Eureka Day Community Partners

♪ We're proceeding news and theater facts ♪ ♪ Behind the scenes behind the acts ♪ ♪ Interviews with artists and staff ♪ ♪ Will make you think and even laugh some weeks ♪ ♪ City speaks ♪ ♪ City speaks ♪ ♪ City speaks ♪ - Hello and welcome back to City Speaks, a new play podcast coming at you from the South Side of Pittsburgh. I'm your host, Rachel Dan Boas, and I'm the production manager and apper Poe to today's topic, the COVID Safety Officer here at City Theater. Today, I'm speaking with Crystal Ross and Dr. Amish Adalja. Crystal is a clinical pharmacist, a health leader and educator, and the current vice president of the Allegheny County Immunization Coalition. And Dr. Adalja is a scholar and educator with the Johns Hopkins Center for Health Security, the Bloomberg School of Public Health, and the Center for Global Health, his work is focused on emerging infectious disease, pandemic preparedness, and bio-security. So welcome to you both. We appreciate you being here. And I have to say, both of your bios are incredibly impressive and narrowing down the questions to ask you has been really hard. But in the interest of time, I'll stick to questions that connect with the characters in the plot of Eureka Day, both of which you have seen. I'm particularly interested in how the ideas of community resilience and trust building intersect with preparedness. So my first question is, could you talk a little bit about the difference between medical preparedness and social preparedness when it comes to infectious disease? - Both of those concepts actually have to integrate to work effectively. If you look back to COVID-19, the United States was the most prepared nation in the world by far in terms of preparation for an emerging infectious disease and infectious disease emergency. We had the best toolbox, the best tools. But if you don't have a willingness to use those tools, then you end up the way we did in the United States with really dismal levels of hospitalization and death that basically dwarfed many other countries that were much less prepared. So if your community is not accepting of the tools or if your policymakers don't know how to deploy the tools appropriately or communicate the value of those tools, it doesn't matter at all. So you have to think about preparedness really holistically. It's not just antivirals, antibiotics, vaccines, diagnostic tests, masks. It's actually making sure that people know how to use them and know what value those objects offer them in their day-to-day life when they're dealing with an infectious disease emergency. - And how do you build trust with communities that have vaccine hesitancy or maybe don't have that information? - It's very, very challenging. What we have are people that sometimes approach their position on vaccines or specifically a position against vaccines almost like a religious idea, meaning that it's impervious to you showing them the data, explaining it to them. And we're seeing that right now with measles outbreaks that are occurring all over the United States. That even parents of children who have died, some of them double down and say, "That was God's will. "God created the measles virus. "The vaccine is something unnatural. "We don't want to interfere." Those types of people are mostly unreachable, but what we really try to focus on are people that can be, that are on that vaccine hesitance spectrum, where they have questions, they're not getting good answers, they don't necessarily know which experts to trust. That's where you start to build rapport. And it's not usually me pontificating about it. It's usually their primary care physician or a community health worker or a pharmacist that they see at their local pharmacy that makes that connection to them. And this is why this vaccine is important to you, why it has individual value to your life or to your child's life. And what questions do you have? And I might not know all the answers, but I can point you to the correct answers and tell you which answers are definitely not right. But it's a very, very challenging thing, but we know that people really relate to people that they see on a day-to-day basis, that they already have a trusting relationship with rather than somebody pontificating on television or on the radio about something. And Crystal, you've been involved in a lot of community immunization efforts. What have you found to be effective or what have you learned? I would have to agree with developing a rapport. My face is in the community a lot. And I often get a lot of questions from patients or even the patients family members in nursing homes. And we do have a lack of vaccinations in nursing homes who are going in there. And some of the families don't even know they're available. Or if they family member had a vaccine. So again, going over the vaccine hesitancy and getting people to get vaccinated, that may have questions as to what's this going to do to my body? How is it going to affect me? I'm like going to get sick. So answering some of those questions of what actually happens, what can they expect from the vaccine? Thank you. Do you find that the approach to reaching people on that spectrum of hesitancy is different in an acute situation, like in the middle of a pandemic, versus say what we are in now, which is more of a calm period. I mean, I know that COVID hasn't gone away. But I'm remembering the days during the pandemic, when we didn't really know what was happening. We didn't-- it was pre-vaccine. We didn't fully seem to understand exactly how it was being transmitted. And I'm wondering if that changes the way that you communicate with people. In general, yes, because the stakes are a little bit different. So during a public health emergency, like COVID-19, the vaccine was the way out. This was what was going to save the world. And this was a virus that wasn't known to the human species before 2019. This was a vaccine that was made in record time, which was a good thing. This was a vaccine using new technology that had not been used in vaccines before, even though it had been studied for decades before. So that posed specific challenges that we had to overcome. That you don't necessarily have to overcome when you're trying to tell someone to get the measles vaccine, which has been around since the 1960s, or the Mumps vaccine, which is the subject of Eureka Day. That's something that's really baked into people's understanding of what vaccines are. So it's definitely harder when you're dealing with something novel using new technology than something that's tried and true. But what we see is there was vaccine hesitancy that was very high to the COVID-19 vaccine. And that has now bled into vaccines for childhood immunizations like the MMR, measles, mumps, shabella, like tetanus shots, like whooping cough shots, even to animal vaccines for rabies for pets. It's basically metastasized out of the COVID-19 environment into all vaccines. And part of this also has to do with that COVID-19 was such a shock to people. It wasn't just that there was this novel virus that was killing people. It was also all of the public policy debates that occurred over masks and shutting down this business as essential. This one is not essential. Schools being closed, all of that got bundled up in a lot of people's minds with the vaccine. And some people now oppose all of it because of that. So COVID-19 posed a specific challenge because of how it really unleashed this kind of, what I would call tribal thinking about how you respond to infectious disease, which now makes people question all vaccines. And while you look at, when you look at polls, most people even Republicans 80% or so support childhood vaccinations, it's a very vocal minority. But that vocal minority that's choosing not to vaccinate their children is enough for measles outbreaks to take hold and become now a new endemic disease in the United States and for the US to be on the cost of losing elimination. So COVID definitely accelerated what happened. And you can't explain RFK juniors rise to power without relying on what happened with COVID. COVID is part of what propelled RFK juniors to become the most powerful health-efficient in the United States right now. - That was going, one of my questions was gonna be, does this feel like a situation unique to the United States or this conversation about not believing in the efficacy of vaccines or thinking they're dangerous is that something that is more of an issue here than elsewhere? - I would call it a global phenomenon. It just seems to be very hyperacute in the United States because it's taken on such an, and so it's so integrated now with our tribal politics that it's become something that's in the headlines every day. But if you just look to Canada, Canada lost its measles elimination status just last year before the US did. So Canada has already had this same type of problem. We're seeing this in Europe as well. It just is very much attuned into our day-to-day politics in the United States, which I think is very different. But global vaccine hesitancy is a major public health threat. And if we were to face an infectious disease emergency now, a new epidemic or pandemic threat, a lot of us don't know what would happen because we wouldn't see operation warp speed again. We would see something like the opposite. And I think we would all be the worse off for it. - Are there, are there efforts at different levels of policy making to try to balance out essentially RFK? Like if we are lacking in leadership at the federal level when it comes to vaccination, is there an effort to try to keep, to try to find leadership at, say, the regional level or the local level, or is that federal leadership kind of irreplaceable? - There definitely have been efforts to try and circumvent the federal leadership because it's basically poison now that RFK, junior controls all of it. So what we've seen are states, for example, Pennsylvania is part of a Northeast consortium of states that are trying to develop their own vaccine guidance. That is in opposition to the CDC's. The same thing is happening in the West Coast as well with Governor Newsom leading, [BLANK_AUDIO] leading a similar type of initiative on the West Coast. So we're starting to see that happen. We've also seen the professional societies, particularly the infectious disease society of America, the American College of Physicians, the American Academy of Pediatrics, American Academy of Family Medicine, American College of Stetrics and Gynecology, all really step up and try and fill that void. But obviously, states and locals and these things are not a complete substitute for the CDC, which was the premier public health organization in the world. I would get chills when I would walk into the CDC just because of the people that walk through those doors performing in the work that they do. So we can't really supplant it, but there are efforts. And one of them is the Allegheny County Immunization Council. - Would you talk a little bit more about the work that the council does? So the council is trying to collaborate together with all of the different societies and actually be a voice and provide the information. So on our website or LinkedIn, you can see, we try to give the information of people often ask, where do I go? Where if I can't rely on the CDC, where am I supposed to go? And all the organizations, he mentioned our correct. That's where we're going to look for advice or to prevent an outbreak from heart-occurring. So trying to fill that void. - Is there anything about Pittsburgh that makes it unique when looking at how to deal with a health emergency? - I definitely feel like we have some of the V-top health systems here in Pittsburgh, even from my own experience I have a mother-in-law that lives in New York. The physicians that are here are just phenomenal and trying to get that same type of care in another state. Or even in another country, my sister-in-law lives in England, the health care that they have is not the same as the US and Pittsburgh is definitely one of those areas that we really strive in in Pittsburgh. - I would just add that I think of Pittsburgh as one of the healthcare capitals of the world. And this is a place where innovation has occurred. Jonas Salk developed the polio vaccine here in Pittsburgh. Thomas Starswell pioneered liver transplantation here in Pittsburgh. CPR was invented here by Peter Saffer and Freedom House was the first emergency medical, modern medical emergency service. This all happened in Pittsburgh. So we have all of the assets for this not to be a problem here. Those assets just have to bear on this problem. I think that we can fix this problem, but it is going to take a concerted effort to really underscore to people what a technological leap forward vaccines are and how important they are for humans just trying to live their life in a world and where there's many infectious disease threats. - You know, working in a nonprofit theater, we are always thinking about what we can do with the resources that we have. What kind of resources do does the medical community need in order to make those advances? - Having allies in the general public is a really important part of this. So I used to give this lecture on anti-vaccine movement. I've been doing it for probably over a decade and I would ask the crowd, can you name a pro vaccine celebrity? And no one would have been able to answer. And I think that speaks to the fact that we need allies that are there in the arts, in business everywhere that are really saying that vaccines help our businesses run, help our arts work and help everybody have a normal life that's less disrupted by infectious disease threats. So I think that organizations like City Theater just by having Eureka Day here and sparking conversations is going to get people to think, well, vaccines are important. This is an important public policy issue. I should have a position on this. I should think about this. So I do think that doing plays like this and Pittsburgh Public Theater recently did enemy of the people, which has very similar themes to Eureka Day in terms of how to trust experts. And all of that actually helps us concretize and give examples to people. This is a live issue that really merits discussion and it leads to real consequences. There are about a dozen cases of measles in Pennsylvania right now. There is a major outbreak going on in South Carolina. We're worried about Wooping Cofford. There's lots of things that we worry about, but we worry about when we talk to ourselves, we need to talk more broadly to the general public and we need the general public to actually carry on those conversations themselves. And I think that Eureka Day has a great opportunity to do that here in Pittsburgh. - Thank you. I will come back to Eureka Day in a little bit at the end because I do want to ask about your impressions and your thoughts. But I had one more question about the subject of community resilience. And what that means, what is the definition essentially of community resilience? What does a resilient community look like? In a health emergency? - So resiliency has to do with an ability of an individual, a community, an organization to be able to withstand some kind of threat to it that it doesn't get disrupted. It can bounce back very quickly. And in order to do that when you're thinking about a public health emergency or an infectious disease emergency, that means that it has the assets in place ahead of time that this is something that's proactively done to prevent anything from causing a disruption. So that might mean having a high level of vaccination in the schools. It may make sure that, you know, it may not compromise people have the resources there. It means having a functioning health system. It means having a robust public health system in terms of the county or the state health department being able to operate fully without worried about worrying about budget and worrying about staffing. That's all part and parcel of being a resilient community when it comes to public health. And it's something that has to be done not just when Ebola is in the headlines or COVID is in the headlines. It has to happen even when they're not in the headlines because you can't go through these panic in the neglect, boom and bust cycles and expect to have resiliency in a community. It's not just something you do immediately. Think about the way we think about, I work in infectious disease and national security and taking an example, think about how prepared we are for nuclear war or war, how much the department, planning the department of defense does, 10 year plans, even longer time horizons where they're making sure they're always prepared for whatever threat might be coming. We don't do that in health security. We, the timeline is the next election cycle. Is it two years, four years, six years? That's the most. They don't actually think and think about even our local policymakers and politicians. How often did they actually campaign on an infectious disease issue? When did they say, you know, what we're going to do is have the highest vaccination rate in our area. We're going to be the most resilient against flu. They never do that. So you have, this something is that they don't care about until they do care about it and then they panic and then you get policies that lead to negative consequences like what happened with COVID. So community resiliency to infectious disease has to be happening now all the time. And there are real concerns that this has even become worse than what it was prior because of the current political environment. Do you find, you know, you were talking about the election cycle and how that decision-making changes every time there's someone new coming in potentially. And I imagine that can create a kind of whiplash. And I think we're seeing that on the federal level. But does that make it harder to make policy that lack of consistency? Yes, it makes it very difficult because you end up having to try and cater to whatever the pet interests are of the people in power. So right now people are struggling to figure out how do we do public health when RFK Junior is so opposed to vaccines? Well, maybe he's not opposed to diagnostic testing and he's not opposed to antiviral. So we're gonna work on those issues. So what you don't have is a comprehensive plan because you're trying to pick and choose what political things are going to be viable in the current environment and which and you're going to completely exclude the things that aren't because you're still trying to get traction and do this work. So yes, the whole system is completely disrupted at the federal system. And I don't see an end to this even though there have been some indications that the administration is starting to back away from some of its anti-vaccine policy because they see this as an election liability, not because they see it as a public health problem. They see it as an election liability. But if they really want to be serious about that, they need to remove RFK Junior from the position not just to all this kind of window dressing that's happening at the sub-level. - I think you answered my sort of my set questions. So is there anything else on those particular topics that you want to, before we go into the talking about the play a little bit more, is there anything else that you would like our listeners to hear from you? - I do feel like he said it's at the federal level, but it also will trickle down to the state level and then the local level. So trying to get people informed on vaccines and just public awareness, we need to be more proactive rather than reactive because we need to be prepared for whatever may come our way. - Thank you. So turning to Eureka Day more specifically, I know you've both seen it. Was there anything about the play that stuck with you in particular? - As somebody who studied the anti-vaccine movement, I think it really harkens back to an older era when the anti-vaccine movement was kind of a creature of the far left, the setting of the play, the type of rhetoric you're hearing, even though that same rhetoric is being voiced by our FK Junior today, it's interesting because it kind of was more of an idyllic time and I wrote the little essay that's in the play bill where I talk about that contrast. Now this is kind of into our tribal politics and it's now thought of as a creature of the far right. That to me is the most interesting part because how people think of those things two diametrically opposed positions. The far left. in the far right, but the rhetoric that both of them use, and it's all very voiced by the character of Susan, is the exact same rhetoric that you can see coming from the far right. So it is the same movement. Yeah, and I've heard some interesting things on Instagram about the pipeline from home studying and prepping, and that isn't always the left or the right, and how there are other things that can be a pipeline into that kind of thinking, some of which seems to center around distrust of institutions more broadly, not just medical institutions, but that's an interesting point about the fact that it is not a right or left hesitancy necessarily that there are groups in both, although as we've talked about, I think the difference right now is that the right is in power, and the influence of them being in power has a different kind of impact with RFK. Yeah, definitely. And I think that this is, you have to think of this as strategic because RFK is someone who was traditionally a Democrat from one of the most storied Democrat families in the history of this country, and basically arose from the politics of the left. And I think what ended up happening is COVID was such a shock to the general public, especially certain people on the right that it totally got them to start questioning experts. And the anti-vaccine movement, they were revving up, they saw this, and in the maha movement, the make America healthy, again, movement that RFK junior spearheads, they capitalized on this integration that they could move some of their ideas which had flourished on the far left to the right. And I don't think that that was lost on the Republican policymakers because they saw this is a powerful voting block. We can court them because remember, it was President Trump that developed Operation Warp Speed. That was the signature achievement of the first Trump administration, one for which he received, he should receive credit for because not many of us thought that we could actually get a vaccine in less than a year, and he pushed. I can remember the press conference with the CEO of Moderna and Pfizer saying faster, faster, faster that President Trump was saying. He had to back away from that because it wasn't politically viable anymore because that group of anti-vaxxers became politically more important to him. So this is a really, I think, an interesting conversation about an interesting idea of how this all happened, but this, it's not surprising to me that it happened after COVID. That gave the anti-vaccine movement this opening to really broaden and become a more pluralistic movement that has people from the far right and the far left, but it's still led by people like RFK Jr. who have always led it. I feel like we blame social media for everything these days, which may be right or wrong, but do you feel like social media has played a role in some of that tribalism you're talking about? I definitely think it makes it easier for people to stay in their own echo chambers, and the algorithms will only feed people what will either anger them or what they like, one of the two. So, it's increasingly easier for people to be insular and only get their news with a slant. There's always been slant in the news. That's always occurred, but there were ways to kind of get out around it, but now you don't really have to. I think that social media can be a force for good, and it's primarily a force for good, but it isn't a way where people that are preventing disinformation can easily reach people, and it can be very heavily influential. I can't count how many times I have to debunk something that's on social media that has no basis in fact or reality, and that's only become more so. But social media, and I've been making videos and trying to do a lot on social media to try to counter this by giving people good information, showing them what's interesting that's going on in the field of infectious disease, but it's always going to be a battle. But I think people would have said this about newspapers a long time ago as well. Our newspapers causing people to have this, but I think we have to adapt to it. Crystal, did you have anything that stuck with you? I agree. There's so many different social platforms that people use, and really searching and seeing what really is true news, and newspapers were the way before or even television, and with the new generation coming out, they get their news from social media. So we have to make sure that what information we provide on there is correct. And everything, even looking up at chat GPT, everything is not correct on there that they present, and people need to realize that. Absolutely. The other day I was searching something on Google, and I asked the question in two different Google browsers and got two different AI answers, even though it was the same question in the same browser, which was so interesting to me. Anyway, before I go down that rabbit hole, was there anything that stuck with you when you saw the play? Just people having different perspectives and how in a private school or in a school, that really does happen. I see it in my sense, in school with anti-vaxxers or people that really vaccinate. And sometimes I take a step back and just want to hear what they have to say and where they're getting their information from. So some people's minds we cannot change, and they just have vaccine hesitancy. But those people that are in the middle, really I can feel like we can be influential, and that you did see in the play how you can influence the others or give them information to go the route that they choose or the route that most of the public may be going. Yeah, there are a couple of characters in the end to make some maybe unexpected choices based on their previous actions. One thing I'm asking a number of people who've seen the play, and this maybe is a little bit off topic. But one of the features of the plot is that they're making decisions by consensus. And I was wondering if you had thoughts about the idea of making decisions by consensus. In particular, I asked because for instance me as a production manager, that would never work. I mean, you team build, but you can't necessarily make decisions by consensus. But there are benefits to it. So I'm wondering what you think about that in terms of making decisions about health in a community? There are some things where the context allows for decisions to be made by consensus, but that's not always going to be the case. And when you're thinking about consensus, you have to be playing at least by the same rules or having the exact same idea of how you make decisions, what counts as evidence, what counts as fact, what's a valid argument, what's an invalid argument. So in the play, you have a character, Suzanne, primarily who is my arch villain who I had a problem even talking to the actress to play her, because I couldn't separate the character from the actress. That she's kind of trying to say we do this by consensus, but then she's spewing out alternative facts that aren't true. So how can you build consensus when someone views as the truth is completely different or completely at odds with what actually is the truth? So yes, you can do that, but you have to say this is the general facts here. This is what a valid argument looks like. This is an invalid or a logically flawed argument that you're giving. So that's not a basis for building consensus if one person is going to spew all kinds of arbitrary assertions and expect other people to take that as this in the same way that they say, well, this is what the health department is saying we should do. There is a value you have to understand how to use experts in what facts the experts are drawing upon to make their conclusions. But in the play, those don't matter to Suzanne. Yes, and I agree that she is a difficult character. Yes, and I feel like there's a point when you're figuring out what to say. She needs, there's a difference between fact and emotions. And a lot of times they tell you it will take the emotion out of what your decision is. And you can tell Suzanne really didn't do that because of her previous personal experience. So the character of Suzanne, just one last thing on this is that she's taken this anti-vaccine position as part of her identity, which is the problem that a lot of us are facing is now when you tell them you need to get a vaccine, they see you as attacking their identity. And that's well dramatized in the character of Susan that she is personally affronted by all of this because of her experiences that she's drawn the wrong conclusions from. But now that's part of her identity and who she is. And when you tell her that the mom's vaccine makes sense here based on the facts of reality, it doesn't matter because it's going against her identity. I feel like in that situation there's so much for her to lose if she has to question her identity. It's not just that, you know, if she questions her vaccine or her hesitancy, I don't know, it's more than that, her anti-vaccine because it's such a part of her identity, then she has to question all these other things as well. And that's really scary, I think, for some people. Thank you so much. This has been so great to talk to you. Any final thoughts that you want to share before we close out today? really scares me because it's about a society, it's a side of a society that's turning its back on science and technological solutions. And there's always this idea that people think civilizations are always going to get better. Societies always going to get better progress is always going to come. That's not a foregone conclusion. And the fact that we're fighting over vaccines and trying to defend them is a testament to that. That this isn't a foregone conclusion. And things have happened in societies. We've fallen into dark ages where people have turned against science, technology. That's why, to me, the stakes and this anti-vaccine movement and demonstrating the benefits of vaccines to people's individuals' lives. This is a life or death matter to me. And I think that that's why it's so important that the message of Eureka Day is something that people, that resonates with people that they see that this is, this needs a whole society response. - Thank you. And with that, again, thanks to you. Both. And don't forget to check out Eureka Day by Jonathan Specter. It's on stage until March 29th. You can get tickets at citytheatercompany.org. Thank you. [MUSIC PLAYING] [BLANK_AUDIO]