“This is Important, and I’d Like to Tell You Why:” Med Students & Advocacy

uvmmedicine blogger Brian Till '17
uvmmedicine blogger Brian Till ’17

In June, the Vermont state legislature passed a bill disallowing philosophical exemptions to childhood immunizations. The law was the first of its kind in the U.S., and has since been followed by a similar law in California. During the debate leading up to the vote, more than 100 students from the University of Vermont College of Medicine signed onto an opinion piece, published by Vermont Digger, advocating for a repeal of the exemption. Students and faculty also called legislators to discuss the issue and attended the final vote in Montpelier. Brian Till ’17, who organized the letter writing, answers some questions about how he became involved in the issue, and what he and his peers learned through their lobbying efforts.

How did the idea for the letter come about?

Nobody really expected the vaccine issue to be raised during this legislative session. A similar measure was raised in 2012, and managed to make it through the Senate before failing in the House. So there were a number of people, the governor included I think, who weren’t eager to reopen the issue. But several senators managed to attach an amendment removing the philosophical exemption to an otherwise uncontroversial health bill. The Senate took a single afternoon of testimony, passed it, and kicked it onto the House. It was kind of just classic parliamentary maneuvering. At the beginning of the term I was on a family medicine rotation at Stowe Family Practice, and conversations with physicians there got me thinking about the issue. That, combined with some initial encouragement from my classmate, Joe Miller ’17, spurred the letter campaign on.

It was signed by over 100 medical students – how did you rally support? What was the discussion like – any questions or debate?

As we were considering a piece, we thought that if we could get 30 people to sign on, that would be a large enough block of names at the end of the piece to grab people’s attention.  We asked our associate dean for students, Dr. Christa Zehle, if she’d be willing to review the piece and send it out to the student body at large if we could write something in time. She had been really supportive of our advocacy on the issue from the start.

Earlier in the week, I had started trying to lobby the healthcare committee members in the House who were on the fence about supporting the measure. I found primary care doctors from their respective districts and encouraged them to get on the phone with their reps – actually calling them to answer any questions the representatives might have. Dean Zehle is a pediatrician who lives in Burlington, and when we asked if she’d be willing to lobby representatives in her district, she graciously agreed. It’s easy to disregard an email or even a voicemail, but when someone – particularly a doctor – is there on the phone, saying: “This is important, and I’d like to tell you why,” it can be quite powerful.

There wasn’t time for much of a discussion or debate, unfortunately. The whole thing came together over a weekend.  Dr. Raszka, who practices pediatric infectious disease and runs Attacks & Defenses in the Foundations curriculum, was kind enough to give us edits, as did Dr. Carney, who is a former commissioner of health herself and runs the Public Health Projects course in Foundations.  She is a terrific advocate, and was extensively involved in lobbying on the issue behind the scenes.

What did you learn through organizing this effort?

Early in the week, I was amazed to learn how eager my classmates were to engage with the issue. Sarah Manning ‘17, Alissa Correll ‘17, Hillary Anderson ’17, Joe, and a number of others I know put in calls to reps and spent time discussing immunology and herd immunity with them. I think seeing their enthusiasm inspired me to try to churn out a piece.

After the email went out to the student body, the first reply came from Dean Zehle signing on to the piece. A few moments later the inbox swelled. Zoe Agoos ‘15, a fourth year who used to work for Paul Farmer and also worked in publishing, gave some incredibly strong edits with her reply, as did Becca Martin ’15 and several others. We got to about 135 names if memory serves. The email went out at about 3:30 p.m. on Sunday and we needed to have all the names in by 10:00 a.m. Monday morning. Given the constraints, it’s hard to have asked for a better response.

I was also impressed by the conversation within the first year class about the piece. Maggie Graham, a student who also has three children, wrote a really thoughtful Facebook post explaining why she wouldn’t be signing. Maggie’s argument is an important one. She contends that our vaccination rates are a reflection of us, as a medical community, failing to effectively communicate with the public, and that by mandating vaccines we could alienate parents. The natural answer to that problem is engaging more effectively with our patients, as opposed to legislating the problem away. She’s undoubtedly right. At this point, though, we’re faced with the very real threat of vaccine preventable illnesses gaining a foothold in our community, with potentially serious consequences.

So while I completely agree with Maggie, and while there is very interesting research happening around the issue of how we better engage with those hesitant or unwilling to vaccinate their children, our capacity to improve communication quickly is limited. However, any sort of long-term solution will have to come from Maggie’s line of argument.

Where were you for the actual vote?  

The night before the vote, the house Healthcare committee held a public hearing. A number of students from the medical school and pediatric residents drove down to Montpelier for the event, as did a large number of physicians. It was a tremendously powerful evening. This is a strange political issue in that, at this point, because vaccines have been so successful, the risks of not vaccinating are largely intangible to those outside of the medical community. And in the end, the physicians who spoke carried the day. Their stories about the fundamental changes that they’ve seen in their careers because of vaccines were very moving. They spoke about seeing the elimination of morbid and preventable illnesses with their own eyes.

The day of the vote I was in an orientation for pediatrics. There was an amendment, known as the Donahue amendment, which would have effectively neutered the bill. It failed by only two votes. And at least one of those who voted in favor was on Twitter while the vote was occurring. It was a very surreal moment to be engaging with this legislator via social media from the back of the lecture hall, making sure he had seen our piece and answering lingering questions.

In general, why do you feel it’s important for medical students to be involved in public health policy issues?

I think there’s a very real phenomenon by which physicians – who spend almost all their waking hours caring for other people – get to the end of their days and the end of their weeks and have very little left. They recognize the shortcomings in health policy. And they recognize the massive implications of those failings for their patients’ health. But many of them just don’t have the time and space to engage with the political bureaucracy. There are number of physicians here who are excellent role models in terms of advocacy, Dr. Lewis First, Dr. Raszka, Dr. Carney, and Dr. Zehle among them.

But broadly speaking, right now there aren’t enough people fighting for the kinds of measures that are going to significantly impact our nation’s health in the long term, both at the national level and at very local levels. And there’s nothing to say that these advocates need to be physicians. But I believe there’s a recognition amongst my classmates that doctors have a unique role in society, and they’re eager to leverage their understanding of health and healthcare to try to impact our communities in a positive way. Here in Vermont, we will be contending with healthcare reform, medical marijuana, the opioid epidemic and many other issues worthy of our collective attention in the legislative sessions ahead.

My generation has already started to move into practicing medicine and it’s fairly clear that they have very different attitudes than their predecessors in terms of how much they’re willing to fight to reclaim some of their time for themselves and their families. And I just hope that, as more of us enter the workforce, we manage to carve out space to play a role acting as advocates, too.

What are your thoughts about this topic?