Language of Business Episode 6: To Vaccinate or Not

Language of Business Episode 6: To Vaccinate or Not

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No matter who you run into these days people  want to know whether you got Pfizer, Moderna,   J&J or if you're from outside the United States, something  else entirely. Are all vaccines created equally?   Who knows? But we will, very shortly!  We're on location with Christopher Gill,   Professor of Global Health at Boston University  and welcome to The Language of Business.   It's a pleasure to be here. Thanks for joining  us. How do you differentiate amongst all of these   different vaccines? So it's actually a it's a  great question, because it's not a simple question   um and the reason it's not simple. Is that the,  the if you know the efficacy of a vaccine is going   to vary a little bit depending on the population  that's being studied, and also the variants that   are circulating through that population of  time. And so, for example, if you, you know,  

if you run a study where it's all the you know  the original wild type Wuhan variant, which   had not yet acquired any of these sort of nasty  tricks, in terms of evading the immune system,   then the vaccine is going to behave, you know,  very, very well. Whereas if you do a study where   it's all Delta and the Delta is, you know,  sneakily trying to work through your immune,   you know, bypass your immune system, then the  vaccine will appear to work less well. And so   there's that sort of, you know, spectrum of, of  challenge there and so studies that were done   quite early on in the development of these new  vaccines like the Pfizer and the Moderna vaccines,   which were the first to come through, were largely  unaffected by these variants, uh at least in the   United States. Whereas, you know, some that  have come much later such as the Covid vaccine  

had to contend with a lot of variance in their  population, which I think really punished them.   If you looked at this from a high level, and  regardless of the manufacturer, do you think the   vaccines as a whole have been effective so far?  Absolutely. And in fact, even in the the latest   outbreak when you're, you know, we've been focused  on this um cluster of cases in Provincetown,   Massachusetts-- it's been in the news-- you  know, everywhere in the last week or so,   um and the the workup of this outbreak by the CDC  was very interesting. But it was also a little bit  

misleading, I think in the way that they presented  the data. Because, for example, they said, you   know, the viral loads in the patients who had been  vaccinated and under vaccinated were roughly the   same. And that's no doubt true. In fact, I went  back and read the fine print in the MMWR and the   CT values. The cycle threshold values were nearly  identical, so what they said is technically true,  

but it's, it's kind of missing the point that  these are all people who became symptomatic   for one reason or another. And so it's not  representing all the people who got vaccinated.   It's all the people who failed despite getting  vaccinated, and what their viral loads were.   And so comparing those two groups is, is, you  know, and finding that they're roughly the symbol,   you know, similar, doesn't tell you that the  vaccines are failing. It tells you that amongst  

those who failed, the viral loads were high,  which is not exactly the same thing. And I think,   you know, we tend to sort of miss that, and more  recently there have been some some studies that   that came out, and looked at the same question,  but had a longitudinal follow-up. So they could   see what is the the natural history of someone  who became infected, had a breakthrough infection   despite getting say the, you know, the Pfizer  or the J&J vaccine, and there the information is   very clear that the viral loads drop much faster  in those have been vaccinated. So they may stay   around the same height at the very beginning  of an infection, but they plummet quickly.   In filming for this episode several people  are taking what they're calling a 'wait   and see attitude.' The FDA hasn't  officially approved these vaccines,  

some people are reading a lot of scientific data  both for and against. Given your immense knowledge   of global health and epidemiology what would  you say to someone who's still on the fence?   These vaccines actually have been extensively  studied, so the the two sort of licensure studies,   pivotal licensure studies combined had about  80,000 subjects in them. It was extremely large   even for vaccine studies, so that, that is unusual  what those studies lacked was six month follow-up,   because they they applied for emergency use  with about two months worth of follow-up   data. So what we're seeing is are there late  deferred side effects. Now we will know the  

answer to that question within the next you  know four to six weeks, but in the meantime,   you know, something close to 180 million people  in this country have received those vaccines,   and we have not seen any outcroppings of like  this sort of, you know, occasional, but uh the   concerning side effects, that you sometimes  seen in vaccines like you know a triggering   of an autoimmune disorder like Guillain-Barre  syndrome, which has happened with the flu vaccine   for example. Very, very, very, low rates, I mean  we're talking about the one in the million range.   But we have not seen that, and after 150 million  people vaccinated you would expect if it was going   to happen we would have seen it and it has not  happened. And that's just the United States. So,   you know, the European union is roughly the same.  So these vaccines have been put into 300 million   people on the planet so far, plus and we have  not seen a safety signal. So in that regard,  

I think these are probably some of the most  extensively studied vaccines in history, uh and   certainly some of the most effective. BU received  some extremely positive press about its efforts   to keep the campus safe. During the 2021 academic  year what are BU's plans for the fall, regardless   of whether there's a surge or not? We were very  pleased that we were, you know, able to sit in   the middle of a, you know, an epidemic hot spot in  the City of Boston, and and prevent a, you know,   a disaster on campus. And so it can be done and  that was before vaccines. It was basically though   all the heavy lifting was done through masking and  so now with the vaccines I think what we're going   to see is, you know... first of all, Bob Brown has  mandated vaccines for the entire faculty, staff   and student body at BU. So, you know, once that  plan is executed, we will see what we have seen   elsewhere. In highly vaccinated communities that  there will be occasional breakthrough infections.  

They will be largely inconsequential infections.  The sniffles... maybe feeling lousy for a day or   two... but nothing nothing catastrophic. You  know, is it possible that someone might end up   in the hospital? It's possible, but you know I  think at this point we're talking about a very,   very very low risk proposition um, and on top  of that, they're going to ask us to wear masks   when indoors, which seems reasonable um. I  think maybe on the conservative side but I,   you know, given all of the uncertainties about  the Delta Variant, I think it's reasonable.   Thank you very much. Dr. Christopher Gill,  Professor of Global Health at Boston University.   Big choices after college, right? Grad  school maybe? Soar from your undergraduate   major to a great career in business. Biomedical  engineer to health care analyst, health science  

to clinical systems analyst, mechanical engineer  to solutions engineer. Before you know it,   you can have a Master's degree in Management  Studies. Nine months and you're in business. So much of the news these days is how individuals  are being affected by Covid. Their businesses,   their lives, their health. But what about the  physicians and nurses who are taking care of all  

of us? How are they handling this? And frankly,  how are they managing their different slates of   patients? We're on location virtually with Dr.  Liza Meyerhardt, Internist at Newton-Wellesley   Hospital, and welcome to The Language of Business.  Thanks for having me, Greg. Nice to have you here.   So how are you holding up? So far, I think I'm  doing fairly well. Um I think it was much more   challenging a year ago, when we didn't know  what we were contending with, and we were   kind of thrown into the mouth of the dragon, so to  speak. I was working um virtually and then I was  

working in the Covid wards, because they actually  needed people who were not inpatient doctors to   step up and come work on the front lines. So  that was something I hadn't done in 17 years,   and that was scary and exhilarating. And I think  we've come a long way, but it's a little daunting   to be taking a step backwards right now, in August  of 2021. And approximately what percentage of your   your patients that you see are vaccinated? So you  know we live in Needham where there's about a 98%   vaccination rate. Um and my office  happens to be in Needham as well   so I think we believe it's around 90% to 93%  approximately of our patients. It's a very   very high number. And of the seven percent  that aren't vaccinated, does anybody know why.  

It's a really good question, and something that  I think all of us feel is kind of the crux of our   our job, at this point, is being educators and  trying to really understand the why and trying   to dispel some of the misconceptions about the  vaccine. And how are you doing that with the   elusive seven percent? I came up against someone  from my first time last week who was openly um   against vaccination of Covid specifically and I  kind of had to internally dialogue with myself   to take a moment, and take a deep breath. Because  my initial inclination was like to lurch across   the exam room, which I didn't think was going to  go very well. And um I think that the, you know,   the most important thing is really to to get  a sense of what it is that they're afraid of,   or what they feel the vaccine is going to  do to them. I think it's really important to  

let them have space to talk honestly about what  they're worried about, and then I think our job as   scientific people is to really provide data that's  kind of digestible in little sound bites that can   explain why the science works, and explain  kind of how the vaccine came to fruition,   faster than any other vaccine in our history,  which I think is um one of the points that a lot   of people bring up as to why they're nervous. Um  and I think you really have to appeal to people on   a personal level. I don't think they care that  it's a doctor talking to them, they certainly   don't care if it's the President of the  United States. I mean they really want to  

hear from people that live in their communities,  and so I think a lot of it is also connecting   them with other people who may come from similar  backgrounds, and may be able to shed some more   light on their situation. In preparing for  our interview I've probably read a hundred   different studies, some of which indicated  that unvaccinated people are spreading Covid-19   more so than vaccinated ones. Others are saying  the jury is still out. What is your thought on   that? So if you had asked me that a month ago, I  would have said, you know, being vaccinated is not   only the best safeguard against getting sick but  it also is nearly impossible to spread the virus.   And we we knew that from some Israeli studies,  and certainly from local studies. I think we felt   fairly confident that it was much less likely to  spread. That the viral load in the in the nares,  

or inside the nose of vaccinated people, was  significantly less than that in unvaccinated   people. But unfortunately data this week and  largely obtained from studying the Provincetown   Delta flare in the last month has shown us that  the vaccinated people can spread the virus. And   that their viral loads are equal, if not higher,  than some unvaccinated people with the Delta   Variant. So I think this kind of changes the  game completely, and is one of the most I think  

alarming um kind of new pieces of data that's  come out recently, and really changed how we   think about the evolution of this of this disease.  Do you know unfortunately if people are dying,   are they co-morbidity type patients, or they young  and healthy? What has that data uncovered? So far   so that data has been interesting. I mean  a year ago, in March and April, when I was   working in the hospital we didn't really know  what the co-morbidities were going to be that   put people at the highest risk. Of course, we  thought of things like underlying heart disease,   underlying malignancy, and we were very  suspect about underlying pulmonary disease,   lung disease so asthma smokers... emphysema.  Interestingly, one of the biggest risk   factors was actually body mass index. So being  overweight, or being obese, was one of the largest   risk factors for poor outcome. And I will  say that when I was working in the hospital,  

the young people that were in the intensive  care unit last year, that were really fighting   for their lives had an average body mass index  of you know over 35 to 40. So they were really,   you know, outside the norm, and that seemed to  be the biggest risk factor, aside from some of   the other obvious ones that we talked about. But  that's kind of another counseling point when I'm   speaking to patients, just about trying to get  their health in check. It's really important.   Dr. Meyerhardt: Thank you so very  much thank you Dr. Liza Meyerhardt,   internist at Newton-Wellesley Hospital and one  of the frontline physicians working alongside   our nurses protecting people from Covid-19. Are  you a problem solver? Do you see the big picture   and the small details? Want to turn big data into  big decisions? Take AI to the boardroom, translate   rocket science into the science of business, build  your career at digital speed, with a Master's   of Science in business analytics. Be ready for  careers like analytics consulting, data science,  

analytics strategy, data translation, BI analyst.  10 months and you're in business analytics. To vaccinate or not to vaccinate. That is  very much the non-Shakespearian question.   Arguably this whole thing started as  a political divide-- red states versus   blue states-- and currently it's morphed  into almost an 'anything goes philosophy.'   Some people are steadfastly against getting  vaccinated, others are taking a wait-and-see   attitude. Our guest who has asked that we preserve  their identity as well as their voice, and is   currently taking a wait and see attitude.  Welcome to The Language of Business. Thank you. Why are you taking a wait-and-see attitude with  the Covid vaccine? Well first of all I've been   struggling with this for for many months. But  one reason is the vaccine came out in eight  

months and if you research vaccines, they take  years to come out. The second is the vaccine   industry-- they have no liability for anything if,  if a company knowingly puts products out there,   knowing that they can get sued. How can you trust  them with a product the way they have no liability   at all especially when they came out with this  so fast? And another thing is this vaccine is   the first time it's been used in humans. It's not  approved by the FDA. I'm waiting for the approval.  

I know it's a dangerous disease and it has killed  people, but out of the hundreds and hundreds of   people that I know that have had it, that no one  has had any um adverse and problems with Covid   they would get sick and then they were not sick  at all. and they would just get better. So given   that we've agreed to mask your face and your  voice, how are you dealing with this publicly?   Well publicly I don't really voice my  opinion with people that I don't know,,   My family and close friends know my views,  my husband knows my view, people that know me   support me but I'm not really out there publicly.  I don't do stuff on Facebook or anything like   that. If your employer made a mandate that  you, and everybody else, had to get vaccinated,   would you comply, would you quit, would you  sue? What would you do in that particular   case? That is a tough question. I would I,  I may comply. I wouldn't sue. I would um  

entertain the thought of finding another job.  But you know I don't know the answer to that yet.   Does your, does your spouse or your rest of  your family-- your children-- feel the same way?   My spouse does not. He's, he's vaccinated. My  daughter just got vaccinated. My son is just 18.   We have a doctor's appointment with him. He has  some health issues so we wanted to talk with   his doctor about it. We have different views,  yeah. Thank you so much for joining us today,   talking about your views about vaccinate versus  not to vaccinate, on The Language of Business.   Big choices after college, right? Grad  school maybe? Soar from your undergraduate   major to a great career in business. Biomedical  engineer to health care analyst, health science  

to clinical systems analyst, mechanical engineer  to solutions engineer. Before you know it,   you can have a Master's degree in Management  Studies. Nine months and you're in business. How do you keep everybody educated about the  pluses and minuses of Covid-19? We're on location   with Dr. Carol Bascom-Slack, Assistant Professor  of Medical Education at Tufts University,   and welcome to The Language of Business. Thank  you. Carol: How do you keep either students or   colleagues educated about what's happening with  all things Covid? Um I think first and foremost   we make sure that our students are grounded  in good scientific understanding of virology   and immunology, and that actually begins long  before they come to me. At the lower grades, where   uh you know it's really important  to make sure that students   know where to get accurate information, I think  there's a lot of misinformation floating around   and you know, if you don't uh know where to  go to get good information you can be confused   pretty easily. How effective do you think the  vaccines as a whole have been, to date? Well  

I should start by saying I'm not an immunologist,  I'm not a virologist, so my understanding is based   on the literature that's available to the general  public. But I think of the three approved for use   in the US, uh clinical trials have shown that all  are safe and effective... meaning that they do a   great job at protecting people against getting  severely sick. And having said that research   is still continuing beyond the clinical trial  stage on individuals in real world conditions,   and so far that evidence has been pretty positive.  Most data is on the MRNA vaccines-- those created   by Pfizer, BioNTech and Moderna, because they've  been available to the public for longer and I'm   sure data will be reported for the Johnson  and Johnson vaccine as it becomes available.   But overall the vaccines have proven to be very,  very effective. So much press is being given to  

the mutation of Covid now with the Delta Variant.  What does it exactly mean that a virus mutates?   So in the case of the coronavirus  that causes Covid-19 mutations   uh again are simply changes in the genome that  occur each time the virus replicates, probably   most often the changes that occur are detrimental  to the virus. They probably make it less fit but   sometimes changes make a virus better at infecting  or surviving inside human cells. So this is what  

we're currently seeing with this Delta Variant.  There was a mutation that occurred that, you know,   it's a normal process that occurs in viruses and  um this change led to an altered surface structure   which renders the virus more um capable of better  transmission and evading our immune system.   And we know that there are significantly more  viral particles in the airways of patients   infected with Delta relative to other strains.  You've spent so much time educating people on as   you said earlier in our interview 'real world  information,' yet there's so many millions   of people across the world that are taking a  wait-and-see attitude about getting vaccinated.  

What would be your message, or your  thoughts, to that group of people, please?   The highest spread of cases and severe outcomes is  in places with low vaccination rates and virtually   all hospitalizations and deaths have been among  the unvaccinated. Um this situation is really   like none of us uh living have ever experienced  before. It's hard hard to even comprehend the   number of individuals dying and the toll on  our health care workers and on the economy.   I have friends and relatives living overseas in  countries where the vaccine is not available, and   so I think in the US we are extremely privileged  to have had early access to vaccines. So I must   say I, I find it a little frustrating to see  vaccine going to waste here, while the virus   continues to propagate allowing variants to  emerge. As a scientist, what keeps you up at   night the most about the entire pandemic? I was  kind of in a state of confusion in the beginning   like everyone else and I think as the data have  come in it became clear that we could get this   under control if we took the right measures. I was  very optimistic and hopeful when the vaccines were  

first approved for use and now I think I have  become very concerned that we are not going to   conquer this, that this is something that we  are going to have to live with, that certain   individuals are reluctant to get vaccinated and so  this will be with us for a long period of time and   I, I worry about the toll it is going to take  on people's mental health and the economy, and   and so on and so forth. Dr. Bascom Slack:Thank  you so very much! Sure, you're welcome, thank you.   Dr. Carol Bascom-Slack, Assistant Professor  of Medical Education at Tufts University. Support for The Language of Business is from  Boston University Questrom School of Business.  

We're also available as a podcast on Spotify,   Stitcher, Google play or wherever you  get podcasts. Thanks for watching!

2021-09-15 11:03

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