Association between Immunization Status and Alzheimer's Disease

Alzheimer's Disease is a progressive terminal disease. Many treatments are focused on lifestyle modification to delay diagnosis and onset. Join host, Geoff Wall, with guest Jake Galdo, as they look at a new study evaluating the association between vaccines and the development of Alzheimer's Disease.
 
The GameChanger
Postviral inflammation may play a role in the development of Alzheimer's Disease. A recent claims-based study found an association between immunization status and the development of Alzheimer's Disease.
 
Host
Geoff Wall, PharmD, BCPS, FCCP, BCGP
Professor of Pharmacy Practice, Drake University
Internal Medicine/Critical Care, UnityPoint Health

Jake Galdo, PharmD, MBA, BCPS, BCGP
Course Content and Developer, CEimpact
Managing Network Facilitator, CPESN Health Equity
CEO, Seguridad
 
Reference
Harris K, Ling Y, Bukhbinder AS, et al. The Impact of Routine Vaccinations on Alzheimer's Disease Risk in Persons 65 Years and Older: A Claims-Based Cohort Study using Propensity Score Matching. J Alzheimers Dis. 2023;95(2):703-718. doi: 10.3233/JAD-221231. PMID: 37574727; PMCID: PMC10578243.
 
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CPE Information
 
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Discuss the potential mechanisms of inflammation and viral infections with the development of Alzheimer's Disease.
2. Describe the study discussed and its application in guiding patients to receive vaccines.

0.05 CEU/0.5 Hr
UAN: 0107-0000-23-367-H01-P
Initial release date: 12/11/2023
Expiration date: 12/11/2024
Additional CPE details can be found here.

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Transcript

Speaker 1: 0:08

Welcome to the Game Changers podcast, where we have clinical conversations that impact your pharmacy practice. Let's listen in as our team discusses this week's clinical practice game changer.

Speaker 2: 0:18

Hello and welcome to Game Changers clinical conversations. I'm your host, jeff Wall, professor of pharmacy practice at Drake University. Welcome to our podcast. It's been a while since we've had Jake Galdawan. I appreciate he's, as I often say, my co-pilot with the pod and there is absolutely no way this pod would exist, or a lot of other issues, programs that CE Impact does, without Jake's involvement. So, jake, welcome to the program.

Speaker 3: 0:45

Thanks, jeff. I know it's been a while. We've talked a lot, but we haven't been able to talk to everybody else, so it's exciting to talk to you, to everyone about this topic.

Speaker 2: 0:53

I appreciate that. And today we are going to be talking about a fascinating study that looks at the receipt of vaccines and the subsequent development of Alzheimer's disease. That's right, I said vaccines and Alzheimer's disease. Now we're going to preface this right out of the gate that this study was not a randomized control study that we're going to be talking about. I would love to see a randomized study looking at this, but given the length of time involved and the many issues involved, I'm not sure that's ever going to happen. But this may be the best study we ever get on this issue.

Speaker 2: 1:27

About the relationship again between vaccines and they talked about several vaccines which we're going to get into a second in development of Alzheimer's disease, and you may say to yourself that doesn't make any sense. Why would vaccines have any role in the development of Alzheimer's disease? Well, even though we still, even though we have a couple drugs out now to treat Alzheimer's disease nominally, we really don't fully understand all the etiologies associated with Alzheimer's disease. Yes, we know about towel proteins. Yes, we know about amyloid and plaque development, but what causes that to happen in some patients versus not Now? Yes, there's some genetic markers.

Speaker 2: 2:04

There's some other things, some environmental markers, but one leading hypothesis is that inflammation due to infection, particularly viral infections, may increase the risk of Alzheimer's, and of course, the reason for that is that especially viral infections cause neuro-inflammations, and they don't just cause inflammation of tissues or lungs or your sinuses or wherever the infection was. Many viral infections, as you might imagine particularly herpes zoster, but also some other ones as well do cause neuro-inflammation, and the hypothesis is that this inflammation can basically cause a degeneration of the neurons, which can lead to subsequent dementia. So then the theory, of course, is that if you don't get those infections, that it may decrease the neuro-inflammation involved and decrease the development of Alzheimer's disease or even just other types of dementia. So again, no one, I suspect, is suggesting that okay, you better get your herpes zoster vaccination because you don't want to get Alzheimer's disease, and I think the current thought is that there are many things patients can do that aren't direct treatments for Alzheimer's that may prevent the development of dementia down the line.

Speaker 2: 3:28

For example, there's now at least a couple of studies similar to this, large retrospective studies that suggest that staying physically active, keeping your brain involved with things like puzzles or games, can also decrease the risk of, is associated with a decreased risk of Alzheimer's disease. So, basically, what I would say after walking away from the study is this is just one more reason for patients to get their vaccines, and in a world where I just noticed, yesterday or the day before, that CDC has just reported that we now have an all-time high of patients who are declining vaccines, particularly kids, which makes me so angry I want to jump out of a window.

Speaker 2: 4:06

I think any information we can give the patients to promote vaccine uses to the good and if we can say look, there's at least some evidence suggesting this might be the case. Maybe that's what convinces a patient to get their Zoster vaccine, compared to one who would not. So the hypothesis of this study says that vaccines basically might be associated with the decreased development of Alzheimer's disease, primarily because of neuroinflammation. This isn't the first study on this. There's been some previous smaller studies that have suggested that there may be something going on here. But the problem with those studies is that they only looked at a single vaccine and of course most patients don't just get a single vaccine. I mean, they're going to get additive vaccines on top of each other. So it isn't like someone gets their Tdap vaccine but they don't get their Zoster vaccine, or maybe they do, or they don't get the reverse, et cetera, et cetera.

Speaker 2: 5:02

So that's one of the big gaps in the literature is that we really don't know the possible cumulative effect of these. And we don't know because each of these retrospective studies have just studied one vaccine. They also don't know, they never had the size or the scope to really kind of measure, over a long period of time, the development of dementia, especially when looking at the numerous and they talk about this in the study quite a bit the numerous confounders that are associated with a study like this. And so, because previous studies were smaller, because they only looked at one vaccine or they had a very small time window, they felt like a bigger study was needed, and so the purposes of this study were to, you know, again, evaluate the relationship between exposure to the Zoster vaccine and the other interesting piece about this study is they looked at both Zoster vaccines because the study would have a long enough look back period.

Speaker 2: 5:56

They were able to look at Zoster vaccine as well as Shingrix. So I think that was kind of interesting, and so they wanted to take a look at those as well as other vaccines. Particularly they targeted pneumococcal vaccine and Tdap, and then they also wanted to look at if it varies by type of infection. And again they wanted to look particularly at the pneumococcal vaccines, because we have a couple of those, as well as Shingrix versus Zoster vaccine, which I thought was kind of interesting as well. This was a database study because, again, that's the only way you're probably really going to be able to have the numbers to do this kind of study.

Speaker 2: 6:32

They used the very commonly used Optum Clemphomatix database. This is a gigantic database that takes information from all these different sources in the United States. They look at insurance plans, administrative claim plans, laboratory panels. They look at information from clinics that's been de-identified medications patients are on. It's just in a system that does not have a socialized healthcare. The Clemphomatix database is probably the best database you're going to get to take a look at the whole picture of health and medicine in patients in the United States. It's just kind of the way it is. It includes patients who have both medical and prescription drug coverage through private insurance or Medicare or Part D Medicare. They also it has mortality information. It also includes the Social Security Administration master file looking at deaths. All that data is incorporated in the Clemphomatix database. It's pretty pricey. I've looked in the past about trying to get information from it and it's pretty pricey, but again it's probably the best thing out there.

Speaker 2: 7:48

In this study they did a look back, look forward design, so they basically looked from the years 2009 to 2019. Largely there were some other sub-analysis that they did and they started at one period of time where they went backwards and that was called the look back period and then they had a follow up period where they looked forwards to see what was going on. They included patients who were at least 65 years old at the start of the follow up period, so they could be younger and 65 in the look back period. They were included if they had at least one record in the look back period and at least two records in the follow up period. The patients had to have in the follow up period a information on what vaccines they received and then ICD-10 markers or other markers for dementia. That being said, if they had already previously had a history solve in that when they did the look back period, if they had a history of dementia in their diagnosis or they were prescribed any medication that's used almost exclusively for Alzheimer's disease, like nephysil or memantine, those patients were excluded from the cohort.

Speaker 2: 8:55

They also, when they looked back they from the look back period, they wanted to take a look at vaccine administration. It was counted if they received on or after the index date. So on the first days of follow up period and before the following of either the first notation of diagnosis Alzheimer's disease death or they went past the eight year follow up period and again they looked at the receipt of three different vaccines the Tdap vaccine, both types of Zoster vaccines and both types at the period at the time this study was done of pneumococcal vaccines. To find out if the patients actually got them, they queried their database for both brand names and generic names for all these different types and again there's several different name, brands and manufacturers involved with things like the Tdap vaccine, for example. They did exclude patients and patients who were vaccines were not indicated, so they did try to match an indication for the vaccine. So, for example, if somebody was under age 50 and received the Zoster vaccine, that isn't an FDA approved indication and so, unless the patient, they would probably for all intesperous with that men, as they were excluding patients who are largely immunosuppressed or had some other issue where they would need to get a vaccine early. Basically, as I mentioned, they did look at Zoster vaccine chingricks as well as the PCV13 and PPS of the 23. Again, they did not look at the new PCV20 because that wasn't how it actually when this time period was looked at, from 2009 to 2019. They looked at diagnosis of Alzheimer's disease. They'd have at least two records in the diagnosis, at least two different records saying yes, this patient had Alzheimer's disease, or one a diagnosis marker, as well as one prescription for a drug for diabetes.

Speaker 2: 10:53

With this kind of study you're gonna have to do covariate or propensity match scoring to try and accommodate all the dozens, if not hundreds, of confounders that may affect the outcomes.

Speaker 2: 11:06

For example, you could argue that patients who are vaccinated can have, just overall, better health.

Speaker 2: 11:11

They probably have more contact with the healthcare system, they probably are in a higher socioeconomic group, all of which could affect the development of dementia, and that's just the tip of the iceberg.

Speaker 2: 11:23

Smoking and level of education, and alcoholism, drug abuse I mean, you could go on and on and on and on. And so they actually had this gigantic chart in the study where they listed numerous confounders that they did, and what they tried to do is include these confounders, including demographics, comorbidity, medication use, number of health encounters, number of well-visit examinations, and basically tried to match patients with covariance to do that. And they did that with propensity score matching and so basically assigning a score with matching for these various covariance from one patient to another. So our kind of you know, in most of these studies you're going to have to do either you know a logistic regression or you're going to have to do, you know, covariate matching or propensity squaring matching. These guys did multiple of these, I think, because they realized that they were going to have to to try and minimize the, you know, the dozens, if not, like I said, maybe even hundreds of confounders that could possibly affect, looking at the relationship of a vaccine receipt. And they don't know of Alzheimer's disease.

Speaker 2: 12:30

They also did multiple different subanalyses, you know, trying to compare different, different covariates. But in particular they did multiple subanalyses trying to match the different types of vaccines. So in the results they basically talk about, you know, okay, we're going to take a look at if somebody got, for example, tdap and Shingrix versus someone who got Tdap versus Zostavax. We're going to take a look at someone who didn't get pneumococcal vaccine, pcb 13, versus someone who got Shingrix, and I mean all the different combinations. They wanted to kind of take a look at that and so you know they tried to bring that all together and they in the end they looked at four or four or five subanalyses trying to compare some of these different combinations. Because again that's one of the things I wanted to look in the study was, you know, if you get some vaccines but not all vaccines, what role does that play, as well as the overall association of Alzheimer's disease with individual vaccines. And that was kind of interesting, I thought as well, in particular when they were trying to compare the different pneumococcal and different Zoster vaccines. And again they did, you know they tried to look at every permutation and combination of the different types of patients would get. You know that they get one, the PCB 13, but they didn't get the Zoster. But they got the Zoster but they didn't get those PCB 12, and just on and on and on and on, and you know it was certainly complete.

Speaker 2: 13:58

I will definitely give these guys that that this was. I think they did everything they possibly could in the study to account for covariance and did everything they possibly could in the study to take a look at the relationship between individual and separate vaccinations and the risk of Alzheimer's disease. Again, look back period was 2009 2011. Look forward period was 2011 and 2019. For all the analysis, they computed relative risk, absolute risk reduction and, interestingly, they automatically calculated number needed to treat If the patient, if there was a statistically significant difference in patients who had recede of of a vaccine and didn't, and the subsequent development of Alzheimer's disease, and they find one total they looked at after applying inclusion, exclusion criteria.

Speaker 2: 14:49

They looked at almost 1.7 million patient charts. So that's pretty impressive but again not surprising in these large database studies. They did all that and they broke everything down. They found that there was a total 122,000 patients to receive vaccines against a tetanus and diphtheria, with or without pertussis, during the follow up period, 212 patient, 1000 patients to receive vaccinations against herpes zoster and, interestingly, 286,000 patients received vaccines against pneumococcus. And I wouldn't have guessed that. I wouldn't have guessed that T DAP was less than than pneumococcus and you know, I probably wouldn't have guessed either that that zoster was less than pneumococcus. And again, I'll be interested to hear, and I think, jake's thoughts on this, and he does a lot of this in an outpatient basis.

Speaker 2: 15:38

Baseline characteristics are pretty much what you'd expect to see. Average age was about 72 years old. There was a slight majority of females again not necessarily surprising during this. The vast majority of patients, 76% of patients, were white and different races made up kind of the difference. Geographically was was relatively similar. However, it was worth noting that the majority of these patients came from either the West so West of Mississippi or the South, so that those two cohorts combined was about 70% of the groups. And we also looked at at number of comorbidities and most these patients, again since we're over 65, had had had comorbidities associated with them, the big ones, and they were all pretty similar between, at least numerically, where things like hyperlipidemia about 70% of patients that hyperlipidemia a certain percent of patients that had hypertension, about 23% of patients had a scheming heart disease. They note that only about 8% of patients had obesity. Kind of have a hard time believing that. And again, just certainly what I've seen is way more than 8% of the patients that I've seen have obesity were over 65 in my hospital. So I thought that was kind of interesting. About 23% of patients across the board had type two diabetes and then relatively small groups of patients had had alcohol or substance use disorders about 10% patients smoked.

Speaker 2: 17:06

And then they did do a good job in looking into covariance and some medications that may increase the risk of dementia, in particular anacholinergic drugs, and again, about 4% to 5% of patients who are on anacholinergic drugs and that's, you know, steroids and other things they looked at as well. So I think again they did a pretty good job given what they had to, kind of you know, compare these, patch them up as close as they could with all the various compounders that we looked at. So then, when we kind of break down to kind of the results, they looked at the estimation for vaccine and the development of Alzheimer's and that eight period, eight year follow up period, and they basically found again because like you know I can certainly read off the you know the 70 or so how comes they had what they basically found was that on the whole almost any receipt of almost any combination of vaccine you could you could think of, so you know, you know some combination of Tdap versus herpes zoster, versus pneumococcal vaccines had a decreased risk of developing Alzheimer's down the road. And you know they looked at again the various combinations. Almost all have had at least some decrease. But when it, when it, when they finally came down to things and they broke things up by individual vaccines, they found number needed to treat. So patients who received either Tdap, herpes zoster or pneumococcal vaccines on the whole had somewhere between a number needed to treat to prevent one case of Alzheimer's disease of somewhere between 15 and 50.

Speaker 2: 18:37

And in fact the only exception to that is interestingly, was patients who received Zostevax without shingrix, which I think is kind of interesting, where they the the effect size, which was much smaller, and they found a number needed to treat of 120.

Speaker 2: 18:51

Whereas shingrix had a number needed to treat of 26. So kind of interesting, I think. Now, of course, we don't really use Zostevax anymore, but I think that that does point to some interesting. You know potential reasons why this may be going on, but bottom line is, yeah, I mean, you know, when we take a look at individual receipt of vaccines compared to unvaccinated, number needed to treat was somewhere in the in the 15 to 50 range for all the different combinations and even one vaccine, someone who may not have even completed all the vaccine series may have shown a decreased risk of developing Alzheimer's. So again, you know pretty, pretty interesting information and, again, solid effect size. These are patients you know who have, you know, very low number needed to treat, which, you know, again, considering the outcome is the development of Alzheimer's, dementia, I think, pretty significant. Those numbers are far, far better than any of the medications that we currently have for treating.

Speaker 2: 19:49

Alzheimer's. Even some of the big, you know super duper new monoclonal antibodies don't have that, don't, aren't anywhere close to that. Now again, I'm not suggesting that there's causation, I'm not suggesting that, getting you know, we should receive vaccines solely to prevent Alzheimer's disease. But it certainly seems to be a nice bonus that that there's certainly a negative relationship associated there.

Speaker 2: 20:11

So the authors talk about this, and in some depth, and you know they I think they may have even been surprised about the benefit that they found there, and note that you know, overall, it was somewhere between, you know, a decrease risk or a relative risk decrease of somewhere between 20 and 30% of the various and in different vaccines, with actually the highest being Tdap, interestingly, and the lowest being her disaster, which again kind of may go a little bit against about one of their hypotheses about why this might be. The bottom line was that there was a reduced risk and a preventative effect across the board and patients with dementia.

Speaker 2: 20:47

Now, they know that there is going to be limitations. Again, you know they used one database. It was a good database but it wouldn't capture everybody and certainly you know there might be selection bias there or misclassification bias. They're looking at charts. That's always an issue with everything charted correctly etc. Etc. So I mean that those are all things we have to kind of deal with as well. But you know, bottom line was, was was that the study you know and it's probably one of the best studies will be done on this issue did find a very positive relationship between receda vaccines, particularly Tdap, zoster vaccines and macaquil vaccines, and a decreased risk of Alzheimer's disease.

Speaker 1: 21:25

So what does?

Speaker 2: 21:26

that mean, and again, you know we're not, we're not giving vaccines just to prevent Alzheimer's disease. How can we use this information in the community. Jake Aldo is going to give me a hand on interpreting that right after this message from CE Impact.

Speaker 1: 21:39

Are you a pharmacist by design? Since we hold a vital position on the healthcare team, it is our responsibility to advance our knowledge and skills so we can provide the best possible care to our patients. Being a pharmacist by design means striving to be the best version of ourselves, not just as professionals, but as individuals dedicated to improving patient outcomes. Learn more about pharmacists by design at ceimpactcom. Join us and begin your journey to being the best version of your pharmacist self.

Speaker 2: 22:08

All right. So we're back talking about this very interesting study looking at receda vaccines and a lot of Alzheimer's. I hope it's kind of, you know, make this practical. Again. I'd like to welcome back Jake Aldo from CE Impact. So, jake, you're a community pharmacist, you know, and you work with primary care physicians all the time and other pharmacists. What do we do with this information?

Speaker 3: 22:29

Well, I think you know, let's kind of pause on the whole aspect of vaccine and Alzheimer's. Just think about Alzheimer's in a nutshell With Alzheimer's in related dementia. We don't have a cure. It's a terminal disease, it's a progressive disease and the best thing that we can do with all the data that is available, is prevent. And we prevent by managing risk factors, blood pressure, blood glucose, all those good things. But we also do it by having a healthy diet, by exercising, by doing mind games and this, to me, is another one that gets added to that list being up to date on our vaccines. Again, it's not let me give you your flu shot and you're going to not have Alzheimer's. But when we look at the magnitude of some of these effects, it's like, oh my God, why would you not do that? That's just as good as a drug sometimes.

Speaker 3: 23:15

And to your point much better than the $100,000 monoclonal antibodies that are out there, which, again, don't treat, they delay the progression. This is preventing. This is, you know it's a big deal. So I think you know, undercutting that, supporting that, can we just need to think through that? And I don't. I was listening to you. I don't recall if you said that, but just in case I think it's always good to repeat it. This is a follow-up study that you and I talked about about a year ago, where it was just on flu vaccines, last time showing the impact of the flu vaccine, and now it's showing the impact on all these vaccines. So again, the body of evidence in this area just continues to grow with the significance of being vaccinated.

Speaker 2: 23:59

Yes, and I think Pink points to, as I said, no one is probably gonna get the flu vaccine or, I'm sorry, the pneumococcal or zoster vaccine, solely because they're like well, I read the study room. My physician told me that there's this relationship. Though I don't know, maybe somebody will. I wonder in the vaccine, hesitant, what's your take? Do you think this might be? People are like well, I don't think I'm ever gonna get zoster, or I had chickenpox, or I didn't have chickenpox as a kid, so I'm probably not gonna get zoster or whatever. In their mind, whatever. In a way, they're kind of justifying not receiving shingricks, for example. Do you think that saying, okay, well, that's great, but do you really? You know someone with Alzheimer's? Do you really wanna end up that way? Well, no, I don't. Well, we can't prove for a fact that the vaccine prevents this, but we have some pretty good evidence suggesting that it may be a preventive strategy. Do you think that's gonna be enough to push some people to get vaccinated when they wouldn't normally?

Speaker 3: 25:03

I think it could. But I think the biggest thing with vaccine hesitancy is repeated messages. We actually have a longitudinal project going on right now with like 100 or so pharmacies in Missouri where a community health worker is addressing vaccine hesitancy during routine med sync appointments. And so we have, you know, all these pharmacies. They have patients that are in med sync programs and a couple of days prior to that med sync the CHW reaches out to make sure that everything's ready for the medications before they come to get on that pickup. But at the same time the CHW who happens to be attacked, but the community health worker, who's recognized by the state as someone that can address vaccine hesitancy so not a technician, even though they're the same person the community health worker can have these conversations with patients and they can do it longitudinally.

Speaker 3: 25:50

They can do it every month during med sync. They can talk about the benefits while we do it, and I think that that is gonna be more of the factors that's driving hesitancy, or reducing those barriers to hesitancy, is engagement longitudinally with patients, and that's happening through community health workers, more so than the random physician once a year or the dentist, so they can also address hesitancy, which is kind of cool.

Speaker 1: 26:14

I think, that.

Speaker 3: 26:14

The other factor that's driving into this, though, going back to health equity, is just access to care and affordability. You know, I do not understand honestly why the government just doesn't pay vaccine, pay for immunizations for everybody, take it off of all benefits, just like the government should pay for it. We saw the impact that happened when COVID did that and the ability to vaccinate on COVID, and we see the numbers now when that's not a case, and it's just. It's fascinating to me that, like the COVID vaccines, what $150, that's expensive, not discounting the cost on that, but what's more expensive? Having a bunch of hospital pharmacists that their hospital didn't let them get vaccinated or didn't cover it, and so they didn't do it, and so now they're sick for a week, and the cost of an employee being sick for a week particularly high cost employees like healthcare providers far outweighs the cost of $150 vaccine.

Speaker 2: 27:11

Absolutely. And you know, many hospitals and health systems have not offered it and I think for that exact reason it's not that they don't want their employees to get it. They looked at the numbers and just said you know, we can't afford to offer, you know, some of these vaccines to our employees.

Speaker 2: 27:28

And you're right, you know, I mean, you know even if you go beyond things like going back to COVID, going back, you know, looking at things like long COVID and stuff. You know the bottom line is, yeah, if we can decrease people from just being sick for a week at the indirect costs associated with high levels of employee illness this guy high. So I mean I completely agree with you there. So you know, I agree with you. I think that you know it's certainly the multiple messaging right. Certainly, you know, every time they see any healthcare provider you know pharmacist, nurse, physician, dentist, chiropractor, I mean not anybody, I don't know.

Speaker 3: 28:07

I think that you know you listed healthcare providers.

Speaker 2: 28:11

We fixed that Fair enough. Fair enough. You know, massage therapist I don't know, you know. I think that we do need to, you know, to have a unified voice and just say you know these are good for you.

Speaker 2: 28:24

And yes, you hear, you get this never ending stream of nonsense on social media about. You know the issues with vaccines, which isn't new, which is, you know, goes back to the. You know the polio vaccines in the 1950s and stuff like. I mean, there's always been some vaccine hesitancy but it's been amplified so much in the last 10 years and particularly the last three years. And I think you know multiple messaging and multiple. You know providers being aware of this information, because I can tell you right now that my guess is most physicians will not read this study or maybe only vaguely aware of it.

Speaker 2: 28:56

And I think you know my job as an inpatient pharmacist is to kind of remind my physicians, especially my hybrid docs who work inpatient and outpatient, that you know this is something that you know it is a good, good talking point with their patients, especially if they're kind of on the fence about.

Speaker 2: 29:14

You know. Well, you know I hear the. I hear shinglets really hurts and you know I never had, you know, chicken pox and I don't think I don't think shingles is that big of a deal, which, of course, anyone who's had shingles will, you know, laugh in your face if you say that to them, you know. So I'm just I'm not interested in getting it or you know, it's a pain and I have to show up and then I'm getting a shot, and I don't like shots and all those other. I mean I think I think if they can say, okay, well, you know, that's certainly fine. But let's talk about some shared decision making, and one of those things is we have a, you know, a fairly good study that doesn't prove, but definitely suggests, that if you get your vaccines you're just less likely to develop Alzheimer's disease, and that's, that's a benefit that goes far beyond you not getting the flu. This year. You're not getting, you know again shingles in your lifetime.

Speaker 2: 29:59

So I think I agree with you that that's kind of a way to go. Any last thoughts.

Speaker 3: 30:03

Get vaccinated. The data shows that nobody's really vaccinated for COVID flu or RSV right now, so go get vaccinated.

Speaker 2: 30:09

Yeah, the COVID numbers are sobering and and, like I said, yes, you know, across the board now we have evidence that suggests and CDC has just announced that, yeah, vaccine hesitancy is at an all time high between kids and adults. And you know, is it going to take a big outbreak of measles, a big outbreak of polio, a big outbreak of something along you know some disease that nobody has seen in you know over half a century for people to finally get it through their heads that. You know that. You know these are good things.

Speaker 2: 30:39

I mean, there's a Simpsons episode, you know, where you know they're trying to save money and Homer says you know, we're always getting vaccines for Maggie for diseases she's never, ever even had, and unfortunately that's I think that's the thought process that a lot of people are putting toward vaccines and unfortunately I'm afraid that it's going to take another pandemic or it's going to take another big outbreak of a previously unknown disease or, you know, haven't seen disease for it to really change things around. So, thanks a lot, jake. As always, it's good to have you back on this side of the podcast and hopefully we'll have you back a lot more here real soon.

Speaker 3: 31:16

Okay, thanks for having me, Jeff.

Speaker 2: 31:17

So that's it for this week's game changers. Again, thanks for listening. We will see you next week, but remember, time flies. I don't know where it's going, but the most important day is today.

Speaker 1: 31:26

We'll see you then, jen, here. Be sure to check out our education at cempackcom. You'll find it to be your one stop shop for all the CE resources you need. Become a pharmacist by design member today to access it all for free, including CE for this podcast. Thanks for listening. We'll talk to you next week on game changers clinical conversations.