Introduction:

Welcome to Policy Chats, the official podcast of the School of Public Policy at the University of California, Riverside. I'm your host, Rachel Strausman. Join me and my classmates as we learn about potential policy solutions for today's biggest societal challenges. 

Joining us today is associate professor at the University of Western Australia, Katie Atwell. My fellow classmate, Andrew Shannon and I, chatted with her about vaccine hesitancy, mandates, and public health policy. 

Rachel Strausman:

Thank you so much for joining us today, Associate Professor Atwell. Public health has been an important policy concern for many years, but with the recent COVID-19 pandemic, it has really been thrust into the limelight. With the creation of the COVID vaccine recently, vaccine hesitancy and vaccine mandates have become a much contested issue, which is why we are so grateful to have Associate Professor Atwell here today with us from the is a global public policy expert on vaccines and vaccine policies for childhood and COVID-19 vaccines. So with that, we are so grateful you're here today. Thank you so much for joining us. Thank you for having me. So let's get straight into it. You just recently wrote a book and during the process of   writing it, you had the opportunity to conduct interviews with policymakers and activists. Can you share any insights that you found And particularly surprising from these interviews that emerged? 

Katie Attwell:

I think it's perhaps not that surprising, but remember that I'm coming to your country as a tourist. Maybe tourists isn't the right word, but as an outsider. So I think it's just very powerful the way people respond to policy problems that they see in their own context with solutions that are also informed by that context. So I'll give you a bit of an example. The activists that I interviewed for the book, they were basically people like me. They're about my age, similar background, similar education and also children of a similar age and they, like me, had become motivated to face the issue of vaccine refusal in their communities. They felt scared by the outbreaks of infectious disease that could be prevented by vaccines and they wanted to change things. And that really mirrored my experience in Fremantle, Western Australia, where I'm from. The difference, and this almost around the same time as well, right, it's actually that close. But in the context I was operating at the time, vaccines in Australia for children, it was very much a voluntary thing that parents did. There was a mandate, so to speak, but there was a personal belief exemption as well. So it was very much like a voluntary act. No one was going to be made to do it. They didn't want to. And so when I wanted to tackle that problem in my community, I went to behaviour change. I went to persuasion. I went to techniques that work with volunteerism because the political landscape in Australia at the time was like, well, there's no way that there's no political will to make this mandatory, right? To make it something that really people have to do. Now the people in California that experienced similar things in their communities went in a different direction. Part, I think, informed by the Disneyland measles outbreak, but also informed by the fact that the way they saw their mandate and the way they saw the personal belief exemption in this state working really made them think, we want to change the law, we want to get rid of that personal belief exemption. And they thought that even when the context in which they were encountering vaccine refusers wasn't a context where the changing law would actually stop people being there, right? You're not keeping vaccine refusers out of the places these people were encountering vaccine refusal. But their sense was, well, So, if we make this requirement much more stringent in schools, it will send a message to everybody that they need to be vaccinated. So they kind of wanted to change society by changing the law. And I wanted to change society by trying to intervene in people's behavior change. Now ironically enough, my country, Australia, followed California, not deliberately, but followed California just a year later by also getting rid of our personal belief exemption. So even though I thought, you know, just a few years earlier that I would never see that in my country, we've now ended up with a very similar policy to California. 

Rachel Strausman:

It's very interesting that you bring up how they had different landscapes to start off with, but they kind of ended up merging into a similar policy side of vaccines. But can you, please just for a moment, elaborate on what specifically happened in 2014 in Disneyland in terms of the measles outbreak? 

Katie Attwell: Absolutely.

There are measles little outbreaks you know frequently and have been for a number of years now even though it had previously been classified as a controlled disease. It's a notifiable disease which means if there is an outbreak, and we all know this from Covid now, we have contract contact tracing, we kind of have to work out who's been where and who might have been exposed. So that stuff wasn't unusual and in fact the year before Disneyland and the year after there were about the same number of cases. So it's not that Disneyland was this hugely big outbreak with enormous numbers of cases, but what it was, was an outbreak that somebody, probably an unvaccinated person or not fully protected person from somewhere else, brought it in. I mean, Disneyland attracts people from all over the world. Someone brings in measles. But what happens when they get there is there are enough unvaccinated or under vaccinated Californians that it starts to spread. because if our vaccination programs are working properly, we should be able to handle one person, one case kind of blundering in and, you know, we should be able to handle that. But by the time the disease is spreading through unvaccinated Californians, then California has a local problem, which is that not enough people are vaccinated to give community protection. So basically Disneyland is a really high profile outbreak and it's, you know, in policy, we would call it a catalyzing event. and it brings everybody's attention to where we're at and pushes change. 

Andrew Shannon:

Thank you so much, Associate Professor Atwell. It's really amazing hearing this from a perspective from someone of a different country. And going based off that, I wanna kind of discuss about the book. And you discussed the tensions between the increasing immunization rates and the debates about parents' rights and government coercion. How do you navigate this complex ethical landscape in your analysis and what broader implications does this have for public health policy? 

Katie Attwell:

Great question. Well again I mean I think I have to speak as an outsider when I say that the preoccupation in your country with liberty and with parents rights and freedom and individual freedom and individual choice is a much bigger thing here than it is in other places. I would say especially than compared to continental Europe for example but also other collectivist societies like Southeast Asian societies for example. In my country Australia we like you guys you know originally came from the Brits and that you've always had these things in intention I think which is you know the freedom of the individual and you know all the ways that the liberal theorists talked about where does your freedom end and somebody else's you know freedom or right getting get infringed by you know someone else wanting to exercise theirs. So for me, writing this book in particular was a constant dialogue with my co-author Mark Navin, because he's American, and he's a philosopher and ethicist, as well as a clinical ethicist, which means he's dealing with ethics, not in a kind of abstract sense, but also helping to make life and death decisions in a hospital setting as part of an interdisciplinary team. So we had lots of debate, and he is often there kind of schooling me about what American society is like, because of course I know what American society is like I've consumed American global culture like everybody else in the English-speaking and non-English- speaking world but definitely for me and all of us you framed your question around it's interesting talking to someone from another country we'll say right so we're kind of having this debate and dialogue and things that would be completely familiar or normal or routine or banal in Australia, wouldn't be in America. So I think what I'm saying is that how we navigate these things are always contextual and they're informed by the political community that we're talking about. What you might get away with in California, you would not get away within a red state and what you get away with in Australia, you might not get away with in California. You have to look at the people, you have to look at the political ideology, the history and also I think as well though the kind of the sentiment in the community and in California despite this strong freedom discourse flowing through Californians veins like the rest of the country there was nevertheless this impetus to say well your freedom ends here and your freedom ends here with your ability to kind of make vulnerable people sick and I think that’s the other thing that the activists and the technical expert and civil society actors and elected officials, of course who changed California's vaccination policy, they were so successful in mobilizing a discourse that gets you thinking about vulnerable people, and again I know we've just lived through all of that with COVID, but there's also been a bit of a sense with COVID if some people are like well old people who cares or sick people who cares or co-morbid people they brought it on themselves like there's been it quite, and that's not just in your country that's also in mine there's been a bit of a narrative that maybe we don't need to care about these people, but the people we were asked to care about in the Disneyland aftermath were children, and it's easy to care about them because they're cute. easy to care about them because they're cute. 

Rachel Strausman:

Yeah I think you bring up a good point that it's easy to notice you know children at Disneyland getting measles when even though the same number has been occurring every year, kind of going off of that how important is it for a policy to be considering the community's response in advance? Like how does that affect the effectiveness of the policy that's being worked on or proposed? 

Katie Attwell:

So you asked how important it was to think about the receptiveness of the community before you introduce a policy. What I've been learning through this latest round of field work is this massive implementation gap between what the policymakers, particularly the state level, are doing and I'm talking here about in a normal setting, it’s legislators, but in a the emergency setting, it's executive orders, it's the governor, it's the public health officer. So these people are going, okay, like this is now the law of California, but then it relies on all of these other people at a local level to actually implement it. And I've heard stories of unwilling implementation either at a site level, so a hospital is supposed to require that its workers are fully vaccinated or showing proof of a negative COVID test, and then you're hearing stories, oh but the infection control nurse at that hospital is anti-vaccine. So that's something that's not getting implemented. Or we hear of law enforcement like blatantly telling public health at a county level, we have no intention of enforcing these mandates. So in terms of thinking about how a community receptiveness, those officials, particularly I think the law enforcement, particularly sheriffs who were elected, and the Board of Supervisors, again, who are overseeing the county health officers, and the Board of Supervisors are elected, these people are completely minded towards their local community. So they will know, you know, that these policies will not get implemented there. And that means that the health officers certainly won't be bringing in any of their own local mandates like no vacs, no going out for dinner or no vacs, no going to the football stadium, because again, it won't, you know, they could bring that policy in, but it's not gonna be implemented, so what's the point? So I think it's crucial that you understand that receptiveness, not just because the policy might backfire, but because I think if you bring in a policy that you can't then implement and enforce, you're actually bringing people's attention to government's weaknesses and I think that could be potentially quite damaging as well. 

Rachel Strausman:

That's actually very an insightful point that you bring up that if you're going to bring up a policy it's not just about having a good policy it's about is it going to get implemented because I think a lot of times we don't think about the fact that if it's not implemented it's going to bring up weaknesses in the government because it's either going to get implemented or it's not. But going into a more broader view of policy, I know you mentioned Italy and France, but how does California and then possibly like Italy, France and Australia, how do they all differ in terms of how they handle vaccine mandates and vaccine policy? 

Katie Attwell:

Well childhood is obviously the one that I know in a greater deal of depth. I mean one of the, it's been very interesting talking to people here about COVID mandates and everyone's so frazzled as well as there were so many mandates at different levels that no one can, people are like, I think, I don't remember, you know, and as well there are so many mandates for other things like masks or, you know, stay at home orders. So we'll talk about childhood in the first instance, because at least it's a bit cleaner and I know it better. One of the things that differs is what is the consequence of nonvaccination. In California, as you would all know, it's school enrolment and daycare enrolment. In Italy, they decided at around the turn of the century, their Supreme Court said, said you can't keep kids out of school because school is compulsory. So they had had a school entry requirement for their vaccines only for four of them and that basically got turned over and not really replaced. So although those four vaccines were sort of mandatory and ostensibly you could get fined by the state, like by the state's, kind of, public health unit, in reality that also wasn't really happening. So they reached for a new consequence, and a new stick, which was enrolment in early education and care, so preschool, pre-compulsory school. In my country, Australia, at the federal level, families who are on kind of anything from like a middle income downwards get money from the feds every fortnight to help raise your kids, and that money used to be sort of done in various different ways, so I'm oversimplifying here. Getting that money is now conditional on your kid being fully vaccinated. You still get most of it they're not, but you definitely miss out on a chunk. And then at state level, we have the same as Italy. We have the requirement to be vaccinated to enrol in early childcare or school, but not in every state, but in most of them. And then in France, I would say from that sense, probably the most sweeping, they've got the school ones and they've got the daycare ones. So like the United States, I guess, but the changes that happened in Italy and France was that they had had mandates just for three or four older vaccines, and newer ones were just recommended. So in their big policy changes, which occurred in 2017 and 2018, what they did was go, right, it's not just gonna be those three or four now, now it's gonna be more like 10 or 11 or 12. So it was about expanding the suite of vaccines that would be mandated. 

Commercial:

Social injustice, health disparities, climate change. Are you interested in solving pressing challenges like these currently facing our region and the world, then consider joining the next cohort of future policy leaders like me by applying for the UCR Master of Public Policy Program. Learn more at mpp.ucr.edu. You can also find the link in our show notes. 

Andrew Shannon:

Right, and to kind of build off that, in California, the vaccination policy for the childhood, as you were mentioning, is usually to exclude children that are unvaccinated you know attending the educational facilities or their schooling. So can you discuss maybe any unintended consequences or challenges when implementing these policies and what can other regions learn from California's experience? 

Katie Attwell:

Yeah look it's really interesting and the stories people tell about California are really interesting and then if you go into the data you kind of learn other things as well. So, I mean, the biggest thing, and certainly one of the things that Mark and I would debate about and argue about a lot was this question of punishing children for the decisions of their parents, and he takes that line quite strongly and is quite critical of it. I'm critical of it too, but I think that it is also reasonable to ask everybody to contribute to community protection, and children are punished for the decisions of their parents all the time because lots of people out there are making something that I subjectively would think about decisions and of course you know within the limits of the law we're all allowed to raise our children as we see fit, people might look at the way I'm raising my children and say “oh, you know, they're making mistakes,” but from an ethical perspective that's not something I'm so troubled by especially as they can homeschool although I do feel bad because I think those kids won't be getting you know the experience they might otherwise have at school and I think school is really important. So that would be one unintended consequence because if you think about the mandate, what the government is hoping is by holding up the stick and saying we will exclude you, that people will change their behaviour. But there are plenty of people, maybe not plenty, but there are a sufficient number of people who say right we'll just take the stick, we'll take the consequence. And that's not really what government wanted right, but that's what happens and it's a little bit like disciplining your children, like they say “I’m taking away the iPhone for a week,” you actually have to do it otherwise next time you threaten, you know, they won't do it, so if you're trying to change behaviour you actually do have to show that you can follow through with consequences. So the other aspect of the unintended consequences I think is around if we were to look at actually what happened in California and where the change was the change was actually in not in those kind of really committed vaccine refuses and what we saw following 2016 in California when the policy was implemented, unvaccinated children were migrated by their families into other categories of nonvaccination. Medical exemptions, most notably, which the state then cracked down on a few years later, but also these other kind of various categories. Also, if you have a disability that's recognised under federal legislation, the mandate can't apply to you because federal law supersedes state law in that regard. So although it did increase vaccination rates, it didn't really increase them amongst those committed refusers. And then I would come to probably the most serious for me unintended consequence, which I think is that in California, and I get it, your policymakers and the amazing parent activists they interviewed all want their lives and their place and their state to be better. And I want California kids that can't be vaccinated or California parents who were going through cancer treatment, to walk the streets safely and not get measles or other diseases. So I get it. The problem though is that making a law like this in California, which is possible because the Democrats control the houses and the governor, so they can make that policy change happen. But because mandate policies have become very polarized and now we're really seeing Republican elected officials wanting to maintain non-medical exemptions, or maybe to even add more, and then we're seeing Democrats wanting to get rid of non-medical exemptions and strengthen the mandate without the exemption, the concern is the sort of way that what happened here then influences what happens in other states. And the risk, and we lay this out in chapter 10 of the book, is you end up with vast swathes of this country that cannot govern vaccine uptake and cannot prevent infectious disease. And the really sad thing, And I remember writing chapter 10 with Mark and getting pretty gloomy because, you know, we have the technology, like, this is not a technological fail, this is a kind of human fail, this is a political fail. But if we're right and this fail starts to happen, the other really sad thing is that your country doesn't have other really strong ways at a state level, at a government level of getting vaccines out to people. Like, it's always been the mandates, like, that's how you guys have always governed vaccine uptake. Yes, physicians do amazing work. Yes, not-for-profits do amazing work. You know, there's other things going on in this space, but in terms of how government gets vaccines done, it's mandates. And so if that starts to break in any state that has, you know, a red rule, then I think you're in for a bumpy ride in this country. 

Rachel Strausman:

And in terms of the mandates and the current policies, we've been talking a lot about stick policies as you call them. Have there been any carrot policies that are effective where you can to try to get that population of consistently resistant non-vaxxers to go ahead and get vaccinated? 

Katie Attwell:

Yeah look, the short answer is no. I mean this is a group of people that you can sometimes reach some of them in some ways but historically in my country and in other countries as well, public health approach has kind of been, well, as long as there's not too many of them, like as long as the numbers are small, and the other thing is as long as they stay quiet, right? right? Because some would say as well that they actually have a motivation to stay quiet because, and this is actually written about by Dr. Sears, who was a sort of anti-vaccine, well anti-vaccine slash vaccine selective pediatrician who is quite influential in these communities. is, he would actually say in earlier editions of his book, if you're choosing not to vaccinate your kids against measles, mumps, and rubella, don't tell anyone, because you actually want them to keep vaccinating so that they keep the disease away from your kids, which is vile, which is a disgraceful thing to say. But the thing is, especially now, vaccine refuses generally don't think like that because they generally don't think vaccines either work or are necessary or are needed. It was interesting, actually, some field work I did in Australia a few years ago these communities. Sometimes they think that their children are too healthy to be vaccinated, so it's like, oh vaccines are for, you know, kids that are going to childcare centres or, you know, kids whose parents are not doing all the great things we're doing, but we're doing all this organic food and we play with wooden toys and our children go to ward off school and our robust little kids can fight off an infection if they see it and it's okay to get sick sometimes. So there's that. And then the other one is my kids really vulnerable. My kids had health problems. The western medical system hasn't been able to resolve all of those health problems. I'm worried that vaccines are going to make my child more unwell and more harmed. So it's interesting these kind of two narratives sometimes not manifesting through the same child, but definitely manifesting in the same communities. Sometimes it's like the super robust healthy kid that doesn't need it. And sometimes it's like the vulnerable Western medicine failed me and therefore I'm also wary of vaccinating my kid. So to go back to your larger question around what works, if you guys correct that as the next generation you'll be doing our world a massive service. I don't think we're there yet. 

Rachel Strausman:

Well even if we're not there yet I think the work that you've been doing is so inspirational that you're going ahead and trying to get the context as you say from different communities over what's bringing on this vaccine hesitancy because it's not one simple they're doing it because of this, as you're explaining. Kind of building off of that, vaccines have really been more of a public issue since the COVID-19 pandemic. So has there been any visible shift in vaccine policies post COVID-19 or what trends have you seen? 

Katie Attwell:

I think in terms of policies, as we return to sort of a business as usual setting, we're not seeing like, to my understanding anyway, no one's kind of dramatically or drastically changed how they're doing things. But I think we're seeing some concerning trends that will possibly mean policy changes in the future. And by the way, those policy changes may not be changes to mandates, but they may be changes to other things that governments can do to try and increase vaccine rates. So one of the challenges we've seen, and again, sometimes this is a challenge of are we even collecting the data? Are we measuring what baseline information we have so we can track change? But certainly, for example, in my country Australia, there have been some surveys that have indicated high levels of vaccine hesitancy amongst parents than existed previously. One of the funny things about Australia is that for years actually, and this is true of other kind of high-income English-speaking countries too, there might be like quite high levels of hesitancy but that's not playing out in behaviour. So you've still got massive, really strong compliance with the vaccination schedule. People are feeling the fear of it doing it anyway basically so higher levels of hesitancy is a bit of a canary in the coal mine, it's a problem, where it will become a really big problem as if it translates to people actually not vaccinating their children and that's where the mandates can come in handy because they give you a reason to keep going they also set a social norm that said we don't want governments to be lazy and just be like “oh, we're mandating therefore we don't need to,” also do really good communication campaigns or also provide training and compensation for our physicians to engage with in conversations with hesitant parents for example. So I think we will see vaccination continuing to be a really topical issue. I mean for me, it was a topical issue even before COVID right, but it was definitely niche as well. So people when I was would say what I worked on everyone was like oh that's really interesting and the parents you know my generation or people becoming new parents, yes it's a thing, but you know, you talk to like a 60 year old or you talk to a teenager and they're just it's not something that everybody would know about and talk about. Now it's something everybody knows about and talks about because of COVID. So I think we will continue to see a big issue on that basis and perhaps also because some of the you know more concerning things that have happened in the wake of the COVID pandemic and that have perhaps spilled over into people's thoughts and feelings about childhood vaccination, I think will pose policy problems in the future if those challenges are not met and headed off early. 

Andrew Shannon:

Thank you for that. And you bring up an interesting point about these challenges that we face and maybe how we counteract them. And I noticed in terms of vaccine hesitancy, a lot of arguments that I've heard, one of the biggest ones that comes to my mind is about individual rights. I know you touched about that a little bit earlier in the podcast, and would you maybe elaborate about maybe the opportunities or challenges that comes about when you try to navigate this world of individual rights and trying to implementing vaccines and especially in the context of like the recent COVID-19 pandemic. How do we accomplish this? 

Katie Attwell:

Look it's really really hard and it's harder in your country than mine and I've already talked about that. I mean I was able to look at the COVID-19 pandemic and look at America and think that's not going to go well there because that strong individualistic current that runs through all of your veins to a greater or lesser extent but is very much part of the fabric of your whole society makes it very difficult for the state to enact power over people, right? Because people won't consent to it or some people won't consent to it. Now that's true, that has been true in other places too but I think a far smaller group of people has had a problem with it and also those feelings and sentiments don't exist at such a mainstream level. People in other places are more happy to be told what to do, basically. Like I said, I was able to predict that it would be really hard here, but I wasn't able to go, oh, therefore, they should do X. It was just more like, oh, dear, that's going to be hard. I mean, on this trip, I've heard about people in some communities, and I think, again, this is quite privileged, white, wealthy communities in parts of California and probably in other parts of the country, too, where, although their vaccination coverage rates for kid vaccines were quite low comparatively, of course still high right because even in places where it's low it's still like you know above the 80s, so sometimes when people face a different kind of threat or challenge they will change their mind. So I think one of the things we have to really make sure we do is always talk and it's hard and it's getting harder in your country because of political polarization and because the political divide is becoming like violent and nasty and and you know people really are becoming tribal and you know and the very us and them but I do think that to the extent that we can keep talking about vaccine refuses and vaccine refusal and something that people might not do forever and people might change their mind if and when they're given the reason or opportunity to and I wish I knew what it was to generate that reason or opportunity I mean obviously one of the things that would make sense to the extent that it were possible would be to have somebody who speaks to that freedom and liberty discourse saying, yeah, I still believe all of that. But I've gone and got vaccinated and this is why. And to be able to make those arguments in ways that are congruent with individualism so not just, “Oh, I went and did it to protect grandma or whatever.” And actually one of the studies that I was involved in early in the pandemic in Australia. We kind of profiled people based on their moral values and then worked out what kind of messaging would work for them. There's a certain type of person in this categorization that's like the kind of person that wants to go and have adventures and experiences like and doesn't want to be held back from doing that so that fits with that individuality stuff right. And so the way you would encourage vaccination for that person would be to say if there's an outbreak of disease stuff's gonna be closed, you can't go anywhere, it's gonna be really boring, get vaccinated so you can get back out there and get into it and get enjoying life. So we definitely need our vaccine messaging to reach people where they are to meet the attitudes and beliefs that they have but that's messaging that's not mandates. I think the message about mandates is that for some people they will always be unwelcome and a really big ask. And then it's a question for every political community to say is the juice worth squeeze? Are we going to squeeze out some other juice that we weren't expecting and don't want? Or is this something that even though there's going to be a few people who are really unhappy about it that we think we can do and we think we can do without damaging the legitimacy of the state? And the other thing that's so important to talk about here is like what is the outcome? Like what are we actually achieving? And we don't talk about that enough with mandates. So, for example, in Western Australia, where I'm from, we had a crazy pandemic. We didn't have a pandemic until 2022. We shut our state borders. We were in a big state like California. Not very many people, though, unlike California. So, people were not coming in unless they had like very special exemptions. So, anytime we had a case in the community, we would all like go into lockdown for five days, sometimes longer, and then, oh okay, now we're back out, schools are open again, shops are open. So you know you couldn't see a touring band from the East Coast or from overseas but you could go and see local music, you could eat out, you could go and see sports games. They did a whole weird thing with the sports people putting them in a bubble but they moved around. What I'm trying to say is that in that setting we had a really interesting experience with mandates because our mandates were really about the government going “Right oh, at some point we're gonna have to reopen the borders, we’re going to have to let the virus in.” We want to make sure that, and by that time, of course, we had the vaccines, most of us were able to have had our third dose by the time we were reopening. And it's like, okay, how do we have enough of enough of us vaccinated so that when when it finally does come in, we don't overwhelm our health system. So there are all these different ways and reasons governments might mandate, and we don't talk enough about what they're trying to achieve. And when my state government was doing those mandates, most of us were on board with them, because we wanted to reopen safely and we didn't know what it was gonna look like, right? We just did not know what our experience would be when we opened and when the virus came in. And one of the things that the vaccine refuses that my team was interviewing at the time, was saying was by now, we know these vaccines don't stop transmission. They reduce it, but they don't stop it. By now, we know that these vaccines don't prevent infection. They would prevent serious infection, but they don't prevent infection. So these people are going, you know, this is not like a measles vaccine which is like an amazing shield that just stops measles getting into you. This is not that and and they could see that and they're like, so why are you doing this to us this just feels like punishment and and I think they have a point and there you might still say okay well fine like because the governments they're going yes but we're not reopening till 90% of you have been vaccinated so that's a big number to get to and we'll kind of do it however we have to But you can see, I hope, in my rather rambling narrative here, that there can be various drivers that governments are trying to get to when they're mandating. And if we are not transparent about what they're trying to do, it ends up being this sort of black and white of, “oh, let's mandate because it's good” or “it will protect us or it will stop disease.” And COVID really messed that up because the vaccines, although amazing, very thankful for my many doses, you know, couldn't do what a measles vaccine does. 

Rachel Strausman:

Your discussion and your perspectives on context and how it's so important in policy, whether it's talking about catalysts like the Disneyland measles outbreak that can really shift a public's perception of an issue or just looking at people's perspectives and how their framework for their reasoning as to why they would agree or disagree with the policy, I think it's so valuable and especially what you were mentioning about having very specific targeted messaging to certain people. I think in a world today where we have so much technology and we can get so much data to really analyze little things about people, it's so important to get that community buy-in because bringing into what you were talking in the beginning it's so easy, for if a policy comes in to be you know, such a great policy, but if it's not going to be implemented it's not going to be effective and I think that this is just such a great place to end because it goes to show why work from researchers like you is so important so valuable not only in public health policy but also in all of public policy as a whole, because it really provides insights onto will a policy work and how can we make sure that it makes it through the implementation stage, because I think the politics stage of it all and getting policy passed seems to get a lot of the attention but in reality the work doesn't stop there. So with that, thank you so much for joining us today. We really appreciate you being here, and we are really grateful to get to hear your insights. 

Katie Attwell:

Thank you. Thank you both for a wonderful interview with very good questions. 

Outro:

This podcast is a production of the UC Riverside, School of Public Policy, and our theme music was produced by C Codaine. For the latest updates on the School of Public Policy, be sure check us out @ucr_spp on Instagram or visit our YouTube channel. I'm Rachel Strausman, till next time.