization records that flowed through our networks in 2024, for every record reported there were 13 queries. Said another way, for each vaccination reported into a state IIS, there were 13 times when someone was checking on vaccination status. That means a doctor’s office, a pharmacist, school nurse or parent was getting smarter. So, the data is being used to make better decisions, which means that someone isn’t being over-vaccinated, that money isn’t being wasted. That simple number of 13-to-1 is telling an ROI story.”

2. We learned about the international import nobody wants.

All this year, the news was full of endless talk about tariffs, imports and exports. But, it was only by reading reports from STCHealth epidemiologist Sara Brown that we learned this sad export news: 

“Mexico is currently facing its largest measles outbreak in decades. Lab results and case tracking suggest that this outbreak may be partly linked to the one that began in Texas.”

She added, “Anti-vax thinking is a luxury – it’s easy when you think all your neighbors are getting vaccinated.”

3. We learned the thought-process behind building a website that actually saves more time and money than it costs.

Dr. Todd Wolynn, Executive Director of the Trusted Messenger Program, is a pediatrician and was co-founder of Kids + Pediactrics in Pittburgh, where he achieved remarkable vax rates. He credits a lot of the success of the practice to communication skills, and he argued that the problem with most organization’s websites is that they tend to be the online equivalent of a brochure, which tend to be bragging about the newest equipment, program, award, or something flattering about an executive. As Dr. Wolynn asks, “Who the hell’s the audience for that message? That’s all about branding for some mega profit or non-profit.”

How to do better? “You start with the most common questions your patients ask,” Dr. Wolynn explained. “For us, one of them was, ‘What’s my dosage for my 6-month-old for ibuprofen or for acetaminophen?’ So we created a simple dosing guide online, very easily available on our website and posted to social media. Then we did it for allergy meds. That thing was downloaded literally tens of thousands of times. You can bet a significant portion of those tens of thousands would have been phone calls to the office.”

4. This isn’t what anyone means by “alone time”: We got big changes in rates of “solo-parenting,”…

Stats guru Bill Davenhall dug into a publication by the Census Bureau (FM-1 U.S. Census Bureau, Current Population Survey) and came away with 62 year-long look at 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 wrote: “It probably comes as no surprise to the reader that the traditional ‘audience’ for messaging about immunizations has changed since 1950. Family arrangements for parenting in 2022 would suggest we need to rethink the communication strategies in immunization, especially for children.”

5. We got some surprising GOOD NEWS:  The world MIGHT HAVE GOTTEN SAFER in recent years. Yes, really.

We asked global securing expert, Brad Goble, a Canadian consultant whose work includes NATO and the Global Health Security Initiative community this question: Are we safer now? He surprised us by saying this: “I’ve been extremely optimistic. We have made enormous progress in the last 50 years, and particularly the last few years. We have made the world safer.”

Naturally, we wanted to hear more. “The global effort really started after 9/11,” he began. “Then, in 2007, we had the Global Health Security Agenda. But it was in 2020, when we had the first pandemic of our era, that we discovered just how underprepared we had been and that’s when lots of lessons were learned.” Brad suggested that one of the most significant responses to the pandemic was the creation by the EU of HERA, the Health Emergency Preparedness and Response Authority. Of that organization, he told us, “The European countries really did respond, demonstrating that they are taking health security seriously.” An article from the journal Health Policy put “seriously” in perspective: “The European Union (EU) Health Emergency Preparedness and Response Authority (HERA) is a new Directorate-General within the European Commission. With a budget of at least €1 billion per annum, about the same as the World Health Organization (WHO) holds in its core budget, HERA is set to become a major global health player.”  Indeed, Brad points out, “There is a shift in the international scene. For many years, the U.S. held the keys to advances in health security; but now global units are recognizing that they need to become more engaged. The world is paying more attention.”

6. We welcomed fresh eyes on an old cartoon.

In honor of our 100^th issue of the IINews, we asked the man who’s done all those cartoons to reflect on his favorites. Here’s one that stood out:

7. We learned that Public Health and pharmacies need each other more than ever.

It wasn’t long ago, back in the pandemic, when pharmacies were heroes: 315 million Covid vaccinations given during the main Federal effort (FRPP), nearly half of all the U.S. Covid vaxxing… all while keeping up their usual pharmacy duties. Definitely heroic. And yet, back from the battle, what’s happened to those heroes? Rite-Aid filed for bankruptcy. Walgreen’s announced mass store closures. And we continue to lose independent pharmacies. Some way to treat a hero.

Meanwhile, other heroes of the pandemic aren’t having it much better:  The folks of public health are also facing a fresh set of uncertainties.  So, here’s the question: Could pharmacies and public health come together again in a way that makes both stronger?

Jason Briscoe, a pharmacist who headed operations for a regional drug chain before joining STChealth as Vice President, working to bring technological efficiencies to healthcare, offered this uplifting call to action:

“One, if pharmacies are in need of more opportunities; and, two, they proven the ability to deliver on the things Public Health cares about, then let’s connect those dots. And let’s do it in non-pandemic times to start covering more ground and doing right by patients. Whether it’s immunizations or clinical services, that’s the intersection — community pharmacy can be an extension of, and a driver for Public Health all day, every day. Let’s just connect the dots.”

8. We got new meaning to “Honey, I shrunk the kids.”

Stats guru Bill Davenhall offered a startling prediction: In 2025, there are about 18.9 million children under 5 years of age living in the United States. In 2030, it’s estimated that there will be about 353,000 fewer.”

9. We learned a new term: “Culture Vulture”

Executive coach Bill Godwin has led several companies, including a telehealth company that was bought by Walmart, and who has developed a reputation for creating high-performance cultures. He described the impact of negative employees, the ones he calls “culture vultures,” and talks about how leadership often looks the other way.

“Every leadership team I’ve worked with, every leadership team that I have led, has been dysfunctional. Every single one. The question for the leadership team is the degree you can reduce it.  The hardest case is the good employee who’s got a bad culture effect. Every company has them, and every CEO, myself included, wants to put their heads in the sand; we keep that person because they’re so highly productive or the rain maker or whatever. We hope it will get better, but we know it ruins our culture long-term.”

10. We got some much-needed perspective on the influence of health leaders who question immunizations.

“One more thing to keep in mind about the future of immunizations: If we forget why we need vaccines, the diseases will remind us.” That’s from STChealth’s Medical Advisor, Dr. Scott Hamstra.  He added, “We humans are not great at understanding risk. In the past, pathogens were the best educators, and sadly they may need to re-educate us once again.”

But, after those dark thoughts, he gave us some hopeful ones:

“Let’s back up and think about what’s going on at the highest levels of vaccination policy. ACIP was made up of lots of professionals (pediatricians, physicians, epidemiologists, public health, pharmacists) all kinds of science experts. The pros came together to review the data and give us a single unified voice.

“What happens if you destroy that unified front? Well, all those professionals are still out there. They’re still doing the same things. If your leader disappears, the team is still going to play. If the coach goes down, another coach takes over, or the players step up to keeping playing the game. The reality is that most parents and most professionals are going to continue to do what they are doing because it’s the right stuff to do. I sometimes think people believe leaders have more influence than they really do. The professionals with years of training and experience are going to keep doing the right things, and the team is going to keep winning.”

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STATS OF THE MONTH

Do You Understand Your Audience?

By Bill Davenhall, Geomedicine Analyst

Behind all the demographics, there is something that lies somewhat in the dark but looks us in their face every day. I refer to the “body of observational literature,” the product of our accumulated culture and daily living.

Frankly, much of the communication that is pushed out by agencies or by institutional and governmental marketers, is a captive of a “one size fits all” syndrome – largely due to budget constraints. There are certain characteristics of populations that drive various consumer markets and behaviors, such as their attitudes about immunizations and a whole host of beliefs. For example, the chart below is an attempt to summarize the various attitudes and characteristics that influence the response to your effort: it’s called Generational stereotyping, somewhat a mixture of science and art. It’s useful for anyone that must understand their “audiences.” Of course, these characteristics don’t always cluster by geography, but within every geography will be a fairly predictable number of each generational segment at work – either making things easier or harder for you to reach goals of participation.

Review the chart below and figure out which Generational Segment you occupy — by your age or your birth year. Simple step. Then read the summary of that generation that I have gleaned from my research. It might sound some alarms but then move you to want to learn more about how many of these generational segments exist in your “market” and then help you decide how best to communicate with each generation. I like to remind my readers that to change your view on things it often involves moving your chair — so I would suggest you begin to see these generational differences from another view.  Much like the futility of trying to put toothpaste back into the tube, trying to change the generational characteristics is a very hard task – and almost impossible. The phrase “baked-in” comes to mind.

After you have either chosen the generation that you’re in, or you want to understand a different approach to a different generational group, read the very concise description that I have provided. I consulted with various AI re-creations of the generational characters as offered by several dozen research organizations with an interest in segmentation marketing. While it’s not perfect, most of the characteristics will perhaps ring true to what you have observed firsthand.

As you might imagine, I am always looking at data from a geographical point of view trying to access how many of what kind exist in what specific geography. The reverse is also true – identifying the characteristics you think will offer success and then attempt to find the geography where this attribute exists in the greatest number. Either method gets you doing what I suggest – spend some serious time understanding as best as you can this generational difference since they will often make the difference in how well your messaging and participation is working.

As always, I appreciate 2^nd opinions.

                                                                 What is your Generation?

Reference	Your Age in 2025 Between	Generation Name	Estimated Number US 2025 (m)
1	80 & 97	Silent	20
2	61& 79	Baby Boomer	70
3	45 & 60	Gen X	65
4	29 & 49	Millenium	72
5	13 & 28	Gen Z	68
6	0 & 12	Alpha	60

One sentence summary of Generational Characteristics

1. Silent Generation are the resilient, duty-bound survivors of the Depression and WWII who valued quiet conformity, lifelong loyalty, and traditional faith over flash, quietly building postwar America while suppressing their traumas. Reserved and formal in their communication style. Family vs individual. Shaped by scarcity. About 20 million people in this generation in the US in 2025.

• Baby Boomers are the postwar optimists who grew up with unprecedented economic security, rocked the 60s, built the 80s–90s economy on long hours and loyalty, and remain the last American generation where regular church/synagogue attendance was the default rather than the exception. Idealism and long emails. Conservationist and “live to work” ethic. About 70 million people in this generation in the US in 2025.

• Gen X is the small, cynical, fiercely independent and authentic generation raised on divorce and MTV, who learned to expect nothing from institutions, mastered both analogue and digital life, and now quietly run most of the companies today (but  “invented” remote work). Sarcastic, blunt, and low drama. About 65 million people in this generation in the US in 2025.

• Millennial is the optimistic-turned-cynical cohort who invented adulting, got crushed by economic crises, and led the first mass exodus from organized religion in the Western world. Like email and emojis. Life balance important. On-Line dating popular. Student debt a huge issue. The beginnings of the “nones” – spiritual and not religious. About 72 million people in this generation in the US in 2025.

• Gen Z is the hyper-connected, trauma-informed, and fiercely authentic — the first generation to treat mental health as non-negotiable, traditional institutions as obsolete, and the planet’s future as personal responsibility. Larges cohort of religious “nones” and marriage and kids delayed.  About 68 million people in this generation in the US in 2025.

• Alpha are the first true AI natives who learn from tablets and robots before teachers, accept diversity and climate action as facts of life, and are being raised by screen-addicted but hyper-aware Millennial/Gen Z parents in a world where church is something you might see in a history video. Infants with cell phones and iPads in their hands. Friends come from Internet games and apps like Rolox and Minecraft. Real play comes second. About 60 million people in this generation in the US in 2025.

Sources: Internet AI, GROK4, MS CoPilot, Google and a variety of market research sectors (product, communication & religion.