July 18, 2023 • 32 mins
We are witnessing alarming levels of trust erosion and vaccine skepticism that have emerged in the post-COVID world. Join us as we take a deeper look into this critical issue with Christina Wells, MD, MPH, DipABLM, FAAFP and Marian Sassetti, MD, FAAFP.
These seasoned family doctors, with over five decades of combined experiences, address the concerning decline in vaccine confidence. They share their encounters with unexpected mistrust within their practices. They also bring to light the startling number of children missing out on critical vaccines, painting a picture of the current state of vaccine uptake worldwide.
Yet, all is not doom and gloom. As we progress through this enlightening conversation, we map out effective strategies for overcoming these challenges.
Topics include:
- Practical methods to track and communicate vaccine schedules
- The vital role of healthcare providers in advocating for vaccines
- Innovative ways to improve vaccine delivery
Emphasizing the significance of accurately communicating the effectiveness of the COVID vaccine, we delve into the potential repercussions of decreased vaccine uptake.
We wrap up by tackling the pivotal task of fostering vaccine trust, sharing insights on how to effectively communicate vaccine information to patients and parents.
Join us on this deeply impactful journey as we navigate a path to promote vaccination access, trust, and ultimately, the health and well-being of our communities.
Objectives:
- Awareness of alarming levels of trust erosion & vaccine skepticism post-COVID
- Understanding where vaccine skepticism and mistrust stem from
- Ways to navigate challenging conversations with patients who don’t trust vaccines
- Explore strategies to rebuild trust and improve vaccine uptake in our patients
Visit us at illinoisvaccinates.com/podcasts.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Carl Earl Lambert, Jr., (00:04):
Welcome back to season two of Beyond
the Needle a physician's guideto increasing COVID-19
vaccination rates.
I'm Carl Lambert, a familyphysician and a member of IAFP,
and I'm an assistant professorof family medicine at Rush
University Medical College.
This podcast series is broughtto you from the Illinois Academy
of Family Physicians, IAFP,through the Illinois Vaccinates
(00:26):
or IVAC project.
Joining for this podcast seriesis provided by the Office of
Disease Control through theIllinois Department of Public
Health.
For more information on theIVAC project and receiving free
CME credit for these podcasts,visit illinoisvaccinates.
com/ podcasts.
Thank you for joining us as wecome together to vaccinate
(00:49):
against COVID-19.
Christina Wells, MD, MPH, (00:54):
Hello and welcome to another episode
of Beyond the Needle.
I'm Dr Christina Wells and I'mhere with Dr Marian Sassetti,
and today we're going to betalking about trust erosion and
vaccine skepticism post-COVID.
Again, I'm Dr Christina Wells,I'm a family medicine physician
and a faculty member at theUniversity of Illinois, and Dr
(01:16):
Sassetti, can you introduceyourself today?
Marian R. Sassetti, MD, FA (01:19):
Sure , I'm Marian Sassetti.
I'm a family doc with over 30years of experience in a private
practice just west of the citycalled Lake Street Family
Physicians, and I'm also anassistant professor at Rush
Medical School.
Christina Wells, MD, MPH, (01:32):
Thank you, dr Sassetti, and we
welcome all of our listenerstoday, as we talk about another
topic that we know is impactingall of us as healthcare
providers, some statistics thatwe want to point out that are
startling is that there havebeen declines in routine
vaccination worldwide since 2021, with 25 million children
(01:58):
missing out on DTAP vaccinations, and this is 2 million more
than in 2020 and 6 million morethan in 2019.
And so what we have seen isthat during COVID, there has
been a decline in the uptake ofvaccinations.
A survey by the AmericanAcademy of Family Physicians
(02:22):
found that 20.8% of respondentsreported decreased vaccine
confidence, and so today again,we're going to talk about what
has caused this decline invaccine uptake and what are
things that we can do ashealthcare providers to help to
improve vaccine uptake in ourpatients.
(02:45):
So, dr Sassetti, what have youseen in terms of hesitancy that
has come about since we've beenin COVID, and how that hesitancy
has not only impacted theuptake of COVID vaccine, but how
that has spilled over to theuptake of other vaccinations.
Marian R. Sassetti, MD, FA (03:06):
Sure .
So, just speaking personallyfrom our practice, we were
really blindsided.
We understood that there wasthis hue and cry for the vaccine
.
We were delighted, we were init, we were providing the
vaccine and then what seemedlike out of the blue, there was
an enormous amount ofinformation pouring in about
some rabbit holes that ourpatients were going through on
(03:27):
the internet.
It was all internet-based andcoming up with often rabid
concerns and belief systemsabout what was happening with
the vaccine and why theyshouldn't trust the medical
community, why they should stoptrusting science, why they
should stop trusting me.
So enormous amounts of shockingkind of mistrust.
In trying to get to the bottomof it was almost impossible
(03:51):
because our patients werequoting things we had never
heard, people we had never heardabout, but the sources.
That seemed to just beextraordinarily impactful.
So it blindsided us and then westarted to read about it in the
literature and we began to seeit as a real phenomenon In my
own patients.
What continues to surprise meto today is the fact that they
(04:14):
will trust me.
Actually, I have a young motherwho was insistent, didn't give
her kid MMR vaccine.
Her child was born during COVID.
Refused all vaccines forherself COVID vaccines flu
vaccines refused to vaccinate.
This child, who's now two yearsold, feared that she had a DVT
and called immediately and cameto my practice immediately.
We got her care.
I had to find a gentle way ofexpressing to her this
(04:38):
misalignment, where she trustedme implicitly and immediately.
It was the first place she wentto when she was afraid she had
a blood clot, but continues toinsist that anything I put in
her baby and what she talksabout it is all those chemicals
and that they can hurt the baby,it can cause autism and just
quoting ancient tropes andthings like that.
So I was astonished that on onelevel she still had this
(05:00):
implicit trust in me and I wasable to have a conversation that
started with.
You know, I'm reading the sameinformation, I'm relying on the
same experts, I read the samejournals.
All of the things that make youtrust me to take care of your
potential blood clot are thesame things I'm reading that
make me want to take care ofyour baby and want to keep your
baby safe from illnesses.
(05:21):
Still not buying it, I'm stillchipping away gently as I can,
but those kind of things arevery surprising to me.
So what has ever happened inour patient's life has allowed
them to be entrenched in thisbelief system that those of us
who are talking about vaccinesreally are part of some
conspiracy ourselves.
And one of the more gentlepatients who I was trying to
(05:43):
talk to, who said you don't knowthat you're being manipulated,
dr Sassetti, and I said really?
And she said yes, I know yourheart's in the right place, I
know that you read and you're upto date, but you are being
manipulated by pharmaceuticalcompanies, by the government, by
people making money off of allof these vaccines that you're
putting in.
My child Could not chip away atit.
I couldn't talk about polio, Icouldn't talk about all of the
(06:05):
armamentarium I've used.
Some of my patients are simplyentrenched and I personally need
help on a neurologic level.
I haven't looked at theliterature.
I'm kind of entrenched in itbecause of my interest in mental
health.
I'm not seeing what ishappening in our patient's
brains.
That just seem to be hijackedby this very fierce, very
(06:26):
aggressive, often very hostilesection that's coming from
somewhere in our society that isleading them to believe that
there is so much to bemistrusted in these vaccines.
So this child is not protectedagainst anything, so very much
at risk, for all of the vaccinesthat we've had triumph over.
I mean all the illnesses thatwe've had triumph over measles,
(06:48):
mumps, rubella, polio all ofthose things that we thought
were a thing of the past are nowspringing back into reality
because of this misinformationcampaign that is very, very
pernicious.
Christina Wells, MD, MPH, D (07:01):
And I think part of it, dr Sassetti
, may be streaming from thatplace of fear.
I've seen a lot of differentthings in my practice.
I've seen less people cominginto the clinic because of fear
of getting COVID or some otherillness.
I've seen people not coming inuntil they're really, really
(07:21):
sick.
I've also seen less childrencoming in for things like well,
child checks.
And so I think that there isthis place of fear and when
there's a place of fear, you maybe more willing to be
susceptible to thatmisinformation, that sort of
feeds that fear and leads tomistrust that is misplaced.
(07:47):
And so I think that it'sstartling and we need to be
talking about ways of how do weget beyond that fear, ways of
how do we instill trust with ourpatients.
How do we have messaging that'sgoing to be more
patient-centered, how do weincrease the health literacy of
(08:07):
our patients so they can bebetter educated about vaccines,
what they do and their risk andtheir benefits, and that those
benefits outweigh any risks thatmay happen.
But being also honest with ourpatients about risks that may
come from being vaccinated insimilar ways, risks that come
(08:29):
from taking a medication or anyother risks that we may
encounter in our lives, buthelping patients to really
understand and be more healthliterate in these areas, which
may help to decrease some ofthose fears and take away the
misinformation, or thegravitation to that
misinformation, that may beprevalent.
(08:49):
So what have you seen in termsof how this is impacted?
Have you seen less well childchecks?
Have you seen less peoplecoming in to get their routine
immunizations?
Or in what practices have yourparticular health care center
(09:09):
put in place to be able toincrease uptake of routine
vaccinations as well as toprovide better messaging to
patients about the COVIDvaccines and other vaccines?
Marian R. Sassetti, MD, FAAF (09:25):
So several answers In general.
Early in the pandemic, ofcourse, when we reopened and
then began to have the hybridpractice, we did see a decrease
in all comers and then began tosee specifically a decrease in
well child visits.
I'm happy to say we seem to beup back to our regular
statistics, maybe a little bitless of the well child.
(09:46):
We seem to be getting thosepeople in.
As far as what we've done aboutvaccine, we have a lot of the
literature from the AAFP that wehave hanging in our practice.
We have a lot of literature ineach of the rooms.
We have some nurses who arereally well trained.
Our triage nurses are reallywell trained in information and
in understanding how to confrontmisinformation, sometimes over
(10:06):
the phone, but most of the timethe people who are confronting
the misinformation are providers, the physicians and the
physician assistants in thepractice, and what we've done is
the same kind of language Ithink we talked about it before
which is to acknowledge it andwe all have begun to say it
makes sense that you're afraid.
This is a really scary time onour planet.
Tell me what your worst fearsare.
(10:26):
I'm really getting at it and Iagree 100%.
Dr Wells, I like that you usethe phrase.
Why are they gravitating tomisinformation?
I think we really have to getour arms around that, because we
have to use that in the sameway.
What is it that makes somebodylisten to somebody other than us
?
What sources do they go to thatthey are ascribing much more
trust and truth to?
(10:47):
Why is it that some anonymoussource is more available to them
?
Why do they trust it more?
Why do they engage with thatrather than their health care
providers that, theoretically,they've trusted for years?
So I think we really do need toget our arms around it and to
honor it.
So the first thing I'll do isjust say it makes sense and
you're a great mom.
Usually it's a mom in my office.
(11:07):
I do enjoy when the dads showup, but you've been a great mom
and we've been a great team.
Tell me about this.
Help me understand one of myfavorite phrases.
Or I have other patients whodon't want the vaccine, so I
want to understand from you.
You tell me in your own words,because I want to understand it.
And then I wonder if and I askpermission again I'm wondering
if we could talk about it again.
(11:27):
I'm wondering if we could bringthis up again because it's
really important and it's a realconcern of mine.
I haven't had a mother say no,she doesn't want to talk about
it.
We are moving the needle alittle bit when I bring up the
issue of neurodevelopmentaldelays.
Long COVID in children isbeginning to show us the impact
(11:48):
and show up as behavioral orneurocognitive issues and that's
beginning to stop a lot ofparents in their tracks.
And I say there's a lot ofautism, there's a lot of
problems that we wish we weren'tfacing.
The one I don't want to face isa COVID related outcome with
your child.
Can we partner on that?
Inevitably they say yes.
(12:08):
Then I say well, then let'stalk about something that we can
prevent that.
Can we talk about ways that youcan trust me again around this
topic?
What would you need to trust meagain?
So I really want them to teachme what it is that they are
hesitant about, instead of mejust reminding them why it's so
valuable and why it works sowell.
I want to understand what wouldmove the needle for them and
(12:31):
how we can talk about it.
Christina Wells, MD, MPH, Dip (12:32):
I think that's an excellent
approach.
I think that one trying tounderstand your patient's
beliefs that may be leading totheir hesitancy or how their
beliefs have been shaped bymisinformation, is really
important, because that helps toopen the door for conversations
, that helps to open the doorfor being able to provide
(12:55):
education and also being able tobuild trust and, hopefully,
confidence.
The other day I was talkingwith a person and they were
saying that, well, doctors getpaid to get these vaccines, and
so that's why they're promotingthem.
And I said well, if doctorsgetting paid, I'm still waiting
(13:17):
on my check.
Yeah right, because I haven'tgotten one yet to be able to,
and so that has nothing to dowith why I may be promoting the
vaccine.
It's purely about my concernabout your health and I feel
like it's one tool in ourtoolbox that we can utilize to
(13:37):
help in terms of prevention.
But I also tell that there aremany other ways that I also want
to incorporate a holisticapproach to address your health.
So they don't feel like I'mjust focusing on one thing, but
I think as we ask our patientswhat they believe, then we may
be able to dispel some of thosemyths or their beliefs of why
(13:59):
they think that certain thingslike the COVID vaccines, are
being promoted and really it'ssomething that is absolutely not
true in most instances.
So I think that's reallyimportant to understand what our
patients believe and try toreally get at the root of that.
So another question is we'vebeen looking at I was looking at
(14:23):
the CDC's Lets' rise campaignand their strategies of how to
increase vaccination and Iwanted you to comment on these.
But I wanted to throw out acouple of these strategies that
they have.
Some are to try to reinforce,with our patients, confidence in
(14:43):
routine vaccines.
Other things are to makevaccination a sustainable
practice and also to support aculture of vaccination within
your practice.
One of those things is offeringvaccines at every visit, even
when it's not a well-child visit, as long as the child isn't
coming in and having a moderateor severe illness.
(15:07):
How do we promote uptake forvaccinations at all visits for
children and adults?
How do we make access toroutine health care services and
vaccinations accessible to allpeople in terms of time,
transportation and other factorsthat may be barriers to them?
(15:28):
So are there ways that youroffice has put in specific
strategies to make vaccines moreaccessible and to make not only
COVID vaccines a part of yourroutine practice, but to get
more of those routine vaccinesdelivered to patients at all
(15:49):
visits.
Marian R. Sassetti, MD, FAA (15:50):
Yes , absolutely.
And you know what, dr Wells, Iwant to reinforce for our
audience this wonderful programthat they can access.
It's called Let's Rise L-E-T,apostrophe S Rise, wonderful
resource that I hope everybody'slistening can access and that
really does help you walkthrough these conversations.
So I'm happy that we are wellresourced in our office with
(16:11):
really good RNs and MAs.
One of the priorities is goingthrough each chart before we see
anybody and seeing whatvaccines are due.
So my staff will actually dothat and highlight what vaccines
are due if they're coming infor a cough, a fever, something
like that, so I'll know.
Walking into the room at theend of the visit, typically I
say by the way, did you knowthey're due for the X, y or Z?
(16:34):
And then we have in placestanding nurse visits.
So I'll have a clipboard,despite electronic records,
where we use a clipboard and Icircle a nurse visit and I say
to the patient bring this up tothe front.
And the patients I think likeit because they see the
communication that I'm giving tothe front desk and sometimes I
think that was a little bitintimidating, wondering what I
(16:54):
was communicating to the frontdesk.
They'd go up to the front deskand not be so sure.
But there it is, it's circledin my handwriting and it says
your baby needs this vaccine.
Let's bring you back If theydon't want to give it that day.
And typically I ally with themif the baby has a fever or
something, the baby is feelinglousy or child.
I keep saying baby.
That's my Italian culture.
Babies go up to 31, by the way,but a lot of visits.
(17:17):
I'll actually say you know whydon't we go ahead and give them
this vaccine?
They're due for it.
And just like you said, drWells, in this, in your medical
home, this is what we do.
We see what vaccines are due,we see what else needs to happen
to keep you and your child safe.
I'm a big family systems personso I use the whole family system
.
Who else needs their vaccine?
(17:38):
You know you're going to comein, maybe mom, dad.
I have little young familiesthat come in and make their flu
shots together.
I love that.
We encourage that.
You know family flu visits,that kind of thing.
So, to answer your questionssuccinctly, we have a flag
system where we know whatvaccines are due.
Whatever the visit is, we willbring up the vaccine that's due.
Much more often than not.
(18:00):
If it's, if the child is notill, we will go ahead and get
severely, you know, a fever,really feeling lousy.
We'll go ahead, give thevaccine.
And we also have the leewaybecause we're well, we're happy
to have enough resources to askthe parents to if I haven't seen
a dad in a while, the day I wasbringing a child, and are you
up to date on your dbt, thatkind of thing.
(18:21):
So the flag system works andthe little system where I write,
go up to the front, make anurse visit.
A lot of people, a lot of myadults, want the shingles
vaccine on a Friday becausethey've heard they get sick from
the shingles vaccine.
We've really accommodated that.
We love that.
We love communicating yourpatients.
Great, we'll do it your way.
(18:41):
That's perfect.
Let's get this vaccine in you ina way that works for you and
for transportation.
We're very conscious oftransportation issues and when
it works for our patients.
So we have patients whosometimes are in our waiting
room an hour early becausethat's the transportation that
worked for them.
So we accommodate that.
I'll say you know.
However, you're getting here,how are you going to get here to
get this vaccine?
(19:02):
Do you want to make it part ofthe next visit.
So sometimes I'll say, let's,let's do your hypertension visit
and your dpt on the next visitif you don't want to do it right
now.
So we've gotten really, reallycreative and we've just embedded
every vaccine that's due.
My patients are used to walkingin and knowing that we're going
to talk about a vaccine that'sdue.
So we're really lucky to haveour nurse force working for us
(19:23):
that way.
Christina Wells, MD, MPH (19:24):
That's great.
One of the things that we doand I think we're also a work in
progress is we will print outthe vaccination records visit
and then that way we can seewhat the patient may be,
especially for our children.
We do this mostly see whatthey're looking for.
(19:44):
So, like the earlier this weekI saw a patient for an issue
that was not a well child and Isaw that this patient did not
have a code with booster.
It was a 17 year old and alsodidn't have a flu shot.
So we're talking aboutsomething else and I asked the
mom why don't we go ahead andupdate the code with booster and
(20:04):
the flu shot?
And we were able to do that thesame day.
So something else we're startingto implement our reminder calls
and I think that's important.
I know that sometimes staffingissues might not allow for that,
but it's possible havingimplementing reminder calls
where you can see and go throughand look, you can do an audit
(20:25):
to see what the children andeven adults are maybe missing
vaccinations and then callingthem and scheduling them for a
visit or, if they were seenrecently, depending on the
policies in your clinic, to beable to come in for a nurse
visit to update those vaccines.
So I think that we're startingto implement some things.
(20:45):
We still have some steps to gointo how we solidify our
processes, but I'm hoping thatwe'll move towards more of these
strategies that are going tohelp break down barriers to
access so that patients can havethe vaccines that they need.
So, as we wind down here, Ijust wanted to get some of your
(21:06):
final thoughts about what otherimprovements do you think that
we can make in messaging and howwe deliver the vaccines, so
that we can help to build moretrust and more confidence in
health care and in thevaccinations massive topic.
Marian R. Sassetti, MD, FAA (21:30):
Let me start with something I think
I've alluded to in anotherpodcast, and again it's trying
to build trust in a lying I likethe word lying with our
patients, being in solidaritywith our patients when a family
is undecided, or you're actuallytelling me no, I don't believe
in it.
I'll say I think we've not donea great job in public health
and I think where we failed isreminding people why we give
(21:52):
vaccines.
And I say you know, rememberwhen I gave your baby the
chickenpox vaccine, it wasn'tbecause I wanted to prevent
chickenpox, it was because Iwanted to prevent the awful
things that happen if they getchickenpox.
I think it's good for ourpatients to see that we
acknowledge mistakes that wemade.
And I said you know, and Ithink it was a mistake that we
didn't package that the rightway.
And now patients come in andthey say my brother-in-law got
(22:14):
the vaccine and then he gotCOVID.
And I'll say how did he do?
Did he go in the hospital?
Did he go in the ICU?
No, and I say, well, great.
That reminds me to tell yousomething I think we haven't
done well.
The reason we want you to getthe COVID vaccine is because we
don't want you to be in thehospital and we don't want you
to end up in the ICU orcertainly dead.
So it is true, the vaccine thatI want you to get might not
(22:37):
prevent you from getting theillness.
What I know it will happen isthat it will prevent you from
getting severely ill andsuffering, and I really don't
want anybody I care about to besuffering on my watch.
So I embed that in that whole.
Let's remind each other whywe're giving vaccines and to
acknowledge the reality thatmakes them skeptics, which is
hey, so-and-so got the vaccineand they got sick, so I'm not
(22:58):
getting it and they are missingthe message.
I think that it's reallyimportant that the vaccine was
designed to prevent verysignificant illness,
hospitalization, certainly deathand it's working
extraordinarily well.
Christina Wells, MD, MPH, Dip (23:12):
I think that's really great,
because I think that that led tosome misinformation in the
beginning, when patients werethinking that, well, if I get
the vaccine, then I shouldn'tget sick at all, and I had to
remind people that the purposeof vaccinations is to reduce
hospitalizations and to keep youfrom dying from COVID and other
(23:33):
illnesses that the othervaccines that we give protect
against.
So it's important that we'reclear, as healthcare providers
as well, about our own messaging, so that patients understand
what really is the effectivenessof this tool and how vaccines
really work and what they canand what they cannot do.
(23:54):
Also, because we've haddecreased uptake of vaccinations
, we're seeing the rise of otherdiseases that we thought were
eradicated things like polio andmeasles, and what we don't
understand is that the reasonthat children and adults weren't
(24:16):
getting this is because theywere vaccinated, and we forget
about the devastating impactthat these diseases brought upon
us, and so reminding ourpatients that these things can
help us, these vaccinations,will really help us to be able
to prevent the devastatingimpact that these diseases
(24:38):
represent, and so I think it'sgoing to be reeducation and
continuing ongoing education andreminding our patients of where
we come.
We don't see some diseases now,like smallpox and other things
because of vaccinations, and soreminding our patients of the
importance and what vaccines cando and what they cannot do.
(24:59):
Any other thoughts on that?
Marian R. Sassetti, MD, FAAF (25:02):
No , I think that's excellent.
Certainly, what I'm beginningto do is to use a language, a
new language for me and where Italk about, we have triumphed
over diseases that we didn'tthink we could A generation ago.
Mothers were weeping over theirchildren getting polio and they
were clamoring for a vaccine.
Now we have children who aresuffering and parents aren't
(25:26):
clamoring for a vaccine.
That makes me pause and wonderwhat I and you can do about that
situation.
And then I said you know, Iwant to honor the fact of what
you're reading.
You know, you bet you are agreat mom and clearly you want
the best for your child.
I've seen that from day one.
Let's just talk about just youand me, and I'm experimenting
(25:47):
with this.
It's not finished yet and I sayyou know, there's people out
there that you're listening toand I honor that, and you are
trusting that body of literatureor whoever that is.
I want to paint a picture foryou.
I want to paint a picture ofthe measles epidemic that's
happening in Ohio, where, Ithink it was, 37 children died.
(26:08):
I have to look it up, but I'llgive that number.
And then I say so it's just,it's just a matter of time until
we see measles in Illinois.
I want to help you and youdon't have to tell me now, but
what is your position going tobe if your child gets measles?
I want you to think about that.
I don't want you to be scaredabout it, but you and I have
been great partners and I justwant to bring this up.
(26:29):
It's just a matter of timeuntil measles is on our doorstep
.
What is your position going tobe if your child gets measles?
Because I have to tell you wedon't have anything to treat it.
I wish we did.
We don't.
At least with chickenpox we cangive a.
acyclovir We don't have anythingto treat measles.
I want you to think about that.
And then I don't say anythingelse and I'm not a doctor that
scares people, but I do say wehave to remind each other.
(26:51):
This is your medical home.
I'm responsible for helping youunderstand what might be coming
to our doorstep.
So that's a new language I'mexperimenting with.
It's beginning to get sometraction.
I don't know, but this measlesepidemic next door is a big deal
.
Christina Wells, MD, MPH, (27:07):
Right .
So I think that we have to bethinking about how this
overarching mistrust anddecrease confidence in vaccines
that are coming from a lot ofdifferent avenues and a lot of
different outlets and thinkingabout how we really target our
messaging so that we can makesure that patients, their
(27:28):
families, parents are gettingcorrect information and not
perpetuating the issue wherewe're getting to a point where
we start to see the resurgenceof all of these diseases that we
thought that we had eradicated,because we know that more and
more illnesses are going to beon the rise.
We're never going to be withoutsome sort of illness that we're
(27:52):
faced with.
So any other thoughts for ouraudience today in terms of
messaging vaccine hesitancy thatyou would like to leave them
with?
Marian R. Sassetti, MD, FAAF (28:03):
Oh , just my usual Thanks for
tuning in.
You could do this.
What came to my mind is howcognizant I am that, how tired I
am of the whole topic and howthat translates into what
happens in my practice.
I do encourage us to be veryaware of our fatigue and our
desire to really just anotherone.
Are you really going to refuse?
(28:24):
Today, I noticed by the end ofthe day I have a different
demeanor that I have to bereally careful of.
So a lot of this is self care.
So, for all of those who arelistening, first of all, thank
you.
Thank you for continuing to dothis important work.
And, number two, let's makesure we take care of ourselves
and each other, because on a daywhere I'm worn out, the
conversations are far lesscompassionate and empathic, and
(28:47):
I'm very aware that I'm veryfatigued.
So if you feel that bubbling upin you, I would just encourage
you to recognize it and dowhatever self care you need to
do.
In the old days, I would neverallow myself to get behind
because I was doing something,you know, either going into my
office and doing somemindfulness, or taking some deep
breaths, or doing some boxbreathing or whatever.
Now I really do that.
(29:08):
If I'm aware of how fatigued Iam at the end of the day and
I've got a parent that is avaccine refuser I recognize I
better take care of myselfbefore I walk into that room.
So just another reminder we'regrateful for the work you do.
I'm sure your patients aregrateful, and let's take care of
each other and ourselves.
Christina Wells, MD, MPH, D (29:26):
Yes , you know just a reminder that
vaccines are an effective way toreduce severe illness, and I've
done several mission trips toAfrica.
I've seen people over there whodon't get vaccinated.
I've seen adults who have polioactually crawling on the ground
and other things that arehappening because they don't
(29:47):
have vaccinations like we haveover here and so they're
susceptible to those diseasesthat we don't see here.
But we've got to stop making itseem as if it's the vaccine and
that's all that there is.
I think we have to make it apart of everything else that
we're doing, because when wemake it seem like all of there
is, it makes it seem like thereis something suspicious about
(30:09):
that or there's somethingspecial about that that concerns
me or that gives me fear.
But if I put it in the contextof this is one of the tools that
I'm going to use to help youprevent illness, help you
prevent disease, along withthese other tools that I'm going
to use, then I think it may bemore palatable for patients,
(30:30):
because they don't feel as ifthere's this one thing that
we're pushing and that's theonly thing we're pushing.
You know, it's like the onlything I can do to fix
cholesterol is to take a statin.
No, that isn't the only thing,but it can be helpful.
And so I think we got to get outof the way of thinking of how
we promote and our messagingagain.
So thinking about ways that wecan target our messaging, build
(30:54):
trust and confidence in vaccines, and it is not really our job
to reduce hesitancy, but it'smore of our job to help our
patients that have confidenceand trust in the information
that we provide to them, andthat will help to reduce vaccine
(31:15):
hesitancy.
And then also, we should havethe approach that vaccines are
great tools, but also helpingour patients to understand that
there are other ways that we arealso thinking about in terms of
prevention.
Vaccines are not the only way,but it's one way that we can
help to prevent severe illnessand disease.
And so let us continue thinkingabout how we partner with our
(31:38):
patients, how we havepatient-centered approaches in
our messaging, and so that wecan help to really really
decrease the uptake ofmisinformation and help to
rebuild confidence in ourhealthcare system.
So thank you for joining us foranother episode of Beyond the
(32:00):
Needle.
Carl Earl Lambert, Jr., M (32:06):
Thank you to our expert faculty and
to you, our listener, for tuninginto this episode.
For more episodes of Beyond theNeedle, please visit
illinoisvaccinates.
com.
Here you'll also find links toan online toolkit, how to join
learning collaboratives inbootcamps, podcast transcripts,
speaker disclosures andinstructions to claim CME credit
(32:28):
.
Subscribe to Beyond the Needleon your favorite streaming
platform.
Welcome back to season two of Beyond
the Needle a physician's guideto increasing COVID-19
vaccination rates.
I'm Carl Lambert, a familyphysician and a member of IAFP,
and I'm an assistant professorof family medicine at Rush
University Medical College.
This podcast series is broughtto you from the Illinois Academy
of Family Physicians, IAFP,through the Illinois Vaccinates
(00:26):
or IVAC project.
Joining for this podcast seriesis provided by the Office of
Disease Control through theIllinois Department of Public
Health.
For more information on theIVAC project and receiving free
CME credit for these podcasts,visit illinoisvaccinates.
com/ podcasts.
Thank you for joining us as wecome together to vaccinate
(00:49):
against COVID-19.
Christina Wells, MD, MPH, (00:54):
Hello and welcome to another episode
of Beyond the Needle.
I'm Dr Christina Wells and I'mhere with Dr Marian Sassetti,
and today we're going to betalking about trust erosion and
vaccine skepticism post-COVID.
Again, I'm Dr Christina Wells,I'm a family medicine physician
and a faculty member at theUniversity of Illinois, and Dr
(01:16):
Sassetti, can you introduceyourself today?
Marian R. Sassetti, MD, FA (01:19):
Sure , I'm Marian Sassetti.
I'm a family doc with over 30years of experience in a private
practice just west of the citycalled Lake Street Family
Physicians, and I'm also anassistant professor at Rush
Medical School.
Christina Wells, MD, MPH, (01:32):
Thank you, dr Sassetti, and we
welcome all of our listenerstoday, as we talk about another
topic that we know is impactingall of us as healthcare
providers, some statistics thatwe want to point out that are
startling is that there havebeen declines in routine
vaccination worldwide since 2021, with 25 million children
(01:58):
missing out on DTAP vaccinations, and this is 2 million more
than in 2020 and 6 million morethan in 2019.
And so what we have seen isthat during COVID, there has
been a decline in the uptake ofvaccinations.
A survey by the AmericanAcademy of Family Physicians
(02:22):
found that 20.8% of respondentsreported decreased vaccine
confidence, and so today again,we're going to talk about what
has caused this decline invaccine uptake and what are
things that we can do ashealthcare providers to help to
improve vaccine uptake in ourpatients.
(02:45):
So, dr Sassetti, what have youseen in terms of hesitancy that
has come about since we've beenin COVID, and how that hesitancy
has not only impacted theuptake of COVID vaccine, but how
that has spilled over to theuptake of other vaccinations.
Marian R. Sassetti, MD, FA (03:06):
Sure .
So, just speaking personallyfrom our practice, we were
really blindsided.
We understood that there wasthis hue and cry for the vaccine
.
We were delighted, we were init, we were providing the
vaccine and then what seemedlike out of the blue, there was
an enormous amount ofinformation pouring in about
some rabbit holes that ourpatients were going through on
(03:27):
the internet.
It was all internet-based andcoming up with often rabid
concerns and belief systemsabout what was happening with
the vaccine and why theyshouldn't trust the medical
community, why they should stoptrusting science, why they
should stop trusting me.
So enormous amounts of shockingkind of mistrust.
In trying to get to the bottomof it was almost impossible
(03:51):
because our patients werequoting things we had never
heard, people we had never heardabout, but the sources.
That seemed to just beextraordinarily impactful.
So it blindsided us and then westarted to read about it in the
literature and we began to seeit as a real phenomenon In my
own patients.
What continues to surprise meto today is the fact that they
(04:14):
will trust me.
Actually, I have a young motherwho was insistent, didn't give
her kid MMR vaccine.
Her child was born during COVID.
Refused all vaccines forherself COVID vaccines flu
vaccines refused to vaccinate.
This child, who's now two yearsold, feared that she had a DVT
and called immediately and cameto my practice immediately.
We got her care.
I had to find a gentle way ofexpressing to her this
(04:38):
misalignment, where she trustedme implicitly and immediately.
It was the first place she wentto when she was afraid she had
a blood clot, but continues toinsist that anything I put in
her baby and what she talksabout it is all those chemicals
and that they can hurt the baby,it can cause autism and just
quoting ancient tropes andthings like that.
So I was astonished that on onelevel she still had this
(05:00):
implicit trust in me and I wasable to have a conversation that
started with.
You know, I'm reading the sameinformation, I'm relying on the
same experts, I read the samejournals.
All of the things that make youtrust me to take care of your
potential blood clot are thesame things I'm reading that
make me want to take care ofyour baby and want to keep your
baby safe from illnesses.
(05:21):
Still not buying it, I'm stillchipping away gently as I can,
but those kind of things arevery surprising to me.
So what has ever happened inour patient's life has allowed
them to be entrenched in thisbelief system that those of us
who are talking about vaccinesreally are part of some
conspiracy ourselves.
And one of the more gentlepatients who I was trying to
(05:43):
talk to, who said you don't knowthat you're being manipulated,
dr Sassetti, and I said really?
And she said yes, I know yourheart's in the right place, I
know that you read and you're upto date, but you are being
manipulated by pharmaceuticalcompanies, by the government, by
people making money off of allof these vaccines that you're
putting in.
My child Could not chip away atit.
I couldn't talk about polio, Icouldn't talk about all of the
(06:05):
armamentarium I've used.
Some of my patients are simplyentrenched and I personally need
help on a neurologic level.
I haven't looked at theliterature.
I'm kind of entrenched in itbecause of my interest in mental
health.
I'm not seeing what ishappening in our patient's
brains.
That just seem to be hijackedby this very fierce, very
(06:26):
aggressive, often very hostilesection that's coming from
somewhere in our society that isleading them to believe that
there is so much to bemistrusted in these vaccines.
So this child is not protectedagainst anything, so very much
at risk, for all of the vaccinesthat we've had triumph over.
I mean all the illnesses thatwe've had triumph over measles,
(06:48):
mumps, rubella, polio all ofthose things that we thought
were a thing of the past are nowspringing back into reality
because of this misinformationcampaign that is very, very
pernicious.
Christina Wells, MD, MPH, D (07:01):
And I think part of it, dr Sassetti
, may be streaming from thatplace of fear.
I've seen a lot of differentthings in my practice.
I've seen less people cominginto the clinic because of fear
of getting COVID or some otherillness.
I've seen people not coming inuntil they're really, really
(07:21):
sick.
I've also seen less childrencoming in for things like well,
child checks.
And so I think that there isthis place of fear and when
there's a place of fear, you maybe more willing to be
susceptible to thatmisinformation, that sort of
feeds that fear and leads tomistrust that is misplaced.
(07:47):
And so I think that it'sstartling and we need to be
talking about ways of how do weget beyond that fear, ways of
how do we instill trust with ourpatients.
How do we have messaging that'sgoing to be more
patient-centered, how do weincrease the health literacy of
(08:07):
our patients so they can bebetter educated about vaccines,
what they do and their risk andtheir benefits, and that those
benefits outweigh any risks thatmay happen.
But being also honest with ourpatients about risks that may
come from being vaccinated insimilar ways, risks that come
(08:29):
from taking a medication or anyother risks that we may
encounter in our lives, buthelping patients to really
understand and be more healthliterate in these areas, which
may help to decrease some ofthose fears and take away the
misinformation, or thegravitation to that
misinformation, that may beprevalent.
(08:49):
So what have you seen in termsof how this is impacted?
Have you seen less well childchecks?
Have you seen less peoplecoming in to get their routine
immunizations?
Or in what practices have yourparticular health care center
(09:09):
put in place to be able toincrease uptake of routine
vaccinations as well as toprovide better messaging to
patients about the COVIDvaccines and other vaccines?
Marian R. Sassetti, MD, FAAF (09:25):
So several answers In general.
Early in the pandemic, ofcourse, when we reopened and
then began to have the hybridpractice, we did see a decrease
in all comers and then began tosee specifically a decrease in
well child visits.
I'm happy to say we seem to beup back to our regular
statistics, maybe a little bitless of the well child.
(09:46):
We seem to be getting thosepeople in.
As far as what we've done aboutvaccine, we have a lot of the
literature from the AAFP that wehave hanging in our practice.
We have a lot of literature ineach of the rooms.
We have some nurses who arereally well trained.
Our triage nurses are reallywell trained in information and
in understanding how to confrontmisinformation, sometimes over
(10:06):
the phone, but most of the timethe people who are confronting
the misinformation are providers, the physicians and the
physician assistants in thepractice, and what we've done is
the same kind of language Ithink we talked about it before
which is to acknowledge it andwe all have begun to say it
makes sense that you're afraid.
This is a really scary time onour planet.
Tell me what your worst fearsare.
(10:26):
I'm really getting at it and Iagree 100%.
Dr Wells, I like that you usethe phrase.
Why are they gravitating tomisinformation?
I think we really have to getour arms around that, because we
have to use that in the sameway.
What is it that makes somebodylisten to somebody other than us
?
What sources do they go to thatthey are ascribing much more
trust and truth to?
(10:47):
Why is it that some anonymoussource is more available to them
?
Why do they trust it more?
Why do they engage with thatrather than their health care
providers that, theoretically,they've trusted for years?
So I think we really do need toget our arms around it and to
honor it.
So the first thing I'll do isjust say it makes sense and
you're a great mom.
Usually it's a mom in my office.
(11:07):
I do enjoy when the dads showup, but you've been a great mom
and we've been a great team.
Tell me about this.
Help me understand one of myfavorite phrases.
Or I have other patients whodon't want the vaccine, so I
want to understand from you.
You tell me in your own words,because I want to understand it.
And then I wonder if and I askpermission again I'm wondering
if we could talk about it again.
(11:27):
I'm wondering if we could bringthis up again because it's
really important and it's a realconcern of mine.
I haven't had a mother say no,she doesn't want to talk about
it.
We are moving the needle alittle bit when I bring up the
issue of neurodevelopmentaldelays.
Long COVID in children isbeginning to show us the impact
(11:48):
and show up as behavioral orneurocognitive issues and that's
beginning to stop a lot ofparents in their tracks.
And I say there's a lot ofautism, there's a lot of
problems that we wish we weren'tfacing.
The one I don't want to face isa COVID related outcome with
your child.
Can we partner on that?
Inevitably they say yes.
(12:08):
Then I say well, then let'stalk about something that we can
prevent that.
Can we talk about ways that youcan trust me again around this
topic?
What would you need to trust meagain?
So I really want them to teachme what it is that they are
hesitant about, instead of mejust reminding them why it's so
valuable and why it works sowell.
I want to understand what wouldmove the needle for them and
(12:31):
how we can talk about it.
Christina Wells, MD, MPH, Dip (12:32):
I think that's an excellent
approach.
I think that one trying tounderstand your patient's
beliefs that may be leading totheir hesitancy or how their
beliefs have been shaped bymisinformation, is really
important, because that helps toopen the door for conversations
, that helps to open the doorfor being able to provide
(12:55):
education and also being able tobuild trust and, hopefully,
confidence.
The other day I was talkingwith a person and they were
saying that, well, doctors getpaid to get these vaccines, and
so that's why they're promotingthem.
And I said well, if doctorsgetting paid, I'm still waiting
(13:17):
on my check.
Yeah right, because I haven'tgotten one yet to be able to,
and so that has nothing to dowith why I may be promoting the
vaccine.
It's purely about my concernabout your health and I feel
like it's one tool in ourtoolbox that we can utilize to
(13:37):
help in terms of prevention.
But I also tell that there aremany other ways that I also want
to incorporate a holisticapproach to address your health.
So they don't feel like I'mjust focusing on one thing, but
I think as we ask our patientswhat they believe, then we may
be able to dispel some of thosemyths or their beliefs of why
(13:59):
they think that certain thingslike the COVID vaccines, are
being promoted and really it'ssomething that is absolutely not
true in most instances.
So I think that's reallyimportant to understand what our
patients believe and try toreally get at the root of that.
So another question is we'vebeen looking at I was looking at
(14:23):
the CDC's Lets' rise campaignand their strategies of how to
increase vaccination and Iwanted you to comment on these.
But I wanted to throw out acouple of these strategies that
they have.
Some are to try to reinforce,with our patients, confidence in
(14:43):
routine vaccines.
Other things are to makevaccination a sustainable
practice and also to support aculture of vaccination within
your practice.
One of those things is offeringvaccines at every visit, even
when it's not a well-child visit, as long as the child isn't
coming in and having a moderateor severe illness.
(15:07):
How do we promote uptake forvaccinations at all visits for
children and adults?
How do we make access toroutine health care services and
vaccinations accessible to allpeople in terms of time,
transportation and other factorsthat may be barriers to them?
(15:28):
So are there ways that youroffice has put in specific
strategies to make vaccines moreaccessible and to make not only
COVID vaccines a part of yourroutine practice, but to get
more of those routine vaccinesdelivered to patients at all
(15:49):
visits.
Marian R. Sassetti, MD, FAA (15:50):
Yes , absolutely.
And you know what, dr Wells, Iwant to reinforce for our
audience this wonderful programthat they can access.
It's called Let's Rise L-E-T,apostrophe S Rise, wonderful
resource that I hope everybody'slistening can access and that
really does help you walkthrough these conversations.
So I'm happy that we are wellresourced in our office with
(16:11):
really good RNs and MAs.
One of the priorities is goingthrough each chart before we see
anybody and seeing whatvaccines are due.
So my staff will actually dothat and highlight what vaccines
are due if they're coming infor a cough, a fever, something
like that, so I'll know.
Walking into the room at theend of the visit, typically I
say by the way, did you knowthey're due for the X, y or Z?
(16:34):
And then we have in placestanding nurse visits.
So I'll have a clipboard,despite electronic records,
where we use a clipboard and Icircle a nurse visit and I say
to the patient bring this up tothe front.
And the patients I think likeit because they see the
communication that I'm giving tothe front desk and sometimes I
think that was a little bitintimidating, wondering what I
(16:54):
was communicating to the frontdesk.
They'd go up to the front deskand not be so sure.
But there it is, it's circledin my handwriting and it says
your baby needs this vaccine.
Let's bring you back If theydon't want to give it that day.
And typically I ally with themif the baby has a fever or
something, the baby is feelinglousy or child.
I keep saying baby.
That's my Italian culture.
Babies go up to 31, by the way,but a lot of visits.
(17:17):
I'll actually say you know whydon't we go ahead and give them
this vaccine?
They're due for it.
And just like you said, drWells, in this, in your medical
home, this is what we do.
We see what vaccines are due,we see what else needs to happen
to keep you and your child safe.
I'm a big family systems personso I use the whole family system
.
Who else needs their vaccine?
(17:38):
You know you're going to comein, maybe mom, dad.
I have little young familiesthat come in and make their flu
shots together.
I love that.
We encourage that.
You know family flu visits,that kind of thing.
So, to answer your questionssuccinctly, we have a flag
system where we know whatvaccines are due.
Whatever the visit is, we willbring up the vaccine that's due.
Much more often than not.
(18:00):
If it's, if the child is notill, we will go ahead and get
severely, you know, a fever,really feeling lousy.
We'll go ahead, give thevaccine.
And we also have the leewaybecause we're well, we're happy
to have enough resources to askthe parents to if I haven't seen
a dad in a while, the day I wasbringing a child, and are you
up to date on your dbt, thatkind of thing.
(18:21):
So the flag system works andthe little system where I write,
go up to the front, make anurse visit.
A lot of people, a lot of myadults, want the shingles
vaccine on a Friday becausethey've heard they get sick from
the shingles vaccine.
We've really accommodated that.
We love that.
We love communicating yourpatients.
Great, we'll do it your way.
(18:41):
That's perfect.
Let's get this vaccine in you ina way that works for you and
for transportation.
We're very conscious oftransportation issues and when
it works for our patients.
So we have patients whosometimes are in our waiting
room an hour early becausethat's the transportation that
worked for them.
So we accommodate that.
I'll say you know.
However, you're getting here,how are you going to get here to
get this vaccine?
(19:02):
Do you want to make it part ofthe next visit.
So sometimes I'll say, let's,let's do your hypertension visit
and your dpt on the next visitif you don't want to do it right
now.
So we've gotten really, reallycreative and we've just embedded
every vaccine that's due.
My patients are used to walkingin and knowing that we're going
to talk about a vaccine that'sdue.
So we're really lucky to haveour nurse force working for us
(19:23):
that way.
Christina Wells, MD, MPH (19:24):
That's great.
One of the things that we doand I think we're also a work in
progress is we will print outthe vaccination records visit
and then that way we can seewhat the patient may be,
especially for our children.
We do this mostly see whatthey're looking for.
(19:44):
So, like the earlier this weekI saw a patient for an issue
that was not a well child and Isaw that this patient did not
have a code with booster.
It was a 17 year old and alsodidn't have a flu shot.
So we're talking aboutsomething else and I asked the
mom why don't we go ahead andupdate the code with booster and
(20:04):
the flu shot?
And we were able to do that thesame day.
So something else we're startingto implement our reminder calls
and I think that's important.
I know that sometimes staffingissues might not allow for that,
but it's possible havingimplementing reminder calls
where you can see and go throughand look, you can do an audit
(20:25):
to see what the children andeven adults are maybe missing
vaccinations and then callingthem and scheduling them for a
visit or, if they were seenrecently, depending on the
policies in your clinic, to beable to come in for a nurse
visit to update those vaccines.
So I think that we're startingto implement some things.
(20:45):
We still have some steps to gointo how we solidify our
processes, but I'm hoping thatwe'll move towards more of these
strategies that are going tohelp break down barriers to
access so that patients can havethe vaccines that they need.
So, as we wind down here, Ijust wanted to get some of your
(21:06):
final thoughts about what otherimprovements do you think that
we can make in messaging and howwe deliver the vaccines, so
that we can help to build moretrust and more confidence in
health care and in thevaccinations massive topic.
Marian R. Sassetti, MD, FAA (21:30):
Let me start with something I think
I've alluded to in anotherpodcast, and again it's trying
to build trust in a lying I likethe word lying with our
patients, being in solidaritywith our patients when a family
is undecided, or you're actuallytelling me no, I don't believe
in it.
I'll say I think we've not donea great job in public health
and I think where we failed isreminding people why we give
(21:52):
vaccines.
And I say you know, rememberwhen I gave your baby the
chickenpox vaccine, it wasn'tbecause I wanted to prevent
chickenpox, it was because Iwanted to prevent the awful
things that happen if they getchickenpox.
I think it's good for ourpatients to see that we
acknowledge mistakes that wemade.
And I said you know, and Ithink it was a mistake that we
didn't package that the rightway.
And now patients come in andthey say my brother-in-law got
(22:14):
the vaccine and then he gotCOVID.
And I'll say how did he do?
Did he go in the hospital?
Did he go in the ICU?
No, and I say, well, great.
That reminds me to tell yousomething I think we haven't
done well.
The reason we want you to getthe COVID vaccine is because we
don't want you to be in thehospital and we don't want you
to end up in the ICU orcertainly dead.
So it is true, the vaccine thatI want you to get might not
(22:37):
prevent you from getting theillness.
What I know it will happen isthat it will prevent you from
getting severely ill andsuffering, and I really don't
want anybody I care about to besuffering on my watch.
So I embed that in that whole.
Let's remind each other whywe're giving vaccines and to
acknowledge the reality thatmakes them skeptics, which is
hey, so-and-so got the vaccineand they got sick, so I'm not
(22:58):
getting it and they are missingthe message.
I think that it's reallyimportant that the vaccine was
designed to prevent verysignificant illness,
hospitalization, certainly deathand it's working
extraordinarily well.
Christina Wells, MD, MPH, Dip (23:12):
I think that's really great,
because I think that that led tosome misinformation in the
beginning, when patients werethinking that, well, if I get
the vaccine, then I shouldn'tget sick at all, and I had to
remind people that the purposeof vaccinations is to reduce
hospitalizations and to keep youfrom dying from COVID and other
(23:33):
illnesses that the othervaccines that we give protect
against.
So it's important that we'reclear, as healthcare providers
as well, about our own messaging, so that patients understand
what really is the effectivenessof this tool and how vaccines
really work and what they canand what they cannot do.
(23:54):
Also, because we've haddecreased uptake of vaccinations
, we're seeing the rise of otherdiseases that we thought were
eradicated things like polio andmeasles, and what we don't
understand is that the reasonthat children and adults weren't
(24:16):
getting this is because theywere vaccinated, and we forget
about the devastating impactthat these diseases brought upon
us, and so reminding ourpatients that these things can
help us, these vaccinations,will really help us to be able
to prevent the devastatingimpact that these diseases
(24:38):
represent, and so I think it'sgoing to be reeducation and
continuing ongoing education andreminding our patients of where
we come.
We don't see some diseases now,like smallpox and other things
because of vaccinations, and soreminding our patients of the
importance and what vaccines cando and what they cannot do.
(24:59):
Any other thoughts on that?
Marian R. Sassetti, MD, FAAF (25:02):
No , I think that's excellent.
Certainly, what I'm beginningto do is to use a language, a
new language for me and where Italk about, we have triumphed
over diseases that we didn'tthink we could A generation ago.
Mothers were weeping over theirchildren getting polio and they
were clamoring for a vaccine.
Now we have children who aresuffering and parents aren't
(25:26):
clamoring for a vaccine.
That makes me pause and wonderwhat I and you can do about that
situation.
And then I said you know, Iwant to honor the fact of what
you're reading.
You know, you bet you are agreat mom and clearly you want
the best for your child.
I've seen that from day one.
Let's just talk about just youand me, and I'm experimenting
(25:47):
with this.
It's not finished yet and I sayyou know, there's people out
there that you're listening toand I honor that, and you are
trusting that body of literatureor whoever that is.
I want to paint a picture foryou.
I want to paint a picture ofthe measles epidemic that's
happening in Ohio, where, Ithink it was, 37 children died.
(26:08):
I have to look it up, but I'llgive that number.
And then I say so it's just,it's just a matter of time until
we see measles in Illinois.
I want to help you and youdon't have to tell me now, but
what is your position going tobe if your child gets measles?
I want you to think about that.
I don't want you to be scaredabout it, but you and I have
been great partners and I justwant to bring this up.
(26:29):
It's just a matter of timeuntil measles is on our doorstep
.
What is your position going tobe if your child gets measles?
Because I have to tell you wedon't have anything to treat it.
I wish we did.
We don't.
At least with chickenpox we cangive a.
acyclovir We don't have anythingto treat measles.
I want you to think about that.
And then I don't say anythingelse and I'm not a doctor that
scares people, but I do say wehave to remind each other.
(26:51):
This is your medical home.
I'm responsible for helping youunderstand what might be coming
to our doorstep.
So that's a new language I'mexperimenting with.
It's beginning to get sometraction.
I don't know, but this measlesepidemic next door is a big deal
.
Christina Wells, MD, MPH, (27:07):
Right .
So I think that we have to bethinking about how this
overarching mistrust anddecrease confidence in vaccines
that are coming from a lot ofdifferent avenues and a lot of
different outlets and thinkingabout how we really target our
messaging so that we can makesure that patients, their
(27:28):
families, parents are gettingcorrect information and not
perpetuating the issue wherewe're getting to a point where
we start to see the resurgenceof all of these diseases that we
thought that we had eradicated,because we know that more and
more illnesses are going to beon the rise.
We're never going to be withoutsome sort of illness that we're
(27:52):
faced with.
So any other thoughts for ouraudience today in terms of
messaging vaccine hesitancy thatyou would like to leave them
with?
Marian R. Sassetti, MD, FAAF (28:03):
Oh , just my usual Thanks for
tuning in.
You could do this.
What came to my mind is howcognizant I am that, how tired I
am of the whole topic and howthat translates into what
happens in my practice.
I do encourage us to be veryaware of our fatigue and our
desire to really just anotherone.
Are you really going to refuse?
(28:24):
Today, I noticed by the end ofthe day I have a different
demeanor that I have to bereally careful of.
So a lot of this is self care.
So, for all of those who arelistening, first of all, thank
you.
Thank you for continuing to dothis important work.
And, number two, let's makesure we take care of ourselves
and each other, because on a daywhere I'm worn out, the
conversations are far lesscompassionate and empathic, and
(28:47):
I'm very aware that I'm veryfatigued.
So if you feel that bubbling upin you, I would just encourage
you to recognize it and dowhatever self care you need to
do.
In the old days, I would neverallow myself to get behind
because I was doing something,you know, either going into my
office and doing somemindfulness, or taking some deep
breaths, or doing some boxbreathing or whatever.
Now I really do that.
(29:08):
If I'm aware of how fatigued Iam at the end of the day and
I've got a parent that is avaccine refuser I recognize I
better take care of myselfbefore I walk into that room.
So just another reminder we'regrateful for the work you do.
I'm sure your patients aregrateful, and let's take care of
each other and ourselves.
Christina Wells, MD, MPH, D (29:26):
Yes , you know just a reminder that
vaccines are an effective way toreduce severe illness, and I've
done several mission trips toAfrica.
I've seen people over there whodon't get vaccinated.
I've seen adults who have polioactually crawling on the ground
and other things that arehappening because they don't
(29:47):
have vaccinations like we haveover here and so they're
susceptible to those diseasesthat we don't see here.
But we've got to stop making itseem as if it's the vaccine and
that's all that there is.
I think we have to make it apart of everything else that
we're doing, because when wemake it seem like all of there
is, it makes it seem like thereis something suspicious about
(30:09):
that or there's somethingspecial about that that concerns
me or that gives me fear.
But if I put it in the contextof this is one of the tools that
I'm going to use to help youprevent illness, help you
prevent disease, along withthese other tools that I'm going
to use, then I think it may bemore palatable for patients,
(30:30):
because they don't feel as ifthere's this one thing that
we're pushing and that's theonly thing we're pushing.
You know, it's like the onlything I can do to fix
cholesterol is to take a statin.
No, that isn't the only thing,but it can be helpful.
And so I think we got to get outof the way of thinking of how
we promote and our messagingagain.
So thinking about ways that wecan target our messaging, build
(30:54):
trust and confidence in vaccines, and it is not really our job
to reduce hesitancy, but it'smore of our job to help our
patients that have confidenceand trust in the information
that we provide to them, andthat will help to reduce vaccine
(31:15):
hesitancy.
And then also, we should havethe approach that vaccines are
great tools, but also helpingour patients to understand that
there are other ways that we arealso thinking about in terms of
prevention.
Vaccines are not the only way,but it's one way that we can
help to prevent severe illnessand disease.
And so let us continue thinkingabout how we partner with our
(31:38):
patients, how we havepatient-centered approaches in
our messaging, and so that wecan help to really really
decrease the uptake ofmisinformation and help to
rebuild confidence in ourhealthcare system.
So thank you for joining us foranother episode of Beyond the
(32:00):
Needle.
Carl Earl Lambert, Jr., M (32:06):
Thank you to our expert faculty and
to you, our listener, for tuninginto this episode.
For more episodes of Beyond theNeedle, please visit
illinoisvaccinates.
com.
Here you'll also find links toan online toolkit, how to join
learning collaboratives inbootcamps, podcast transcripts,
speaker disclosures andinstructions to claim CME credit
(32:28):
.
Subscribe to Beyond the Needleon your favorite streaming
platform.
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