I think I know almost everybody here. I'm Michael Hamburger. I'm really pleased to welcome you guys.
Thank you so much for coming out on a beautiful afternoon. That may be part of the reason for our small
crowd here. I'm not sure. I've had a couple people today suggest that 5 p.m. is not the ideal time for
a public forum like this, but we also get comments about evening events as well.
Anyway, let me just say a word about our organization, Concerned Scientists at IU, and then turn it
over to our friend Tyler Morris, one of the leaders of our student advocacy group, Advocates for Science
at IU, who will be moderating the discussion today. So I'm a retired faculty member at IU and proud
to be one of the founders of Concerned Scientists at IU. We have been around for
Now almost 10 years since February of 2017, we are an informal, non-partisan, non-profit, non-affiliated,
non-funded group of faculty members, students, community members who are committed to supporting the
integrity of science, support for science, and kind of rational decision-making based on
the best we know about the world around us. Again, our group has a kind of loose connection with the
national organization, Union of Concerned Scientists, but we are formally unaffiliated.
Our student affiliate group has been around also for all that time and has really been the source of
a lot of energy and enthusiasm for the programs that we've been supporting over the past few years.
We've done a lot of public forums like this. We've hosted prominent speakers. We've done a number of
election-related forums. In fact, I'm still claiming, unless proven otherwise, that we did the first
ever national congressional
forum focused on science and technology policy issues, and we've tried to do that in every major election
year. We've also written commentaries on regulatory issues and met with legislators at the state and
federal level on important science policy issues.
I'm so excited for the event that we're doing today. It's one of these issues that move from the background
and as kind of accepted science and health policy now is in the foreground of political battles and
policy battles. And we have three experts here who we'll introduce in a moment. I wanted to be sure
to introduce our next forum, which is
We've just been set up in collaboration with Climate Week 2026, and we realize that Climate Week is
just a few days after the midterm elections and decide there's going to be a lot of interest, of course,
on the elections themselves, the results and the impacts of those elections. Of course, we don't know
what those results will be. I do, actually, but nobody else does.
And we may be still battling over certifying the results of those elections. But we've brought together
three experts, including David Watkins, who's the legislative director for the Union of Concerned Scientists
in Washington, David Koniski here at the School of Public and Environmental Affairs, and Marjorie Hershey
from the Political Sciences Department, who many of you know as three experts on political process.
environmental policy and at the national level. So I think that will be a lively discussion. That will
be virtual. We will be sharing information about how to sign up for that. You'll notice there's an absent
QR code. If you're not already on our mailing list, please do so. We've got a sign up sheet outside
and we will get you information about that forum.
Let me turn it over to Tyler Morris, who's going to say a few words about the structure for today's
event. And again, I just request, since we've got a small cozy group and some really exciting speakers,
that we keep this as lively and as interactive as we can. So take it away, Tyler.
Yeah, thank you, Michael. So as Michael mentioned, I'm Tyler Morris, a graduate student here in the
School of Public Health, and I'll be moderating this evening's discussion. So we're going to start first
actually with the presentation from Lisa on recent policy developments at the federal and state levels.
And then after that, we'll hear some introductions from our other two speakers, Jim and Katie, and then
we'll move into a panel discussion on some questions that we've come up with together.
Um, and then we'll have time for Q and a for the audience. So Lisa, I think I'll go ahead and hand it
over to you and you can introduce yourself and your work. Thank you. Okay. I'm really excited to be
here today. So thank you for the invitation. Uh, talking about vaccines is my favorite thing to do.
So when I had a Tyler reach out and ask about, um, coming today, I was ecstatic.
gets me out of my office. And I get to share some really interesting, if not troubling, information
with you all. So I'll apologize up front, because some of my slides are really text heavy. I understand
that. I know Katie is a health communications professor. She's going to be like, bad, bad, Lisa. But
you don't need to read it all. I want to have it for you to see.
all of the things that are happening. And I'm happy to share the slide deck afterwards. So if anybody
wants to take a closer look, you'll be able to actually read the text from there. So I'm Lisa Robertson.
I'm the executive director of the Indiana Immunization Coalition. The coalition has been around for
about 23 years. And I have been the director for the past 13 years. And things have changed
quite substantially in those 13 years.
Our mission is to reduce the spread of vaccine-preventable diseases, primarily in Indiana. So that's
all we think about is vaccines, barriers to access, language, anything that we can do to make access
and acceptance of vaccines easier and better in Indiana. And we do this through education, events like
this, advocacy, so we're at the State House.
at least every week during session. We do postcards every other month to all of our legislators. We
visit them when they're back in their home districts during the off session. So we spend a lot of time
thinking about policy. And then we do, we have a public citizens action group. So Hoosiers Vaccinate
is our advocacy arm and I will kind of share a little bit more about that when we're talking at the
end and there's stuff outside on the table.
And then during COVID, the big change that happened about six years ago, we used to do education advocacy
outreach. That's what we did. During COVID, we were watching our immunization rates drop. I mean, we
could see them going down, which we knew, right? Because our physicians were focused on first that to
and under, right? They were focused on COVID. They were looking at tracking disease, COVID vaccines,
our health departments. Everyone was focused on COVID.
Rightfully so. So what we decided as a coalition was we were going to focus on routine vaccines and
we entered the clinic space. So my board of directors, I'm not sure why, said yes and allowed me to
start a clinic. And over the years we have, I kept thinking like, oh, it'll start to decline, it'll
start to decline. That has not been the case. We run typically three to five mobile teams, at least
four days a week.
Last year we administered 55,000 vaccines, which is as Katie would want me to tell you about three and
a half vaccines per person that we saw. So we're always trying to make sure we don't have missed
opportunities. So we have been in this space. We are, we are really like, we're not just talking about
it. We are living and breathing this every day. I have no disclosures. So I always like to start my
presentations with pictures of
Usually it's just a picture of my kids, but I was thinking about like, I've been doing this for a while
now and they have been my models and I have their consent. There's no HIPAA issues here. They know that
I use their pictures. In fact, they're going to get their flu and COVID this week. So I was like, send
me your pictures. I'll pay you. I'll give you $25 if you send it to me. So, but this is them kind of
over the years getting their vaccines.
And I like to show this picture to remind people that, you know, there are a lot of really horrible
stories about vaccine preventable diseases, right? We know families who have lost children to influenza
or to Hib or to pertussis, but we all have our own story. And the most powerful thing that I can tell
my friends and my colleagues and families that I see in my clinic is that the two people that I love
more than anything else in this world are fully vaccinated.
They have their complete HPV series. They have both meningitis B vaccines. They get their flu and COVID
every single season. That's the most powerful thing I can say to another parent. And so I always, if
I'm talking to a parent, I'll say, oh, both my daughter and my son have all their HPV vaccines. Or yes,
they get their COVID vaccine every season. That's a really powerful statement. So we all have those
stories. It doesn't have to be this really terrible circumstance.
And there's even a picture of my husband up there because I love him too. And so that's his picture
about, you know, he's getting his pneumonia vaccine up there. So, so just thinking about how you can
share your story. If we are not using our social media spaces, if we are not using our voice to tell
positive vaccine stories, then we are letting the anti-vaccine rhetoric win. Because if we're not doing
it, who's going to do it?
So I just put this up here. This is the IDOH website. I hope everybody's familiar with it. But they
do amazing job tracking data. So if you want to know what your school system looks like, what your county
looks like, what the immunization rates are, they have dashboards that are phenomenal. So I hope you
use them. They do a really great job of sharing the data. So I'm going to talk about vaccine rhetoric
and anti-vaccine rhetoric and where we are now politically.
But I just wanted to remind people that this is nothing new. This is not a new phenomenon. This did
not start during COVID. This has been something that has been going on since our very first vaccine.
Now it has changed a little bit. But as you can see, this was 1879 when the Anti-Vaccination Society
of America was founded. And it was founded because of the smallpox vaccine. And it was founded because
of mandates.
because states were starting to impose mandates around getting smallpox vaccination. And you can see,
there was even, they were going to court. So the American waged court battles to repeal vaccination
laws. This was back in the 1800s. So what we are dealing with today is not a new phenomenon. This has
been going on for a really long time. This was some of the rhetoric,
in the papers, I put be a man on here because it actually says that in this article, which I thought
was really funny. But I was telling physicians who at that time were men not to vaccinate, to be a man
and to stand up and not vaccinate. But I thought this was really funny. It's in the slide deck so you
guys can read it when you get it. Hopefully you can email it out.
So we're not really going to talk about anti vaccine though, because that that is a space that is really
hard to move people out of. So we're really going to talk about today's vaccine hesitancy because that
is really what we're seeing. It is it is misinformation. It is the wrong information. It is.
not knowing who you can trust, who's giving you the right information. And so a lot of what we're seeing
today is hesitancy. And that is very, very different from anti-vaccine. These are people who maybe are
complacent, maybe it's a convenience or an access issue, maybe it's a confidence issue. And so knowing
why people aren't accessing vaccines or why they're saying no to some vaccines is really important to
understand.
So here's the AAP schedule, which we all know and love. And this is the current, the 2026 schedule.
And I just put this up here to remind you that this is gold. This is like the golden schedule. I would
call it gold science, but we don't want to use that terminology. That's what I would call gold science.
But this is where we start, right, because this is where
back in January with RFK and HHS, this is where the drama started. So here's the AAP schedule, which
we have followed for decades. On January 5th of this year, HHS released the new childhood immunization
schedule. And it was broken down into these three buckets, so recommended for all children, recommended
for certain high-risk groups,
and then recommended based on shared clinical decision making. And so this kind of just changed that
schedule into these three very kind of hard to grasp buckets, especially shared clinical decision making.
I always think this is a really horrible thing to call this bucket, because we have shared clinical
decision making for meningitis B, HPV over the age of 27, but I always think like,
What vaccine does anybody administer without shared clinical decision-making? It's not like I'm administering
anything to a patient or a child without having had a conversation with them about what they're receiving.
So I always feel like every vaccine we administer, we're doing shared clinical decision-making, right?
So this schedule was released on January 5th of 2026. It caused a lot of chaos.
kind of think about the general public, like if HHS says this is the childhood schedule, and you don't
understand how this childhood schedule is made in general, you have no idea that this is not a good
idea. You just know our HHS has said this is the schedule. So then what happened in this, like I said,
lots of text, please don't read it. So then what happened was fairly soon after that in March, AAP,
sued RFK, so AAP versus RFK happened. On March 16th, the federal district judge blocked that vaccine
schedule that we just looked at, paused all changes made by ACIP, which is the Advisory Committee on
Immunization Practices, reverted everything back to the 2025 schedule, said that ACIP had not been legally
formed under the RFK administration. The administration then filed an appeal
The case is still in trial. The appeal was heard at the district court in October, so just a couple
weeks ago, the first week of this month. And we're still waiting to hear what's going to happen from
that case. So that alone kind of throws everything into chaos, right? Like, here's one schedule that
everybody has followed. Oh wait, here's a new schedule. Oh wait, now that schedule's been repealed.
We're going back.
Not just to the last, we're going back to the 2025 schedule. Well, on that schedule, the flu and COVID
that was approved was not the current season schedule. So it has been a roller coaster. So in May of
2027, or May 27th of 2026, the America Health Insurance Plan, so AHIP, tried to reassure everyone and
say, it's okay, insurance will continue to cover all vaccines regardless of what schedule is out there.
until at least the end of 2027. So that at least gave providers some reassurance that they were gonna
continue to get reimbursed for vaccines, trying to like calm some of these stormy waters. Then on May
29th, the president issued an executive order directing the CDC and ACIP to realign our vaccine schedule,
reducing the number of recommended vaccines to
closely replicate what was done in our peer nations like Denmark, which I've never thought of Denmark
as a pure nation. They have, you know, universal health care. They have great access. They have a very
kind of homogenous population. But that was what this executive order said. The ACIP was still barred
from meeting per the federal judge's rule. So the ACIP couldn't do anything because they didn't exist
at this time.
In June, a new ACIP charter was posted. The version downplays the panel's role in recommending the use
of new vaccines. It says part of the ACIP's responsibility is to assess alternatives to disease prevention.
But then they didn't actually vote on this ACIP charter. So we still don't have an ACIP charter and
we don't have an acting ACIP. And then,
This is like just keeps going on. So even before that, all of the covid funding was repealed. So this
is like a never ending issue. So this happened on August 10th and this actually was concerning. The
last executive order was pretty like watered down. There wasn't a whole lot in it. This executive order
was different. So in this executive order on August 10th,
The President, one, recommended that combined MMR vaccines be administered as separate single antigen
vaccines when the product becomes available in the United States, while the product's not available
anywhere in the world as separate antigens, so that's a problem. And the manufacturers have said we
are not going to produce separate antigen MMR. Some very underdeveloped countries still have MR as a
separate vaccine.
but nobody has M and R, measles, mumps, and rubella, all as separate antigen vaccines. So not even possible.
Childhood vaccine should be administered at separate medical visits, which I don't know if you guys,
like my son is a needle-phobe, and so like if I said to him, every time you're going to see
your pediatrician, you're gonna get a vaccine, every single visit, it doesn't matter.
I don't know if he'd ever see the doctor again. He's 19 now, so I can only do so much. But I just think
about how much stress that puts on a parent, if you're trying to be like, but then I was thinking too,
like as a medical professional, if that means you have to come and see me more often, that means I'm
gonna get paid more, right? Because, so I mean, there's that would be a positive. HHS should assess
the timing and sequencing of childhood vaccines, which is what they,
AAP and ACIP have been doing for decades, should develop alternatives to aluminum containing adjuvants.
So this is kind of going back to the whole thimerosal and vaccine issue. Aluminum is the new, you know,
evil product in our vaccine. And there's lots of research on this, which I'm happy to share with you all.
And then this is the one that scared me the most, and I'm sorry, it's a little hard to see at the bottom.
But the executive order advises states to reconsider their school entry and attendance requirements.
It directs the attorney general to support legal challenges to state laws that allegedly conflict with
federal, constitutional, or statutory protections involving parental authority, religious freedom, disability
accommodations, equal protection, and medical and religious exemptions. And so that
Right there is what we are very concerned about. And I'll tell you why. After I tell you what just happened.
So HHS announced a package of actions centered around vaccine injury reporting and care. This just happened
like last week. Basically saying we should pay providers to report to VAERS, which is troubling all
by itself. VAERS is kind of a passive
Um, reporting system, anyone can submit a report to VAERS, how CMS would pay providers to report to
VAERS. We're not, I don't even know how that framework would work. Um, and, uh, it talks about EHR data
standards. So I won't read you all this. This just happened. We're just watching this in the systems
right now. Um, but this is what they're trying to do, right? This sows that kind of fear and that,
um, apprehension around vaccines and vaccine injury. And, you know, they're setting up a clinic to study
vaccine injuries. Um, so they're really kind of getting this rhetoric out there. And if you don't live
and breathe in this space, it's really, you don't know what's behind a lot of this policy. So what we're
watching in Indiana and what kind of keeps me up a lot at night,
is without an ACIP, so without the Advisory Committee on Immunization Practices, we actually don't have
ACIP. So all of our legislation in Indiana is based on ACIP. So if you read our pharmacy legislation,
it says pharmacists can administer based on ACIP recommendations. Our school requirements can be made
based on ACIP recommendations, things going into the state registry,
based on ACIP recommendations. It is in our legislation all over the place because we never in our wildest
dreams thought that that would not be who we wanted to be listening to when it came to vaccine policy.
So because there is no, so that last ACIP schedule and recommendation that exists is from 2025, there's
technically not a current recommendation from ACIP for flu or COVID because it's done every season based on the,
the vaccine itself. So pharmacies are in a really troubling spot because legally they're not sure that
they can administer COVID and flu because the language that gives them authorization to do so references
ACIP language that is outdated by a year.
So that's a concern. And for big pharmacies, not as big of a deal, but for those pharmacies that use
our state health commissioner for standing orders, like our smaller independent pharmacies, it's a big
issue. School mandates were released seven months late this year. So we had kids leaving school going
into the summer. The school nurses didn't know what was going to happen with school mandates, so they
didn't say anything. So we got back to school this year, and kids are so far behind because those
mandates were not released until the summer. And so now school nurses are playing catch up and it's
a mess. And the more concerning thing is our state health commissioner has the authority to change school
requirements at any time. So she could change our school requirements tomorrow. It is written into our
legislation that she has the authority to make that change without going through, there's a committee
on school immunizations that meets every year.
But she could make that change that the governor said to her we are making this change. I am demanding
that you make this change She has the authority to make that change without going back to legislation
to legislators. So that's We are watching it all very very closely so what else it means for Indiana
is Measles we currently have 50 measles cases in Indiana last Monday, we had 30
Uh, yesterday we had 50, so it is increasing rapidly. It's in 10 counties currently, um, primarily in
the Amish population. Uh, but it, I know they were testing two or three other counties, um, yesterday,
so we should know tomorrow if there are cases there. So we are, we are seeing the impact of what all
of this upheaval and misinformation and lack of clarity is doing to our systems.
And so just a reminder, this is what we're gonna talk about today, hesitancy. I won't read this to you,
because I wanna move on to our panel, but just remember that people that are hesitant, sometimes we
get into this like, oh, well, they just don't, like they're, I don't wanna say, I'm trying to use a
nice word, but sometimes we think that they're not paying attention, or they just will believe anything,
or, but it is really hard
to know what is true information, who is a good source. When our HHS is giving bad information, if our
CDC is not standing up and saying what's right, if our state health department can't talk, you know,
they're not allowed to say that measles is in the Amish population, we can't blame our population for
being concerned or not knowing what's real or, you know,
being hesitant about vaccines because they are hearing so many things that maybe aren't true. So we
have to give them grace. We have to be willing to take time to talk to them. And we have to have a good
understanding of vaccine science. And these are really great non-government resources, which again,
please check them out once you guys get the slide deck.
Yeah, so thank you, Lisa. I think that was very helpful for me personally because there's so much uncertainty
right now with where things are at with like childhood vaccine recommendations and school mandates and
obviously all the legal battles right now. Even being someone who is very interested in these things,
I struggle even trying to stay up to date with all of these. So that is very helpful. But before we
get into our panel discussion, I actually wanted to invite our other two members up
Jim and Katie, so you guys can introduce yourselves and your work.
I think Katie we can start with you if you want to introduce yourself and work any comments you would
like to add to Lisa's presentation
Yeah, hi, I'm Katie Head. I am a communication professor at IUPUI, which I will always call it, because
that's who hired me. People always wonder why a calm person speaks about vaccines, but I think as we
saw from Lisa's presentation, so much around health and medicine and decision making has to do with
communication. So that'll be the lens that I bring tonight.
I also am the Assistant Director of the Office of Community Outreach and Engagement at our IU Simon
Comprehensive Cancer Center at the School of Medicine in Indy. So I do a lot with cancer and cancer
screening as well. And if you know anything about cancer and vaccines, you probably are right to assume
that HPV is my main love. And I spend a lot of work with that.
I was lucky to run into this chick almost a decade ago. It's crazy. And we've worked really well together.
We work on a lot of community-engaged projects together, both funded and not funded. And I am lucky
to serve on the board of the Indian Immunization Coalition as well. So yeah. Thank you, Katie. Jim?
My name is Jim Laughlin, and as was
so eloquently displayed in the flyer you got, I am retired, which means I'm old, which also gives me
some credibility, I guess, because I've been here through the course of many of these vaccines that
weren't available when I first started in my practice, and I grew up in an age where a lot of these
vaccines weren't available, and now have lived through the vaccine era, which has been a godsend.
I came to Bloomington after graduating from IU School of Medicine and Riley residency at Indianapolis.
Did my pediatric residency there. Also did a pediatric pulmonary fellowship. So did dabble in academics
and the science of clinical studies during that time. Came to Bloomington in 1981 and set up solo practice.
I was in solo practice till 1995 and we saw the need to
have more access for pediatric care, and I set up a group called Southern Indiana Pediatrics, and it
rapidly grew from original three members to 20 providers of pediatricians and 14 nurse practitioners.
We had a lot of fun during that time period. And one of our main focuses was on access to care for kids
in our community and the surrounding 10 counties around here. We joined IU Health and were branded as
Riley Physicians in 2011. And we've been with Riley Hospital and Riley Physicians ever since that time.
And I think that's a
Oh, I did want to say that I have been very active in the past with the National Academy of Pediatrics
and actually served on a national committee called Ambulatory Practice in Medicine. That committee set
policies for office-based practice policies, which included
administration of vaccines and what vaccines we would endorse as an academy, along with the cooperation
of ACIP. Great. Thank you, Jim. So I think to get us started with our first panel question, I know,
Lisa, you discussed a lot of this, like what's going on at the federal level, especially, but I wanted
to get a better idea of what you guys are seeing here in Indiana. So Jim, being a pediatrician and
Katie and Lisa, I know you guys do a little bit more like work kind of out in the field, going around
places. So I guess my question is, through your work in Indiana, how have you seen, especially focusing
on something like vaccine hesitancy, how have you seen that change throughout, you know, the time that
you've been involved in your work here, especially these past couple of years and these past 12 months
maybe especially?
So Lisa, maybe we can start with you first. Sure. That's a big question. I think what we see, and again,
we're out in the community doing vaccines every day. And I think we're seeing more hesitancy around
particular vaccines. So a little bit around MMR, not as much as I would have thought. But of course,
still around HPV.
COVID, of course, and flu, lots of hesitancy. People that before would have kind of, you know, we could
make a recommendation and they would accept whatever was recommended, now tend to have a few more questions.
They tend to still be acceptors of vaccines, but they want a little clarity. They want us to reassure
them that they're making the right choice. They need to understand that
We're coming from the same spot where we want their child to be happy and healthy. We have the same
goals for them as their parents do. It does take, I think, a little bit more empathy and a little bit
more time, but I'm not seeing a huge. Now, we're a vaccine clinic, so they're not coming to me if they
don't want vaccines. It's not like the pediatrician who's getting those families as well. If we see
them, they at least
want their school-required vaccines, and we can talk to them about other things. So we're in a little
different space, because we know they're at least somewhat of a vaccine acceptor when they come to us.
But we've definitely seen we have to answer a few more questions and be a little more patient, provide
a little more guidance, and really understand the schedule. And then I think the other thing that we
see, and this is definitely way political,
is in areas where ICE is more active and we're having a clinic, we see far fewer people. And so one
of the populations that we serve the most is probably our families that are immigrating from other countries,
our refugees. We see a lot of migrant farm workers. And so,
you know, really thinking about where we can go that is a safe space for them is really important, where
they feel like they can come and not be at risk. And we can't always find that. So we were at a school,
we thought that would be a good place, but ICE had been active a couple days prior and we probably saw
a third of the families we normally would see. So there are a lot of other things going out, you know,
not just vaccine hesitancy, but there are other political things going on that are impacting people's access or
the ability to get vaccines. Yeah, and I'm kind of new to the policy space. It kind of scares me a little
bit. I just do mostly calm. But I've learned a lot working with this organization and others. And I
think what's been interesting, and to address your question over the past few years, policy in Indiana,
we, relatively speaking, maybe until recently, have had a really progressive state when it comes to
vaccination.
Pharmacists can vaccinate that's not true in every state We also have dentists that can vaccinate with
state policy that says dentists can vaccinate with flu and HPV Is that right those two? That's all they
want to do But then I think to dr. Laughlin's point like policy happens at the clinic level too, right?
so we think well pharmacists often have things like
the ability to store vaccines and the policies you have to have around vaccine storage that dentists
don't have. That's one of our big rollout problems around helping dental practices get to do vaccination.
And they're perfect for HPV because they're often, you know, doing a throat neck exam.
Um, there's also been some, some policies, uh, around workplace vaccination, you know, thinking about
our healthcare providers and their need to have flu and COVID vaccine, which Lisa's organization tracks
closely. Um, uh, there was a really great, uh, policy for college students as someone who's a professor,
uh, that they needed to get, have their, both of their MenB vaccines, um, public universities. We were
raring to go to get that going and unfortunately that was,
hard to implement, and then students couldn't register for the spring semester. So universities said,
oh, we don't really want to do that anymore, right? So to be able to opt out of policies. But I think
just one thing I want to point out and I talk to my students about, particularly when I'm working with
med students and school public health students, is policy is an evidence-based
practice and we need to remember that, right? Like when we think about the idea of recently we raised
the tobacco tax in Indiana finally, right? That's an evidence-based intervention. We know people, we
saw quit line calls go up, right? We know people will stop because they can't afford that. So I think
if we can think about policies
we can talk about policies and the rhetoric around policies as evidence-based interventions, right,
rather than mandates. And we're trying to make people do things. I think that's important to remember.
And these things work. As an HPV vaccine lover, I just want to point out that a few years ago, 25% of
HPV vaccines in the state of Indiana were given by pharmacists. And that would not have been possible
if we didn't have that policy in place. So policies can work, and they do work.
Thank you. Jim, anything you want to add? Just to reiterate, I think the shift in vaccine hesitancy
over time has been pretty dramatic in our experience. For many, many years, there were always going
to be certain parents that were worried. And I use the word worry rather than denying their kids getting
vaccines. They have questions, they worry about
the impact of vaccines, they don't understand them. And so we've always had that group of people that
we had to try to explain the risk benefit for vaccines and the safety of vaccines. Over the last, since
COVID particularly, that has become such a political issue that we have seen it go from those that were
just worried to those that don't want vaccines based on
new information that's coming out from the government, which is different than what we've always tried
to endorse and follow. And so it has become more of a political shift. And I always joke, and I can
say this in front of a number of you who I know are from the university, my biggest skeptics for vaccines
used to be my university professor parents, because they wanted to discuss it and make sure that it
was okay. And I relished that.
because you could have an interchange that was not a political argument. It was more of a science argument
and a safety argument. But now it's clearly more along political lines. And so I know that in the Bloomington
area, for instance, the vaccine hesitancy is less than it is in the surrounding counties of Indiana.
And that's largely due to political demographics. So it's a real thing.
Thank you. Actually, so just a brief follow up for you, Lisa, since Jim just brought up like the different
communities in Indiana. I know obviously what you do, you have a lot of people who trust vaccines and
understand the importance of them that are coming to you. But do you see differences in different areas
of the state, like say somewhere like Bloomington versus maybe more like rural Indiana? Yeah, for sure.
I think, you know, we
we're mobile. So our goal is to reduce barriers and by, you know, taking vaccines to where people are
already. And we definitely see some more hesitancy, primarily around COVID really in our more rural
communities. And a lot of times those are, you know, just conversations that, that we have to have.
But I will say that as we continue to keep showing up, so, you know, we were in Davies County, which
is a tiny County in the South,
We were there for the third time, so every six months we were going. The first time we were there, we
probably saw about 11 people, and then we were at like 20, and this last time we saw over 40. So I think
a lot of this, we talk about rural communities, a lot of it is trust, and it's building up that trust,
and part of being trusted is showing up time and time again.
And so we are trying to really live that and to continue showing up for these communities where access
is probably an issue. And we say, we still know that our providers, our physicians, our nurses are the
most trusted messengers when it comes to health. So people may not trust the government, they may not
trust our State Department of Health, but they still trust their provider. They sure as heck still trust
their nurse. And so working with the school nurses really important.
Because in a lot of these communities, we say, oh, trust your provider, talk to your provider. Well,
they don't have a provider, right? Their provider is the school nurse or maybe the local pharmacy. And
so we have to change our thought around this. We can't say, oh, they trust their provider. Well, especially
when we're looking at our uninsured population, they don't have a regular provider. So who are they
listening to? Who is showing up for these communities?
time and time again, because that's who they trust, and that's who we need to find in these communities
to partner with. Thank you. Yes, I think now we can move to our next question. I really wanted to touch
on this. This has been a question, too, that has been talked about a lot online. All of this is very
politically active right now, but with childhood vaccination schedules, I know, Lisa, you touched on
that right now in your presentation, but I was wondering if
at least I'll start with you, if you could discuss how families can navigate some of the uncertainties
going on right now with the childhood vaccination schedule and maybe a follow-up question that you can
think about is what role should those requirements play in protecting families and also local communities
because there's a lot of discussion there about families having their personal choices and getting vaccinated but then
how that can affect the community if we have low vaccination rates. So yeah, maybe you can just talk
more about like the vaccination schedule and things going on there. Let's see, that's a big question.
So I think with our childhood vaccine schedule hasn't changed really a whole lot in the past, besides
adding COVID and RSV, which was a huge addition to our pediatric schedule.
really reducing hospitalizations for our youngest babies. I don't I don't think people like I think
people are still looking at the AAP schedule. I think that they still in general like pediatricians
and local health departments and private practice everyone is still following that schedule because
the HHS schedule was pulled back so quickly. I mean it happened it happened relatively fast.
So we still get questions. We get questions about birth dose hepatitis B, like why are we giving hepatitis
B to infants or to babies day one? And there's a lot of research that goes into that. I'd be happy to
discuss afterwards. I think it's fascinating. But I think it's important that providers, medical assistants,
this is a huge goal for me this coming year, is helping educate our medical assistants. Because they're
the ones that are taking our patients back to the office
you know, back to the clinic, back to the office. And if their vaccine has a tent, they can really like
derail that conversation really quickly. And so making sure our medical assistants have the right information
when it comes to the childhood schedules, I think is really important. And then school requirements.
And I think this is hard because parents have the right to make this choice for themselves and for their
children, right?
I believe that, but I also believe in the common good and the public good and that for those families
who can't make that choice, right? So we have young children who are immunocompromised, who are going
through cancer treatments, who, you know, whose immune system, maybe they can get vaccinated, but their
immune system does not respond to vaccines at all. So we have an obligation to protect those children
as well. And so,
you know, that's why we have school mandates so that those children still can come to school because
if we were letting measles and chickenpox and whatever run rampant in our school systems, those children
who are most immunosuppressed would not be able to attend public schools. And we have a mother who talks
at a lot of our stuff who has a, you know, her child has some, you know, you would probably know what
it is, some deficiency in his immune system. So he doesn't respond to vaccines and she,
did some research on the preschool that he was in and found out that probably half of the kids were
not fully vaccinated. And she was terrified, you know, every day sending her kid to school.
She was like, he could come home with, you know, the flu or something that, that could kill him. But,
you know, most families, most children are going to be okay. And so I think we've gotten away from talking
about the public good and about community good. And I don't know how we get back to that, how we,
bring people back to feeling responsible for helping protect other people? Maybe there's a good answer,
I don't know, but. Yeah, I think, you know, one of the things we talk about at our vaccine conferences,
you know, and sitting around being nerdy, is vaccines are so interesting. It will never not be interesting
work. But it's one of the only things, and you can come up with other examples if you want, but it's
one of the only things where it's a public health intervention.
It only works at the public level, but it's a private decision, right? And so getting people to buy
into that. And to Lisa's point, a lot of the research I do in Indiana and around the country is looking
at predictors of vaccine decision making and things like that. And altruism is something we've also
added in political affiliation recently. We used to not have to add that in as a demographic,
and now we do, and it's one of the strongest predictors, Dr. Laughlin's right. But we've added in altruism.
And we never used to study that, but we've thrown in that measure to kind of see, and it is a very strong
predictor of people's willingness. It's just general altruism. Like, will you help someone take their
groceries to the car? You know, these questions are very general. And it is a strong predictor
of vaccination. So I do think some of our social and cultural leaders have a role to play in this. I
know some of the,
There's not a single large religious organization that is anti-vaccine, and some of the leading religious
organizations have actually come out and said it is your duty as a fellow human to protect others through
vaccination. And I don't know how we get those messages more out there, but I think it needs to be part
of it. Jim, anything you want to add? Oh, I did what's been said already. I think there are a couple.
things that came to mind as I was listening to this, though. I think we have become somewhat complacent
as the incidence of many of these contagious diseases has decreased because of the vaccine's success.
And so many parents think, oh, it's not necessary. It's not going to happen to us. Why should I risk
having that foreign substance injected into my child? And so from a parental standpoint,
standpoint, responsibility standpoint, that's one issue. That's a little separate from the public health,
for the good of the public health, because not too many of us would argue that we need to strap our
six month old into a car seat. And that's a public health issue, but it's also an individual decision
to protect your child. And I think as a parent, that's one of our duties, ultimately, is to do what
we can to protect our children and to think that
Well, I'm not going to get in a car wreck, so I don't need to put my kid in a car seat is kind of comparable
to saying I don't need to get an MMR because my child is not going to get one of the severe complications
of the measles. So there are all kinds of reasons parents are not having their kids vaccinated, but
I would say that
it's not gonna happen to me and that complacency argument is also one that we have to kind of keep in
mind. Yeah, I think that's an excellent point too. Cause I think one of the unfortunate ironic things
has been, you know, certain folks saying, well, you know, this disease isn't around anymore. So why
are we still vaccinating for it? Not understanding that that's, you know, that made a reason why it's
not around anymore. So yeah, that, that complacency and, um,
especially with, you know, I think even some younger folks nowadays when they've never heard of some
of these diseases, more like measles is coming back now. So, yeah, I think, yeah, it's just really tough,
you know, Katie, like you mentioned, how do we communicate this to different communities and, you know,
different people who respond differently to things. So, yeah, it's, I think,
I had a follow-up there, I was thinking of asking, but I think for now, just actually go ahead and move
into our next question. Katie, I actually think these two next questions will be very good to hear from
you first. So this is regarding this information, misinformation age we're living in where there's just
constant information and misinformation coming from right now the federal government, social media.
So I guess the question I have is when federal guidance, like right now, and these independent third-party
medical organizations like the American Academy of Pediatrics, when their recommendations and health
guidance is differing, how would you suggest, say, talking to parents about that? Because historically,
it was look at what the federal government is recommending, like the CDC or HHS, but right now,
We're more hesitant to say go look at the CDC website. Even recently they they've changed some of the
language about vaccines and autism. So I guess what would your suggestions be for helping people evaluate
you know things they hear online or when they hear different guidance from like the federal government
and other organizations.
I want to start with a story I work with a national organization that quarterly, we meet with a group,
a panel of moms who have adolescents to kind of talk through how they're thinking about vaccines and
vaccine information. And we were talking about the executive order that came out over the summer recently.
One of the moms, this woman named Janice, who's great, she lives in Wyoming, she has six kids, and she's
been with her pediatrician, you know, her oldest kid I think is like 21 and her youngest is 12. She's
been with the same pediatrician the whole time. And she said, we were talking about this very thing,
and she said,
I luckily can ask him, but if I was a mom of a newborn baby, I have no idea what I would do. I wouldn't
have had an established relationship with a trusted provider yet. I wouldn't have had a provider at
all. I would not have known how to make sense of these things. And all the other seasoned moms in the
group chimed in, and they were like, absolutely. I just say, what do you think I should do, and turned to
to that provider for guidance. So I do feel for new moms, right, especially first time moms trying to
really make that decision. We know moms are the major decision maker on vaccines. That's why I'm saying
that. But I think when it comes to making sense of guidance,
probably preaching to the choir a little bit that when it comes to science, consensus is important,
right? And so I think if we can help the public understand that this is the discordant, the errant sort
of group that's happening, and yet everybody else is saying, no, no, no, let's just keep doing what
we're doing. AAP, ACOG,
family physicians, AMA, they're saying, no, no, no, we're not changing. We're following the guidance.
We all are in consensus around, and AAP has really stepped up. I work with another pediatrician.
He said, it's never been more exciting to be a member of the AAP than it is right now, right? They're
just like, you know, you go to our meetings and there's like security outside the rooms because,
you know, and they're like, that never happened before.
I think if we can emphasize the consensus approach, that this is the one that's different and I know
we used to follow the federal, but really we're saying stick with the consensus here and that we feel
comfortable and we feel that this is the right guidance. I also wonder, and I know this started bubbling
probably before you retired, but I wonder how much parents actually
bring in knowledge of those different things or if they just kind of come into that clinical space,
just I'm confused, I don't know what the right guidance is? Is that kind of how they come into that
space? Both. Both. Some of they come into asking questions and not wanting a particular vaccine because
they read it on the internet or their spouse is concerned because not all parents are in alignment for sure.
And there are some who have done their research, and they bring files in. But when you look at the sources,
that's where the argument comes, because you've got good sources on the internet, and you've got plenty
of bad sources. And so that's where I have to kind of sort out and try to have them sort out the good
information from the bad information. And we've mentioned ACIP. I don't know.
Maybe I should just mention that in the past, to become a member of this committee, it took years of
vetting during the application process for a person to be chosen to be a member of this committee. And
all of these members have extensive academic experience and scientific experience and clinical experience
to help form a group that isn't willing to argue
about certain things, but is basically using science as the basis for their decision in the end. And
I think the credibility that they had was so outstanding that that's why all these organizations follow
them to a T, because that is the gold standard and was the gold standard, not now. Because the committee
now has been revamped to include vaccine anti-vaxxers and those who have actually been involved suing, you know,
monetary gain. So it's it's a completely different field right now. Yeah. And I'm really glad you brought
that up. One of my mentors, Greg Simmons, some of you probably know him always likes to remind people
it is an anti vaccine industry. Right. We're not spreading this and disinformation for the good of humanity.
Right. There's a don't get this vaccine. Take
Ivermectin instead. Don't follow this advice. Watch my YouTube video and like it and share it.
Buy my book. Try these supplements, right? The reason the anti-vaccine industry and the spread of this
misinformation exists is it is an industry. There is a monetary gain to it. And we've played around
with that messaging. And it doesn't quite land with groups.
Someone's trying to con me, right? I would like to know, but I think it's important to remind people
that, like, what is the motive behind this information coming out? Lisa, anything you'd like to add?
I think the only thing I would add is, you know, we talked about, we got a little complacent because
the vaccines, we're doing such a great job, we didn't really, but I think,
As providers, we also got complacent with it. And so we have to own some of that because even when I
started 13 years ago, we didn't even talk about the infant immunization schedule because it was so,
the acceptance rate was so high that we didn't have to talk about it. And so we focused on where we
could make the most impact, which was like at the adolescent schedule with HPV and meningitis B and
maybe a little bit in the adult space, especially with chronic disease.
And so my first probably six years, seven years, we didn't even talk about the infinite immunization
schedule. And that's on us for not reminding parents that this is why we're doing this. This is why
this is important. These are the diseases we're preventing. So I think not only did the public
get complacent, but as providers, I think we did as well. And so owning some of that space again I think
is really important. Yeah, I think that's a really good point.
And something you mentioned too, Katie, with like new mothers, that's such a vulnerable group. So when
they don't have care already established with the pediatrician, that's where I think those bad actors,
those anti-vaccine groups can come in and scare people away from getting vaccinated. So yeah, it's really
unfortunate. I think obviously that's what we're seeing a lot of right now, even within our federal
government somehow, we've gotten to this point.
And yeah, actually, Jim, I really liked your response because that was actually a question I was going
to ask you is how, you know, because I think it's interesting to hear the differences between your guys'
work and then, Jim, where you're seeing, you know, a broad range of people that are coming in that maybe
aren't coming to you for vaccines like they are for you. So I guess, Katie, another question I have
for you, though, to kind of just build on that.
communication side of things. I was wondering if you could share some approaches and I mean I think
all three of you probably have a lot of experience here just what approaches have you found most effective
when talking with worried parents or vaccine hesitant parents. Obviously if you have someone who's in
complete denial of vaccines
that may not be someone you could even have a conversation with. But when someone is actually concerned,
how do you go about addressing that? What things help, what things do not help? I think that could be
helpful for all of us here if someone has a concerned family member and wants to try and address something
like that in a productive way. So a lot of what I realized when I went into this area is the importance
of taking communication science and making it
easy for providers and public health professionals to be able to use, right? So I do a lot of training
and a lot of things like that, many through Lisa's organization. The first thing we like to remind providers
and people working in public health and people who will be sitting at the Thanksgiving table next month
with Uncle Steve, who listens to a few too many podcasts and news organizations that aren't truthful,
is just because somebody has questions doesn't mean they're hesitant.
Right? And we see that with anything. Is it okay to take this antibiotic? Is it okay for this vaccine?
So that's an important place to start. We want shared clinical decision making for any medical intervention
that we're providing. But something that I started instituting in my talks around the time that COVID
started is some communication science. So one of the things that we,
talk about is echo chambers. Have people heard of the idea of echo chambers? A few folks have. So it's
the idea that we live in communication environments, particularly in today's very targeted, minute media
spaces that we can all live in, right? And Lisa listens to podcasts and reads books I never even heard
of. We're close friends, so we talk a lot, right? It used to be we all watched the same three news channels.
We had the same radio stations. We all were exposed to the same media, but now we can pick.
So we live in these echo chambers where we hear the same messages over and over. And the people who
are close to us are listening and watching and reading the same messages close to us. And so if you
live in an echo chamber where you've been told that vaccines are dangerous, that they're going to hurt
your baby, they're going to cause long-term consequences, they're going to be infertile when they grow
up, it's going to kill them, would you get your child vaccinated?
You wouldn't, right? And so I like to remind providers that this is their reality that these people
are living in. And I think if you can start from that place, from a place of empathy, that we really
are coming from different worlds. There was that old book, men are from Mars, women are from Venus,
right? It's kind of the same thing, but it's thinking about the echo chambers and the information
environments that we live in.
bring in, it comes from my colleagues in psychology, is something called motivated reasoning. And this
is something that's really hard to break people out of, but trusted providers can do it. And it's the
idea that when I come across information, especially if I've been living in a really tight echo chamber,
when I come across information that supports what I already believe, I'm like, of course, yes. So I'm
a big Swiftie.
I have to draw, I have to bring that in as a certified Swiftie, I have to mention it at every point.
So if I see an article that says, oh, her new songs are great, I say, of course they are, they're great.
If I see an article though that says her new songs are horrible, I'm not even gonna listen to it, I'm
not gonna critically evaluate it, I'm not gonna read it. We do that with all kinds of information. We're
motivated to believe and pay attention to things that support our already held beliefs and to completely, you know,
not believe and not pay attention to things that disagree with what we believe. How do we break through
these echo chambers and this motivated reasoning process? It's very hard. And one of the ways we do
that is through evidence-based communication interventions. We do that through helping people learn
health literacy and critical thinking skills. We help them learn how to sort through information.
I also want to do a shout out to people like Dr. Laughlin that we put, I think this is on us, we've
put so much pressure on pediatricians and family practice and PCPs to address vaccine hesitancy and
they don't have time. They also don't often have the training or the ability to do that and nor should
they. Yes, they should work with their patients.
But Dr. Loughlin and his colleagues do not have time to look through Uncle Steve's printouts that he
brought to talk about, right, he's got to get through all of the other things. And so, you know, I think
it's so incredibly important for every single person in this room that when you see misinformation,
you are obligated to call it out in a thoughtful, evidence-based approach. But when you are
at the Thanksgiving table and someone brings up misinformation,
You jump on it. I want you to think of Dr. Laflon how tired he is. He had to retire because he was so
tired searching through all the Google printouts. We cannot put the onus of responsibility just on our
providers because they are not the only people who are part of this kind of vaccine ecosystem that we
live in. The most important place of course that that happens is the online space. And I'm sure Dr.
Laflon could speak to given that he's been in practice since 1981.
practiced way before the internet came around, right, and the crazy change that that created. We did
a study about five years ago when Twitter was still Twitter, and we pulled all of the posts around HPV
vaccination in a six-month period. And I'll finish up, Tyler. Sorry, I get talking about common,
I can't stop. What percent of all the vaccine, HPV vaccine posts on Twitter in a six-month period, what
percentage do you think contain misinformation?
I thought it was 25% is the only, but those were much more statistically significantly more likely to
be retweeted, to be liked.
right, compared to the boring ones from the Indian Immunization Coalition, right? So we have to think
about the power that these unethical actors are using to spread information and try to understand what
they're doing and how we can not use the same tactics, we should be ethical communicators, but how we
can battle that. I think that was great. One of the things that,
I thought about when you were talking is, how do I approach a patient when they are asking questions
or hesitant? And my approach has always been, I don't wanna be confrontational and I don't wanna be
considered a zealot because that just turns the patient off and makes us in a defensive position. And
pretty much I've always said, well, if they refuse a vaccine, I almost always start with the question,
Are there concerns you have that I can help with? Because then you start to open, you open the conversation
or keep the conversation open, because some of them will just say no, but that's rare. Most of them
will express a reason or some reasons, and that gives you a foothold of, well, how do I need to work
this conversation to provide the information that might make them think about it?
And I can't tell you, it's like when we talk to parents who smoke, I can ask them at every visit, would
you like information or help to quit smoking? And we were actually involved in a national study with
the AAP. And it takes the average parent who smokes sometimes up to nine times being asked that question
before they may say yes. And my experience with immunizations has been sort of similar, is that I may
ask them at each visit,
if they have changed their mind or if there are other questions they have. In a relatively high percentage
of patients, I can talk them into getting vaccines. There are some that are just going to say no, but
I think that trust factor and that willingness to engage in conversation without putting on a defensive
front is real important. I've had
I know of pediatricians who don't see patients in their practice who refuse immunizations. We've never
been that way. Because I know there are many, many reasons why parents would refuse those or make that
refusal. But I think it's important to kind of try to keep an open dialogue. And by doing that and being
non-confrontational, I found that that is the best way to approach vaccine hesitancy in most of our
patients. Yeah, I'll just add really quickly.
I think one of the hard things is you can scare people out of doing things, right? So the anti-vax movement
is really good at scaring people so they don't get vaccinated. You cannot scare someone into doing something.
And so we can share stories of kids with measles and the six deaths in Pennsylvania, but it is really
hard to scare people into doing something. And I think the other just two quick things is we can't dismiss people.
So if they bring in Dr. Google and they have all these things, you can't dismiss that and say, oh, this
is just all garbage or these are not good sources. The best thing to do is kind of look at them and
be like, oh, well, this part of this article is true. And I believe this. Here's where there might be
some issues. And here may be some other sources you could look at to see. But we can't be dismissive.
And we have to answer their questions with honesty. And I think sometimes that's harder when they ask
about side effects. And I think when someone asks about side effects, we would have nurses occasionally
be like, oh, there aren't really any side effects. It's going to be fine. That's not true. I mean, it's
probably going to be fine. But their arm is probably going to hurt. It might be red and swollen. They
might get a fever the next day.
They might be fatigued. And so if we can answer those questions honestly and say, here are the most
common side effects that will likely happen, and if they do, you can put an ice pack on it or take ibuprofen,
then they don't feel like they've been dismissed. They feel like you've heard them, you've answered
them. And so really thinking about how we are responding to these questions, because I know it's easy
sometimes to just be like, and sometimes I'm really, really good at this, and sometimes I'm really bad.
I walked away from one family one time and I heard the grandma say, well, she's a smart ass. And I thought,
Well that did not go as planned. So then we get we get busy and we get you know everything's hectic
and sometimes we're not as patient as we should be. And I will say looking back on that conversation
like I dismissed her concern. And so in that one interaction right there I broke that trust right. That
family will never come back and see me again. And so it is really really important that we are very
careful with how we are talking to and managing these families.
I just want to add, I wish Lisa would have talked about this when she was doing her slides. But for
those of you that don't know, the federal government has decided that vaccines are such an important
public health intervention that you cannot sue a pharmaceutical company or a doctor if you get injured
for a vaccine. There's a special, what's it called, the Vaccine Injury Court? Compensation. Compensation.
And Lisa's organization has had a really wonderful scholar who studies this and has been part of it
present. Is that recorded?
But it's incredibly interesting. There's no other medical intervention we have, right, that has this
special. So if you do get injured, there is a way to take care of you. Although what's really interesting
is her research showed that something like 75% of vaccine injuries, documented vaccine injuries, not
the fake ones that you see on Twitter.
are due to administration error, right? So it's not even the vaccines. It's really just, we have maybe
somebody who is giving it wrong. So anyway, read about that. It's incredibly interesting and the history
of that is interesting, but it's an interesting policy that was put in place in our country because
we believe vaccines are so important. Yeah, thank you all. That was very informative, very helpful.
I really appreciate everything that you guys have done in these areas and things you guys continue to do.
I think from here though we have about 15, 20 minutes so maybe we can open it up to audience questions
and looks like we already got one.
If you look here long enough, I think the one medical institution which most Hoosiers have almost complete
trust in is Riley Hospital. It has an extremely high reputation. If you don't know somebody, neighbors,
friends, all seem to have connections with Riley somewhere along the line. And in your last slide, I
looked for Riley. There were two .edu's among your resources, one in Philadelphia and one in Minnesota.
Does Riley not have? Let me ask you differently. If there is no such .edu from IU School of Medicine
and Pediatrics or Riley Hospital, why not? I mean, that's a source. I think Dr. Laughlin could hand
a pamphlet that said Riley Hospital or IU School of Medicine Department of Pediatrics. That would,
I think, dispel a lot of this mistrust immediately.
Yeah. No, I think that's like, I don't even know. I didn't think about it. I don't know what their resources
pages around immunization specifically look like, but they fund us every year. Quite, you know, they
fund quite a few of our clinics and so. Yeah. CHOP.edu doesn't mean diddle.
Yeah, that's Philadelphia Children's Hospital. It's an amazing resource. And they've done an amazing
job with outreach and public education. And I would, even though I was a Riley physician, Riley Hospital
does a very poor job of outreach, particularly into primary care. I'll be the first to criticize that.
as a frustration, but it's an opportunity for them, actually, to be aligned publicly to say, okay, we
endorse ACIP. We endorse the Academy of Pediatrics. We're in the same page because it is a trusted resource.
I think the Colts and the Riley Hospital are the two biggest names. Of course, the Colts are going down
the tube, so why can't Riley be number one now? As soon as IU Health acquired your practice, you founded, Jim,
What did they rename it? From Southern Indiana pediatrics, it became Riley Physicians. We were the first
primary care group in the state to be branded Riley pediatricians. As you would say now, it's a brand.
Yeah. But I do agree that there's an opportunity there to engender trust with that name in mind. Yeah,
I am going to take that opportunity and see what I can do, because we work with them all the time.
But yeah, they are not on my list. You're right. Tim?
I was impressed with Katie's statement about the necessity to combat misinformation. So I'd like to
ask the panelists specifically what they think is the most effective thing to do when two of the most
prominent purveyors of misinformation are our Secretary of Health and Human Services and our President.
fun times, isn't it? You know, I want to go back to just Dr. Laughlin's, you know, the interpersonal
open-mindedness of, you know, that when we encounter misinformation in our social networks that we address
it. I don't think it's always the best idea to address it online, although if that's where it's happening,
maybe try to find a way to do it. But if you can try to talk to that person in
person and see what's going on. But I think that interpersonal connection, we've got to start fighting
this battle on the home front. We can't just do it on Facebook and on TikTok and things like that. We
have to do it in our communities. So forums like this are important. A lot of the workshops and things
that Lisa's organization hosts are important. And there's a lot happening, but I think it has to be
more this in-person stuff. We're still kind of living in the Zoom age where
people are not engaging with information. Go ahead. I just want to say that what I'm going to take away
from this, the most important thing I've heard, is the story, which I could use as a metaphor, of the
daycare situation. Like, if you haven't been vaccinated and you're at a concert and someone next to
you can't be vaccinated and you're caught just starting around the tube, you've been responsible for
their death. And so that metaphor idea,
of that daycare situation. I think I'm going to use it with one person I know that I want to get this
point through to that it's just such an excellent story. And I want to encourage that story to be told
more. Yeah. And we've been talking about like altruism, doing it for the public good. I do want to talk
about a really effective intervention that happened. You can use this story too. One of the most effective
vaccine interventions we had was around whooping cough. Babies, new babies catch whooping cough from
grandparents, friends coming.
kissing that new baby. I mean, we all want to kiss that new baby smell, right? Gets whooping cough,
it's dangerous. And so the idea that we need to cocoon the baby and that you cannot come visit unless
you've gotten an updated vaccination was an incredibly effective intervention that came through AAP,
through pediatricians, and through other groups. And so we all care about babies. How can we start caring?
about the person who's beside us at the concert, for sure. But I really like that story. I think that's
a happy story. We do have successes. I mean, one of the things Lisa and I like to remind people, and
I'm sure Dr. Laughlin does, is most people still get vaccinated, right? We just need the rates to be
higher for us to get herd immunity. But most people are still getting vaccinated, and that's important
to remember.
I think one thing I wanted to add to what you just said, Katie, I was thinking earlier when you were
talking about like misinformation on social media too, I'm sure you're familiar with the term super
spreaders of misinformation. So someone actually like RFK Jr. And I know there is literature on this
that a lot of that misinformation comes from these concentrated areas, these echo chambers. So I try
to remind myself of that when I think about like vaccine rates and things like that.
that most people still are getting vaccinated. Most people still do trust their physicians. Although
you may see things on the news, like from our current health secretary and from the president, you may
see these things and you may think that, you know, like everyone is like super vaccine hesitant now.
But I try to remember that most people still do get vaccinated and trust their physicians. Absolutely.
So a few years ago, they did a study that found that 12 accounts on Instagram were responsible for the
majority of vaccine disinformation, which is information created with malicious intent. Guess who one
of those Instagram accounts was? It was RFK Jr. And then he became the Secretary of Health and Human
Sciences, right? But as I said earlier, disinformation, bad information, it's much more likely to go
viral than good information. Michael?
Other areas of science hesitancy, it seems to me one of the most pernicious things that's happened is
identification of a few experts, even going back to tobacco, the tobacco battles and certainly the climate
change, to find a few people with a prominent academic bio and so on who speak publicly in opposition
to the consensus view.
Do you find that that community of say physicians or public health practitioners is growing here in
Indiana or elsewhere who are kind of providing that lone but loud voice in opposition to the consensus?
I don't think in Indiana. I think I think we have had a couple of celebrity vaccine. I mean, I think
a paw off it.
I think of Peter Hotez, I think. Our own Greg Zimmet. Our own Greg Zimmet. I think, but I think we need,
like I said, I think we need people outside of medicine and science, like no offense to our scientists,
right? I think we need church leaders, I think we need political leaders, I think we need celebrities,
right? We need the cults, too.
win games, but we also need them to come out and do a flu vaccine campaign, right? It cannot just be
on scientists and medical professionals and the Dr. Laughlin's of the world. This is something that
affects all of us. We need more people. We need more celebrities to get involved. Well, Katie, maybe
you can talk to Taylor Swift. I'm working on it. She just doesn't take in my calls, but yeah. Yeah,
but I do think there is a growing
we are seeing a growing issue where the hesitancy is among providers. And I think that's, especially
when we have very young providers, my family physician is way younger than me and she's got young kids.
And if she was vaccine hesitant, that would influence me a lot. She's never seen these diseases. So
we are seeing this growing hesitancy in providers.
So not just our physicians, but also in some of our nurses, our MAs. And when we have that, it's really
hard to be like, oh, we have trust. Talk to your provider when they're actually, I will say pharmacists.
Sorry if any of you are pharmacists. Of all the groups that we educate, I find the most hesitancy in
that group. And a lot of it is just, they're like, oh, that's too many vaccines at one time. I'm like,
no, that's not what the science says. Let me share with you the science.
And so a lot of it a lot of it does come from our providers and some groups worse than others. But it
is it is a growing issue I think and especially with some of our younger providers. What would you say to those
Let me tell you a story about when I was a young doctor and saw. Can you tell me why? I'd approach it
the same way I would with a vaccine-hesitant parent. Then I could unload with statistics and
good information. I was thrilled when we came out with a single vaccine that provided six different
immunization components in it.
two, four, and six month old baby. Instead of getting six individual shots, they get one. What a win.
And to think Trump wants to divide the MMR into separate components, one of the myths I'm gonna say
right here is that pediatricians do not make money on vaccines. It's a tremendous overhead, it's a pain
in the ass to keep records,
To store them, you have to have special freezers and refrigerators. You have to check them two or three
times a day and document the temperature. And then you have to record the vaccines. You have to record
them in the registry. I mean, it's one process after another to go through the process of doing this.
And this is why many adult providers don't even stock vaccines in their offices anymore.
because it's too much trouble. They tell you to go to the pharmacist. Well, that's another barrier.
I can talk about barriers to vaccine access all evening long. But one of the things we've tried to do
in our practice is we don't discriminate based on your ability to pay. And vaccine compensation, if
you have insurance, you're required to have vaccine coverage. If you don't have insurance and you have Medicaid,
they cover it for free. And if you don't have any insurance, you can be part of the Vaccine for Children's
program. So there's financial considerations for families should not be the problem. It's really access
to getting the shots themselves. Steve, I know you had a question. Yeah, so in the presence of lots
of health misinformation from the federal government, there have been various consortia of states that
have gotten together to try to
basically replace CDC as the source of information. So I know of ones in the Northwest and the Northeast.
Do you know if there are any discussions in the Midwest, including Indiana? I mean, there are discussions,
but I mean, the likelihood of it happening are because our governor is trying to get back in the good graces of
our president after he couldn't get the redistricting passed. So vaccines seem to be a way for him to
get back into that space. So there are discussions about it, but our political leaders are not going
to approve anything like that. So we as coalitions and as public health agencies
are all talking. We have a Midwest consortium that we talk every month. But at the policy level, no.
What the Northeast and Northwest are doing is fantastic, and we're following them closely, but it seems
unlikely. Or if it does happen, it will not be good. We would be partnering with Florida, and that would
be a whole nother shit show. You know what? We should have mentioned about a good Indiana vaccine advocate
is Dr. Adams.
who was the Surgeon General under the first administration of Trump. And he's now affiliated with Purdue.
But he has been incredible. He speaks for us sometimes. And he is online addressing misinformation a
lot. So he is a great Indiana vaccine advocate. He's very active on Twitter. Yes, yes, yes, yes. We
had another question over here. Yep. Yeah. I was thinking about vaccine hesitant folks, what their
the benefits of having that perspective, right? There's emotional, social benefits of having
that perspective. They might have reallocated their trust from their doctor to moms or others, right?
To vaccine hesitant. And that made all these preemptive moves even in those posts about don't believe
the statistics or these facts, they're gonna distort them and so forth. Is the approach any different
or hesitant skeptics with that orientation? Whether there really is this emotional connection they have
with a social benefit, they're in a group of other moms. How do you help us think about that group,
which I think is wrong? Because they are, that trust is not disappearing, it's just being reallocated.
Are you speaking to some tribalism?
maybe happening around this issue or around that community. But there's real emotion. Like, I'm part
of that group. I'm getting benefits from this. That's why I have this belief. It's not just random or
just oppositional. It's like, I'm part of it. I feel energized. I feel part of a group. I feel like
I'm fighting something. Whatever those range of emotions that are very powerful. And statistics and
facts might not
do anything in that situation. Statistics and facts will do nothing in those situations. Did you have
a comment about it? I have a question that's, I'm starting to have a theory that's been building up.
And that is that people don't know what evidence is and people don't know what science is. And I'm even
wondering if in the professional realm that there's so much learning that doesn't have to do with hands-on
doing experiments and finding out what is actually involved
and proving something that people don't get it. I had a housekeeper for maybe 40 years, and we loved
each other. And she would not get vaccinated. And I tried to talk to her about science. And she was
from rural Michigan. Not a clue. I mean, there was no discussion at all. She had no understanding. But
I'm wondering if the big picture is we're not really teaching science. I think that's not uncommon,
to be honest.
I think there's so much mistrust based on a lot of mistakes made during COVID that that just reiterates
people's criticism of science. And I think it's a valid thing, just like if you have a cohort of people
that you're around that agree with you, you're going to continue to be around those people, because
that's the message you want to hear. I read a great phrase, and I'll
finish up with this that I thought was fabulous as it relates to this topic. Religion requires faith.
Science requires doubt. And that's why science is constantly changing. We accept that we're going to
continue to change because as we learn new things, we have to be willing to doubt our current premises
of what's true.
We're just trying to approximate. I have a bumper sticker that somebody gave me for my car that I'm
too shy to put in. Science doesn't give up what you believe. I actually have a shirt like that. Yes,
welcome here to the home. Yeah, no, I know. Well, I think we actually got to wrap things up. It's about
five minutes after, and I think close at seven, right? So I think maybe I think Jim, you have to take
off, but Lisa, I think
You were able to stick around for a few. I'm not sure about you, Katie, but maybe we can have some individual
questions if audience members want to come up and hang out for a few more minutes. And I brought a few
refreshments. So well, before we get kicked out of the library at 7, we have a few minutes to chat.
How about a big round of applause? Thank you. Any of you before, except Dr. Laughlin, whose reputation is
We've got the perfect people here. Tyler Morris, how about a round of applause for him? And a big thank
you to the library and the Class TV. I should have mentioned that we're going to have a high quality
recording of this that will be available in a few days. So thanks so much for making the time to come
here and hang around for a few minutes and chat. Bella as well, another ASIU member to livestream.