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Lead Balloon Ep. 16 - Vaccine Messaging: How Comms Professionals Can Help Save the World from Covid

Updated: Feb 9

With former HHS Spokesman Bill Pierce and Dr. Maria Sundaram

With Covid-19 vaccination efforts finally getting underway, communicating properly about this process is critical to saving lives and re-opening the economy.


That responsibility extends beyond the traditional bounds of public health communication, according to public health experts, and touches nearly every strategic communicator in the country--and indeed every American citizen.

In this episode, we welcome back two past guests to the show.


Bill Pierce was formerly a spokesman for the Department of Health and Human Services in the George W. Bush Administration. Today he’s a crisis communications consultant at APCO Worldwide and an adjunct professor at Johns Hopkins University.


And Dr. Maria Sundaram is an epidemiologist and post-doctoral fellow at IC/ES, the Institute for Clinical Evaluative Sciences in Toronto, and a global authority on Covid-19.


These world-class public health communicators are in agreement that how we all communicate about the vaccination process going forward will play a major part in how many lives are saved.


We’ll also explore what needs to happen from a StratComm standpoint, the best ways to deal with all the misinformation about vaccines, what went wrong in the last year, and why this could be a turning point in the war on Covid.


Because if we do it right this time, communicators could still help save the world.

(Pictured in this week's podcast art: Dusty's hero, his wife, getting her vaccination as a frontline M.D.)



Transcript:



Dusty Weis:

If you're like me, as a comms professional, you felt especially helpless during the COVID-19 pandemic. And so as we surpassed 400,000 Americans dead, 4,000 deaths every day, when I look at what my wife does for a living as a medical doctor, and I look at what I do, what I do seems pretty unimportant in this moment. Well, it's not. There's a new front in the war on COVID. And this time, my fellow PR and marketing mavens, we have a chance to fight on the front lines.


Dr. Maria Sundaram:

It is a challenging undertaking to fight a pandemic. And I think that that's the case, even with very good consistent messaging. But if the messaging is not consistent, then it's not possible as we're seeing.


Dusty Weis:

Dr. Maria Sundaram is an epidemiologist at ICES, a world leader in studying vaccines in the pandemic. And Bill Pierce served as the spokesman for the Department of Health and Human Services in the George W. Bush White House. They joined me in episode seven of this podcast, just two weeks into the pandemic before we'd all learned how to use Zoom. And they're back now that the focus in the war on COVID has turned from communicating about prevention to communicating about vaccination.


Bill Pierce:

Vaccination, in this case in particular, whether you are a member of the far right, the far left, the middle, the whatever you are, it can be the militia. This is what you do for your fellow members of your community, however you define that.


Dusty Weis:

We will explore what needs to happen from a stratcom standpoint, how professional communicators like you can play a part, the best ways to deal with all the misinformation about vaccines, what went wrong in the last year and why this could be a turning point in the war on COVID; because if we do it right this time, communicators could still help save the world. I'm Dusty Weis. From Podcamp Media, this is Lead Balloon, a podcast about PR marketing and branding nightmares, and the well-meaning communications professionals who are living them still.


Dusty Weis:

I know this is usually a storytelling podcast, but when the nightmare is unfolding in real time, there's value in breaking away from the formula. So please subscribe to Lead Balloon in your favorite podcast app, if you haven't already. Follow us on social @Podcampmedia.


Dusty Weis:

Since vaccination is finally getting underway and it's the next most critical step in fighting the COVID-19 pandemic, it seemed like it was time to bring the experts back in. Bill Pierce was a spokesman for the Department of Health and Human Services in the George W. Bush administration. Today, he's a crisis communications consultant at APCO Worldwide and an adjunct professor at Johns Hopkins. And Dr. Maria Sundaram is an epidemiologist and postdoctoral fellow at ICES, the Institute for Clinical Evaluative Sciences in Toronto, and a global authority on COVID-19. They are in agreement that how we communicate about the vaccination process going forward will play a major part in how many lives are saved. I last talked to the both of you at the end of March, 2020. As you look back at the past year, what are some of the things that you expected that you saw come to fruition and what are some things that have surprised you?


Bill Pierce:

I think what I expected was the extremely difficult nature given the circumstances, the leadership in our government, in communicating about this pandemic. I was not surprised in what I believe is they did a very, very poor job of communicating and that poor job of communicating made the situation worse. I wasn't surprised about that. I think what I was surprised about, which I'm sure most were, was just the magnitude of this. How vast, not just in the US, around the world, how quickly it spread, how many people have become infected and ultimately tragically how many people have died. I wouldn't have predicted that number, but on the other hand I'm also not surprised.


Dusty Weis:

What about you, Maria?


Dr. Maria Sundaram:

I'm kind of glad that you're not playing the whole episode with me at the end of March, because I'm sure listening to it would be cringe-worthy on a couple of different levels. One of them probably being how full of energy I still was probably back then. It's a different time, different Maria. Bill, you really hit the nail on the head when you said the challenges with communication, I think many public health professionals probably saw that coming. When you have different trusted entities saying different things about a very challenging situation for which information is still developing, it makes it really hard to get people all on the same page. And that's pretty much exactly what happened. We had this group of people saying it's not a big deal. It's all a hoax.


Dr. Maria Sundaram:

And then we had another group of people saying, no, it is a really big deal. You need to brace for impact, which just really creates a divide in terms of then they're saying, okay, well, this is not about science, this is about politics, which also really creates a big problem. I think at the very beginning I had a somewhat naive idea, which I have now been disabused of, which was that in general people would see the science and get really excited about the science and get very personally invested in the science. I think, unfortunately, because of the differences in communication, what we can say is supported by the science, people disagree on now because they'll say, well, that's not the numbers from the White House, or that's not what the president said, or that's not what the governor said. That has been a bigger challenge I think that I expected.


Dusty Weis:

I think you both raise a really interesting point there. This is something that I have struggled with not just as a member of our society, but especially as a former journalist, this notion that facts could be politicized like they have been over the last year. Bill, you lived in this world and still do in a lot of ways out in Washington, DC. How did we get to this place?


Bill Pierce:

Well, we didn't get here overnight, even before President Trump, though he weaponized this issue because he looked at his whole world through a political self-centered notion. I've known about Donald Trump since the '80s. His history led up to this point and frankly, had America been better at history we would've seen all of this coming. His behavior was not a surprise. He's always done this. He's always bent the will of the circumstance in his direction, or at least always tried to. Never hesitated to reject facts, reject information, say what he wants and work very hard to get whoever his audience was to actually believe what he is saying is true.


Bill Pierce:

But in a pandemic, in a virus, he met his match. And then some. Matter of fact, he didn't meet his match. He was wildly over-matched. He had no capacity to actually talk about the situation because his history leading up to this didn't prepare him in any way, shape or form. I think Henry Kissinger said long ago that your experience and your knowledge or intellectual abilities that you bring to the White House, you will then expand it during your course at the White House. You're not going to learn anything new during this time. And this was clear with Trump. He hasn't learned anything new in, I don't know, for 30 or 40 years.


Bill Pierce:

So, that's what we saw happen. He literally believed he could bend the will of this virus and what it would do to his own point of view. He thought that, and that's what he tried to do. So that's why we ended up with people just disregarding facts because his supporters believed that. They believed his words always to be true. So if he said it wasn't a big deal, that they believed it wasn't a big deal. If he said it was fake virus, or it was the same as the flu, or whatever he said, they actually believed him. So that where we all of a sudden got this incredible cleave in the body politic where far too many people believed all the things that he said, even though it's a virus, it will do what it will do.


Bill Pierce:

And therefore, the most important voice is the expert who understands the virus. And that was the class we had from literally day one. I just saw secretary Azar finally admitted that Nancy Messonnier was right. And that was what she said in February.


Dusty Weis:

Wow. And she was punished for it. She was muzzled for speaking the truth then.


Bill Pierce:

She was punished for it. But again, this notion of the world being seen through these extremely politicized eyes has been coming since the mid '90s. It was this president leveraged it, weaponized it in a way which no other president ever has and hopefully no other president ever will.


Dr. Maria Sundaram:

And I think, Bill, you probably can speak to this a little more than I can as a public health professional, but I think unfortunately one of the consistent themes of White House communication during this pandemic has been to over promise and under deliver. And I think that's also been the case with the vaccine rollout specifically.


Dusty Weis:

Bill, based on your background here, what role does communication play going forward in the vaccination process?


Bill Pierce:

I think it plays a significant central role. I think there are two parts to this. There is the logistics of it. Clearly the Biden administration is moving towards a mass vaccination model, which the Trump administration did not have. You can't mass vaccinate via hospitals. There's not enough space and they have all these other things to do. So you actually have to create a pure vaccination channel. And then in that respect, it's go where the people are. So that's what the Biden administration is doing. So they're going to be doing everything from mass vaccinations at mega churches and convention centers.


Bill Pierce:

They're going to use employers, any place where there are large amounts of people who can easily get to that place, because then they're going to have the challenges of going to the places and addressing the folks who don't have ability to drive to the mass vaccination center. So it's going to be an all options thing. But the biggest point is this is mass vaccination, the whole idea of these singular channels to do nothing but vaccinate.


Bill Pierce:

The communication is the second part of that. And in communications, there are two parts. The first part is the safety communications, which I'll come to in a second. But the second part is communicating about the mass vaccination campaign so people understand there's not just a single way for me to get this vaccine, that I don't have to immediately rush down to the convention center even though I don't have a car and I don't really know the bus system or whatever it may be. So we have to be able to communicate well about this mass vaccination campaign in clear and concise.


Bill Pierce:

But the overarching is about the safety and why we all need to do this. Why of 340 million Americans we're probably going to need something north of 250 million of us to be vaccinated in order to put the kibosh to this thing. And that's where specific kinds of messaging needs to take place. There are some overarching things, and then you've got the messaging to the African-American community, to the Hispanic community and the techniques for doing that. I was talking to somebody about the American Indian community where they focus heavily on tribal leaders because people will follow the tribal leader. Same thing in the African-American church. People will oftentimes follow the lead of the pastor. So they're working with pastors.


Bill Pierce:

But overall, I think the message needs to be that vaccination, in this case in particular, this is what we do for our family, for our neighbor, for our friend, for our social group. This message works whether you are a member of the far right, the far left, the middle, the whatever you are. It can be the militia. This is what you do for your fellow members of your community, however you define that. That's what we've really got to help people understand is this is what we do for one another, but define one another not as if you live in the middle of nowhere, Nebraska or Wyoming; this isn't about New York City, this isn't about Portland, Oregon, this is about your small community in Wyoming. These are about your friends and your neighbors, the people you associate with. We've got to get the logistics right. We've got to communicate about the logistics so people will understand and they feel that it's fair and equitable. And then we need to communicate overarching about why we need to do this.


Dusty Weis:

From the perspective of professional communicators in corporate America, in agencies, and certainly in government, what role can we play even if we're not directly in a hands-on role with pandemic response duties?


Bill Pierce:

It's a cascading thing. It starts at the top. That's why, again, the Biden administration, have a very different idea about what to do, not just logistically but message-wise to get the governors on the same page, to get the state representatives on the same page, to get the pastors, to get the corporate leaders, to get whoever it is to deliver what those messages are. So as professional communicators, we need to be saying the same things as everybody else is saying. Contradictory messages is what's so harmed the effort up to this point. Complete contradiction within the government itself. And if that will change, then we need to follow that lead.


Dusty Weis:

And lest anybody thinks, oh, this is just another Trump basher right here, you served in a Republican administration and you're seeing this with clear eyes at this point. But when you look at the way that the outgoing Trump administration has handled this to this date, and looking at it from the perspective where these are lives, every day right now we're losing 4,000 Americans. That's much more than 9/11, every single day. The outgoing Trump administration, their approach to this has been, we're going to scale up the vaccines and then we're going to give them to the states and we're going to let the states decide how to move forward with that. And that would seem to be completely inconsistent with good public health policy because the messaging is not unified and the logistic response is not unified. So how far behind, Maria, would you say that we've fallen at this point?


Dr. Maria Sundaram:

Well, as an epidemiologist, I probably would answer that with, behind what? If we are talking about behind where we could have been with public health infrastructure funding and with a societal and political investment in that structure, all of these deaths were preventable. Every single last one of them. That is very, very hard. It's a hard reality. Certainly there are things about this pandemic that are hard. There are a lot of reasons why responding to a virus that can cause severe disease and also asymptomatic disease is very challenging, but there's also been so many unforced errors and I think you've named some of them, I think maybe the biggest one of them being really inconsistent messaging. There are good and important reasons why individual states might have different approaches to pandemic preparedness and control.


Dr. Maria Sundaram:

Some states have a largely rural population. Others have a largely urban population. There are many sort of different reasons and different shapes that the outbreak could take at different times in different states. I understand that. But when people are looking at different state plans and saying, well, the state next door has different rules, none of these rules mean anything, that's when we need a national messaging campaign, Bill, as you were saying, to say, "Listen, here's what's happening and why. Here's why every single person, Nancy Messonnier and [inaudible 00:17:04], everybody is on the same page. This is what we're asking you to do. Here's why we're asking you to do it." I'm not sure what else to say here because it is a challenging undertaking to fight a pandemic and I think that that's the case even with very good consistent messaging. But if the messaging is not consistent, then it's not possible, as we're seeing.


Dusty Weis:

If I can for a moment, Maria, can I just say that you sound really frustrated as a public health expert and as a professional communicator right now?


Dr. Maria Sundaram:

I think at this point I've even maybe moved past frustration and I'm just sad now. I think it's really hard to know that the deaths that you're seeing are preventable, the illnesses that you're seeing are preventable. It's hard from a professional standpoint, it's hard from a personal standpoint. My parents are still in La Crosse County.


Dusty Weis:

La Crosse County, Wisconsin.


Dr. Maria Sundaram:

If you go to the La Crosse County public health website, you'll see that they have a message that just says we've stopped contact tracing. We don't have the resources. There are too many cases in the community. If you leave the house, assume that have been exposed. That sort of thing was preventable.


Bill Pierce:

Yeah. I think if we look, to back up your point, if we look at other countries, granted most of them are smaller than the United States, they're not as geographically vast nor diverse as the United States in terms of our rural and urban splits and suburban and all that. But still it shows you the reality. The reality is in fact through good messaging, through good public health behavior and a society where there isn't this incredible schism that we have in our country, that in fact you are able to put a damper on this. On the other hand, it also shows you the challenges of this virus in particular because in places where; South Korea, Germany, pick your places, seemed to have done a pretty good job out of the gate are now seeing extremely challenging times where this virus is making a comeback.


Bill Pierce:

And that's even, again, in places where they were doing good work, consistent good public health practices, et cetera. That is what is so super frustrating. I'm not so sure we could have prevented every death. I'll take a slight exception there, but we certainly, certainly had we had been better prepared, the public health infrastructure we should have had, et cetera, we certainly would have seen a pandemic that would have been much less disruptive causing much less death in this country. I do believe that was absolutely doable. But not with this administration in charge, not with this administration. They didn't have that capacity.


Dusty Weis:

One of the questions that I had planned to ask here was about combating misinformation, combating fake news. I think it's safe to say that that's not even a question worth asking at this point in the conversation because if you can't combat it in the White House, you're sure not going to be able to combat it in the darkest recesses of the internet. But Maria, when we talked a year ago, it was in part because you had opened up your Facebook page to take questions from people and you had had hundreds and hundreds of responses, and I've seen you throughout the course of the year continue to use social media to allay concerns and answer questions. But as we enter the vaccination phase now, what role is misinformation about vaccines playing on social media and how is it, if at all, being combated either by people like you or by the social media platforms themselves?


Dr. Maria Sundaram:

That's a great question. Yeah, I think vaccine misinformation is kind of special in a way because vaccine misinformation about COVID-19 is already happening on kind of this existing skeleton of vaccine hesitancy sort of more broadly that already existed in the US before this pandemic and was already a concern in the US and worldwide before this pandemic. And that is unfortunate because it could mean that the vaccine hesitancy becomes worse as these ideas, this misinformation becomes more entrenched. On the plus side, it does kind of give us a starting point for us to say, okay, well, these are the myths that some people believe about vaccines or these are the common questions that people might be asking about vaccines in general, we can try to head some of these off at the pass.


Dr. Maria Sundaram:

And I've been really very happy to see a lot of this work happening on social media. And I will say as well for someone who expected most of the consistent communication to come from sort of governmental leadership and public health leadership, I think it's been really wonderful to see people reach out sort of directly to people that they have personal relationships with on social media to say, "Hey, let me talk about why you might feel hesitant. Or you have this question that's a good question, let's answer it together." On this kind of collaborative sort of gently empathetically addressing vaccine hesitancy. Even before this Pinterest took a pretty big stand in combating vaccine misinformation, and I think that not only are some social media platforms taking that more seriously but also individuals are perhaps feeling a little bit more empowered to call that out when they see it. And that's nice as well, especially when it's done in an empathetic way.


Dusty Weis:

I think you touch on an important point there, Maria, because I know that I've certainly been guilty of this myself, and this is something where I have a ton of respect for both of you. You both have incredible bedside manner when it comes to talking to people that maybe don't believe things that are rational or factual. You don't come right out and say, "Listen you idiot. This is the way that it is." And I do, and I need to work on that. But Bill, from your perspective as a crisis communicator, why is that empathy so important?


Bill Pierce:

Well, for a couple of reasons, I think in the world of vaccine hesitancy, there are several groups of people. The most extreme group are the people that we call the anti-vaxxers. So these are people who for various reasons oppose vaccinations, and they always will. We're not talking to them. What we're really talking to is people who have legitimate concerns. The African-American community has legitimate concerns when it comes to not vaccines specifically, but the official medical world, government world, response interaction and honesty and transparency with them.


Dusty Weis:

And those are concerns that are based in fact.


Bill Pierce:

Fact. Fact, fact, fact. And also just in general for lower income communities because they don't get the same access to healthcare that the rest of us do. And so there's legitimate things there. So that's why they have legitimate concerns. And that's why we just need to talk to them. And one of those legitimate "concerns" is people saying, "Gosh, I don't know, they did this so fast. Just a few months they were able to do this." Actually, this is about 15 years culmination of work here, mRNA. They didn't just do this in the last three months. They didn't come up with this idea. They've been working out this for a long time. They manufactured it quickly, and that's where the government, actually the Trump administration did something very good, which was the whole Operation Warp Speed in helping these companies manufacture and turn from the research bench, where the lots of work had been done, into actual vaccines.


Bill Pierce:

So that's one piece of misinformation we really need to talk to people about is this is not a quick vaccine. This is a culmination of decade or more of work. My brother is in line, he's in the category of being in line next. He signed up, and I said, "Well, take a selfie. We all want to see it, the whole family. You'll be the first in the family to get it." And he said, "Oh, I don't know if I can do that. I really don't like needles." I mean, there's some people legitimately, and that's, I get it. But it's not going to stop him from doing it. But we have to put ourselves in people's shoes and think about where they're coming from when we have these kinds of conversations. Because to be honest, if we get all of those folks and then everybody else who just naturally would rush into doing this, we don't have to worry about the anti-vaxxers in the sense. As long as they don't expand their world, that'll be enough Americans to actually put the kibosh to this thing.


Dusty Weis:

Backtracking for a moment there. I don't want to keep piling on the Trump administration, but it's hard not to right now. Mr. Trump has repeatedly referred to this vaccine as a miracle. Sitting as professional communicators where every word is chosen for a reason, no, it's gosh darn not. It's the result of 15 years hard work by talented scientists and groundbreaking advances in genetics and bioengineering. Are there other choices of communication like that that have hindered people's trust in this as it's been developed and rolled out over the past couple of months?


Dr. Maria Sundaram:

Well, I mean, I'm extremely very excited about vaccines. I'm a vaccine preventable infectious disease epidemiologist. You can already guess how I feel about vaccines. I'm very excited, pro-vaccine, but it's a very big challenge to then say vaccines are not the end all be all. Once we have a vaccine that doesn't mean the pandemic's over. We know that pandemics don't end with a bang, they end with a whimper. The last five cases of this are just going to be exactly as dangerous as the first five. And so a vaccine is going to help us, but it's not going to completely eliminate all of the disease that's happening and all of the illness and the death that's happening without all these other measures too.


Dr. Maria Sundaram:

So that's been a real challenging one to communicate because you don't want people to be like, well, okay fine, then what's the point? I'm not going to get vaccinated, or none of this matters or there's not going to be an end to this. Obviously there is going to be an end and the vaccine is a really important component of that, but we have to walk the line of being psyched, rightly so, about this really great advancement, but then also saying, okay, but this doesn't mean the game's over. This is like the eighth inning.


Bill Pierce:

Right. I think that's a really important point. Think about how long did it take us to wipe out smallpox? We've had the vaccine, a smallpox vaccine, I don't know, 150 years?


Dr. Maria Sundaram:

More than 180 if I recall correctly.


Bill Pierce:

180 years we've had a smallpox vaccine, we only eliminated it in 1979, was it?


Dr. Maria Sundaram:

I think that's right. I just looked it up last week and I already forgot.


Bill Pierce:

Yeah. These were very hard concepts to try to talk to the public about about how maybe COVID-19 will become a illness that will continue to circulate in the United States and we'll only have a few thousand cases of it every year once we get everybody or as many inoculated as we possibly can, and it will still circulate, but there aren't enough "hosts" for it to widely circulate. And maybe we'll have to get a vaccine booster every couple of years. Those are things we'll work out. But I think Maria's point is an important one is that the vaccine is not the answer. It is an important answer, but yet these other things still remain important things for us to do, particularly as we start to vaccinate ourselves. And these are kind of hard concepts. Even if you're talking with people who really want to know it and understand it and learn it, it's hard to wrap your head around that. It is difficult. It's a challenge.


Dusty Weis:

I think communicating about vaccine efficacy is another one of those topics where if you start going down that road and talking about, oh, this is a vaccine that's 95% effective or 90% effective, those of us who aren't scientists or public health experts look at that and we go, "Oh, 90%. That's great. That's a solid A- in the conventional rubric." But it also means that someone who got that vaccine can still get sick. What context is missing when we talk about those numbers, Maria, and how do you make sure that that's included in a professional communication dialogue about the vaccines?


Dr. Maria Sundaram:

There's a couple of things that I usually think about when we think about vaccine efficacy and effectiveness, and this is also, it's a little inside baseball, but there is an important very small difference between the words efficacy and effectiveness. Efficacy meaning kind of like values that you're getting out of a clinical trial where you have people whose jobs it is to call participants and be like, do you have a headache today? So we have a very clear understanding of exactly what day they got vaccinated, exactly what day they had a headache, exactly what day X or Y or Z happened. In the real world, obviously things are much messier, much more unpredictable. There's a lot of other contributing factors as well. In the real world, we call that an effectiveness estimate, but the clinical trial estimates are usually what we term efficacy.


Dr. Maria Sundaram:

In general, we think that efficacy estimates are kind of a best case scenario. In the real world where things are a little bit messy, that number could be revised down a little bit. Another real big challenge is that vaccines are a little bit a victim of their own success. We really kind of think of, "I've been vaccinated, that means I'm perfectly immune. I'm never going to get this disease. I got the vaccine." And for a lot of vaccines, that is almost 100% the case. We have these very, very highly effective vaccines that out of a thousand people that get them, maybe one person will wind up getting infected anyway. That's an incredible achievement.


Dr. Maria Sundaram:

But people are always surprised when someone who is vaccinated then does wind up with that disease. I get that, but that's what we're talking about when you said, "Hey, 90% is a solid A-, it's a pretty good spelling B grade." That does mean that someone who's in that 10% could have a sub-optimal immune reaction to the vaccine and just doesn't mount that antibody response in the way that we'd like to see and then does get infected. And that doesn't mean the vaccine doesn't work. It means that the vaccine works most of the time in most people.


Dr. Maria Sundaram:

And then the final thing that I think is really challenging and important for people to know as well is that just because you get one shot doesn't mean you're vaccinated. The Pfizer and the Moderna vaccines both contain two primary doses. So you have to get both doses, in one case three weeks apart, in one case four weeks apart, and then you have to wait a little bit after that second dose for your immune system to mount those antibodies for you to be fully protected at the highest possible level. We're hearing some news reports of rare infections after the first vaccine. People, a couple of days after they get the first vaccine, maybe they're falling ill with COVID-19.


Dr. Maria Sundaram:

Perhaps it'll be a little bit easier to understand if we consider a couple of factors. One of them is five days is not enough time for your body to mount this kind of really robust antibody response. They haven't gotten the second dose yet. And then a lot of the people that are receiving vaccines right now are, rightly so, people who are extremely high risk for getting COVID-19. These are healthcare workers, frontline healthcare workers and the people who are living in long-term care and older adults.


Dr. Maria Sundaram:

We understand that they have a different exposure profile than you or I when we're working from home, not interacting with sick people all day. It really depends on the context that you're thinking of these vaccines in. I hope that people are sort of learning a little bit about this is understandable, I understand this 90% or this 95% estimate. And we have to think about the context in which we're getting that estimate and then the context where we're trying to apply that number as well.


Dusty Weis:

And more than anything, it just sounds like it's important not to when somebody does get the first shot but then still gets COVID point at that and go, "See, it doesn't work." If anything, it's the exception that proves the rule.


Dr. Maria Sundaram:

I think we've seen over the last year that epidemiology seems like a very intuitive science. And I think in a way it's something that we believe our brains are sort of built for. Does A cause B? If I turn the light switch on, will it get brighter in this room? And that's a big part of kind of what we're asking when we're asking questions in epidemiology, does the vaccine reduce disease? Does coughing on someone make them at higher risk? And unfortunately, as I'm talking about these different, smaller sort of contextual considerations, I hope that people are sort of seeing why epidemiology is a little bit harder than it might seem at first glance and why we have to go to school for so long to be qualified to be in the positions that we are to communicate about it.


Bill Pierce:

When I'm putting together communication strategies or thinking about how we talk about things, and particularly if it's a new subject or a subject not well known, understood in the public arena, I say, what are the well-known things out there that the public broadly understands that might be an equivalent or help shine a light on that? And the efficacy question, I think of EPA's estimated miles per gallon on new cars. So you get that sticker side of the car and it says, estimated combined miles, 35. Now, go out and drive that car and the chances you're going to hit 35 are pretty slim. You might hit 30, you might hit 41, and it depends on where you're driving. Am I in the city? Am I in the highway? Am I combo? Is it snowing? Is it raining? All those things will impact actual miles per gallon.


Bill Pierce:

So to me, the 95% number is estimated miles per gallon. So we're going to be in the ballpark of, depending on the exact vaccine, 90, 95. It could be 96 for some people, it could be 83 for other people. The then big challenge is understanding what it actually means. And I always tell folks, "Look, if you get a flu shot, there's a good chance it will help you from getting the actual flu. But there's also a really good chance that if you do get the flu, your symptoms will be much less." And that's how you have to think of the benefit of a vaccine in general.


Bill Pierce:

Why do I want to take this vaccine? I want to take this vaccine if it's just for myself because it will either prevent me from getting this or it means if I still get it, it will be a much less serious risk to me. And then I'm doing it for my family because then if I don't get it, I won't spread it. They don't get it, they won't spread it. So, this is what we do for each other, however you define your group. So I'm not, that we have to stay way away from the politics of any of this.


Dusty Weis:

We'll continue this conversation with Bill and Maria, and I promise there's an uplifting part to bring us all back up again in a minute here on Lead Balloon.


Dusty Weis:

This is Lead Balloon and I'm Dusty Weis talking with two leading authorities on how we should be communicating about the COVID-19 vaccine. Bill Pierce was the spokesman for Health and Human Services during the George W. Bush administration and led their comms response to the anthrax scare among other things. And Dr. Maria Sundaram is an epidemiologist at ICES in Toronto.


Dusty Weis:

Back to vaccine hesitancy. Maria, when we talked a year ago, you and I, we had this exchange. How long are we going to be cooped up in our houses I think is the burning question on everybody's mind.


Dr. Maria Sundaram:

The two short answers I can give you is I don't know, and definitely longer than everyone wants to be cooped up. When you're inside for two weeks, you're like, "Wow, this is a really long time. I'm ready to be done with this." I can't tell you how many times people have asked me in the last two or three days, when are we going to be done? Unfortunately, not soon. It's very, very hard to know other than not soon. It's going to be a very hard several months at least for people and possibly more.


Dusty Weis:

I listen to that now and I am absolutely bowled over both by your prescience and by our collective naivety as a society, because here we are almost a year later. I'm still cooped up in my basement. So, what role does pandemic fatigue play both in things like getting people to wear masks in public, but also in how this vaccination campaign proceeds and how do we combat it?


Dr. Maria Sundaram:

I think it's really interesting to hear my own voice from last March. I think it's a really interesting thought experiment to just think about what we were all doing last March. We were all like watching YouTube videos to sanitize our groceries and scaring each other with information from questionable sources. I think we all had a different risk perception than we do now. And part of that is perhaps learning a little bit more about the virus and the shape of the pandemic. And certainly I think a lot of it is just the sort of brain chemistry that we have to go through in order to live through something that is extraordinarily challenging and scary.


Dr. Maria Sundaram:

Neuroscience dictates that we cannot be in a state of panic 100% of the time. We can't be doing what we were doing in March 100% of the time. We simply get tired. And so I understand why people are getting sick of wearing masks. They're getting sick of being inside. We were sick of it after two weeks, and it's been almost a year now. And I think one other thing that really contributes to that is unfortunately when we seek leadership making recommendations for the people that they serve and then not following those same recommendations, that really undermines everyone's sort of willpower to adhere to stuff that they really just find really annoying.


Dr. Maria Sundaram:

So I do think pandemic fatigue plays a big role. I think leadership and setting examples plays a big role in combating that. And I think what's hopefully become a little bit more obvious to people is the real impact that we have on others, both potentially negatively but also positively. If you're willing to say, "Hey, I can't meet you in person right now but I would love to Zoom chat with you." Or if you tell someone, "Oh my gosh, I love your mask. It's such a cute mask." If you set an example for others, if you encourage them, I think we can't underestimate the power that that can have. Just like, Bill, you were saying, getting a vaccine is something we do for our community. Supporting each other in all of those other interventions, all of those other precautions is also something that we can do for our community. And I really do think maybe even it doesn't feel that way, but the impact of that is potentially really big.


Bill Pierce:

We haven't yet touched on who I think is one of the very best science communicators, of course it's Tony Fauci. I've had the distinct pleasure of actually knowing him for 20 years now having met him when I was in the Bush administration. He's living what he's telling us. He's not going out to dinner like he used to. He's not seeing his children who he saw often. They're not getting together for Christmas. They're not getting together for Thanksgiving. Unfortunately, there are many politicians, both sides of the aisle, who didn't do that.


Bill Pierce:

Obviously the president of United States led that by just not practicing any of this, but so did Gavin Newsome when he was caught traveling North, or wherever it was, he had to have dinner at some special restaurant for some special reason. You just can't do that. Those things can be so, they can undermine so much good work quickly that you just can't do those kinds of things. And so that's why we're literally resetting. People have said the new year, I've seen many people say actually it doesn't start until January 20th, because we're going to get a chance to reset in a very big way. It's a huge burden on this administration and President-elect Biden.


Bill Pierce:

We're going to get a chance to reset. Even amongst the people who were such big supporters of President Trump, you're still going to get a chance to reset. And clearly a president elect and soon to be president who has empathy for all Americans, and I truly believe that, and he's going to live this by example, and that's going to be really important.


Dusty Weis:

I think listening back to that clip of you and I, Maria, that hindsight proves that it was a silly question for me to ask a year ago, but it's still a question that's burning on everyone's mind, when will the pandemic end? Or perhaps I can now say with a year's worth of hindsight more accurately, what does the timetable look like going forward from here?


Dr. Maria Sundaram:

One thing that I didn't get into when we talked about this last time is what does elimination mean and what does eradication mean? I didn't mention it at the time because it sounded like a real nerd thing to bring up, but now everyone's an armchair epidemiologist, so I think it's maybe worth bringing up now just because you got a little something else to talk about at your Zoom happy hour. I'll just sort of briefly say eradication is when we basically make a pathogen extinct. It's not on earth anymore. It doesn't exist. We've only ever eradicated one human pathogen, and that's smallpox. But it is extremely, extremely hard to eradicate a disease.


Dr. Maria Sundaram:

There are a couple of factors that make a disease eradicable versus probably not eradicable. One of them is that it has to be just in humans. So it can be, for example, in animals. Another one is that if you get infected with it, or if you get a vaccine against it, you have kind of lifelong sterilizing perfect immunity. Another one might be that it's really easy to tell when you do have the disease. with smallpox, that was pretty easy. You have a very clear sign that you do have smallpox. and I hope that you're starting to see from these criteria that I'm listing that SARS-CoV-2 doesn't meet several of them, if maybe any of them. So eradication is very likely not possible.


Dr. Maria Sundaram:

There is another option here, which is elimination. This is kind of like the efficacy effectiveness thing. They sound like the same word. I get that. there is an important difference between eradication and elimination. You can remove the sort of community level transmission of a pathogen and then say that area has eliminated the virus. So for example, the US has measles elimination status, and that was achieved through the use of measles vaccine. Now, it's possible for an eliminated disease to come back in an area and the US very nearly lost its elimination status last year, maybe it was actually two years ago now, I'm living in this weird time capsule as are we all, due to several measles outbreaks in New York, in New Jersey, and then in Washington state as well.


Dr. Maria Sundaram:

So measles is a really good example of a respiratory virus that's very, very transmissible. And so I hold out hope that SARS-CoV-2 is able to be eliminated with the help of a vaccine but not solely due to the vaccine. Obviously we're going to need other measures as well, including better funding for public health infrastructure. But as I mentioned before, it's going to take a long time and it's going to take a huge amount of work, more than I think we really realize. Even just contact tracing for one case of measles can be upwards of a hundred thousand dollars because of how many people one person can come in contact with, how transmissible measles is. If someone's not vaccinated, it's perhaps the case that many of their contacts are also not vaccinated. And that also sort of creates a problem for community level transmission.


Dr. Maria Sundaram:

So, I think the vaccine is going to do a lot for us in the short term, but it's not going to solve all our problems and I'm hopeful that we can kind of learn some lessons now about fatigue because we're going to need to apply those lessons when it comes down to lower level community transmission, but still kind of not the optimal vaccine coverage that we want.


Bill Pierce:

I think that distinction between eradication and elimination was really good, and I think that's extremely important for us to talk about a lot for people to understand. I doubt we'll ever eradicate SARS-CoV-2. But what's interesting is, that kind of supports the point Maria you just said is, I just saw a report last night that flu instances are way down in the United States right now. I'm in Pittsburgh area for the next several days, we have another house up here, so we come here for change of venue and pull up here just like we would at home. Locally, they've had like four reported cases in Allegheny County where normally they'd have 6,000 reported cases in the month of January for just in this one county, and they've had four. And the reason; enough people are wearing masks, enough people are social distancing, enough people are washing their hands.


Bill Pierce:

So what this I think shows us is these things which people have criticized and poo-pooed and said they don't work, they work. They actually work because they're keeping us from the flu. Now, SARS-CoV-2 may simply be more infectious than the flu hence even those doing those things, we have to do them in greater numbers. We have to be more diligent about them. We have to be more consistent about them. But it also is some evidence that shows that in fact they do work. So it's going to be a combination of doing those things, the vaccine, better testing, better tracing, that will help us, in Maria's words, eliminate CoV-2.


Bill Pierce:

But that could be two years from now before we eliminate. It could be four years from now, five years from now, 10 years from now. But by the fall, the hope is that the number of people getting sick and the number of people dying are significantly less. But I expect to be... I'm a huge baseball fan. If there's a baseball season that fans can attend this year, I'll be wearing a mask to every game all the way through the end of the year. It'll be a nationals masks for Washington nationals. You've got to be wearing your brewers mask and that's okay, but that's what it's going to take.


Dusty Weis:

And I think Bill that finding ways to celebrate the successes that we have had, like, as you mentioned, the fact that there have been six cases of flu in Allegheny County. That is wild. I hadn't heard that anywhere.


Bill Pierce:

Reported flu. Doesn't mean that's how many there are, it just means how many of those reported.


Dusty Weis:

But I think that that is a great way to combat pandemic fatigue, because we need something to celebrate right now. And I'll note this. As I was prepping for this interview, I had to go and I had to Google the US death toll. Of course, more than 4,000 people are dying a day, about 400,000 people since this all began. I actually, I realized that it had been weeks since I even checked in on that number. And that shocked me because early on, I was Googling that daily. Same for you guys. When did you stop Googling those figures on a daily basis, or have you?


Bill Pierce:

Unfortunately my newsfeed provides me that almost every day. I don't intentionally look for it, it comes to me.


Dr. Maria Sundaram:

I would say it's probably about the same for me. And I will say as well, I think for each of us, we have sort of maybe a different threshold of when we said to ourselves, okay, I can't look at this anymore, because the exact numbers can get tiring.


Bill Pierce:

It will be 20 years in the making where I think we're going to find out more people died than what we know, number one. And number two, the number of people who died of something else who did not have to die, heart attacks, cancers, when we reflect and look backward, are going to be huge because we know people aren't going to the emergency room. They're dying. And they're dying because instead of when they felt that, what was a heart attack, they didn't call 911, and so they died at home and they get reported as dying at home.


Dusty Weis:

And yet you see among the general population and certain wings of it, this tendency to look at that figure and go, "Oh, well, those people were weak anyway. Or they didn't die of COVID, they died of a heart attack. Or they didn't die of COVID, they died of a car crash." Bill, I want to play you another clip from our conversation a year ago which really stuck out at me when I was listening back to it.


Bill Pierce:

We need to tell Americans the truth about what's going on as best we can when we can and not hold back from them. Because I also believe we can trust Americans as a group, collectively, to do the right things. Individually and small groups, yeah, you're always going to find people who won't, but collectively I think Americans do the right thing. Overall, we can count on them. Now, I am a realistic optimist. I wake up every day expecting the best things to happen, prepare for them not to occur, and that's the realest part of me.


Dusty Weis:

As we have touched on already in this conversation, Americans were not communicated to about this disease properly, but I have to ask Bill, how is your realistic optimism holding up after a year of this?


Bill Pierce:

Absolutely, still holds up. I woke up every day thinking something good would happen but I knew we had an administration which couldn't lead, but that didn't stop me from trying to be as realistic as I could be. Not optimistic, realistic. I describe to people now, once the vaccine was approved and started to actually have shots in arms, we have the Johnson & Johnson vaccine, which is getting closer every day. We have a Novavax vaccine. I describe it as being in the woods. We are still deep in the woods, but we can see those rays of sunshine which break through. We have a long way to go, but we at least see there's a way out.


Bill Pierce:

I still believe that. To be honest with you, I believe the American public, broadly speaking, when communicated to truthfully, honestly, consistently, will listen and at the end of the day will still do the right things. Even some of those who now aren't I believe will. Some of them but not all of them. Some of them. And every little bit matters. And frankly, they can do the right things begrudgingly. They can yell at me when they're doing them all they want.


Dusty Weis:

As long as you've got a mask on when you're yelling.


Bill Pierce:

Well, but if I will afford to assent. I have no problem with legitimate protest complaint, any of that. No problem with it. The Americans are like that. We will grudgingly argue mentatively. We'll still do the right things, and we should. It's all about ultimately doing the right things, the things that need to be done. Your attitude in doing it is not what's important.


Dusty Weis:

To that point, and lest I be accused of Debbie downerism, here's nother clip from Maria a year ago.


Dr. Maria Sundaram:

I've seen a lot of really heartwarming things about people just doing whatever they can to try to be social in the face of social distancing. Having Zoom happy hours and meeting in the street sort of eight feet apart drinking a beer. There was a guy who sent over his number to a girl on a drone because he thought he liked her dancing on the rooftop and she thought he was dancing by himself. Those are really wonderful things about humans and I hope that we sort of can see the good things about our willingness to work around this and our willingness to put push through this.


Dusty Weis:

I have to laugh there, Maria, A, because the thought of a Zoom happy hour being a novel thing instead of just an every week occurrence is just absurd at this moment in time. But here we are. We've been doing this for a year. And in that very first world problems sort of way, even if you have had a year where you've stayed healthy and even if this has only affected some people in your periphery and you haven't lost anybody close to you, it still feels like a year has been stolen from us. But there have always been these brilliant examples of creativity from people who just want to feel some semblance of normalcy. So, what are some of your favorite instances from the last year of that and what have you personally been doing to get by?


Dr. Maria Sundaram:

I will say actually you're making me think of something that I am actually really psyched about. At the very beginning of this, I think one of the things I said was we're going to be spending a lot more time online, and talking to a video of a person is not the same as talking in person to them. And when you have like three other people sharing your bandwidth, or if your internet is spotty, or if their connection is not great, it's really frustrating to try to communicate with them. And I was like, this is probably a little bit closer to what disabled folks experience on a daily basis, at least from some standpoints. And maybe we can use this frustration and challenge to develop empathy for what they are going through already. Other people's experience is with isolation, other people's experience is with trying to communicate and having that be a challenge.


Dr. Maria Sundaram:

And I do think that we've gotten a lot more understanding about embracing chaos. I just had an interview yesterday where the person who was interviewing me was like, "My two kids are home right now. They're five and eight. They're both trying to learn at home. They're both going to come in here. During this 30 minute talk, they're both going to come in here more than once." And then as soon as she was done saying that, she turned to the right and she was like, "I don't want to box right now. No, I don't want it. Thanks for this box, please go have recess." And then she was like, "I'm so sorry." And I was like, "Yeah, you absolutely don't need to apologize to me. We're in this weird time right now. There's absolutely nothing you can do and I understand that." And I think that most people are like, now we're kind of seeing there is no point for us to have these expectations, that things are not chaotic.


Dr. Maria Sundaram:

And I think a lot of people have gotten better about talking about mental health, their struggles with depression, their struggles with chronic anxiety. I think a lot of that has been de-stigmatized and I really am so psyched that we're sort of entering into this understanding with empathy a little bit. And I will say also obviously we all have growing to do as far as creative ways to be social. So you're talking to someone who is extremely extroverted and I've been inside almost for a whole year and most of my extroversion unfortunately has just been me tweeting a bunch all the time. I've learned to play a lot of games online. I have like a Settlers of Catan app now. I've gotten really into Mahjong. There's all sorts of different ways that people have gotten really creative about it. It's been so cool to see musicians playing with each other. That Dave Grohl drum competition with that-


Dusty Weis:

Oh, that little girl, Nandi?


Dr. Maria Sundaram:

Well, I laughed so hard. That was amazing. I got chills. I was like, this girl rocks. I love her so much.


Nandi:

Dave Grohl has been kicking out something special, I'm sure it's epic.


Dave Grohl:

Okay Nandi. But I've got something special for you, something you've never heard before. Something I've never heard before, because I'm about to write this off the top of my head for you. (singing).


Dr. Maria Sundaram:

And I do think this is really uniquely human thing of looking at something that's objectively terrible and being like, how can I make this fun? Obviously the discomfort that I've gone through is minimal compared to many. I've stayed healthy luckily and my family also has stayed healthy luckily. But I will say that doesn't mean that it's been easy for any of us. I think two things can be true. It's not a zero sum game, we can all have a bad time. That's a fact of it. And I think that misery loves company in a way. If we're commiserating, I think that is also positive.


Dusty Weis:

Bill, how about you? How are you hanging in there?


Bill Pierce:

In the words of Washington, I'd like to associate my remarks with a gentleman from Canada via Wisconsin. The first thing I think is my wife and I are fortunate. And so we don't have many of the things to overcome that lots of other people do every single day, number one. So I don't sit here and bemoan one day. Number two, though, lots of good has come out of this, to Maria's point, in the sense that... We have a neighborhood group of six houses that get together every single Saturday night on Zoom. We started off playing this great game where we had to, it was a scavenger hunt where you would go find these six or eight or 10 things and they had to be in your home. We had a blast for like six weeks doing this, six, eight weeks.


Bill Pierce:

And then we morphed into just a conversation. But then we also played 20 questions. We did all kinds of stuff and we still do it, and this started in March. I get together with a group of my friends from high school every single Sunday night. It's just a chat session where we just chat about all kinds of stuff, and everybody brings something different to the table. One of my friends, he's a physician, so he talks a lot about what's actually going on in the ground in this area. Another friend of mine, he's a pastor and a theologian. So he's got a perspective, and he's West coast, and another guy here in Pittsburgh actually just retired, so he sees a different world. So it's really great conversation.


Bill Pierce:

And then my family does a call every Sunday at five o'clock and has since March. Not that we didn't always talk amongst ourselves, we did, but not this regularity. And gosh, we seem to actually really be enjoying it. I mean, people seem to be really having fun with it. It's a big family and we've had some tragedy this year and it's been really important in some of that tragedy. I'm the youngest, so I have much older siblings and we've had some deaths in our family.


Dusty Weis:

I'm sorry to hear that.


Bill Pierce:

Well, but it is life. It is what happens. But because we did this thing, it's made it all a little bit easier to be able to confront and address those tragedies because we have established these regular communications. Another neighbor, we go sit in their front yard, eight feet apart, and have drinks. And we've just figured out, and this is the optimistic part of me in the way I look at Americans. We figure this stuff out. We figure out because we are curious, we are inventive. We're not particularly thrilled with the status quo ever in America. And so, we figure out new things how to do stuff. You on your comments brought up the Tommy Thompson COVID smash. What a great idea.


Dusty Weis:

This is a for context here. Bill, you of course served under Health and Human Services Secretary Tommy G. Thompson, former Wisconsin governor. Maria, you're a loud proud Wisconsinite at heart and for those who are unfamiliar with it, this is our former governor, now nearly 80 years old. Current president of the University of Wisconsin System. And as part of his awareness campaign for COVID, he is regularly, I guess, channeling his inner Gallagher and putting on a mask and goggles and smashing watermelons while delivering COVID public service messages, which, you know what, I'm here for.


Tommy G. Thompson:

Smash COVID.


Bill Pierce:

It's hilariously funny, but yet at the same time it's delivering an important message. Tying this into messaging is, the message is consistent, but the way you deliver it can be as varied as America.


Dr. Maria Sundaram:

I actually do want to say one more thing. There have been points throughout this pandemic where we didn't have very much information, we had to make a decision. And then there have been other points where new information has come to light and reasonable people can disagree on what that information means. What's the risk benefit analysis for children going back to school depending on their age, depending on community level transmission, depending on the contact tracing that's available? What is the specific value of masks in open areas versus in indoor areas? What is the meaning of these new variants? What does that mean for a vaccine effectiveness? Many of these based on the limited information we have available, there are situations where reasonable people can disagree on some of the finer points. And I really do hope now that everyone has kind of gotten a crash course in epidemiology this year that we're prepared now to have these slightly more nuanced conversations in a really productive and interesting way. That's what I'm hoping for, that's what I'm crossing my fingers for.


Bill Pierce:

That's a really good point. As a society, I think we're learning more about the scientific process. We're learning more about the epidemiological process. How much more we'll see, but yeah, it's something said in March can be different in September that doesn't mean you were wrong in March, and we'll see how the public reacts to that. But I hope public better understands these kinds of things. Frankly it's what really attracts me to this kind of communications is because it is challenging to do, but it's extraordinarily important and vital.


Dusty Weis:

And ultimately I hope that the general public is able to take away from this that science is not a subject that you studied in high school. Science is a process of gathering information and comparing that to the information that you had and reaching conclusions, and then gathering more information to challenge those conclusions. And in the instances when science reaches a conclusion that it turns out later was not fully correct, it's not because science is broken, it's because science is working the way that it's supposed to.


Bill Pierce:

Right. The earth is not flat. That doesn't mean science was wrong nor does it mean it's broken. It just means we've learned new information it's not.


Dusty Weis:

Because I'll say this. If we're still having a discussion six months from now about whether COVID was manufactured in a Chinese lab somewhere, I'm going to tear my hair out. And that is fully intended to be a joke based on my choice of haircut. But Bill Pierce, former spokesman for the Department of Health and Human Services in the George W. Bush administration, currently a crisis communications consultant at APCO Worldwide, and Dr. Maria Sundaram, epidemiologist and postdoc fellow at ICES, global COVID-19 expert, thank you both for joining us on Lead Balloon.


Bill Pierce:

Thank you.


Dr. Maria Sundaram:

Thank you so much.


Dusty Weis:

That is going to do it for this episode of Lead Balloon. Please make sure you're subscribed in your favorite app and tell all your friends in PR and marketing if you heard something of value during this episode. Lead Balloon is produced by Podcamp Media where we provide branded podcast production solutions for businesses. Check out our website, podcampmedia.com. Follow us on Facebook, Twitter, and LinkedIn. And if you've got a story to share, reach out to me directly dusty@podcampmedia.com. Till the next time folks, I'm going to work on kicking this frog in my throat, probably get tested for COVID, but thanks for listening and stay well, I'm Dusty Weis.


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