Narrator  00:00

Be inspired, supported and empowered. This is the Global Healthy Living Foundation Podcast Network.

Shelley Fritz  00:11

Welcome to Informed Immunity, the podcast dedicated to bringing you the latest evidence based information on vaccines, community health and the fight against infectious diseases. We’ll break down vaccine, science, policy and access, especially for adults living with chronic illness. This season, we’re covering three of the most common respiratory viruses: influenza, commonly known as the flu, COVID and RSV, unpacking what’s new, what’s misunderstood, and what’s most relevant for high risk groups. I’m Shelley Fritz, Patient Centered Engagement and Insights Manager at the Global Healthy Living Foundation, and your guide on this journey to better health. In this first episode, we’re focusing on influenza, the flu. We’ll explore what’s new this season, why people living with chronic conditions face greater risks, and how vaccination can prevent serious complications. So let’s get started. Flu season might feel familiar, but it’s far from harmless, especially for people with chronic conditions. Each year, influenza leads to serious illness and hospitalization for 1000s of adults. Yet, vaccination remains one of the best ways to protect yourself. Joining me today to discuss what’s new this flu season, who’s at greatest risk and how to stay protected, are Samantha Picking, Pharmacist and Senior Director of Immunizations at Walgreens, and Robert Popovian, Chief Science Policy Officer at GHLF. Thank you both for being here

Dr. Robert Popovian  01:40

Thank you for having me.

Samantha Picking  01:41

Hi everyone. Thank you so much for having me today. Shelley.

Shelley Fritz  01:44

I’d like to start with you, Sam. As someone living with chronic illness, I try to time my flu shot in a way that gives me the best protection for the season. I also need to consider my medication schedule. What should patients know about the timing of their flu shot for the best protection?

Samantha Picking  01:59

I love that you mentioned aligning it with your medication schedule and how to work that in. The convenience about getting your vaccination at a pharmacy is that you could be picking up your medication that you need and get a vaccine at the same time. But when it comes to seasonal timing, you want to be vaccinated ahead of peak respiratory season, so it’s important to ensure that you’re up to date with all your vaccines, really, before we enter that period of when viruses start to ramp up. So according to current guidelines, everyone six months and older should get an annual flu shot by the end of October. Now, if you miss that period, that is okay. That’s the ideal time, right? Because you want to get it done by the end of October before respiratory illness starts to ramp up, but if you don’t get in October, you still can get it in November, December, January, February. So if you don’t remember until February, there is still time, because flu viruses are still circulating, and you’ll want to protect yourself. Now, the reason we say now is the time is because it does take about two weeks to build up that optimal immunity against the virus after you receive a vaccination. So you want to get ahead of respiratory season. You want to get ahead of the holidays or gatherings that you may be at in the coming months.

Shelley Fritz  03:11

Okay, so I’m calculating in my head when my next infusion is and just thinking maybe I should even just message my doctor. It sounds like patients might want to check with their doctor to time when they get their flu shot, because there could be several things to consider in timing your flu shot.

Samantha Picking  03:26

Yeah, whether it’s your doctor or your pharmacist, you can talk to them at any time to really discuss your personal needs, personal preferences and what timing works best for you.

Shelley Fritz  03:36

That’s a great point. And my pharmacist does know all the medications I’m taking, so that’s the perfect person to talk to. That’s such a helpful reminder about pharmacists being a resource. While pharmacists can help us figure out the timing and options, it’s also important to understand what exactly we’re getting. Robert, flu vaccine formulas change from year to year. Could you walk us through trivalent versus quadrivalent? How to think about coverage and why high risk adults should still prioritize a flu shot.

Dr. Robert Popovian  04:05

Thanks, Shelley, thank you for having me on this podcast. So couple of things. Number one, yes, every year, the flu vaccine gets updated based on what CDC and FDA especially, deemed to be the most active genotype of the virus that is available from the southern hemisphere, because they go through the flu season before we do, and they try to predict what will be the type of vaccine that then needs to be produced to protect all of us in the United States, which are in the northern hemisphere. So Shelley, the question about quad versus trivalent vaccines, flu vaccines has been going on for a while. What it means is really that the trivalent covers two types of the influenza A virus and one type of the influenza B virus, versus the quadrivalent vaccine for flu, covers both two types of the influenza A virus and two types of the influenza B virus. So it basically has four types of coverage versus three types. Having said that for the upcoming flu season, which is 2025 and 2026, only the trivalent vaccine is available. And the reason being is that one of the influenza B viruses is no longer in circulation, so it doesn’t need to be covered. However, having said that, it is important to note for our seniors who are listening to this podcast that, in fact, there’s a high dose flu vaccine that’s been indicated by the Food and Drug Administration that’s specific for seniors, and they should be seeking that vaccine out when they’re visiting their pharmacy and talking to their pharmacists about the flu vaccines.

Shelley Fritz  05:37

Ah, so while the vaccine provides broad coverage against the main flu strains, not everyone experiences the same level of protection. In fact, research shows that up to 80% of adult flu hospitalizations are among people with chronic medical conditions. Why are people with chronic illnesses at greater risk?

Dr. Robert Popovian  05:55

Well, that’s simple. Majority of patients with chronic disease are what we refer to as immunocompromised. So their immune system is not fully functional, and therefore, as you have a chronic disease such as rheumatoid arthritis or even hypertension or any type of a cardiovascular disease, you’re under high low risk of being immunocompromised. So your immune system needs the little boost that the flu vaccine will give you as protection. And what you see is that patients who are chronic disease, patients have higher hospitalization rates and mortality morbidity rates in general from flu.

Shelley Fritz  06:31

It’s eye opening to hear how much higher the risks are for people with chronic illnesses, but we know it’s not just about protecting the individual, but it’s also about the people closest to them: caregivers. We’ve seen studies showing that caregivers aren’t more likely to get vaccinated than non caregivers. Why is caregiver vaccination so important when they’re supporting people with chronic illness?

Dr. Robert Popovian  06:54

Well, caregivers, family members and those are important because a lot of chronic disease patients, especially the elderly, they do interact with individuals who take care of them on a day to day basis, and they need to be protected as well. So when flu vaccination is recommended for the elderly, who are immunocompromised, it should be also be recommended for caregivers who take care of them, because if they get infected, they can infect the older patient who’s immunocompromised. But in addition, you want your caregivers to be healthy, because if they’re not healthy, then who’s taking care of those patients?

Shelley Fritz  07:17

Exactly. A CDC study found that Black and Hispanic Latino people have a higher flu hospitalization rate. What factors drive these disparities and what can be done to address them?

Dr. Robert Popovian  07:38

Well, it’s less about genetics or race. It’s about access and availability of immunization in those underserved communities. You know, in GHLF, we’ve done studies that show immunization access is far lower in poorer neighborhoods compared to more affluent neighborhoods. Therefore, when you look at Hispanics and African Americans or Black patients, what you see is that they generally, there’s an overpopulation of those individuals in poorer neighborhoods, and hence, they have less access to immunizations, and therefore they end up getting sicker and they have a higher mortality and morbidity rate. So it has nothing to do with genetics or race, it has to do with access to healthcare, and it has to do more with where poor neighborhoods have less access to healthcare, and those neighborhoods are over represented by minorities that we spoke about.

Samantha Picking  08:34

That’s such an important point. Sam, let’s move to vaccine options, especially what patients ask you about the pharmacy. All US flu vaccines are now thimerosal free. And what does that mean? Why was that change made, and how does it affect safety or effectiveness?

Samantha Picking  08:50

Yeah, so what we know is flu vaccines are still safe and effective, and they have been for decades. So no changes there. But for the 2025-2026 flu season, the CDC now recommends single dose flu vaccines, which are free of thimerosal as a preservative. And just to take it back as to what thimerosal was or how it’s historically been used, thimerosal has historically been used as a preservative in a multi dose flu vaccine. So you have pre filled syringes or you have a multi dose vial. Pre filled syringe is just that individual dose for the patient. You can put a needle on it, and that’s your vaccine. A multi dose vial contains multiple doses, where you have to draw up multiple vaccines from the same vial. So that’s why it needed a preservative, because you’re using it multiple times. However, if you look at last season, about 95% of the US vaccine supply was thimerosal free, and now, in accordance with federal guidelines, none of the vaccines contain a preservative for seasonal flu vaccines. So none of the flu vaccines available at Walgreens pharmacies contain thimerosal. For the past several years, we’ve only used pre filled syringes.

Shelley Fritz  09:58

So now we’ve clarified why thimerosal was phased out, and what that means for vaccine safety. Let’s shift to another option that people may be considering for this season. There’s now a nasal spray flu vaccine available. What should adults know about this option in 2025?

Samantha Picking  10:14

So it’s a nasal spray, so that is the only needle free option for flu vaccine, and it uses a weakened, live influenza virus to protect against the flu. It is only approved for healthy, non pregnant individuals ages 2 through 49. The vaccine can be administered by a healthcare provider, or for the first time this year, it actually is approved for self administration at home, for those eligible patients. Now for individuals interested in getting a flu vaccine this year, your local Walgreens pharmacy is here to help. Our pharmacists work with each patient to determine which flu vaccine is right for them based on their age, health history, and we’re confident that we’ll have sufficient options to meet the varying needs of our patients.

Shelley Fritz  10:57

Thanks, Sam, it’s helpful to know what options are out there. Now, I remember from a conversation before our recording that Walgreens does not currently administer the nasal spray vaccine in their pharmacies. And Robert, I saw you nodding when Sam was telling our audience about that nasal spray Do you want to expand on that?

Dr. Robert Popovian  11:14

So Shelley, couple of things. Number one, the flu nasal spray vaccine has been around for a while. I remember years and years ago, my children received the nasal spray for the flu vaccine, and the reason they did is because they didn’t like having needles at their age being poked. It’s a quadrivalent vaccine. It’s a nasal spray, and it’s really for people who have a needle phobia or they don’t like needles, but it has some limited use. For example, it’s only approved for ages of 2 to 49. In addition, it’s not for everybody. For example, for the elderly who need broader protection, or the immunocompromised patients. So it’s a choice that’s out there for patients. But again, it is important to note it is something that patients should be discussing with their providers, whether it’s pharmacists or physicians, to see if it’s appropriate for them.

Samantha Picking  12:09

So plenty of safe and accessible options are out there. Let’s talk about how guidance helps patients navigate them. Sam, how does CDC, ACIP, guidance help pharmacists and patients decide between when to get the flu, COVID and RSV vaccines?

Samantha Picking  12:25

It’s a great question. Now, CDC is Advisory Committee on Immunization Practices meets quarterly, but issues annual vaccine guidance for our seasonal vaccines like flu and COVID. And that’s based on extensive reviews of clinical trial data, epidemiological studies and real world evidence. Now, recommendations are then used and include details on who should receive vaccines, when they should be administered, and specific considerations for priority populations based on risk factors. Pharmacists then play a critical role in implementing those ACIP recommended vaccine strategies. For example, we use this guidance to determine when vaccines can be co administered, to inform dosing schedules and to counsel patients on their vaccination plans. Each year, our pharmacists receive extensive training and assessments to ensure we can properly educate customers about vaccines, testing and treatment options and administer in full compliance with the latest guidelines and applicable laws. Now, clinical decision making has always been a part of pharmacy practices, and this is across all services, not just vaccines, so we are prepared to advise patients on which vaccines may be right for them.

Shelley Fritz  13:38

Timing clearly plays a big role in protecting people before peak virus season. That makes it easier for patients to feel competent getting the right vaccines at the right time. And Robert, for older adults, there’s another consideration. High dose flu vaccines reduce pneumonia and heart failure events. Can you explain why higher dose vaccines make such a difference for this population?

Dr. Robert Popovian  14:00

You’re talking about immunocompromised patients who their immune system is not functioning well, and they do require the higher doses of the flu vaccine to be able to be protected better. And remember also the quadrivalent provides that additional influenza B antivirus protection. So because of those reasons, patients who receive them probably have sequelae of better outcomes, whether it is be heart failure, which can be triggered through influenza and getting sick and other diseases. So again, this has to do because better protection for patients with chronic diseases reduces their severity of illness of their chronic disease that they are already burdened with and therefore, in studies that have been done, there’s been demonstrated that higher dose flu vaccines actually prevent heart failure and other type of events. Because again, if you don’t get sick, your chronic disease doesn’t get worse. If you do get sick, it gets worse, and then you end up basically having comorbidity and mortality related to the disease that you’re suffering from,

Shelley Fritz  15:01

That makes a lot of sense. It’s encouraging to see that high dose vaccines can lower the risk of serious events. Still, we know that for people with chronic conditions, flu can trigger dangerous complications. Robert studies show that severe complications from flu are much more likely to develop in individuals living with chronic diseases. What can some of those complications be? And how can we prevent flu from escalating to that point?

Dr. Robert Popovian  15:26

Well, the worst complication is mortality, right? So it increases the mortality rate in these patients, but again, hospitalization, morbidity involved in a time loss from work. So anytime you have a patient with chronic disease, as we’ve discussed, they have an underlying condition that makes them more vulnerable to any type of bacterial or viral infections. So when they get sick, the outcome is worse for them, so they end up either being hospitalized or, heaven forbid, dying from it. So therefore it is super important patients who are elderly, and especially patients who are not elderly but suffer from chronic diseases, are protected from either viral or bacterial infections, and one way to do it is through the flu vaccination, and especially that’s why the quadrivalent, high dose flu vaccine is recommended for older patients.

Shelley Fritz  16:15

That’s a really important point, and it’s not just about catching the flu, but how the flu can make an existing health problem so much worse. I think a lot of people living with chronic illnesses don’t even realize just how quickly the flu can escalate. It shows how critical prevention and vaccination are, not only to avoid infection, but to protect against those dangerous complications.

Dr. Robert Popovian  16:36

That is absolutely correct, and it’s under appreciated, currently with the environment that we live in through our public health officials, that vaccination does prevent a lot of bad outcomes, not necessarily only from that infection, but other type of diseases that the patients are suffering from, which are exacerbated due to the infection.

Shelley Fritz  16:55

Thanks, Robert. Sam, let’s finish with the practical side. Where can listeners go to get their flu shot, and what should they know about cost and coverage?

Samantha Picking  17:03

Yeah, it’s a great question. So it’s easy to get your flu vaccine. It’s so convenient at the pharmacy. There’s so many locations. Pharmacies like Walgreens continue to be that convenient and accessible place to get a flu shot and other recommended vaccines. If you’re getting your flu shot, you might as well find out what else you may be eligible for or need to be up to date. Most insurance plans cover flu shots for eligible individuals, although provider networks may vary. So as always, pharmacy teams are available to assist with questions on insurance and also potential costs, and they can tell a patient right then and there what their insurance covers.

Shelley Fritz  17:40

That’s great. That’s very helpful to know. Thank you for sharing the no cost option, and it’s so convenient just to text to get an appointment. Thank you, Robert and Sam, for being here today, taking the time to share all of your great insights with us. This will be a great episode.

Samantha Picking  17:53

Thank you so much.

Dr. Robert Popovian  17:54

As always, thank you for having me, Shelley. I’m always happy to come on and talk about infections and patients and vaccination.

Shelley Fritz  18:06

This is Informed Immunity. Thank you for joining us on this episode. Remember, the fight against infectious diseases, including COVID, is a community effort, and your participation is crucial. For more reliable information on vaccines and to stay up to date on the latest of public health, visit our website at GHLF.org/vaccine-resources. We’ll drop the link in the episode description, and you can also check out the Centers for Disease Control and Prevention or World Health Organization websites. This podcast was made possible with support from GSK. If you enjoyed this episode, please rate our podcast, write a positive review and share with your friends and family. It will help more people like you find us. Until next time, stay informed and stay healthy. Together, we can make a difference.

Narrator  18:57

Be inspired, supported and empowered. This is the Global Healthy Living Foundation Podcast Network.

Narrator  00:00

Be inspired, supported and empowered. This is the Global Healthy Living Foundation Podcast Network.

Shelley Fritz  00:11

Welcome to Informed Immunity, the podcast dedicated to bringing you the latest evidence based information on vaccines, community health and the fight against infectious diseases. We’ll break down vaccine, science, policy and access, especially for adults living with chronic illness. This season, we’re covering three of the most common respiratory viruse-influenza, commonly known as the flu, COVID and RSV-unpacking what’s new, what’s misunderstood, and what’s most relevant for high risk groups. I’m Shelley Fritz, Patient Centered Engagement and Insights Manager at the Global Healthy Living Foundation, and your guide on this journey to better health. In this second episode, we dive into the reality of COVID in 2025 what rising infection rates mean, how vaccines are adapting to new variants, what long COVID means for people with chronic illness and the practical choices patients face about boosters and staying protected this season. So let’s get started. COVID may not dominate headlines the way it once did, but it continues to impact daily life, especially for people living with chronic conditions. Joining me today to unpack this topic are Samantha Picking, Pharmacist and Senior Director of Immunizations at Walgreens, Stephanie Lebsack, a trained speech language pathologist living with severe asthma and other chronic lung diseases, and Dr. Tyler Evans, Infectious Disease and Public Health Physician. Thank you all for being here.

Samantha Picking  01:40

Hi Shelley, thanks for having me today.

Dr. Tyler Evans  01:41

Great to be here. Thanks for having us.

Shelley Fritz  01:43

COVID may feel like it’s in the past, but it’s still shaping our lives in 2025. To start us off, Dr. Evans, you were New York City’s first Chief Medical Officer for the Office of Emergency Management during the initial COVID surge in 2020. Looking back, what lessons from that chaotic time are still guiding how you approach COVID in 2025?

Dr. Tyler Evans  02:04

Sure. Great question. I start with COVID is not in the past. It never will be, right, because it’s endemic now, it is in our world. It’s not going to go away, and that’s okay. I mean, the most important thing is sort of acknowledging that and creating as much sort of prevention elements around it as much as possible to ensure that if and when we do get infected with COVID again, that we are kind of preventing, reducing, or mitigating as much of the sort of impact of COVID as we possibly can. What is in the past is the pandemic. So the COVID-19 pandemic was obviously a very formidable moment in history, and I was the Chief Medical Officer for New York City in the very close to the beginning. I had come on as chief medical officer in late March, early April, 2020 so just kind of think back to that time when we didn’t really have a lot of understanding of the science. We certainly didn’t understand sort of how to respond to it. And from a public health standpoint, it is not just about treatment. It’s much bigger than that. So we needed to really sort of unpack what we were dealing with, and then sort of throw things into different phases. And it sort of depends if you’re going to talk to sort of an epidemiologist or medical providers or physicians about how those phases were sort of unpacked. The first phase was really just all about sort of discovery and understanding. What are we dealing with? What is this, right? The second phase was really starting to create a response to it, and in that response, we needed to first, let’s focus on all the humans that are currently at risk, as well as the humans that can help to sort of prevent or mitigate that risk, and those are the healthcare workers, right?

Dr. Tyler Evans  03:33

Lot of nurses, a lot of EMS. In the very beginning, we were thinking emergency, right? So we need paramedics, EMTs, ER docs. That’s not really what we needed. We needed some of that, but that’s not really what we needed with the pandemic. So again, first stage discovery, what are we dealing with? Second Stage, let’s start to sort of build out what the sort of solutions are going to be. So the city said, all right, let’s basically create isolation and quarantine hotels as well as healthcare worker hotels. And then down the line, what we created was risk reduction hotels. So the isolation hotels were folks that were infected. And these were, I’m in New York right now. It’s great to be back, but we’re talking sort of high rises down in Times Square, whatnot. Quarantine were folks that were exposed to it. And then the healthcare worker hotels, which were, we ultimately had think we were managing, at one point, over 400 hotels across the city. Then the next phase was contact tracing, testing, and then vaccinations and then treatment. So there were all these sort of different responses, but really to sort of to encapsulate, sort of the answer to your question. What we realized during the time was a how to respond to a novel public health emergency, number one. Number two, how to communicate that to the communities, to the public, particularly to New York City, the largest city in the country, we saw the city sort of come together during this sort of unknown period, while the scientists and the physicians and nurses were kind of figuring it all out.

Shelley Fritz  04:49

Thank you, Dr. Evans, your perspective really emphasizes how much we’ve learned and how those lessons are still shaping decisions today. And speaking of lessons learned, you were deeply involved in one of the largest vaccine rollouts in history. You helped oversee the administration of more than 2 million COVID-19 vaccine doses across 10 states. What did that scale of rollout teach you about reaching high risk and historically marginalized communities?

Dr. Tyler Evans  05:16

I suggest preface that prior to the COVID pandemic, I had spent a lot of time in low and middle income countries, working on infectious disease outbreaks. I worked on the Ebola response twice. I worked on mass immunization programs. I’ve worked with large refugee programs, but in the US, that was completely useless prior to the pandemic, but during the pandemic, it actually turned out to be pretty, sort of helpful. So I kind of understood how to roll out mass immunizations. And so we had operation warp speed, which is very, sort of famously described, and socialized, and that I was able to kind of take that knowledge and I jumped into the private space, because a lot of us were sort of frustrated with the government response. It just wasn’t fast enough, and it wasn’t set up to be fast. So we did it ourselves. We built a company, and we administered over 2 million COVID vaccines in 10 states, and we did it in seven months, and we did over a million in California. But what I was really particularly proud of was our ability to respond to historically marginalized communities, and what we were seeing in the very beginning, Shelley was a certain demographic pattern, and I used to jokingly describe them as the triple C’s, Caucasians with cars and computers they knew how to get in other communities that didn’t have that access. They just they were sort of marginalized from these from sort of access so that. So then again, we really sort of pivoted and started focusing more on those smaller scale community pods, working with community health workers, working with faith based leaders, other leaders of communities that people really trusted. So really, really proud of that work.

Shelley Fritz  06:41

It’s incredible to think about the level of coordination and those trusted partnerships are critical. We’ve heard about the public health view, but let’s bring in a patient perspective with Steph. Steph, can you introduce yourself and tell us about your patient journey?

Stephanie Lebsack  06:55

Yeah, I’m Steph Lebsack. I live in Dallas area Texas. Newly live in Dallas area, Texas, and I am a person that lives with chronic lung disease. Very briefly. I was a 27 weeker back in the 80s who survived, and I have a condition called bronchopulmonary dysplasia in adulthood, and that kind of presents like COPD. So I have a bunch of things that go along with that: severe asthma, chronic respiratory failure, acute respiratory failure. I have a non invasive ventilator at home, and so I have a quite complicated and I think my pulmonologists have even used the term complex in turn regarding my, how I look on paper. But otherwise, I’m a wife. I’m a mother. I have two children, one’s almost a teenager. I am a speech language pathologist by trade, but did just stop working in March, secondary to my health conditions.

Shelley Fritz  07:45

Thanks for sharing your background. Living with asthma adds a unique dimension to navigating COVID-19. So how has living with asthma shaped your experience with COVID?

Stephanie Lebsack  07:56

Just being fully transparent when COVID started, I was terrified because I thought, well, it doesn’t sound great for folks like me, and it was starting to not go great for folks like me. I did not catch it in the first strain or the second strain. I didn’t catch it for two years in and I’ve now had it three times. I’ve been hospitalized two out of those three times, even with more lesser strains or conditions that could maybe be milder than the beginning, it’s still quite a battle for me when I catch COVID. I last had it in July, and so I think my first reaction to COVID was just of heightened emotion and being scared, and then, like probably a lot of folks, wanting some kind of answers that science didn’t have yet. And then, of course, my family, we probably stayed locked down longer than some families, right? And then, like Dr Evans mentioned, it’s still not over for folks like me. It’s still a pretty serious entity.

Shelley Fritz  08:56

It’s been an interesting journey since COVID-19 came about, for sure, it must have been an incredibly stressful road to navigate, and we’ve heard about patients and systems, but let’s focus on where people actually get vaccinated, the pharmacy. So Samantha, around 90% of COVID vaccines are given in pharmacies. Why is pharmacy access so critical?

Samantha Picking  09:19

Well, you said it, that’s exactly it, 90% of COVID vaccines are given in pharmacies, meaning pharmacies are critical to COVID implementation. And what we know is that Americans visit their pharmacist two times as often as other healthcare providers, and often it’s where most people turn to first when they have a healthcare concern or question. And as pharmacists, we’re not just providing or administering vaccines, we’re listening to patients, we’re addressing their concerns and providing evidence based guidance every day, so pharmacists have the ability to quickly implement vaccine strategies and ensure broad patient access. A great example is how pharmacies stepped up during the COVID pandemic to quickly administer COVID vaccines to the nation. But as a more recent example, during recent measles outbreaks, we quickly activated pharmacy teams in Texas and other hot spots to educate and administer MMR vaccines. We nearly doubled MMR vaccination in the first part of the year, and that means a nearly 250% increase in Texas counties most impacted by those outbreaks, and a quadruple increase in New Mexico and Colorado. So at Walgreens, we’re committed to being that most convenient and accessible place to seek recommended vaccines, and that’s what community pharmacy is providing care and advice. We’ve all played this role for decades in pharmacies and administering vaccines, and really, we don’t intend to stop now.

Shelley Fritz  10:42

So this season, education, access and trust will be more important than ever, and our pharmacy team members and our trusted pharmacists are already playing that key role, that convenience is a huge benefit for those who recently had COVID, though timing matters. If someone recently had COVID, how long should they wait before getting a booster?

Samantha Picking  11:01

It’s a great question. So you have natural immunity, which provides some protection against re infection of the virus, but vaccine induced immunity offers an even stronger protection, and that’s why even if you’ve had COVID recently, you still need to stay up to date with your vaccines. But if you have had COVID recently, you may consider delaying vaccination by about three months since you have that natural immunity that may last that long. Now also, if you are one of those populations that were eligible for a booster dose, you actually should wait two months since your last booster dose before you get another vaccine.

Shelley Fritz  11:34

Ah, okay, so thank you for clarifying the timing about getting a booster. Boosters are one piece, but guidance is always shifting. Dr. Evans, how do we make sure vulnerable groups like people with chronic illnesses or marginalized populations aren’t left behind as guidance changes?

Dr. Tyler Evans  11:50

Sure. Well, that’s a really, really important question. And Steph, thanks for sharing your journey. I think it’s it’s really important to share those personal narratives, despite how painful they must be to sort of conjure up those feelings. Unless people really can sort of personify some of these diseases, is sometimes it’s hard for folks to really digest. Unfortunately, we have politicized public health and particularly COVID-19, far too much, and it’s hurts people like Steph and other communities out there. We had one of the highest rates of mortality in the entire world. We are the wealthiest nation in the entire world. We have such advancement in technology and science, and yet we squander it because of these, this bickering that we have and this politicization of science. Science is not intended to be politicized. It is an evidence based model. There is no room for opinion there, right? It is evidence based, and we can interpret that in slightly different ways, but the opinion really does not have a strong place in public health, which is informed by the science. So unfortunately, we’re in this space right now where it’s really hard, if folks thought it was hard, to really sort of sift through the sort of the commentaries and the guidance on like, what I should be doing, how I should be protecting myself. Historically, for sort of other diseases, influenza, sort of a common one, we’ve had a number of flu outbreaks and pandemics. So if folks thought thought that was tough, it’s now increasingly become even more difficult. If you’re in the emergency room and you see two docs that are openly in the exam room, you see two docs that are openly arguing about your diagnosis and your treatment. How is your level of confidence in that sort of that system of clinical service gonna be? It’s gonna be probably pretty compromised, and when we have so much ornamentation in medicine, right? The important piece is here is that the bad news is we are getting further away from one centralized sort of repository of information where folks can just go to so they can get their updates on, like, how to stay safe and and whatnot.

Dr. Tyler Evans  13:45

This is the first time in 60 years, over 60 years, where the American Academy of Pediatrics has deviated from the CDC or the Department of Health and Human Services. So it’s like, where do you go, right? If all this isn’t good scientific debate, this is deep, dark, disruptive divisiveness. So where do we go at this point? Really go with your primary care doctors. I can’t tell you to go to any particular institution, if it’s kids. Yes, go to American Academy of Pediatrics. If you are pregnant or any gynecological issue, sure, go to the American College of Obstetrics and Gynecology. Don’t chat GPT it. Don’t go to Facebook or your social media for it, because don’t go into those echo chambers. Don’t go to Dr. Google. You know, yes, get informed, but always connect with a healthcare professional, somebody who actually studied this stuff, somebody who actually can sort of differentiate between falsehoods and fact. Yeah. And so the best way at this point, hopefully. So that’s the good the good news is there are primary care doctors, good ones in the States, and there’s some there’s a caveat there. There’s a lot of folks that don’t have access to primary care doctors. Right for those folks, there’s FQHCs, federally qualified health centers that exist. And most folks, if they look in the right places, can actually sign up for care. So I’d really encourage folks who don’t have a primary care provider to try to connect with one. And that can be your guide. That’s your guru. That’s the person to sort of guide you on your sort of on your journey as much as possible, to really understand what your background is, what your risk factors are, and whatnot.

Shelley Fritz  15:06

It is a troubling time, and I appreciate you sharing your glimmer of hope and advice for patients, for people who have autoimmune conditions like myself, for people who are immune compromised, who are wondering what to do for themselves. It’s important to note what I heard was, don’t go to social media, don’t use AI. Go to your primary care doctor so that they can consider those specific characteristics of what you’re going through and find the best treatment plan for you and give you the best advice that’s for you. It leads us to a timely issue. So recently, COVID vaccines were removed from the routine vaccination schedule. What are the possible consequences for public health? Is there anything you can elaborate on there?

Dr. Tyler Evans  15:47

I’ve been tracking a lot of these pieces, you know, the ACIP Advisory Council Immunization Practices. I was actually nominated for them, which is essentially, they’re the subject matter experts that sort of guide immunizations and sort of recommendations on rollouts. And just be clear, ACIP and actually, CDC doesn’t really have a lot of teeth in terms of direct authority. They’re really advisory recommendations. Historically, most states and municipalities did follow the CDC or other federal agencies that are sort of identified as the subject matter experts, because that’s important. And again, I talk about this in the book Pandemics, Poverty and Politics. One of the big problems is we need to have streamlined communications when it comes to emergencies, right? So from the FDA’s to the states to the counties to the cities to the communities, it needs to be one message. It needs to be streamlined. And again, science should not be divisive. Public health should be one monolithic message. Now, importantly, throughout that entire sort of journey of communications, we need to ensure that the communities, community based organizations are tracking that. So community based organizations at a national level, state, city, county, community level, that they’re out there tracking this information, that we’re talking to them, understanding the concerns of their folks. So we need to be talking to them so they understand the risks and benefits of certain diseases and treatments. Okay, so super, super important, and that that’s missing right now. But I am an optimist, and I do think that that’s coming back. In terms of the boosters that are out right now for COVID I’ll just put out my recommendation. My recommendation is that anybody who has access to that on at least an annual basis should get that booster. For the most part, we’re seeing that the current COVID-19 boosters and any sort of Omicron, sort of variant of concern right now, for the most part, it’s they’re pretty protective, they’re pretty effective of any sort of emergent, sort of variant. Right now we are in cold and flu season, so get your booster, get your flu shot at the same time. It is pretty effective. In fact, there’s some of those effective vaccines out there. Now, the question you asked Shelley was slightly different was, what happens if people don’t get it?

Dr. Tyler Evans  17:38

What happens is, we’re going to get increasingly sicker, right? We increasingly get sicker. And this is infectious disease. It doesn’t just stop at the individual. And I’m really concerned about kids, because kids, they’re kaleidoscopes of microbes. I’ve got two little kaleidoscopes myself, my little covidians. And it’s funny, when I was in the belly of the beast in the heart of New York City, I did not get infected one time with COVID, but at least six months after that, with my little kids going into daycare or whatnot, I must have, at this point, been infected about a dozen times. So if we remove childhood requirements on immunizations, it’s a serious, serious concern. It’s a concern for those kids, for those families, especially those families that are living in multi generational homes. Folks that are more historically marginalized, poverty is often sort of an influencer of that those folks are not going to have access to doctors or health care the same way that other sort of societies are going to, the teachers are going to be sort of impacted. So super concerned about that. It is a concern. Again, I am an optimist. I do think that we are going to see some outbreaks of some of these infectious diseases, especially you look at measles. Measles is literally one of the most infectious disease out there. There’s a way that we can sort of score that. And in terms of that scoring, it is one of the highest. So I am deeply concerned about the sort of manifestations of that, but I think hopefully when people start seeing these manifestations, we can use these as real world examples for the rest of the community.

Shelley Fritz  18:51

Thank you. It is really scary, and I’m watching Steph too. She agrees. I can see her nodding in the background. I will get back to you in just a minute, Steph, I promise. But Sam, I think you may have something to add to what Dr. Evans said.

Samantha Picking  19:04

All great points there, and I completely agree. I have three little kids, and man, they can spread illnesses, especially at school. And I think the most important thing is access, education and trust in vaccinations, and especially in the younger population, it’s not just them getting sick, but it’s also impacting our lives. I know if my kids get sick, one of them gets sick this week, the next one gets sick the next week, then the next week, and my life is turned upside down for three weeks, and I barely make it to work at times. So, so important to keep our children healthy and ensure that they have access to vaccines.

Shelley Fritz  19:38

Thanks, Sam. But one more question for Dr. Evans, and as the virus keeps evolving, so do the vaccines? How do COVID vaccines change or adapt to respond to variants in the COVID virus like the SARS COVID Two variant?

Dr. Tyler Evans  19:53

The current vaccines that I was saying before, do you provide quite good coverage of the current sort of variants that are emerging? It’s not as good as sort of the original, but it is quite good. The way that these vaccines, especially mRNA vaccines, are engineered, is different than the way that influenza vaccines have been historically, sort of engineered, and part of that is because the way that the viruses manifest in populations. So with flu, you get something called antigenic drift. And every year, the antigen, which is essentially the sort of the tip of the protein, basically is changing. And so we need to sort of track that and basically engineer or produce a vaccine that can then respond to that. Now the problem is they’re typically doing it from the year before, and so from that time to the time that they’re actually released. The next year, there’s going to be some variance there. So the way that COVID-19 is particularly the mRNA technology, the way that it’s produced, it’s a lot more efficient, and so we’re able to track this pretty quickly. The problem, though, now is creating more hurdles, more hoops for universities or pharmaceutical industry, and so they need to be incentivized, right? And the more kind of hoops that government creates for the pharmaceutical industry, the more challenging is going to be to track the variants and produce responses as quickly as we can. But again, right now, the simplest version is they are quite effective, and they are engineered differently from influenza. It’s unfortunate that RFK just shot down roughly half a billion dollars in mRNA technology, because there’s such promise for mRNA technology, and not just in the United States, but in a number of countries in the Global South, we had a lot of lot of promising applications for diseases like dengue and chikungunya, a lot of viruses out there that that impact millions of folks, especially kids, every day. So really, really, really, sad to see those cuts.

Shelley Fritz  21:42

It is sad to see those cuts, and so the intent is for the regular updates to be a proactive measure that public health experts use to maintain vaccine effectiveness. Let’s hope that the funding comes back or continues.

Dr. Tyler Evans  21:53

One last thing is just the boosters are so important for I was just talking about general population, but folks that are really at risk, folks like Steph, it’s so important to have access to that. And by Steph, by virtue of you being here, you have a voice, literally. A lot of folks don’t, though, right? And for folks that don’t have for the folks that are historically marginalized and vulnerable, they’re not the same thing. It’s really sad, because how does their voice get out? Right? Like, how are they getting in to ensure that they’re protected, and especially given the sort of the sort of, the divisive, sort of world that we’re in. So it’s really hard. And if this podcast or episode is getting to folks that can hear this, for folks that are really, that are vulnerable, you have to get those boosters. And it’s particularly it is there’s increasing evidence that it is really protective for long COVID as well, which is, I know there’s millions of people sort of struggling with long COVID, and we’re still trying to figure out. We’re still trying to figure out how to how to better understand, how to best sort of detect it as well as sort of respond to it. But we do know that the simplest version is the boosters basically reduce the amount of viral load. They may not absolutely protect the manifestation of disease, but they certainly reduce the amount of viral load. That’s a fact, not an opinion. And so by doing that, there is some recent evidence that by reducing the viral load, there is a correlation with the reduction of long COVID.

Samantha Picking  23:06

Just to add to what Dr. Evans said, and to really keep it simple for patients, they’re probably thinking, Why have I had to get so many COVID doses at this point? And why do I need to keep getting it yearly? And it’s a typical thing that viruses change. They adapt, they morph, so that a yearly seasonal vaccine like COVID now, and as we have done for flu for many years, it needs to change and adapt to the circulating viruses. That’s why we need a yearly vaccination. And we’ve been doing this for years for flu vaccines the same way. And again, the really cool thing about the mRNA technology is that we can adapt those COVID vaccines very quickly.

Shelley Fritz  23:44

Thanks, Sam, that is good to know. I want to get back to what you were just saying about long COVID. Dr. Evans, that’s an important topic to broach for our audience, too. Steph, when did you realize your symptoms from COVID weren’t going away and might be long Covid?

Stephanie Lebsack  24:00

Thank you so much, Dr. Evans for your information, and I’ll just preface with for my experience with the vaccine. I just knew as a chronic illness patient that if it could even just reduce my symptoms, that is monumental for someone like me. If there’s an at risk list of conditions when something happens, I’m on it every time, and re being reactive to that in a safe as possible way. That’s why I did it, is because I knew if this can even give me some kind of protective layer whatsoever on this experience, I need that. My family needs that. So going forward, the first time I caught COVID, actually, again, I’m a speech pathologist, and I worked in a hospital during some of the height, since as times of the pandemic, and as much as my colleagues tried to help me not have to go into patients with COVID rooms, I didn’t have a choice, sometimes, as in a service profession, and I did, and I actually never caught it from working in the hospitals. I caught it from coaching my daughter’s softball team. That’s how I caught it. Outside, and the girl came back to play, and there she was coughing, and I felt it in the air, and I thought, I’m gonna get it. And sure enough, I did. And we didn’t know how it would go, but it went. My symptoms were very prominent, I would say, 40 plus days. I was also diagnosed with dysautonomia and POTS. So I now have a cardiologist after that experience. And I’m very, very fortunate, and I should even say very privileged when we’re talking about communities. The institution where I receive care is on the paramount of COVID-19 research and respiratory entity research, and that’s where I was going during the height of the pandemic and then the continued version of COVID-19. And so I’m very, very fortunate with the care I’ve received. I feel like I had information early on and right away, and I was very informed. But again, not everybody is so fortunate to be able to be informed. So I’m very, very privileged in that regard. But long COVID was pretty tough. I always tell people I’m not the same since it happened the first time, and then I’m even more not the same after the second time. The third time was last month, followed by an awesome intubation two weeks ago for rhinovirus, but still not the same from even that third time. Te fatigue and the living with fatigue like that is a new experience, a challenging experience, and very, very real, and not something to be dismissed or minimized, for sure.

Shelley Fritz  26:27

What a frightening time for you. Thank you for sharing that. And you’ve definitely been at risk so many times, and I’m sorry for what you’ve gone through. Your long COVID and other chronic conditions led to hospitalization. So what is something that you wish more people knew about the potential severity of long COVID If you’re living with a chronic condition especially?

Stephanie Lebsack  26:48

Yeah, so I think something that I hear a lot, and my health journey is really open on social media, and I have lot of people that hear it, so I do get stuck in these social media holes. So to speak, Dr. Evans, like you mentioned, and stuff, and it can be really daunting to see misinformation that is still, surprisingly and sadly being posted and available. And I think that that has been the toughest part, as far as just continually trying to stay safe in a quote unquote “post pandemic” world, which it’s still happening, right? It’s not post anything. It’s still here. I think the biggest challenge is someone with multiple chronic illnesses and concomitant diseases is that it’s still really minimized. And people say, Well, for me it was just a cold. Well, for me it really wasn’t. And so I think that our awareness just still is so down, even with policy, my husband is a public school teacher and or in the hospitals where folks work, they’re right back to pre pandemic, but attendance policies with workplaces are right back to where it was before. Even in hospitals, nurses have to come to work sick. I’ve had nurses in ICUs come to work sick, masked, while treating me a very compromised person. So I think that’s the hardest part for me, is just trying to stay safe in a world that still doesn’t take it seriously.

Shelley Fritz  28:12

Can we circle back for just a minute? Steph, I know there’s so much to talk about with your experience with COVID and long COVID, but I want to go back specifically to when you thought you realized these weren’t just symptoms of COVID, that this might be long COVID, and I’m not even sure at the time that there was even a term for that. It was just it just wasn’t going away. When did you realize that?

Stephanie Lebsack  28:33

So, I knew it wasn’t the typical virus. I lost multiple friends to COVID. I know other people that can say the same thing, people who were otherwise healthy before getting COVID, who unfortunately passed away because of COVID. And so I knew that what I had gotten into was not your typical virus, and it was capable of different things. So something I had experienced was day four, I felt a little better. Day five was awful. That’s not typical. Usually, I’m getting better. I mean, I tend to get better slower than most folks. That’s just me and my body. And then day 10, really awful. In fact, day 10 was when I had to go on oxygen. And so that was different. The experience of COVID and its waxing and waning was absolutely different. The other thing I knew was it just wasn’t going away at all. So I still was sniffly. I was on high dose steroids while I had COVID. Still wasn’t going away. Long COVID had been defined by the time I caught it, but we were still kind of learning what that looked like then, and so I knew on paper it was past this many days, it was considered long COVID. But then I also knew that even when the overt symptoms started to subside, I still didn’t feel right, and I felt embarrassed to talk about those symptoms. I felt perhaps maybe they’d be minimized or dismissed. And I think people still are going through that unfortunately. Unfortunately, a lot when it comes to long COVID.

Shelley Fritz  30:02

Thank you for sharing, Steph, I know that’s probably even hard to think back about too in that time, right? Dr. Evans, I’m going to let you weigh in here. Steph just shared some powerful points about what it was like to recognize that it was not going to go away, that this was something that was with her for a while, and she had to pivot to figure out how to get through it.

Dr. Tyler Evans  30:22

Steph, the experience that you were sharing is just, just, is a is really emotionally poignant, because it is just so it’s not episodic, right? Like it’s chronic, it’s ongoing, and these infections, it’s just another nail, you know, in a sense, and that’s hard. The key message that I would sort of respond to here is, when folks are making decisions on whether or not a vaccine in general or a booster is the right thing for them. And let’s just assume we’re in a somewhat normative world where the actual scientists and the public health professionals, their voice is universal, and it’s actually getting to the communities. Okay? So let’s just assume that for a second, that’s a big jump from where we’re at right now. But the message we really need to get through is, when it comes to immunizations, as well as other decisions around public health, it’s not just about you. I hear this all the time. Well, I don’t know if I need if we get the flu shot. I’ve never gotten the flu. Yeah, but it’s not about you. It’s about Steph, and it’s about other kids that are more vulnerable in other communities that you love. It’s about them, and even if it’s a one out of 100 or even one out of 1000 chance that you might hurt somebody else if you don’t engage or you don’t play, is that really the right decision? I mean, we live in communities. We are global citizens, whether or not we subscribe to that idea or concept or not, we are. It’s a fact. Over 7 billion people in this world, and we are just a minor little drop in this larger sort of constellation of collisions, and we’ve got to think about other people, right? And most humans, most Americans, they’re good folks, right at the end of the day, unfortunately, we’ve weaponized a lot of this dark stuff, and I’m not going to jump there. I’m going to jump to the good stuff. There’s a lot of, most folks I talk to at the end of the day, if you engage them, you talk to them about it might take two or three questions to get there, but ultimately, we all kind of want the same thing. And so, it’s just important to really try to get to that, and to ensure that when folks are making those decisions again, that they’re thinking about not just about themselves. They’re thinking about their kids, their grandparents, their cousins, their community leaders, their church attendees, everybody, their soccer colleagues, the concentric circles go on and on, and we really have to think about that, because this for folks like Steph, it’s not ever going to go away, right? The risk is never going to go away. So the best that we can do is to protect our communities that are a little bit more vulnerable. That’s such an important message to get out there. And if that they do, if they are sick, particularly folks that don’t have access to healthcare, that we try to support them. We try to provide them with as much access information as they possibly can get.

Shelley Fritz  32:46

Such an important point. Dr. Evans, thank you. And something that you said really resonated with me, and that was that you may think I didn’t get the flu before, so I’m not going to get the flu. I don’t need the booster. It’s not about you, it’s about everybody else. It’s about people who are more vulnerable, like Steph. So it’s thinking about other people as well. Now let’s toss in some other important vaccines that patients may be wondering about. What’s your advice for patients who are juggling multiple vaccines, the flu, RSV and COVID this season?

Samantha Picking  33:15

First thing we want to remember is that getting multiple vaccines at the same time is safe, and this is a standard medical practice supported by major health organizations like the World Health Organization, the CDC and American Academy of Pediatrics. For many people, getting all the recommended vaccines in a single appointment is the easiest way to stay up to date. I know for me, and historically, what I’ve done if I need both my flu and COVID vaccine, I’d rather just get them at the same time, versus having to make two appointments because it’s not likely that I’m going to come back. And the scheduling is tough, especially busy lives this time of year, as always, though, our Walgreens pharmacists are available to counsel, provide guidance on what is best for a patient based on their personal health needs, latest recommendations and maybe their personal preferences or lifestyles.

Shelley Fritz  34:02

It’s something we really need to think carefully about to ensure that we can get different vaccinations and boosters scheduled without conflicting with medication schedules too, and to offer optimum results. There are some differences between different types of COVID vaccines, such as the Pfizer vaccines, Moderna vaccine and J and J vaccine, particularly in the vaccine schedule and eligibility. Can you explain the biggest differences between the types of COVID vaccines? So a listener might have a better idea of what is right for them.

Samantha Picking  34:34

One thing is that all COVID vaccines prompt our bodies to recognize and help protect us from the virus that leads to COVID-19. Here in the US, we have two different types of vaccines. So we have mRNA vaccines, and those are produced by Pfizer and Moderna, and then you have a protein based adjuvant option from Nova Vax. So mRNA vaccines utilize advanced technology to deliver basically in. Instructions to help your body build immunity. And this type of vaccine was actually the first vaccine available against COVID, here in the US. Then you have the Nova Vax vaccine, or Nuvaxovid this year, and that’s the only protein based non mRNA COVID vaccine available in the US. So think of this vaccine as more like other types of vaccines, like a flu vaccine, so similar to the historical vaccines that we’re used to. It’s also important to note, since you mentioned it, the Johnson and Johnson vaccine actually is not available on the US market, and has not been for several years, so we no longer have that vaccine on the market. Eligibility does vary across these vaccines. So for example, the mRNA vaccines by Pfizer and Moderna are approved for patients 12 years and older. They also have pediatric formulations that are available. The non mRNA option, so that’s the Nuvaxovid, is only approved for patients 12 and older. So the best thing to do if you’re confused or may not understand which vaccine is right for you is to talk to your pharmacist, they can kind of talk you through what vaccines are available, what may be best for you based on your preferences, health conditions, and what your specific recommendations are.

Shelley Fritz  36:10

That’s great advice to talk to the pharmacist. So the key differences are in the technology, number of doses and who each vaccine is recommended for, but all the recommended vaccines are safe and effective at reducing the risk of severe illness.

Samantha Picking  36:24

That’s correct. And I think the easiest thing to remember is, at this point, for most healthy patients, just one dose is recommended.

Shelley Fritz  36:32

So even though we’ve come a long way, we still have to stay alert and flexible as the virus changes, make sure we get our boosters, bundle up, take care of ourselves, use precautions, especially when out in public, because we’re thinking of other people, not just ourselves. It makes so much sense, and it really seems like people respond best when they hear from someone who understands their community. So let’s loop in with the patient voice, Steph. If someone is on the fence about getting a booster, what would you want them to hear from your story?

Stephanie Lebsack  36:59

I just want them to know that when you take that step of protecting yourself, you’re also taking this step of protecting someone like me, someone like my grandmother, someone like my family, and that helps us take care of each other. I think that’s the biggest thing is that we still just need to be mindful of one another. It’s not gone, and we still need to make efforts to try to be safe as possible and keep our loved ones and friends and neighbors and communities safe.

Shelley Fritz  37:28

Steph, Sam and Dr. Evans, thank you so much for taking time to speak with us today. This is a very powerful conversation, and I hope that a lot of people get to hear it and it resonates with them.

Samantha Picking  37:38

Such an important discussion. Thank you so much for having me today.

Dr. Tyler Evans  37:40

I couldn’t agree more. Thanks, Shelley.

Shelley Fritz  37:45

This is Informed Immunity. Thank you for joining us on this episode. Remember, the fight against infectious diseases, including COVID, is a community effort, and your participation is crucial for more reliable information on vaccines and to stay up to date on the latest of public health. Visit our website at GHLF.org/vaccine-resources. We’ll drop the link in the episode description, and you can also check out the Centers for Disease Control and Prevention or World Health Organization websites. This podcast was made possible with support from Moderna. If you enjoyed this episode, please rate our podcast. Write a positive review and share with your friends and family. It will help more people like you find us until next time, stay informed and stay healthy together, we can make a difference.

Narrator  38:36

Be inspired, supported and empowered. This is the Global Healthy Living Foundation Podcast Network.

Narrator  00:00

Be inspired, supported, and empowered. This is the Global Healthy Living Foundation, Podcast Network.

Susan Jara  00:11

Welcome to “Informed Immunity: the Podcast Dedicated to Bringing You the Latest Evidence Based Information on Vaccines, Community Health, and the Fight Against Infectious Diseases.” I’m Susan Jara, Director of Patient Education at the Global Healthy Living Foundation, and your guide on this journey to better health. In this audio guide, we’re tackling some of the most common myths and misconceptions about vaccines. We’ll break down the facts to help you feel confident in making informed decisions about vaccinations. Whether you’re worried about vaccine safety or simply curious about the truth behind the rumors, this audio guide will provide clarity and insight. Today, we’re joined by Samantha Picking, Pharmacist and Director of Immunization at Walgreens. With her extensive experience in developing immunization strategies and ensuring equitable access to life saving vaccines, Samantha will help us debunk these myths and explain how vaccines truly work to protect our health.

Susan Jara  01:12

Before we get to the vaccine myths. Samantha, can you please briefly remind our listeners, what are vaccines and how do they work to protect our health?

Samantha Picking  01:20

Of course. So, what I want to remember is, vaccination is the number one way that someone can protect themselves or their loved ones against serious disease and respiratory illnesses, like flu, COVID and RSV. Getting vaccinated prevents illnesses, medical visits, hospitalization, days away from work, and even death. When it comes to flu, COVID, or other illnesses that we’re preventing through vaccination. There is a chance that some people get vaccinated, still feel sick afterwards, but their symptoms and severity of illness, if they do end up getting those diseases that we’re preventing, are reduced significantly because they got vaccinated. Now, vaccines work by stimulating the body’s immune system to produce antibodies. They do this by limiting an infection; the presence of a disease-causing organism in the body, to engage the body’s natural defenses. Vaccines are usually administered through needle injections. However, there are some that are administered by mouth or sprayed in the nose.

Susan Jara  02:14

Thank you, Samantha, that was a great overview. Now, that we have this basic understanding of how vaccines interact with our immune system. Let’s tackle some of those common myths. Let’s start with, “Is there any evidence that vaccines cause autism?”

Samantha Picking  02:28

This is a big one that’s out there, and there is no credible scientific evidence linking vaccines to autism. There was an original study that suggested there was a link. However, that study was found to be fraudulent and was retracted. Its’ author also lost his medical license, due to these ethical violations in the study. And there have been multiple large scale studies. There are tons of vaccinations that have been done over the years, and these studies included those, by the CDC, the Institute of Medicine, have confirmed that vaccines do not cause autism.

Susan Jara  03:00

Yeah, that is a big one. Thank you so much for clearing up that major concern for, you know, so many listeners out there. What about the claim that, “Vaccines can cause the diseases they’re supposed to prevent?”

Samantha Picking  03:10

Yeah, and sometimes this may feel like it, because you get side effects after you get a vaccine, and again, they’re rare and small, but there is no way vaccines can cause the disease they are meant to prevent. So, some vaccines actually contain an inactivated form of a virus or parts of a germ, which cannot cause disease. The flu vaccine, for example, is manufactured using what’s known as dead or inactivated virus, so it really cannot cause influenza for a person receiving that vaccine. In addition, there are vaccines that are known as live attenuated vaccines, so they have a weakened form of the virus, but they can’t actually cause the illness itself, especially in healthy patients.

Susan Jara  03:51

Thank you. I’m so glad we have that myth debunked, that you can’t get the flu from getting the flu shot. Another common question people have is, “Whether natural immunity is better than vaccine induced immunity?” Can you please explain this for our listeners, Samantha?

Samantha Picking  04:06

Of course. Vaccines provide a safe way to build immunity, without the harmful effects of the disease itself. Now, natural immunity may occur after infection. However, the risks of the disease are far worse than the risk of actually getting a vaccination, because we know those are safer. If you’re actually getting the infection, say flu, you could be suffering from severe complications, severe illness, or even death, if you are choosing to go with natural immunity versus getting a vaccination.

Susan Jara  04:33

Thank you. And you know, I think that’s definitely worth reiterating, that vaccines provide a safe way to develop immunity. And I think there’s a lot of misconceptions about immunity, especially when it comes to COVID-19, for example, if you’ve received your COVID-19 vaccine during the beginning of the pandemic, do you necessarily need to get another one?

Samantha Picking  04:53

Yeah, that’s a great question. And at the start of the pandemic, we really weren’t sure. We didn’t know how COVID would react, as a virus. Now, natural immunity from having COVID-19, may not provide that long term protection and reinfection is possible. Stronger defense against variants; we now know that COVID-19 virus changes, similar to what we see with flu. So, that allows us to change the vaccine and better protect it against the newer variants, that are surfacing for COVID-19. And the vaccines are helped to design to protect against those different variants, as the virus change on us. Now, public health benefit to getting the vaccine; getting vaccinated helps reduce the spread of virus to others. You may not feel like you need it, because you’ve had the infection. However, a major benefit of vaccines is protecting those around you, whether it’s your grandparents, little ones, or just people in the community that you’re interacting with, that you may not realize have weakened immune systems.

Susan Jara  05:49

Yeah, thank you for that. Public health benefit is just so important, especially for so many of our listeners, who are immunocompromised, or who take immunosuppressing medication, or who have loved ones who are also immunosuppressed. And you know, this kind of makes me think of another concern about receiving vaccination. Can receiving too many vaccines overload our immune system. Could you please address that, Samantha?

Samantha Picking  06:13

The one thing to remember is, our immune systems are amazing. They are capable of handling exposure to 1000s of antigens, daily, that we don’t even realize we’re exposing ourselves to. So, no, receiving multiple vaccines at once does not overload our immune system – It’s designed to do that. Vaccines are only a tiny fraction of what the immune system encounters daily. According to the CDC, even side effects of vaccines are generally the same when given with other vaccines. Just on Monday this week, I got both my flu and COVID vaccine, and I’ve had both of them separately, and I’ve seen no difference, in terms of how I feel after those vaccinations. So, they may vary by individual, but it’s important to remember that even if you do experience those common side effects, like headache, fever, pain, swelling, it just means vaccines are working. It’s also shown in studies, that combination of vaccines is safe and effective. According to current CDC guidance, it’s safe to get multiple vaccines at the same time, whether it’s flu, COVID, RSV, pneumonia, or really any vaccine you may be missing at that moment. It’s better to get protected when you’re there, getting vaccines, than allow for any additional gap, until you get that vaccine.

Susan Jara  07:20

Let’s explore the topic of vaccine side effects, which is another area that generates a lot of questions and concerns. Do vaccines cause severe side effects?

Samantha Picking  07:31

What I can tell you, Susan, it’s a great question. Severe side effects from vaccines are extremely rare. The most common side effects are mild, so, soreness of your arm or soreness at the injection site. Maybe a low grade fever, but the benefit of vaccination far outweigh the small risk of any side effect.

Susan Jara  07:47

Speaking of seriousness, let’s touch on whether these vaccine preventable diseases are really as serious as they seem. Is this something that individuals should worry about developing flu, RSV, COVID, pneumonia?

Samantha Picking  08:00

Absolutely! Vaccine preventable diseases can be very serious, and even deadly for people, again, with compromised immune system, taking immunocompromising medications. And while I may be healthy, I may be also exposed to people that are immunocompromised, so I’m protecting them by getting my vaccination. And just as an example of this, flu can cause mild to severe illness, and at times, can lead to life threatening complications. Pregnant women, young children, seniors are really at the highest risk for complications, when they contract flu. In addition, to communities of color; Black, Hispanic, Native American communities tend to experience higher rates of severe illness and hospitalization from the flu. Often due to decreased vaccination rates, but also socioeconomic factors. And then those in rural communities, that may not have access to health care, if they are experiencing a severe reaction to say, or complication from flu. RSV, very similar, can be anywhere from mild to severe, ranging from just a cold, having severe lung infections, like pneumonia or other complications. And again, this is a lot for the younger population, so infants and also older adults. As an example, my kids had RSV when they were little, and from that, ended up with pneumonia, ear infections. I’ve had two kids in the hospital from RSV, and it’s just really something I wish I had a vaccination, at that time, to prevent from having to go through that, with my children. Also, vaccines prevent against severe outcomes and help maintain public health. Getting vaccinated is the most important thing that you can do, to help protect yourself and those around you. In addition, to vaccination, every day preventative actions, helping reduce the spread of flu, COVID, RSV, during respiratory season, we are about to enter respiratory season, and this is so important, so avoiding close contact with people, who may be sick, covering your nose and your mouth when you sneeze, washing your hands often, avoiding touching your eyes, nose, and mouth. All these additional things, in addition to getting vaccinated, is so important this time of year.

Susan Jara  09:51

Thank you. Thank you for putting things in perspective and offering just tangible advice that, you know, our community can use on a daily basis to stay safe. You know, access to vaccines is so important, and I know Global Healthy Living Foundation and Walgreens work together, to really, you know, promote access, which is so important. It’s really important to remember that vaccines are not just about individual protection, but about community health as well. So, thank you so much for joining us today, Samantha. We’ve covered a lot of important information about vaccines, and debunking common myths, and let’s hope we address some common concerns. And you definitely provided evidence based information, to help our listeners make informed decisions about vaccinations.

Samantha Picking  10:31

Susan, thank you so much for having me today. I really enjoyed this conversation – It’s so important!

Susan Jara  10:39

This is “Informed Immunity.” Thank you for joining us on this audio guide. Remember, the fight against infectious diseases is a community effort, and your participation is crucial. For more reliable information on vaccines, and to stay up to date on the latest in public health, visit our website at ghlf.org, or check out the Centers for Disease Control and Prevention, or World Health Organization website. This podcast was made possible with support from GSK. If you enjoyed this episode, please rate our podcast, write a positive review, and share it with your friends and family. It will help more people like you, find us. Until next time, stay informed and stay healthy; together, we can make a difference.

Narrator  11:24

Be inspired, supported, and empowered. This is the Global Healthy Living Foundation, Podcast Network.

Narrator  00:00

Be inspired, supported, and empowered. This is the Global Healthy Living Foundation, Podcast Network.

Susan Jara  00:11

Welcome to “Informed Immunity: the Podcast Dedicated to Bringing You the Latest Evidence Based Information on Vaccines, Community Health, and the Fight Against Infectious Diseases.” I’m Susan Jara, Director of Patient Education at the Global Healthy Living Foundation, and your guide on this journey to better health. In this audio guide, we’ll focus on the challenges of navigating the health care system, particulary, when it comes to getting recommended vaccines. We’ll talk about common barriers to getting vaccination, along with practical solutions to overcome them. So, you can best protect yourself and your loved ones. Whether you’re trying to navigate the health care system, worried about vaccine safety, or just curious about the latest advancements – this podcast is for you. So, let’s take this journey together and take one step closer to building a healthier future for all. Today, we’re joined by Dr. Robert Popovian, Chief Science Policy Officer at the Global Healthy Living Foundation, and a leading expert in health care policy and biopharmaceuticals. With extensive experience in health economics and policy, Dr. Popovian will help us navigate the complexities of the health care system, when it comes to vaccination.

Susan Jara  01:23

Welcome, Dr. Popovian.

Dr. Robert Popovian  01:25

Thank you for having me.

Susan Jara  01:26

Could you briefly explain, to our listeners, the work you’ve been leading with GHLF in the vaccine space?

Dr. Robert Popovian  01:31

GHLF has had a long history of working in vaccine policy, and advocacy, and education. This is prior to the pandemic, actually, they were very much engaged with adolescent vaccination for meningitis. Obviously, with the pandemic, GHLF took on a larger role in vaccine education and advocacy, and since then has followed through, and has tried to provide education, research, as well as, advocacy in the space, to ensure that patients who are vulnerable, especially patients with chronic diseases or autoimmune disorders, have access to vaccines and are educated about the benefits and the risks.

Susan Jara  02:08

Thank you. I know a lot of the work, that we’ve done, has been surrounding common barriers to adult vaccination. Can you please talk about some of those barriers that you’ve identified, in your own research?

Dr. Robert Popovian  02:19

Let’s start with discussing misinformation. So, that’s the number one thing: there’s a lot of misinformation about vaccines, and their safety and efficacy, and GHLF has taken a leading role in trying to educate patients about the benefits of immunization. But there are other barriers, so we’ve tried to identify, for example, access in low income communities, with regards to a barrier that we’ve identified. We did a research on reimbursement and how that reduces access with physicians, and pharmacists, and immunizing. We’ve tried to look at how pharmacy benefit management companies have tried to manipulate the market. We’ve also lauded and supported things, like zeroing out of pocket costs for vaccinations, especially for Medicare Part D patients, who are extremely vulnerable, since they’re seniors, and we’ve tried our best to also try to identify what are the barriers that patients have, through doing survey research that we’ve published recently.

Susan Jara  03:18

Thank you! Just going back, could you elaborate a little bit about misinformation? What do you think is the top misinformation that patients have regarding vaccination?

Dr. Robert Popovian  03:28

Well, the number one thing is that, unfortunately, during the pandemic, there was a lot of overpromising about what vaccines do. Vaccines, from the minute that they were developed, the intent was to prevent the worst outcome, and in this case, is mortality and morbidity. Unfortunately, there was a lot of enthusiasm when the COVID vaccine came out, that the vaccines were going to help reduce the spread of COVID infections; and that’s not true. Vaccines have always aimed to reduce mortality and morbidity, as I stated, and that’s been the biggest barrier in being able to get over the hump with some patients, to go back to the basics, and explain to them what the value is. So, that’s the misinformation that was out there, about what the intent of immunization is. But also, there’s been, historically, misinformation about the safety of the vaccines, which has been refuted over and over again throughout the years. In fact, one of the original publications that sort of raised concerns about vaccination is no longer even available, publicly, because the journal that published it has withdrawn it, and the individual who published it actually lost their medical license to practice. So again, I think it’s twofold: one is the misinformation that is done intentionally or unintentionally with uninformed patients, but also the overpromising that sort of like what vaccines do, which we need to sort of level set with patients, which is, they are intended to really prevent the worst outcome.

Susan Jara  04:52

Great, thank you. You also kind of touched on financial barriers and used the term “zeroing out of pocket costs.” Could you explain that, for maybe one of our listeners, who doesn’t understand that?

Dr. Robert Popovian  05:02

That’s an interesting thing. So, True Affordable Care Act, passage of the Affordable Care Act, vaccines have had zero out of pocket costs for commercial insurers. Unfortunately, one of the areas that patients still had to pay out of pocket costs to acquire the vaccine, was among seniors in Medicare Part D vaccines. And fortunately, one of the benefits of the Inflation Reduction Act passage was that they zeroed out of pocket. So, now in the United States, unless you’re uninsured and/or you don’t have any government insurance, like Medicaid or Medicare, there is no out of pocket cost for anybody who has some type of an insurance. So, as a patient, when you show up at a pharmacy or a physician’s office and acquire vaccine, out of pocket costs should not be a barrier that you face as a patient. Now, having said that, Susan, there’s a lot of instances that we still see that there has been misinformation, or intentionally or unintentionally, that patients have showed up to a pharmacist or a physician’s office and they were charged in out of pocket costs. Partially, that has to do with the way the benefit design was placed, by either the employer or the insurer that they acquired, where they probably had to pay up front and then get reimbursed. And by the way, that’s not the case. You know, the intention of the law is that patients don’t pay anything out of pocket, when they show up. So, there’s still some barriers with regards to that, but we are trying to, one by one, educate the patients to become better consumers and push back, when they’re asked for any kind of out of pocket and when they show up at a pharmacy or at a physician’s office.

Susan Jara  06:33

Great, thank you so much. You had mentioned, you can go to your pharmacist, you can go to your provider for vaccinations. Could we talk a little bit about the role of pharmacists, in improving vaccination rates?

Dr. Robert Popovian  06:44

Yeah, absolutely. And we did a specific study, and I’ll mention the study in the context that we’re going to be discussing. So, pharmacists are one of the most, if not the most accessible health care professional, in the United States. About 90% of individuals, living in United States, live within five miles of a pharmacy. And pharmacists have taken the lead pre-COVID, but especially post-COVID. With regards to adult immunization, we did a study with IQVIA, that demonstrated that about 80% of adult immunization, post-COVID, is now being administered in a pharmacy, by a pharmacist or a pharmacy technician, and that’s impressive. Obviously, a lot of it was the COVID vaccine, but since then, the majority of the flu vaccine, majority of the pneumococcal vaccine, and shingles, and now RSV are being administered in pharmacy, in the 80%+ rate. So, pharmacists play a huge role in this, and we did a specific study looking at low income communities; we wanted to see what is the accessibility of low income communities, by the way, Susan, that are over represented by minorities. And what we found is that, in low income communities, there’s better access for pharmacies than physician offices, who immunize. And why is this important? Is because one: not only there’s physical access, but remember, pharmacies also have longer hours of operation, and they are open seven days a week, instead of five day, usually. So, when you add up those things, it becomes not only the physical location, but the hours of operation and everything else makes it even much more accessible. And remember, low income patients, generally, are hourly wage earners. So, as an hourly wage earner, if you don’t show up to work; you don’t get paid. So, you require access to health care professionals, who are available after hours of work. And this is why also a pharmacy and a pharmacist plays a larger role in immunization, in these type of communities. And as I mentioned in the beginning, these communities are overrepresented by minorities, both racial and ethnic minorities. Therefore, it becomes a DEI (diversity, equity, and inclusion) issue, frankly, with regards to, how we should, basically, champion and make it easier for patients to acquire their vaccines at pharmacies.

Susan Jara  08:52

Great, thank you. Can you please discuss the findings from your paper relative to vaccine access and supply, especially for high risk chronic disease adults?

Dr. Robert Popovian  09:01

Yes, so, you know, we did a paper, specifically about that. Obviously, these papers are available publicly for anybody can read. We specifically looked at how pharmacies play a large role in administration, like, for example, with the low income communities, how they’re accessible in physical locations, and how they were doing significant number of the adult immunizations, but one of the things that we’ve found is that there’s an appetite by the pharmacy benefit management (PBM) companies and insurers to now get involved. Traditionally, vaccines have been an area where PBMs and the insurers have not played a role, because there’s no out of pocket costs, so there’s no benefit for the insurer to do anything, other than just administer and process the prescription, basically, or process the vaccine payment. But what we’ve learned is that they are trying to get involved in it, and the reason being, for a variety of reasons, partially has to do because they see it as a profit center, that’s been untapped, and they’re trying to basically manipulate the market to be able to garner more benefits from the pharma companies, and that has disrupted the market, and it’s going to disrupt the market, especially for patients with chronic diseases, because remember, again, going back Susan, who’s going to benefit the most from vaccines, it’s elderly, patients with chronic diseases, or patients with autoimmune disorders, who their immunity is at risk. So, because of those reasons, we need to make sure that PBMs stay out of the vaccine market and that they don’t start messing around, like, they’ve done with the traditional biopharmaceutical market, where the access has been restricted for patients and because of that, patients suffer.

Dr. Robert Popovian  09:34

And so, what steps can a patient take, to be involved in this greater access and to prohibit PBMs and insurance companies from interfering?

Dr. Robert Popovian  10:42

They need to be educated, number one; they need to know what their rights are; they need to know that, if they show up to a pharmacy, or a physician’s office, and somebody requires them to pay out of pocket, they need to question that, because by law, no one, that has any type of government or private insurance, should be paying anything out of pocket to acquire that vaccine. So, they need to become better advocates, push back, if they’re asked to do so, and also, one of the things, I always talk about, is that they need to get educated about what are the requirements for them to acquire this vaccine. So, Center for Disease Control provides recommendations about who should acquire certain vaccines, and sometimes those are not in alignment with the Food and Drug Administration label. In fact, they’re contradictory at times. And what we need to do is do a better job, and this is where GHLF comes into play; Global Healthy Living Foundation and all the patient organizations, about educating patients about, if CDC is saying this is the recommendation, and you show up at a pharmacy and the pharmacist says, or a physician’s office then says, “You don’t really fit the bill, with regards to the recommendation,” you should be asking ‘Why?,’ and push back, and then try to acquire the vaccine based on your needs, and have that discussion with the pharmacist or physician. Now, fortunately, CDC, they’re trying to do much more clear recommendations for these vaccines, about the risk of the patients, but unfortunately, this is raising other set of issues, that we’re now working on, because it’s making it far more complicated for pharmacists and physicians to identify these risks, within their office environments or in their pharmacies.

10:42

Great, thank you. That’s really important for our patients to advocate for themselves, and as you said, push back, and know guidelines, and what vaccinations they need, and work with our provider to make sure that they’re staying on schedule. A lot of education at GHLF is also surrounded about COVID-19, and we had talked about a lot of miscommunication around vaccination, due to COVID-19. Can you talk about how the COVID-19 pandemic influenced adult vaccination rates and also public perception of vaccine?

Dr. Robert Popovian  12:40

So, obviously, there was a lot of enthusiasm, when the vaccines were being developed. If you recall, Susan, we were all locked up and we were all looking forward to a vaccine that will help us get out, and being able to live our lives in a normal way. So, the enthusiasm was there. Unfortunately, what happened is that there were some legitimate questions by patients and even health care professionals, who wanted to know, ‘How did we develop a vaccine so quickly, and effectively, and whether or not the vaccine was safe?’ Unfortunately, those individuals were sidelined, and the questions were not answered. And these were legitimate questions; even I, as a pharmacist, as a healthcare professional, I wanted to know, ‘How did we get to a point, that we were able to develop a vaccine within six months, when we traditionally developed a pharmaceutical over 10 year period, right?’ So, there were some legitimate questions that needed to be answered. The other thing, like, I touched in the beginning, is the overpromising of the vaccines, by certain health care officials, both on the federal and the state level. They should have been honest about it. Look the vaccines, as I said from the beginning, they’re intended to prevent the worst outcome, which is mortality and morbidity. They’re not there to basically reduce communicable diseases, that we’re still going to get COVID, we’re still going to get the flu, but when you have the vaccine, it’s going to reduce the burden of illness, and it’s going to reduce the potential morbidity and mortality. So, I think that also was a problem that we need to get over. And then, frankly, the mandate issue, was a problem, because it was the first time that people, whether employers or government, was mandating people to get the vaccine. And again, instead of having a discussion with patients and answering their questions, they were just telling them “Be quiet, you don’t know any better. Just get the vaccine and everything will be fine.” And then, when you see these things, like in the social media, where patients got the COVID vaccine, but still got COVID, instead of saying, “Yes, you got COVID, but guess what? You’re not dead, or you’re going to be fine, because it’s going to be a less severe infection.” Or there was a lot of misinformation about natural immunity, right? People were saying, “Well, I got the COVID infection, why don’t I just get it and develop natural immunity, and then, instead of getting the vaccine.” Well, what officials should have said is that, “Yes, that is true, you can get the infection and get natural immunity, and you don’t need the vaccine, but you’re also taking a risk of dying, if you get the infection.” Versus if you got the vaccine, and even if you got COVID, the burden of illness would have been significantly lower. And that’s why I think, Susan, vaccines are the most cost beneficial intervention ever developed by the medical community, by researchers, by biopharmaceutical industry. And what we need to do is to go back to the basics of why they’re necessary and who is the vulnerable population that would benefit the most. And it’s sad to see now that we’re two, three years past the height of the pandemic, that we have become complacent about vaccination, and in fact, only about 30% of seniors, I think, last year, got the new version of the COVID vaccine, with the new entity, and this is scary, and we’ve seen also a drop in other adult immunizations, over time, and pediatric immunizations. These are scary times. We need to go back to the basics, and, what I say to people is that, we need to start treating patients as adults and having a conversation with them, and not wag our finger and say, “You just have to get it and be quiet.”

Susan Jara  16:00

I love that! To start treating patients like adults, and make them feel empowered and educated.

Dr. Robert Popovian  16:05

Absolutely.

Susan Jara  16:06

Looking forward, what policy changes, or initiatives, do you think are necessary to really sustain and improve adult vaccination rates?

Dr. Robert Popovian  16:14

Number one, as we started to discuss, we need to ensure that state laws, that prohibit pharmacists from immunizing, are streamlined and expanded. Because pharmacists are the most accessible health care professional, as we’ve said before, and especially in the low income communities. If we want to get low income patients, at better access, we need to have the pharmacist involved. Okay, that’s the number one thing. So, state laws need to be streamlined/expanded. What I say is that, pharmacists should have the same authority as a physician, in administering the vaccine. Vaccine is not a diagnosis. There’s a FDA label, and as health care professionals, pharmacists can’t follow those directions. So, that’s the number one thing. Number two thing is that we need to guard against insurers or PBMs trying to manipulate the model, for their profitability. Remember, as I mentioned, no one pays out of pocket for anything. So, what is the benefit that we’re getting here, for the PBM involvement? Traditional PBMs and insurers have been involved because there’s a benefit to the patient, right? They’re gonna lower the out of pocket costs or cover something, but right now, nobody pays anything out of pocket, so there is no patient benefit for their involvement. So, we need to guard against that. Number three, I would say, we need to do a better job of educating and advocating for vaccines, and need to go back to the basics. As we said, we need to treat patients as adults, and encouraging to get the vaccine, not mandating the vaccines, because that will help. So, that will come with ongoing public health type of endeavors that we need to do, and reducing the misinformation and everything else. But again, as I said from the beginning, since I’ve been involved in the health care policy space, health care in general, I’ve always said vaccines are the most cost beneficial intervention that has ever been developed in the health care system, and we need to become better advocates for these important medicines. Because at the end of the day, what we know about the vaccines is that they’re going to reduce mortality and morbidity, and that’s the key.

Susan Jara  18:04

Thank you so much, Robert, for joining us today and talking about misinformation, and vaccine access, and really the importance of educating our patient community on vaccination, to protect themselves and their loved ones.

Dr. Robert Popovian  18:17

I appreciate it. Thank you for having me.

Susan Jara  18:22

This is “Informed Immunity.” Thank you for joining us on this audio guide. Remember, the fight against infectious diseases is a community effort, and your participation is crucial. For more reliable information on vaccines, and to stay up to date on the latest in public health, visit our website at ghlf.org, or check out the Centers for Disease Control and Prevention, or World Health Organization website. This podcast was made possible with support from GSK. If you enjoyed this episode, please rate our podcast, write a positive review. and share it with your friends and family – It will help more people like you, find us. Until next time, stay informed and stay healthy. Together, we can make a difference.

Narrator  19:07

Be inspired, supported, and empowered. This is the Global Healthy Living Foundation Podcast Network.

Narrator  00:00

Be inspired, supported, and empowered. This is the Global Healthy Living Foundation, Podcast Network.

Susan Jara  00:11

Welcome to “Informed Immunity: the Podcast Dedicated to Bringing you the Latest Evidence-Based Information on Vaccines, Community Health, and the Fight Against Infectious Diseases.” I’m Susan Jara, Director of Patient Education at the Global Healthy Living Foundation, and your guide on this journey to better health. In this audio guide, we explore the future of vaccine research, focusing on advancements that could impact chronic conditions. Today, we are joined by two experts: Dr. Philip Dormitzer, Senior Vice President, and Global Head Vaccines R&D, and Infectious Disease Research at GSK; and Dr. Jamila Louahed, who leads the Global R&D for Therapeutic Vaccines, and is the Belgium R&D Site Head, at GSK Vaccines.

Susan Jara  00:59

Hi, Jamila and Phil. Thank you so much for joining us today.

Dr. Phil Dormitzer  01:02

It’s a pleasure to be here. Thanks for having us.

Jamila Louahed  01:04

It’s a pleasure to be with you, Susan.

Susan Jara  01:06

Thank you! Phil, do you want to please start, and maybe just tell us a little bit about yourself, and how you’ve come to be on this podcast with us?

Dr. Phil Dormitzer  01:14

My name is Phil Dormitzer, and I lead Vaccines, Research and Development, and Infectious Disease Research at GSK. So, our basic job is to develop new vaccines, to maintain the vaccines that are out there, and the goal is, ultimately, to improve the health of people who receive our vaccines.

Susan Jara  01:32

Great, thank you! Jamila, would you like to introduce yourself to the audience, as well?

Jamila Louahed  01:36

My name is Jamila Louahed, and I’m working with Phil as a Global Head for therapeutic vaccines, and I’ve been passionate to really understand how immunology and immune system can really play a role to prevent diseases. So, I’m really happy about the success that has been done in vaccine and more to come in the future.

Susan Jara  01:52

Great, thank you so much! Let’s just jump right in. Phil, do you mind telling us a little bit about the current state of vaccine research?

Dr. Phil Dormitzer  02:00

So, it’s a very exciting time in vaccine research, because we have a number of platforms or technologies to make vaccines, that are really coming together. We have the new vaccines, like RNA vaccines, which played such an important role in the COVID-19 pandemic. We also have, for example, the RSV vaccine, which involves the new ability to structurally understand and engineer antigens. There are also new technologies for vaccines against the sugars on the bacteria (the carbohydrates), with a new platform technology we called MAPS. So, across of a variety of technologies target different kinds of pathogens. We have new technologies now being deployed for vaccines.

Dr. Phil Dormitzer  02:01

Great, thank you. Jamila, would you like to add anything?

Dr. Phil Dormitzer  02:07

Maybe just to add that many very true new vaccine has been done, thank to new technology, and as mentioned by Phil,many new technology to better understand the pathogen, together with new platform, technology has really helped to have vaccine for more have to treat diseases, like the RSV, who took 60 years to be able to have the first vaccine again,the RSV.

Susan Jara  03:04

Wow, 60 years. It’s really amazing just hearing about this research and just really helps reassure us that better solutions are on the way for our patient community. So, it’s really exciting. Let’s talk a little bit about some of the innovative approaches, that GSK is specifically using in vaccine development.

Dr. Phil Dormitzer  03:22

So, maybe I’ll mention specifically a couple of things. One is, you mentioned the RSV vaccine, you know the RSV vaccine, people struggled for years, really, since the 1960s to make an RSV vaccine. And it was a scientific, really breakthrough, that was made initially at NIH, when they found out that the antigen people used to combat RSV, the spike protein on the virus, changes shape, and they actually have to determine the shape of the molecule that elicited the most efficient immunity, and then, how to stabilize it in that shape. And then that really set off a new era in RSV vaccines, where attempts that hadn’t worked in the past, now, with this new knowledge, started working, and that led to the RSV vaccine. So, it was a clear example of a scientific breakthrough, that led to a technological breakthrough, that meant a vaccine target that people had struggled with for many, many years, now became a tractable target, and today we have effective RSV vaccines.

Susan Jara  04:15

And, Jamila, would you like to add to that?

Jamila Louahed  04:17

Again, I think if you look about the amount of data that now we can really capture a new technology. We have a better tool to understand how the pathogen really play a role, and together with this knowledge, we can transform this knowledge into something that can be used in the vaccine compositions. And the best example was mentioned for RSV; The same finding was used for the COVID-19 in the future, and we know now that many new technology is really unlocking new fields, like the carbohydrates. How can we overcome the number of serotypes that are associated with pathogen? There is now new technology that can overcome some of the hurdles we had in the past.

Susan Jara  04:56

Thank you. And can you explain a little more how targeting carbohydrates, specifically strengthens the immune response in new vaccine technologies?

Jamila Louahed  05:05

If you think about a virus, usually you need to unlock the key that the virus will use to enter into human cells, because it needs all the machinery of the human cells. So, if you find a key, you are in a good track to be able to have something that can really neutralize the virus. A bacteria; It’s a different animal; It’s bigger than a virus, and usually it has carbohydrates at the external level of the bacteria, and this is what you need to target; To be able to neutralize the bacteria. And the tools that you use for virus are different than the tool that you might use for attacking a bacteria, so having good technology that can induce an immune response against those carbohydrates will be very important.

Susan Jara  05:45

Great, thank you – That was a really perfect explanation, I appreciate it. Can we talk about some of the potential vaccines that are being developed for individuals who are living with chronic conditions?

Jamila Louahed  05:56

I think there is one area, where today, people does not value existing vaccines for chronic conditions. And I’m always very surprised to see that patient with heart disease, pulmonary diseases, or people that has some immunocompromise, they are usually much more at risk to develop a disease than a healthy adult, and they usually doesn’t think about having preventative vaccine that could help them to not work on their comorbidity status. So, I would say, first of all, I would really encourage that people that have some weakened immunity or have strong undermined disease to be able to use vaccine, like vaccine against the flu, vaccine against the pneumococcal bacteria, because if they get infected, usually they are much more at risk to have a severe diseases. That’s, I would say, the first chapter, which is making sure that adults, that has comorbidity, really ensure that they can prevent the disease.

Jamila Louahed  06:52

The second piece, which is more, how can we eventually, in the future, tackle chronic diseases through an active immunizations. I’d like to use one example that people will understand easily, is if you think about the breakthrough innovation that helped protect, again, Hepatitis B, very good preventative vaccines, which has been worldwide distributed. You are protected against developing a chronic disease. Unfortunately, many people have not been vaccinated, and they have encountered a virus and developed what we call a chronic Hepatitis B. Those patients developed this disease, because they have not been able to mount a good immune response, to be able to be protected. So, what we are really developing, usually, all our expertise, is to see how, eventually, can we intervene in those patients that has developed the disease, how can we reset the immune response, to be able to have a new treatment, to really have those patients to live better, because unfortunately, today, nothing really has worked to treat those patients. That’s chronic infectious disease.

Jamila Louahed  07:53

The other one, which I really like, and people tend to forget it, one of the best vaccines that prevent cancer, is the vaccine against papillomavirus, HPV. What if, tomorrow, we have more of those vaccines? That can eventually prevent cancer, which can eventually prevent some of the chronic diseases that are associated with those infections. And this is an area where we are actively looking for, because we have some successes that has shown that we are able to modify the course of the disease, and we really want to make sure that eventually we can really leverage the tool. There has been some recent findings, that suggest that by vaccinating adult, with a vaccine that prevents shingle disease, we might, eventually, delay some neurogenetic diseases, like dementia. If this turned out to be proven in prospective study, this is a tremendous opportunity to be able to tackle the disease, where today, there is not much it is working. So, if tomorrow, we can have appropriate treatment, we call therapeutic vaccine that can delay the disease, this would be very transformative, in the field of prevention.

Susan Jara  08:58

Wow, yeah. I mean, most people think of vaccines as protection, not prevention. So, it’s really interesting to hear them in this light and how vaccines, especially for people living with chronic conditions, can help with comorbidities and wow, I mean, if we could possibly reduce dementia risk with a shingles vaccine, you know that definitely makes the future feel brighter. Phil, did you want to comment on this at all?

Dr. Phil Dormitzer  09:21

So, there have been now a number of observational studies, that have seen an association between immunization against the virus, that causes both chicken pox and shingles, varicella-zoster virus, specifically shingles vaccination, and lower rates of dementia. What we don’t know, is if that’s a causal association or not a sympathetic association, they could be both caused by the same thing. So, what we need to know, now, is to figure out, is it a causal association or not? That’s going to take a lot more study. So, at this point, the reason to take a shingles vaccine is to prevent shingles. We will determine, through additional study, whether the association that has been observed, between taking a shingles vaccine and a lower risk, or delayed, dementia is causal or not.

09:21

Thank you so much for clarifying that. I know that there’s been a shift in public perception about vaccination with, you know, the COVID pandemic, and it certainly has influenced vaccine research as well. Jamila or Phil, will one of you want to kind of talk about this, how the COVID pandemic played a role in vaccine research and public perception of vaccine?

Dr. Phil Dormitzer  10:23

Sure, and maybe I’d mention maybe three brief things. First, one thing that the COVID-19 pandemic response with vaccines really taught us, is how, when everybody cooperates, how fast things can go. Wasn’t just industry; it was industry, it was regulators, it was physicians. Everybody was really on the same page, and we accomplished the development of that vaccine, as an industry, faster than anybody thought was possible. Second thing we learned, was a new technology. It was the first time a new technology, mRNA vaccines, which are very good at adapting quickly and being changed quickly when you need to, for example, when a new pathogen, like SARS-CoV-2 comes out, how quickly that can be deployed. The third thing we learned, it was a little more sobering, is that when you introduce new technology, it takes people a little bit to adjust to it. So, we also saw, although many people were very glad to get the vaccine, also vaccine hesitancy. And so it’s important to not only bring new technologies forward, but also to make sure that we provide people the information they need to feel comfortable, with those new technologies as well.

Jamila Louahed  11:24

I would add also: trusted information is key. I think people need to make sure that the information they get from a clinical study, but also from other key stakeholders, in the healthcare are important. And usually people doesn’t start by not thinking about vaccine is worse, it’s sometimes something that has been prone. So, making sure that the right information is shared, is really important.

Susan Jara  11:47

Yeah, I agree. I mean, that’s why we’re coming together today, you know, to make sure our patient community has trusted information from experts like you. So, I really do appreciate you breaking things down. Let’s jump to our next question: What role do chronic condition vaccines play in improving patient outcomes?

Dr. Phil Dormitzer  12:04

Really, one vaccine really comes to mind, that addresses a chronic condition, and that is the shingrix; the shingles vaccine. When you get infected with varicella-zoster virus, as a child, you get chickenpox. But the virus doesn’t go away; it goes latent in your cells, and it stays there, really the rest of your life, and can come back later in life as shingles; a painful condition with a rash that spreads along the root of a nerve. Now, you would think you got infected with this virus when you’re a child, you still have it, what good would immunization do? You’re already immune. But in fact, when you immunize, even people, who’ve already been infected, are now chronically infected with varicella-zoster virus, you greatly reduce the likelihood that they get shingles. And one of the complications that people really don’t like from shingles is postherpetic neuralgia, when the pain lasts even after the rash goes away. So, it’s an example of something quite surprising, that immunizing someone who’s chronically infected with the virus, has an immune response against this virus, by improving the response against that virus, you can actually prevent some of the long term consequences of that infection.

Susan Jara  13:07

Great, yes, a lot of people in our community talk about shingles and how painful it is, and it’s really important for them to get vaccinated.

Jamila Louahed  13:14

Shingles is a great example, where you are infected and this virus is part of your body, and if you think about many other viruses, can also be associated with the same chronic condition, herpes simplex virus, which is causing either Sol course or genital fpase. Those are important viruses to be tackled in the future, if you want to prevent the disease associated with those viruses in patients.

Susan Jara  13:38

Yes, thank you. It is, it’s not only preventing the disease, but improving quality of life as well, right? So, let’s talk a little bit about what patients can possibly expect from the future vaccine developments.

Dr. Phil Dormitzer  13:51

Maybe, I can mention a couple of things. Having seen the example of what RNA could do during the pandemic, it might be useful against other pathogens, that change a lot. Influenza comes to mind, where, although it’s not brand new, a new pathogen, every year, you need to update the flu vaccine to match new flu strains. So, that RNA technology that allowed us to respond quickly to the pandemic, may allow us to respond more quickly to changes in, for example, the flu virus. Another thing that might come along is, and this is just slightly off of vaccines, and that is advances in diagnostics. One thing we saw during COVID is the use of home diagnostic kits. Diagnostics are getting better, again, easier to use, so maybe not always for vaccines, but sometimes for anti infective drugs. The ability to test, even at home, for what you’ve got, may help you know what you should take. It can also affect immunization in other ways, as the ability to not only determine what people are ill with at home, but what they’re immune to at home, starts to advance.

Jamila Louahed  14:46

I think there is a lot of effort to make sure that we continue to innovate, to improve our vaccines, to have a better coverage, when it comes to protections. We are also looking to approach that can eventually provide more compliance and coverage for patients, who have vaccine that has a long lasting protection, is definitely an area that we are working on. Combination of vaccines is also something that can be of use for the patients, but also can help to be protected for broader pathogens. So, the other piece that we believe that can be also expected in the future is to have new technology that can have not only a long lasting protections, but better schedule. One can imagine that eventually, having schedules that are much more convenient for patients, might also have more coverage in the future.

Susan Jara  15:36

Yeah, long lasting protection, prevention. We talked about a lot of simple reasons to get vaccinated, and we also know it’s important for patients to stay up to date, in order to make better health decisions. It can help patients really learn about new or improved vaccines, that may offer better protection. With that in mind, can you please talk a little bit about where patients really should be going for vaccine research information?

Dr. Phil Dormitzer  16:00

Always good to be an informed consumer. And there’s a lot of information out there, some of it is good, but some of it is a little questionable. I think consulting your doctor is very important and making sure that you have a solid relationship with the primary care provider, because there’s a lot to know out there. So, sometimes it’s very helpful to have a reliable guide to work with. So, by staying up on the latest research from reputable sources, one can help sort truth from fiction out there, which is very important when you’re trying to make decisions about your own health.

Susan Jara  16:30

Yeah, absolutely. Sorting truth from fiction is key, right? And we talked a lot about vaccine myths in a previous episode of the audio guide. So, if you haven’t already, please go back and have a listen. Jamila, did you want to add any points?

Jamila Louahed  16:44

I think there is a lot of information that can be available from trusted sources. I think the WHO, the CDC, they areinformed scientific community, as well as journal, that can really be used. There is also patient advocacy, where people can also rely, so they usually are quite vocal, but this is where, for me, the more informed you are, the better you can make your own judgments, to be able to be efficacious.

Susan Jara  17:08

Absolutely. Maybe we can just wrap up: Is there a final statement or a few words, you think that patients should really keep in mind when thinking about vaccine and vaccine research?

Susan Jara  17:19

Great. And Jamila, can I turn to you at the same question? Any last parting words about vaccination research for our community?

Dr. Phil Dormitzer  17:19

Maybe a couple really simple things. First, ounce of prevention is worth a pound of cure. Human vaccines have really transformed the health of the world. There are many vaccines that we now take for granted; The childhood vaccines, they’ve been around for a long, long time, they remain important. When you take away vaccine coverage, these things, with rare exceptions, like smallpox, are really not gone forever, they’re still out there. So, it is very important to maintain current vaccines. And today, vaccines aren’t just for children anymore. We now see increasing importance of adult vaccination. We’ve had flu for quite some time, shingles, a little bit less long, pneumococcal vaccines also informed for adults, and now we have the RSV vaccines as well. So, the number of vaccines that can help prevent us through a life cycle, not just when we’re children, but when we’re adults as well, is increasing, and they make a difference.

Jamila Louahed  18:14

Maybe a provocative one. I want to say that, unfortunately, vaccine are a victim of their success; because many diseases have disappeared, and people tend to forget the benefits, that of the immunizations. So, it might be provocative, but this is really what has happened, unfortunately, sometime in patients, that people have forgotten, devastating disease that now we don’t see anymore. And the last maybe conclusion, I would say, there is no greater return on investment, that’s stopping disease before it’s start, which is what you do with a vaccination.

Susan Jara  18:43

Absolutely, thank you so much! And thank you, I really appreciate you sharing your research and breaking everything down for our community. Thank you for all the incredible work you’re doing to advance vaccine research. It’s really been a pleasure having you both with us today.

Dr. Phil Dormitzer  18:58

Oh, thank you.

Jamila Louahed  18:59

Thank you.

Dr. Phil Dormitzer  18:59

It’s a fun time to be in vaccine research.

Susan Jara  19:05

This is “Informed Immunity.” Thank you for joining us on this audio guide. Remember, the fight against infectious diseases is a community effort, and your participation is crucial. For more reliable information on vaccines and to stay up to date on the latest in public health, visit our website at ghlf org, or check out the Centers for Disease Control and Prevention or World Health Organization website. This podcast was made possible with support from GSK. If you enjoyed this episode, please rate our podcast, write a positive review, and share it with your friends and family. It will help more people like you, find us. Until next time, stay informed and stay healthy. Together, we can make a difference!

Narrator  19:49

Be inspired, supported, and empowered. This is the Global Healthy Living Foundation, Podcast Network.