Safeguarding Public Health with the Vaccine Integrity Project

Buddy Creech: [00:00:14] Hi everyone. This is Buddy Creech with Let's Talk ID. Today my guest is Dr. Bruce Gellin, who's an infectious diseases specialist and epidemiologist, senior advisor to the Georgetown University Global Health Institute, and adjunct professor of medicine at Georgetown University Medical Center. Doctor Gellin previously served as senior vice president and chief of global public health strategy at the Rockefeller Foundation and president of global immunization at the Sabin Vaccine Institute. He also served as deputy assistant secretary for health and director of the National Vaccine Program Office, spearheading the first Pandemic Influenza preparedness and Response Plan and establishing the President's Advisory Council on Combating Antibiotic Resistant Bacteria. Most recently, Doctor Gellin has been working with the Center for Infectious Diseases Research and Policy on the Vaccine Integrity Project, an initiative dedicated to safeguarding vaccine information and availability in the US. The summer, I sat down with Dr. Gellin to talk about the Vaccine Integrity Project, which IDSA and PIDS are actively engaged with. And since that initial conversation, IDSA has begun work with the Vaccine Integrity Project on influenza, RSV and Covid 19 vaccine guideline recommendations for immunocompromised patients and other high risk populations that may be extremely valuable to providers during this tumultuous time at ACIP and HHS more broadly. Bruce, thanks for joining me today. It's a real privilege to have you on.

 

Bruce Gellin: [00:01:41] Yeah, I wish I was there in person, but that's the way the world works.

 

Buddy Creech: [00:01:44] We'll try to fix that in the future. We love to start these podcasts. We've got a lot that we need to cover today because the world is a swirl right now. But we always like to start with origin stories. We always like to figure out how individuals came to do what they're doing, why they chose infectious diseases or public health or whatever they might be doing. Can you hum a few bars about why you do what you do and how you got there?

 

Bruce Gellin: [00:02:08] Yeah, I'm going to give you a chapter and then a paragraph. The chapter is when I was in training, I went to medical school at Cornell and the ID service was incredible. But in that we had a course on parasitology caught by Ben Kean. And Ben Kean was this iconic guy, which you should read about it. I don't have time to talk about him. And for three weeks all we had was parasitology. He would sit in the front of the class holding his dog, smoking a cigar, and he introduced his friends from around the world he brought in for three weeks were the iconic people from global health. We spent all this time together. Morning were lectures. Afternoons were labs. Evening, we were going out drinking with them. And so I'll bet you could probably trace a number of people in ID to at Cornell to that parasitology class.

 

Buddy Creech: [00:02:50] This is awesome. So what I hear you saying is we need more pets, more cigars, and more drinking. Boy, I don't know. That sounds like an interesting, uh, model for workforce development.

 

Bruce Gellin: [00:03:02] It's more theater. I mean, this guy was a character, but we all were part of that. I mean, there are many other pieces, too, but that was my introduction to this thing where you got to see these people who we brought in from all over the world to teach this course.

 

Buddy Creech: [00:03:15] That's incredible. And tell us a little bit about what you're doing right now. What is occupying most of your time, what's occupying most of your creative thought, and what does it look like right now for you?

 

Bruce Gellin: [00:03:27] Yeah. So I am not the role model for retirement.

 

Buddy Creech: [00:03:30] [laughs]

 

Bruce Gellin: [00:03:31] And there may be better ones and I haven't quite figured it out. I was at the Rockefeller Foundation for several years helping them with a pandemic early warning system. Then they shifted to the whole foundation, took on climate change, and each of the programs that climate change, climate and health, climate and nutrition, climate and energy and innovative financing and climate. I left a year ago and then was part of the faculty of Georgetown and their Global Health Institute. Not anything near a full time job at that time. I've been spending most of my time and then going to sort of events in Washington, because there's no shortage of talking heads doing things. Around the time of the election, I had a conversation with Mike Osterholm, wondering about what would happen to a number of things in public health, but specifically about vaccines and immunization programs. And then the question came up is, if there were issues with the way that the leadership of the Department of Health and Human Services went, if there were issues with the Department of Health and Human Services, what could non-government actors do to keep the system from becoming skewed? I'll just leave it there. And so that was the beginning of what's now called this Vaccine Integrity project. We'll talk some more about it, but that's where I'm spending most of my time for the last couple of months.

 

Buddy Creech: [00:04:41] Well, and I think this is one of the things that for IDSA, for PIDS, for pediatricians, internists, family practice, folks alike, there's a lot of confusion right now. There's a lot of chaos right now, and there's a lot of uncertainty about maybe the tactics that folks will use to erode confidence in our vaccine schedule to create barriers to being vaccinated. We could run down a lot of different rabbit holes. But talk to me a little bit about the Vaccine Integrity Project, about some of the things that you all have prioritized, and then maybe we can think about ways that we can be involved at the either the grassroots level or formal level. I mean, all of us have learned very quickly how to efficiently contact our legislators, our senators, our congresspeople. A lot of us are trying to figure out how to write certain editorials and whatever it might be, but talk to me a little bit about what you all have prioritized and then where you see us being involved.

 

Bruce Gellin: [00:05:36] So the first origin story was parasitology. The second origin story was as IDSA in the center of it. I was a medical officer at NIH hearing these incredible things about the promise of science, the promise of vaccines. And my wife was, we were pregnant with our son, who's now 27, and she would tell me about going to these things called Moms Club. This is before the internet, before social media. And you had these incredible stories. So it turns out that vaccines and vaccinations were so radioactive, they didn't want to talk about them because there were so many issues with them. And this is before Wakefield. So this was already going on. And that led me to, with IDSA support and then the financial support of the Robert Wood Johnson Foundation, start something called the National Network for Immunization Information, anchored at IDSA with PIDS. And the premise was the most important voice in medicine is your doctor. So we assembled, through that, the medical professional societies, the long list of all of them, so that they would have the same opportunities to share messaging with their membership, because it's going to differ depending on if you're an obstetrician or a pediatrician or geriatrician and like. So that was the idea behind that, of trying to take that premise of the most important voice of the doctor and ratcheted up to the medical society so they could then provide that to their membership. So I've been in this game for quite a while.

 

Buddy Creech: [00:06:59] So how do you see that differing now compared to then, in terms of the general trust that patients may have with their providers, or with trust of science in general? That's hard for me to get my head wrapped around, to be honest.

 

Bruce Gellin: [00:07:15] I think it's a challenge, and I think, frankly, it's a challenge for younger physicians, which is defined at anybody younger than you. [laughs]

 

Buddy Creech: [00:07:24] [laughs]

 

Bruce Gellin: [00:07:24] Frankly, I'm seriously I think that on the immunization front, the people in training now who were those younger physicians may have heard about these things, may have seen them in a grand rounds, but they haven't. It's not the same as every other night worrying about what kind of meningitis is this going to be, where those things have now essentially gone away. So I think because of that, there's a different visceral connection to infectious diseases and the power of vaccines, because they haven't seen these things melt away. They just see what it is now and how much childhood has changed because of vaccination. That's a general premise. I'm sure it can be challenged on that, but I think that's an issue to sort of pay attention to. And also the way the system works is now patients are negotiating with their physicians. They come in with a raft of things. They've done their research and how to have that conversation about a whole range of things, not just vaccinations. I'm not sure how many patients come to their surgeon to talk about what kind of gallbladder surgery should you take it from the list side lateral event. But in this one, people have done their research. We know they haven't done the research, they've done their search, and they find things that they have questions about. And I think that's part of this is, you know, people have questions and they need to have their questions answered. And because they have questions, they shouldn't be categorized or stigmatized because they have questions. There's a whole range there. But I think that's going to be an important piece of this thing, is if responses to questions are judgmental, you're not going to be very convincing.

 

Buddy Creech: [00:08:47] Oh, I couldn't agree more. I think this is where our strategies of maybe firing patients or removing them from our practices when there was some vaccine hesitancy. Thankfully, those recommendations have softened quite a bit over the years because we realized that when they're not in our practices, they go to care situations that are a lot more destructive or a lot, a lot less likely to in any way woo them towards the fold of those that are vaccinated. You know, it's interesting we have our first grandchild, and when I'm struck by is the onslaught of information that's available to folks. But then secondly, the social pressure that some of the young parents feel now, that certainly wasn't present when we were raising our kids. The social pressure of, oh my gosh, you vaccinated your children, really? You gave them all of those? And trying to combat that piece, which is at least new for me, that's going to require a winsome ness and a, I don't know, a re categorization of what we're actually trying to do here, but there's both a cognitive issue. There's a practical issue. There's a social issue. And only when we see all of those together can we maybe start to solve the problem, I think.

 

Bruce Gellin: [00:09:56] I think that's right. The other part of it is the social norm. And maybe we need to take a step back and reestablish what that social norm is, because the majority of people are still supportive of vaccinations as a principle. You may pick and choose among them, but I think that unless we sort of re-establish that and trying to think about how do you then shift, that is really going to be I think that's going to be part of the of the challenge going forward. If you are a parent and bringing your child to a new school, I would think you want to know what might be circulating in that school. So that kind of information might be important as well as how people make their decisions.

 

Buddy Creech: [00:10:30] One of the things I'm trying to learn a lot about is decision making at the adult level. And why do we do the things we do? And I've really been helped by Jonathan Haidt, sociologist at NYU, who talks about moral foundation theory and some of the things that drive why we make decisions, but also this notion, and I don't remember where it stems from, but the notion that we really hate to change our minds unless we have an out, unless we're faced with new information, and then we have a little bit of an excuse to justify changing our minds. Otherwise we have to come to the grips of I was wrong. I found that some conversations happening when the measles outbreak took off in Texas. The conversations that I had with some people saying, you know what? You may have made an okay decision when measles was virtually eliminated from the United States, but the calculus is different now, and you're dealing with a different equation, and that deserves a different answer, potentially. And you really need to reassess whether that's still the safe thing to do. And it was remarkable to see people go, you know, you're actually right. I think we need to go ahead and get at least one dose. And I'm like, okay, we're getting there. Slowly but surely. That requires a lot of time, a lot of relationship. And it's not a tweet. It's not a TikTok video. Not to say that those can't be useful for us, but it requires a lot of conversation. I don't know, I don't know what those venues are going to be where we can have those types of conversations with people.

 

Bruce Gellin: [00:11:53] So after a few rounds of discussion with Mike Osterholm and some of the others, we launched the Vaccine Integrity Project at the end of April, really announcing what the purpose was. And our intentions going forward is we're going to start to explore this territory. The focus, really, and the goal was really to ensure that vaccine policies are continued to be driven by the evidence and making sure that evidence is not skewed by ideology or by politics or anything else. And that's really the heart of what we're trying to do to make sure that as we go forward, that evidence is what drives immunization policy. At the end of April, we announced that we were able to launch, that we were able to get support from the Alhambra Foundation to do some of this early diagnostic work, I'll call it. And really, the first effort was really to talk to everybody who's a stakeholder in the immunization ecosystem, from the academics to the people on the front lines of public health, the medical societies, obviously including IDSA and PIDS and others, and just making sure that we get a sense from them of what they're seeing, what they're worried about. And the heart of the question was, what do you think that non-government actors could do in this space? If you're not the FDA, you can't license a drug. If you're not the ACIP, you can't vote for the vaccine for children program.

 

Bruce Gellin: [00:13:12] But there are other places where non-government actors could make a difference. And that's the question we ask people. There have been enough hand-wringing sessions that people worried about and complain about what was going on, but this is really intended to be a solutions focus. Tell us what you're worried about. Tell us what you're thinking about. And based on that, that was really what was behind what we put out that initial interim report, which is what we heard. And therefore that was really the goal of that exercise. So the question was what? The harder questions are how would you do it? Who could do it? Who would support it? But we started with what could be done. So we're grateful that we had input over this intense period of time from so many organizations, including IDSA and PIDS. Now the next part is doing them. So this is the opportunity to go from diagnosis to treatment, if you will, of how we're going to actually move to that. The main message is while this is organized by this group of CIDRAP, this doesn't mean this CIDRAP is going to own this universe. We lay this out. There are some things that that we're likely to take on. Others are going to have to do their part of it, and you'll get a sense of it when I talk about some of those highlights.

 

Bruce Gellin: [00:14:17] So, for example, let me just go through this at the high level. There were eight sort of themes that came through. One of them was increasing communication and improving information dissemination, developing and disseminating clinical tools and guidelines, maintaining the nation's vaccination infrastructure, stabilizing the vaccine safety system. Supporting state and local health departments, safeguarding insurance coverage and then anticipating things to come. For example, we've heard about an autism study, an autism and vaccine study. We're going to have to make sure that we are ready for that. We know that in the MAHA report, they talked about the immunization schedule and the suggestion that all these vaccines are contributing to chronic diseases of children. We've now seen the ACIP agenda that raises some questions about the direction of things to come. We've heard some chatter about another look at vaccine adjuvants and the role of aluminum and some of all this stuff. So I think there needs to be an early warning system, if you will, and to not wait until something comes out, but try to anticipate some of those things. So those that are at a high level. And for those who take a look at the report, I want to just highlight that while those are the overarching themes, within each of those, there are 3 or 4 things that were identified as things that one could do. That doesn't mean that those are the only things.

 

Bruce Gellin: [00:15:36] It doesn't mean that those are the things that will be done, but those came through as subthemes, if you will, of here are some things you could work on. I won't get into each of those because it's longer than we can talk about. But just to look at that. Finally, a pitch for this is that what we've done is we've, hope you'll provide this as a link, we put a I'll call it a form, if you will, that lines up with each of these themes. And I've asked people to sort of right into that and tell us either their suggestions of the things that need to happen or things that they're already doing in service of that, because there's a lot going on. There are a lot of coalitions, there are a lot of groups doing things and a number of different levels. I keep hearing about different organizations all the time, and I think that it'd be good to sort of develop that kind of a landscape. And this is this is our hope is that by people contributing into that, we'll have a better sense of where there's synergies, where there are gaps, and maybe where there's some duplications as a way to sort of outline how to begin to move forward. Again, not that we're going to run it all, but just so everyone has that information.

 

Buddy Creech: [00:16:33] Well, and it provides a framework, right? It provides a framework that we can then at least start to assemble around, because I think that's been one of the challenges up until this point in the I mean, I don't want to keep using militaristic phraseology for it, because I don't know that that's always fair, but it certainly does feel like there's an attack on our vaccine infrastructure in the US. And whether that's an attack at the recommendation levels, the licensing and authorization levels, maybe even at the payer level, there seems to be a coordinated effort to undermine confidence and our ability to deliver what we know to be safe and effective vaccines for children and adults, and having a framework where we can start to divvy up and say, okay, you take this, we'll take this. That's really helpful. I think, for our societies and for individual providers, you know, now we have this framework. There's a lot of us wanting to do something. This feels like a chance where we can start to divide and conquer based on our areas of expertise where we might have a voice in these areas. Maybe you could speak to that and how we prioritize certain aspects over others, or which ones seem most urgent right now.

 

Bruce Gellin: [00:17:49] So when I ran the National Vaccine Program office, the tagline was people like coordination, but they don't like to be coordinated.

 

Buddy Creech: [00:17:58] [laughs]

 

Bruce Gellin: [00:17:58] But this is really about that kind of coordination. And it's not that anybody who's going to own this, but this is a chance to sort of see that it's not going to be self-assembling. So we're going to have to keep that in mind. But there are a lot of players out there who have things to add. Clearly, the group that you're speaking to is going to be a large part of that. This morning I talked to the American Pharmacists Association, the insurers. There's a whole range of people who need to see how they fit into this movie. I think that's really trying to put that together in a way that is efficient and nimble is going to be really the challenge to go forward. And again, it's not that the Vaccine Integrity Project is going to own all those things. I think for some of these we'll play the role of secretariat, of assembling some for certain things. But I think it's really up for all to take a look at this. You know, the fact that the IDSA has signed on to the part of this is indication of what you just said, that there's obviously a need to be able to try to use your skills and expertise and experience towards this end.

 

Buddy Creech: [00:18:53] There are a lot of us in our societies right now, we're getting a lot of emails and we're trading a lot of emails of what can we do? Can we do it more strongly? What are the places that we need to really start being creative? And I guess one question for you, you've been doing this for a while, you've seen different iterations of eroding confidence or of challenging administrations or whatever might be the external force, what are the things that if we're trying to be creative right now, I don't know how specific we want to get, but do we need to be thinking about what it looks like to have an ACIP equivalent that's based outside of the CDC? That can provide some clarity to providers or payers? Do we need to continue to beat the drums with our legislators of this is not the way to do things. This is a better way. I'm putting you on the spot a little bit to say, where do you think we're going to get the most bang for our buck?

 

Bruce Gellin: [00:19:48] I think I would start with the end. I was trying to improve health. All that process stuff is a problem, but complaining about processes is only going to go so far. But I think if you go to why you took the career that you did, what you're trying to do, and trying to make sure that with the patient in mind, you're going to provide the best for health and wellness and prevention of infectious diseases. I would start there and then work back to how you're going to make sure that complaining about the ACIP membership. There are plenty of that going on. And you'll want to do a share that I guess. But I think it's particularly for the clinicians out there to say that this is what we're about. This is why we're doing it. And we want to make sure that if people are going to make decisions, they have it on the best information in the same way we get information about these things. So I think something along those lines. My other point is, and I don't know what the IDSA state structure is, but I think to me, local matters a lot, says somebody who lives in Washington inside the Beltway. But I think it really matters. You know, people who are speaking from the hospital where you take your kids, people see from somebody whose sister is on a baseball team, you know, these are people that are known people in the community, and that means much more than somebody in a suit or somebody in a surgeon general outfit or something else. So I think that the degree to which you're helping people do that at the on the ground, in the front lines and to be available and as I said, part of this is I know there's a lot of this is how to help people have a conversation that's constructive and not polarizing in the way that you want to sort of not set people off, because what's the joke that when you're traveling and people don't understand? You just talk louder? But it's not going to work. So I think that's part of this as well.

 

Buddy Creech: [00:21:23] I can't say it better than that. I do want to underline that, because I think that's our tendency sometimes is that when we're faced with something that seems crazy or completely off the rails, we want to answer it with something that is equally as aggressive or definitive or demonstrative. And sometimes that's the right thing to do, and I don't want to discount that. But that's a card that has to be played very strategically. And I really appreciate one of the ways that I've gotten the most purchase in vaccine hesitancy conversations over the last two years is when I've had a little bit of a willingness to enter into the conversation with humility about how we handled the pandemic, and the pandemic is such a surrogate for so many people, and it was so polarizing in terms of what we did or did not do, the ability to go into someone being concerned about MMR vaccine or pertussis vaccine, to be able to answer their questions about the pandemic and say, yeah, we did some things that I bet we'd do differently next time. It sort of signals that we're thinking about these things. We're always trying to make them better. I guess I'm just trying to figure out how we can best restore public trust in what we do, why we do it, and the science that we rely on. Because it feels right now like that's a completely uphill battle. So if you have some words of encouragement, especially for our younger folks who are having these conversations all the time.

 

Bruce Gellin: [00:22:49] You know, I think that the biggest mistake of the beginning of the pandemic was something that didn't happen. That happened essentially in every outbreak at CDC is here's what we know, here's what we don't know, here's what we're working on, and here's what we think you should do now. But as we learn new things, that's less likely to change. Stay tuned. I think that's one. And you know, you can't rewind the clock for that one. But I think that was I think the fundamental issue. I think the other part is this idea that science is truth. Science is a process. When I was a kid, my mother used to say, I hate to give up chocolate and have them find that it's been good for you all along. But there is this whole process, and we know that there are changes and changes to recommendations that seem logical until they didn't because of new science. That's another recognition that we need to better communicate what science is. And this is continuous process of trying to figure out what's best. And it will change based on new information. So I think those are among the pieces. And the other part, and it's not as true day to day, but during the pandemic, the tsunami of science was overwhelming. And so I think it was just hard to keep track of all this stuff. And when you get some things that conflict with another, you know, it'll sort itself out over time. But in real time, people think the experts are idiots. They have no idea. So I'm just going to do what I want.

 

Buddy Creech: [00:24:06] That can be unsettling. And when we're already polarized on any number of issues, it's easy to become polarized on a few more. Maybe I'll ask us to maybe end with this. I want to ask how you would encourage local engagement for those of us in practice, or those of us doing research, or have any number of of jobs within the sphere? What are some of the low hanging fruit that you'd encourage? And then, do you have any words for those students and trainees and young folks who they finally made it to a finish line, or they're about to be at the finish line and they're like, oh my gosh, what have I gotten myself into? You know, you've been around the block a little bit. You've seen things ebb and flow. Can you speak to what we can be doing? And then a word of encouragement to our younger folks?

 

Bruce Gellin: [00:24:49] I'll start with a ladder. I mean, I'm sure every specialty has its issues. This one happens to be in the crosshairs right now. But this is the world. This is the world of information. And patients are going to come in with all kinds of stuff that you're going to need to have to respond to with the goal of trying to have them have the best outcomes. And there are a number of different approaches to this, but I think that, you know, maybe that's where people have the patient conversation training just to make sure that they have something that people are going to listen to and aren't going to be turned off from the beginning. Remember, what was the first one?

 

Buddy Creech: [00:25:20] Local engagement. What's that low hanging fruit for most of us that we can make sure that we're engaged in right now.

 

Bruce Gellin: [00:25:26] It's sort of the opposite, that is. But don't shy away from it because it's too hard. I think this one, and it's not easy to figure out what those opportunities are. This is a challenge, and I think that this is where people need to step up to that challenge. Now it's going to be uncomfortable, but to step up in whatever ways it may be, it may be when you hear somebody telling you a story at a baseball game, you say, well, let me try to talk about that. It's one not to let these things go away, but to have as constructive a conversation as you can. And to me, the question is how do people come to what they believe? And so that's where I think the conversation is really not or didn't you know, x, Y and Z. But how did you get to that. Where did you toe that? And then the question is what information from what source might help you look at this in a different way? It may not get you anywhere, but I think it's an openness to that conversation and try to help them because, as you said, it's difficult to change your mind. We blame the algorithms for doing that. There's clearly blame in there, but it's also a part of the way we think.

 

Buddy Creech: [00:26:24] Yeah, but if we model curiosity and if we model those types of open questions to try to figure out how folks got from point A to point B, and then I think an encouragement to all of us in a day of fractured conversations where we often retreat into our own tribes, the ability to have conversations with folks that we know disagree with us, and to be able to maintain that stability and actually try to learn from each other, there can be really something powerful about that. Well, this is a chance where I want to make sure our members know that if there are ways that you want to be involved, if there are ways you think your particular skill set or access could influence some of these conversations, please reach out to IDSA and to PIDS and and let us help navigate all of that in order to put you in the right places, connect people that may have similar interests. And I think that goes a long way for us to have a response. Bruce, I think you're the very model for retirement. I mean, like, you know, we don't need to be picking up doing seashells on the seashore here. You're not limiting to it at all. Between you and Kathy Edwards as my models for what retirement looks like, I guess I get to go from like 80 hours a week to 75. Maybe that's what retiring looks like? It's pretty ridiculous, but it's also pretty inspiring. So thanks for the work that you're doing.

 

Bruce Gellin: [00:27:38] I got a lot of complaints. My family said, this is it. This is what you're doing.

 

Buddy Creech: [00:27:41] I have a feeling my family's going to be just fine with me continuing to work, because then I won't be in there hair as much. That's really helpful, Bruce. Thank you for that, Bruce. I mean, I'll put you on the spot. How do you think we can increase trust and improve trust in science and in what we offer as providers?

 

Bruce Gellin: [00:28:01] This issue of trust is bigger than just vaccines. There's a lot of people thinking about it. And there are a couple of things to think about is, you know, Francis Collins has a new book called The Road to Wisdom. It's called The Road to Wisdom: Untruth Science, Faith and Trust. In it is a acknowledgement of a group called Braver Angels. I didn't know about them, but Braver Angels is really trying to improve sort of dialogues. By understanding others, you can build trust when listening to and understanding other opinions. In addition, you can get a fuller view of complex issues. That's their tagline, but it's worth knowing that that's a broader issue than just this one. Another thing that would be worth these people listening to, because it's really quite different. There's a podcast that I've become aware of by a woman named Brinda Akari called Why Should I Trust You? They're long. They're an hour and a half. And she brings in disparate voices. She's a former journalist and pushes people in different directions. It's a way to passively hear these kind of conversations, so you can see how she's trying to bring in different viewpoints. And then finally, and I say this without having to listen to it. Katelyn Jetelina's, Your Local Epidemiologist, has a piece called, "what do you tell people when they tell you they've done their own research?" So I think that clinicians, people on the front lines are challenged all the time by people who say they've done their own research. I think it'd be worth taking a look at Katelyn Jetelina's post on Your Local Epidemiologist, and have her advice to how to take on a question like that.

 

Buddy Creech: [00:29:29] Thank you for doing this. The biggest thing I wanted to capture with this is people know about the Vaccine Integrity Project. People know that we're doing things, but that we need arms and legs to do it.

 

Bruce Gellin: [00:29:39] It's a role for somebody at IDSA to type into that form. But I think you should put that out there to others. Listen, if you have something. Take a look at these. And if you have suggestions or a way that you can see of what you or your group or whatever it is can fit in. They want to hear about it because there's a lot going on and we're trying to get the best, you know, collaborations across the board as possible.

 

Buddy Creech: [00:30:00] Keep fighting the good fight. We'll see what happens next week.

 

Bruce Gellin: [00:30:03] It's hard to know. I mean, they've got people who don't know anything and they've got to try to make some decisions.