Vaccines have accomplished a lot of good over the last century with the eradication of diseases like polio. However, they are not without risks, and many people are raising concerns about the vaccine requirements in place. So how do we balance individual health and autonomy with the good of our communities?
This week on Family Policy Matters, host Traci DeVette Griggs welcomes Dr. Monique Yohanan, a Senior Fellow at the Independent Women’s Forum, to discuss vaccine policy from a perspective that balances parental rights with public health concerns.
The opinions expressed by our guests are their own and do not necessarily represent the opinions or perspectives of NC Family.
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Family Policy Matters
Rethinking Vaccine Policies: Part 2 (with Dr. Monique Yohanan)
TRACI DEVETTE GRIGGS: Thanks for joining us this week for Family Policy Matters as we continue a discussion with Dr. Monique Yohanan, senior fellow at Independent Women’s Forum, to discuss her new paper and documentary “Rethinking Vaccine Policy.” She’s proposing we all take some time to reconsider long standing policies on vaccines, and we jump back in by repeating an important comment from part one, where she explains why she believes this level of mistrust over vaccines that we’re experiencing was inevitable.
MONIQUE YOHANAN: We look at two separate interests, and they’re both really important. But parents, and, I would say, healthcare professionals, and in particular public health leaders, they come at this aspect, this issue, from different points of view. So, from a parent’s point of view, your job, your primary responsibility, your heart really is with your individual child, and you’re thinking about your child and what is going to benefit your child, and how can I be the best advocate for my child? From public health leadership, there’s a different perspective, and that perspective, really, it’s not just about what benefits this individual child, but what benefits society as a whole? But I would go a step further, and this is something I did a master’s of public health. And when I was in that training, there was a phrase that was routinely repeated, which is that every issue of public health is first and foremost an issue of social justice. And so, this tension, I think, is in part because you have parents who are thinking about their individual children and how to advocate for them, and you have public health leadership. And it’s not even so much about the millions of children who might be affected medically. It’s about how can vaccine policy, how can public health serve social justice aims. That kind of tension between individual care and individual needs versus public health goals, many of which are really well intended, but are inherently going to lead to a level of friction, I think, is a big part of what underlines some of the issues we have in discussing this.
TRACI DEVETTE GRIGGS: You mentioned a reset or a recalibration. Is this what you’re talking about, is trying to make some changes in those kinds of policies?
MONIQUE YOHANAN: You know, when I think about the reset, to me, the first thing I would suggest we consider is getting back to four first principles. When I consider some of the diseases that are so harmful in an outbreak, a measles outbreak can be devastating. A pertussis or a whooping cough outbreak, that can be devastating. And I do think it’s important to go back to the way back machine before we had a measles vaccine, in 1963 almost 4 million kids every year got measles, and tens of thousands of them were hospitalized, and hundreds of them died every year. We don’t ever want to go back to those days. But I do think that the good intended ideas of let’s use the schedule for more things. Let’s expand it and expand it. We’ve lost focus. So, in terms of a reset, I would say if we could get back to some of the core vaccines, if we could get back to thinking about measles, mumps, rubella, diphtheria, and pertussis as really core vaccines, and then for the others, having a discussion with parents. And you know, the idea of shared decision making, to me is not, “I’m the doctor. You do what I say.” It’s actually having a real discussion. Because when we look at this internationally, there are lots of different models that smart people in lots of countries around the world do things a little differently. They aren’t necessarily as rigid in terms of the timing. They don’t push for as many vaccines. And there really isn’t this linkage, to me, taking away school during covid was so devastating for so many kids. The idea of the linkage, you know, we’re going to have to have something to substitute it if we get rid of mandates. But I will tell you that taking away school from kids, if we learned anything from covid, we should know that that’s something we need to be really, really careful about.
TRACI DEVETTE GRIGGS: Since you brought up the topic of covid, talk about that a little bit. Do you see that as something that really brought this to the fore front?
MONIQUE YOHANAN: I really do. I think the way that we handled covid, there are a lot of lessons that we continue to learn from it. So as a starting place, what I would say is Operation Warp Speed was truly a phenomenal scientific achievement. And to get a vaccine that quickly to market in the beginning of this pandemic, that was truly an extraordinary achievement. And I do think that the early forms of the vaccine against some of the early strains probably worked pretty well, especially for people who had comorbidities, people who had histories of heart disease, for example. Those people, the vaccine in the very earliest strains with covid, those things made sense. And some of the ideas about mandates, even, you could see how maybe there was some evidence. But what I will say is, starting in 2022 for a lot of reasons, the vaccines, it was pretty clear, were not going to be the solution that we wished they were. And I do find that there still are a lot of professional organizations that are caught up in what they wish there were the evidence, you know. So, as an example, we wish that the vaccines worked for healthy kids to keep them out of the hospital, but there just is not evidence for that in any meaningful way, that we would mandate them, that we would include them on a schedule. Literally, the rest of the world pulled them off the schedule for kids and pulled them off of recommendations for kids a couple of years ago. But we have our professional organizations here that are really committed to, “no we have to have this kind of maximalist approach.” The evidence for the covid vaccine now, if you do not have comorbidities, if you are not older and have multiple different medical conditions you’re dealing with, there’s just not great evidence for them now. And I do think that there are people who are still sort of clinging to this idea of the way things were handled during covid. Unfortunately, I think one of the consequences by what I would call overreach during covid is you had parents who questioned the entire rest of the schedule.
TRACI DEVETTE GRIGGS: Okay, well, talk to medical providers, then, what are some specific things that you think doctors need to start with now, under our current policies?
MONIQUE YOHANAN: From a provider standpoint, I think that getting a sense of where parents are, and so getting a sense of how much buy in they have. I would say most parents are not purely anti-vax, and most parents are not exclusively, “I’m just gonna do everything.” But getting a sense of where people are, to start, is important. And then looking at what are the core vaccines that are most essential. So, when I think about a vaccine like the measles vaccine, that’s probably a lot more important for me to think about a child getting than a vaccine for hepatitis A, which, frankly, kids are not at risk of severe disease from hepatitis A. So, to the extent that parents are reluctant, having discussions about, well, what if we minimize the number of shots? What if we space them out? There’s also just aligning the vaccines with natural immunity. So, while 85% of kids who get a measles shot at 12 months are going to get great benefits for it, the reality is 95% of kids will get an even better benefit if they wait till 15 months. So, in terms of timing, there is flexibility that we can have, that’s evidence based that aligns with immunity, that are examples we can point to other countries that have used them successfully. But I think really having a discussion with what’s essential, you know, what do we really need to do for this child, and then understanding that there is room for flexibility that still can get us to where we need to be and where we want to be from a community standpoint.
TRACI DEVETTE GRIGGS: Talk to parents, now. I’m right in the middle of reading this historical novel that’s based in the early 1800s and there was a very graphic description of diphtheria and some of the other childhood illnesses. And I’m thinking, I wonder if people understand how serious this is?
MONIQUE YOHANAN: First of all, although I’m a physician and I do have a master’s in public health, I’m a mom, and everything I do, sort of, it’s mom first, and then the other things inform that. And so, I think from a parental standpoint, understanding that public health goals are not always going to be the goals that a parent has for their child, and giving them and starting with that level of respect that they deserve. What I would say is that, I think about one of my colleagues, who is a person I trained with. He’s a wonderful internal medicine doctor, and he talks about when he has a patient who gets a new diagnosis of diabetes, he says, it’s my job to make sure to write for your prescriptions, to have labs to follow up. It’s your job to be an expert in this disease. So, you have to be the expert in this and that’s how we partner in this management. That’s what I would encourage parents to do, and that parents, I do think that the CDC still is a very reliable source, but I would say that parents should become experts in the vaccine schedule. That they should look at all the individual vaccines that are going to be offered for their children, and not just look at what we do in the United States, but trust their guts. And if for them, they feel like, you know what, this isn’t the right timing for me, for my kid, I would encourage them to look across to see, are there examples in other countries? All of this information is freely available online. But again, I do think the CDC policies really are quite evidence based. I know we get caught up in press conferences and things like that, but their policies really have been quite thoughtful. But again, it is, I do think, the obligation of a parent to really become an expert in the schedule and do their own reading.
TRACI DEVETTE GRIGGS: So, are you hopeful? I know when we first start talking about some of these issues, and they’re so emotional, we often settle down and have a more reasonable conversation. Do you think that’s where we’re headed on this vaccine discussion?
MONIQUE YOHANAN: Well, I try to live with hope. I think that, you know, don’t be sad twice, right? So be hopeful in the moment, and then if things don’t work out, then you revisit things. I am hopeful honestly. You know, one of the people who was one of my most helpful reviewers as I was writing this paper was a parent who’d had an experience of a child who’d had a horrible reaction to a vaccine, and I was just so impressed by the level of depth of understanding about the topic, and what she knew about it, and her level of research. I am hopeful, because I do think that although it’s uncomfortable as a professional and my physician head here, my life is easier when a patient just does what I tell them to do. But that’s not really the way medicine can be practiced anymore. But I am hopeful because I do think that parents actually are very informed on this, and I do think that they’re really demanding their rights as parents. I think that that can only be for the better. I am hopeful in the sense that I do think that we have, actually, some specific moments in this moment in time, not just with this administration, but one of my other hats is, I’m the Chief Medical Officer for a health technology company. There’s technology now that allows us to do more personalized care in a way that we couldn’t have done even 20-30, years ago, but when I think about if we’re going to be doing more nuanced, more individualized vaccine care, we actually have the technology to do that now. That’s not a future state, but we can actually target individual kids. We can do better in terms of our outreach. So, I do think the combination of really listening to parents and using the technology that we’ve got now, and really having a will to have some humility about some of our mistakes during covid, you put all these things together, and I really am hopeful.
TRACI DEVETTE GRIGGS: Well, I am so glad to hear that. We’re just about out of time for this week, before we go, Dr. Monique Yohanan, where can our listeners go to find your paper and your documentary “Rethinking Vaccine Policy: Vaccines are Important, But Not Equally Necessary.
MONIQUE YOHANAN: It’s at IWF.org/vaccinepolicy. And if you just go to IWF.org, it’s on the landing page there. I’m just, again, so grateful for the opportunity to speak about this topic. We have been so polarized and so pro-vax, anti-vax. I do think that there’s a middle ground, and that’s really what I strove for in my paper.
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