Speaker 1 (00:06):
Welcome to Sabin's Community Conversations on Vaccines, presented by Immunization Advocates. In this episode, we are joined by Dr. Naveen Thacker, the executive director of the International Pediatric Association. Vince and Francesca talk to Dr. Thacker about the challenges of rolling out the COVID-19 vaccine and the decades he has spent on routine immunization and polio eradication in India. He also shares his recent appearance in a PSA for the COVID vaccine and IPA's new online learning module, the Vaccine Trust Project.

Francesca Montalto (00:38):
Hello, and welcome to Community Conversations on Vaccines. I'm Francesca Montalto

Vince Blaser (00:43):
And I'm Vince Blaser, director of Immunization Advocates at the Sabin Vaccine Institute. For many years, Sabin's provided journalists and health workers around the world with information and experts on vaccines and immunization. Sabin's new Immunization Advocates program puts tools, resources, and connection opportunities from Sabin and our partners in one place. So if you go to immunizationadvocates.org, we have a hub of resources free for both journalists and health workers, which we continue to expand. As part of that expansion, we are really excited to launch this podcast as an additional resource for global health stakeholders.

Francesca Montalto (01:21):
Yeah, and the COVID-19 pandemic has really put a spotlight on vaccine science and research. And because of that, we see scientific terms in the news more often, but it's important to remember that the situation now with COVID-19 is personal for everyone from the socioeconomic, physical, and mental health effects to how we live our daily lives. In fact, because of the pandemic, Vince and I have never actually met in person, although we have gotten to know each other virtually over the last few months through casual Zoom conversations about our weekends and our families

Vince Blaser (01:51):
Yeah, Francesca, we were recently discussing that situation. I know your mom and her, her journey to get the COVID vaccine we were just talking about. Would you like to share a little bit more about that?

Francesca Montalto (02:03):
Yeah, absolutely. So my family is actually mostly made of health workers and teachers, which are both essential to consider when it comes to getting the vaccine, preventing the spread of COVID-19, and saving lives. And recently, my mom, who is an emergency department nurse in Maryland in the United States struggled to obtain the COVID-19 vaccine, despite her regular interaction with COVID patients. And this was really troubling and frustrating. I was probably texting her daily asking, you know, "are the vaccines available yet?" "Do you have an appointment?" She finally did get her first dose a few weeks ago, and we were obviously really thankful and privileged for the fact that she has now been vaccinated. But I think her situation is a small example of larger issues at play with COVID-19 vaccine distribution, you know, be it issues with planning and implementation, structural barriers and socioeconomic, racial, and ethnic inequities and access here in the United States and around the world.

Vince Blaser (02:58):
Yeah, absolutely. Well, how was that moment when she was finally vaccinated knowing I imagine the pride that you have as she goes into her shift, taking care of COVID patients all of this time and doing this amazing work.

Francesca Montalto (03:13):
Yeah, it was definitely a relief, especially after hearing all the stories about her working with COVID patients and not having the proper PPE. It's definitely a relief to know that she is vaccinated and that she has this preventative to make sure that she stays healthy and is able to take care of the community. And I want everyone around the world to feel this same sense of relief as soon as possible. And I hope that Immunization Advocates and this podcast series can play some role in improving vaccine access, acceptance and demand.

Vince Blaser (03:43):
Of course, we're talking about structural barriers and inequities to access and the information in the United States where we are, Francesca, and globally. There are many countries that have yet to receive any COVID-19 vaccines, others that are just starting to administer vaccines, and it's something that I think we'll continue to talk about during this podcast. So with that, let's bring in Dr. Naveen Thacker, the executive director of the International Pediatric Association, the secretary of based in Gujarat, India. Now, Naveen, before we get started, I know that many of our listeners recognize from their own experience, the great care that they have received from pediatricians throughout their childhood. But I'm curious, why did you decide to become a pediatrician?

Dr. Naveen Thacker (04:30):
Thank you, Vince. It's nice to be joining you for this conversation. So that's a very interesting question, you know, andyeah, so I born in an upper-middle class business family and from childhood, I have, you know, a dream or, you knowa person for doing something beyond doing business. So I decided to go to medical school and after my graduation, when it was time to choose any subjectI was you know, first in the merit list, I had a choice. So I decided to go for pediatrics. So fulfill my dream by, you know, doing something for children around the world, and which is, I am realizing maybe you know, after 35 years or so by serving through the International Pediatric Association,

Francesca Montalto (05:34):
That's fantastic. And I actually have a soft spot for pediatricians. My dad worked in pediatrics for many years of his career. So I always admire the work that pediatricians do around the world,

Vince Blaser (05:45):
Certainly a great Francesca, pediatricians, nurses, community health workers, and other members of the health workforce team are critical to ensure lives get started healthy and strong. And of course, a critical component of that are vaccinations. The whole world right now is paying greater attention to vaccine acceptance with the COVID-19 vaccine rollout. But pediatricians for decades have been in the thick of conversations with parents, guardians, and children. We're curious, Naveen, on trends and changes you've seen in vaccine acceptance over the last 30 years.

Dr. Naveen Thacker (06:21):
So, it's interesting that over the years we have seen the immunization, at least in most part of the world, was a norm, you know, people know that the child becomes six weeks, or in some countries eight weeks, then they have to go for the immunization. And we have not seen much barriers about, you know, acceptance of immunization in most part of the world, particularly India, from where I come, you know. But COVID vaccine, you know, it has really changed the conversation first thing, as of now, we, we are not directly involved with our children, are not giving vaccine, but because pediatricians are involved in immunization, still people turn to them for their advice, even if it is immunizing adults. And we have seen the effect of the infodemic, the abundance of information rapidly evolving recommendation, uncertainty, you know the rapid say approval of the vaccine, making the vaccine available.

Dr. Naveen Thacker (07:32):
This has really complicated the thing, and we have never seen such, you know, hesitancy or say reluctance to get vaccinated. So that's really what I call that this is this is going to. If we do good in COVID vaccine, it will also, and this is also a time when people are talking about vaccine, everyone talks about vaccine. So there is a lot of vaccine enthusiasm also, and if we manage COVID vaccine rollout nicely, then whatever we are lagging in some, you know, reaching to some certain level of immunization that will improve. If we don't do very well in COVID-19 vaccine then definitely the overall immunization program is going to suffer.

Vince Blaser (08:24):
Yeah, I couldn't agree more. There certainly is a lot on the line, not just for ending this current pandemic, we all want to see over as quickly as possible, but acceptance for many other vaccines that save millions of lives every year. You and your member pediatricians at the International Pediatric Association around the world were seeing a trend of waning vaccine acceptance before COVID-19, which you led this past year to create a new set of learning modules for health workers focused on communications and advocacy skills called the Vaccine Trust Project. Sabin is working with IPA to roll out the project and have additional conversations about vaccine acceptance in Eastern Europe, Latin America, and elsewhere. Tell us a little bit about why the pediatricians in your association felt this project was needed and what results you're hoping for out of it.

Dr. Naveen Thacker (09:20):
Yeah, so you are right. When I was in Gavi board four years back, we started listening you know, repeatedly about vaccine hesitancy and then WHO declared that it's one of the top global threats in 2019, that vaccine hesitancy. It was not so in India, in routine immunization, but we have faced that during campaigns. So we realized that whatever is vaccination is good in so many countries, be it because of social norms or social copy. And if there is whenever there are, you know, we've faced that in India, that when you have campaign suddenly, if there is shift those people who are following it at the pace of demand, not understanding completely, they also shift away. So we realize this is very important, and that is why it was very timely that we started thinking about how to deal with vaccine hesitancy.

Dr. Naveen Thacker (10:22):
And we knew from our experience personally, for me from polio eradication, that medical professionals are a trusted voice. We also realize that medical professionals and health workers are trusted voice, but they are not equipped to deal with the challenges. They are never trained in medical school about communication say dealing with using the social media in the part of the benefit of the promoting vaccine or dealing with the local vaccine denial. So we thought, what can we do? We talk a lot about science, but what, how we can equip them. And that's why we designed this course where we have behavior science behind vaccination, interpersonal communication, social media, advocacy. So all these modules, which are never taught in the medical school we incorporated in our course, and we had two training workshops.

Dr. Naveen Thacker (11:26):
But then suddenly COVID came and we immediately adopted to the learning management system. Andso this gave us an advantage, and it was very useful when COVID vaccine rollout came, that everybody was looking for these, you know, how they can do that better. And immediately our course became very popular. We rapidly, with the thanks to the Sabin Vaccine Institute, that we translated that into the many languages. And we have now reached out to already around 2000 registration already done. And we have course in six language and two more languages very soon.

Vince Blaser (12:09):
Yeah, certainly as trusted voices in their communities on decision-making on vaccines, it's really important for health workers, not only to engage in conversations with patients during visits, but also to engage on social media with reporters and traditional media and to advocate for immunization. But engaging on some of those venues can be daunting, even if you haven't done it before. And it's great that the Vaccine Trust Project can help put health workers at ease in communicating on these external platforms. And when we say health workers obviously Naveen, you're most familiar with your fellow pediatricians, but of course it's a whole team of health workers of many different cadres who deliver immunization programs. Tell us a little bit more about that and how you're engaging different types of health workers in this project.

Dr. Naveen Thacker (13:05):
So, yeah, it's because it's team work, you know, you have to have, everyone has to speak in one voice. And if we, leave,who deals with the family in India, like, you know, it's the ASHA,you know, who is in contact with the family, then it's...

Vince Blaser (13:26):
Can you explain what an ASHA is, Naveen?

Dr. Naveen Thacker (13:29):
Yeah, it's a social worker in, you know, a community, 1,000 per population, and their job is basically to mobilization, you knowof the community. So then you have agility nurse, midwife and then other health workers. And if they don't talk in the same language, then, then it's not you know, nurses, but our medical workers, physician assistant. All these people are important. Anybody who comes in the, you know, from the health system who comes into contact with the community, they all have the same, you know, same page.

Vince Blaser (14:12):
You know, Francesca. I know that that resonates with what you were mentioning about your family of health workers.

Francesca Montalto (14:21):
Yeah. I have a lot of different levels of health workers in my family. You know, my brother works at a mental health facility, my father's a doctor, my mom's a nurse in an emergency department. I definitely understand the need for all levels of health workers to participate in, you know, passing along accurate vaccine information. And I think the Vaccine Trust Project does such a great job with helping community members be able to communicate. And I think that's really relevant today. And I also think, you know, it's important to dive into issues of equity. And so Naveen, I'd love to know, you know, with your work in India and around the world, what issues you think need to be addressed to assure equitable access to both routine immunization and COVID-19 vaccines

Dr. Naveen Thacker (15:06):
All my life I have worked on polio eradication, and I remember we have conveyed from very beginning until polio, exists anywhere in the world. Nobody is, you know, we cannot say we are polio free. I remember how this global polio eradication initiative started when they eliminated polio from the Latin America, the commission, which had written the report, they very clearly said, unless polio exists anywhere, you cannot presume. And we have seen after that, you know, the polio returning to continent in between, you know...

Vince Blaser (15:46):
When was that, Naveen?

Dr. Naveen Thacker (15:50):
I think 1994Latin America watch first. And I read that report in a special infectious disease journal supplement in '97,

Vince Blaser (16:02):
Tell people about how the polio eradication program worked there in India and just, you know, the number of the, you know, the scale of it, the number of years it took that sort of thing.

Dr. Naveen Thacker (16:15):
Yeah. I was very deeply involved from not only from the administering vaccine and, as a rotarian, to work at local level, to sit on India expert advisory group on polio at top policy level making you know, the policy for the India. So yeah, we started in '95, national immunization date, and we thought we will be there very soon, but finally the success we could reach in 2011, we had the last case. So it was a long, long journey learning from our mistakes and, you know, taking the mid-course, correction guided by a strong partner, save a strong political commitment, which we could do that. And not only that we have given many innovative ways to the rest of the world and all that polio legacy is now paying, you know say, fruits when it came the COVID, you know, because there was a national polio surveillance project. There were surveillance medical officer in east district of India almost is this district at least in high burden of states so they were immediately recruited, you know diverted for the contact tracing and so many other things.

Vince Blaser (17:37):
So you know, it's a curious and it's a really interesting case because, and you know, one of India's strengths is the wide diversity of cultures, religions, languages, et cetera that you have there. And so I imagine in that polio campaign, there was quite a wide array of communication strategies you had to employ there are. Do you feel like some of these same ones you know, because you had some successes, some failures, some ways you had to adjust, do you feel like that the country was better prepared in terms of communicating about a COVID-19 vaccine?

Dr. Naveen Thacker (18:24):
Very well prepared in terms of planning, the rollout logistics transport, administrators, everything. And we did prepare in our opinion well for communication, but you know, the COVID is a different ball game, and you have a different population to immunize. And we have some issues there, but definitely that had helped us in preparing very well logistically, you know. You must have heard India has even included dry runs, you know, the mock drills and everything, which no one no country has done. So we give 170 million doses of polio within a week when we conduct the polio vaccine. So that is a capacity of India to immunize. But, again, as I said, COVID will leave us with a COVID legacy and many new learnings. Together with polio and COVID, we will be perfect to tackle anything in the future

Francesca Montalto (19:33):
Now Naveen, Dr. Thacker, you participated in public service announcements in India in relation to the COVID-19 vaccine, you were vaccinated very early on. So I think our listeners would just love to hear about that process and how you helped to spread the word about the COVID-19 vaccine and how it's safe and effective and important.

Dr. Naveen Thacker (19:56):
Yeah. So that's very interesting. I was staying with my son and grandson and enjoying time. And I was invited by the government of Gujarat, which I belong to Gujarat, to serve on the immunization taskforce. And then finally there was a lot of questions and reluctance that, you know the people are hesitant. So I offered that I can take vaccine first. So immediately I got response, please come. And you know, we will be happy that if you are ready to take vaccine. So, I came to Gujarat. I was first person in Gujarat to be vaccinated in presence of hundreds of media outlets and the chief minister and deputy chief, and then so many interviews and all that, "how do you feel" and all that. And after three days of that, I just made a very small video riding my bicycle and saying that after three days I don't have any side effects except gratefulness.

Dr. Naveen Thacker (21:05):
And that was picked up by, not my effort, but that was picked up by ministry of health and family welfare. And they just put them on their Twitter handle and within 48 hours, it was, it is still there. It had 60,000 views. And, the same time I was interviewed by BBC Gujarati, and they put them on their Facebook and that had 25,000 or so views. And so I realized that I could motivate and inspire, and beside that hundreds of phone calls and all that, around a hundred thousand people within 48 hours, and that one only me, but also similar person, like, you know that gave the cue to everyone. And then they started putting such videos and all that, you know, so that's the power of social media and communication, a very small short video of 30, 40 seconds, just saying that I'm perfectly all right after three days.

Vince Blaser (22:16):
You know, kind of curious as to how you, you know, Francesca already asked about this a little bit, but you know, this coming year, obviously I think we all see, you know, a major opportunity to potentially put a big dent and hopefully end this pandemic pretty soon. But you know, as you say, it's a different ball game with COVID-19 vaccinations, and we are you know, there's issues both in terms of acceptance, but also in terms of access and, at the same time, there's also a COVID, the pandemic has also caused a lot of disruptions in people's access to some of the routine childhood immunization. So kind of, what are the, what are your top issues? What are you trying to get your, your members at IPA most focused onyou know, what are the two or three things that you, if you, if we can do well, you'll be happy with this year in terms of you know access and acceptance to vaccines.

Dr. Naveen Thacker (23:34):
Yeah. So we, we need to communicate and make sure that everyone gets the vaccine. And also not, we don't want any other epidemic at the cost of one epidemic. You know, we don't want a epidemic of diphtheria, pertussis, polio, measles. So we have to, as pediatricians, we will continue to advocate that and you know make sure that the children are getting their vaccination. But we have to accept that 2021 will be, is still dominated by talk about COVID COVID and COVID. You know, unless we can reach out to the large number of population across the world, we will not be able to end the acute phase of this pandemic. So that's very, very important. '21, We have to prepare but need to balance and continue to advocate the vaccine equity, and India is taking lead. Even when, you know, we have not immunize our whole population, are significant, but it's still, we have continued to serve with the rest of the world. And I think others have to follow, and many countries have come forward in that because, you know, realizing that they will not be safe if COVID is in other parts of the world. So vaccine equity, vaccine availability, and focus on other services, including routine immunization for children are our priority for 2021.

Francesca Montalto (25:15):
So, Dr. Thacker, do you feel like we can be optimistic about anything going forward, particularly not just with COVID-19 vaccines, but with routine immunization now that it's, you know, really top of talk for a lot of people.

Dr. Naveen Thacker (25:29):
There was never so much investment in vaccine, there were not so much talk about the vaccine that everybody, every person in the community world is talking about vaccine, vaccine and vaccine. So this is our best chance toyou know, capitalize on that and moving forward make it you know, that we reach out to every child, every person talk about the vaccine along the life course and get rid of the vaccine preventable diseases.

Vince Blaser (25:59):
Yeah. If anyone wants to be inspired, just check out IPA's Twitter account @IPAworldorg and read some of the testimonials of how health workers around the world are utilizing these courses and conversations with their patients and communities. Dr. Naveen Thacker, thank you for kicking off our Community Conversations on Vaccines. We wish you the best of luck in working with health workers around the world to improve vaccine acceptance.

Speaker 1 (26:27):
You can watch Dr. Naveen Thacker receive his first COVID-19 vaccine dose administered in Gujarat and deliver the PSA on his bike at immunizationadvocates.org/podcast. Thanks for listening to Sabin's Community Conversations on Vaccines, brought to you by Immunization Advocates. For more information, visit immunizationadvocates.org.