A pediatrician explains 'confusing' vaccine guidelines, health equity impacts
A patient receives a COVID-19 vaccination as she takes part in a vaccine study at Research Centers of America on Aug. 07, 2020.
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NINA MOINI: It is a confusing time in public health. Some states, like Minnesota, have started new vaccine policies with the goal of protecting people's access. Other states have moved in another direction. For example, Florida plans to end vaccine requirements for children. These changes at the state level are happening as the federal government's approach to vaccines is in upheaval.
United States Health Secretary Robert F. Kennedy Jr. fired the director of the Centers for Disease Control and Prevention, as well as a committee of advisors who influence vaccine policies. Kennedy then filled some of those roles with people who, like him, have spread misinformation and conspiracy theories about vaccines.
Joining me now to talk about what all of this means for doctors and patients in Minnesota is Dr. Nathan Chomilo. He's a practicing pediatrician and chair elect of the American Academy of Pediatrics Council on Health Equity. Doctor, thank you so much for your time this afternoon.
NATHAN CHOMILO: Thank you so much for having me, Nina.
NINA MOINI: I wanted to start, if you don't mind, just talking a little bit about when we're talking about childhood vaccines, and that umbrella, what are some of the main vaccines that are talked about there? Just for people who maybe don't have children or don't know top of mind. How many are there? What are the specific vaccines you refer to there?
NATHAN CHOMILO: Yeah. So over time we have continued to develop ways to protect children and families and really communities. When children receive all the recommended immunizations on time, our whole community benefits. And so there's a lot of shots that try to pair with a child's developing immune system. We just welcomed a lot of children back to school, and we're excited about them learning. Well, children's immune systems are also learning.
And so this is a schedule that has been developed carefully over time, with lots of rigorous research to see what is the best time and intervals between shots to protect against 18-some diseases that we didn't always have the benefit and luxury of having protection against. So really common diseases that folks have heard of like measles, polio, tetanus, or whooping cough, hepatitis. Several types of bacteria that cause severe complications like pneumonia, or infections of the lungs, meningitis, or infection of the brain.
Things that my colleagues who trained decades ahead of me had seen children show up into emergency rooms and in the ICUs frequently every year. And during my training and since, we've seen a steep decline because of immunizations. And so this is what's at stake here, is really the health and well-being and full potential of the children in our community.
NINA MOINI: And I think one of the things that we're grateful to have your perspective around is, I think it's hard for people to envision how changes at the federal level, when you talk about an institution like the CDC, trickle down and could impact sending their child to school here in the state of Minnesota. Could you explain the link there, the influence that the CDC has over child vaccinations in Minnesota, and if that is in peril now?
NATHAN CHOMILO: Yes, I think there are several things, and I think everyone who follows healthcare knows that our healthcare system is rather complicated. But when it comes to immunizations, the shots themselves get approved by the FDA, which is a separate branch from the CDC and our HHS division of the federal government.
And then the CDC provides the guidance for clinicians, so that's your doctors, your pharmacists, to give the shots. And that has historically been done through an advisory committee that has been independent, nonpartisan committee of experts that look at the data, look at the evidence, look at what FDA said in their acceptance, and says, here's who we recommend get the vaccines and when.
And then school nurses, physicians, pharmacists, take that and use that to help guide our vaccination programs. So when CDC changes it, that does then call into question the guidance that is used. Particularly if guidance coming out of the CDC, with this current iteration of the ACIP, is not grounded in sound science. And so then states have to look to different areas to find that guidance.
NINA MOINI: And just tell me what the ACIP is, again, for listeners.
NATHAN CHOMILO: Yeah, the Advisory Committee on Immunization Practices is that historically independent advisory committee to the CDC director. And so that is the committee that Secretary Kennedy fired all of the existing members and reconstituted earlier this summer.
NINA MOINI: Right. So if you, in your capacity as a doctor, feel that the CDC guidance changes on these committees that are, like you said, historically nonpartisan, where would you or where would others turn instead for guidance?
NATHAN CHOMILO: Well, thankfully, we have a lot of other folks who are really invested in the health of our children and families. And so the American Academy of Pediatrics has actually been creating vaccine guidance before the ACIP even existed. For over 90 years, they've been making vaccine recommendations.
And so the American Academy of Pediatrics did recently put out their set of recommendations for this upcoming year to help guide physicians like me, to help guide policymakers at the state and other levels, like our insurers, on what is really, again, grounded science around keeping children and families healthy and safe.
NINA MOINI: What do you think of the situation I mentioned there at the top, with Minnesota Governor Tim Walz enacting their own rules state by state? Maybe that creates sort of a patchwork across the country. What are your thoughts on that?
NATHAN CHOMILO: Yeah, I think certainly it's important for us to continue to have our public health institutions, our healthcare systems that are really there to protect us in a time of need, be guided by science, be guided by decisions that are free of partisan influence. And so I think it is important that if the federal government has made a decision that the leaders it is entrusting are going to be more informed by partisan issues than by science, that there are alternatives for folks to look to.
And I think what you see happening here in Minnesota, what you've seen, there's different groups of states in the northeast and the west that are also looking at this. Again, the American Academy of Pediatrics is working to develop guidance. Dr. Osterholm at the University of Minnesota has a vaccine integrity project as well. And so the hope is that from this group, these different groups, that we will have some consistency that can step into this time of uncertainty and provide guidance to families, guidance to pediatricians and other providers.
NINA MOINI: I want to talk a little bit, doctor, about the intersection of all of this and your work around health equity and accessibility. How are you viewing all of that? Or are you concerned about accessibility and equity as it relates to some of these changing standards at the federal level?
NATHAN CHOMILO: Yeah, thank you for asking that, Nina. That is a big concern of mine, having previously served in a role as vaccine equity director for our state's COVID-19 response. Because to me, caring for our community means removing the barriers that families run into when trying to get their kids immunized, or other healthcare services, and so sometimes that can be things like insurance coverage. But sometimes it's things like clinic locations or hours.
And what this uncertainty does is it takes resources away from our ability to focus on meeting those barriers. It's really a misguided, misleading review of these long-standing recommended schedules. It distracts us from real, practical issues that make sure that proven vaccines are easily available and always affordable to families who want them.
And we know whenever we put up barriers, it's more likely to impact the most disadvantaged, whether that's by geography, race, ethnicity, language, gender identity-- a number of these things that keep folks away from access to health is going to be exacerbated by some of the confusion we're currently facing.
NINA MOINI: And the committee that we've been talking about from the CDC, that provides this guidance on vaccines, is, I see here, actually scheduled to meet next week. Although it might get postponed. I'm not sure what's going on there with the meeting. But if it were to happen, what do you think are maybe the best and the worst-case scenarios to come out of that meeting, from your perspective?
NATHAN CHOMILO: Well, certainly the best-case scenario is that they look at the evidence, they look at even their own reports from earlier this spring on the impact of diseases like COVID-19 and flu and the importance of vaccination in those settings. Hopefully leads them to continue to provide guidance that allows all families who wish to get them, for that to be available, to be clear, so that locations like pharmacies, like our public health pop-up clinics, can administer them without any ambiguity. That would be the best-case scenario.
I think the worst-case scenario is that they start to introduce more of this misguided, unsupported claims that then put barriers in front of folks who want to protect their children and their families from things like COVID-19, from flu, or even other really well-established diseases. And I think that's the thing that we're all waiting to see, is how that will impact folks' ability to access that. Our immunization programs like the Vaccine for Children programs and others, how it will impact our ability as states to continue supporting those programs. Those are all things that we're looking for closely.
NINA MOINI: And just lastly, doctor, with all of the confusion that is going around right now, what do you say to perhaps parents who come in and are concerned, or families that are concerned about what is to come for the health of their child? What do you say?
NATHAN CHOMILO: Yeah, I mean, I really empathize. It's confusing, especially when there's an incredible amount of false rumors being spread online and other places. I think finding your sources of truth, talking with your pediatrician, or your family practice doctor or other provider. Talking with folks that are looking at information online from trusted sources like the American Academy of Pediatrics, where they're going to continue to share accurate information about immunizations and child health. And really wanting to know that we're trusted partners in supporting the health of their child.
It really is one of the joys of my career, is being able to see children and families reach their full potential in health, be able to grow and learn new things, do well in school, navigate challenges. And so this is just one other piece that we are really invested in and finding and helping children and families find answers to, and really helping protect from avoidable suffering. Because again, vaccines are an amazing advancement in medicine that not only protect against really scary things like death, but just suffering.
Even just this last week, one of my children had a high fever and we were worried that we'd have to go to the hospital, right? And I know that fear of having to-- your child is so sick that they might have to go to the hospital. And vaccines help protect against that. Not just those big things, but that suffering that we can avoid. And so really, again, leaning into those relationships, leaning into trusted sources of health, will help folks navigate through this time of uncertainty, whichever way the federal government goes.
NINA MOINI: All right, Dr. Chomilo, thank you so much for your time today. Appreciate it.
NATHAN CHOMILO: Thank you so much for talking about this, Nina. You take care.
NINA MOINI: Thank you. That's Dr. Nathan Chomilo, a pediatrician and chair elect of the American Academy of Pediatrics Council on Health Equity. And hey, later today on All Things Considered, we'll learn more about Minnesota's new vaccine guidance from the commissioner of the state health department. And on tomorrow's 9:00 AM show, guest host Chris Farrell will be talking with guests about, again, the changing public health policies. And he'll be taking your calls, so tune in for that.
United States Health Secretary Robert F. Kennedy Jr. fired the director of the Centers for Disease Control and Prevention, as well as a committee of advisors who influence vaccine policies. Kennedy then filled some of those roles with people who, like him, have spread misinformation and conspiracy theories about vaccines.
Joining me now to talk about what all of this means for doctors and patients in Minnesota is Dr. Nathan Chomilo. He's a practicing pediatrician and chair elect of the American Academy of Pediatrics Council on Health Equity. Doctor, thank you so much for your time this afternoon.
NATHAN CHOMILO: Thank you so much for having me, Nina.
NINA MOINI: I wanted to start, if you don't mind, just talking a little bit about when we're talking about childhood vaccines, and that umbrella, what are some of the main vaccines that are talked about there? Just for people who maybe don't have children or don't know top of mind. How many are there? What are the specific vaccines you refer to there?
NATHAN CHOMILO: Yeah. So over time we have continued to develop ways to protect children and families and really communities. When children receive all the recommended immunizations on time, our whole community benefits. And so there's a lot of shots that try to pair with a child's developing immune system. We just welcomed a lot of children back to school, and we're excited about them learning. Well, children's immune systems are also learning.
And so this is a schedule that has been developed carefully over time, with lots of rigorous research to see what is the best time and intervals between shots to protect against 18-some diseases that we didn't always have the benefit and luxury of having protection against. So really common diseases that folks have heard of like measles, polio, tetanus, or whooping cough, hepatitis. Several types of bacteria that cause severe complications like pneumonia, or infections of the lungs, meningitis, or infection of the brain.
Things that my colleagues who trained decades ahead of me had seen children show up into emergency rooms and in the ICUs frequently every year. And during my training and since, we've seen a steep decline because of immunizations. And so this is what's at stake here, is really the health and well-being and full potential of the children in our community.
NINA MOINI: And I think one of the things that we're grateful to have your perspective around is, I think it's hard for people to envision how changes at the federal level, when you talk about an institution like the CDC, trickle down and could impact sending their child to school here in the state of Minnesota. Could you explain the link there, the influence that the CDC has over child vaccinations in Minnesota, and if that is in peril now?
NATHAN CHOMILO: Yes, I think there are several things, and I think everyone who follows healthcare knows that our healthcare system is rather complicated. But when it comes to immunizations, the shots themselves get approved by the FDA, which is a separate branch from the CDC and our HHS division of the federal government.
And then the CDC provides the guidance for clinicians, so that's your doctors, your pharmacists, to give the shots. And that has historically been done through an advisory committee that has been independent, nonpartisan committee of experts that look at the data, look at the evidence, look at what FDA said in their acceptance, and says, here's who we recommend get the vaccines and when.
And then school nurses, physicians, pharmacists, take that and use that to help guide our vaccination programs. So when CDC changes it, that does then call into question the guidance that is used. Particularly if guidance coming out of the CDC, with this current iteration of the ACIP, is not grounded in sound science. And so then states have to look to different areas to find that guidance.
NINA MOINI: And just tell me what the ACIP is, again, for listeners.
NATHAN CHOMILO: Yeah, the Advisory Committee on Immunization Practices is that historically independent advisory committee to the CDC director. And so that is the committee that Secretary Kennedy fired all of the existing members and reconstituted earlier this summer.
NINA MOINI: Right. So if you, in your capacity as a doctor, feel that the CDC guidance changes on these committees that are, like you said, historically nonpartisan, where would you or where would others turn instead for guidance?
NATHAN CHOMILO: Well, thankfully, we have a lot of other folks who are really invested in the health of our children and families. And so the American Academy of Pediatrics has actually been creating vaccine guidance before the ACIP even existed. For over 90 years, they've been making vaccine recommendations.
And so the American Academy of Pediatrics did recently put out their set of recommendations for this upcoming year to help guide physicians like me, to help guide policymakers at the state and other levels, like our insurers, on what is really, again, grounded science around keeping children and families healthy and safe.
NINA MOINI: What do you think of the situation I mentioned there at the top, with Minnesota Governor Tim Walz enacting their own rules state by state? Maybe that creates sort of a patchwork across the country. What are your thoughts on that?
NATHAN CHOMILO: Yeah, I think certainly it's important for us to continue to have our public health institutions, our healthcare systems that are really there to protect us in a time of need, be guided by science, be guided by decisions that are free of partisan influence. And so I think it is important that if the federal government has made a decision that the leaders it is entrusting are going to be more informed by partisan issues than by science, that there are alternatives for folks to look to.
And I think what you see happening here in Minnesota, what you've seen, there's different groups of states in the northeast and the west that are also looking at this. Again, the American Academy of Pediatrics is working to develop guidance. Dr. Osterholm at the University of Minnesota has a vaccine integrity project as well. And so the hope is that from this group, these different groups, that we will have some consistency that can step into this time of uncertainty and provide guidance to families, guidance to pediatricians and other providers.
NINA MOINI: I want to talk a little bit, doctor, about the intersection of all of this and your work around health equity and accessibility. How are you viewing all of that? Or are you concerned about accessibility and equity as it relates to some of these changing standards at the federal level?
NATHAN CHOMILO: Yeah, thank you for asking that, Nina. That is a big concern of mine, having previously served in a role as vaccine equity director for our state's COVID-19 response. Because to me, caring for our community means removing the barriers that families run into when trying to get their kids immunized, or other healthcare services, and so sometimes that can be things like insurance coverage. But sometimes it's things like clinic locations or hours.
And what this uncertainty does is it takes resources away from our ability to focus on meeting those barriers. It's really a misguided, misleading review of these long-standing recommended schedules. It distracts us from real, practical issues that make sure that proven vaccines are easily available and always affordable to families who want them.
And we know whenever we put up barriers, it's more likely to impact the most disadvantaged, whether that's by geography, race, ethnicity, language, gender identity-- a number of these things that keep folks away from access to health is going to be exacerbated by some of the confusion we're currently facing.
NINA MOINI: And the committee that we've been talking about from the CDC, that provides this guidance on vaccines, is, I see here, actually scheduled to meet next week. Although it might get postponed. I'm not sure what's going on there with the meeting. But if it were to happen, what do you think are maybe the best and the worst-case scenarios to come out of that meeting, from your perspective?
NATHAN CHOMILO: Well, certainly the best-case scenario is that they look at the evidence, they look at even their own reports from earlier this spring on the impact of diseases like COVID-19 and flu and the importance of vaccination in those settings. Hopefully leads them to continue to provide guidance that allows all families who wish to get them, for that to be available, to be clear, so that locations like pharmacies, like our public health pop-up clinics, can administer them without any ambiguity. That would be the best-case scenario.
I think the worst-case scenario is that they start to introduce more of this misguided, unsupported claims that then put barriers in front of folks who want to protect their children and their families from things like COVID-19, from flu, or even other really well-established diseases. And I think that's the thing that we're all waiting to see, is how that will impact folks' ability to access that. Our immunization programs like the Vaccine for Children programs and others, how it will impact our ability as states to continue supporting those programs. Those are all things that we're looking for closely.
NINA MOINI: And just lastly, doctor, with all of the confusion that is going around right now, what do you say to perhaps parents who come in and are concerned, or families that are concerned about what is to come for the health of their child? What do you say?
NATHAN CHOMILO: Yeah, I mean, I really empathize. It's confusing, especially when there's an incredible amount of false rumors being spread online and other places. I think finding your sources of truth, talking with your pediatrician, or your family practice doctor or other provider. Talking with folks that are looking at information online from trusted sources like the American Academy of Pediatrics, where they're going to continue to share accurate information about immunizations and child health. And really wanting to know that we're trusted partners in supporting the health of their child.
It really is one of the joys of my career, is being able to see children and families reach their full potential in health, be able to grow and learn new things, do well in school, navigate challenges. And so this is just one other piece that we are really invested in and finding and helping children and families find answers to, and really helping protect from avoidable suffering. Because again, vaccines are an amazing advancement in medicine that not only protect against really scary things like death, but just suffering.
Even just this last week, one of my children had a high fever and we were worried that we'd have to go to the hospital, right? And I know that fear of having to-- your child is so sick that they might have to go to the hospital. And vaccines help protect against that. Not just those big things, but that suffering that we can avoid. And so really, again, leaning into those relationships, leaning into trusted sources of health, will help folks navigate through this time of uncertainty, whichever way the federal government goes.
NINA MOINI: All right, Dr. Chomilo, thank you so much for your time today. Appreciate it.
NATHAN CHOMILO: Thank you so much for talking about this, Nina. You take care.
NINA MOINI: Thank you. That's Dr. Nathan Chomilo, a pediatrician and chair elect of the American Academy of Pediatrics Council on Health Equity. And hey, later today on All Things Considered, we'll learn more about Minnesota's new vaccine guidance from the commissioner of the state health department. And on tomorrow's 9:00 AM show, guest host Chris Farrell will be talking with guests about, again, the changing public health policies. And he'll be taking your calls, so tune in for that.
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