From Sky news.

This is connections.

I'm Raquel Stephen.

Today we're talking about something that touches nearly every family in Monroe County.

Vaccines and public health.

From required school shots to shifting federal guidelines and the return of measles in nearby communities.

The conversation around vaccine is evolving.

We have two guests to help us untangle all of this.

Doctor Marilyn Aviles, they.

Brown is the commissioner of the Monroe County Department of Public Health.

She joins us to walk through local vaccine requirements, new guidance, and what public health looks like in a time of deep skepticism.

Doctor Vilas de Brown, welcome.

Thank you so much for having a pleasure having you here.

And we're joined in studio by Doctor Andrew Cox.

We're going to call him Doctor Andy from here on out.

He's an attending physician in pediatric infectious disease at Rochester General Hospital, as well as the associate director for infectious disease and immunology research for Rochester Regional Health.

Welcome, Doctor Andy.

Thank you so much for this opportunity.

And of course, our listeners, my co-host that are listening to me, call us at 1844295 talk to join in on the conversation.

That's 855 or at (585) 263-9994 or email us at connections@wxxi.org, or just comment right in our YouTube chat or channel.

Start off with Doctor Vilas de Brown.

We've seen some confusion nationally about vaccine schedules, especially after new CDC and how announcements.

Can you clarify what's required here in New York versus what's happening at the federal level?

Sure, sure.

So all children that are going to go to school, whether that's pre-K daycare, K through 12th grade, they're required to get a number of, just basic expected vaccines.

So that's the measles.

Mumps.

Rubella.

Varicella.

Diphtheria.

Pertussis.

Tetanus.

Help me out here.

There's the whole laundry list for for much younger children.

If you're going to pre-K or daycare you need to get, Haemophilus influenza or Hib.

And as we age and get into the teenage years, we start to need booster shots for tetanus booster shots, a meningitis shot.

When you get into seventh to 12th grade, you need a booster after your age, 16, to go to college for meningitis.

And we always recommend, even if it's not required, that folks also protect their children from the human papillomavirus.

So HPV and the seasonal flu and the seasonal Covid vaccines.

Yeah, a lot to keep up with as a parent a lot.

Now, I know New York no longer allows non-medical exemptions for school vaccine requirements.

What counts as a valid medical exemption?

So there are certain conditions that would impact a person's immune system where, if we gave a live vaccine, it might actually make the person sick.

And so some of those folks can't actually get those vaccines.

But those medical exemptions are actually the conditions that would make someone eligible for a medical exemption are pretty rare.

So the majority, the vast majority of of adults and children are eligible to get the protection that they deserve and that the rest of the community deserves by getting these very safe vaccines.

And have you seen an uptick in exemptions?

Request?

You know, those requests don't actually come to our department.

So I can't speak to the rates.

Certainly that is a trend.

There are concerns.

There's a lot of misinformation flying around, in online, in regular media.

And so folks have more questions.

But the vaccines are safe and they're effective.

And I certainly get my kids every vaccine that they are eligible for.

I take the flu vaccine, the Covid boosters, every year to protect myself and to protect the people around me.

Yeah.

Thank you.

And, Doctor Andy, I want to get into some of your, your research, as well, which focuses on infant immune responses to vaccines.

Correct.

Doctor?

Andy.

Yes?

What are you discovering?

So we are discovering that, the protection afforded by vaccines, does not affect every single infant equally.

There are a small percentage of children who we tucked term a prolonged neonatal immune profile for whom they don't get the full protective benefit of the vaccines.

And so they're even more dependent upon the rest of us and the herd immunity that we can all provide by getting our vaccinations.

And are there ways to identify kids who might not respond to vaccines?

Absolutely.

Right now, we can identify them after the fact so we can identify them by the frequency that they have ear infections through the first two years of life.

We can identify them by looking at the responses that they have to the required vaccines.

But we are still looking and have not yet found that, factor that we could look at at infancy or at that first visit at two months that would predict the children that would go on to, need extra protection.

What kind of interventions or technologies are emerging to improve a vaccine response?

Thank you so much for that question.

You're welcome.

So one of the things that we are doing is diving deeper into what best orchestrates a robust immune response to a vaccine.

One of the things that we can change in vaccines is one of the components called an adjuvant.

That's a piece that's not part of the vaccine itself in the in the immune response that you gather, but helps educate your immune system on how to respond to that.

Right now there is research going on into additional adjuvants that can be used to better educate the immune system beyond the ones that are currently used in our vaccines.

And do you have any concerns at all that that this is being misunderstood.

And and it might feed the idea that vaccines don't really work.

Absolutely.

That's why I thank you for the question.

So the it is not that vaccines do not work in these infants.

It is that the way that their antibody responses change?

Do not go up as much as other children.

So for example, one of the great, examples of this is the pneumococcal vaccine, where that shot that you get the protects now against 20 different types of pneumonia, the level of antibodies that you need to protect against really serious infections, like brain infections is relatively low.

And pretty much all infants meet that.

But there are some infants who don't have enough response to block infections that are not as invasive, like an ear infection.

And so for some of the children, they have a response to the vaccine that protects them and keeps them out of the hospital, but they may not have enough of a response to necessarily blunt the ear infection from occurring.

All right.

That's a lot.

Doctor Cox, I hope our listeners are following.

Let's talk about this big change that happened this year, the Covid vaccine, right, vaccine for healthy children and pregnant people, were removed, was removed from the CDC's recommended immunization schedule.

What does that mean for families here?

Well, currently, we haven't actually seen any, changes from insurers, choosing not to cover those vaccines yet.

That is now a possibility, a frightening possibility.

But actually, the American Academy of Pediatrics just put out their own recommendations this morning.

Yesterday was really, really recent.

That they still recommend it for pregnant women for, for all of those populations.

And, you know, the HHS secretary, right.

Robert Kennedy Jr, called this change a step toward making America healthy again.

But critics say it could make it harder for families across, families to access vaccines.

How might this affect insurance coverage?

As you said, it doesn't or not yet.

It doesn't yet.

And that still stands to be seen.

So, many of these changes are quite concerning to me, to many of my, you know, health care colleagues.

And, so we are hoping that, insurance companies will realize it's cheaper to prevent illness than to treat hundreds of thousands of people in the emergency room, God forbid, in the ICU, in the intensive care units with, you know, severely invasive, you know, meningitis, other types of infections.

And so we're hoping that that financial incentive will maintain coverage.

But making those changes in policy could lead to these ripple effects that would make our communities much less healthy.

Yeah.

And in actuality, and with the layoffs of the the expert panel at the CDC, expert panel, Doctor Vilas Brown, your face is showing me a little bit of frustration, too.

I know, on YouTube.

Hey, can you tell the public what could be the effects of, of of this?

So the Advisory Committee on Immunization Practices, it is a body that was created to review all of the research to take in not just cherry pick one study and one line out of a study to raise hysteria or concern.

It's to look at all of the different studies, to take the new research, integrate it with what we know already about how the body works, published research, and come to the best evidence based recommendations for when we should start giving vaccines at what age, which communities are at risk, which communities members or which conditions shouldn't get the vaccine so that we can maximize the number of people who are protected and those of us who can get the vaccine, thereby protect those who can't get the vaccine.

But now, if we are going to remove immunologist pediatricians, family docs Epidemiol.

Just people that actually understand statistics and know how to read all that science mumbo jumbo and turn that into policy, well, now we're going to end up with, less science based decisions that, is going to impact the rest of the community.

It's going to make us less healthy.

And we're bringing up science.

What does what does the science say about the risk of all of this?

Vaccines have never been safer.

I mean, we have decades of research and just lived experience giving people these vaccines to demonstrate that here in the United States, rates of measles, for example, used to be even far, far lower than they are now.

And as fewer folks get vaccinated, as more folks request these alternate schedules, instead of following the traditional schedules, that opens the door, opens the possibility for folks to be exposed and then contract these illnesses like measles, and then spread it around to other communities.

So that has unfortunately already led to pediatric deaths in Texas, in other places in the country.

Now, when we almost eradicated measles from at least this continent.

And if we take the comparative, study approach of rates of vaccination in the United States compared to low resource countries that don't have high enough rates, they lose many, many more pediatric children to these preventable illnesses that lead to death when they don't have access to the resources that we so abundantly have access to here.

So all of this concerning conversation, it increases fear and it drives well-intended people to, have less vaccine confidence.

And that could have devastating, life altering consequences.

And how is this affecting the way you both talk about vaccines to families, doctor?

And so as a pediatric infectious disease doctor, I normally see them when their children are sick with something.

I don't have the opportunity to take care of healthy children very often.

But it's a part of every conversation with every family that I see in the hospital on.

Are you up to date on your vaccines?

I know, but the answer is before because I can see the medical record.

But then I ask them and why not?

And it's an incredibly important chance for us as providers to listen to what our patients have to say, to understand their concerns and to be able to answer the questions they have about safety, about why so many shots in so few years, and to be able to educate them that we've saved by better estimates, over 100 million children's lives in the last 30 years worldwide with vaccinations, that's a pretty incredible number of children that we've been able to protect.

Yeah, yeah.

And so as an outpatient provider, I'm a family doctor.

I see children at Starlight Pediatrics, which is a clinic that the county runs for children in foster care.

You know, I get to have conversations to teach people, you know, you're a child's body can handle these vaccines.

Your their immune system is fighting way more infections every time they stick their grubby little fingers in their mouths or eat dirt, then the the whatever the germ or pieces of, the microbe might be in a vaccine and so their bodies can handle it because they're doing it every day.

We're just giving them the option to the body, to the opportunity to build that protection early, because that process can take, I don't know, up to two weeks.

When you first see a new microbe, a new bug that your body's never been exposed to, but the next time you see that germ, that virus, your body can respond quickly in a couple of days.

And so we want to give kids that protection so they don't end up under Doctor Andy's excellent care.

But let's be honest, they'd rather see me in the basement than see you.

And, you know, we're we're talking about the confidence in vaccines and vaccine hesitancy.

Right.

And a lot of, demographics are people have this mistrust or distrust with the medical aid, and for valid reasons, women and people of color.

Yeah.

Yeah.

Let's be honest.

There's a history of abuse, of, not honoring people's consent, of using people's bodies for research in the past, in the long past, like decades ago, past.

And so that that is valid and that is real.

And we have to address that.

But we now have so many protections and checks in place.

Anyone who's doing research, who's at of any kind has to get approval and to do research.

When it gets to the point of not just using a petri dish, not just using mice, but a human being, the protections that have to go are put in place.

I mean, I don't know how long it took you to get approval, but it's probably a really long time so that we can protect folks so that we can make sure we're doing research, especially if it's a vulnerable population, like children, people who are incarcerated, you know, there are there's an entire system built to protect folks so that we can take that next step and develop that next better, even safer than the already really safe vaccines that we have right now.

And Doctor Andy, for those who have this mistrust with research.

Right.

And what research is actually discovering, what would you say to them?

The first question I normally ask is why?

So try and understand what their fear is.

Again, the past hundred years we as scientists, especially the United States, have not always conducted things as ethically as we should have.

And so that's something we have to be able to admit and ask apologies of those communities for.

But then the next question is, do you want more children's lives to be protected against diseases that lead to hospitalization and lead to death?

And the the way to do that is to continue studying what happens.

So in addition to studying infants who have poor responses, we also study infants who have really robust immune responses to vaccines.

Again, to be able to characterize what aspects of those responses can we heighten?

Can we make our vaccines just as safe as they are now, but increase protection even further from the greater than 90%?

We are for most of our vaccines in people who may be vaccine hesitant.

Right?

There's a difference between being vaccine hesitant and anti-vax or.

Yeah, so there's there's a number of different terms.

I would argue we need to build vaccine confidence no matter who we're talking about.

Right.

Because, I think if we asked that question, do you want your child to live a happy, healthy life?

Everyone universally would say yes.

And so exploring that the the concerns and understand the nuance of is it a historical factor?

Is it my child has this particular condition and I don't know if, this vaccine is going to interact with that.

That's the job of, our pediatricians or family docs or advanced practitioners and so many places, to really figure out what is the concern, because we have valid, rebuttals, honestly, to a lot of the myths that are out there.

And I don't want to go into all of them because I don't want to give them airtime.

But the vaccines have been vetted very carefully.

They're not going to alter your body in a negative way where you start being you.

We're just using the power of someone's own immune system to protect them ahead of time before they're exposed to that germ.

It's like we don't put a helmet on a child when they're falling off a bike.

You put the helmet on before they even start writing so that if they have a dangerous incident, they're protected.

Yeah.

And I what I just want to ask, like, what role do you feel like physicians and pediatricians in schools play in either reinforcing trust.

Oh well so we can build it one patient at a time having these conversations that we've already mentioned.

We can also use our voices to speak and testify the way so many folks have with these governing entities with, you know, hearings that hopefully will continue to, occur at the federal level.

We can continue to well, not me.

My job doesn't let me advocate because I work for the government.

But any other physician and health care provider can call their, you know, elected officials at the state at the national level and just share the information.

These are the facts.

And these are my patients that I'm concerned about.

And I don't agree with these changes.

And how can we protect and deflect some of the worst case scenario outcomes that we we can already anticipate are coming down the pike, but it's a one on one level.

It's making sure our institutional policies are in line with removing every possible barrier to vaccination, whether we set up, you know, remote clinics somewhere else, whether we facilitate transportation barriers to get folks to, those appointments and even for adults, you know, can we encourage our employers to offer, sick time policies so that folks can get time off and take their child or get themselves vaccinated without threat of losing their jobs?

There's so many barriers, and we as health care providers can speak to all of those different levels.

Yeah.

I have a comment from a, someone on YouTube.

Arielle, on it appears that the county's Department of Public Health data on Covid levels in wastewater has not been updated for several months.

Does the commissioner know why this is the case?

Yeah.

So, so testing for Covid in wastewater is a really interesting, potential way to monitor for what the current infection risk is.

There are a lot of community partners that are using those data.

We happen to have other sources.

We we get information from hospitals.

We get some of those data about, who is, testing for Covid.

We get positive and even negative results.

It's a reportable disease.

So we do have other means of monitoring the situation.

And there's only so much bandwidth to monitor every possible source.

Yeah.

And it seems like Covid is not it hasn't gone away.

Oh, it's not going to go away.

It's here to stay.

And so that's why I say every year get your flu and your Covid shot.

So that your body can maintain protection to whatever the, the newest, strain of the, of the viruses and doctor Cox.

Andy.

Doctor Andy.

What do you hear most from your your parents and your patients?

When it comes to vaccine and to a lack of confidence.

Lack of confidence.

Yeah.

So one of the things I think is a consequence of all the progress we've made in the last 20 years, in that the vaccines that even I received as a child in the 1980s are a much smaller set than those that we give now.

Because we've been successful at research, we've basically eliminated, Haemophilus meningitis from the US.

My training as a pediatrician was vastly different than the the generation that came before me.

So a lot of it is the pace of change and families, having questions that providers may or may not be granted time to answer.

So a lot of it is the pace of change and being able to explain what the purpose for the individual vaccines are that they have questions about.

Yeah.

And the Covid, the pandemic really, stepped up this the skepticism.

Right.

Because we're watching this in real time.

We're watching our physicians who we're supposed to trust say, I don't know.

And this this could really add to this fear.

And so some of us had the benefit of getting to be on webinars talking about, you know, how the vaccine was, produced so quickly and air quotes here for those who are listening that watching on YouTube.

You know, we've had RNA vaccine technology for 20 years before Covid came along.

It's just that you and I didn't know about it because it was in the military.

It was in the research stage.

And so when the entire world shut down due to this novel virus, all of those research, money and brainpower and resources were directed towards one thing.

Well, of course you're going to make progress faster than anything, ever.

But also so you can probably speak better to the different phases of clinical trials.

But normally you do phase one testing and then you analyze the data.

And if you decide to proceed, then you do phase two and you analyze the data and then phase three, and you can give it to people and continue to do analyzes and make sure that in real world use of the vaccine, we're not seeing negative outcomes that you just couldn't see because you had too small a population.

So all of those phases were compressed, so they overlapped.

Instead of being one sequential after the other, they started being kind of staggered to move this quickly so that we could protect lives.

And so some of us had the benefit of being on those webinars to learn about that and being able to share that information.

But that information wasn't, as quickly disseminated as we would have hoped.

So that's why even some of our own colleagues were a little bit concerned to something shady going on.

No, it's just that we compressed everything and every resource was trained on this one disease.

Not, you know, there are Celan and, Hib and measles and all these other things.

So that's why we were able to make these kinds, this kinds of progress.

But I mean, you already mentioned, Andy, that the rate of change of improvement has been accelerating already, even before covet in Doctor Andy, as, as a researcher, I would love to hear your response to this.

Like watching everything happening in real time.

With the Covid vaccine and mRNA, it was incredible.

It's the first time as humans, we've been able to abort a pandemic period.

We've not been able to do this before.

When previous pandemics have gone through the world, the survivors or who was left and the world either had survivor immunity or they didn't survive.

And with this pandemic, we were able to save millions of lives because thanks to decades of work, we could create a vaccine.

While the pandemic was still occurring instead of the normal process of ten years later, we can actually have a product that mimics the response that we need to see in humans to protect them now and this, this, this technology is way different than what we use for influenza right now.

There's flu vaccines that have it in it.

And so what are we what is a what is what's next like a week where.

Yeah.

So the thing that just came on the market from a what's next perspective that is thrilling to me as a pediatrician is the vaccine against respiratory syncytial virus or RSV.

We now can give moms a vaccine during pregnancy to protect their infants, and we can then give infants of a vaccine.

It's an antibody, that works the same as a vaccine, but it has slightly different ingredients to protect them, and that has reduced the rate of infants entering the hospital with respiratory infections by 80 to 90%.

That's fabulous.

So the goal is to be proactive not reactive.

Yeah.

Of course always always always.

And we're going to take a quick break.

And when we get back we'll hear more from the Commissioner of Public Health, Doctor Maria Velez.

They Brown and doctor Andy Cox infectious disease specialist from Rochester Regional.

Stay with us.

I'm Evan Dawson.

Coming up in our second hour we bring back a recent conversation and diabetes the latest when it comes to treatments, the latest when it comes to understanding how to deal with type two diabetes.

With effective management, type two diabetes can result in serious complications.

And there are some new developments to talk about.

You're going to hear them coming up in our second hour.

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This is connections.

We're talking with Doctor Andy Cox.

He's attending physician in pediatric infectious disease at Rochester General Hospital, and doctor Maryellen Aviles.

They Brown I'm getting way better at saying your name as it goes on.

As I keep saying it, she's a commissioner of the Monroe County Department of Public Health.

Now.

Doctor Vilas they Brown we were just talking about vaccine hesitant hesitancy before the confidence vaccine, about vaccine storing, vaccine confidence in Monroe County.

I want to ask, what is what is it like to serve as the public face of science and health guidance at a time when trust in the institution is declining?

Well, I actually had the benefit of being the deputy commissioner during Covid, so I was not, the target of a lot of really negative attention.

I'm really grateful, for my, my friend, my colleague Mike Mendoza, and for his very calm demeanor and just very straight shooting.

This is what we know.

This is what we don't know.

This is what you can do to protect yourself and your family.

So, it is, challenging at times.

It is very gratifying.

And it's a lot of work.

Yeah.

And you're also a Latina woman in in leadership role in public health.

First woman.

I'm the first Latina in this position, so excuse me.

Pardon me.

The first Latina in this position.

How has that shaped your approach?

Well, it hasn't changed what I do.

I've always been concerned about, you know, marginalized communities, folks that have been underrepresented in receiving care in clinical trials, and often folks who have higher rates of everything, you know, vaccine preventable illnesses included.

And so even before I was in this role, it certainly was, working within our department to make sure we're considering the needs of that community, working with many other partners to bring Covid testing Covid vaccines to specific zip codes, where we know people are living in poverty due to historical racism, systemic racism, you know, folks that are concentrated in urban centers of poverty.

It's not coincidence that they tend to be people of color, people that have been othered.

So LGBTQ community, all kinds of of minoritized groups.

So that work, preceded me at the Department of Public Health, and I was really happy to be able to step in and continue to advocate and make sure we're considering folks with limited English proficiency.

How do we get the information that we're sharing today to, refugees from Eritrea, from Somalia, like all these language?

I mean, I can educate in Spanish.

I can't speak all those other languages.

So making sure that we're considering and deploying resources to address those needs.

And I know one of the strategies, throughout the Covid and, and now is meeting people where they are, right.

How how why how important is, is is that well, is incredibly important.

There are what we call the social drivers or determinants of health.

A lot of people think, oh, my health depends on seeing my doctor.

It's really only about 20 minutes.

You get to be with your doctor a couple times a year.

So the things that actually impact whether someone's going to be healthy or headed towards illness often include things like where you live.

Do you have, a healthy place to live?

Do you have a place to live?

First of all, or are you unhoused?

Do you have transportation to get to, center to get care?

Do you have insurance?

And I'm going to talk about all that.

But we know that's changing in a, suboptimal way.

Let's say.

And so, you know, do parents have the resources to feed their kids?

Because if you don't have that, you're not going to be thinking about going to the doctor and getting these vaccines.

So thinking through, how do we address all of those other social drivers that can then free up the bandwidth to think about, oh, yes, my child needs their well-child check.

My child needs these vaccines before we get to September.

And oh my goodness, are they going to be excluded from school.

Yeah.

And you know, with this influx of patients and it seems like our our doctor is still establishing that rapport with their patients.

Because I know you have to you're smiling at me.

But, I think you know where I'm going.

Here.

I'll try it.

You see?

Yeah.

You see a lot of patients, is it?

That's still.

Is that still at the core, where you establish a rapport with your patient because you're you're seeing your patients for 20 minutes and then they're gone.

Right.

I know we've had some times where we just we're in the we're just sitting in the waiting room and we're not really having that that bonding moment with our physician anymore because of how quickly things are happening and how fast you have to turn around these things.

I am continually impressed and amazed by my colleagues, by the ways you find to create those opportunities for the conversations.

And, you know, we need to take the time if we're going to be able to address people's questions and actually lead to effective behavior change.

We we need to partner with families.

And you can't partner with someone that you're not talking to.

So whether it's, you know, walking them down the hall and starting that rapport or, you know, our, our nurses are, you know, mid-level providers are going in and, and also creating that sense of safety, that sense of trust and then sharing information with us.

It is challenging.

The financial incentives often interfere.

But yes, so many of us are still, you know, do what you gotta do for the patients.

Good.

Yeah.

And I we have another, comment I would like to read, the YouTube person said, I think it sucks that individual providers are doing more work than the federal government to combat vaccine disinformation.

And this is and they go on to say, and this is before Trump, give me an an for FCC that actually moderates YouTube.

But TikTok.

There's another comment.

But he said that he thinks it sucks that the providers are doing more work than the federal government is is true.

I think providers are doing the most effective work they can.

The government does provide through the centers for Disease Control, for example, really easy to understand infographic on every vaccine.

Why to get it.

What the what the what it overcomes but it requires families to look for it and that extra step is normally too high of a barrier.

So it falls to us as providers to meet families where they are, you know, and if that means, you know, using some of those resources, having them at the ready to in that drawer when you're sitting there talking to the patient to hand them posting things, and certainly our role as a Department of Public Health is also to share information, credible, science based, evidence based information out through partners like KCI going on other, modalities.

We have our own social media page that folks can follow.

And we're constantly putting out messaging and information that is backed by science.

So we can work with our two health systems.

We can work with the Monroe County Medical Society.

When Covid was new, and as we were going through, we would send information out through all of those partnerships so that then the hospitals can inform their own staff, and then those staff can inform their patients.

So it takes all of us working together and we've done it.

We did it during Covid.

And I was so grateful and impressed with the response.

And now it feels like we need to gear up and and do that kind of coordination again.

I think that's a great segue into this next question here.

You are both physicians in an era where a lot of people are especially younger adults, are getting medical advice on TikTok and Instagram before they ever talk to a doctor.

How do you approach that reality now?

I it doesn't change a lot.

I mean, maybe the pace and the amount of information and misinformation that people can consume has changed.

But, you know, we always again, go back to that relationship with the patient.

What are your fears?

What are you concerned about?

What do you think might be happening with you?

Let me address those worst case scenario fears.

Here's what I think.

Here's the plan.

And here's the reason that I think you should get these vaccines.

Here are the reasons that I want to.

I suggest you protect your child with these vaccines or whatever the treatment is.

And, Doctor Andy, how would you respond competing against TikTok and Instagram for medical advice?

The the advantage we have is the relationship we have with our families.

The TikTok and Instagram etc.

are in general one way communication streets from these influencers to their population.

And for us, we're building on the relationship we have with families.

We can answer their questions.

We can sit down and talk to them and listen to them, and not have them as a thing that we're making money off of because of every click they make, but rather people that we're engaging with to provide health and happiness.

Certainly in pediatrics, we get to build a relationship optimally with kids over multiple visits.

And so you can build that trust with a parent over one child's life span and over.

If you've got multiple kids and it's even longer that you can build that relationship, build that trust.

Do you see at any point where social media and public health got along, they can we use it.

We're putting out our our information on those same platforms because we are trying to reach people where they're getting their information.

So yeah, that the onus is on us, preferably with some state support, with some federal support to put out credible information.

It's a tool and it can be used for good or for, ill. And so we are doing our part to put out reliable, credible, evidence based information using those same tools.

And what do you both wish people asked before forming opinions about vaccines?

Yeah, there's not like one thing because it's so dependent on what their family experience is, what their historical experiences, their own individual like, just just ask.

Ask your physician, your nurse practitioner.

Ask a reliable person that has your best interests at heart.

And as you mentioned, not like trying to get you to click so they make money off of your often fears or you know, hysteria.

Yeah.

Now I want to jump into measles.

Go.

You go.

Are we ready?

Yeah, I want to jump.

In some of the potential outcomes of vaccine hesitancy, which have been what we've been talking about, Monroe County recently had, like last month, an exposure a measles exposure linked to the double tree in Henrietta.

What happened and how was that case handled after the same way we always handle things.

So, we.

Well, this was a complicated case in that the family had driven through New York state to Boston and ended up in Florida.

So we got a call from the Florida, State Department of Health.

And so we didn't actually have access to interview the patient themselves.

They didn't want like 14 different municipalities trying to get the same information from one scared family.

But, investigations are very standard.

We have protocols.

We've got fantastic staff that were always happens at 3:00 on a Friday morning until midnight to find out where was the exposure.

When did they arrive?

Working with the hotel to find out.

When did they check in?

When did they leave?

What room were they in?

We gather names of, employees who might have been exposed, gather names of, everyone who was at the hotel at the time.

And then we start, looking up information and calling folks.

Were you have you do you have documented evidence of your vaccine?

Do you give us consent to look up your information in the New York State Immunization Information System?

And so we find out the highest risk first.

So the employees make sure everyone, is protected by, past, measles, mumps, rubella vaccine or if not, and until we have proof of that, folks have to stay home and make sure that they're not, going to be spreading measles, unknowingly to other guests or other folks.

And so, that's what we did.

It was a lot of phone calls, a lot of looking things up in different medical systems and then, hoping and praying.

Thankfully, we didn't have any, future cases come out of, of that one exposure.

And why is this such a concern or fear of most kids are already vaccinated.

Well, so, measles.

Measles can be fatal.

Fatal?

Measles can make people really sick and, I've actually never seen a case of measles myself because we used to have really high rates.

And we still do actually have, pretty high rates of vaccination in, in Monroe County, thankfully.

And so but the fear is always that someone, especially someone immunocompromised, someone very young, you typically don't get your first measles shot until you're one year of age.

And so, you can get it as early as six months of age.

And given the world we live in now, if people are traveling, not even internationally, if you're going anywhere, get your six month old there, an extra dose, at six months of age, because you never know when you might be exposed.

And so out of that, we had we had some positive.

So there were a number of, of entities that reached out to us.

For example, the strong Museum of Play reached out.

And, you know, kudos to Steve Dubnyk and the leadership there, like thinking if that family had visited the strongest even that's my worst case scenario nightmare, because that would be so many phone calls and so many potentially very young children that might have been exposed.

But if someone had been exposed, there are, you know, very standard treatments, what we call post-exposure prophylaxis.

We can give you a vaccine or another.

It's called immunoglobulin.

In some cases, it's it's a bunch of the antibodies that your body might not make itself, but still do the same job as your own antibodies to protect you.

And so talking through some planning about what would happen if the worst case scenario came to be and taking some preparatory steps.

So, some good came out of that.

And any time we get a chance to ask, implore, begged people to please get these vaccines because they're safe and effective, we'll take it.

And Doctor Andy, as a researcher, how does it make you feel when these diseases that we're eradicated are resurfaced?

It's crushing.

I mean, I've dedicated my educated life to creating vaccines and making them work better and continuing their safety for children.

And so when, when it's chosen to when we see these vaccines, we see these vaccine preventable diseases come back and we have things that work against them.

It's just crushing.

There are diseases we don't have good vaccines against yet.

And those are things that we still have to continue to fight.

But when we have vaccines and they're just not used, and we see children like the children who have died in Texas, from measles, it's it's crushing.

You know what?

How does this affect the work that you do?

Do you?

I don't know if it affects the work that I do directly.

It redouble our efforts.

It makes sure that, we continue to communicate clearly with, the public and all of our loved ones, about the safety of vaccines.

But I don't know if it changes the kind of day to day work that I do.

Yeah.

Does it does it still give you hope?

Do you still want to go in and do this if.

Yeah, people are not, are being hesitant or not.

Yes.

You're vaccinated.

Measles is still saving lives.

The measles vaccine is still saving lives.

MMR it it saves more lives when we can have the entire population protected.

So we can have we're even protecting people who haven't received the vaccine.

But it's still something that we can do to protect the youngest and most vulnerable among us.

And so that's still something that's incredibly valuable.

Yeah.

And I was going to touch on what are some of the consequences of having a low MMR vaccination rate.

And yeah, the consequences are the virus spreads.

It's the most infectious virus we've, studied so far in science.

So when whenever someone's in a room, they're more likely to expose everyone else in that room to the virus.

And if you haven't had the vaccine, then you may not be protected against spreading that virus to someone else.

So it's it's one of the viruses that can spread the fastest.

And so when you, have a population that's not protected and there's individuals in the population who can spread that to other individuals, you just reach, a dangerous situation.

And do we fear at all in Monroe County that this can be an issue, measles spreading?

I mean, it could we fear any of these conditions spreading?

And so that's why we continue to do the work that we're doing.

We're getting close to the back to school season.

And so our clinic, currently you can call and schedule an appointment for Tuesday, Wednesday, Thursday, and you can call 7535150 to call and schedule an appointment.

But closer to the school year and certainly that that first month of September, we extend our hours five days a week into the evenings.

Folks can also email im clinic.

I am clinic at Monroe county.gov to schedule an appointment.

And so we're certainly going to continue to do that work.

It's always best for children to receive those preventive vaccines in the context of a well-child check with their own provider.

Again, families can form that connection and have their questions about all kinds of things answered.

But we also then screen children for their development, for their growth.

We can do anticipatory guidance and have conversations about, hey, don't share straws at school.

Hey, teens, let's talk about not delaying that first initiation of sexual activity, all those preventive things that we want to talk about that we can do.

When you're examining the whole patient, as opposed to just coming to our clinic and getting the vaccines, we will do that work.

It's important.

And my team is awesome.

And they find a way to build rapport in those couple minutes.

But for the child's benefit, it's always better.

Better to look at the whole picture and think about the family.

How are the parents doing?

Are there stressors as there always are?

How do we how do we support folks?

Do you have enough food in your house?

Things like that?

And what will we tell?

Like parents that are still confused are still stuck about what's right for their child.

As we talk to your provider, talk to the person who went into medicine to help patients because we love our patients.

Talk to someone who has access to your and your child's entire medical history because they can give you the answer.

Should I get this vaccine?

Most of the time it's yes.

But they go into the details about, you know, which one, might you not because you have some, I don't know, immuno compromising condition.

Maybe you shouldn't get this one, but this can still protect you.

And sometimes folks with specific heart conditions, lung conditions, they're at higher risk.

And so that provider can then tell you, I really, really think you should get the Covid and the flu vaccine so you don't end up under Doctor Randy's care.

Doctor Andy, what would you say to its appearance that feel that do feel stuck or confused or about what what's best for their child?

Yeah, I think it's talk to your provider.

And it's also both from the provider and the patient perspective.

You don't have to make the decision that moment you.

It's a conversation that continues.

It's a relationship that continues.

And so for the provider, it's if they say no today, talk to about it next visit.

If the if the patient is nervous and afraid, have that conversation, say, I'm not ready yet, but I'd like to talk to you again about this.

Let's schedule another visit so I can come in and have this conversation.

It's recognizing that yes, the earlier we get the vaccines and children, the better we protect them and the more likely they don't experience these diseases.

But it's important for all children to receive the schedule.

And so making that a continued conversation with the providers, I think, is something I tell all my families that don't.

Don't let not doing it today be the reason you never do it.

That's a great that's a great comment, doctor Leslie Brown, I know you mentioned your team, right?

Being awesome.

What do you want people to know about how you and your colleagues are working to keep people healthy, especially during a time when federal messages seem inconsistent?

Yeah, that's a nice term for it.

So we do have our immunization clinic so folks can come to us, but we also do have our public health van, which we can take out and we can do, STI testing.

So sexually transmitted infection testing, we do take our vaccines to our sexual health clinic on 819 West Main Street.

We have in the past taken the flu, the Covid vaccines to homeless shelters to, you know, food pantries for folks that maybe might not be able to get to us.

We, as I mentioned before, when we receive new novel, different information from credible sources, we do share that with our health system colleagues, and the few remaining independent providers who are part of the Monroe County Medical Society.

And so we and certainly at Starlight, we are taking care of kids, who have had some awful life experiences and giving them that, that vaccine protection.

Yeah.

And Doctor Andy, with the inconsistencies, I know some people are like in New York State, stand alone and make their own vaccines.

And what are we doing here as far as our own path?

No.

Is the answer to in New York State make their own vaccine?

It is an incredibly, expensive and very appropriately, incredibly tightly regulated process.

So even a state as large as New York, is not able to do it alone.

Honestly, most countries can't do it alone.

It's something that's done on a global scale, not on a more local than that.

But what we can do as a state is, and as for example, Elizabeth mentioned the that the American Academy of Pediatrics is doing is we can stand up and say, yes, the HHS said this, but we as providers or we as a state health system believe the the opposite or a different thing to be true and continue to advocate for the protection of our patients.

Yeah, I know there's a lot of health care workers that are leaving the field now that are that are feeling burnt out.

What what keeps you motivated in doing your research, doctor Andy?

It's partially remembering the kids that, we were not able to protect, kids that did die of vaccine preventable diseases that I saw during, my medical training.

And it's also seeing things as exciting as the Covid vaccine, as exciting as the RSV vaccine.

And recognizing that kids are going to be protected, they're going to live better lives.

More kids worldwide are going to make it to age five than they did 20 years ago, and that those beautiful extra lives are something that are worth working as hard as I do for.

And Doctor Vilas, Dr. Brown, what keeps you motivated?

Again, it it's the potential to do good.

In public health getting to think upstream, getting to think about the social determinants of health.

How do we bring these awesome, really cool technological advances to folks that otherwise wouldn't get it so that everyone gets to have that increased, length and quality of life?

There is so much potential to do good and we'll weather this storm.

We're still going to be here.

We're still going to do the work.

We're still going to do the work around diversity, equity and inclusion do.

And, we're going to find a way to do that work regardless.

And so it may feel a little bit more difficult, a little more taxing.

But the benefit to the community, the benefit to my individual patients and getting to feel like, wow, I had a part in saving however many thousands of lives during Covid with this pneumococcal vaccine, with the rest of the work that my department does that that is real.

I'm going to hold on to that extra tight at the moment, but there's so much good and there are good people that are doing it with us.

And so it's good to be motivated by each other as well.

It's energizing.

Yeah.

Doctor, any, any cool stuff happening in your corner or your side of the neck of the woods?

Yeah.

We're working on, the incredible complexity of working on a vaccine clinical trial.

Working on a clinical trial for a different type of pneumococcal vaccine that would protect against all of the, serotypes, not just the 20 that are included in the current vaccine.

And it's made more cheaply.

So hopefully would be able to help the world that can't afford our, current pneumococcal vaccines.

So that would be awesome.

Yeah.

Now we want to thank you, Doctor Andy, for for joining us in Doctor Mariana villas the brown I great I'm getting great I'm getting great at say your name.

We're going to stick around with Doctor Mariana Villas de Brown and talk a bit more about other public health issues impacting our community that will be available in our podcast feed on Apple, Spotify, or wherever you listen.

Subscribe to the Connections podcast and never miss an episode.

And if you're listening live, we have a special rebroadcast of connections with Evan Dawson coming up after the break.

Thank you to my guests.

Thank you and the whole team.

I'm Raquel Steven.

I'll see you tomorrow with more connections from WXXI.

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