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Mandatory Vaccine Policies: Challenges & Solutions · The SHEA Podcast

• 0:08
  SPEAKER_03: Welcome to the Rapid Response Podcast brought to you by Society of Healthcare Epidemiology of America, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:25
  SPEAKER_03: I'm Walid Jawed, I'm a professor of medicine at ICANN School of Medicine and hospital epidemiologist at Monsanai Downtown, and I'll serve as your podcast moderator today.
• 0:36
  SPEAKER_03: The discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:48
  SPEAKER_03: She is excited to launch this episode of Podcast COVID-19 update, what we know now.
• 0:54
  SPEAKER_03: Today's discussion will focus on a very important topic: mandatory vaccine policies, challenges, and solutions.
• 1:02
  SPEAKER_03: Our speakers today are Dr.
• 1:04
  SPEAKER_03: Reta Murti, Professor of Medicine Individual Infectious Diseases at Cedar Sinai Medical Center, and professor of clinical medicine at UCLA David Gapson School of Medicine, and George Chapman, Director of Infection Prevention and Control at Cincinnati Children's Hospital Medical Center and Associate Professor at the University of Cincinnati Department of Pedriatics.
• 1:31
  SPEAKER_03: Thank you both for joining us today.
• 1:32
  SPEAKER_03: Let us move right into the discussion.
• 1:35
  SPEAKER_03: One of the questions we have is implementing mandatory vaccine policies is certainly a hot topic among healthcare professionals.
• 1:43
  SPEAKER_03: Can you both describe your involvement in this area?
• 1:46
  SPEAKER_03: What is your overall feel for how these policies are being implemented and received?
• 1:52
  SPEAKER_03: And especially now that there is a concern over Omicron variant.
• 1:57
  SPEAKER_01: Josh, I'll go with you first.
• 1:59
  SPEAKER_01: Oh, okay.
• 2:00
  SPEAKER_01: Thank you.
• 2:00
  SPEAKER_01: And thanks so much for having me.
• 2:02
  SPEAKER_01: It's really great to talk about this topic.
• 2:04
  SPEAKER_01: So I was one of the members of the writing group for the J Guidance for the COVID vaccine as condition of employment.
• 2:12
  SPEAKER_01: And together, Dr.
• 2:13
  SPEAKER_01: Murphy and I co-led writing of the implementation guide for the COE process.
• 2:19
  SPEAKER_01: So what's my overall feel?
• 2:21
  SPEAKER_01: I think that it's it's appropriate that these policies are being implemented.
• 2:26
  SPEAKER_01: And I think overall they are being well received.
• 2:29
  SPEAKER_01: I think that, you know, there are a number of questions that are important for institutions to ask.
• 2:35
  SPEAKER_01: I don't know how well they're being asked on an individual basis, but I imagine that there are a lot of questions that we'll get into.
• 2:42
  SPEAKER_01: One thing that I do want to say is in terms of how does this relate to the Omicron variant, I think that Omicron is just a reminder of why we recommended this condition of employment in the first place.
• 2:54
  SPEAKER_01: At the time that we were writing the recommendations, Delta was on the rise.
• 2:57
  SPEAKER_01: Now it's Omicron.
• 2:59
  SPEAKER_01: There'll be another Greek letter that we may be talking about down the road.
• 3:02
  SPEAKER_01: The key here is that the path to controlling the COVID-19 pandemic includes vaccination of as many people as possible.
• 3:09
  SPEAKER_01: And so as healthcare workers and as healthcare professionals, we should be leading the way.
• 3:14
  SPEAKER_01: Thank you.
• 3:14
  SPEAKER_01: Rika, what are your thoughts?
• 3:16
  SPEAKER_00: Well, I think this is fundamentally gets down to why what we do in healthcare.
• 3:22
  SPEAKER_00: And I think Dr.
• 3:22
  SPEAKER_00: Shashton mentioned the importance of the Omicron variant as a reminder.
• 3:28
  SPEAKER_00: And really, we've had during this pandemic multiple reminders of why it's been so important to protect our healthcare workers who are at the front lines.
• 3:38
  SPEAKER_00: And I I do think we as healthcare epidemiologists have a long history of having been at the forefront and trying to advocate for safety of our patients, of our healthcare workers and our visitors in our community.
• 3:52
  SPEAKER_00: And I think we have a lot of lessons learned from past experiences such as the influenza pandemic more recently, than the H1N1 pandemic, and our efforts collectively across the country in introducing really the concept of having a vaccinated healthcare workforce against influenza.
• 4:11
  SPEAKER_00: I think those are really important historical perspective now as we're thrust into this pandemic and how we've experienced it.
• 4:19
  SPEAKER_00: And I absolutely agree that there's always going to be another crisis like this, but at any time, if there's no time, there's really no time like now during this particular pandemic that we need to continue to come back to the core of why do we do what we do and how can we best serve our community.
• 4:37
  SPEAKER_00: So I think the role of mandates from my perspective has become very critical, particularly in the healthcare sector.
• 4:43
  SPEAKER_00: We've all experienced, both from the SARS epidemic 20 years ago, the really the tragedy around some healthcare professionals at the front line who were uh affected, not only infected, but but had uh fatal outcomes.
• 4:57
  SPEAKER_00: So I think we it's a we owe it to ourselves to remember those heroes and realize what all of our frontline workers have gone through during this pandemic as well.
• 5:06
  SPEAKER_00: It's here to stay for some time.
• 5:08
  SPEAKER_00: And I think we've seen evidence of uptake of more boosters, for example, by the community as news of the AlmaCron variant has emerged.
• 5:15
  SPEAKER_00: So it's just another reminder.
• 5:17
  SPEAKER_00: We need to lead from that perspective of what we think are the is the best science and best way to protect everybody and hope that you know that it'll sort of ultimately will be judged, I guess, by history at some point.
• 5:28
  SPEAKER_00: But the success of our efforts is going to depending on how well we protect our caregivers.
• 5:33
  SPEAKER_00: Probably a long-winded answer.
• 5:35
  SPEAKER_00: We can certainly cut it down.
• 5:36
  SPEAKER_03: Oh, that was actually perfect.
• 5:37
  SPEAKER_03: Josh and Rick, I I totally agree with what you were saying.
• 5:40
  SPEAKER_03: And I was just reflecting back when you were speaking about the experiences as to what last two years have really been, and then when the vaccines came and so on and so forth, this uh event, this pandemic has never been seen before, at least in the modern timeframe.
• 5:57
  SPEAKER_03: We compared it to uh influenza pandemic of 1918.
• 6:01
  SPEAKER_03: I'm not sure if it's a comparison, a fair comparison.
• 6:03
  SPEAKER_03: This is far more different, far more aggressive enemy that we're dealing with.
• 6:08
  SPEAKER_03: And we I think when we came together for the condition of employment conversation, it was really geared towards time of action is now.
• 6:16
  SPEAKER_03: We need to put in some support together for institutions.
• 6:20
  SPEAKER_03: A lot of institutions at that time were considering this, but had no support out there.
• 6:24
  SPEAKER_03: So we wanted to put the support out there for them as well.
• 6:28
  SPEAKER_03: And and then the implementation guidance that you guys provided had been really a good pathway of implementing how to how to get it done.
• 6:36
  SPEAKER_03: So I've been actually amazed, and as you said, like this is not the last variant we are dealing with, and uh we will probably continue to do that.
• 6:44
  SPEAKER_03: And the reason for implementation guidance really is to help people get vaccinated and help others get vaccinated.
• 6:52
  SPEAKER_03: So you both have been involved in Shay's work group around mandatory vaccine policies.
• 6:58
  SPEAKER_03: And can you provide our listeners some insight into what you have done and what you have learned from this group?
• 7:04
  SPEAKER_03: And Dr.
• 7:04
  SPEAKER_03: Muti, can you start us on some conversation?
• 7:08
  SPEAKER_00: Sure, I'd be glad to start.
• 7:09
  SPEAKER_00: So I think this experience with being involved through Shay with these uh working groups around with vaccine and others is really a fantastic experience for those who've not had the opportunity to do so.
• 7:23
  SPEAKER_00: I'd highly encourage you to be involved.
• 7:26
  SPEAKER_00: But it essentially it the the working, the fundament the concepts of the working group are to bring together a group of individuals, and in this case it was a fairly large group.
• 7:36
  SPEAKER_00: I want to say it was over 20 people who represented expertise, not only crochet in terms of healthcare epidemiologists, infectious disease physicians, uh, infection professional and prevention professionals, but also others who other stakeholders, including those with regulatory experience, those with legal expertise, who can really bring together all the different facets of the conversation.
• 8:01
  SPEAKER_00: And so the the group essentially was was an opportunity to bring together this group and work through the overarching goal.
• 8:09
  SPEAKER_00: And one of the key questions was what was this group going to end up deciding?
• 8:14
  SPEAKER_00: And so we're really coming into this with a sense of we don't know what the what the conclusion will be.
• 8:19
  SPEAKER_00: The intent is to actually review all the information available and and really keep an open mind whether or not we might have biases coming into the conversation.
• 8:28
  SPEAKER_00: And that's I think that's what uh being involved with a group like this really allows you to do.
• 8:32
  SPEAKER_00: And uh would just add that so so in terms of the actual working group, we kind of met several times, talked through some of the issues, broke down the topic into multiple subjects, and kind of developed subgroups that would then go off and research the literature as well as really have conversations to bring back to the larger group for discussion around the specific questions we wanted to tackle.
• 8:57
  SPEAKER_00: And at the end of the the close to the end, once all the information was compiled, we would put the discussion to a vote.
• 9:04
  SPEAKER_00: Individual recommendations would be voted upon.
• 9:06
  SPEAKER_00: And that's I think the intent of the whole process through what was really described through our Shay handbook for developing these kinds of expert guidances really is to understand that they may not be a grade level evidence out there, and in this case certainly wasn't because we're dealing with new information, but there is a process that is that is established for us to follow that allows us to have an have some structure and be respectful of you know what's published, be respectful of the expertise, but really come together as a group and come out with the best recommendations.
• 9:40
  SPEAKER_00: I'll just add that I, from my perspective, say has a long history of advocacy when you know when it comes to the safety of the public and our healthcare, you know, industry workers and professionals.
• 9:51
  SPEAKER_00: So I think you know, we're all advocates for as you say, you say mission, having a safer, healthier future for all.
• 9:58
  SPEAKER_00: And I think that's a good reminder for why being involved with these kinds of efforts to is really critical and a huge learning opportunity because you're actually influencing policy with really that that sense in mind, using the expertise but delivering and uh recommendations that can really support our mission of all of our members in uh hospitals and healthcare facilities.
• 10:22
  SPEAKER_00: So I think that's kind of just another perspective.
• 10:25
  SPEAKER_00: I think it's really worthwhile to keep in mind and uh learning from this kind of experience is tremendous about the different facets and perspectives that people bring, but all with the same goal of coming out with the best recommendation for our society, and in this case, getting endorsement from multiple other stakeholders, other societies as well.
• 10:45
  SPEAKER_01: Yeah, so I don't know that I could say it much better, but I will add a couple of things.
• 10:50
  SPEAKER_01: One is I totally agree that the multidisciplinary approach was amazing.
• 10:54
  SPEAKER_01: The perspectives that were brought to the table from employee health, occupational health, from legal and other aspects really opened our eyes.
• 11:04
  SPEAKER_01: Shea is about, and healthcare epidemiology is often about we know what the evidence is, we know what we can do.
• 11:10
  SPEAKER_01: Now, what do we do next?
• 11:11
  SPEAKER_01: How do we act on this?
• 11:13
  SPEAKER_01: And I think that Waleed, you said it perfectly, that the agreement, the basically consensus was time for action is now.
• 11:19
  SPEAKER_01: And I think we really came together and were able to answer that question together.
• 11:24
  SPEAKER_01: The enthusiasm was amazing.
• 11:25
  SPEAKER_01: The leadership from David Weber was just absolutely fantastic.
• 11:29
  SPEAKER_01: He kept us moving and he had us all voting, and Valerie Deloney keeps us in line, which is absolutely essential.
• 11:37
  SPEAKER_01: But it was, you know, a matter of people, people did their homework, people came and and we had great discussions.
• 11:44
  SPEAKER_01: And I think it it was emblematic both of how there was an urgency to get this done, but also that we all really understood that we had to, we had to figure this out together.
• 11:55
  SPEAKER_01: And so we did so.
• 11:57
  SPEAKER_01: And I was really pleased to learn so much from my colleagues and to and to meet so many people that I had never interacted with before.
• 12:04
  SPEAKER_00: I think it's also good to just remind now a recollection, it seems like it was so long ago.
• 12:09
  SPEAKER_00: But I think you had almost like an eight to ten week time.
• 12:12
  SPEAKER_01: Oh, yeah, it was lightning speed.
• 12:14
  SPEAKER_00: So I think, Josh, to your point, it was a very rapid uh, you know, effort with a sense uh really a as you pointed out, a sense of urgency to act that you know we and so everybody was very passionate and yet very committed to delivering, you know, the the call to action, whatever that was, and and absolutely agree every individual.
• 12:37
  SPEAKER_00: And I wanted to add, besides occupational health, employee health, human resources experts, as well as uh legal and regulatory, really passionate group of people and all very, very committed.
• 12:47
  SPEAKER_00: So thank you for mentioning that.
• 12:48
  SPEAKER_00: The time frame was was very compressed, unlike most writing documents.
• 12:52
  SPEAKER_01: Right.
• 12:53
  SPEAKER_01: It usually takes us at least 18 months, if not longer, to put together an expert guidance.
• 12:59
  SPEAKER_01: And that's that is just simply impressive about how we put together a document that is useful and has some really helpful content in it in such a quick time.
• 13:09
  SPEAKER_01: It was it was very exciting.
• 13:11
  SPEAKER_00: And just to add, in that compressed time period, things were changing as we uh as we went through.
• 13:17
  SPEAKER_01: That's a good point.
• 13:18
  SPEAKER_01: Yeah, and we should we should just know one more thing is that in our vote, the initial vote was not unanimous, right?
• 13:23
  SPEAKER_01: So this was a wonderful example of a very healthy discussion and debate, a respectful listening and reflecting back on people's opinions.
• 13:30
  SPEAKER_01: And and we truly did come to a consensus in the end.
• 13:33
  SPEAKER_01: Um and then we all thank Kumbaya.
• 13:35
  SPEAKER_01: Next question.
• 13:37
  SPEAKER_03: No, I I think just reflecting back on the same that even though it was lightning speed, I I do remember a lot of conversation, George, uh, yourself, Eureka, like it wasn't take this decision to support a mandatory vaccination policy was not taken lightly.
• 13:51
  SPEAKER_03: And uh like there was a lot of debate and uh and and a lot, a lot of voting uh and and review of literature on each and every point.
• 13:59
  SPEAKER_03: And so you both work in different areas in infection prevention.
• 14:02
  SPEAKER_03: Uh Dr.
• 14:03
  SPEAKER_03: Murti, you work in adult systems while Dr.
• 14:06
  SPEAKER_03: Shabson is pediatric.
• 14:08
  SPEAKER_03: Can you both talk about differences on implementing vaccine policies in your specific areas?
• 14:13
  SPEAKER_03: I'll uh Dr.
• 14:14
  SPEAKER_03: Shabson, I'll I'll start with you, just time.
• 14:17
  SPEAKER_01: Yeah, so a couple of things about the pediatric context.
• 14:21
  SPEAKER_01: The first is that we have an extra layer of need of protection.
• 14:25
  SPEAKER_01: Until recently, nobody under the age of 12 could be vaccinated.
• 14:29
  SPEAKER_01: So there was a sense that we had to create as much of a cocoon, as much of a protective layer for all of our patients as we could.
• 14:37
  SPEAKER_01: It still exists because under five, which is a good chunk of our patients, a good proportion of our patients, and infants with COVID can become severely ill.
• 14:48
  SPEAKER_01: It's it's that much more important for us to continue not only to advocate, but also to make sure that we're providing maximal protection.
• 14:56
  SPEAKER_01: I think a similarity would be that the majority of the transmission that we were seeing, and the majority of the risk was because of our employees interacting with each other, which they're going to do.
• 15:06
  SPEAKER_01: From a pediatric point of view, there really was not a huge amount of risk from patient exposure.
• 15:11
  SPEAKER_01: The first few waves we did not, not all of us.
• 15:14
  SPEAKER_01: I mean, there were different areas, but it wasn't as, it wasn't the same as adult disease.
• 15:20
  SPEAKER_01: Delta, we saw more pediatric disease, but still the biggest risk was having lunch with somebody unmasked.
• 15:27
  SPEAKER_01: And so I think that it was very similar in terms of ensuring coverage as broadly as we can, because people come to work to interact with one another.
• 15:37
  SPEAKER_01: They've been going through a very long period where they haven't been able to do that and they miss it.
• 15:42
  SPEAKER_01: And we're trying desperately to meet the need for social interaction and honestly for productive employment with safety.
• 15:50
  SPEAKER_01: And this is one of the avenues forward.
• 15:52
  SPEAKER_03: That's such a great insight.
• 15:54
  SPEAKER_03: Dr.
• 15:54
  SPEAKER_03: Murti, uh, your thoughts.
• 15:56
  SPEAKER_00: Yeah, I and I I think from the standpoint of healthcare organizations, while pediatrics, Josh outlined, kind of has some additional layers that might be needed because of the absent lack of vaccine access until recently.
• 16:11
  SPEAKER_00: Really on the adult, if you think about the any general hospital, any large hospital or even community hospitals, it's a mixed bag, even if you don't have a dedicated pediatric service or hospital.
• 16:22
  SPEAKER_00: We have a mixed population.
• 16:25
  SPEAKER_00: Even if in our hospital, for example, it might be pediatrics wards, and yet many of the staff are are from other parts of the hospital.
• 16:32
  SPEAKER_00: So I think that in reality, there's probably more similarities than differences from the standpoint of implementing uh policies.
• 16:39
  SPEAKER_00: But I agree from the patient perspective, certainly that that was a concern.
• 16:43
  SPEAKER_00: But in our healthcare institutions, we have such high-risk patients.
• 16:47
  SPEAKER_00: You know, we we have a a matrix model where often our units are, you know, all come have all comers in the in these units with different levels of risk, whether it's transplant patients or you know, ICUs or or wards.
• 17:02
  SPEAKER_00: So I think the overarching concern is to establish kind of that organizational stance and really get to everybody with a consistent message.
• 17:12
  SPEAKER_00: And uh I do think there are probably a lot of similarities now, of course, as we have more access to vaccines.
• 17:18
  SPEAKER_00: I think that that levels the playing field somewhat.
• 17:20
  SPEAKER_00: Yeah, but I do agree with Josh's point that most of our focus has been on illness among healthcare workers, not only from interaction between themselves, but also the fact that they're members of our community.
• 17:30
  SPEAKER_00: So they are at risk from being exposed in the community.
• 17:33
  SPEAKER_00: And if they if they come into our health healthcare settings and are incubating illness and are pre-symptomatic, they're posing a risk to our patients.
• 17:41
  SPEAKER_00: So that's I think probably a consistent risk across the board.
• 17:45
  SPEAKER_03: Thank you.
• 17:45
  SPEAKER_03: Thank you for that insight.
• 17:47
  SPEAKER_03: It's very helpful to kind of understand how the different systems are approaching this complex issue.
• 17:53
  SPEAKER_03: So, do we have any information around how organizations have implemented processes for exemptions, such as religious or medical, and how those are being viewed for approval or denial?
• 18:05
  SPEAKER_00: Well, you know, these are complex issues.
• 18:08
  SPEAKER_00: And I think one of the things that was we really talked about during the writing group and in the implementation group was how important it was to have an organizational approach that was credible and you know reliable and consistent.
• 18:24
  SPEAKER_00: You need to have the buy-in of the people who are one to know that there is a process to request exemption.
• 18:32
  SPEAKER_00: But more importantly, to know that the organization has a process that can be applied, you know, to everybody in the same way, and it's fair, but importantly, it's it's credible and consistent.
• 18:45
  SPEAKER_00: So I think they're all required, we've been our organization uh historically, even with influenza vaccine, we've had influenza vaccine mandates for almost eight years now.
• 18:55
  SPEAKER_00: And so during that process, we established a close collaboration between our occupational health and HR and legal teams, along with our clinicians and epic professionals, to really have a planning group that that's the panel through which these exemption requests all go through.
• 19:14
  SPEAKER_00: And they are logged and follow-up is is insured.
• 19:17
  SPEAKER_00: And we have to make sure that we weigh that that these experts, our legal and HR experts, are the ones who are responsible for ensuring compliance with the state and federal laws.
• 19:27
  SPEAKER_00: And so we rely on them.
• 19:28
  SPEAKER_00: So in our organization, we have, for example, this panel.
• 19:31
  SPEAKER_00: Often the medical exemptions are routed through a clinician panel, whether it's employee health, our epidemiologist, our chief of staff, our occupational health physician, so that it is a transparent process shown to be supported by the medical staff quality oversight process as well as through administration.
• 19:49
  SPEAKER_00: And our you know, religious exemptions are often are sort of directly routed to our HR and legal group who would use them for their compliance and follow-through.
• 20:02
  SPEAKER_00: So I think it's a kind of a well-established process now.
• 20:06
  SPEAKER_00: The toolkit that's the implementation toolkit that we worked on through SHA that has templates for these exemption requests.
• 20:13
  SPEAKER_00: And so there's several examples of these toolkits.
• 20:16
  SPEAKER_00: But most organizations have set up some kind of a committee or panel for review.
• 20:20
  SPEAKER_00: And I think one of the key key things beyond the credibility is to make sure that there's some flexibility to understand that individual, if people are looking at the individual, not necessarily just a piece of uh paper.
• 20:33
  SPEAKER_00: What they understand is there's a somebody who is undergoing a specific issue in their life and they want to defer it for some time.
• 20:41
  SPEAKER_00: I think that kind of individual, human level understanding and empathy and compassion has to be part of the equation as you're trying to establish a uh, you know, a policy that the organization stands behind with the goal of vaccination for everybody.
• 20:57
  SPEAKER_00: Those are my thoughts, Josh.
• 20:58
  SPEAKER_01: Yeah, I totally agree.
• 21:00
  SPEAKER_01: I think I imagine that most places have a committee, because I think sometimes what we focus on is the people who decide not to adhere to a rule or follow a mandate and will look for ways to get out of it.
• 21:11
  SPEAKER_01: And there will always be people who do that, but the vast majority of people are sincere, mean well, and want to do the right thing.
• 21:18
  SPEAKER_01: And if their religion, if a medical condition dictates that there's risk to them to take this vaccine, and that risk is not tolerable to them, it's very important to try to understand where they're coming from.
• 21:31
  SPEAKER_01: There's going to be different levels of health literacy, there's going to be different levels of access, there's going to be different perceptions that may not be clear to all of us just because of our upbringing and our background, but extremely important to listen to individuals and to understand what they're saying, and then to try to put it in context, and the best way to make a good decision is to do so as a group.
• 21:54
  SPEAKER_01: We all know what our individual institutions have done.
• 21:57
  SPEAKER_01: And I think one thing that's been very interesting is you can.
• 22:00
  SPEAKER_01: Can look at the evolution of knowledge and the evolution of how people approach this requirement by looking at what people are granting as medical exemptions.
• 22:08
  SPEAKER_01: Pregnancy is a perfect example for infertility.
• 22:11
  SPEAKER_01: Do you choose infertility early on?
• 22:14
  SPEAKER_01: There were some folks, and we've been so fortunate that Rick is saying we have examples in the implementation kit.
• 22:20
  SPEAKER_01: People have been very generous to share their internal documents so that we could have insight into it.
• 22:25
  SPEAKER_01: But, you know, the discussion was while we recommend strongly for pregnant women to get vaccinated, that's there's no question to that.
• 22:33
  SPEAKER_01: What is the risk to the fetus is a question.
• 22:36
  SPEAKER_01: As far as we know, it's low.
• 22:38
  SPEAKER_01: And as far as we know, if we risk benefit in the presence of a pandemic, it favors vaccination.
• 22:43
  SPEAKER_01: Both of those are true statements.
• 22:44
  SPEAKER_01: But for the woman who is four months pregnant, who has had miscarriages or not, there's a reality that we have to try to address.
• 22:51
  SPEAKER_01: And so I really appreciate that many of us have tried to meet our people halfway.
• 22:56
  SPEAKER_01: What we did at my institution was we granted an exemption through the pregnancy.
• 22:59
  SPEAKER_01: So it ends on the day of delivery, and they need to be completed their series by the time they come back from their maternity leave.
• 23:05
  SPEAKER_01: So it's it's acknowledging the concern and the stress, not creating more stress, but at the same time saying we're all in this together.
• 23:12
  SPEAKER_01: Were you not pregnant, you would be getting vaccinated.
• 23:15
  SPEAKER_00: I was just going to add that, you know, we just to sort of bookend Josh's comments, that implied under all of this is that this process for exemption is to uh have a process for people to work through their objections of whether they meet the valid medical exemptions or conscientious objections for others.
• 23:37
  SPEAKER_00: And that's often where there's a lot of time and effort needed.
• 23:41
  SPEAKER_00: But at the end of the day, is the organization has to stand behind those decisions.
• 23:46
  SPEAKER_00: And if somebody doesn't, the implications are that if the exemption is not granted, there's a choice for the individual to either proceed to get the vaccination or face, you know, leaving the organization.
• 24:00
  SPEAKER_00: And and I think that's ul ultimately why this process is so important.
• 24:04
  SPEAKER_00: It is a major, major decision point.
• 24:06
  SPEAKER_03: But I was gonna just add to what uh Josh was saying, and it really resonates with me as well, as to uh and what you had said, that like it's not like we we are making the decisions in silos, it's it's uh and we shouldn't.
• 24:19
  SPEAKER_03: It's a committee, it's a group of individuals, but the healthcare workers, the people we work with on a daily basis, they have been with us to uh and we have to bring them along.
• 24:28
  SPEAKER_03: And really, for example, as uh Josh was mentioning about the pregnant women, it can be it can be very difficult decision for a pregnant woman to make at that time.
• 24:39
  SPEAKER_03: It might be absolutely crystal clear to me that the need the outweighs the risk, which it is, but uh, I totally uh we all need to consider the worries and concerns from others.
• 24:50
  SPEAKER_03: And so I think that's where a committee structure is helpful, but because a decision like this is not easy to make for somebody else's livelihood.
• 24:59
  SPEAKER_03: And it should not be that the ID doc who's running IP is making all these decisions, it should not be that.
• 25:05
  SPEAKER_03: It should really be a bigger committee with experts, with uh HR experts, as you said, Rika, and uh legal guidance and all that, so that decisions that are made are really uh really made with uh a lot of conscious deliberation with that.
• 25:20
  SPEAKER_03: So thank you, thank you for for the those insights, both of you.
• 25:23
  SPEAKER_03: Uh, how about how about religious exemptions?
• 25:26
  SPEAKER_03: And I know a lot of ID docs are not directly involved in the religious exemption, uh, even in our system as well.
• 25:32
  SPEAKER_03: We are not directly involved.
• 25:34
  SPEAKER_03: But any any thoughts on that, uh Josh?
• 25:36
  SPEAKER_01: Yes, unfortunately.
• 25:38
  SPEAKER_01: I mean, I am involved, so but I serve as the medical subject matter expert.
• 25:42
  SPEAKER_01: So if a claim is made about a vaccine, I'm there to say, here's the content.
• 25:46
  SPEAKER_01: Oftentimes for influenza, it was objecting to the components of the vaccine.
• 25:50
  SPEAKER_01: And so I was able to clarify that question.
• 25:52
  SPEAKER_01: I think that what we I can just speak to our experience.
• 25:56
  SPEAKER_01: What we try to do is we try to look for a sincere belief.
• 26:00
  SPEAKER_01: Faith is by nature faith.
• 26:03
  SPEAKER_01: It's it's a leap.
• 26:05
  SPEAKER_01: It's not, you can't argue it, and you can't argue it with science, but people can express why they're feeling what they feel and show their sincerity through having a conversation.
• 26:16
  SPEAKER_01: So oftentimes they will submit a form and then we'll have them resubmit.
• 26:19
  SPEAKER_01: We may give clarifying questions, we may challenge them on certain claims.
• 26:24
  SPEAKER_01: We don't try to win an argument and eliminate, but we also don't try to give carte blanche to people who will just claim my religion, it's against my religion.
• 26:32
  SPEAKER_01: And I think that, you know, you take the COVID vaccine and you take the question of the use of aborted fetal cells.
• 26:38
  SPEAKER_01: And I think that it's it's another perfect example of how for me, there's no issue because the use of stem cells in research has saved more lives than I can count.
• 26:49
  SPEAKER_01: And so I support it completely.
• 26:51
  SPEAKER_01: And this event happened years and years ago, and our rules are different now, and blah, blah, blah, blah.
• 26:56
  SPEAKER_01: But I know that it's real for some people.
• 26:59
  SPEAKER_01: And so, you know, again, we try to have that recognition and that understanding.
• 27:05
  SPEAKER_01: It's less about the legality and more about the sincerity and about meeting people where they are.
• 27:12
  SPEAKER_01: We have people who applied for exemption from flu and said, because I don't want anything that uses fetal cells.
• 27:18
  SPEAKER_01: And we wrote back and said, good news, no fetal cells in flu vaccine.
• 27:22
  SPEAKER_01: So you can have a flu vaccine.
• 27:24
  SPEAKER_01: COVID-19, different story, right?
• 27:26
  SPEAKER_01: Just trying to balance as much as possible.
• 27:28
  SPEAKER_01: Now, I just want to say one thing that may be more the next question, but there's a temptation for those of us who are in favor and those of us who honestly are responsible for going through these requests.
• 27:40
  SPEAKER_01: They're very emotional, they're very challenging.
• 27:43
  SPEAKER_01: It can be a very draining process.
• 27:45
  SPEAKER_01: And I imagine it's the same for the people who apply.
• 27:47
  SPEAKER_01: But there's a tendency to either say, no, I'm going to make it so that you have to get vaccinated.
• 27:54
  SPEAKER_01: Or if I give you an exemption, I'm going to make the barriers so high, I'm going to put extra burden on you to make your life miserable so that you instead choose to get vaccinated.
• 28:04
  SPEAKER_01: And I don't think that anybody says that consciously, but I worry that that's where it goes.
• 28:10
  SPEAKER_01: And what I try to remind myself is so I don't think of the person who is coming up with a way to pretend that they have a religion that says they can't get this vaccine and they they find the right words to use to get through.
• 28:21
  SPEAKER_01: I think about the person who has a history of myocarditis and almost died of myocarditis, and their cardiologist says, I don't think you should risk it.
• 28:29
  SPEAKER_01: Right.
• 28:29
  SPEAKER_01: That person, I don't want to give a vaccine to.
• 28:31
  SPEAKER_01: We had an employee who had some sort of TIA or something.
• 28:36
  SPEAKER_01: I couldn't tell you what.
• 28:37
  SPEAKER_01: It's not a common reaction, but darn if I'm going to have that person take a second vaccine.
• 28:42
  SPEAKER_01: Let's not, let's not risk.
• 28:44
  SPEAKER_01: Remember that we're here to try to help people and make people healthy.
• 28:47
  SPEAKER_01: So I think that that's one piece that especially around the religious exemptions, because, you know, nobody will ever agree on religion.
• 28:57
  SPEAKER_01: And so it's, it's, I don't agree with your belief.
• 29:00
  SPEAKER_01: I think it's extremely important for us to understand that all we have to do is we have to understand the sincerity.
• 29:05
  SPEAKER_01: And then we have to tell these individuals that given this, I respect that, but given this, I need you to do everything you possibly can to prevent transmission.
• 29:14
  SPEAKER_01: And we did that before we had vaccines.
• 29:17
  SPEAKER_01: So that's really what we do for people.
• 29:19
  SPEAKER_01: We don't have to create extra walls, extra barriers, extra hoops.
• 29:23
  SPEAKER_01: We just have to tell them, yeah, now you really do need to wear a mask.
• 29:26
  SPEAKER_01: Now you really do need to wash your hands, et cetera.
• 29:28
  SPEAKER_00: I think the important things there, just and I completely agree, are really understanding that you know, with sincerity or conviction is that uh there are nuances to these to the sense of personal belief that whether it's rooted in, you know, a faith or uh or other.
• 29:46
  SPEAKER_00: But I think that's Josh's point, it's so important to carve out the pieces that are are in between that may not be clear-cut medical contraindications, but have this historical context of experience of an individual that we will never we don't have all the answers from a scientific perspective of what some of these reactions have made in.
• 30:07
  SPEAKER_00: And so in those settings, we would often ask the person to provide documentation of those reactions just so we kind of have them in our again, just to have them as part of our process so that it just demonstrates the due diligence and kind of is able to withstand, you know, scrutiny later to say, did you follow a process that had some consistency and credibility?
• 30:27
  SPEAKER_00: So I think we can't compromise that approach of really listening to the individual.
• 30:32
  SPEAKER_00: And uh yeah, uh some of those fears are real.
• 30:35
  SPEAKER_00: And we don't have the answers there.
• 30:37
  SPEAKER_03: And I I think I I think what both of you are have said, I I think the medical exemption is a very difficult process and religious in itself by definition is extremely complicated.
• 30:49
  SPEAKER_03: There are a lot more things that come in play, and and we and we have to be sensitive to everybody's strongly held beliefs and also it's uh it's a lot more complicated situation.
• 30:59
  SPEAKER_03: That takes me to my next question, and I think Josh has kind of alluded to it.
• 31:03
  SPEAKER_03: So I'll start with Dr.
• 31:04
  SPEAKER_03: Mooti first.
• 31:06
  SPEAKER_03: What are some of the biggest challenges around implementing mandatory vaccine policies that you encountered?
• 31:13
  SPEAKER_00: I think in the past, when it came to like influenza vaccine, it I will share that in our organization, it took a few years to be able to work through the key elements of aligning the stakeholders, really communicating the why, getting people to understand the message and the process that we were open to, really demonstrating that you know respect and inclusion and some confidence and the real life experiences.
• 31:39
  SPEAKER_00: It wasn't a pandemic then.
• 31:41
  SPEAKER_00: This was after the H1N1 cumulative years of vaccine shortages, we're in a different place now.
• 31:46
  SPEAKER_00: So I think in terms of this COVID-19 mandatory vaccine policy, it is it is largely around you know, a lot of concerns around the rapid development of vaccines and in addition to the prior historical kind of vaccine hesitancy across the board.
• 32:06
  SPEAKER_00: And I think that's this this experience of here certainly highlighted the importance of tackling that that public publicly in how do you get to communicating and closing those knowledge gaps from all sectors, including generational, historical gaps, disparities, the trust trust and perception gap among sectors of our population, including our healthcare workforce.
• 32:33
  SPEAKER_00: So I think those are those are some examples.
• 32:35
  SPEAKER_00: Um and then I'll add another one that is you know, there are real concerns about shortages of labor in healthcare.
• 32:42
  SPEAKER_00: And other countries, for example, have not even tackled this because they are concerned about, in fact, you know, visiting some folks in in England, they're very concerned about the drain of their workforce to other countries on the continent.
• 32:55
  SPEAKER_00: And so legitimate concerns from the healthcare workforce that were faced here as well is another challenge.
• 33:01
  SPEAKER_00: So those stakeholders include administrators and leadership of the organization to to kind of really be on board.
• 33:08
  SPEAKER_00: So I think those are some examples.
• 33:10
  SPEAKER_00: I'm sure Josh can add others, but um clearly important.
• 33:14
  SPEAKER_01: Yeah, yeah, I I will agree with all of those.
• 33:16
  SPEAKER_01: Probably the main one that I'll address is is or or add is that we talk a lot about vaccine hesitancy, but we don't have a good method to address it straight on.
• 33:28
  SPEAKER_01: And it's not a problem that can be fixed quickly.
• 33:31
  SPEAKER_01: So we don't have an answer.
• 33:32
  SPEAKER_01: We we have methods and we have ideas, but we don't really know how to counter it.
• 33:37
  SPEAKER_01: And misinformation is very, very challenging, not just from a sinister point of view, not really.
• 33:42
  SPEAKER_01: It's just that people believe one another when they talk.
• 33:45
  SPEAKER_01: And so people say, Well, I heard, and that tends to be more convincing than I saw a published paper that said, or that makes sense, that doesn't make sense.
• 33:54
  SPEAKER_01: So I think that one of the biggest challenges is that we've never really taken on vaccine hesitancy, straight on.
• 34:00
  SPEAKER_01: We've talked about how to get around it, we've talked about anti-vaxxers, we, you know, we've tried to frame things.
• 34:04
  SPEAKER_01: And I think there's a ton of material that people have produced and a lot of people who are trying to address this.
• 34:10
  SPEAKER_01: And I think there's wonderful work out there.
• 34:12
  SPEAKER_01: But what strikes me is that as a country, as an institution, the first move was to mandate and then explain why, rather than to go forward and say, we're thinking about mandating.
• 34:26
  SPEAKER_01: I want to hear from you and then address those issues straight on.
• 34:29
  SPEAKER_01: And it's hard to do because you're not sure where you'll end up.
• 34:33
  SPEAKER_01: But I really think that that will continue to be our challenge moving forward because we're gonna end up answering and justifying rather than starting from a place of we all need to be safe, not everybody's gonna agree how we stay safe, right?
• 34:48
  SPEAKER_01: Exactly, or the decisions that are made.
• 34:50
  SPEAKER_01: But we're in this together.
• 34:51
  SPEAKER_01: And so we need to make sure that we're aligning on this and let's talk about this.
• 34:56
  SPEAKER_01: So honestly, I think it's better because I think those conversations inevitably happen.
• 35:02
  SPEAKER_01: But I think that as we said, this is not the last that we're seeing of this type of challenge and societal challenge.
• 35:10
  SPEAKER_01: And I think our one of our biggest challenges is going to be to have these straightforward, honest conversations to come to a consensus of what we think is the best way forward.
• 35:20
  SPEAKER_03: That's well said, Josh.
• 35:21
  SPEAKER_03: I think you used this phrase in one of the meetings that we are building the plane as we are flying.
• 35:26
  SPEAKER_03: It has stuck with me ever since.
• 35:28
  SPEAKER_03: And that's where it is, right?
• 35:30
  SPEAKER_03: We are all experts and we we knew about how to tackle a lot of outbreaks.
• 35:34
  SPEAKER_03: But the issues that we're facing in this pandemic are not what were in the books, what we knew, what we were was in the history about this, the societal challenges, the issues, the social media impact, and all other things.
• 35:47
  SPEAKER_03: It's really not one thing.
• 35:48
  SPEAKER_03: It's and it doesn't seem right for us to judge others and their decisions.
• 35:53
  SPEAKER_03: But at some point, like I when you were saying all that, I thought, I was thinking to myself, why did I get vaccinated?
• 35:58
  SPEAKER_03: Because I felt like I had no choice, not because I wasn't given any choice.
• 36:02
  SPEAKER_03: I got vaccinated as soon as I qualified, because to me, this was the only way forward.
• 36:09
  SPEAKER_03: This was literally the only way forward.
• 36:11
  SPEAKER_03: But others are not there.
• 36:13
  SPEAKER_03: They are not epidemiologists.
• 36:14
  SPEAKER_03: And I think part of our job is to understand and bring them to that point and try to actually support them in that journey.
• 36:21
  SPEAKER_01: I'll just can I just add one thing to that, Wally.
• 36:23
  SPEAKER_01: I think very, very well said.
• 36:25
  SPEAKER_01: What before the vaccines came out, I was not, I hadn't decided what I was going to do because I wanted to see the data, right?
• 36:31
  SPEAKER_01: I wanted to see the data.
• 36:33
  SPEAKER_01: And and I I wish I could share this with more people, but I was so inspired and astounded by the safety data, by the efficacy data.
• 36:43
  SPEAKER_01: Like, wow.
• 36:44
  SPEAKER_01: You know, that's like when HCV treatments came out and they were getting 99, 100%.
• 36:49
  SPEAKER_01: I was like, oh, come on.
• 36:50
  SPEAKER_01: Like it's real, it's legit.
• 36:52
  SPEAKER_01: And I was talking to a guy that I work with here.
• 36:56
  SPEAKER_01: We we did a lot of the COVID trials here in Cincinnati Children's for adults as well as kids.
• 37:00
  SPEAKER_01: And I called him and I said, Are these numbers real?
• 37:03
  SPEAKER_01: And he said, You bet.
• 37:04
  SPEAKER_01: And the two of us were tearing up.
• 37:06
  SPEAKER_01: It was just so exciting.
• 37:07
  SPEAKER_01: So absolutely, I knew that I would have to make an important decision.
• 37:11
  SPEAKER_01: And when that data came out, it was a no-brainer, right?
• 37:15
  SPEAKER_01: And so then I was totally surprised with all this pushback.
• 37:18
  SPEAKER_01: Like, well, you don't, this is wow, like this is one of the best vaccines I've ever seen, you know?
• 37:23
  SPEAKER_01: So anyway, I agree.
• 37:25
  SPEAKER_01: Not everybody is there, not everybody understands it the way that we understand it.
• 37:28
  SPEAKER_01: And we just have to help them towards it.
• 37:30
  SPEAKER_00: And I think echoing both of your comments around the experience last December when the data was available.
• 37:37
  SPEAKER_00: I remember when the day was available, there was this collective cheer and this real.
• 37:42
  SPEAKER_00: I mean, I just felt emotionally a sense of this incredible inspiration, pride, and excitement that made we were going to turn the corner finally in this horrible year that we all had.
• 37:53
  SPEAKER_00: Having said that, I think, you know, one of you mentioned social media.
• 37:57
  SPEAKER_00: You know, for years, I'm sure we've all been giving talks to our boards and our uh members of the community and our healthcare workers about vaccination, the history of vaccinations.
• 38:07
  SPEAKER_00: People have forgotten this generation, you know, uh you know, a couple of generations have had no experience with vaccine preventable diseases having evolved as they have.
• 38:17
  SPEAKER_00: And so after that, the evolution of the internet social media, where basically a single voice on a blog can be set at the same stage as a researcher who's knowledgeable about the that data that you just described.
• 38:34
  SPEAKER_00: And so it's you know, it's it's really become a compartmentalized public where people can kind of have a voice and amplify uh with in you know, terms like influencers, uh, where we they can have a big voice, even though even though they may not have the data or expert and put on the same uh playing field as experts.
• 38:52
  SPEAKER_00: So it's not it's not equal.
• 38:54
  SPEAKER_00: And we have that to deal with in addition to the inherent concerns about vaccines that then play into the vaccine hesitancy and amplify it.
• 39:01
  SPEAKER_00: And we haven't even talked about politics, but it's also there.
• 39:05
  SPEAKER_03: Yeah, I I remember one of the news outlets asked me about some uh some questions about what I thought about the some of the political policies, and I my answer to them was simple that this is pandemic, this is not politics, right?
• 39:19
  SPEAKER_03: So I'm not gonna answer those questions, but you're right, like there's so many other factors that we we need to kind of contract uh and and kind of move forward on.
• 39:27
  SPEAKER_03: I I think uh Rika and Josh, you both have alluded to really important hesitancy issues.
• 39:32
  SPEAKER_03: And I think part of our job is, and I and I keep on thinking to myself about this is we have been in this profession for a long time, but others who are just hearing about pandemic, they're learning by fire right now about pandemic and management and epidemiology and all these things.
• 39:47
  SPEAKER_03: So I think uh there's a lot of responsibility, probably a lot more fear, as Josh said, like the data when it came, and you uh you also said the same thing that we it was an emotional moment for all of us.
• 39:58
  SPEAKER_03: But I think it was limited by the fact that very few people understood exactly what this meant.
• 40:03
  SPEAKER_03: This was this is still now.
• 40:05
  SPEAKER_03: I I don't even know of any other vaccine that's the same.
• 40:09
  SPEAKER_03: Like there's no nothing like that.
• 40:10
  SPEAKER_03: I think there's billions, not millions, billions of people who are vaccinated.
• 40:14
  SPEAKER_03: And there's there's the data is like amazing.
• 40:18
  SPEAKER_03: But again, there's uh there's a lot that we we need to do to kind of get people to understand this.
• 40:24
  SPEAKER_03: So, what about solution to these problems?
• 40:26
  SPEAKER_03: What have you uh your institutions been doing to alleviate the concerns and challenges that arise, Dr.
• 40:32
  SPEAKER_01: So I think that the first thing that we always go to is education.
• 40:36
  SPEAKER_01: Education doesn't stick, but we are well-educated people.
• 40:40
  SPEAKER_01: And if we have never I never learned that, I never heard that, nobody ever told me, I didn't read that.
• 40:46
  SPEAKER_01: It's very hard for people to accept.
• 40:48
  SPEAKER_01: So I think that we've put out as much information as we can.
• 40:51
  SPEAKER_01: Our former uh CEO, there used to be a once-a-month meeting for managers.
• 40:57
  SPEAKER_01: He turned that into uh leadership rounds that was broadcast online, and anybody in the institution could log in, and anybody in the institution could send a question directly to him or one of the leadership groups.
• 41:08
  SPEAKER_01: And the topic for many, many months for most of the call was COVID.
• 41:12
  SPEAKER_01: What are we doing about COVID?
• 41:13
  SPEAKER_01: How are we doing about COVID?
• 41:14
  SPEAKER_01: And it was answered in real time.
• 41:16
  SPEAKER_01: And I think that that is a way to engage directly with people to meet people where they are, you know, having informational town halls.
• 41:23
  SPEAKER_01: We also have social media platform in our institution.
• 41:26
  SPEAKER_01: It's a Microsoft platform called Yammer.
• 41:28
  SPEAKER_01: And we've used it for ideas and we've used it for uh letting people know when there's going to be a food truck at a campus or something like that.
• 41:37
  SPEAKER_01: And so this inevitably was used for people voicing opinions.
• 41:41
  SPEAKER_01: And, you know, the majority of it was actually really helpful and respectful that people could understand one another.
• 41:48
  SPEAKER_01: There was some moderating done.
• 41:50
  SPEAKER_01: And so we did have to help people be productive in their conversations.
• 41:55
  SPEAKER_01: But I do think that people were able to share experiences and people were able to see the different pieces and not just throw sound bites at each other.
• 42:04
  SPEAKER_01: And my hope is that that really helped create a sense of community and a sense of we don't all have to agree, but we all understand this is a requirement.
• 42:14
  SPEAKER_01: Dr.
• 42:14
  SPEAKER_01: Murti.
• 42:15
  SPEAKER_00: Yeah, I and I I think you know, education is is never enough education.
• 42:20
  SPEAKER_00: You know, we we are we are ourselves are continuingly learning.
• 42:25
  SPEAKER_00: But I think the key message is to get information out to as many people as possible, as frequently as possible, and continue to update them.
• 42:33
  SPEAKER_00: And I think I will I will say that one of the biggest challenges for folks was this sense of everything was changing.
• 42:40
  SPEAKER_00: Policies were changing, new guidance was appearing.
• 42:42
  SPEAKER_00: So there was never enough information being sent.
• 42:45
  SPEAKER_00: There's no such thing as too much information or too frequent.
• 42:48
  SPEAKER_00: So, in addition to the the town halls and the leadership meetings, uh in our organization, there were daily organization huddles similarly.
• 42:56
  SPEAKER_00: And uh at every level, organization-wide, leadership huddle, there's all staff huddles, there were open forums that that were that were really intended to kind of not only answer questions, but get some basic information out with key changes.
• 43:10
  SPEAKER_00: But partnering with that, you that's never going to be enough, right?
• 43:13
  SPEAKER_00: Not everybody can log on all the time.
• 43:15
  SPEAKER_00: And and it's great to be able to log in and check, but even that, people were pretty stressed.
• 43:20
  SPEAKER_00: So other things that are that in our place we did was written communication.
• 43:24
  SPEAKER_00: We mobilized our marketing team, kind of retooled all of their efforts toward communication in the written form, whether it's online, group, all e all blast emails to medical staff will be one, and then to all staff would be the other, and often with similar information, because we're you have to know your audience.
• 43:43
  SPEAKER_00: You have to make sure that people are receiving the information.
• 43:47
  SPEAKER_00: It would be in a form that was easy to read, that could then be posted and printed for people who don't have access to the internet.
• 43:54
  SPEAKER_00: So not forgetting people who really are not don't have the ability to log on.
• 43:59
  SPEAKER_00: Uh that's a other than for those other forums like daily huddles to make sure they get the information.
• 44:04
  SPEAKER_00: Internet sites being updated regularly with with all the new materials.
• 44:10
  SPEAKER_00: I will say that probably the one of the most stressful elements for staff, certainly from uh all levels, was the rapidity of change and kind of trying to overcome that anxiety that they many felt about, well, we're doing this now, but an hour later it's going to change and tomorrow it's going to change.
• 44:26
  SPEAKER_00: And how do you steer that ship?
• 44:29
  SPEAKER_00: And so understanding the agility of an organization depends on that kind of rapid communication and implementation of changes.
• 44:39
  SPEAKER_00: I think the other element is is really making sure when you incorporate these messaging to in introduce not only the science and the policy, but also some assurance, some wellness so in all of the the communications that went out there were always some something around wellness techniques and and self-care.
• 45:00
  SPEAKER_00: Because I think you know having that in front and center to acknowledge what people were going through was an important element in in addition to providing support, you know, spiritual support and others.
• 45:12
  SPEAKER_00: Those are some examples.
• 45:13
  SPEAKER_00: I know many people have many other examples and I'm sure we do have others as well.
• 45:18
  SPEAKER_00: But there's just no I don't think there's any anything we can say that um there's too much of communication or finding channels to touch and connect at a human level as well as you know in blast communications of all kinds.
• 45:32
  SPEAKER_00: Walking rounds, leadership rounds I mean we all went around no matter where we're sitting in meetings back to back, in between going out there on the floors if you're not directly taking care of pay patients to to make sure to touch base with folks, being visible I think is another one from from our standpoint too.
• 45:49
  SPEAKER_00: People view infection prevention, you know folks as as being resources and and very much part of the team in our in our organization in all of our organizations.
• 45:58
  SPEAKER_00: So those are some examples.
• 45:59
  SPEAKER_03: Yeah no absolutely I think those are those are really important important elements having a as a as Josh said earlier having this platform where you can openly discuss issues kind of gives an outlet and also provides a little bit of guidance.
• 46:15
  SPEAKER_03: I think every institution probably did something similar and Rika as you were saying like having this rapidly evolving situation kind of causes this chaos that all everyone that we as epidemiologists have to manage and provide people a little bit more stable hand stable life.
• 46:32
  SPEAKER_03: So I I think I think what we we did and I remember from uh from the experience was uh we actually made a single source of truth a centralized internet site where all the policies for COVID everything is in one place including for vaccination including for travel including for everything else mandatory or whatnot so everything is in one place but kind of really facilitates that into one place especially with the implementation of the mandatory vaccination processes it has been very very helpful and the other thing really is to reaching out to people with different town halls and open conversations both at individual levels I think I've met a lot of people and you all of you guys have probably done uh so at like one-to-one uh in a small group bigger groups and the entire institution different level of uh conversations have been very helpful I'm gonna actually Can I add one other thing I think another fun uh underpinning element of getting to the concern and and the question the concerns and challenges in organizations as much as there was all this rapidity and and you know navigating the unknown one of the things I think is important from a leadership perspective is that as much as possible you should try and align everything with existing existing kind of models.
• 47:51
  SPEAKER_00: So you're not creating new governance structures for example there's some comfort for people to know that even if you're doing things really quickly that you're doing things according to the established governance structure.
• 48:02
  SPEAKER_00: So whether it's infection prevention committee gets morphed into a you know executive group but it has all the key people and the board gets to hear about the decisions.
• 48:13
  SPEAKER_00: And I just say that because we don't necessarily think about that when we're in the moment trying to make decisions.
• 48:18
  SPEAKER_00: You do what you need to do.
• 48:20
  SPEAKER_00: We all design our systems to respond for emergencies but to make sure that there is that backdrop so that at the end of the day, whether it's a physician on the medical staff who you know rarely comes here and is trying to figure out how to deal with something or a staff member in a nursing division who wants to know that this was actually supported at all levels, that there is some assurance to that that we even if it's after the fact to make sure to circle back and say this was vetted, this was approved, we followed all the existing protocols, we did what we needed to do in the moment.
• 48:52
  SPEAKER_00: And so that in terms of the rapidity of stuff is is just another piece I think it's probably it's common to everybody.
• 48:58
  SPEAKER_00: It's worth remembering.
• 49:00
  SPEAKER_03: So such such important conversation I'm gonna skip question eight.
• 49:03
  SPEAKER_03: We'll jump to question nine because it's it's it's probably gonna be more it's gonna be pretty big podcast and we want to be as a wrap up I would like to see if you either of you have any closing thoughts Dr.
• 49:16
  SPEAKER_01: Shefton Yeah so so many things so little time.
• 49:20
  SPEAKER_01: So I'll I'll I'll share what I what I wrote down which is to properly implement and sustain, we need to better understand where people are and how they perceive the need for vaccine and about mandating right that would be ideal.
• 49:35
  SPEAKER_01: But unfortunately we do not have the convenience of time to do so we we just don't we're in the middle of a pandemic.
• 49:41
  SPEAKER_01: We have to stop this pandemic and so we've implemented the mandate.
• 49:46
  SPEAKER_01: Now there's still a lot we can learn about hesitancy, acceptance, religious beliefs that'll serve us well both during this time as well as as we move forward.
• 49:57
  SPEAKER_01: So even though we've decided to mandate and we've implemented it's not over.
• 50:02
  SPEAKER_01: It's far from over and going back to where we started which is supporting the health of our staff of our patients of our caregivers of our families of ourselves all of these things still relate back to continual learning and continual evolving around this this need to stop this pandemic.
• 50:23
  unknown: Dr.
• 50:23
  SPEAKER_00: Murti Yes uh so I think Jeff said it so well I guess what I would just close with in in my thoughts are, you know, if you're thinking about vaccine mandates, we've had versions of vaccine mandates in different sectors, schools in healthcare and and other sectors and they're no doubt a powerful tool for safeguarding public health and when chosen carefully they can save lives and that's been shown and published with influenza vaccine mandates in healthcare it's been shown with measles and so there's that historical piece.
• 50:58
  SPEAKER_00: At the same time I think ultimately the success of any of these mandates in in doing what our intention is not only to achieve and sustain vaccine rates but also to have that credibility that it was the right decision depends on how they're implemented.
• 51:15
  SPEAKER_00: And I think this is where leadership really matters.
• 51:17
  SPEAKER_00: And you know to to do this in a way that ensures respect and inclusion in the decision making process in an organization as well as making sure that there are consistent and thoughtfully developed policies that can be seen by the the individuals that affect that are affected as credible and consistent in their application.
• 51:38
  SPEAKER_00: We've talked it through some of those.
• 51:40
  SPEAKER_00: So I I you know I I think those are all important concepts that you know we'll be staying with for some time and I don't think this is this pandemic is certainly not over and that the concept of these mandates may be extended further.
• 51:54
  SPEAKER_00: You know what are the boosters how that will develop so I don't think the story is over but I think what we have learned so far is going to be critical for us to incorporate as we go forward.
• 52:05
  SPEAKER_03: Wow this is this is fantastic I really really appreciate this great conversation I learned a lot and I hope our our listeners will also enjoy the conversation and hopefully this will be helpful to give everybody perspectives on experiences from from both of you guys.
• 52:22
  SPEAKER_03: I I really want to thank you again for sharing your perspectives and experiences this podcast can be accessed on Chay's online education center learning CE under the Rapid Response program where you will also find resources such as Chay COVID 19 town hall.
• 52:40
  SPEAKER_03: If you're interested in becoming Chay member take$20 off membership using the coupon code learning CE22 at the checkout.
• 52:48
  SPEAKER_03: This concludes today's episode of Rapid Response podcast thank you so much for tuning in