Taking Healthcare by Storm: Industry Insights with Jeff Neccuzi

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Jeff Neccuzi, a subject matter expert on immunizations and former Director of the West Virginia Division of Immunization Services.

Jeff Neccuzi discusses the impact of the COVID-19 pandemic on vaccine uptake, growing vaccine misinformation, and the state of school vaccination policies in West Virginia. He emphasizes the role of primary care providers in combating misinformation and the importance of vaccinations, including measles and shingles, for public health.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-062025-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today we're talking about a incredibly important topic, vaccinations. We'll be talking with Jeff Nacuzzi, a subject matter expert on immunizations to explore the impact of the Covid Pandemic on Vaccine uptake, the current state of vaccine misinformation, and how we can better educate the public on the benefits of vaccines.

We've seen a lot in the news. It can be a little bit confusing, I think, but best way to combat. Confusion is to get information and education. So we'll also be touching on school vaccination requirements in West Virginia, which is changing a lot to the growing concern over measles outbreaks.

Something that's really important right now, as well as the importance of vaccines for older adults. So we are going to be unpacking the crucial role vaccines play in protecting public health and where the future is. For vaccinations, immunizations. Jeff Nacuzzi, thank you very much for joining us today.

It's my pleasure. I appreciate the opportunity to speak with you. Yeah. So let's dive in. Tell us how you came to do what you do, and have you always lived in West Virginia? Yes. I was born and raised here in Charleston. I've lived almost entirely in Charleston. You know, it's funny how I came to be  an immunization program specialist.

 My education was actually in sports management and  I really. I had never given a thought to public health, let alone vaccines or immunization.  But you know, I learned quickly. I started in the field of immunization at an interesting time.  In 1992 we had just come out of a nationwide measles outbreak that had resulted in over 55,000 cases, thousands of hospitalizations.

130 deaths. And the United States had to take a look at itself at its public health to decide how could this outbreak happen. After all, we have a safe and effective vaccine for measles. Well, what we came to find out was we didn't have a great vaccination rate. A good vaccine doesn't help if barely half of your children are taking it.

So an offshoot of this was what we know of now as the Vaccines for Children program. Then President Clinton he instructed DHS to take a look at our vaccine delivery system, and we found great inequality rate in efficiency. And really a lack of awareness. We had children in both the urban and rural environment, significant pockets of under immunized, onim immunized children.

It may wait for an outbreak. So  the CDC funding guidance required each state to establish a VSC coordinator. And I applied for that position. I'd only been on the job for about a year, but I was excited. I was energetic and most of all, I was fortunate to have mentors my immunization program director, the epidemiologist and physicians that worked in public health.

We were a very well funded, well staffed. Public health system, or at least in, you know, epidemiology and prevention services. Sounds like you were in the right place at the right time, right? That's what I think, yes. So how would you say the Covid pandemic I. Has impacted public perception and uptake of vaccines overall, both positively and negatively.

And have you seen a long-term shift in how people view vaccination since the onset of the pandemic? Yeah, unfortunately, I do, the Covid vaccine, unlike, vaccine hesitancy among parents of young children. is somewhat, it's not somewhat, it's totally understandable  in that they hear a lot of inaccurate but very scary messaging.

They hear stories on social media. Sometimes even the news media itself will print and. Say inaccurate things about immunization. So  I believe that the covid vaccine was a political football and that a lot of the vaccine hesitancy to Covid was more political than, health in nature, but absolutely not.

That is absolutely not the case.  I believe with with the immunization of infants and toddlers, I think parents are legitimately scared by what they see and hear and read. And it's really hard to uns scare somebody especially the parent of a very young child. And so we get that fighting though the battle against covid vaccine hesitancy.

As a very formidable challenge. Yes, it has been. There's a lot of convincing messages on social media that they're convincing. I'll just say that. Yeah, they're scary. Yes. So vaccine misinformation, it's growing.  In today's society, as we said, especially with social media, it plays such a big role.

So what strategies do you think are most effective in combating vaccine misinformation and how do we address vaccine hesitancy directly in communities that are skeptical or fearful, as you were saying, right. That's the challenge of our time. misinformation is an insidious threat to public health.

It's often crafted just as carefully as, legitimate evidence-based messaging, by public health and medical organizations.  you might have heard it said before, you know, mistruth can travel halfway around the world before the truth gets its pants on.  I firmly believe that it's an uphill battle and we have to fight it.

On all the phones, it's a  it's a great challenge to public health. And I think that the most effective messenger is your primary care provider. Public health messaging has to be somewhat sanitized in dispassionate whereas your primary care provider can really give you the blunt message particularly with adults.

Vaccination. You know, if your primary care provider tells you, Hey, you have heart disease, you have COPD, you have diabetes. If you don't get your flu and pneumococcal vaccinations, you're playing roulette with your health and, public health messaging, can't really deliver.

You know, that kind of message, that effective messaging, that, that really gets somebody's attention. But public health does help to inform our medical community. It helps to inform our media, the news media and the social media for that matter. Although social media doesn't necessarily  take away the right messages or promulgate the right messages in response.

But I do think that the public health. Has a limited role in messaging and the strength of a provider's recommendation is the most critical aspect to vaccine confidence. I would agree with you and I think it's important that. Every individual finds a primary care physician that they can trust so they can get the best tailored messaging from their provider.

Most definitely. So something that's been in the news that I've been keeping up with, I was a physician who practiced in West Virginia. The school vaccination requirements in West Virginia. So can you give us an overview of what the current state is of school vaccination requirements in West Virginia?

And are there any specific trends or challenges in the state compared to others? And how are local policies evolving? Yeah, well, , these are very interesting times. School vaccination requirements in West Virginia are actually, the policy is actually in a state of flux as you surely know. West Virginia is one of five states that allows only medical exemptions to compulsory immunization for school enrollment.

And we're actually even. More unique among those five states. We're the only state that for a medical exemption the state reviews and must approve a practitioner submitting a medical exemption in West Virginia. It's not automatically accepted as it is in the other four states. So that really makes the school.

Compulsory immunization policy. A little more contentious in our state, but make no mistake about it, west Virginia's policy is the envy of every state in the United States but so our policies are strong and our governor has issued an executive order.

Basically to create a non-medical exemption. It could be religious or it could just be any personal belief that the parent may hold. And this of course was not codified by our state legislature. And whether or not this become is challenged in a court will probably decide whether or not, this policy remains in effect. But for now, parents can simply state a preference, a desire for their child not to receive a vaccine based on religious or personal beliefs. And the state will not enforce the requirements on their child, which is not to say that the state has non-medical exemptions. We're just choosing not to enforce the medical exemptions in the state. Now, that is not public health. Simply because this issue needs to be either codified by the legislature or resolved between Governor Morrisey and the opponents that wish to challenge it. It's interesting.

 More to come. So interesting. I think, and I think this is related, we can talk about measles. Measles is in the news because there is an uptick in measles outbreaks across the country recently. So how crucial is vaccination in controlling these outbreaks? And I think I know the answer to that question, but I'd love to hear what you say.

And what do you think is driving the increases in cases? We have a vaccine that works. Why do we have, you know, increase in these cases? Well, as you know, measles is just so infectious.  It's virtually impossible to control without a vaccination. I don't I don't believe it can be done.

It's an airborne disease. If I have measles and walking into a room of 10 unvaccinated people, nine of them will become infected. Just because I was there and I was breathing. I don't have to speak. I don't have to. Contact anyone just by breathing in the same, air. And so that's our challenge is to restore vaccine confidence.

The measles vaccine is particularly effective, it's in combination with  Ella and mumps vaccine, and they all have varying levels of effectiveness, but measles vaccine. And people that receive one dose. It's  the current estimate is 93% effective with one dose and of the remaining about 98% of the remaining 7% will get antibody response after a second dose.

And two doses are what's required in, all 50 states, in the territories in the District of Columbia. So, the measles vaccine is essentially the only tool to contain measles. But measles has been a boogeyman from the, for the seventies, eighties, and nineties. It was D-T-P-D-T-P was the scary vaccine.

DTP was the vaccine that parents were afraid of, and frankly, they were justified in their fear. The DTP vaccine made with wholesale pertussis, produced a lot of scary vaccine adverse events. Children  would become catatonic. Other children would become quite the opposite.

They would have bouts of inconsolable crying hours and hours  and so this really frightened parents and totally understandable. But a medical journal in Great Britain published an article in The Lancet a highly respected medical journal. And it was basically it was a fraudulent article by a medical doctor who had a major conflict of interest.

He was working to patent, not patent, but to produce. Single antigen, measles, single antigen or bowel, single antigen mumps vaccines, not in combination with each other. And he had an interest in proving that the MMR vaccine was harmful or less effective. And so he chose to present data that he thought would prove that the MMR vaccine, was harmful to children. But the problem was  he fraudulently designed his study. He got results that could not be replicated and basically was excoriated  in the medical community. He lost his license to practice in both England and in the United States because he came to the United States shortly thereafter.

Anyway, so the measles vaccine is very effective, but we have to take it and we have to stop fearing it. Frankly, we have to fear the disease more than we fear the vaccine. Yeah it's, really unfortunate.

So let's shift a little bit and talk about vaccines for older adults. I'm gonna be 50 soon, and I've been doing some research on shingles and I didn't realize, the risk of getting shingles if you're unvaccinated is fairly high. It's like one third of individuals will get shingles over their lifetime if they're unvaccinated, and individuals who make it to 85.

Their unvaccinated half will get shingles. It's very painful. It's something we really aren't talking about in the news, but there's a vaccine. So we talk about the importance of vaccines for older adults, especially considering diseases like flu, which still hospitalizes older adults, shingles, pneumonia.

How can we better educate and encourage the older population to stay up to date on their vaccinations? That's a great question. Unfortunately I think the biggest challenge is that many practitioners do not stock the vaccines they recommend for older adults. Adults generally have to go to a public health department, a community health center somewhere.

It's somewhat inconvenient for an adult to stay up to date on immunization, unless, again, I'll come back to this. I think it's the most important thing, unless they get a strong recommendation from their provider. And so adults have to respect the diseases that the vaccines prevent. Just the way, you know, the parent of an infant or toddler should we do have adult vaccines available because of the pharmacies. The pharmacies are the greatest, do the most immunization of adults now in the United States.  Particularly with the  flu and pneumococcal vaccines. Those are seasonal, of course. And now, you know, RSV vaccines are now available and the shingles vaccine, as you pointed out, is a very  it's a devastating, you know, it quite produces quite a lot of pain.

It's only different and its priority for, public health  or excuse me, adult safety net clinics because it's not real easily transmittable. And so public health has to first and foremost devoted to resources to the vaccines that spread more easily, you know, airborne diseases like influenza Of course a particularly high priority, but no, you're absolutely right. Shingles is a very  painful disease. And anybody who's ever had chicken pox has that virus stored latently in their spinal column. And I don't believe  the medical and science communities know yet what exactly activates that virus to produce the shingles disease and the painful blisters and rash.

The many other really horrible effects of this disease.  but yes, shingles vaccine is very important too, but it just, isn't as easy to come by in our public health clinics.  And a lot of people, particularly adults with Medicare. They have to purchase an additional  part D component of Medicare to have coverage for most adult vaccines.

I think, you know, part B,  any health plan for that matter, not just Medicare. I've never heard of one that doesn't cover influenza and pneumococcal vaccines. Those are by far the most cost effective vaccines. The most sought out vaccines by the public. But it's important that our adult populations know that there are many vaccines available to them.

They're extremely safe and effective. They just may not be able to find it in their medical provider's office or in their local health department. It may take some effort to locate, locate a dose, and they should I do, yes. So, just shifting a little bit, I read that you had a role and maybe you developed, I think you developed the vaccine purchasing estimator tool or vpe, I think VPET.

Yeah. Vpe. Right. And how does, how it plays a role in vaccine distribution and accessibility. And what impact does this tool have on making vaccines more available, especially in underserved areas? Right.  It's crucial to. A state like West Virginia where we have significant areas that are medically underserved and immunization isn't as widely available as we would like for it to be.

So what we did in West Virginia I'm, the most proud of this more than anything. In my 32 years  career in immunization, we developed a plan to provide a safety net. For children who live in a medically underserved area who have insurance or Medicaid that covers vaccines 100%, but they don't have a doctor.

They can see that participates in the VSC program or a doctor that stocks vaccines at all. Even for privately insured patients. Many doctors don't do that in West Virginia in our rural areas. Some of the family general practitioners are seeing everybody from birth to a hundred. They don't have a significant enough percentage of their population to make it viable, feasible to stock vaccines.

So they have to refer people out for vaccinations. Well, basically we decided  that barrier, that, was a barrier to immunization, and we created a safety net. We assured that the local health department in every county of our state would be able to provide vaccines to every child, whether they were eligible for our state supplied vaccines or not.

So we developed this tool. We estimated the, we took actual vaccination rates for our state. We multi, well   it's too hard to explain, but we use the VPA to  provide a safety net for childhood vaccines to assure the state of West Virginia through its local health departments guarantees immunization to every child in the state.

And we have attempted to do this with adult vaccines as well.  But of course, you know, we've been unable.  Funding for adult vaccines doesn't compare to the funding. We get for childhood immunization. Immunization and for good reason.  We really have to control immunization among children in school settings because these are where outbreaks can flourish.

And in fact, the whole community, not just the school children. Sounds like a really useful tool. Most definitely  so last question, looking towards the future, you talked a little bit about how West Virginia's vaccine climate compared to other states in terms of uptake, hesitancy policy  you know, in, the school policies.

So again, looking to the future, what are some emerging trends or developments in vaccine science that you're excited about and how can we prepare for future challenges in public health? I think one of the most exciting trends in vaccine development it's the development of adjuvanted vaccines.

An adjuvanted vaccine, of course, is a vaccine that has a stabilizer or an immune enhancer. These are designed. Actually to stimulate a stronger immune response. An adjuvant might be something like a small safe amount of an aluminum to essentially irritate the immune system to elicit a stronger response for the immune system.

And then, and I guess the downside of that, of course, is that, you know, it will produce, at least in theory, a more local. Non-systemic, non-serious reactions. It's something that if a person can live with it you know,  a more sore arm or anything like that, but know that they have established  that they have produced like you, a good immune response, it seems worth it to me  to have a day or two of some mild discomfort to know that you're getting a really strong response.

To diseases that can kill. So I think I personally find that to be a very promising trend. We're using some of those. We make flu vaccines. We make a few vaccines these days that are avan. and they're doing a great job.  I'm not sure whether or not it's a  a financial issue or if it's more of an issue in establishing confidence.

in an adjuvanted vaccine that might carry the risk of increased local reactions. And another thing I would do, or another thing that excites me in terms of future trends of vaccination, is that we are continuing to make them pure and safer than ever before.  Every childhood vaccine in the United States can be had in a form that will contain no preservative preservatives include the mercury containing ol, which a lot of parents you know, worried what can produce autism well as a heavy metal.

Yeah. There are certain risks with those, but they're in such small amounts in vaccines. In fact, mercury, the amount of mercury a person, a pregnant woman could get more mercury out of a tuna sandwich the than out of like a thousand doses of a flu vaccine. And even then, as I said, you know.

There are many flu vaccines. Most flu vaccines They're in a single dose form and no preservative is needed. And so really things are looking up for safer, more effective vaccines.  The future is even more promising that what we have now, we just have to have  people just have to take the vaccines for them to do their job.

And I would agree, and I think it's important to stress that they're safer, that, going forward to make sure people understand so we can kind of get a handle on things like this measles outbreak that's happening  and, you know, maybe a larger pandemic that's coming down the pike.

So  I'm encouraged, so that's good. Thank you so very much for joining us, Jeff Oozie, this has been so enlightening.  I really enjoyed learning about your insights and  you know, things are evolving so much in this area. Maybe we can bring you on again to share your insights going forward.

Absolutely. I would love to do that. Great. Thanks so much. Thank you very much. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.