Russ White: 00:00

It only takes one case of measles or other vaccine preventable diseases for an outbreak to begin, but vaccines can prevent or lessen the severity of conditions for everyone. That's according to Peter Gulick, professor of Osteopathic Medical Specialties at the Michigan State University College of Osteopathic Medicine, and Sean Vaez, professor and director of the MSU College of Human Medicine's Center For Bioethics and Social Justice. Gulick and Vaez discussed the disinformation that leads to vaccine hesitancy and share respectful ways to educate citizens on the health benefits of vaccines. Let me start, and and, Peter, why don't we start with you a little bit about your time at MSU, what you do, why are you passionate about this work?

Peter Gulick: 00:52

Well, I came to MSU back in, 84, trained in infectious disease medical oncology. My whole career has been kinda centered around HIV because, obviously, I've seen it back before it was even recognized as a virus. Grid was the initial term, gay related immunodeficiency. And so that's been kind of the common denominator in my career, although obviously I've done a lot of other infectious diseases. I've done medical oncology for 25 years, gave that up to concentrate more on HIV.

Peter Gulick: 01:30

And so, that's been the one virus that, I've been very much interested in. And then, other viruses came about during my career. Hepatitis c, I became involved with also back in the early nineties, and that was the next virus that, came about. And then, you know, things with, outbreaks of influenza and then obviously the COVID was the next big pandemic that came about really suddenly. Kinda took everybody by surprise.

Peter Gulick: 02:02

But, yeah, I've always been, interested in, you know, patients, infectious diseases. Immunocompromised patients is one of the areas that's highly interesting to me since I've dealt with it with my cancer patients and now with HIV. So, you know, anything related to that and how to control conditions with them and how to improve their immunity is very important.

Russ White: 02:27

Yes. Well, and I I know you know your stuff, Peter, because the media comes to you all the time for your expertise, which is I

Peter Gulick: 02:32

know that.

Russ White: 02:33

Which is very nice. So and, Sean, tell us a little bit about your role at the College of Human Medicine and about your center for bioethics and social justice, kind of the mission there, your passion for that work?

Sean Valles: 02:45

Yeah. I've been at MSC for actually quite a while now. I came in 2010, straight out of graduate school. I had gotten my PhD in history and philosophy of science, working primarily in evolutionary biology theory and how it applies to human genetics and the uses and misuses of genetics. So making assumptions about which things are genetic, the history of eugenics and how it sort of still still impacts us today.

Sean Valles: 03:09

And from there, I made my way into public health theory and into into really focusing on social determinants of health and all the ways that the world that we live in every day is is basically sort of subtly changing our health for for better or for worse. And so, you know, we sort of think about how important our health is when we go to the doctor maybe once a year, But then it's really the state of the 364 days of the year where you get where the health happens. And so so where do you live? What kind of air are you breathing? What kind of water are you drinking?

Sean Valles: 03:35

Do you feel stressed at work? Do you do you, do you feel like you have to turn down another street whenever you see a police car passing, that sort of thing? And so it makes a difference. And so that that passion brought me to the opportunity to, to to be the director of the of what was at the time, the Center For Ethics and Humanities in the Life Sciences in the College of Human Medicine. It was part of an early wave of of of medical ethics centers that were established in colleges.

Sean Valles: 03:59

And I came in, and we just discussed what should our focus be? What can we be excellent at and sort of be distinctive in the space of medical ethics centers where when it was founded, there were there were not that many, and now there are many of them. So what makes art special? And so we discussed it, and we decided that we will be we will focus on social justice. And so how are all those ways of the world that we've designed in in fair and unfair ways and that affects us those 364 days of the year when we're not inside the doctor's office?

Sean Valles: 04:26

How does that make it so that people have access to access to to good health, so that people have enough food to eat so that they they don't have to live in fear, so that they're not, they're not being mistreated while they're while they're at the doctor's office. And so all those things, that's just sort of our angle on these these sort of big issues of medical ethics. And that that also impacts, vaccines where it's not just what happens between you inside the you and the doctor and having that conversation. It's all the all the messages and thoughts and fears you have during those other 364 days of the year.

Russ White: 04:54

Well, Sean, you led me beautifully into the main topic we wanted to get you and Peter on. Kind of the science and vaccination hesitancy we're seeing sort of a rise in, but maybe we wanna start with how long have we had vaccinations and and they've always been accepted or has there always kind of been this hesitancy?

Peter Gulick: 05:14

Well, I guess I I'm not sure exactly the dates, but I know they've been

Russ White: 05:18

In general.

Peter Gulick: 05:18

Since the early 90, you know, 1900. So it's not something that just came out of a box recently. But, yeah, there's always been that that, you know, the the concept that, you know, we we get exposed to pathogens all the time and, you know, our bodies react to them and some of them react well, others don't, you know, based on a lot of factors and ways to improve our immunity or ways to protect ourselves better, to avoid problems rather than have to confront them. And, over the years, you know, and and everybody can agree to this, you know, we've seen changes in, you know, the evolution of, different organisms, viruses, bacteria, etcetera, where they're becoming harder and harder to treat. There's becoming more of them.

Peter Gulick: 06:05

I mean, we rely on antibiotics all the time. That seems to be the main crutch everybody wants to grab onto, and we've created our own little, you know, horror show, so to speak, where now we're dealing with multiresistant organisms where there are no more antibiotics. We have organisms like clostridium difficile as a result of antibiotics. And so now the main, goal is for educators like myself is to talk to people about not using antibiotics or controlling the use rather than just giving an antibiotic out for every sneeze or cough or, you know, congestion that occurs there. And so vaccines are an attempt to try to improve and and do something for your body, try to improve your own immunity because, you know, many times, you know, confronting a pathogen when you already have a preexisting immune system, you may still get infected.

Peter Gulick: 06:53

No question about that, but you will not get the severity, the the side effects, the complications that you would had your body dementia totally exposed. And in the day and age now that we're dealing with, there's more and more and more immunocompromised patients. Our treatments of a lot of diseases like asthma, rheumatoid arthritis, or inflammatory conditions. So how do you deal with inflammation? You suppress inflammation.

Peter Gulick: 07:17

And what happens when you suppress inflammation? Well, you improve condition like asthma or you improve rheumatoid arthritis or improve Crohn's disease, but you also expose yourself to an immunocompromised condition and that's where then you get exposed to different organisms. And how do you protect yourself at that point? So vaccines are kind of one of those areas where, hopefully, that'll fill the gap. Sean?

Sean Valles: 07:40

Yeah. It's, it's funny because I think people think that somehow we can come up with some sort of solution to to a any kind of bug that's gonna try to infect us. But if you think of it more like more like computer viruses, where there's never a final a final sort of this is the end all be all solution for computer security. If you just install this one thing, no no virus will ever will ever infect your computer no matter what you do. Like, no.

Sean Valles: 08:05

There are hackers who are trying every single day to find a new way of sort of breaking through baking breaking through the defenses that you set up on your computer. And so it is this constant arms race as some people put it in in evolutionary theory. They call it the red queen hypothesis. There's a line in in one of the, Alice in Wonderland book saying, you know, you can do that. It seems like in order just to stay still, you need to you need to just run faster and faster just to sort of stay in place.

Sean Valles: 08:28

And it's like that with our our body is always trying we're trying to adapt to the to the things that are trying to these viruses and bugs. They're just trying to come in and and reproduce. That's that's all they're trying to do, and our cells are how they do it. And so they're they're always adapting and reproducing and mutating and changing just a little bit and constantly evolving. And so we have to evolve our strategies against them.

Sean Valles: 08:46

And so we need to, evolve our strategies against them. And so we need to we need to make the best use of the vaccines and antibiotics that we have. We need to come up with new new ones. We need to adapt to to new new pathogens, like clostridium difficile, which is just a horrible, horrible infection that you can pick up in the hospital. And so it's, we have to be we have to be active.

Sean Valles: 09:07

We can't just sort of be passive in all of this. We need to sort of have, like, strategies and think carefully about this because there are a lot of bugs out there, and they are evolving all the time, and they have very short lives. And so their their generations go real quick.

Russ White: 09:18

To what do you attribute sort of this rise in hesitancy, the misinformation, and and why would people not wanna have a vaccine that's gonna make them healthier, I guess.

Sean Valles: 09:30

Well, there there are a lot of different reasons. Some people just don't like getting getting a needle in their arm. Some people are worried about the ingredients. Some people sort of have a, a built distrust in the biomedical system. You know, if you haven't had great care inside hospitals, it seems like all the new drugs that you see advertised on TV don't aren't really for people like you or they're out of reach of in affordability.

Sean Valles: 09:54

And, it's it's hard to build up that trust that this thing that's being put into your body while you're healthy. Usually, we get usually, we get treatments while we're sick. And so, and, you know, typically, you're getting a vaccine while you're while you're feeling fine. And so the idea that you should get this shot that has these ingredients that'll do something that will change your body in some some sort of way is is a little intimidating. And so one thing that I think is is very widely misunderstood is that people sort of wanna have this binary of you're either, like, pro vaccine or you're an anti vaxxer, which is a term I really just I really dislike.

Sean Valles: 10:26

And so it's not that there are there are pro vaccine people and there are anti vaxxers. There are there's a there's a spectrum of of hesitancy. There's the people who are like, just give me whatever you got inside that syringe. Like like, load me up. And then on the other end of the spectrum, there's, there's absolutely never.

Sean Valles: 10:42

And I think this this assumption that sort of everyone who has the slightest the slightest doubt is sort of on that far, far end of never, never, never, and that's just not the case. Most people are are reasonable and willing to listen to listen to arguments and to sort of have a conversation. And if you take people seriously, then maybe you can actually get somewhere with them.

Peter Gulick: 10:59

You know, when a person gets something in their arm and all of a sudden their arm swells up and get sore or they get little bits of, you know, fever in that, then it's right away. And I hear this so many, many times. It's like, well, I never had the flu, but once I got the vaccine, boy, did I get the flu. And it wasn't the flu. It was just your reaction to the vaccine, but that is one major concern.

Peter Gulick: 11:18

And then the other concern is with all this technology available now, you can find anything you want by just looking into Google or whatever, and you can find the most horrible things you wanna find about vaccines and then you can you know, because anything is publishable in Google and you can get whatever you want. And then people, you know, hear from other people. And then there's different groups of individuals, you know, like, black African Americans are fearful because they were using the experiments years ago with the stevia. And so, you know, giving them something, you have to, you know, really explain why you're doing it. A lot of times in their communities, You know, they they, grow up and, you know, their parents or, you know, whatever tell them no vaccines are not a good thing and this and that so they get that in their mind and other groups as well.

Peter Gulick: 12:04

And so there's those fears and and then you have these reports about, you know, different conditions like autism and things like that that is a result of the vaccine. And so that just adds more fear to it. And it's like, my body's strong enough. I'll be able to get rid of it myself. So why do I need a vaccine?

Peter Gulick: 12:19

And so then they rely on other aspects. You know? A lot of people go into alternative therapies and stuff where they get over the not that they're bad or or saying they just never been studied enough to know how effective they are, but they feel that they wanna take control of a lot of things themselves. And vaccines is something that they feel like it's something invading. And it might be a you know, even though we try to explain that it's not the organism itself, but they still feel that it's, you know, it is that virus or bacteria you're getting in, especially with the newer vaccines like the mRNA vaccine.

Russ White: 12:51

Is there even an estimate how many Americans are not crazy about vaccines to put it that way? Have we ever estimated that?

Sean Valles: 12:59

Not all vaccines are created equal

Russ White: 13:01

Okay.

Sean Valles: 13:01

In terms of people's perceptions of them. And so childhood vaccines are a different sort of dynamic because it's a large way of conversation between, between parents or caregivers and and a physician. And so it's not really it wasn't my choice whether or not to get my measles vaccine when I was a kid. That was I was, I I was not yet able to make that decision, whereas the sort of the the conversation around, COVID vaccines is quite different, and it's also different from from flu vaccines. And so, I think there's there's this, again, with that with that sort of tendency for people sort of have this binary, you're either pro vaccine or anti vaccine.

Sean Valles: 13:36

There are lots of people who would say they're pro vaccine, but if you ask, did you get your flu shot this year? Like, well, not really. Like, well, let's talk about why that is. Is it is it the inconvenience? Is it because you didn't wanna have your arm sore that day or whatever?

Sean Valles: 13:49

It's people have reasons. Even I I was a little overdue for a for a vaccine yesterday, so my arm is a little well, just a tiny bit sore today. It's fine, but but, you know, even someone who cares very deeply about this, like, well, I had to find time in my schedule to go to go do this. And, like, what if I wanted to do something later that day? Like, what if I felt a little sick?

Russ White: 14:05

I guess in general, what are your thoughts on how we get people to overcome this hesitancy? Or is it they're not reachable? Or obviously, you 2 would like more people to get vaccinated. Are you do you have some thoughts on how we break through some of the misinformation?

Peter Gulick: 14:21

Well, I think education Yeah. As much as you can do. I mean, I remember when the, and I still lecture somewhat on it, but the, human papillomavirus vaccine, the HPV vaccine. And it was like, well, my kids don't get exposed to STDs, and why should I get it and this and that. So I approached it a different way.

Peter Gulick: 14:38

I approached it, and I had a lot of, individuals from the community come in, not kids, but, you know, the parents and stuff. And I said, look, this is a cancer producing organism. It's not just an organism that'll give you make you sick and create a few little lesions on your genitals and it goes away. This can cause cancer, cervical cancer, anal cancer, oral head and neck cancer. I said, and you can actually prevent this by getting the vaccine.

Peter Gulick: 15:04

And what I found very interestingly was after the lectures, I had the parents come up, especially the, mothers and say, can I get that vaccine? Prevent a prevent a cancer. So I try to educate them fully on what the vaccines do and the different vaccines and how they're effective and what are the consequences if you don't get the vaccine. And, you know, it can be a lot worse than and so I think just trying to give them the full education and explain to them how the vaccine is made and that's not and do it at as simple terms as possible. And the more you edge and some of you never gonna get to.

Peter Gulick: 15:44

Some some are just convinced that it's not a good thing and you can talk till you're blue in the face and you just can't do much there. And with my AIDS patients, because they're so immunocompromised, many of them, you know, because of the, you know, if if they're especially if they're AIDS and they don't get the vaccine, then I have to find other ways of controlling, you know, viruses, especially COVID 19. Like, if they get you know, it then talk to them about Paxlovid or something where at least I can treat them still so that they don't get seriously ill. But, you know, you look for alternatives if you

Russ White: 16:17

can't convince them. Sean?

Sean Valles: 16:19

Think one of the most important thing is just to take people seriously and to to listen to what their concerns are. So just like there isn't a single reason to not get vaccinated, there's not a single attitude towards all vaccines. There are different different reasons why people want to to want to do them. And so, like, you if you wanna have a real conversation, then you have to actually find out, like like, what are your concerns?

Peter Gulick: 16:39

Mhmm.

Sean Valles: 16:40

Can can you say what you've heard? And I'd like to listen to that, and here's here's another piece of information that you can take into account, and you don't wanna beat somebody over the head with the information, and you don't wanna do what's, what's called the deficit model of of science communication where you just say, well, obviously, if you if you had the right information in your brain, then we would just fix all these problems. So if you just understood and so I'm just gonna tell you this information. And then once I've said that, it's like, okay. Good.

Sean Valles: 17:05

Now you believe all the right things, and so now you're gonna do what I say. And that's not really how it works.

Russ White: 17:09

That makes so much sense.

Sean Valles: 17:10

If If it worked that way, then teaching would be so much easier. Oh my god. But it sure isn't.

Russ White: 17:17

What about this concept of herd immunity?

Peter Gulick: 17:19

Yeah. The more people that are vaccinated, the more, you know, obviously, you get that protection because you have few areas where the virus can infect people. So the but then if everybody feels that, well, if you 3 get it, then I don't have to worry. And then if he feels, well, if I get it, then he then all of a sudden that hurt you know, you get less and less people. They're depending on others to get the vaccine besides themselves.

Peter Gulick: 17:39

So you have to be very, very careful of that concept. Plus, you have to remember in this day and age, and I keep bringing this up over and over, everybody's not created equal. Nope. Everybody doesn't have an immune system that may be able to cope with the pathogen, so you have more and more and more. I forget what the percent is, but it's 3% or so as a whole, you know, is immunocompromised to some degree.

Peter Gulick: 17:59

So those individuals really require that herd immunity because many of them don't respond to the vaccine. So they're dependent on everybody else to protect them and should they get the virus, that's when the morbidity mortality go extremely high. So you really, you know, that that concept is important, but we have to understand and patient and people have to understand as well. And that's one area I forgot to mention when I explained vaccines to patients. I say, where do you live?

Peter Gulick: 18:26

And, well, I live with my mother, my grandmother, my grandfather. I said, well, do you realize that they don't have a good immune system? And so by you coming home and maybe giving, you know, having a COVID or whatever, that you may not get sick. You may do very good, but they may get deathly sick and they may die from the families. So I try to explain all that to them and try to explain that concept.

Sean Valles: 18:52

Yes. And no one's no one's holding any adult down and giving them a vaccine against their will. Even that when the Supreme Court considered considered this, over a 100 years ago, it was over a a I believe it was a $5 ticket. I mean, it was $5 was worth a lot more then, but still it was it was the question about can we ever sort of say it is your responsibility as a member of a community to get vaccinated? And at the time, the supreme court said said yes.

Sean Valles: 19:16

They their their their reasoning for it was was pretty faulty and was sort of changed over time as far as what the law says. But even then, it's it's not a matter of anyone disputing. It is it is, of course, your individual choice whether you wanna get your flu shot or whether you wanna get your COVID shot or whatever the thing is. If you're a minor, then it's more complicated, but and so it's it's not a question of what you have to do. It's a question of what is the right thing to do.

Sean Valles: 19:37

And so if you were going to be around other people who you could hurt by by being exposed to something and then passing it to them, then you should take that into account as a way of trying to, you know, trying to protect your the people around you, your loved ones, your your neighbors. This this is a thing that's that, that to me is a is a social justice issue is is what how do we take care of each other? It it's hard out there. It's not all that difficult to do it. It's a little discomfort in your arm for a day for most of us, and then the benefit is is quite enormous for a lot of these.

Peter Gulick: 20:09

And, you know, with vaccines too, sometimes you prevent these changes in you know, like with COVID, we were seeing all these different variants form and we still see variants form. And, you know, if we allow the virus to proliferate more, you know, eventually you know, right now we're dealing with COVID that's relatively I don't wanna say benign, but it's not like the delta strain where people are going in the hospital and having a, you know, really horrible respiratory problems and the COVID storm. But who knows if we allow them to mutate more, we may be getting that super virus again. So trying to suppress it or get that herd immunity so we don't have that virus continuing in the environment and growing and changing and mutating is another reason why, you know, vaccines could be very important.

Russ White: 20:52

Yeah. Well, Peter and Sean, thanks so much for this great information. Sean, just some final thoughts on on vaccinations you'd like to leave us with.

Sean Valles: 21:00

You know, 99% of the time, no matter whether it's in health care or some other thing, it's usually a good idea to try to spend a little bit of time preventing the problem instead of dealing with it once it's already a crisis, whether it's your finances or relationships or car problems or whatever it is. Like, spend the the few minutes of dealing with it now instead of having to deal with it or once it becomes a real problem. And so vaccines are just the perfect example of that. You know, you can get the you can get the shot now, and then that is a that is a thing you don't have to worry about at all or something or something that's just not as much. And so just that tiny bit of investment in prevention so you don't have to have to have to have the crisis that pops up unexpectedly, and you have to miss work, and you don't know who's gonna take care of your family, and you had you're not and maybe you have, long terms no long term consequences from an infection.

Sean Valles: 21:48

Sometimes the infection goes away, but then you have you have respiratory problems. You have, you have headaches. There are all sorts of different things that can happen after an infection. And so just that small investment in the in prevention, it's just usually a good call.

Peter Gulick: 22:01

I guess one last thing and and it goes with Sean here with the bioethics and everything. Respect each patient you deal with. With. Respect their feelings. Respect their thoughts.

Peter Gulick: 22:09

Respect what they so sometimes you can't convince everybody, but respect their thoughts about it, their fears, and don't just keep pushing them or belittling them or basically because I've had patients come to me where they said, well, doctor, you didn't my doctor or my health care provider never explained it as good as you did. He just said get it, and if you don't get it, then you're just gonna get sick and you may die and just left it that way. Whereas you went into more you know, and you respected what I said and listened. So I think the respect is a big thing too.

Russ White: 22:36

You can

Peter Gulick: 22:37

win people more over with honey than just, you know yeah.

Sean Valles: 22:40

And the same thing at the dinner table too. So it's it's very easy to to sort of, you know, to look look across and sort of judge somebody for the for the choices they made with their with their their health care decisions and,

Peter Gulick: 22:50

you know,

Sean Valles: 22:50

like, well, they made those decisions for reasons. And what are those reasons? And can you respect them enough to listen to them and to enter into to dialogue? And sometimes, like, there is there is just no crossing that bridge. That is that is possible.

Peter Gulick: 23:01

Right.

Sean Valles: 23:02

But is it most of the time? I don't think it is most of the time. I think usually there is there is room for for people to Yep. To to move. Absolutely.

Russ White: 23:09

So really talk with your your primary care physician

Sean Valles: 23:13

is the

Russ White: 23:13

first thing to do, I guess. Right? So my guests on this episode of MSU Today have been Peter Gulick, professor of Osteopathic Medical Specialties at the Michigan State University College of Osteopathic Medicine, and Sean Vaez, professor and director of the MSU College of Human Medicine's Center For Bioethics and Social Justice. And I'm Russ White. This is MSU Today.