Interested in collecting a CME for this event? If you’re a member, you can complete this survey to get 1 CME. Survey: https://forms.gle/eEszEwRsgtoRT1dQ8
Welcome everyone to this doctors for America advocacy Grand rounds my name is Shadle Shaw I’m a neonatologist the Maria fer Children’s Hospital in Valhalla New York and a professor of Pediatrics and neology at the New York Medical College I’m also a 2023 uh Capello Health policy fellow um
We are so so bring this advocacy Grand rounds to you we have an amazing speaker I will introduce her then we will let Dr uh fiscus talk and then of course if you have any questions uh you can chat them and we’ll engage in a little bit of a
Roundtable discussion uh afterwards so I’m pleased to introduce Dr Michelle fiscus to this doctors for America advocacy Grand rounds Dr fiscus is a former member of the National American Academy of Pediatrics board of directors and in that role helped direct National and child health policy for the country’s 68,000 pediatricians she currently
Serves as the chief medical officer for the association of immunization managers leading a CDC funded project to increase covid-19 immunization rates in children as the former medical director of the Tennessee vaccine preventable diseases and immunization program Dr fiscus attracted national attention when contrary to directives from her state government she continued to provide
Evidence-based information regarding immunization to the public and to County Health officials her subsequent removal from her State position in Tennessee placed her in the center of a national debate between politics and public health information particularly surrounding immunization her defiant and heroic stance to continue to educate the public
About the safety and importance of vaccination in the face of tremendous political pressure has really made her an icon amongst pediatricians who are too often now thrust on the front lines of this and frankly too many other culture wars I can tell you uh from knowing Dr fiscus now for a couple years
Um she’s also just really cool she received her undergraduate degree and medical degrees from Indiana University and completed her residency at the Riley Children’s Hospital uh in Indianapolis she’s uh a member of the American Academy of Pediatrics formerly board of directors and has also served again on
The work groups on work groups for the advisory committee on immunization practices so with that I will put it over to Dr fiscus and if you have questions please uh feel free to put them in the chat and we will ask them uh at the end of the talk thank you so much
Well thanks Shadle um I’ve I’ve been looking forward to this for a really long time and appreciate the opportunity to speak with all of you um I I spent a lot of time thinking about you what what I wanted to share with you and um my ability to share some messages has
Changed a little bit um but really what I’m hoping to do is um is to fire you up a little bit at the beginning of this legislative session that we’re all um entering into right now and to um make you aware of just what’s happening um on the state level
Across the country and um make you a little uncomfortable I hope uh about the thought of just sort of sitting on your laurels and and thinking that well maybe if I’m in a blue State I don’t have to worry about things so much so um so uh
Thanks for indulging me for a little while and letting me um share some of my thoughts so as I was researching this talk um I found this quote from the former commissioner of the New York City um Department of Health who who went on to be the um commissioner of the State
Department of Health up until I think the end of 2022 and and this quote just really resonated me much has conflated when medicine and public health attempt to fly below the radar of politics by Dawning the armor of scientific objectivity guarding the Faith by positing the cold logic of the
Scientific model and um she actually said that in 2017 and I think it just it just really resonated with me about you know we are in an era where just being an expert in medicine um is is just not enough anymore to get people to understand um
What they need to do and and we really as Physicians and especially as advocates need to find other ways to communicate um than what we’re really used to doing um and so you know I wanted to point out that there have been Skeptics for a really long time so
Pythagoras in about 500 BC said the Earth is round and we still have flat earthers um roaming the planet right now and then all living things can trace their descent to a common ancestor um Charles Darwin 1850 and you know we’ve had this Scopes Monkey Trial in my
Former state of Tennessee um we still have people wanting to ban the the teaching EV evolution in um in public schools um this is still going on um Robert cot in 1887 that said that specific microbes cause specific diseases and we still certainly have disease deniers so I we have been
Dealing with these issues for um literally centuries and Millennia um um but you know I I I really think we can’t downplay the the impact of the internet and social media and the 24-hour news cycle and how that has strengthened and given um air and volume
To the people who um maybe used to just sort of sit in a hut and think that the Earth was flat um that now have followers and um and communities that that they can connect with that that um breathe you know the same kind of air that they’re breathing and I wanted to
Pause in this for a minute to talk a moment about racism and science and medicine and and so I’m going to be talking a lot about misinformation and disinformation and people who believe in conspiracy theories and and all of that and and that is very different I think
From mistrust of science and medicine because of what has happened historically Tuskegee that went on for 40 years um The henriot Lex um J Mary and Sims who was um was doing gynecologic surgeries on enslaved women um without anesthesia I mean there there are reasons very valid reasons why there are
Populations um Among Us that have a a huge distrust of Science and medic medicine and that is very different and I just want to compartmentalize that from kind of what’s what’s been happening with more um of the right-wing uh Evangelical Christian kind of movements around medical freedom and and
All of that so I just I wanted to one acknowledge um that that in medicine we have done terrible things to people and to to um to very plainly state that um that I am not talking about these populations um during this this conversation um I also should probably
Take a second to just say that I’m speaking as an individual um who was invited to give this talk and I am not speaking on behalf of any of the 501c3 organizations that I am affiliated with who are not permitted to speak about um things like people who are running for
President um so if you’re a pediatrician like me um you know 1998 was really one a lot of things changed for us and that was when Andrew Wakefield published his Infamous article in the Lancet um trying to connect MMR and autism and really this for Pediatrics was kind of the
Advent of the modern antivaccine movement I think um and you know unfortunately it took 12 years for the Lancet to retract that article so even though um it was shown to be bunk and and um Andrew Wakefield was stripped of his MD in in England
Um and all of that it took a really long time for the the publication to actually come out and retract the article and so an awful lot of damage was done in those 12 years and and really in the couple of decades since um wakefield’s paper um
And you know Wakefield now lives in Texas um where he’s good buddies with Del big tree and uh and they’ve produced movies like VX um D big tree is now the um the um public relations person for um the Robert um F Kennedy Jr um presidential campaign so um all of
This kind of comes full circle um you know it was after wigfield that we started to see people like Jenny McCarthy and other celebrities start to come forward also espousing um this anti vaccine um Theory Rob Schneider um of the Happy Gilmore movies um is probably one of the most um
Vicious especially on Twitter um he he put out this tweet after the covid vaccines came out just say no and keep saying no over half of the US population is continuing to say no to this unapproved experimental gene therapy my body my choice and then Second Amendment
For this um so not only pushing back on science but actually in you know intimating that maybe there should be VI Ence associated with that in 2019 the World Health Organization came out with its 10 threats to Global health and you know I think back about this that came out
Right before we realized that we were moving into a pandemic and you know if you look at that top 10 Global influenza pandemic we thought it was going to be influenza it just turned out it wasn’t um Ebola and other high threat pathogens and vaccine hesitancy were all in the
Top 10 um and this was pre pandemic prediction by the the World Health Organization which um you was was really fairly right on U of what we ended up coming into very shortly after um it was in March that the who declared the Corona virus pandemic then about two
Days later president Trump um then declared the pandemic as a National Emergency for the United States um and you know if you recall back to that time there was a lot of downplaying I remember him talking about how um there was there was um Co on a cruise ship uh off the
Western coast of the United States and he didn’t want the cruise ship to dock because then we would have 15 more cases of covid in the United States and at the time we only had a handful of cases um when he came out to talk about operation
Warp speed um and we can go for a long time talking about naming it operation warp speed in May in that same announcement he said and I just want to make something clear it’s very important vaccine or no vaccine we’re back and we’re starting the process and in many
Cases they don’t have vaccines for a virus or a flu comes and a virus or flu comes and you fight through it so you know on the one hand saying we’re going to try to make vaccines as quickly as we can and in the same breath saying but
We’re going full steam ahead anyway even though it’s May of 2020 um we’re going to begin opening things back up again and um and you know trying to take away a lot of the protections that we had around covid and you know you think about how early that was in the pandemic
Compared to where we ended up to plus years later um it’s well three years later really um you know to think looking back that they were talking in May of 2020 about um you know not really needing to pay much attention atton to this pandemic anymore in
Um in September of 2020 Trump said that Corona virus quote affects virtually nobody and talked a lot about how young people have wonderful immune systems and they can just fight this off which I mean is not completely untrue um but October 1st was when he himself ended up
Getting covid-19 of course this was prevaccine and received all kinds of treatments um in the hospital but then just about four weeks later came out saying cases are up because we test all the time and so the only reason that we know about the cases is because we’re
Testing and if we weren’t testing we wouldn’t have so many cases um and so you know really feeding back into this downplaying of of the pandemic and so if you think back about the influence that he’s had over the past several years um you know he was really laying the
Groundwork for for this distrust in medicine all the way through um the pandemic not even counting the you know the sunshine and bleach and and all of those comments and so I found this really interesting so this is from Kaiser family um foundation and they did a poll before the election before the
FDA um gave eua to the vaccines and wanted to know are you worried about the FDA rushing to approve the vaccine due to political pressure because president Trump wants to have the vaccine before election day and it’s really interesting looking at these numbers because they do
A complete flip later on so you’ve got the majority of Democrats saying they’re very worried that vaccines aren’t going to be safe and that the FDA is going to rush this to get this out for Trump and you’ve got a a relatively small number of Republicans saying that they’re
Worried that you know hey 41% we’re not at all worried that they’re going to be rushing this vaccine and then the election happens and then after a while it becomes apparent that that Biden is going to be placed in office and you see everything flip on its head as a result of
This so on December 8th right before the vaccines came out I think we started administering our first vaccines on December 21st or 23rd of 2020 um Trump came out and said every American who wants a vaccine will be able to get the vaccine and and that is a statement that
You can hear resonating across um especially Republican states that didn’t want to have any kind of vaccine mandate you would have that kind of language every American who wants the vaccine can get a vaccine we’re not going to encourage you to get a vaccine we’re just going to tell you that it’s
Available and we think by Spring we’re going to be in a good position that nobody would have believed possible just a few months ago yeah amazing really amazing they say it’s they say it’s somewhat of a miracle and I I think that’s true December 8th so after the
Election um but when there’s still maybe some uncertainty about whether or not we’re going to have the the the change in power that um that the voters said they wanted um so March 1st of 2021 this is after January 6th um it’s become apparent that Trump isn’t going to go
Back into office office and he and the first lady um quietly received their covid vaccines um back in January don’t tell anybody don’t make any kind of of announcement about it and so you go from this hey I’ve done this fantastic thing which was fantastic I mean we we need to
Give credit where credits due with that he did get these vaccines made in an unbelievably short amount of time but you see that go from well you know it would have been one thing had this come out prior to the election but now it’s in Biden’s hands and and
That whole political thing starts to flip on its head and so um I’m a pediatrician I was I was in private practice for about 20 years and um just burned out um decided I need to do something else and I went to Public Health in 2016 first in Maternal Child
Health and then in um January 1st of 2019 19 I took over the Tennessee vaccine preventable dis diseases and immunization program um in Tennessee and so I walked into what was left of a multi-state hepatitis A outbreak and then went into a measles outbreak and a M’s outbreak and then rolled right into
Covid and so um timing for me was not great although it was also the the most amazing and best job I’ve ever had and probably will ever have but we were very used to Flying under the radar you know we made made sure that when kids poop in
The pool that they get closed we made sure that when people don’t put their chicken at the right temperature that the restaurants get closed down we figure out where the eoli in the water came from um and you know and so this was a big switch to suddenly have this
Massive um pandemic to deal with and to be trying in real time to um issue quarantine and isolation and masking recommendations and what do we do do at the schools and um what do we do with colleges and what do we do with people who are unhoused and you know all of
These things everyone’s trying to scramble and do at the same time and so we suddenly were under this very bright light that we weren’t accustomed to having and um you know at one point there were things like ticker tape parades where everybody was celebrating the the healthcare workers that had been
Working through the pandemic and public health um and you know everything was Rah this is great and then things became not great at all and we started to see things like public health um workers and and especially um State officials in public health being either pushed from
Their jobs or um you know fired just downright fired um from doing their job so in California their um Chief Health officer in ore County um ended up resigning after residents took a banner depicting her as a Nazi to a public meeting and held protest T Test outside
Of her home um Amy Acton in Ohio the the chief Health officer there um got a lot more publicity around her resignation but um again you know protests at her house anti-semitic um vital slung at her um the legislative efforts to try to curb her authority to be able to
Quarantine or um put out isolation orders um you know it became started to become this very toxic place and it didn’t really matter if you were in a blue state or a red state or a purple State this was happening everywhere and um in for the people that were in my
Position as head of the state’s immunization programs there are only 64 of us in the country there’s there’s the 50 states there are six large cities um DC and others that are funded separately by the CDC so they each have an immunization program manager and then we
Have the um US territories and freely Associated States so there’s seven of those so 64 of us total and over the course of the pandemic 2third of us left our jobs either retired resigned or fired um and so when you think about the fact that a lot of these people had the
Institutional memory of the H1N1 pandemic or um you know just understood how to do a roll out during an epidemic or a pandemic um and all of these people are gone and along with you know a large number of career Public Health people who decided
To get out and so um you know really that left our Public Health infrastructure on a on a very shaky Foundation um for for the next pandemic and it really has not yet recovered from that um and then there’s there’s my story which I uh can’t really go into
Anymore but um when I was is um at the state my husband was also on the local school board and we lived in a in a fairly affluent County outside of Nashville and um there were um a lot of folks in our County that we had lived in
For 24 years that were not interested in science um this became a a hot bed of activity for moms for Liberty which is a um kind of a fringe organization that began in Florida um the the moms for Liberty group in our area was uh at the
Start of the pandemic busy protesting uh a book that second graders were reading about seahorses because um seahorse males are the ones that incubate the embryos and so if we taught children about seahorses then that could cause gender confusion and so in the Schoolboard meetings they would walk
Around with giant posters of pictures from the seahorse book which is what they were really interested in until this happened and then it became masks and vaccines and um and remote learning and all of that and um and so my husband um and I became Targets in this
Community where about a third or so of the people who live there kind of um fell off sort of the crazy side of things and decided that he and I were going to go out under the veil of darkness and vaccinate the children of Williamson County against covid-19 without their um without parental
Permission to do so because we obviously had ultracold fiser vaccine sitting in our Canmore freezer um but it became a situation where we felt like we were really not safe to stay in the area we were and so um in the fall very shortly after I was let go from the state uh
Fall of 2021 we put the house that we had built for our retirement up for sale and we moved to um northern Virginia and the reason we chose Northern Virginia was because I was still on the board of directors the AAP and my states that I
Um that I was the the um the chair for were um North Carolina South Carolina Kentucky Tennessee and Virginia and so of those the only palatable option was Virginia and the very very northernmost part of Virginia so like literally we were just a toe away from the DC border
We moved to to Arlington the first year we were here and when you J out of our our neighborhood there was the uh the Air Force Memorial was right there so and we were right there as close as we could get to DC as possible um and we
Decided that we would we would stay here for two years until I finished uh my board term and then we would decide what we were going to do from there um but uh anyway if you have interest um BBC actually did a documentary on our story it’s called infodemic Tennessee it’s on
YouTube and if you just put in BBC infodemic Tennessee or BBC Tennessee I think it’s probably the only thing BBC has done on Tennessee really um but you should be able to find it there it’s not very long you can like watch it while you’re on the commode it’s it’s like 30
Minutes um so anyway moving onward so you know what we have seen since the pandemic is this onslaught of anti-science antivaccine anti covid uh Common Sense kind of bills and so um the National Conference of State legislatures uh legislators um has this database that you can look at and so in 2021 there
Were more than 800 bills just related to vaccines mostly covid vaccines um 590 in 2022 in 2023 there were 740 so far in 2024 we’ve got about 236 bills filed in 37 States most of them are still um against vaccines in some way um but you
Know some some of them are are positive but not very many and um and then this is from Kaiser Family Foundation so over half of the states have rolled back Public Health powers during a pandemic and um so 26 states have enacted laws that permanently weaken government authority to protect Public Health um
And so you might see your state up there you might not even um know what’s happened but my state of Tennessee and shuttle state of New York are are on that um a lot of this legislation is driven by Alec so Alec is the American legislative exchange Council and they uh
Say that they are America’s largest nonpartisan organization of state legislators dedicated to the principles of limited government free markets and federalism but what they tend to put out is um is draft model legislation to um to undermine public health authority to put more um Power into the the
Legislative branch and to take power away from the executive so um they drive a strategic effort to limit local Authority so they’re all about preemption at the state level um and then um policymaking through State Legislative um you know issues in that way and trying to limit the executive
Branch um and they claim that one quarter of state legislators across the United States are members of Alec um and Alec is if you look from state to state to state you can see the same legislation being introduced across the US and and Alec is often the one that’s
Drafting that so these are just some of the laws that were enacted um since the pandemic so legislative Authority um saying you know if the governor creates a state of emergency the legislature can just overturn that um many times when these laws have come through the governors have vetoed those laws because
Um you obviously they don’t want to lose their power um but then there is a super majority that can override the the governors ofo um in Kansas they have designated County Commissioners as the local Board of Health so a local Health officer has to go and get approval from
The County commissioners before they can put in any kind of um of Health regulation um in that area um the County Commissioners can opt out of the governor’s Public Health orders and they have also put Li on things like contact tracing and the the lack of foresight
With these laws is is really quite stunning um there’s one law that um well in Missouri that prohibits quarantine they they have enacted that that in the state of of Missouri you can’t order quarantine and so when measles hits Missouri which it likely will because I
Think we’re all going to see it in the next couple of years that’s going to be a problem when by law you can’t quar quarantine someone um there are prohibitions against uh face masks that are Statewide um there’s there’s just a lot of um really shortsighted um laws that are that are
Being put into place that are not going to be very easy to overturn in some kind of an emergency and then on the vaccine side you have Robert F Kennedy Jr who started Children’s Health defense and if you don’t know Robert if Kennedy Jr you
Should um he is yes a Kennedy but an environmental attorney um and I I often try to figure out where his ideas come from but he is uh he says he is not antivaccine but but he is um staunchly opposed to vaccines and now um you know Brenning is an independent for president
Um and has this vax unvaxxed bus that um that is driving around so he has stepped down from the Children’s Health defense uh um but if you look at their site as the page Scrolls through it is all about Robert F Kennedy Jr so he is he is very
Much still um present and fundraising through um the Children’s Health defense and so they are great spreaders of misinformation and disinformation about vaccines and and again um Dell big tree is um is Robert of Kennedy Jr’s um good buddy and and um a media producer um who
And conspiracy theorist who is now his um his publicist um so some of the antivaccine legislation that’s been enacted um you know there’s there’s all the covid stuff you can never ever require a covid vaccine for school entry but also in Florida since last year there there’s a Prohibition of a governmental
Requirement to receive an mRNA vaccine of any kind and so you know mRNA is is really kind of the vaccine technology of the future sure they are incredibly effective vaccines um there is a an mRNA based flu vaccine that’s coming out there will be others that that come out
Um and Florida has prohibited the the requiring of any of those vaccines um my former state of Tennesse uh just this last year now says that homeschooled children don’t have to be vaccinated unless they’re um participating in in school-based sports um in um Montana and Idaho yeah you can still require vaccines but
You also have to tell the parents now about how they can get a non-medical exemption and then uh just yesterday in Tennessee um Joey Hensley uh who was the one who um put in the law about uh not having to vaccinate homeschool kids um now has introduced to remove the
Declaration in Tennessee statute that it’s the responsibility of parents to vaccinate their children according to the CDC and the AAP and replace it with a recommendation that children be vaccinated with vaccines recommended by the Commissioner of Health when advised by the parent or legal Guardians trusted health care provider um and Joey Hensley
Is one of four Physicians uh he’s a family medicine doctor in the um in the Tennessee General Assembly so um this is is to underscore that they are us in a lot of cases and that makes it very difficult for all of us because my MD
Looks just like his MD and it’s his word against mine as to whether vaccines um should be mandated or not so um some of the Heavy Hitters that we’ve seen viget Prasad who’s at UCSF he’s an oncologist an adult oncologist an epidemiologist who has called for the um the
Dissolution of the American Academy of Pediatrics um over covid and and over um gender affirming care Sher tin Penney who’s in oh Ohio um Al also on the the grift and antivaccine circuit Simone gold who started America’s front-line doctors and was also arrested um as an insurrectionist um and then um Joseph
Lao who was the Florida Surgeon General who um took over from um um Scott I’m wanting to say G Le and he’s the FDA guy so I’m just going to not say who that was because blanking on his name right now anyway who is now in
Rhode Island at Brown um so R thank you Scott rivky thank you sh um he would be mortified that I couldn’t remember his name um so Scott rivky was um a pediatrician uh who was the Florida Surgeon General through the first part of the pandemic and then um he wisely
Resigned his position and and saw the writing on the wall and then DeSantis put in uh Joseph ladapo so um it’s it’s difficult when you have um especially people who are full professors in academic institutions where that those institutions are not coming out um to say something about the the um the kind
Of rhetoric that that their faculty are spreading um if you’re interested there is a freedom Summit from uh America’s Frontline doctors at a church in Naples Florida in March um $10 to watch the live stream I think it’s 40 bucks if you want to go down and attend in person but
If you want to see what they’re talking about that’s there and here’s their heavy hitter um speaker list a chiropractor a naturopath a pathologist an aggro buus guy uh an opthalmologist and and a couple other folks there is one Peds I am and that just hurts my
Heart um so it’s you know it’s hard when they look like us and have the same kind of credentials um you’ll also remember the great Bearington declaration this came out oh 202 2020 October 2020 um where the recommendation was that you know hey everybody just needs to get covid um
Because kids are strong and and resilient and um shutle and I were having a conversation before we came on tonight um about you know we don’t have a great track record with viruses um Hepatitis B and C cause liver canc decades later measles causes sspe um 10
15 years down the road HIV kills people um we’re not really sure that we understand what abstein bar virus does um why we think that kids getting SARS K2 over and over again um won’t necessarily cause terrible harm 10 or 20 years from now I don’t know
Because we don’t have a very reassuring track record um with the viruses that we deal with um so how Fringe anti-science views infiltrated mainstream politics and what it means for 2024 so here’s the flip right so you’ve got this decline in adults who believe that it’s important
For kids to be vaccinated in order to go to school but when you look at where that decline is coming from it’s largely from from Republican and Republic leaning people and the people who identify as Democrats or left leaning are really fairly steady over the last few years um but again this quote
Expertise alone is insufficient when people mistrust the experts motives and um when we look at uh this is from the Pew Research Center it just recently came out um when you look at how people value scientific research and progress you see that about a third of in this
Study of Republicans and people who lean to the right um are saying that that US Government investment in science is not worthwhile um that you we’re seeing this aligning politically um kind of across the board and I thought this quote from Tom Nichols who a political scientist was really interesting so we think
Expertise is very exclusion is this very exclusionary idea which it is because it’s supposed to be and not everyone gets to vote on how we fly the plane but the rejection of Science and of expert has become a demonstration of political loyalty that’s the part I didn’t expect
That there would be an entire political movement to basically disavow science and so this has been so largely espoused as part of the identity of people who have a certain political bent that it’s very difficult to understand how to message and and how to get us out of whatever this tal spin
Is that we’ve been in and so um this from actually April of 2022 um why being anti-science is now part of many rural Americans identity and I would argue that it’s not just Rural America it’s it is um people who lean to the right of the midline um are
You know more and more espousing um these anti science beliefs as part of their identity so what do we do about all that um tip O’Neal said all politics is local probably while he was having a beer with Norm in cheers um and and it is I mean
Things happen on the the national stage and it’s important that we’re there and that our voices are there but um we also have a lot of national support to be able to do that but the on the ground stuff with the farmers and the accountants and the bankers and the
Realtors that are sitting in the legislative seats in our states um that that is where we really need to be talking to people and I would hear over and over and over again from legislators we only hear from the other side from the opposing side we only hear from the
Antivaxers and the conspiracy theorists we never hear from the people who are actually grounded in science so there are a couple of resources one is you know there’s not a lot of folks standing up for public health um so there is act foru health.org where you can go on there and
Um they have a a little tab that you can click that tells you what’s happening in your state um and everywhere else um and where you can um you can report things that you’re seeing and where you can ask questions and and get help um and so
Even if it’s just that you know instead of Doom scrolling X um you go to act for public health and just see what’s happening in your state and maybe it’s one of your legislators that you have or could have a relationship with where you can um have some influence and then get
Involved somehow your AAP AFP AOG State Medical Association Mom’s demand action immunization Coalition State Public Health Association Grassroots Coalition whoever needs you and they need your voice and um this is not a spectator sport and so anything that you can do to make sure that they are hearing us the
The people who understand science that can explain it um that can um help them understand why the conspiracy theories and the the disinformation that they espousing is wrong um that that they need to hear from us um and so I know you’re busy I’m busy too um but please
If it’s an email if it’s a phone call um if it’s going out to Coffee um please find a way to help some of the Grassroots organizations and U make connections with people who are making the policies in your state and I will stop there and um I’m really really
Excited to have any kind of discussion um you can email me at MD fiscus fiscus md.com um and um thanks so much for listening I really appreciate it thank you so much Dr fisus I’m going um we have a couple of people basically just complimenting you on the talk and
Thanking you um so I’m going to start off this by uh asking you a question about the rhetoric regarding covid vaccine which of course was very politically entangled as you reviewed but how that’s beginning to really move into what pediatricians have always known there’s some vaccine hesitancy but has really accelerated hesitancy around
The longstanding one would hope wellestablished quotee unquote childhood vaccines the number of children who are now entering kindergarten nationally um um under um um fully immunized has declined to its lowest rate in over two decades at approximately 92% which as we all know with measles just down the road in
Philadelphia from where I am in in New York um is quite sobering when the when the herd immunity rate is 97 to 98% so I was wondering if you could just take a few minutes to speak about how your perspective on on this sort of institutional creep if you were on going
Into the traditional childhood vaccines what’s you know H how did that happen was this just you know it’s just getting bigger and bigger and bigger where that used to be experimental covid vaccines mRNA change your genome type problems and now we’re talking about you know where we used to have
Lines of people who wanted to get the polio vaccine we now have people saying not that yeah it and it’s it’s funny when we were going through all this um so I’ve I’ve met um Peter Su who’s Jonas suk’s um son who’s in California and um and I
You know I thought about calling him up and just saying okay there must have been this kind of crap in 1950 whatever with you know there there must have been the the naysay like how did you deal with that um and I I one of these days
I’m going to catch up with him and and find out what he knows um you know there I I think there was there was there were a lot of missteps for one I you know we there was so much attention brought to how vaccines work in covid you know we
No one knows anything about you know Vector um Vector derived vaccines plasma protein protein subunit vaccines and there was all this you know mRNA mRNA and it just it sounded so spooky and a lot like DNA and you know I I think that was misguided and getting so into the
Weeds just you know it everybody knows what mRNA is or well they think they know what it is they don’t know what it is but um you know that you hear legislators talking about how we need to ban all mRNA and you know the scientists are laughing um it’s so that that was
Part of it and then um you know certainly there has been this growing vaccine hesitancy I I I I separate people who have lack of confidence in vaccines from like antivaxers so the antivaxers to me are like the Rabid maske wearing um you know crazy people who who never in a million
Years are they going to get anybody vaccinated but you know the parents who were like I think I want to space them out or I read this year’s book you know those those are the people I’m talking about that would come into my practice because it was a kind of an affluent
Community that I worked in and um and so that has certainly grown and it you know and it’s really out of fear that you know they don’t want to make a mistake and do something to their kid and regret it and there’s this great cartoon of of
A uh a nurse with a syringe and and a mom holding her baby off to the side away from the nurse and over here is this great big like black Goblin thing that you don’t even know what it is and you know getting parents to realize that choosing to not vaccinate your child
Isn’t not making a decision it’s making a decision to leave them vulnerable to those diseases and trying to help them understand that you know while in action feels safer it really isn’t safer um and then just the spread you know in the mommy groups and the Facebook posts and
Um I remember in in February of 2020 so we had first gotten our cases in the United States but we didn’t have any cases in in Tennessee until March 5th and I know that because I was on call for the state and I will never recover
Um we had this little dinner party uh and it was it was people from our church you you were supposed to have over that you didn’t know and so there were I think there were 10 of us and um and this guy kind of leans across the table
And he say so what do you think about you know this this whole China virus hoax thing and I said I said well I think it’s going to change the world as we know it this was like the middle of February and he’s like oh no it’s just a
Hoax you know nobody’s it’s it’s just nothing and his wife leaned over and said you do know what she does for a living right and and he’s like I know what she does for a living but I still don’t believe that I would like to find that
Person and and see you know kind of what he thinks four years later but you know even then that was February of 2020 before mask mandates and shutdowns and vaccines and mRNA before any of that stuff and there was already that that percolating this is a hoax don’t believe
What they’re telling you kind of thing happening and it was in my kitchen you know it’s um that that whole thing fascinates me that that was already happening and we didn’t even have a case in state of Tennessee yet at the time I don’t know if I answered your
Question yeah I think that I think what well there are a couple of points I think the first thing is that with there you know the the ability of the public to sort of focus on one thing and then not to be able to discern like you said the distinctions between
The different component vaccines and then just to let that fear sort of broaden um is I mean the way things have been going is essentially almost inevitable um so I think that that’s one thing that we have to be very particularly those of us who do Public Health work and pediatricians of course
Even though I’m an neologist it’s all you know Pediatrics is the the the medicine of prevention for the most part but I also think that the point that comes out of your talk as sobering as it was is that you know we practice medicine in clinics we practice medicine
In the ER we practice medicine in the hospital in the delivery room in the ORS but we have to practice medicine in the state house and I think that that is something that a lot of people to understand we can’t we can’t we can no longer just say
Someone else is going to do it or the medical societies are so strong in the individual states that none of that will ever happen right um and I think the fact that you pointed out that some of this is happening in states that are not quote unquote R really shows the power
Of the power that this message sometimes can carry with it and that’s really concerning because I think you’re right I I go to our state capital fairly routinely and I’m pretty sure that I’m one of a handful of Physicians who will probably walk in those Halls and there
Are a lot of angry mothers there are a lot of um people who are upset about mandates of any kind Yep they’re there every day talking exact talking calling phing sending letters I they’re very very passionate um we’re very passionate too but we we tend to more talk about our passion than
Than do our passion I think so this brings me to my sort of next uh next question and then there is a question in the chat that we’ll get to after this is that it seems like there’s almost like a two-tiered strategy that we need to work
On right there’s this sort of higher level state-based get involved like you said with a local with an organization whether it’s your your AAP chapter or your medical society in that state but then there’s also the sort of much quieter individual patient one-on-one counseling and I was wondering I mean
Obviously now shifting a little from from Shelley fiskus Public Health icon to Shelley fiscus physici in exam room four how do you how do you work with the the vaccine hesitant parent who is not in the the 2 to 5% who are completely antiva and you’re just never
Going to convince and it’s not worth it but how do you work with the people who are really in the gray Zone who are skeptical and hesitant and maybe come from a place of good intention but still but still worried I think you know we’ we’ve learned to meet them where they
Are and to to listen more than we talk and so you know inviting that dialogue of you know well tell me what you’ve heard that makes you worried because you know you and I both want the same thing for your child and that’s for them to
Grow up healthy and happy and and you know we both want that but tell me about what your fears are because so many times their fears can be it can be I’m afraid of needles but we’re we’re interpreting it as you know this person is is afraid of vaccines or
You know plasma or protein subunits or whatever but it’s just that you know I’m needle phobic and so I’m needle phobic for my child too um or it may be things that are maybe a little bit easier for us to to reassure folks about you know I’ve heard this vaccine will sterilize
My child if you give it to them and you know where we can really talk about how you know I’ve given it to my own child I’ve given it to thousands of children we have so much wonderful data on HPV vaccine we now have countries that are
That have not had one case of cervical cancer in in women who have received HPV vaccine um you know just lots of things and and I think asking permission which is one of the most important things I ever learned in Pediatrics when you start to have a conversation is to you know what
Is it that you’re you’re concerned about can we talk about that and then would it be okay if I share with you what what my experience has been and just pausing and saying that phrase would it be okay you know and not assuming that okay this
Person came into my office and so I Am Lord and thou sht listen to what I have to say because you’re here obviously to learn from me but to to bring yourself to to the level that they’re on and actually put them a little bit above you
By saying would it be okay if we talk a little more about this or if I share what I know and almost always they will say yes but in doing that you can diffuse a lot of the defensiveness and the the anger that sometimes comes into those conversations and I think you know
Shutle where you’re talking about kind of the exam room four thing I think you know we have been so beaten down over the last four years that when I talked to pediatricians from you know all across the country and and and Family Medicine Physicians and others you know
They don’t even want to have these conversations anymore because they’re they’ve I mean it’s like our own kind of PTSD you know I’ve been yelled at I’ve been cursed at I don’t want to have one more unpleasant conversation I just want to see the kid and get out of the room
And not have a confrontation and the disservice that we’re doing in that to ourselves to medicine to those children that need to be protected every single day in the United States 10,000 babies become eligible to get vaccinated against covid-19 and in a lot of those cases those parents have never had a
Conversation with a physician about why they should vaccinate their child 10,000 babies a day and when we just don’t want to talk about it anymore or we’re not stocking the vaccine because it’s difficult or you know it has gotten a lot easier we should be considering it part of the
Routine vaccination service that we provide for children that’s recommended by acip um when we just don’t want to talk about it because it’s been an unpleasant four years um you know we are leaving those kids vulnerable to we don’t know what in 10 or 20 years and really that’s kind
Of the frame that I keep trying to put myself in when I need to have those conversations is just I might be leaving this kid vulnerable because I don’t want to have a conversation that’s a maybe a little bit uncomfortable for me and that’s that’s not the right place for me to be
In yeah I also think that there’s another piece to all of this which is that we over the past I mean even prior to the pandemic have not created an ideal Public Health delivery system for childhood vaccination in this country uh for the non- pediatricians who are on
This call um you might not know but the largest insurer of children is Medicaid and Medicaid does not pay many pediatricians fairly for vaccines and this was made actually very evident during the covid pandemic when you realize that if you went and got a vaccine at your local pharmacy from a
Pharmacist and you’re remember you’re presenting themselves so there’s no counseling involved you’re basically going there to get the vaccine people were getting paid on average more than double what they were getting when a child came into a pediatrician’s office to get a pediatric vaccine so it gets to a point where it
Becomes cost ineffective to continue this fight and to speak to parents about vaccination and I think that that’s another piece of this which is that if we’re going to rely on the heroism of Pediatricians and Family Medicine doctors and public health Physicians and and Obstetricians to provide these
Immunizations we have to create a delivery system where it’s as easy as possible for the pediatricians and the doctors to do the right thing and make that the default thing and it’s not just about uh about payment um and this is for a question that had said that um any
Thoughts for what we can do uh this year in public given that it is an election year and any opportunities to Advocate whether a whole host of bills that at the federal level that you can hold your elected officials accountable for supporting that includes things like the vaccines act which would actually track
Vaccine hesitancy um the strengthening the vaccines for children program which would allow children in the children in the children’s health insurance program or chip to be eligible for the vfc or vaccine for Children’s Program all these things that seem quite technical but are actually seismic when we talk about our
Public Health infrastructure so I’m going to leave the last word Dr fiskus any um any thoughts for what we can do uh in this election year and any opportunities to Advocate yeah thanks shle yeah absolutely the the strengthening vaccines for children um you know the outside of children the you know we need
A vaccines for adults program um the you know the health departments get this tiny little drop in the bucket of money called 317 money um that they can use to buy vaccines for people who are uninsured and um it’s so little that they have to choose as immunization
Programs do we buy enough MMR and hepatitis A and hepatitis B vaccine to vaccinate a bunch of people or do we buy like one or two doses of shingrix and HPV vaccine because they can buy three or four or five doses of MMR and hepatitis A for what they can get one
Dose of shingri or HPV and so most health departments cannot offer shingri HPV vericella um and and several of the other vaccines to adults and um you just because they don’t get enough money to do it um and so there there is level funding in the president’s budget for
317 um level funding is not great I mean it’s better than cut funding but um you you know the the price of vaccines goes up constantly and it’s we’ve been level funded for a really long time so um we really need support for vaccines for adults program we’ve got um you know
Some folks in CDC leadership that are also supportive of that which is wonderful um you yeah right now um you know taking the pulse on what’s happening in your legislature you know I I didn’t know until someone told me that they had introduced that bill yesterday
In Tennessee to to um to roll back the the language and statute about frontal responsibility to get kids vaccinated um these things come in Fast and they’re and they’re sneaky and they come in under the radar and sometimes their bills that on their surface seem pretty innocuous and and then you really figure
Out what the intent is um there was a a bill I don’t know if you you heard this one of those things in Florida where um someone had had um filed a bill to um have taxpayer money um be used to pay the legal bills of any uh Florida
Resident who happened to to get into um difficulty with with the law and it was totally around one particular Florida resident that they wanted a law in Florida um statute to use taxpayer money to pay those legal bills um so you know there you always have to think about
What is What is the undercurrent what’s the reason why we’re trying to get this passed um and make sure that they understand because your legislators don’t have time to read them they’ve got 20-some year old staffers that are doing that for them and are trying to advise
Them and and um you know so they’re they’re sharp people but so often they haven’t understood the difference between Medicaid and Medicare and a pediatrician and podiatrist so you know we we have to be there um willing to spend the time to um gracefully thoughtfully and humbly educate them so
That they can give the best advice that they can to um to their particular legislature and um and that they vote as we hope they will so if there’s a take-home message that uh I think that it’s important to think that when you vote vote with Public Health in mind and vote with
Science in mind we’re GNA have to close I want to thank you Dr fiscus and I want to thank all the attendees on this doctors for America advocacy Grand rounds it’s been really um humbling sobering uh I think on in in you know on one hand but on the other hand I think
It’s also inspirational because I think your goal of of firing people up and and sort of energizing them to follow these types of bills and to take action I think has hopefully been heard um thank you so much for a great presentation and with that we’ll uh close the advocacy
Grand rounds thank you so much so much for having me