The Progression of Immunization - Episode 3
The Consequences of Not Getting Vaccinated
Key opinion leaders consider the economic, lifestyle, and societal burdens of not receiving necessary vaccines.
Troy Trygstad, PharmD, MBA, PhD: What is the cost of not vaccinating large swaths of the population?
Michael Popovich: It’s huge. There are studies that have shown that it’s anywhere from 8 billion to 15 billon a year, and I think we’ve seen some research to justify this. You’ll see somebody come down with influenza or a particular disease. It’ll cost their health plan a million dollars to care for that individual. We don’t really realize that. But if you begin to map out the cost, that averages out to about $45 for every person in the United States to pay for extra costs when people aren’t fully immunized. This is the additional burden to the healthcare community. So pharmacists play a big role in helping reduce that and become a trusted resource for individuals.
Troy Trygstad, PharmD, MBA, PhD: Right. When you talk about public health you talk about food, shelter, clean water, and vaccinations.
Michael Popovich: Right.
Troy Trygstad, PharmD, MBA, PhD: We try to make every effort to have every single person have access to those 3.
Michael Popovich: Yes.
Troy Trygstad, PharmD, MBA, PhD: Why is it that we don’t focus on that fourth pillar?
Michael Popovich: Right.
Troy Trygstad, PharmD, MBA, PhD: Why isn’t that something that’s as ubiquitous, that it’s just second nature for everybody in our population?
Michael Popovich: There are not a lot of people out on social media talking about how we all should have dirty water, right? Don’t worry about clean water. But, if you look in the immunization space, there’s all kinds of initiatives and activities going on about what people believe or how they’re trying to influence folks, and everybody makes up their own mind. But that’s a huge challenge. And, again, it’s the pharmacist and their role in the community, and the people that walk into their store that are really going to make a difference here.
Troy Trygstad, PharmD, MBA, PhD: Sure. For Dorothy and Tana, humanistically, we have this economic burden, which is intuitively obvious, and it’s costing man billions of dollars every year, potentially more when you think about long-term disease and disability that may emanate from it. What about the humanistic aspect? You have somebody that comes in, they’re at risk: what are the humanistic costs of missing a week of work? Or having now to go to assisted living because they were living at home independently and have some episode-related to something that could have been prevented with a vaccination? Tell me a little bit about this from that practitioner’s perspective when that person is sitting across from you at the table or across the counter. How do you convey that humanistic cost? What does it look like?
Dorothy Loy, PharmD, MBA: It starts with us internally as providers. We need to make sure that we’re immunizing and understand the impact. We do something with our locations where we try to make sure that our team members understand the cost of missing a day of work. And so making sure they understand that and can relay those types of facts, figures and information to the patient. They might say, “Hey, you might be missing a whole week with your grandkids because now you have to go to the emergency room because you weren’t expecting to get pneumonia.” Things like that where it becomes relevant for the patient. Images and stories that the patient can connect to. I think that those types of scenarios really help the patient understand why they need to get vaccinated.
I think a lot of patients buy into vaccinations. It’s just the matter of convenience, time, and you know, all the other complications that may come with getting one. But then once you make it relevant to them I think that it becomes an easy decision.
Troy Trygstad, PharmD, MBA, PhD: Tana, it starts with us. We have to fully realize how to bring this to the front of our patients’ and pharmacists’ minds. In your practice in your pharmacy, how do you convey that to your own staff: “Hey, this is why this is so important. Make sure this isn’t a secondary or tertiary activity. This is a really important activity. It starts with us exuding confidence about how important this is to our patients and our customers, right?
Tana Kaefer, PharmD: Right. We have a flu day at work. Everybody knows this is when we’re all getting our flu shot. You wear your short-sleeved shirt. It’s an event. We have food, because you can’t have an event without food, right? And so we really try to tell our staff the importance of flu vaccinations. And then also we talk about hepatitis B with our patients and technicians. We make sure that they’re up-to-date on that because of the risk with their job, and TDAP [tetanus, diphtheria, and pertussis], and all of the things that we’re telling them to ask patients. They get curious and say, “Well what about me? Why should I do this?” And so you really get to practice that conversation.
I really like what you said, Dorothy, about making it relevant for the patient because stories hit home. When you have something that happened to you or a loved one, and it impacted you in a way to make a behavior change, that’s going to make patients take action.
Troy Trygstad, PharmD, MBA, PhD: Mike, what about herd immunity? There’s this idea that it’s expensive for the healthcare system not to get vaccinated. It may inconvenience you. It may be a burden to you—but what about this idea of not getting a vaccination hurting somebody else?
Michael Popovich: One of the best examples of that we see today is the measles outbreak. We’re beginning to lose herd immunity, which means if enough people get immunized they protect those that aren’t. And some people simply cannot be immunized for various reasons, and so we all have a responsibility not only to protect ourselves but our family and the people we interact with. And the herd immunity approach really does empower individuals to do a greater good for the community.
And when people are not fully immunized they’re creating risk in the population. We see the measles traveling through the United States, in some areas with 1000s of cases, albeit that came in internationally from folks that hadn’t been immunized for the measles. But the people here that are getting the measles are the people that weren’t immunized. I think that’s a huge risk factor. We tend to get lazy and say we don’t need anything, but in reality it’s just like if you change the oil in the car, it’s going to run a lot longer and you’re going to be a lot happier. And so that herd immunity is a big deal.
Troy Trygstad, PharmD, MBA, PhD: So how powerful is this though when you’re having a conversation with a patient? This idea that you know a lot of the studies and understand the social science around healthcare delivery and consumerism that shows that folks generally don’t care as much about their own health actually as they do for others, particularly family members. Parents will not take care of themselves but they’ll do anything to take care of their kids, or their parents. This concept here is a powerful tool that can be used. We’d say, “It’s not only important for you but it’s important for those that can’t get vaccinations.” You might be a carrier at some point in the future and it may not affect you, but may affect somebody else. How many folks will then say, “You know what, I have this responsibility. I feel like I should now get this vaccination because I could be hurting somebody else.” Have you had experiences with that?
Dorothy Loy, PharmD, MBA: Definitely. The mantra of spreading protection, it starts with one person. You, as one person getting immunized, spread that protection to everyone else around you, including your family, but also you coworkers, your neighbors, people that you may not be close to but who you also don’t want to impact negatively. By getting immunized you’re spreading that protection. You kind of become a hero: that one that’s really protecting the protector of those around you, which is a pretty cool concept. That’s something that I think really speaks with patients. Because, one, they see the relevance to them and their lives, but then they also feel like they’re much more empowered to make a change.