Alarming Shifts in U.S. Vaccine Policy – And What We Can Do About It

In this episode, the Princeton Pulse Podcast explores recent developments in federal vaccine policy that have public officials deeply worried, along with strategies for reducing vaccine hesitancy and restoring public trust.

Will Americans lose access to life-saving vaccines, one of the greatest achievements in public health? Will we see a resurgence of previously eradicated diseases, like measles, which is dangerously on the rise? What can we do at the state and local levels to counter misinformation and protect people from harmful diseases? 

Host Heather Howard addresses these questions and more with two guests: Dr. Céline Gounder, a practicing infectious disease specialist and epidemiologist as well as a senior fellow at KFF, editor-at-large at KFF Health News, and medical contributor for CBS News; and Jason Schwartz, associate professor at the Yale School of Public Health, whose research examines vaccination and public health policy, medical regulation, and the impact of science in government decisions. 

The panel discusses alarming trends in U.S. vaccination and immunity rates, our increasing vulnerability to disease outbreaks, the erosion of transparency and processes in scientific decision-making, and how states, the medical community, and researchers can help to rebuild trust in science and public health.

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Learn about the Vaccine Integrity Project of the University of Minnesota’s Center for Infectious Disease Research and Policy and the Edelman Trust Barometer, which reports on public trust in institutions, media, and other sources of health information.

View Jason Schwartz’s research at Yale School of Public Health.

Dr. Céline Gounder shares health news, articles, and research at https://x.com/celinegounder.

Read a recent op-ed co-authored by Professor Howard: New Jersey must act to protect public health from federal sabotage.

The Princeton Pulse Podcast is a production of Princeton University's Center for Health and Wellbeing (CHW). The show is hosted by Heather Howard, a professor at Princeton University and former New Jersey Commissioner of Health and Senior Services, produced by Aimee Bronfeld, and edited by Alex Brownstein. You can subscribe to The Princeton Pulse Podcast on Apple Podcasts, Spotify, or wherever you enjoy your favorite podcasts.

Transcript

Episode #18:
Alarming Shifts in U.S. Vaccine Policy – And What We Can Do About It

SPEAKERS:

Dr. Celine Gounder, Jason Schwartz, Heather Howard

Heather Howard  00:02

Hi and welcome to the Princeton Pulse Podcast. I'm Heather Howard, professor at Princeton University and former New Jersey Commissioner of Health and Senior Services. On campus and beyond. I've dedicated my career to advancing public health. That's why I'm excited to host this podcast and shine a light on the valuable connections between health research and policy. Our show will bring together scholars, policy makers, and other leaders to discuss today's most pressing health policy issues, domestically and globally. We'll highlight novel research at Princeton, along with partnerships aimed at improving public health and reducing health disparities. I hope you'll listen in as we put our fingers on the pulse and examine the power and possibilities of evidence informed health policy. 

Heather Howard  00:48

In early June, U.S. Health and Human Services Secretary Robert F Kennedy Jr. dismantled the panel that advises the CDC on immunizations, firing all 17 scientific and medical experts. Recommendations now lie in the hands of new appointees, some of whom question the well-established safety and efficacy of vaccines. This is just one example of recent efforts to undermine the role of scientific evidence in policymaking. 

Heather Howard  01:17

Will these developments threaten access to life-saving vaccines, one of the greatest achievements in public health? Will they drive the resurgence of previously eradicated diseases like measles, which is dangerously on the rise in Texas and other states. And what can we do at the state and community levels to counter misinformation and protect children from harmful diseases? 

Heather Howard  01:39

The Princeton Pulse Podcast explores these questions and more on today's episode. My guests and I will address alarming shifts in federal policy and strategies for reducing vaccine hesitancy and restoring public trust. Joining me is Dr. Celine Gounder, a senior fellow at KFF, editor-at-large at KFF Health News, and medical contributor for CBS News. A practicing infectious disease specialist and epidemiologist, Dr. Gounder has advised policymakers on Covid, Ebola, and many other public health issues. She's also a leading expert on communicating complex scientific topics. I'm also delighted to welcome from the Yale School of Public Health Jason Schwartz, an associate professor whose research examines vaccination and public health policy, medical regulation, and the impact of science in government decisions. I'm particularly pleased that today's guests are also proud Princetonians who began their careers here as undergraduates. Celine, Jason, welcome to the show!

Dr. Celine Gounder  02:41

It's great to be here.  

Jason Schwartz  02:42

Thanks for having us. 

Heather Howard  02:44

Celine, let me start with you. You're a physician, an infectious disease specialist and epidemiologist. Can you set the table and tell us about why vaccines are an important public health tool?

Dr. Celine Gounder  02:56

Vaccines are one of the most important medical developments, medical achievements, ever. With perhaps the exception of clean water and sanitation, vaccines have been the most impactful of all medical interventions in terms of saving lives and doing so cost effectively, in some cases, cost savingly. And so if you're looking for solutions that are efficient, vaccines are top of the list. We have managed to eradicate one infectious disease among humans, smallpox, and we're pretty close to eradicating polio. The impact of smallpox eradication alone has been tremendous, saving hundreds of millions of lives. And childhood vaccinations are estimated to prevent three and a half to five million deaths among kids every year from preventable diseases like measles and diphtheria and polio. I don't think there's any way to be hyperbolic and to underemphasize how important vaccines have been to public health and medicine. 

Heather Howard  04:09

Thank you. Now, Jason, you're coming at this from the perspective of a health policy researcher or historian of medicine, and with a particular focus on the role of science in vaccine policy. Can you help us understand what historically have been the respective roles of the FDA and CDC? Because I think we want to talk about shifts, but maybe you can help us understand what we've historically understood to be the roles of the FDA and the CDC in U.S. vaccine policy.

Jason Schwartz  04:37

Our U.S. vaccination program is complicated in the United States, and there are distinct roles for federal government, state and local governments, our medical professional organizations, the pharmaceutical industry, and health care providers. When it is working well, it really is like a symphony with specific responsibilities assigned to all of those groups. In the U.S., the federal government is the centerpiece of our national vaccination efforts, with related but distinct roles for the Food and Drug Administration and the Centers for Disease Control and Prevention in setting the context by which vaccination efforts can move forward. So the FDA is in the business of regulating products for use, ensuring that safe and effective vaccines, pharmaceuticals, medical devices, all the other things the FDA oversees, are available, are marketed, are approved, are evaluated, and that those that clear those bars are made available. The vaccines that can be used are those that are approved by the FDA. So we don't have a vaccination effort unless we have an approved vaccine or vaccines to do it, and that is the purview of the FDA and their expert advisors. 

Jason Schwartz  05:46

The CDC picks up the ball from there and helps guide how vaccines should be used, looking at the totality of the evidence for our approved vaccines, thinking about the public health considerations governing their use, and helping decide how vaccines should be used in different populations, developing those recommended vaccination schedules, again, in partnership with their expert advisors that we've heard about in the news. So those two groups are distinct compared to how we might think about pharmaceuticals when it comes to vaccines, but they work together to help guide the use of vaccines here in the U.S.

Heather Howard  06:19

Thank you. That's helpful to have that background so that we can talk about what may be changing on that front. But Celine, before we get to the recent federal changes, it feels like a perfect storm now, because these recent federal changes in policy are coming when we've been seeing erosion in immunization rates. Right? Can you help us understand what the trends have been in immunization rates in the U.S. up until now?

Dr. Celine Gounder  06:46

I think some of these recent changes serve to further fuel skepticism about vaccines, something that predated the pandemic, but really went on hyperdrive during the pandemic. Many may remember a study published in The Lancet that was later retracted in the 1990s linking autism to MMR vaccination. And just to be clear, there is no evidence that measles, mumps, rubella vaccine, the MMR vaccine, causes autism. That has been thoroughly debunked, and the physician who produced that fraudulent study lost his medical license in the UK. However, that did create a lot of doubt in some people's minds about the safety of that vaccine in particular. And then during the Covid pandemic, we saw a number of different things emerge. One was that people were just not making it to the doctor for routine child wellness visits, and as a result, we did see a drop in routine childhood immunizations. Kids were also not consistently in school, and that's the level at which those vaccinations are often enforced as a condition to attend public school. In addition, you have vaccines getting tied up with the backlash to many of the mitigation measures for Covid, and not just vaccination, but also things like masking, school closures, and the like. 

Dr. Celine Gounder  08:21

And so there's this cultural backlash, you could say, against vaccines, that extends beyond the Covid vaccines, that also now affects childhood immunizations. We have seen, for example, the coverage for measles vaccines among kindergarteners drop. It is under 93%. That might still sound good, but it's not because measles is the most contagious infectious disease known to man, and in order to have rates of immunity high enough to prevent transmission, to prevent outbreaks, you need over 95% immunity. And so across the United States, we've seen ourselves drop to what is, for measles, a failing grade -- where we are at risk, vulnerable to having outbreaks. In some communities, vaccination rates are dramatically lower than that 95% threshold. For example, that is the case in West Texas, which is the epicenter of this big outbreak. Many of us are concerned about these developments. Measles is really the canary in the coal mine for this trend. But if we continue to see vaccine exemptions, non-medical vaccine exemptions, increase, people choosing not to vaccinate their kids, it won't just be measles that will be making a comeback, but other diseases like paralytic polio and congenital rubella syndrome, which is where women during pregnancy might get rubella, which can cause horrible congenital birth defects, deafness, heart abnormalities, as well as stillbirth and miscarriage. So this is just the beginning, if these trends continue.

Heather Howard  10:16

So Jason, Celine has laid out a pretty stark picture of what the risks are when population-wide immunity declines. You've studied immunization exemptions. What are you seeing on that front? Are you seeing what Celine just mentioned? 

Jason Schwartz  10:31

Absolutely. Yes. We know that these non-medical exemptions from school vaccination requirements have, for decades, been a weak spot, a point of vulnerability, in our vaccination safety net. Often, these non-medical exemptions, which may allow individuals to opt out of required vaccines on the basis of a religious view or a non-religious, deeply held, personal or sometimes called philosophical belief, are often exploited by individuals who see it as a shortcut or work-around. If they sign the right form, if they if they check the right box, they no longer have to vaccinate their children. The epidemiological evidence is emphatic, again and again, in many settings, in many contexts, that in communities that have higher rates of these non-medical exemptions, we see higher rates of vaccine-preventable diseases. We see those clusters, and it's exactly those clusters in certain communities, whether it's based on a shared socioeconomic set of engagements, or religious beliefs, or cultural beliefs, or common schools, it's those pockets that, again and again, become a vulnerability. And this has been a through line. Even as things have changed and accelerated, as it relates to distrust and skepticism in vaccines in recent years, there's great continuity in terms of skepticism, concerns, doubts, among some parents regarding the safety or value of vaccines, let alone whether governments should be in the business of saying what parents should or must do for their kids. And that has manifested itself in the resistance to vaccination programs for literally centuries. But what we're seeing now is certainly different, in terms of its magnitude, than just about anything we've seen in the contemporary history of vaccination. 

Heather Howard  12:20

Our historian brings us to today. That's really helpful. 

 Heather Howard  12:25

So over the last couple months, we've seen and want to explore these dramatic shifts. It started, I think we would say, with the selection of RFK Jr. as HHS secretary, and then there's been cascading actions, right? We've seen officials at the FDA forced out. We're seeing now more concrete actions being taken. I think the first ones that got a lot of attention were changes in the Covid vaccine recommendations. Can you talk about that, Celine?

Dr. Celine Gounder  12:57

Yeah, so some of these recommendations were around healthy people, adults. Other changes are related to pregnant women and then also children. So let's go one by one. For adults, the new advice is that unless you have an underlying medical condition, if you are under 65 and you're an adult, you are no longer eligible for a Covid vaccine booster. And the issue with that is, while that may be fair advice for the vast majority of people, some people don't know if they have a chronic medical condition, and the vast majority of people in the United States are either overweight or obese. It's very likely that our diagnosis of chronic medical conditions is really an underestimate of what exists. Many people don't have a primary care provider, and so they don't have access to the kind of diagnostic care management to know that they have underlying medical conditions. In addition, some people may be living with others who are highly vulnerable, may work in a job, for example, like me, where I'm working in a hospital where I'm caring for people who are highly vulnerable. These guidelines don't really take some of those other risks into account. 

Dr. Celine Gounder  14:24

Turning to pregnant women, we know that pregnancy is a period of immunosuppression. This is how the body tolerates the foreign tissue of a fetus, and as a result, women are at higher risk for severe infections, not just Covid, but influenza, for example, which can be far more dangerous in pregnant women than other adults. And it's not just immunosuppression. Particularly in the third trimester of pregnancy, you have the enlarging fetus that's putting pressure upwards on the diaphragm, and there's not as much of what we would call "respiratory reserve," where you're not able to compensate, to breathe more quickly and fully in the setting of an infection as you might otherwise. So you're more likely to tip over into more severe disease, to end up in the ICU. The data that was collected during the pandemic, as well as after, shows that Covid vaccines are very safe and effective in pregnant women and also in preventing disease among neonates who really have no other way of being protected against infection. 

Dr. Celine Gounder  15:32

I also want to point out those very youngest of kids are at very high risk of severe Covid. They are the second highest risk group after the elderly and the immuno-compromised. That is a group that, while we may not see a huge number of deaths, there is a very high risk of hospitalization and ending up in an ICU if you're a child under two who gets Covid. That also relates to some of these new recommendations about children and healthy children. Again, there are a lot of kids who may have underlying medical conditions who are not aware because those diagnoses don't get made until a child gets severely ill. And so to deny children access to a Covid vaccine, when we don't know that they may have an underlying medical condition, and when the very youngest of those kids, particularly between six months and two years of age, are at extremely high risk for complications [is worrisome]. The idea that their first encounter with Covid would be with the actual virus and not the vaccine, is very concerning. And if you look at the bigger picture, at how these decisions were made, they were not made through the routine process of scientific consultation. They were made in a very top-down manner by Secretary Kennedy, as well as a couple others who he and the Trump administration have appointed to their positions, and that's not what we consider to be a transparent and scientific process. It's very much cherry-picking evidence and downplaying the benefits of vaccination, leaving large swaths of the population undervaccinated.

Heather Howard  17:25

Jason, what would a transparent process have looked like? This is what you study. How should changes in Covid vaccine recommendations be made?

Jason Schwartz  17:36

What's interesting is that there already had been an effort underway on the part of the CDC's Vaccine Advisory Committee on Immunization Practices [ACIP]. They were taking a fresh look at our Covid vaccination recommendations, and were likely moving toward an outcome that, while not as stark as the new recommendations that Celine just walked us through, were going to refine our current recommendations that, for several years, had largely recommended an annual vaccine for every individual. They were thinking about some ways to tailor their vaccine guidance in line with where we are in the pandemic, what we know about the disease, what we know about the additional doses of vaccines. We don't know exactly where that would have landed because that process was interrupted when the full membership of the ACIP was dismissed earlier this year. But typically, what was underway was exactly how our vaccine recommendations have been developed for the 60 years that this Advisory Committee on Immunization Practices has worked. This group of outside experts who are generally highly regarded, interdisciplinary national leaders in their respective fields relating to vaccines and vaccination programs would meet openly and publicly, usually three times a year. They would rigorously review binders full of evidence regarding all of the issues that went into shaping our vaccination schedules, make decisions over a period of months by meeting, evaluating evidence, gathering information, rigorously thinking about what we know and what we don't know, and at the end, arriving at those recommendations that were rightly seen as the gold standard for vaccination guidance. In the history of this advisory committee, in its 60-year history, folks could count on one hand the number of times that these quote, unquote recommendations weren't implemented, weren't approved and acted upon by the CDC. What we saw with the Covid-19 recommendations earlier this year completely bypassed that committee. And then ultimately, the committee itself was overhauled and a decision was made effectively unilaterally by the Secretary of Health and Human Services. It completely departs from how we thought about vaccine policy here for generations.

Heather Howard  19:56

You mentioned, Jason, that something else has happened in the last couple of months, that the HHS Secretary, RFK Jr., fired all those members. Can you talk about the actions he took and what that committee looks like now? 

Jason Schwartz  20:12

Generally, these committee members are, as I've mentioned, selected through a highly rigorous interview, screening, nomination vetting process, or four-year terms. This is not generally like another set of political appointees that come and go with the changing of a particular administration or the arrival of a new White House or a new HHS. And yet, Secretary Kennedy and the Department of Health and Human Services announced in June of this year that the full membership had been relieved of their duties, effective immediately. The stated justifications were on the basis of purported conflicts of interest between those members of the committee and vaccine manufacturers that, frankly, many individuals have looked at carefully -- both the rigorous policies that the CDC has established to minimize conflicts of interest among its advisors, particularly these advisors, and the actual records of the members who were dismissed. And the strong view is that those allegations are simply unfounded. But those members were replaced and in their stead were added, at least as of now, seven new members of a committee that generally has 15, 17, or so members were quickly appointed. We're not sure how or who ultimately vetted them, but these are individuals who have had generally longstanding links to Secretary Kennedy, a longstanding history of skepticism, to put it mildly, regarding various aspects of vaccines and vaccine safety. That newly constituted committee met last month and signaled a very different approach for how they think about vaccines and what their agenda is -- to look at generally long settled issues around vaccine safety, the safety of the vaccination schedule, the safety of vaccine ingredients. They've already made some recommendations regarding smaller aspects of the vaccination program, but a harbinger through their announcements and their decisions is that they are going to reopen many issues that would imply that they are not confident that what has been seen as the evidence base supporting the safety and effectiveness of vaccines for generations is adequate, in their view. So I think we're seeing just the opening salvos in many more disruptions to our vaccination recommendations and vaccination schedules in the months to come.

Heather Howard  22:39

Celine, can you explain why this is so important, how this impacts who gets to access vaccines and who might be most harmed by the changes in these policies? 

Dr. Celine Gounder  22:52

This has a huge impact on what insurance companies will cover. And there's also the Vaccines for Children Program, which provides vaccines for the most vulnerable children -- from low-income families, for example, who rely heavily on the Vaccines for Children program to get vaccinated. And the decisions about what vaccines are covered by that program is very much determined by these kinds of recommendations, as is insurance coverage under the Affordable Care Act. It's unclear what insurers are going to do if the ACIP no longer recommends a particular vaccine for certain groups. They have not come out publicly and said what their policy will be. I suspect most insurance companies will continue to cover, but that remains to be seen. But stepping back again with respect to your question, it's really underserved communities, communities where people have less good health care access, where people are less likely to have health insurance, more likely to live in rural or urban settings that have provider shortages, and also where people are more likely to live in crowded housing. All of these things predict, if people do get sick, they will likely get sicker and may not have access to health care when they do get sick. Also, they're more likely to get infected in the first place because of their living or working situations. And one of the things we've seen, sort of ironically, I suppose, during the pandemic, is a schism between increasingly skeptical, more affluent people who were upset about the disruptions to their lives, to schooling and so on --  and not to minimize those disruptions -- and lower-income and people of color, communities of color, who are the ones that are dealing with the real burden of disease that may result from lower vaccine rates.

Heather Howard  25:01

Jason, is that system of developing, approving and making widely available vaccines now broken? And what's your hope for the future? 

Jason Schwartz  25:09

It is certainly facing threats on an ever-expanding number of fronts. As you noted a little while ago, it's not just these recommendations or this advisory committee, but it's the cancelation of grants to study vaccine hesitancy. It's the U.S.'s multi-billion dollar commitment to global vaccination through GAVI that was withdrawn. It's the termination or replacement of career scientists at the FDA and CDC who make this work. It's hard not to point to a week that hasn't had some sort of announcement or message or decision coming from the federal government, to be completely candid, that hasn't complicated our approach for developing, regulating, promoting, communicating vaccines. That is an enormous challenge, one that doesn't seem to have a ready solution. But certainly, while we think about the immediate consequences for our ongoing vaccination efforts, we have a respiratory virus season approaching in a few months, and the need for clear guidance about how folks can protect themselves and their families against influenza and RSV and Covid-19 will be incredibly important. Who will take the lead in that work is an open question at this point. So we have those efforts. We have those concerns about childhood vaccination. Then, as you think about our vaccination life cycle, certainly there's a question for vaccine development coming forward in terms of the degree to which vaccine manufacturers will continue to invest, as they have in vaccines, if they have concerns about the world in which even a successful vaccine may or may not be reviewed or approved or introduced. There are questions about the National Institutes of Health’s basic research contributions that help fund so many of those discoveries and laboratories and universities, like universities where I’m sitting and Princeton and elsewhere, that can help support the kinds of work that can potentially lead to new vaccines. I think uncertainty is a great understatement, but certainly the case as we think about every aspect of our vaccination ecosystem as we sit here in mid-2025. 

Heather Howard  27:24

Jason, often in health policy, when we see the federal government retrench or even engage in sabotage, we will see states stepping in. I noted that Colorado recently passed legislation that said, when the state is setting vaccine guidelines, we don't have to rely just on the ACIP. We can also rely on medical societies like the American Academy of Pediatrics. Do you see more states doing that? Should that be happening? You started by talking about how we had this wonderful symphony of a federal system that worked so well. How do you feel about a patchwork of states? I saw also that the West Coast states said that they're going to come together and pool expertise. How do you see that policy landscape? 

Jason Schwartz  28:12

Twofold. I do think states will necessarily need to step up and fill that void in terms of messaging and communication and evidence-based guidelines. That's something they can do to be sure. Whether or not states have the resources to support the kinds of funds that are being cut from both the basic research and programs that come through the CDC to state and local health departments, that's a far harder hill to climb, given what we know about state budgets. But certainly with respect to messaging and communication, that can be an area where states can step up. And the other group filling in are the medical professional societies, the obstetricians, the family practitioners, the pediatricians, the groups that have for decades been close collaborators with the CDC, generally unifying their own recommendations with those of the Advisory Committee on Immunization Practices. They are already saying we can't stay in the background if we can't have confidence in the recommendations that are coming from federal partners. So you're already hearing, in word and action, efforts by those medical professional groups who are so critical in helping communicate to frontline providers, that even though the messages may be changing out of Atlanta or Washington, or the Administration, the science hasn't changed. Helping to try to stabilize this period of uncertainty, I think, is an area where the medical professional societies, in addition to the states, will step up, but they can only do so much. As Celine noted, those federal programs that help ensure that vaccines are available and affordable are linked specifically to ACIP recommendations. There is no substitute in our current policy landscape, absent legislation, for the VFC coverage to be protected if an ACIP recommendation is withdrawn, or if a private insurer chooses no longer to cover a vaccine because they no longer have to, because it's no longer recommended. That fifty-state solution of State Health Insurance Commissioners trying to fill those gaps would be imperfect at best, even if states are eager to sort of champion vaccination programs. And we know there's a partisan divide as it relates to vaccines and public health, as there is in so many aspects of life. I think we'd be foolhardy to think that all the states would try to fill that gap. We'd certainly, I think, often see a blue state, red state divide, which would be not great for public health, particularly in those underserved, rural and urban communities that rely so much on these programs. I hate to paint such a pessimistic picture, but the threats are many and growing. 

Heather Howard  30:41

Especially since communicable diseases do not know state boundaries. Celine, do you have any more optimism? You think a lot about community communication challenges that Jason highlighted? Do you have any more optimism about potential to combat this vaccine hesitancy and skepticism and to rebuild trust in public health? 

Dr. Celine Gounder  31:03

I just want to make a couple other points following up on Jason. First, there is a group out of the University of Minnesota, led by my friend Mike Osterholm, called the Integrity Project, where they're bringing those professional societies to the table together to come to an agreement about what the science says. What is the scientific consensus on the safety and efficacy of these vaccines? How should they be used? We anticipate that a report will be coming out of that project towards the end of the summer, in advance of the school year. I think that will be an important source of information, because it's not only an individual professional society, but really all of them coming together to come to a consensus.  

Dr. Celine Gounder  31:49

The other thing I would say is childhood vaccination requirements are at the school district level, and so this is going to be hyper-local as to what they continue to require and how they enforce it. I do think we'll see a patchwork in terms of vaccination rates as a result, and not even at a state level. It may even be urban versus rural and so on that we'll see breaking out. In terms of trust, some of the folks in the audience might be familiar with the Edelman Trust Barometer. It's a study that's done every year looking at who are trusted institutions or other sources of information. Within the last couple of months, they released their yearly "Trust in Health" report. What's fascinating about that, and this does mirror other trends in terms of trust, as we've seen really for decades, is a decline in trust in institutions and elites and experts that also accelerated during the pandemic. Where we see trust most, or what people trust most for information about health, particularly younger generations, is what I would call lateral trust, as opposed to top-down. Lateral meaning family, friends, and social media. An individual social media influencer may not have as much impact as, say, a Tony Fauci at an individual level, but cumulatively over all of the exposures to those people, that ends up being a more trusted source of information.  

Dr. Celine Gounder  33:30

Alongside this, you also have a few other trends, including the decline of mainstream media. Some of this relates to there not really being a sustainable business model anymore, as advertising revenue has been siphoned off by the big tech companies, aging of the mainstream media audience. A recent poll found that the number one source of news for Americans now is social media, outstripping the TV evening news broadcasts. So I think if we're looking to improve the information that people are getting, to rebuild trust, it really does mean, one, being in those social media environments. Secondly, also being hyper-local, meaning being somebody in a community working with other health care providers, community leaders, faith leaders, school leaders, to be getting information out. I think that ground game is often seen as not as glamorous as going on television and not as impactful. One way I think about it is force equals mass times acceleration. We each have so much force, and sometimes, if you tackle smaller mass or masses, you can actually have a way bigger impact.

Heather Howard  34:55

Celine, great advice, and thank you for raising Dr. Osterholm's effort at University of Minnesota, which is really aiming to fill the gaps now created by and to coordinate the medical consensus, and the Edelman Trust Barometer. We’ll put them in the show notes. Those are great call-outs. 

Heather Howard  35:16

Before we wrap, we always like in this podcast to explore how research can inform policy. And so I want to give you a chance to comment on that. Jason, starting with you, you've engaged in policy processes. Especially during Covid, it was interesting to watch you be involved in Connecticut's advisory processes. What research questions are you hoping to see explored to inform these debates going forward?

Jason Schwartz  35:41

Absolutely. My experience during both the Covid pandemic and even this recent period of vaccine policies being in the news -- perhaps more so than any of us would care to see -- the public health and vaccine communities have emphasized the importance of this work. [They've emphasized] not just the importance of understanding the evidence base that shapes our confidence in the safety and effectiveness of vaccines, but those kinds of processes by which we can ensure that we're evaluating evidence carefully, that we're communicating it clearly, that we're recognizing what we know and what we don't know, and that policymakers and their expert advisors are in the best position to build strong vaccination programs. So my own work has continued to amplify that and also to help understand the importance of what we all think about in public health -- not just the kinds of research that finds itself in peer review publications but are barely seen by folks outside the academy or outside little bubbles in which we all inhabit, but talking about what we learn and what we know about the importance of vaccination programs, about how these policies and programs work, and what their strengths and weaknesses are, and how they can do their jobs better. Whether it's in a pandemic time or regular times, regardless of who's in charge, [we need to] talk about how we can communicate that information to different kinds of audiences, to policymakers and health officials, directly in public forums like this conversation we're having, or with our friends in the media, like Celine and her colleagues. Because, ultimately, if researchers are simply talking to each other, especially on areas of direct importance to health policy and public health, we're falling short of our goals and what our mission should be. I think this period of my own engagement has reaffirmed the importance of thinking about not just what we do, but how we do it, and how we disseminate what we learn.

Heather Howard  37:41

Thank you. Celine?

Dr. Celine Gounder  37:42

Well, some of what I'm going to be looking at is transparency and process. I think we've already seen real degradation in transparency and process in scientific decision-making. I think it's going to be really important for us to hold folks accountable to adhering to those norms. Touching on something Jason said, there is not really, currently an academic path to promotion based on communication that's outside of the traditional grants and papers and attending a conference, and giving a keynote at a conference. I think that is very much to the detriment of the scientific community. I think people do not understand, for example, the value of NIH-funded research, because they don't understand how it impacts their lives. In fact, I'm working with a college student for the National Academy of Medicine to produce a series of social media episodes, video shorts showing how NIH-funded research has led to very concrete benefits in terms of health. 

Dr. Celine Gounder  38:56

Honestly, we should feel more accountable. Many of us who are doing that kind of research funded by taxpayer dollars should be held accountable for explaining what the meaning of our research is, how it's significant to the folks who have paid for it. I think, unfortunately, there are a lot of scientists who think that's beneath them, and I think that's really to their own peril. I think the only way that academic institutions will value that kind of communication is if there is funding tied to it. And so that would mean NIH grants having a line item for that kind of work. There are a number of organizations who work with the NIH and others to advocate for more funding. But this is one of the areas they've also been pushing those organizations to think about, because it is really in their own interest. 

Dr. Celine Gounder  39:53

Finally, the other thing I would add is that it's been fascinating to me that the public health community has not taken a public health approach to why the community itself is currently failing. What is the public health approach? It is gathering data, understanding the risk factors, protective factors, for whatever the outcome, and then figuring out how to make use of that to do better in the future. And if you're in a context where public health is under attack, getting defunded, people are extremely skeptical, it's not about wringing our hands and saying, oh, woe is me. It's about what led to that. And I think, unfortunately, that is not really the approach that is being taken. A big part of that is, how do we better communicate about science and public health? What I'm seeing, unfortunately, is government programs are getting defunded. Philanthropy is jumping in to try to plug some of those holes. They're not talking about communication. And when I say not talking about communication, they might do some PR for their own projects. That's not what I'm talking about here. I'm talking about really communicating to the public about the value of science and public health. And there just hasn't been that kind of effort. I'm hopeful that perhaps some of the big players in the space will start thinking about that as well.

Heather Howard  41:22

Well, I think that's a great place to end. You both have given us a lot to think about on such a vital topic. I really appreciate and thank you, Celine and Jason, for a great conversation.

Jason Schwartz  41:35

Thank you.

Heather Howard  41:38

Thank you for listening to the Princeton Pulse Podcast, a production of Princeton University Center for Health and Wellbeing. The show was hosted by me, Professor Heather Howard, produced by Aimee Bronfeld, and edited by Alex Brownstein. We invite you to subscribe to the Princeton Pulse Podcast on Apple podcasts, Spotify, or wherever you enjoy your podcasts.