Immunization Action Coalition President and Flu Expert Dr Kelly Moore Explains Primary Care's "Tall Order"

For frontline "immunizers," the upcoming flu season represents a "tall order," according to Immunization Action Coalition president and chief executive officer Kelly Moore, MD, MPH.

In a recent interview with Patient Care Online Moore pointed out that "most clinicians haven't spent this much time focusing on vaccination in their career." And now, even as a 4th and dangerous surge of COVID-19 infection drives severe disease and hospitalizations, clinicians who deliver primary care will need to integrate influenza vaccines into their COVID-19 activities as well as look for gaps in routine adult and childhood vaccinations, she added.

"We can just about guarantee that any adult that walks into your clinic is missing some routine immunization [that] they need today."

Among other topics Moore discussed, she warned that unlike last year, influenza will be here this year and that without the strict infection mitigation measures enforced last year, the most effective tool available is flu vaccination. The COVID-19 vaccine, Moore stressed, now can be coadministered with other routine immunizations which could, possibly, make this flu season's tall order easier to fill.

Kelly Moore, MD, MPH, is the president and chief executive officer of the Immunization Action Coalition where she previously served as deputy director. She also is adjunct associate professor of health policy at Vanderbilt University School of Medicine.

The following has been edited for clarity.

Patient Care Online: So you have many years’ experience with influenza and its spread and containment, including leading the pandemic influenza preparedness Planning in Tennessee and also that state's vaccine distribution during the 2009 H1N1 pandemic. I'm interested in your thoughts on the influenza/respiratory virus season we're now approaching given this situation: the low case rates of last year; the potential for lower immunity against some flu strains in some Americans; the poor national appetite that's getting a little bit worse for resumed mitigation measures as we go into the season plus the overlap with the surge in the Delta variant of COVID-19. Do you feel there's a potential for the twindemic this year that we didn't see last year?

Kelly Moore, MD: That’s a question that everybody is wondering about. But one of the things that I learned close to 20 years ago, when I first started following influenza closely, is people cannot predict what influenza is going to do. And if someone tells you, they can predict what's going to happen, they're trying to sell you something. Because what we've learned—even the best experts hesitate to say what a flu season is going to look like. But the conditions that you've laid out, the fact that we had very little influenza last year means that we do have a lot of susceptible people out there. And the more important thing is that we saw how well the mask-wearing, the staying-at-home, the social distancing work to prevent influenza. And we don't intend to keep doing that this season. So since we're not going to be doing that, we have to go back and rely heavily on our traditional best strategies for protecting our health. And that's vaccination. So one of the things about preparedness is that you don't know what the crisis will be. So you have to be prepared every time. You can’t fight the last war. You know, last season was a wonderful remission from influenza that usually takes 10s of 1000s of American lives. So we got a break from that. We cannot expect a similar outcome this season for lots of reasons. And so it's incredibly important that we go ahead and move full force in encouraging our patients to be vaccinated this year, just like they would have before COVID.

And one of the things that is going to be really helpful for us is that we can now coadminister COVID vaccines and influenza vaccines together. So it's going to be really important to start teaching our patients right now, that influenza is going to come back and we need to be prepared for whatever influenza decides to throw at us, even if we can't predict exactly what the season’s going to look like.

PCO: A good deal of guidance that we've been hearing on vaccine hesitancy and the resistance focuses on using science and providing facts to counter misinformation and the myth du jour, and on drawing people's fears out and using empathy? How effective is that in areas where health literacy is lower, and vaccine acceptance has really fallen off. What are our what are our options?

Moore: One of the things we've been working on is health communication and trying to reach the unvaccinated and persuade them in different ways. And we've been studying that carefully. One of the conclusions that we've seen is that just data doesn't really help most people; just giving them more information doesn't tend to motivate them to make a decision to vaccinate. When you look at a patient's decision to vaccinate, it's really a matter of trust. And that can happen where whether they're highly literate in health issues or not so literate in health issues. If they trust their healthcare professional, their physician, their nurse practitioner, their pharmacist, a strong recommendation from a well-informed health professional actually is proven to be the most influential in that patient's decision to get vaccinated. So while the information is really valuable for us who are providing the health care, what we need is to maintain that trusting relationship. And if you are someone who has a relationship with a distrustful patient who's not sure about getting vaccinated, your strong recommendation is really the best thing that's going to make the difference in their decision to vaccinate. And if they have a concern, address that concern, and then restate your strong conviction that vaccination is the best way to protect their health. Sometimes people forget to come back to their original recommendation. And it's important to always return to that. And even if they don't make that decision today, keep bringing it up the next time. And if they really trust you, they will often change their mind and make a decision even if they don't understand all the science.

PCO: What is your sense of how or if the vaccination climate will shift given the FDA’s approval of the Pfizer mRNA vaccine?

Moore: I'm hopeful that having this vaccine fully licensed is going to influence some people who were worried that the vaccine was experimental or untested. That will reassure them, and they'll go ahead and make the decision to vaccinate or that it will be easier to have that conversation. What we have seen is this vaccine has been given to hundreds of millions of people over the last several months in an unprecedented safety surveillance setting where we've had multiple systems to look at that vaccine, how safe it is, what the side effects might be. So we understand these vaccines better, perhaps, than almost any other vaccine that we've used. And what we see is it's about as safe as any other vaccine we administer, there's really not a difference. Of course, people get troubled by the side effects. The you know, feeling bad, a sore arm, and those are common and we have to acknowledge those reactions. But we also need to reassure people that those are harmless. They’re signs the vaccine is working and they're not a sign of danger. And they're well worth putting up with when you consider the danger that COVID poses to their health.

PCO: So we're almost at the end of immunization Awareness Month. I'm curious about where and how the immunization Action Coalition's energies have been spent and what you've got planned going forward for the fall and winter.

Moore: Obviously, up until now, this year has been focused fully on COVID-19 vaccination; there’s no higher priority than this national disaster and emergency and we've gotten so far, you know. Now 70% of American adults in this country have at least started their vaccination for COVID-19. But we have a long way to go, especially in underserved parts of the country like mine down in the southeastern United States. Far too many people are unprotected from COVID-19. So a lot of our focus at IAC has been on getting frontline immunizers the information they need to adjust to the ever changing recommendations about how to use these vaccines. One of the things we're most excited about is the news that you can co administer COVID-19 vaccines alongside other routinely recommended vaccines. Because now as we look at the fall and winter ahead, we're pivoting our focus to focus on COVID-19 and influenza, our traditional seasonal threat. Influenza will be back; it will in some form be circulating and we need to protect our patients against both of these important respiratory viruses. It's not an either/or situation.

The other thing we know is that adult immunization as well as childhood immunization has fallen by the wayside during this pandemic and we need to get people back up to speed on their routine immunizations—pneumococcal disease, even measles mumps rubella, the childhood immunizations, HPV adolescent immunizations. We can just about guarantee that any adult that walks into your clinic is missing some routine immunization and you can just make it a game to find out which one they're missing, and they need today. We recently issued a call to action to focus frontline immunizers on adult immunization and to raise awareness of routine immunizations that are falling behind during the pandemic. So our focus is on now, mopping up with COVID-19 vaccination, certainly addressing whatever comes in forms of booster recommendations, we don't yet know exactly what that's going to look like, but also helping clinicians think about how to integrate routine immunizations, especially influenza, because the time is now for influenza vaccines, into COVID-19 activities. It's a tall order. Most clinicians haven't spent this much time focusing on vaccinations in their career and IAC is here to help. We have lots of resources—skills checklists, job aids that show where vaccines can go if you're giving an adult multiple vaccines, where you can inject them so that you space them out well. So we have lots of tools freely available on our website immunize.org that people can take advantage of—download, share, and use to help get up to speed on how to deliver the vaccines the nation needs.

PCO: My last question is, if we weren't on the screen here, and we were in a room in front of a live audience of primary care clinicians and family practitioners, IMs, GPs, what would be your personal message to them at this point in what's going to continue to be a difficult healthcare environment?

Moore: Well, first I would have to offer my sincere thanks. I am not on the front lines of this battle. I have been in the background trying to provide all the support we can to help frontline clinicians do their jobs. But this has been an unimaginable year and a half. And I know that my friends and colleagues who are on the frontlines are absolutely exhausted. So first of all, thank you, you are remembered, and we are here to help. So let us know at IAC. How can we help? What resources do you need that you're missing that would help you do your job of immunizing people better that we could work on for you? We're here for you to be able to support you in any way that we can.

And just know that we will come out on the other side of this. Vaccines are amazing tools, and they will do their job with time. But it's a lot of work to get them into the arms of the people who need them. And I'm so grateful for the work that everyone is doing and continues to do to protect the public from vaccine preventable diseases.

PCO: Thank you so much for your time today, Dr. Moore and stay safe.

Moore: Thank you, you as well.

A message and an offer from the Immunization Action Coalition to primary care clinicians:

Now more than ever, it’s critical to encourage those who are not yet vaccinated against COVID-19 to choose vaccination. With support from CDC, IAC is able to make available at no cost its “I Got my COVID-19 Vaccine” buttons to wear and share to promote COVID-19 vaccination.

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These buttons are available FREE of charge (including shipping and handling) to organizations and groups that provide or promote COVID-19 vaccinations in the U.S., such as pharmacies, hospitals, clinics, public health agencies, college health systems, and civic or faith-based health advocacy groups.

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Feel free to share this information with other organizations and groups in your area offering or promoting COVID-19 vaccination so that they also can Button Up!