We are so excited to bring on Dr. Josh Williams, a practicing general pediatrician at Denver Health, and assistant professor of pediatrics at the University of Colorado. He has been researching vaccine hesitancy for the past five years, and we are deeply grateful for his time with us on the show to speak about the complexities of vaccine hesitancy in true pandemic podcast style!
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Thank you to all of you who helped us reach our goal to pay off our equipment for this podcast! If you would like to still financially support us for the monthly upkeep and to help hand off some of the editing responsibilities, you can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!
We are so excited to bring on Dr. Josh Williams, a practicing general pediatrician at Denver Health, and assistant professor of pediatrics at the University of Colorado. He has been researching vaccine hesitancy for the past five years, and we are deeply grateful for his time with us on the show to speak about the complexities of vaccine hesitancy in true pandemic podcast style!
Can you Rate and Give us a Review in Apple Podcasts?
Thank you to all of you who helped us reach our goal to pay off our equipment for this podcast! If you would like to still financially support us for the monthly upkeep and to help hand off some of the editing responsibilities, you can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!
You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of face crises. My name is Matt Boettger. and I'm joined with my two good friends and a mysterious buddy. The first one, Dr. Stephen Kissler, an epidemiologist, the Harvard School of Public Health and Dr. Mark Kissler, who is a doctor with University of Colorado Hospital. Before we introduce our mysterious guests who was behind a curtain, like the wizard of Oz. How's it going? You too.
Josh Williams:Good. That's good. All right.
Mark Kissler:Stephen Stephen is lacking the mustache this week.
Matt Boettger:Oh, I didn't even notice that. Oh, he popped up. Perfect. Oh my gosh. That is phenomenal. The, I didn't even notice that. That's brilliant. So what, what makes you lose that one there? Stephen? Oh,
Josh Williams:just
Mark Kissler:too many people with
too
Stephen Kissler:many opinions,
Matt Boettger:man. I feel so bad, man. At least I wasn't.
Stephen Kissler:No, you all were very supportive
Josh Williams:truck
Matt Boettger:thicker and all that kind of stuff. Oh, well, we've got a lot to chat about today. We've been on the horizons here, just wanting to continue to talk about vaccine and what's going on. There's lots of updates need to happen. I don't know. I don't even sure how many updates we're going to get into today because I think the biggest thing is we wanted to bring on someone to talk about vaccine hesitancy and just in true. Good fashion, pandemic podcast style. Just talk about it's complicated and it's okay. Right. So navigating this terrain, but before we get going, like usual, we always rely on your reviews. It helps us move in. The ranks helps to get this podcast and to more. Ears and ear buds and all those kinds of things. I had to do a quick caveat that my wife is a way right now. So my boys are mysteriously upstairs by themselves, randomly walking around the house so we can do this podcast. Watch him. I just heard pounding. So if you hear me get off for a second, because he run downstairs to scream data, I may have to get go someplace, but just a little caveat. I don't know what they're doing by hear them running it as a bad news right now, my house will be a pit and there'll be things broken, but. It's important that we continue moving with the podcast. So please leave a review and if you can support us and in any way it replaced the broken glasses that are going to be done upstairs in a couple of hours, please do so you can do that at, at patrion.com/pandemic podcast or one-time gift at Venmo or PayPal all in the show notes. Okay guys. So let's get started. I'm going to get right into this. We had a good briefing about this Dr. Josh Williams. Welcome. To the pandemic podcast. It's good to meet you for the first time. I've heard great things about you from Mark. Welcome to the show.
Josh Williams:Thanks so much for having me Matt and makes the sealant. Thanks Mark for doing the important work that you're doing as you getting the public. I really appreciated the opportunity to share a little bit with you today.
Matt Boettger:Hmm, absolutely. It's great to have you guys on, so Josh. Let's just start with this. Tell me a little bit about yourself. I don't know anything about you.
Josh Williams:This is, this is,
Matt Boettger:this is how much I prepare you guys. So you're a doctor. So this is the extent of my preparation. So please help. So Josh tell me a little about yourself, who you are and really let us know. How did you get into studying vaccine hesitancy?
Josh Williams:Yeah. Great question. So I'm a, I'm a general pediatrician that I practice at Denver health and the molten web primary care clinic. And I'm a assistant professor of pediatrics at the university of Colorado. And I've been studying vaccine hesitancy for about five years now. And what really launched my start in vaccine has a series, which was actually an interesting. Discussion with my own priest. I was a resident, so it was a tired trainee. And I was trying to do some projects around influenza as a pediatric influenza children who were hospitalized with influenza and looking at missed opportunities for vaccination. I've made an offhand comment to my priest one day when we were chatting. Hey. You know yeah, during this project, but influenced vaccines. Yeah. You know, it'd be influences vaccine. No one gets the flu shot causes the flu. It doesn't either work, but yeah, I don't usually get it. And then just kind of jumped me back and it struck me as an interesting comment. So. I did two things. You know, the first thing I did was convinced my priest to get the influence of vaccine. And then the second thing I did was I started looking into the intersection of religion and vaccination. And so a lot of my work has been around religious roots of backseat. Hasn't seen a historical instances of that as well as empirical and other kind of research into that today. But I've also now started looking into vaccination. Charities determinants of vaccination equity. Certainly being at Denver health. That's something that I'm passionate about as well. And so over the last five years, I've done everything from going to the community and interviewing people to hosting town halls at churches, to even serving parents and children and seeing how their views on vaccines affect whether or not their children get vaccines on time. It's been a fun, it's been a fun ride, and I'm glad that now. As some of the expertise that developed over the last five years, we can apply it to COVID vaccines.
Matt Boettger:Yeah, no, first of all, I just want to say on behalf of me, I guess, and the rest of the world that maybe sympathize with me, thank you for doing this because this is complicated for me. And I think it's complicated in general. And I, to be honest, I have went through my fair share of. Just ignorant and just, just receiving vaccines and not even thinking about what, what it may or may not do to drawing caricatures to people who are on the other side, right. Oversimplifying. They're like, Oh, you're just one of those people. You're anti-vaxxer. And then now, because of COVID, I mean, I say this over and over, so I am literally a broken record. I only had like three things I can talk about life. And one of these things is this idea that this pandemic has opened my eyes to the reality of the complications of the world. And it's either, or it's stuff just. Does it cut it. So just first of all, thank you for doing the research because I want to hear about this because I've, I it's around my circles. I had people all over pro-vaccine anti-vaccine say anything that, you know, it's of the devil and that is actually going to, you know sterilize you by taking it to people who are reasonable are quote, reasonable. Just trying to understand whether they should take it or not. And. Hasn't been out too. So my first question to you is where does this come from? This hesitancy does, is there a history that we can trace to be like, okay, I can sympathize more of why people may be hesitant.
Josh Williams:Yeah. Yeah. Great question. And there is, there's absolutely a history of vaccine hasn't seen, it goes back all the way to the history of vaccination. And so if you think about vaccination, right? So we'd go back in time, early 19 century, you know, probably many listeners might have heard of Edward Jenner, a faint physician living in the countryside in England, and he's kind of caught this little. Practice on the side of the countryside. And, and while he's out there practicing, he notices that these dairy maids on the, on the farms around him seem immune to the ravages of smallpox. And he kind of wonders about that and thinks that maybe this, this disease, that dairy maids are getting count POCs that can actually be transmitted from one person to another is a deliberate mechanism of protection against smallpox and smallpox was, was deadly. It was. Tejas and often call us permanent disfigurement as well as blindness. Right? And so this was something certainly worth looking into if there's a way to protect people against smallpox. And so general decided to take a man from a lesion on an effected dairy maid and transmit it into the son of his gardener. James Phipps and see whether or not he could then don't deliberately infect James with smallpox a few weeks later turns out James resists infection with smallpox because he had cow pox. And the, the story of vaccination is, is born now, general popularized, small products, vaccination. And at the beginning of the 19th century but not everyone was on board. Right. So, and, and there are lots of reasons for that. So first of all, you know, variolation the precursor to vaccination, which is where you actually took. Smallpox from the lesions of people who had smallpox and you gave it to people who were healthy as a means of protection. Well, that was a, that was a lucrative practice for physicians. And so on one hand, you have physicians who are hesitant about fascination. It's untested. It's not been seen before, whether or not this is going to hell and it's also. Eating into their incomes. There was a, there was a famous vaccinator back in the day. It was, or a very later, I should say, who was making 600,000 pounds a year equivalent doing this practice. Right? So you had physicians who were hesitant about vaccination based on what it was going to do, go to practices. And then you have people asking you what, what we're taking. Something that was, was infecting cows or infecting humans with it. Does that mean that people are going to start to, to grow horns or are people going to start to look like cows? And so you look at a lot of the artwork at the time, right? People who are against this procedure, and they're, they're really worried about taking something that was inside of a cow and injecting it into a human. And you have all these characatures and people with heads that look like cattle heads or horns spoken down. And then you also even have religious individuals. Yeah. Know clergy saying, you know, well, God uses sickness and death as a means of punishing people and a means of kind of disciplining people. And so who are we to take that away as a, as vaccinated, right? Who are we to take that away as, as you know, discipline. People and, and try and pretend to be gone. Right. And so there's a lot of, kind of early things that played into to vaccine hesitancy right around the turn of the 19th century.
Mark Kissler:Yeah. And maybe, maybe we can talk first a little bit about the ways that that this vaccine and the new platform, maybe judge, like, how do you think a little bit about. Us understanding understanding the vaccine, understanding the platform and understanding its safety profile and some of the kind of the, and then maybe we can back our way into some of those bigger questions about how, how that overlaps with, you know, the, what was going on in Jenner's time. Does that sound
Josh Williams:reasonable? Yeah, absolutely. So you have to platform here and how it's been used kind of the last couple of podcasts. I had a pleasure catching up on those. But it's worth pointing out, right? That the vaccines that are being shipped around the world right now, or at least the Pfizer magenta ones are using this messenger RNA platform. It's a new platform, but we don't have the same amount of long-term safety data, as we do have with other vaccines that have been around for many, many years or even decades. So it makes sense that people would question putting in RNA vaccines into their bodies. You know, what is this going to do to me in five years or in 10 years as well. But it's also, we're thinking about ways that other Mr. RNA treatments or RNA vaccines have been used in the past few years. And so one good example, they've been. Or as possible cancer treatment. So people with untreatable late stage melanoma who get an MRI and a vaccine to help trigger the immune system to start fighting off melanoma cells on their own. And certainly not working, perhaps thinking the same way as far as generating a protective immune response against an infectious disease, but also giving us insights into the safety. Of MRNs, vaccines and treatments over the course of several years. And so this isn't the first time that we've seen products with marinade inside of them. And at the same time, we're going to have to continue doing our due diligence with following the long-term safety of these vaccines. Just taking the shorter term data that we have, but kind of looking to the future longer-term outcomes as well.
Mark Kissler:Yeah. You know, one thing I'm interested in Josh that I know we've overlapped on before and talked about a little bit is what it takes to get a sense of the long-term effects of a vaccine like this, and sort of how you think about particularly with the Pfizer and the modern vaccines and what you've seen. In terms of their rollout and the data that we have so far. But just kind of getting a little bit of an understanding or get wrapping our arms around what it takes to understand, you know, long-term effects of a new therapeutic like this.
Josh Williams:Yeah. So it takes a lot to understand the long-term effects and I've had lots of people ask me questions about, you know, Josh tell me about whether or not they scene is going to cause me auto immune issues in 10 years or in 15 years kind of autoimmune issues broadly defined for example. Well, it's a good question. It's a question that we shouldn't be looking into, but it's also a really difficult question to answer. You have taken an autoimmune disease like rheumatoid. Right as or inflammatory bowel disease, you know, a disease with an incidence that's already quite rare, right. In the general population. And now you want to try and study whether or not the vaccine is associated with additional cases of that disease. It's hard to prove causation there, but maybe you can find a correlation or an association. Well, you have to look for many years to find the number of cases that you're going to be able to detect a statistical difference. Between crews. You know, I know that Stephen would know all sorts of things about power calculations and sample size, looking at some of his modeling that that he's doing, but right, to even conduct these studies, you'd have to be looking at tens and tens of thousands of patient charts and following those same people over five years or 10 years, and then accounting for all the tiny differences, all the confounding variables that could have happened to those people. In that five to 10 years that you followed them to then try and make some sort of adjusted analysis to say, yes, we think this vaccine is associated with that one outcome or another. So it's much easier to look at the short term outcomes of swelling at the injection site fever in the next 24 to 48 hours and say, yes, we can give you a proportion percent. This number of people are going to have it out of a hundred who get the vaccine and so much harder. To do these longer-term studies. It doesn't mean that we shouldn't do them, but it is much harder to do.
Matt Boettger:I am thinking also, just too it's how do you deal with in my circles? We're like, come on. Are you serious? Like ever since the vaccine was there was really rolled out this an X and Y Z has been more prevalent in the U S you know, I, I get this a lot. Like, you know, you telling me that's just pure coincidence, right? It's just that every, you know, or autism, you know, which I totally know, that's a whole other center of misinformation. I'm assuming from what I read in a small level, but. I mean, help us unfold a help me on some of the complexity of this and the sense of like, how did I respond to that? Yeah. Yeah. When I see those numbers, but yeah, I think you're onto something. So why aren't scientists saying, you know, let's, let's, let's, let's, let's slow down here. Let's slow down. Is it because there's money in the pockets or, you know, then I keep getting more and more pushback and I'm to the point where I'm feeling like, I don't even know where to go now. I've kind of lost. Right? How do I, how do we navigate that train? When there seems to be a little tight. Can like in my mind, in my small world, not Stephen's world. Cause you understand complexity cause that's your whole forte, but I just, I just, I want to stick with a one plus one equals two and that's about it. So how can we fit that in that framework, Josh?
Josh Williams:Oh man, we're going to have to move past simple addition, I think to like experiential math
Matt Boettger:here
Josh Williams:again. Yeah. That's beyond me, but Stephen, but any case Casey, I'm glad you brought up the question about autism for example. Right? So People noticed back, you had 20, 30 years ago, that has a number of vaccines that were given to children, was increasing in the recommended schedule, that there also seemed to be an increase in the number of children that were diagnosed in autism. And so perhaps it was a natural question to ask, is there some way. That the routine childhood recommended vaccine schedules now leading to additional cases of autism. Right now, that question is a really difficult one to answer, unless you're able to look at specific parts of the vaccine or specific vaccines that have been introduced and doing it a rigorous way. And so. Thank, you know, thank God for Scandinavian countries that have these robust electronic medical record systems. Right? So one, one hypothesis was, you know, in vaccines causing cases of autism. And so you look in these Scandinavian countries. For 10 years before the the, the elimination of five aerosol in vaccines and then 10 years after, and you look at the rates of autism in the general population. And these are studies that include, you know, 90%, 95% of all the children in the country. And you're able to look at the rates. Pre and post elimination of five Marisol, you're able to make conclusions about whether or not there was an increased risk and actually there, right there wasn't but I think it's important, whatever you're kind of coming to vaccines or the hesitation, you know, what, what the question might be recognizing that it's, it's easy to kind of generate those questions off the top of your head. It's much harder to scientifically and rigorously study those questions in ways that make sense to statisticians so that we can actually do the proper work of answering the question. Well, Yeah,
Mark Kissler:thanks. This is something I've been really interested in this and sort of sensitive to these questions throughout the pandemic, because we've seen a lot of scenarios in which bits and pieces of evidence might be knit together with a certain narrative that has
Josh Williams:outward
Mark Kissler:potentially plausibility, but arrives at a conclusion. That's actually not. True. And you know, we see the ways that kind of, that evidence or bits and pieces of evidence might be used in order to tell a story that doesn't correspond with reality, you know, or, or, you know, more or less. And I think I've seen I'm just interested a little bit in if you have any insights about practical ways of engaging people in dialogue about that, that isn't alienating or isn't I think there's a lot of ways that, that physicians, you know, I trained in pediatrics. Though I don't practice in pediatrics right now. It's a lot of ways that I think we can shut down dialogue very quickly or that we can, you know, marginalize or further as strange groups that have real, you know, potentially legitimate, at least legitimate
Josh Williams:questions.
Mark Kissler:So I wanna think, you know, I, I'm curious about how you engage that in your own practice, in your research,
Josh Williams:things like that. Yeah, well, Mark, I have so much respect for you and I'm just so sad that you're not practicing pediatrics anymore. It's like just the biggest strike against you. I think of you. And I'm like, man, Mark's a great guy, but yes.
Matt Boettger:Well, it's obvious you cannot be a pediatrician with a stash, man.
Josh Williams:You just, you just can't
Matt Boettger:you to make your choice
Josh Williams:in all seriousness. It's a great question. And I recently wrote a review for a journal on, on how to engage with vaccine hesitancy in clinical settings. And I deliberately titled it caring for the vaccine, hesitant family. Right. And, and the idea there being that, I think this is just another way in which we, as physicians care for our patients and families is by having earnest dialogues with them about their genuine questions and concerns. And so one of the things I allude to in that article is this motivational interviewing, right? And so motivational interviewing is this kind of, depending on. Which person you, you listened to has various components to it. Then you on say for the purposes of our talk today, it's got four different components to it. Well, the first one is partnership, right? You go into these conversations in a specifically, not, not trying to play the role of the expert, but you actually go into these conversations as the role of the friend. Right. And the role of the person sitting across the table, having a cup of coffee, not the person wearing a white coat, telling someone what to do. And so you're partnering to learn more about people's concerns and you using language like, wow, it just makes so much sense why that would be a concern to you. And I was talking to someone this morning about COVID vaccine concern she has, and one of the concerns she brought up. Was fertility. Right. And she currently is a married, I presume would hope to have children later on. And I think her concern to be right. It makes so much sense why you would worry about fertility and COVID vaccines. Right. So I think. Partnership is part of it. And then acceptance is another big part of it. Like you said, Mark, right? We're. We're accepting of our patients of their families, decisions of the parents' decisions, regardless of what decision they end up making. Right? You need to detach this idea that, you know, your worth is wrapped up in whether or not you're vaccinating or not. Right. Your, your worth is kind of independent of your fascination decision. And I think in a polarized. Society is evil, easy to label people one way as, as you know, you're your anti-vaxxers. For example, I find that unhelpful, I think is much more important that we reinforce with patients and families. Hey, this, this choice is yours. And at the end of the day, it's, it's yours to make. And I respect you either way. And then, you know, compassion thinking about how do we have compassion on patients and families when they have genuine concerns. You've alluded to this kind of, you know, there's just a lot of information going around as, as medical professionals, we're trying to sort through it right now. We have lay, people are trying to sort through it as well. And so giving people the benefit of the doubt that they're actually really trying to do their due diligence and trying to understand everything that's going on now. And then finally, one thing I like to do in my conversations is to let good ideas for vaccination actually come from the people who have concerns about vaccines. Right? So just to take the conversation a step back from the actual vaccine, we're worried about just have people tell me more about what's important to them. Right. And you'll hear things like, well, you know, what's important to me is like the health of my children and being in an active family and making sure my kids are kind of growing and learning and developing in school. Right. And so this idea of fuqing ideas for vaccination from our families. Right. And, and just showing people how their priorities align with the public health benefits of vaccination at times. Right. Oh. So I can see, you're really concerned about. Social justice and the community's good. Well, let me tell you a little bit about herd immunity and how that works to benefit those of the community who can protect themselves against pertussis or measles for whatever reason. And so I think there's lots of ways that we as providers can partner with families, demonstrate that, you know, they, they have this intrinsic worth and value independent of their decision and that we understand that and have compassion for them when they're making these difficult decisions.
Matt Boettger:That's good. I, you know, I don't know if this is true, but you're talking about, you know, again, the complexity of the vaccine, the hesitancies and Stephen off the offer before we recorded, we talked about, well, it's not like, this is Stephen's words. You were saying that like, it's not like we're choosing one, one thing over being healthy. We're choosing one thing over the over coronavirus, which has its own set of unknown realities in long-term effects. And then I'm stuck in this middle situation where I'm like, okay, I have two complexities. And how do I bite down on something and, and not fear either, just not having fear or just not doing it, because this is like the complexity for us. Like, what do you do? There's unknowns with this new vaccine there's unknowns with COVID now I'm just scared. I'm gonna sit in my house in a bubble and cry myself to sleep every day until something happens. But yet nothing really happened except for complexity continues to be. And what I'm getting to is. I don't want to make this a caricature, but is this also something of an American like, like difficulty of, I, I feel like in some sense it's a big issue, right? I there's, there's real reasons to have heads of the, about vaccines vaccines. I also am in circles that say extreme things about vaccines that are way off the charts. Right. And I just don't know, like we have a tough time making decisions when things are complicated. Right. It's a lot easier for us and because I can just turn my thermostat up to 80 in the winter and control my environment and make it simple in my world. But this is just a whole other world by which. I don't even know how to step into and let us know. You were just talking about, like, I don't even know how to really have that discussion when, when you were saying, Hey, just have compassion and I will, I will. I promise I will have compassion because I want to have compassion, but I get nervous. I don't know where to go, because like, the people were like, yeah, bill Gates, he's secretly, you know, trying to sterilize the world who is vaccine. I'm like, yeah, I get, I get why you'd feel that way. You know, you know, you know, like, I then I'm there and I'm like, I know, I know, I know Mark. You're looking at me like that that's a Cray Cray situation, but like I'm not even researched enough to begin to be articulate. Like that's just insane, dude. Like it's all I can say. Right? I do you see where I just. This is why I get on my guard. Like, I don't know how to like nuance this stuff and like shake it off and it's okay. Gotcha. I'm going to feel this. I'm going to roll with this. I want to enter into your world. I really want to help and provide the best solution possible. And it's like at the very beginning of, and I'll stop being long-winded at the very beginning of COVID, we talked about, it was hard to insert reason when there was, everyone's talking at each other. Right. And we couldn't really have an informed, good discussion, which then there's some consequences. And now I feel like we're having the same thing about vaccines. Any.
Mark Kissler:Yeah, I was just thinking that I hope that one of the other members of our podcast can solve this problem because I think it's the, one of the big problems right now in our society is how do we speak across these divides, particularly when there's such a high valence of question about which authorities do we trust in which authorities do we not trust where we're getting our information. And this has been hashed and rehashed in lots and lots of different ways, but it is, I think one of the key. Questions that the pandemic has heightened is about this. Like, how do we trust our neighbor? How do we engage our neighbor? And I think you're asking that same thing, you know, and there's lots of ways that we can ask that question, but that's the fundamental question. I think, at the, at the core of what you're asking and I I was hoping that. The judge, whatever the easy answer to that
Josh Williams:question. Well, yeah, yeah. I, I do it the answer framework, but what I can say right is I think about vaccine hesitancy as a spectrum, right? And so you have maybe 2% or 3% of parents who are refusing most or all vaccines for their kids. So the vast majority of parents across the us are actually vaccinating their kids on time or trying to follow some sort of vaccine schedule. And so when you talk about, you know rumors of bill Gates, trying to sterilize America, I think that's what you said through vaccination, right? So that perspective represents such a small sliver. Of genuine true vaccine concerns across America. Right. What, what really represents the majority is the large number of parents who have, or individuals who have real genuine concerns. And they want feedback from us, right? One of the most important predictors of vaccine to see as a physician recommendation. For vaccine, right? When you look at studies like that is that just comes, it comes back to that factor over and over again. And so one of the things I highlighted in that review I wrote is the importance of persistence, right? So for physicians, sometimes these, these. Conversations can be really, really tiring. Right. Really fatiguing to go in and try and, you know, learn more about people's concerns and be a partner and try and invoke their positive reasons. Right. Is that motivationally endearing is really tiring, but I tell new residents when I work with them, like the vaccine, hasn't seen isn't salt over the course of the visit, right. It's all over the course of a relationship. And so the goal is. I want to build a relationship with you. And today I'm my goal. Isn't to vaccinate your child against your wishes. My goal is to get you to trust that I respect you and that I have a child's best interest at heart. And so one of the most satisfying things for me as a pediatrician is when I take a family where they, they really are close to that. End of know, Refusing all vaccines. I'm not going to listen to anything that you're going to tell me. And three to four years later, I get their child up to date on vaccines. Right. And that for me is as largely representative of a change in dynamics of the relationship. Right? It's about who you're listening to, like Mark said is a trusted voice. And so the goal here, I think it's trust.
Mark Kissler:That's great. Thank you. Oh, Stephen, you have something. And then I have a thought just to follow that up,
Josh Williams:you go ahead. Oh yeah.
Stephen Kissler:I was just going to follow that up too, but I, I appreciate that a lot.
Josh Williams:Yeah.
Stephen Kissler:That, you know, it's like so much of your response is rooted in a mutual understanding and narrative. And and going back to the way that you opened this discussion to history as well. I know that one of my,
Josh Williams:Frustrations
Stephen Kissler:and one of the difficulties that I often run up against both as a scientist and as an observer of my fellow scientific community is that one of the ways that we often. Try to gain trust is by talking about science and giving scientific facts and talking about safety and efficacy. Whereas I think oftentimes we would be much better served by, by really understanding the history of where we've come and that, For example, in, in public health, like the event that really looms large in terms of hesitancy for treatment and also just hesitancy to, to trust public health and medical officials is the Tuskegee syphilis study. For example, where there a huge. Breach of trust
Josh Williams:between
Stephen Kissler:medical provider and and patient. And so, you know, we can, we can talk about safety and efficacy all we want to, but if there's, if there are these elements in one's
Josh Williams:history, either one's cultural history or one's
Stephen Kissler:personal history that where, where the concerns are not rooted in in fact, but in, but in trust and mutual understanding, then no matter how many facts we have there's never going to be even the opportunity for dialogue there. So. I appreciate you bringing that so fully under this
Josh Williams:discussion. Yeah, that's a great point. And I think again, getting back to that place of, of partnership, right? It makes sense. Why communities of color are distressful of code scenes. Right now we, you look at surveys that have been gone and going around for the last six months. Do you intend to get them? Vaccines and looking at racial and ethnic disparities by intention, but I'm sure as we follow for the next three to six months, we'll have data around racial and ethnic disparities by uptake. Right. So getting to play. So it makes sense. You know, I want to hear more about your concerns and part of what I've done is go to the community and just ask people, you know, tell me what your concerns are. And one of the. The most rewarding parts of that experience for me has been, the banks that I've had from community members is that it was so helpful. You came. And the first thing you did was asked for our questions, right? You didn't come in with facts, with knowledge, with a shiny PowerPoint presentation to try and convince us, you know, the first thing you did. Hey, I'm Josh. I'm a pediatrician. So tell me about. Your questions. Yeah. What are you worried about? Right. And I found that to be really helpful is as both, you know, content areas, but also thinking about what kind of interventions we could do to try and increase trust.
Mark Kissler:Yeah, I love that. I think I think that's just such a great example of how humility can operate in the therapeutic relationship, not as a way of convincing people to do things, but actually as a way of opening us up and recognizing that there are things that there are things we have to understand about our history as clinicians are very deeply flawed and imperfect history, you know, as a profession. And that approaching with that humility first and that understanding and going into communities. That way it, furthermore, you know, not only is it good clinical medicine but I think it's good science too, right? There's a certain degree to which the, the humility of the true scientist has to be one of the primary virtues, because that's how you learn things that you weren't predisposed to learn maybe at the beginning. And so I love it the way that, that. That interacts both as a personal and an ad, an intellectual
Josh Williams:virtue,
Mark Kissler:you know, there's an overlap there. I, I wanted to say, I think we're getting close to the end of our, of the time that we had a lot of thank you so much for your generosity to be with us. Judge. I wanted to pivot maybe one more question and to draw a distinction that I think is important. And to ask sort of everybody's thoughts about we've we've talked a little bit about this vaccine in particular. We've talked about vaccines in general, and I want to bring it back
Josh Williams:to this particular
Mark Kissler:vaccine. I know that I have people in my life who has particularly those who are
Josh Williams:essential workers,
Mark Kissler:Teachers, or some, you know in some sort of a person facing profession who are considering particularly in the second wave of vaccinations. And so they're trying to figure out, you know, how do I think they, they may be generally pro-vaccine they may trust, you know, the process that this has gone through generally,
Josh Williams:but have some questions. And I'm
Mark Kissler:interested in thinking and helping them think through, you know, how do they decide if this is something that they themselves want to get and participate in? You know, I can talk just briefly about the way that I'm thinking about it, but I want to give you Josh, maybe the last word and, you know, Stephen, if you have any thoughts You can, you can pitch into I think it's, it's an interesting and an important question. And one of the ways that I've been thinking about it a little bit is that I've recognizing that we're opening up into sort of a, essentially a phase four trial of this vaccine. We have really good. You know, to date as good as we can have both efficacy and safety profile data that I think has been established and accepted by the scientific community. And there's also a recognition that I'm by getting, I did get the vaccine last week, by the way, and by getting the vaccine I'm it's
Josh Williams:in some ways, volunteering
Mark Kissler:for part taking part in that phase four. Trial and recognizing that yes, there, you know, can I say 110% that absolutely no adverse offense are going to happen or that they're not going to happen to me? No, but I think that the risks are that the benefits outweigh the risks. For me you know, in my particular case, and also that I'm willing in a certain degree to bear you know, to
Josh Williams:bear a little bit of that risk myself, because
Mark Kissler:that's what we rely on, you know, that's, we I've relied on that. That other people have stepped up to the plate and done the phase one, two and three. Trials, you know, that other people have been unfortunate, it had COVID and we've learned from COVID from their experience and from their bodies, you know, and that often also just aware of the fact that the bodies of those who've been most effected by this are also often people who are in, you know, lower socioeconomic
Josh Williams:status in otherwise marginalized
Mark Kissler:populations you know people of color and that there's a certain degree of. Of humility. I think that comes just from the recognition of. Of that. And so I just, you know, I, I don't think necessarily from my standpoint that there's a a hundred percent right or wrong answer or that I could tell somebody at least today, yes, you should do it or no, you shouldn't. But that's sort of the way that I'm thinking around the question and I did go ahead and get it last week. And so that's kind of where, where I'm at with things. So just wanted to kind of think through it verbally. Stephen, I don't know if you have any thoughts and then maybe Josh, you can kind of take us on.
Stephen Kissler:Yeah. I mean, I think that's a really like, so it's going to be months I'm in an interesting position where I'm probably on the precise opposite end of the spectrum in terms of vaccine prioritization from Mark, where I will not even have the option with this vaccine probably until sometime
Josh Williams:next summer.
Stephen Kissler:If everything goes smoothly And so in some ways that choice is is, is delayed for me. And that, that opens up a certain amount of, and I, you know, Matt, as you were saying that there's, there's all of this complexity and in a way, the unfreedom that I have to it's about choosing to get the vaccine is, is freeing in a sense, because I don't. Have to make that decision personally, but of course I am a, an epidemiologist. And so I do need to be able to sort of think about, and speak about exactly these sorts of things, risks and benefits. And Mark, I think I've been thinking about it in a very similar way to you where there are a lot of uncertainties
Josh Williams:still.
Stephen Kissler:With, with everything with, with our existence right now, both with COVID and with the vaccine. And that, yeah, what we're doing right now is, is both something for our health, ideally for our community's health and also for the, for the greater benefit
Josh Williams:of,
Stephen Kissler:of, of
Mark Kissler:medical knowledge. And
Stephen Kissler:those are the, those are the different axes that we're weighing this decision on from my point of
Josh Williams:view. Yeah, I really glad you both talked about considering this decision on both individual levels and also community levels. And that's, I think what I'd end with is that I think it's easy to try and make this decision in a vacuum, right? It's, you know, we, we say, okay, what are the risks. Some benefits to me and you try and read and do as much background as you can. You make the decision, but as a, as a general pediatrician and a safety net practice, you know, my patients and their families have been devastated by this virus. It's. It's killing their grandmas and their grandpas. It is forcing children into overeating at home because their parents are afraid to bring them out and let them exercise. It's causing significant losses in terms of educational achievement, it's potential for these children. The, the virus is just devastating these communities. And so everyone's calculus is going to be different as far as their individual risks. Profile and what you know is most attractive or most concerning to them about these various vaccines. But for me, what, you know, vaccination has never been about. Just the individual it's always been about. The community is always been about herd immunity. And that's why for me, I got the vaccine this morning. I went in, not just for myself, certainly it is going to offer me some protection. I hope, I hope I hope I'm in that 95%, but I did it because I want it to stop. I want the, the devastation, the destruction to the patients and the families I serve to stop. And this is a small thing that I can do, assuming some of that risk long-term safety to myself in the hopes that, and then people around me or. Having so much suffering right now, but that might offer them a little bit of relief. And so I would encourage listeners who are wrestling with this decision, right? They're going to be wrestling with it maybe as healthcare workers or the next month or so, or maybe as a non healthcare essential workers in the next couple of months, or maybe, you know, your timeline for making a vaccine is sometime this summer. But, but as that time approaches, I would encourage you to think. The community and the people like Mark was saying who, who had had their lives disproportionately disrupted, even shattered by COVID 300,000 deaths from COVID right? Then it disruption to our communities is just on a devastating scale. And so I would hope that that would come into the calculus as well.
Matt Boettger:Thank you so much. I really appreciate coming on. It's been hugely valuable, valuable to me. Yeah, I think we'll close on this. We if you want to leave a review, sorry, I was just so good. Good, good ending. And I just, just encouraging people to take this, take this seriously. I know in my own life there's been three, you know, deaths within two degrees and just hit home the past few weeks for me. And it wasn't until this podcast that you guys. Opened my eyes beyond my own reality that don't just affect me it's for the sake. And, you know, Stephen mentioned that oftentimes it's the younger population that has the best response. So pony up I'm here. I want to help. And I really want to get over this and I want my kids, thankfully, they're not overweight yet, but they are in little cages. So. We, they really want to get out of the cage and to
Josh Williams:there's out there. Do not put your children. Yeah.
Matt Boettger:I did let them know that Santa was back. So they did a few days ago and they were really excited, excited, and they didn't know that they could hug him if he, if they, if they saw him that's how much it's affected our life. Well, great. Well in here for those of you who would like to leave a review, please do so. I hope you have a wonderful week, a happy, happy holiday, a Marion bus at Christmas, a happy new year. So thank you for listening and we will see you all again next week. Take care and
bye-bye.