- [Presenter] Live from your public media studios, WVIA presents Keystone Edition Health, a public affairs program that goes beyond the headlines to address issues in Northeastern and Central Pennsylvania.

This is Keystone Edition Health.

And now, moderator Tonyehn Verkitus.

- Good evening, and welcome to Keystone Edition Health.

Tonight, we'll look into the facts and myths surrounding vaccines and what you can do to protect yourself and the people around you from infectious disease.

First, WVIA's Paul Lazar has more.

- [Paul] From birth to the age of 18, most children receive the full array of vaccinations recommended by the Centers for Disease Control and Prevention in order to prevent contagious diseases like the measles, chicken pox, and polio.

The CDC recommends further vaccinations well into adulthood, but as evidenced in real time by responses to the COVID 19 vaccine, adults may have questions and concerns about the safety and purpose of vaccination.

The most recent data shows 67.4% of Pennsylvanians have been fully vaccinated for COVID 19, but there are many who remain hesitant due to health concerns or confusing misinformation.

For Keystone Edition Health, I'm Paul Lazar.

- Joining us tonight, we have Dr. Shubhra Shetty, Infectious Disease Specialist with the Scranton Primary Center; Dr. William Dempsey, Deputy Chief Medical Officer for the Wright Center for Community Health is with us as well; and also joining us is Rachna Saxena, Public Health Coordinator for the City of Scranton.

Rachna, Bill, Shubhra, welcome.

I actually want to start with you.

Considering the fact that we just dealt with this COVID 19 public health emergency and we're talking about vaccine and vaccine hesitancy, Can you just tell us a little bit about how vaccines help lower infection rates in the city?

- So vaccines, as you know, have always been helpful in bringing down any infectious disease, controlling the infectious, any infectious disease, but in particular, like COVID, when we saw the COVID cases were going up and we have got very high vaccination rates right now so I think it's really helped to bring the infection rate and right now, like when one county is in a pretty good situation with almost, they've got like around 74% partially vaccinated and fully vaccinate around 68%, and with booster dose though, it's not really that well, but it's still higher than and quite of other than counties and which is around 30%, so it did help to control the vaccination and our death rates are actually 752 death count actually.

And so it's like as compared to other counties, I would say that it did help and we did see a lot of hospitalizations and all those things, but it still like it was.

I think the vaccinations helped to control the infections and all those things.

- Bill, why do you think that people have vaccine hesitancy?

I mean, what are the reasons that your patients give you most often?

- Well, I think it started maybe 10 years ago, with autism, where a lot of parents were concerned that the incidence, the increasing incidence of autism was associated with vaccinations and so a lot of parents decided not to vaccinate, so it started, not a lot but a number, but that started with that, and then lately, it was really blown up because it became a political issue and it really never should have turned into that but it did, but I always say whether or not you should be vaccinated, it should be a decision that you and your family doctor makes at the same time.

Anyway, the pros and the cons, I mean every vaccination has risk benefit, and you have to look at your individual situation and measure what's the risk of that vaccine in the possible benefits that you get from and then make that decision, but you have to make it without a lot of emotion involved and too often, it's such a hot potato that gets really difficult for some people to put their emotion aside and their political ideas to the side and really look at it objectively.

- And what percentage of your patients are you saying you're having a conversation about the need for vaccines with?

- I talk to all my patients about vaccinations.

I'm a big advocate for adult vaccines, so I always want to go over all the vaccines that are available for adults right now and whether or not they should have them, and then with children, anytime we have a well visit with the child, we make sure that all their vaccines are up to date, and a lot of kids got behind with the COVID epidemic because they weren't getting their well baby in their well child care, and so we're really working on trying to get those children caught up to where they should be.

- Bringing healthcare to the public can also help promote public health.

We caught up with the Wright Center's mobile health unit to see how they're reaching diverse populations.

- In 2020, the Wright Center for Community Health established the Driving Better Health, which is a mobile medical unit.

A lot of our population either don't have insurance or unable to make it to the doctor's office so we are able to bring their primary care physician to them.

We have helped schools with catch-up vaccines, we have gone to high rises for the elderly population that aren't able to leave, we have also helped with shelters for those that are affected by homelessness.

We have, however, had patients that are hesitant to get the COVID vaccine or to get the flu vaccine.

They always say that when they get the vaccine, they get sick from it.

Any response that they have from it is your body's natural immune response to prove that the vaccine is working and it's protecting yourself from it too.

The biggest thing to help with those that are hesitant for vaccines is just the proper education by coming to the professionals who have studied this, who have experienced it, who deal with it on a day-to-day basis as opposed to reading something on social media or looking something up online.

Our mobile medical unit allows for us to bring bilingual healthcare professionals that come, and it really helped open their eyes to say that they're not alone, that just because they don't speak English doesn't mean that they're not going to get the proper medical care that they need.

We've had patients that have come from Puerto Rico, Canada, we've had India.

They are aware now that they have a clinic that will not only come to them but their children could also come to us as their primary care physician as well.

Without Driving Better Health, a lot of patients in a lot of underserved communities, such as those in rural areas, the elderly, those experiencing homelessness in shelters, they would be unable to get proper medical care that they need and that they deserve.

- Shubhra, Rachna mentioned that not all of the population is fully boostered, why is it important for people to get the booster?

- Yeah, I think it's critically important for people to get the booster because it turns out that the first two doses, the vaccine are very effective, but clearly getting the booster revs off the immune system even further and the immune response.

So what's been seen is that the rates of people getting new infection with COVID, and more importantly, prevention of hospitalization and deaths is reduced if the person is fully vaccinated, which today means somebody who's also had the booster.

So one thing to emphasize is that the whole point of COVID vaccination is to prevent people from getting sick enough to end up in the hospital or dying.

That remains the goal, that's why the vaccines were developed.

Early on, the vaccines actually prevented infection from occurring but as newer strains have come out, what we've seen is people can get infected but they don't get that sick.

So I think that's the main thing and as you know, we're now talking about a fourth booster, potentially, for some portions of the population so I think the story hasn't been written yet about where we're gonna end up with this.

- So when we talk about vaccines and the benefits and efficacy, of course, people also talk about the side effects.

How do you explain to people why side effects happen?

- Well, I usually, I use a bell-shaped curve when I talk about vaccinations, with any vaccine.

90% of the patients or 95% of the patients get the vaccine and they do quite well, but there's a percentage on the one side where the vaccine didn't work, and you hear the stories, "Well, my mother-in-law got that vaccine and she ended up intubated in the hospital."

So that particular patient, it wasn't effective for and then on the other side, you see the side effects and we all have side, could tell stories, I mean I had a senior, well, my wife's uncle, he's about 82, he got vaccinated and he got paralyzed from the vaccine.

I mean, it's very rare, it's a one in a million case but those are the situations you hear about and that's what they publicize.

They don't talk about the vast majority of patients who get vaccinated and do quite well.

You know, we saved thousands and thousands and thousands of lives with the vaccines that we've given for COVID as of late, but when I was a young man, the pediatric floors were filled with kids that were ill, with pneumonia, meningitis, epiglottitis, all sorts of god-awful illnesses that we don't see anymore.

The pediatric floors now are closed because all these children have been vaccinated and they don't see that hospitalization.

I used to do a spinal tap, probably once a weekend on a baby, looking to see if they had meningitis but it was sad, all these children that were so sick because we didn't have the effective vaccines that we have now.

But everybody wants to focus on that case that didn't do well, and that's what you see that the newspapers and the talking heads and social media wanna grab a hold because they're interested in getting viewership and they wanna sell marketing, they wanna sell advertising so doom and gloom sells, unfortunately.

- Rachna, I know that during the pandemic you helped to create a COVID 19 dashboard.

Can you tell us a little bit about the creation, but also how that helped you to get people vaccinated as well?

- So like we just scale back a little bit, like we started when the mayor actually, she created a recovery task force meeting so on that, all the medical institutions and educational institutions were there to discuss, every week there was a meeting, Wrights Center included, Dr. Shubhra Shetty was there, hospitals were there, and they were discussing all these things.

Every week, she would get the update.

I was volunteering at that time, so this started almost like in June 2020, and then we continued with that and during this time, the city was contacted by Bloomberg Harvard Association City Leadership, BHCLI it's called, and they helped us to create city COVID 19 Dashboard.

So now if you go to the Pennsylvania website, it's very complicated, whereas we work with them.

So me, doctor, sorry, fire chief, the previous one was El Lucas and then now the present one, Chief John Judge and analytics person.

So the DV3 had worked together and helped to create this dashboard.

And it just was very helpful basically to inform the public because they would get to see how cases were there.

We would put out the vaccination numbers just to help them understand what is going on.

I hope people saw them, but at least our team plus there were non-profits who I told them, like this dashboard is there and they were able to get that information.

And I think that really helped because they could see the current case numbers, which were not the displayed on the Pennsylvania website, whereas there were counting web numbers.

So it really helped to keep people informed, it is still going on and we updated the guidelines on that, I generally like do it by myself and I try to keep it updated, the guidelines, everything, whatever we can do, keep it current.

So I think it was really a good initiative and it really helped people to keep them informed.

- How do you think living through this pandemic has helped inform how you would respond or physicians in general to another infectious disease outbreak in the future?

- It's a great question.

I think there are so many lessons learned through this pandemic and to be honest, we're still learning, we have to have humility as we approach this because I don't think the full story has not been written about COVID as yet.

I think what it brought to the forefront was how poorly developed our public health system is, how scaled back it has become over the years.

So when the pandemic hit, we were really not prepared as a nation, where a lot of public health systems have been decimated over a period of time, so they had to be scaled up.

Some countries responded better than others, where they were able to quickly test and isolate, initially, now test and treat, I think is the big mantra.

But I think the lesson is learned that you need to have a public health infrastructure, you need to have trained people like Dr Saxena and others who can respond quickly.

You need to have a workforce that is willing to go out there to say, give vaccination to people's homes.

When we are looking at the numbers right now of 70 some percent, we have a vaccine for this, this is the fastest a vaccine has hit, has become available.

It saves lives, but a good 25, 30% of population hasn't had seen and I think there are still people who are just not aware or haven't quite grasped what that means.

I wish we could go out more into communities, go to people's homes and offer vaccination.

There is a precedence for it in other parts of the world, where you go house to house and offer vaccination.

So I think the lessons learned are: A, to be able to identify something quickly when it happens, B, the appropriate response, which is science based and not political, third, developing a vaccine, developing treatment quickly, which we've had some such us with that.

But I think more importantly, correct information and less disinformation, some regulation of that quicker, I think is necessary as we look forwards to what is likely there will be pandemics again, this is the history of viruses and bacteria, it's an arms race, we are all in.

- This is our first pandemic in a sense, right?

And I feel like we often think that diseases have disappeared forever, but what we forget is that we all get vaccinated for them and they still exist.

So I'm glad you brought up the speed of creating the vaccine, because I think a lot of people question the speed and therefore the efficacy and whether or not they should even take it because who knows someone might end up paralyzed.

So how are we able to create vaccines so quickly and so effectively?

Anyone would like to speak to that?

- Yeah, I mean, I think this is such a triumph of science that we have these mRNA vaccines that became available so quickly, the technology had been around for a number of years, it was just that this pandemic created a need for it to be developed very, to sort of revved up development and to come to market quickly.

And I think if they've saved millions of lives.

I could not wait for the vaccine to become available and I certainly didn't want to push anybody else out of line, but the moment healthcare workers were able to get the vaccine, I was ready to get it.

When folks like us who study this, dealt with illness, infectious disease, over a period of time, we were just wanting to get the vaccine because we knew what was coming or what was happening around us.

So I hope that gives the public some reassurance and I want to touch on something you said earlier about vaccine hesitancy.

One of the ways I end up addressing it is I'm like, you know what?

I got it, and not only that, I got one, two and three, and now let's talk.

So I think there are many things you can do in terms of addressing patients legitimate, sometimes legitimate concerns.

But I think they've saved millions of lives.

And as Dr. Dempsey mentioned, people tend to focus on the few negatives that occur, which can be coincidental also it may not be direct cause and effect.

- It's very frightening as a clinician when this epidemic occurred, they said, "Okay Dr. Dempsey, go and take care of those people."

With what?

Well, can I have a mask?

No, there are no any mask.

A gown?

No gown.

Shield?

Nah, no shield.

So you want me to go to take care of these patients, I don't even know what this disease, where it even came from, I don't know what the mortality and the morbidity is when it first started, it was terrifying.

When I came home at night, I separated myself from my family because I was terrified I was going to bring it home.

So we need to have PPE, the fact that we didn't have PPEs, personal protective equipment, was ridiculous.

Why don't we have that?

I was ordering online from China to get masks on my own, to just to try and do what we could do.

I said, the fact that this wasn't available is inexcusable, that we didn't anticipate this, our government should have anticipated all of that, but there's a lack of trust unfortunately with the government by a lot of people, there's a lack of trust with big pharma, and the money is associated with that.

We have to try and get past all of that, and that's what our job is, as primary care clinicians is to sit down and look at that.

I mean the third booster has been shown to be really effective in boosting.

Now the fourth one, you know what I'm reading, that doesn't have the promise that the third one had at this stage, still early, but they're saying, I don't know.

And then the flu vaccine is another issue.

The flu vaccine that they, each year they try and anticipate how that's going to mutate.

And sometimes they hit it and sometimes they don't.

They missed this one, now we didn't have hardly any B.

So it's hard to say, they separate flu into A and B.

So there was hardly any B, there was a lot of A, but they missed it, it's only about 10% effective.

- So with things like the flu that are constantly changing, I'm going to guess that's something like measles isn't constantly changing.

So once you created the vaccine, you have it and that's it.

So it makes it easy to understand why folks would then feel a little like, well, why should I take this if it's not necessarily gonna work?

So how do we go against that argument?

So when you are still doing vaccine in clinics, for instance, how are you convincing people?

No, really come on, get the second and the third vaccine.

- So the same thing that it'll be protecting you against being severe and getting hospitalized.

And it'll also for the people who are like healthy, you'll protect others from getting sick.

Those who are at high risk, so that's why you need to get not just for yourself, for the community, so that's why, it's like a duty kind of thing.

Like when you have to do things to protect others.

So that's what we try to tell them and on Dr. Shetty's thing about the community clinics.

So we have been trying from the cities that we have tried to reach out to the community where we could, they could come easily, they didn't have a transport problem.

We went to the high rise buildings for past three, four clinics, we have done that.

And they were pretty successful because they could just walk in and get the vaccinations there.

There was one mom, as I remember, she had a baby at home, but she sent her two kids to get vaccinated because it was just in the proximity.

So I think, so we are going to continue, we couldn't earlier, because Omicron, it was highly infectious, we couldn't want to do in the short confines, but now maybe we will try to do that, just as Dr. Shetty said.

- I think there's one other point to be made, which is that the mortality, the death rates with COVID are much higher than that for influenza.

It's a new virus and it's a little different.

So influenza is something which shifts every year, it seems like, and you try to predict what might be coming.

We may get to that point with COVID, we're not there yet.

Right now we're still sort of responding to the new strains that are coming up and the possible mutations.

So people have probably heard, so there was the initial SARS-CoV-2, then there was the Delta, there were a few others in between, and then Omicron kind of hit it big, starting in South Africa, Botswana is where it was described initially.

And now there's another variant that's been described, the BA.2.

And there's a study from New York city that about 30% of COVID infections in New York right now are the BA.2.

So there will continue to be some mutations in the virus, changes, so far it looks like the BA.2 is kind of behaving like the Omicron, but I just wanna caution people that are like, oh, Omicron wasn't so bad.

It wasn't so bad because so many people were vaccinated.

The same Omicron wave killed a huge number of people in Hong Kong, especially the unvaccinated elderly.

And the reason they weren't vaccinated was because of disinformation because they didn't want to take the vaccine that was available, there were two vaccines, the Sinovac and the mRNA vaccines, so there was a myth that it's dangerous.

So lots of elderly people who are not vaccinated.

So lots of people died from Omicron in Hong Kong, which had been spared thus far.

So is it that it behaved less terribly in the west and in other parts of the world where the vaccination rates were high because people were vaccinated.

It's not necessary that the virus itself had become less vigilant.

So some of this, we are hoping that like the Spanish flu from a hundred years ago, that with time the vaccine, the virus, I'm sorry, will mutate to be less deadly, maybe more infectious, but less deadly, but we don't know that yet.

- So if we had a goal, let's say of how many, what percentage of people should be vaccinated when we're talking about any infectious disease to protect the public?

Is there a goal number?

- Yeah.

So it's very interesting.

It's different for different diseases.

So early on in the epidemic, I don't want to get too technical, but there is this number called the R0, which is the number of people that can get sick if they're exposed, people who've not had vaccine, have never seen the virus before.

So that number kind of tells you how many people can be infected by disease.

So measles, the R0 is like 14 to 18, it's high, with COVID, the initial COVID, it was about three or so, 2.53, Omicron was closer to five to seven.

So the number of people or the percentage of people that need to be vaccinated for prevention depends on those numbers.

- Okay, well, I guess we better try to get close to those numbers.

- There are things you have consider, is now there are treatments too.

Early on we didn't have treatments.

So now we have monoclonal antibodies and we have antiviral medications that have been very effective as well.

- But I think that's actually gonna have to be a different show.

- [William] But that all comes into the vaccines.

- I would like to thank all of our guests for joining us tonight.

I'm Tonyehn Verkitus, have a good evening.

Thanks everyone.

(instrumental music)