Biden’s Surgeon General On How To Tackle Vaccine Hesitancy

IRA FLATOW: This is Science Friday. I’m Ira Flatow. It’s a tale of two COVIDs. In some parts of the country, cities are opening up, saying it’s time to get back to normal. In others, infection numbers and hospital admissions are creeping up again. And some places, like Los Angeles County, have moved to reinstate mask mandates even for the vaccinated. And even as public health workers advocate for widespread vaccination, disinformation is discouraging vulnerable people from taking the vaccine.

Joining me now to talk about the pandemic and other US public health concerns is Dr. Vivek Murthy, US Surgeon General. He heads the US public health service. Welcome to the program, Dr. Murthy.

DR. VIVEK MURTHY: Well, thanks so much, Ira. I’m so glad to be with you today.

IRA FLATOW: Nice to have you. Give us an idea of where we stand in the pandemic right now.

DR. VIVEK MURTHY: Well, Ira, the pandemic is really a tale of two countries right now, which is very unfortunate. In areas of the country where we have high vaccination rates, the story is still quite good. Many people are able to do the activities they were doing beforehand with the vaccination. They have a very high degree of protection, particularly against hospitalization and death from the virus. But in areas of the country where vaccination rates are low, and there are many pockets where vaccination rates are even under 30%, we are seeing the Delta variant spread quickly. And the consequences of that are showing up in our emergency rooms, in our hospitals, and now an increase in deaths. And so the message is, unfortunately, still the same, which is that the vaccinations work. They are very effective. But we have not been able to get enough people in our country to take them, to get the protection of the vaccine that we can see cases not really come down, but stay down.

IRA FLATOW: Can you explain and understand the campaign of misinformation about the vaccines? I mean, is it due to not understanding or a lack of trust? Or actual malice in some cases?

DR. VIVEK MURTHY: Well, it’s a good question, and the misinformation is really impacting people’s confidence with the vaccine. With that said, let me just say one thing just by way of background, which is that vaccine confidence, which is people’s willingness to get vaccinated with the COVID-19 vaccine has actually been increasing since December, when the vaccines came out. It’s actually at its highest point right now, with about 70% plus of people have either gotten vaccinated or saying they’re eager to get vaccinated as soon as possible. Another 12, 13% of individuals who say they’re in wait and see category. And about 17% who say they’re not inclined to take the vaccine. So while confidence is growing, we want it to go even further, because we want to get more people vaccinated.

But the misinformation stands as an obstacle. And right now about 2/3 of people who are unvaccinated say that they either believe common myths about the vaccine, or they think those myths might be true. Myths like you can get COVID from the vaccine, which is absolutely not true. Or myths around infertility or DNA mutations being linked to the vaccine, also not true, not grounded in fact. Some of that misinformation is being spread intentionally, what we call misinformation. But a significant amount of it is actually just being spread unintentionally. Think about the individual who decides, hey, I see an interesting article. A little worrisome. Maybe I should share this with my family and friends, so that they are warned as well, not realizing all the while that might not be accurate information. So we’re seeing it spread really through both channels, enabled in large part by the technology that we have today, particularly social media platforms

IRA FLATOW: Well, do you think that there’s anything anyone can say or do to break through to change people’s minds? People who are being misinformed, intentionally or unintentionally, or people who are political. They just don’t want to do it because the President says it, or the Democrats say it, or some people they don’t like or agree with say it. How do you get through that, or do you just say I can’t get through that?

DR. VIVEK MURTHY: Well, it’s interesting. For those who are listening and thinking, gosh, this is just too hard to do, I would point you to seniors in our country, where we have almost 90% of seniors who have gotten at least one shot of the vaccine, almost 80% have gotten fully vaccinated. And that means that we have actually a significant number of people all across the political spectrum in the senior category who have gotten vaccinated. So is it possible to break across political boundaries, absolutely yes. But sometimes it’s not about the message. It’s about who the messenger is. And one of the things we learned during this vaccination effort is that the messenger truly matters, because this is about trust. And not everyone trusts the same people or the same institutions.

In fact, if you look more recently at some data that just came out about people who changed their mind about the vaccine, a significant number of those individuals who went from being in a wait and see category, to then ultimately getting vaccinated, said that what changed their mind was hearing information about the vaccine from their family, their friends, or their doctor. Not from billboards. Not from ads that they saw on TV. Not from ads that they saw on social media. But from people they trust. And that’s really what this comes down to is how do we support doctors and nurses, family members, faith leaders, and other trusted messengers and communities, so that they can help bring accurate scientific information to people, so they can make the right decision for themselves. It isn’t– if someone considers all the information and make a decision that I like or don’t like, that’s absolutely fine. That’s their right. What worries me is when people don’t have accurate information, and they’re making decisions off of falsehoods.

IRA FLATOW: OK, let’s talk about trust a bit, because you have two groups that people should trust, the CDC and the American Academy of Pediatrics, basically saying different things with regard to mask wearing in schools. How do you decide as a person between these two organizations that you trust about whose advice you’re going to take?

DR. VIVEK MURTHY: Well, so, the broader question is a good one, which is that at a time where science is evolving, and where the recommendations may be something today, there may be something in a few months based on how the data evolves. One of the challenges we have is how do we make sure people are kept up to date with how the data is changing and that’s why the recommendations are changing. It’s not always easy to do. We haven’t always done a good job of it as a scientific community. And that does sometimes lead to confusion. With regard to the American Academy of Pediatrics and the CDC, what you’re referring to, I believe, is the mask guidance that came out for schools recently. And even though that seems like it may not be consistent or congruent, it turns out actually they are remarkably close in terms of their guidance. Both believe the layers of protection are important. Both talk about the importance of masks, of distancing, of testing in keeping our kids safe when they go back to school. What the CDC says is that vaccinated individuals have the option of wearing the mask or not, depending on what their school and their locality decide, but that unvaccinated kids should wear the mask. What the AAP says is that you should exercise that option. If you’re vaccinated, still continue to wear a mask out of an abundance of caution. And that’s a very reasonable thing to do. So if you look at the broader picture, these two organizations have actually been saying the same thing, working together, expressing to parents out there and to schools that these layers of caution are important, and it’s part of what we’ve got to do to get our kids back to school.

IRA FLATOW: One of the things we’ve all learned in recent years is how global health issues can be. How do we address some of those health concerns, like COVID on a global scale? What kinds of tools can we use? Is it just a matter of money, giving out aid to countries? How do we work with them?

DR. VIVEK MURTHY: It’s a really good question, because I think we were reminded this time of a lesson that we were taught during the Ebola scare, during the outbreak in West Africa back in 2014, 2015. And that lesson is that global pandemics require global cooperation, that you don’t pull yourself up and wall yourself off as one country and say, we’ll take care of ourselves, because these viruses can spread quickly from one country to the other. And that’s what we’ve seen with these variants. So I think to address the broader global nature of these pandemics, we’ve got to do a few things. Number one, yes we do need funding to support a variety of things, including vaccine production and better systems for surveillance, so we can detect outbreaks early on.

But what we also need are relationships or partnerships with other countries, so that we can work closely together. The old saying still applies here, which is that the time to build relationships is not during a crisis, it’s before a crisis. Because you’re going to need to lean on those relationships and that cooperation during the throes of a pandemic. So we’ve got to build those partnerships so we can share data, so we can share technical expertise and learnings and ensure that we’re operating at the top of our global knowledge set.

But the other thing that we’re going to need, Ira, is manufacturing capacity. Now that may not seem so exciting to everyone, but let me tell you that when you’re thinking about putting together billions and billions of tests so you can detect infection in communities around the world, when you’re talking about trying to scale up vaccine production to 14, 15 billion. What we’ve got to do if we want to be prepared for the next pandemic is build the right global partnerships, invest in global manufacturing capacity, build the scientific networks outside of government in the private sector that can share knowledge as well, and invest, not just the United States but countries around the world, in supporting better data surveillance systems, the manufacturing of testing and vaccines and therapeutics. Because we’re going to need all of that to address the next potential pandemic. And there will be another pathogen down the line. It’s not a question of if, it’s a question of when.

IRA FLATOW: Yes, you anticipated my next question, because it is about a question of when and not if. How do we build in a resiliency into what we’ve learned? Tell me some steps that we could take, or that you see that we might be taking.

DR. VIVEK MURTHY: Well, I think there are a number of areas where we’re already taking steps, but they’re going to be critical to keep in terms of momentum. One is investing in our public health infrastructure as a country. I’m not just talking about the CDC and the NIH being equipped with more resources to have even better surveillance systems. I’m talking about local public health. I’m talking about the communities all across our country that have been really decimated in terms of their budgets back during the Great Recession back in 2008, and which never really recovered their funding, even when the economy recovered. They are struggling in terms of their data systems, their personnel, their capacity. If you ask why aren’t we doing better contact tracing in our country during this pandemic, one of the reasons is because you require local resources and personnel to do contact tracing, and again, another area where we are deeply underinvested. So we’ve got to invest in local public health infrastructure.

The second thing that we’ve got to do is invest in our communication infrastructure. If we learned one thing during this pandemic about communication, it’s that you don’t get the message out just by talking to a couple of papers and a couple of TV stations. Because not everyone listens to the same sources. We’re in an environment where people need to hear from different messengers, but there’s a lot of misinformation out there. So thinking about how we build powerful communication partnerships with faith organizations, local doctors and nurses, so that they can be partners in disseminating accurate scientific information is also going to be a critical part of this.

And finally we’ve got to also invest in our basic science infrastructure. It’s sometimes easy to say let’s just invest in what’s going to turn around returns today, or what can pay off over the next 12 months. But basic science research is an important investment for the long term. The mRNA vaccines that we have right now, Ira? These are built on platforms that we have been investing in and developing for more than two decades. Two decades ago, somebody could have said, well why do we want to invest in this? Are we really going to have a vaccine the next 12 months? But thank goodness that they made that investment, because it’s benefiting us today.

So these are all just some of– a few of the many components that we’re going to need to make sure that we’re ready for the next pandemic. And finally I’ll just say partnerships. I talked about the global sense why partnerships are so critical with other countries. But even domestically, we need to have strong partnerships between local, federal, and state government when it comes to data sharing and analysis. When it comes to responding to outbreaks. When it comes to distributing therapeutics. We can’t be 50 states fighting over the same resources. There are times, Ira, where we’re 50 states. There are times where we have to be one nation. And pandemics are a time where we’ve got to work closely together. But again, that doesn’t happen overnight. You’ve got to build those partnerships right now.

IRA FLATOW: This is Science Friday from WNYC Studios, talking with Dr. Vivek Murthy, US Surgeon General. Let’s talk about– aside from COVID, get away from that a bit, because your job is more than just COVID, isn’t it? I mean– what do you see as the major public health issue facing the country right now that’s not COVID?

DR. VIVEK MURTHY: The issue that worries me the most apart from COVID is what’s happening to our mental health. As a country overall, but particularly to our kids. Before COVID, we were already struggling with high levels of depression and anxiety. We were also struggling with high levels of loneliness, it turns out, which have marked impacts on the mental and physical health of individuals. But during COVID, what we saw is actually an increase in depression and anxiety. And particularly in certain populations, including health care workers and public health workers, including parents and caregivers, we saw a real increase in mental health stress and strain. And I worry about this, Ira, because I don’t think that we were doing an amazing job before the pandemic in caring for the mental health and well-being of people in our country. We have significantly underinvested in prevention programs, even though we know what works. We still have a fragmented and underfunded treatment system. And we have this terrible stigma still, which makes people afraid to admit that they’re struggling and that they need help.

But the pandemic has made it very clear, Ira, that all of us have struggled in some way, and we will continue at various points in various degrees to struggle in the months and years that follow this pandemic, this trauma if you will. And so that’s what worries me, but I think that on the bright side, Ira, we have an opportunity to reimagine the kind of country that we want when it comes to mental health, to think about how we talk about mental health and well being in a very different way, and to certainly support it from an institutional and policy perspective, in a way that makes well-being something that’s within the reach of every person, certainly every child in our country.

IRA FLATOW: Many surgeon generals have one big issue that they’re known for. What do you think your signature issue is going to be, or would like it to be when you’re done? Will it be mental health reform?

DR. VIVEK MURTHY: Well, you know, legacies I leave up to reporters and history books and people. That’s not for me to determine. But I’ll tell you what I deeply care about, what I want to focus on. And that includes mental health, but it’s broader than mental health, because it’s about well-being more broadly. Well-being is about more than mental illness. It’s about whether we are optimizing our physical and emotional well-being in each and every day of our life.

I’ll tell you, Ira, that for me, becoming a father really sharpened my feelings about this and my thinking. I have a three-year-old daughter, a four-year-old son, really blessed with these two wonderful kids. But each day when I look at them, I’m reminded that one, when we are born, we have such joy and our capacity for living in the moment and for expressing ourselves openly and honestly is so great. But then things happen to us, Ira, as we go through life. People tell us that we shouldn’t be honest with how we’re feeling, because we might be taken advantage of. Things happen to us, disappointments and other failures, and we become scared, sometimes, to be honest about who we are. It’s not our faults, it happens to all of us. But I think it takes a toll on our well-being.

And so one of the things I find most interesting and most concerning and urgent is this question of how do we rethink the cultural underpinnings of well-being? How do we think about the factors that are driving us to not be who we are, to disconnect from perhaps the deeper impulses we had when we were children that drive us toward happiness and openness and transparency? How do we get back to being who we really are? And that’s a conversation I think we are primed to have during this pandemic as we look to potentially come out of it in the months ahead. Because the question, Ira, for all of us is how do we design our post pandemic life? We don’t have to snap back to 2019 exactly as it was. We have a choice to make. How do we want to live differently? And in my work as Surgeon General and afterward, if I could do one thing, which is to shift us away from living in a work-centered society to living in a people-centered society, where we prioritize relationships, where we build our lives around the people that we love, to me that would be one of the most powerful things that we could do. To harness the extraordinary power of relationships to improve our health, our well-being, and our happiness.

IRA FLATOW: Well, Dr. Murthy, we’re going to watch you and see how well you can make good that ideal. Thank you very much for taking time to be with us today.

DR. VIVEK MURTHY: Well, thanks so much, Ira. So nice to talk to you. Take care.

IRA FLATOW: Thank you. Dr. Vivek Murthy, US Surgeon General, head of the US public health service.

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