Transcript of Meidas Health, Episode 14: The President of the American Academy of Pediatrics

Midas-midi, good to see you for episode 14 of Midas Health. We were recording this with the President of the American Academy of Pediatrics here at the end of August, right before Labor Day. I should note, the plan was to actually go live with an episode that we recorded right before senior leadership at CDC was fired this week. We decided Dr. Susan Cresley was the President of the American Academy of Pediatrics. I'm going to bring her in. Just a moment. We decided that Given just the chaos of the week, really just it feels like everything is unprecedented. That work gets overused. But that was important to do a retake and to acknowledge what happened, to discuss it, and then to make sure that we ended on giving some actionable advice on what to do when it comes to the respiratory virus season and vaccines. That's why we're taking a take two. I'm so delighted to have my dear colleague, Dr. Susan Crustley, join us for Midas Health. Susan, great to see you this morning.

Great to see you, and thanks for agreeing to do this a second time. It's really important.

Why are we doing this a second time?

Because pediatricians are terrified about the recent decisions made by the administration, and quite frankly, it's rattled the foundation of how we can deliver health care to children in this country. When we look at how to protect child help and how to keep our children in this country healthy, from a pediatrician standpoint, we see two foundational pillars. There's the Pillars of Public Health, and those are the people in administrative and policy-making positions who can set the environment in which children can be healthy. They follow the guidance, they follow the science, they listen to experts to find out how do we set the environment in which to deliver health care. That is partnership with pediatricians and pediatric clinicians who are delivering that care to families and communities. Well, with the recent decisions in the last couple of days to fire or try to intimidate and force people to resign who will not abandon science, facts, and what children need, it's taken away half of that pillar. So pediatricians are now standing here without the environment environmental support of public health to provide care to children in every community. From my standpoint, there's three huge things at stake which we can talk about, one of which is access to care.

This includes vaccines, and you and I are going to talk about this in a little bit, but access to care in every community. Families deserve access to the most appropriate recommended care in every community. That has been Totally challenged by decisions made at the administrative level and by removing people who understand that important need. They've made administrative decisions to cancel research funding, and this is to children's health issues, including canceling research funding for childhood cancer. It's been policy decision-makers just decided to cancel it. They have changed the way that we approve medications, the FDA approves medications. They've totally hijacked the process, put in people who are not within the realm of expertise to know how to make those decisions in a science-based fact. All of this is happening among the context of miss and disinformation. I think it's important for your listeners to also hear this is not over. In the coming days, they are likely to hear more information. I want to pick apart what's misinformation. Misinformation is taking a little bit of truth and taking it out of context and maybe unknowingly spread a not complete truth. Disinformation is intentionally altering the facts to distort what recommendations are made and propagating lies and in this case, about child health.

I expect the next couple of weeks this is going to get worse, and you're going to be hearing from the same administrative people who have fired and gutded the expertise that is needed to promote child health. I expect you to hear again, false narratives about, Well, we need to look at the link between vaccines and autism. That is a lie. It has been disproven multiple times in research. Church, and even the autism community has asked for people to quit propagating this lie at the expense of the American people. So pediatricians are terrified, angry, and really looking for whatever voice we can have to make sure that children's health care access to health care is protected in every community. So apologies for the tirade.

No, no, no.

It's unprecedented.

I appreciate the TF. For our listeners, Dr. Crosley is, if you didn't catch it, Dr. Crosley is referencing what seemingly has never happened before, at least for a federal health agency, which is the director of the CDC earlier this week was effectively fired. It was a bit awkward. Actually, the story behind Dr. Susan Montero's getting let go as the CDC director warrants his own podcast. But A lot of escalations with the current Health Secretary, RFK Jr. Hoping for some help from Senator Bill Cassidy. Ultimately, it seems like the President had to intervene and ended up firing Dr. Monterrez. Then three of her top lieutenants, and all clinicians, all in really important positions, like the head of the Zoonotic Diseases Center, head of the Respiratory Immunization Center, and the Chief Medical Officer. So very consequential. You don't just replace that level of expertise overnight. It's impossible to do it. Susan, listening to your reaction, you're the head of one of the most influential medical societies in the country. I think AAP has always been an entity that we all look to for societal guidance. I think you reach far above. Your influence exceeds that of a typical medical society, in my opinion.

I am wondering how you think your charge has changed just in the last, say, 72 hours, if at all.

Yeah, I think that's framing as important. We always start as the American Academy of Pediatrics and as pediatricians in starting and leading with what's best for children, child health, and protecting children across the country. We usually do that staying in what are medical recommendations, what's the best thing to do for kids, and lifting up voices often in places where kids don't have the ability to lift their own voice. But what now is clear is there is an attack on the nation's children and the science behind what children need to stay healthy. We can no longer be silenced, and we can no longer stay in our medical lane in giving recommendations. We have to call out the truth and call lies, disinformation, and manipulation exactly what it is so that children, we can get back to a place where children can get what they need are supported both by public health and those policymakers, decision-makers who are creating the environment in which we, the pediatricians and pediatric clinicians, can deliver care.

You know what What I think has been so interesting to watch, just as an admirer of your leadership, has been to see the transformation of AAP into... I wonder if you would agree with this framing, but you had just said, We have to step out of our medical laying. I've seen AAP actually bring a lawsuit against HHS when it came to recent vaccine guidance over the summer. You've been out there toe to toe, actually, directly responding and being very proactive. I think these are things that we don't typically expect from our medical societies because it seems like often in medicine, and I say this as somebody that's really leaned into public health messaging, you're not taught to embrace that and to lean in. You're taught to keep your head down and just be at the bedside and not draw attention to yourself yourself. In this case, I think it's great attention. I think you're filling a huge gap, and I think you're providing a roadmap for other societies to really get out there. I'm wondering if you could speak about the tactics and your approach to leading AAP at this moment. You had said something really compelling the last time we had spoke that really stuck with me, which was that if it's not the AAP, then who's going to do it?

But I'm wondering, especially now with the events of this week, are you going to double down? Did you expect to be in this having to lean into this type of messaging? Just wondering your thoughts.

I want to ground this on the 95-year history of the American Academy of Pediatrics. It started because people were not standing up for kids. The AEP was founded because a bunch of pediatricians said, Okay, there's things happening in this country, infections, child labor, other threats to child health, and no one is standing up for children. And so as pediatricians, we have to do it. If not us, then who? And so advocacy really is in the DNA of pediatricians. It is often why we're called to act on behalf of children. And so this isn't about us. It's about the kids. In many ways, I think that pediatricians are very much like parents. When you see your kid threatened, and to us, the nation's children are our kids. When you see your children threatened, you start to do whatever you need to do to speak up to protect them. Normally, even a year ago, it wouldn't occur to us that we would be having conversations and calling out administration of decisions that threaten the health of children, because who would have thought that someone would want to do that? I'm not going to pretend to understand the motivation of other people and other decisions.

But I will tell you that pediatricians in the American Academy of Pediatric will do whatever it takes. It was no light decision to have pediatricians decide to step up and sue the HHS Secretary. But if that's what it takes to stop practices that hurt and harm children in our communities, then so be it. We'll do whatever we need to do with whatever partners and partnerships we need to create to make sure that children are valued in every community and their health and safety and well-being is a primary focus of decisions.

I know this is not related to why we've convened, but it's where it is, and I'd We're going to mess with it and bring it up. This is 72 hours. We're shooting this 72 hours after the horrific events in Minnesota on Tuesday, and of this week here in late August of in '25. I happened to see the vice president last night give some comments, in addition to the Health Secretary, on why it is that the United States seems to have this problem of this epidemic of mass shootings. You get exhausted from having to react to everything because it's just too much. But it ended up being the same rehashing of the same justification that I think we keep hearing from one party in the country, which is this is a mental health problem. When I think about what you just said, which is the AAP's mission and charge is focused on doing whatever possible to protect children, then I see the messaging on justifying and reconciling what just happened in Minnesota. It brings renewed relevance to what you're saying, Susan, which is to say that we're distracting and deflecting on the key drivers of something that's awful, like a mass shooting episode at a school, which we know, yes, mental health crises exist in the United States.

There's an unmet need in mental health across the world, but there's one country that has an epidemic of mass shootings, and it's us. It's not the rest of the world. The reason is pretty clear. I've personally looked at this problem. Others have as well. This is not novel, the reasons, but the reasons here are easy access to firearms. I think RFK had said just two days ago as well that there's a problem of overmedication in the United States that's resulting in these mass shootings. There's such a disrespect when it comes to trying to obfuscate and create these false narratives that is very much the antithesis of what you're doing at AAP, which is bringing truth and reality.

It's not far remote First of all, there are no words to say to families and communities who have lost children through tragedies such as this. I will not belittle their loss by having conversation about this. But I will say this is exactly what I was talking about. Children are going to be protected. It needs foundational environment and policies that protect children and those in charge who can make policy and create the right environment along with care for individual families and individual communities. We, as health care providers, as physicians, can't do this alone while policymakers are abdicating themselves of their responsibility and obligation to set the environment that protects children. That's all I'm going to say about this.

Thank you, Susan. Where do we go from here? I noticed that there's a new CDC director that's been named Jim O'Neill. Doesn't appear to really have much in the way. I don't know Jim personally. It doesn't have much of a public health background. He's not a clinician, has served in some bureaucratic roles in government. I am concerned about some of the comments he's made during the pandemic, like Ivermectin being a cure for COVID-19. It worries me that he's being picked to represent policies that I think you or I may not agree with. I am wondering how we think now about the next three to four months, Susan, and messaging using your platform as president of the AAP to get the good message out there about childhood immunizations for COVID, for flu, RSV, if appropriate. Talk to me about that.

The House of Medicine did not cause the environment that we're in, and we can't alone fix it. We need all of our elected officials to step up and do what's right. If you look at the firings and the reasons that people resigned, they were actually asked to falsify, manipulate data, and lie to the American people. Those brave CDC people who left because they refused to compromise their morals and ethics to continue to propagate lies, my heart goes out to them, but the American people deserve better leadership and decision-makers at the administrative level. Having said that, can we move to what we really want to talk about, which is how could people keep their kids safe in this respiratory season now that we've unpacked the crazy?

I'd be delighted. I want our listeners know we're going to spend the second half of this time that we have, again, grateful for this time with the current President of the American Academy in Pediatrics, Dr. Susan Cresley. Yes, let's do that, Susan. I want to see if maybe there's a helpful point here just on the policy engagement before we transition. Do you feel like Is there any tie that you feel that you can perceive is changing from leading elected officials that can actually do something about the current state? I think about senators like Senator Bill Cassidy, a physician Influential member of the GOP, seemingly reasonable, as far as I can tell, based on a lot of what he's put out there. I'm just wondering, based on share what you can share, but AAP has its reach in every community across the country. I'm sure your policy team is having all sorts of discussions. Are you hopeful that perhaps this might have been the last straw?

We're pediatricians. We live in the world of hope. Kids bring joy and hope to our work. So yes, we hope that tomorrow brings a better day and better decision-makers, and we hope that our elected officials and policy decision-makers go to sleep at night and really think hard about what is necessary to lift up children in every community and how to use the experts and get them reengaged in the work so that all of Americans are healthier and safer. We're all working together to make that happen.

Great. I'm glad to hear it. I think a lot of our listeners and we were lead to hear that. Susan, let's pivot. It's We're a few days away from Labor Day. Families are either already back to school or next week is going to be a pretty similar moment for the remaining families whose kids are going back. My kids are going back on Tuesday, Wednesday, and I'm wondering, where do we start? I guess, number one, where would you recommend listeners go for trusted health information on, say, childhood immunizations.

Yeah. So please start with us, Trusted Resources. We have a family-facing website called healthychildren. Org, where you can ask a lot of questions, but also start with the person that you already have a trusted relationship with, your pediatrician or your pediatric clinician who's with you, who's been there since your child's birth, when they were taking their first steps, when they got their first bruise, when you were wondering what to pack in that first backpack, please use us. We are with you in the journey of child health and are happy to answer your questions. But if you're looking for online resources, start with healthychildren. Org and some pediatrician voices that come through the American Academy of Pediatrics.

I should say for our listeners, I've had a chance to navigate this website. Not new to me. My wife's a pediatrician, and so we've used it from time to time in the past. But just to emphasize everything that Deltra Crustley is saying, and we're going to try to get the word out as much as we can on our platforms, this is easy to navigate. Unlike other websites that promise easy navigation and clear communication on something that maybe a lot of people don't think about it all the time, healthychildren. Org is the definition of simplicity. Navigation, you know what to click on to get the information that you need. Everything that's request to just mentioned is, I couldn't agree more with, great resource. I'll also plug in. For folks out there that might be wondering on the adult side where to get information, let's say you live in a multi-generational household and you're worried about grandma, grandpa, whatever it might be. I really like immunize. Org. That provides resources for all age groups, but especially, I think healthychildren. Org has it covered for the pediatric population. Then as you think about older age groups, immunize. Org, a great resource.

Again, it's for a one-stop shop. Should you want to go somewhere for adult-focused information on immunizations. Let's get to COVID boosters. It seems like, Susan, you and I had a chance to have an initial conversation about this earlier this week, but it seems like a lot of the churn at CDC actually was rooted in debates about the COVID booster. What is AAP's stance on the COVID booster this fall season? Why is this controversial?

It's not controversial to us. Just to frame this, the American Academy of Pediatrics has been making pediatric immunization recommendations since the 1930s. That's long before the The Advisory Committee on Immunization Practices and everything in coordination with the CDC came out with vaccine schedules. The AAP has done it long before that existed, and we've continued to do that, often in collaboration and back and forth consideration with the experts of the CDC. But that was broken by the administration in spring when they disinvited and fired a lot of the experts in the ASCIP. We continued to do our work. It is the same work we've always done using the science and the data and incredible experts who know a lot about vaccines, immunology, epidemiology, public health. A lot of those same experts shaped the recommendations. We came out with our recommendations. What seemed like was contrary to what the HHS Secretary released about COVID vaccines. That was not our response. This was our usual process that we do every year to recommend, Hey, here comes the flu season. Here's our policy for what flu vaccines should have. We released our entire schedule, including information about respiratory viruses that are important for all your listeners to know coming up, the flu, COVID-19, and RSV.

Let's start with what are recommendations for COVID vaccines? Please are and why they were made by the experts in the room. I want to start with the littles, the 6 months to the 23-month-old. We made a recommendation that every child, 6 months to 23 months of age, should have the COVID-19 vaccine. Here's why. It's basically two reasons. Number one, they are at a higher risk than the older-aged children for having serious COVID infection, ending up in the hospital, ending up in an intensive care unit, and struggling to breathe. We must... Go ahead.

Dr. Costa, I just want to underscore your point here. You're saying six months to 23 months of Age, AEP's recommendation was any child in that age group.

Everyone in the managed group.

Everyone in the age group gets it, regardless of whether or not they have an underlying medical condition or not.

Healthy kids, unhealthy kids, all kids. If you think about this, one of the reasons people keep saying the pandemic's over, and the administration likes to say that, the pandemic's over, the virus is not gone, and those young children didn't live through the pandemic. Part of the reason us as adults have more strength in our immune system and able to fight off COVID infection is because many of us have been vaccinated and many of us have also had the infection. We've already had immune system strengthened by living through the pandemic. This year and every year, subsequently, we're going to have new young lives that haven't lived through that and haven't had the chance to boost their immune system. They need primary protection and strengthening with the COVID-19 vaccine. That's Group One.

Just to layer into that, the way you describe that, one, it's just so clear, very clear description. Also just feels obvious that, of course, these immune systems are developing. They didn't live through the peak of the pandemic. For anybody that's wanting to... Sometimes we get outreach from folks saying, Hey, show me the data, show me the data.

Happy to. Just Google.

I'll provide some folks some prompts here so they can do their own research. Then Dr. Crusty, we'd love to brainstorm on to make sure people have any data points that they want. But if you just Google pediatrics and COVID hospitalizations, I just did this, you'll see a recent manuscript published in the journal Pediatrics, one of the most prestigious medical journals in the world, showcasing that kids, and this was looked at a period between 2022 and 2024, that that age range, Dr. Crusty, that you just mentioned, still accounts for the clear plurality of hospitalizations amongst kids across the country, that that age range is uniquely vulnerable, and this is on the tail end of the pandemic. That's a vulnerable group. I think also to underscore the current Administration's guidance, released just this past week, suggests that for that age range, 6 months to 23 months of age, that that group should get a booster only if they have at least one in underlying medical condition. Otherwise healthy, 6 to 23 months of age, they're not recommending it. Aap is saying, No, you're still vulnerable because your immune system is developing, as you just beautifully pointed out, very clearly pointed out.

So thank you. Didn't mean to interrupt.

No, that's important information. The second group is kids who've never had a primary series of COVID vaccine. Because, again, these are developing, strengthening immune systems. Those Some of those older kids even didn't live through the pandemic or did not have a vaccine during the pandemic or have the illness. Everyone deserves a primary layer of protection from COVID-19. Even healthy children, if families want it, we recommend the child get a COVID vaccine. That's Group Two. Group Three is children who are at high risk for serious disease. We list in our policy statement all of the conditions that entails. If you have a question of whether your child's high risk, ask your pediatrician or pediatric clinician. That's group three. Then there are kids who live in group homes because we know children like to spread lots of things besides they share their crayons and their germs. If you're living in a setting where children may be more vulnerable, we want to make sure that those children who live in hospital group settings and other group settings, that everyone in that environment is protected, not just high-risk kids with a defined medical condition. The last group is very important for your audience.

Children who live in a family where a family member or someone in their household is at high risk. Again, children share their respiratory germs, sneezzing. We can't expect them to keep their germs to themselves. This is respiratory spread. So coughing or sneezzing in an environment spreads COVID-19 virus. What if you have a mom who's on chemotherapy or an elderly grandparent living in your house or a sibling who has one of those high-risk conditions? Those families deserve to have family, community, community immunity so they can protect the most vulnerable. All of those groups that we say that everyone who wants the vaccine and those who we think are most at risk deserve to have access to that vaccine in every community in the country. That is going to take a lot of work from a lot of people because the decisions that are being made centrally by the administration are threatening that access to care.

Dr. Crosby, on that last point, can you explain to our listeners why a child living in a multi-generational household, why they getting vaccinated would protect their vulnerable older loved I say that as somebody recognizing why that would make sense. But I do wonder if there's some confusion out there amongst our listeners who may say, You know what? I've gotten vaccinated and I still test positive. Could you walk us through why that still is useful?

Yeah, happy to. Especially this is very important for respiratory viruses like flu and COVID-19. Those vaccines, just to be clear, were never designed designed to keep you from testing positive or getting sick with COVID-19 or the flu. They were designed to reduce the risk of the severity of your illness, decrease the likelihood that you end up in the hospital, in the ICU, or horribly die, and when you reduce everyone in the household's chance of getting seriously sick, coughing longer, sneezzing longer, spreading those germs longer, if everyone in that vaccine or everyone in that family household is protected with a vaccine, you have a much lower viral load. There's much lower... Even if somebody gets sick, you have a much lower chance of spreading that around in significant numbers, and that, as a result, protects text the most vulnerable in that household. Hopefully, that made sense.

That's perfect. The current HHS Secretary, RFK Jr, actually put out a video a few weeks ago that I took exception to as a pulmonologist because I thought it was either he knowingly deflected and put out wrong information about the purpose of the vaccines, or he just didn't know the difference between the upper and the lower respiratory tract. But I remember this video vividly because he was asked to respond to it. But he had said in that video, to paraphrase him, that these vaccines were not effective against preventing infection of the upper respiratory tract, which, to your point that you just laid out, is not the purpose of these vaccines, nor have they ever been the purpose of these vaccines, to protect against severe complications in the lower respiratory tract, otherwise known as their lungs. I appreciate you clarifying that because I think that either there making those statements knowingly deflecting and trying to create confusion, or they don't know the difference. Either one's bad, but I think it's important for people to recognize why it's so important.

That's why we need expertise in the room to inform the decision. Whether it is just not understanding or it is purposeful, we need people who will stand by the facts to give families what they deserve.

How about flu? Do you expect anything to change about recommendations from flu? Secondarily, how is AAP approaching recommendations to superflu? Are there any changes from historical guidelines?

We don't have any changes from our guidelines. Everybody six months and up, should get a flu shot. Annually, it's the best way to protect themselves from significant lower respiratory tract infections. Every year, there are healthy kids who end up in the hospital, in the ICU, on breathing machines. We, as doctors, have no way to really say, This healthy child is more at risk for this happen as opposed to this child. We just don't know. No family, and you and I had this conversation, no family wants to stand at the bedside and watch their child struggle to breathe from any of these respiratory illnesses. No clinician wants to have to witness the heartache from the family and watch that child either. Anything that we can do to reduce the number of children, adults, seniors who end up needing hospitalized care. I mean, we would love nothing better than you to put us out of business in the Intensive Caring Minute, and so we don't ever have to go there. But that would require lots of things, including high vaccination rates.

Rsv. Susan, can you walk us through how RSV applies to children?

Yeah. Rsv is important because we now have a game changer. Set of tools in our toolbox that we didn't have a couple of years ago. Rsv has always been, and that stands for Respiratory Syncytial Virus. There have always been a lot of young infants who have a hard time with the RSV virus, in part because their airways are so small, they can't clear mucus very well, and they struggle to breathe. In very young infants, when they get RSV infection, sometimes they get what's called apnea, which is they just forget to breathe and stop breathing, which is horrifying to witness if you're a parent. We have a couple of tools now in our tool parts that didn't exist. Some of them also are also for seniors because we also know a Old people are at higher risk for respiratory infections as well. One of those is vaccines. Those are vaccines, and those are vaccines traditionally the way we know them in that they make your immune system stronger to protect you. Should your body see the RSV virus, it already has a strengthened immune system to be able to deal with the virus. Seniors are eligible for the vaccine.

Please talk to your primary care provider or your pharmacist about getting it. It's important that pregnant women be offered the RSV vaccine because we know that they provide antibodies. When they get immunized during pregnancy that pass through and then protect their baby, those young infants that are too young for some things to get vaccination. I would be remiss if I didn't loop back to COVID here. Pregnant women, ACOG, the American College of Obstetrics and Dynacology, just came out recommending that COVID-19 vaccine be given to all pregnant women. That's because we know that pregnant women are at high Higher risk for significant COVID infection and higher risk disease should they get sick. Plus, they get to protect their infants through that same process in the early days of life. So RSV vaccine for elderly and pregnant people. There also are now two products that are antibodies, which are targeted to the RSV virus that can be given to infants up till eight months of age if it's their first respiratory Respiratory Season for RSV. We usually think of the respiratory RSV season from October through March, sometimes April. If your child is eight months or under starting in this October coming up season, they may be offered the RSV monoclonal antibody before they even leave the nursery.

Please say yes, because they're going home to a community where your neighbor may have respiratory illnesses. You may live in a place where other people are sick. Get them protected as early as possible, but if not in the hospital as soon as possible after starting October first in your pediatric or pediatric clinician's office so they can be protected from RSV. There are certain high-risk kids who can get a second season starting in October to make sure that their second respiratory season, they are protected again.

Wow, there's a lot there. I thought as clear as day, Susan. Thank you for that. I'm going to try to summarize what I just heard, and please correct the record if I got anything wrong here. But when it comes to COVID-19 boosters for kids, for for our audience, Dr. Cresley here, again, President of the American Academy of Pediatrics Holding Court, just went through recommendations. They do differ from what the federal government has put out, and so it's important to understand that nuance. But for any child between 6 months and 23 months of age, regardless of their medical history, so they could be perfectly healthy or they may have an underlying medical condition, they are recommended by the American Academy of Pediatrics to get a COVID-19 booster. In addition, for children between the ages of 2 and 18 years of age, and I have a cheat sheet here. In addition, any child within that age range that is at high risk of severe COVID-19, so underlying medical condition, is recommended to get the booster shot. Any child that's a resident of a congregate setting, long-term care facility, is recommended to get the COVID-19 booster shot this fall.

If they've never had a primary series, meaning they've never been vaccinated with the COVID-19 vaccine, they are recommended. Lastly, in this high-priority recommended cohort for the upcoming COVID-19 booster, any household contacts of a child that might be at high risk for COVID-19. So think parent that might have a serious underlying condition or grandma and grandpa that's older in life, we want to protect those individuals. And so vaccinating your child in that case will protect your vulnerable older loved ones. Did I get that right, Dr. Crusty, in terms of our COVID-19 recommendations?

You did, except for that 6-23 month old is a primary series for most kids, not a booster. It's a technical difference. But when we talk about annual boosters like annual flu, there's a difference between the first time you get it, because for some people, that may be two doses. It It's not for everyone. Your pediatrician can help you figure out how many doses constitutes adequate protection. But that 6-23 months old, especially the six months, that's not a booster. They've never had anything.

They've never had it. Thank you. Thank you for that clarification. For flu, no changes. We expect no changes or any distance between AEP recommendations. We hope federal government recommendations is to avoid confusion.

Except for the recommendation that FIERMERS will be taken out of multi-dose virals, and I don't want to spend any time on that because it doesn't really have any implication for what families can get and what they need to know because it was already gone from the vast majority of flu vaccines. It was basically a position statement on the administration, not based in fact, because Thiermerce doesn't cause any medical problems. So let's move on from there.

I'm glad you brought that up, but I agree. For families out there, six months of age, for children, six months of age and older, the recommendation from AAP which we expect to be unchanged at the federal government level, is that they should get vaccinated against the flu. Anything to add there? Anything I'm... Any nuance on some of that one?

No. And buy any available FDA-licensed product. There's no preference.

Can children get vaccinated in the same arm, different arm? Does that matter? In the sense of if they show up at their pediatric pediatrician's office, can they get both COVID and flu at the same time, same arm, different arm? Would you prefer to space those up?

Yes, yes, yes, yes, and yes. Okay. We will give you whatever vaccine you needed. If your child is a baseball pitcher and is right-handed and you want them to have both shots in his left arm, we're happy to accommodate. If you want to split them up, so if your child has a local reaction, you know which one it was, happy to do that. What we want your child to do is be protected however and whenever we can protect them from a vaccine preventable illness.

Great. I'm going to tell folks because with RSV, few Two things to consider, and that's where I'd love to direct folks, well, across both COVID, flu, and RSV, to healthychildren. Org and to your child's pediatrician, just to make sure you're having a conversation about RSV and that all the right things are being done. I thought you went through a beautiful description of it, but that is where these resources can be helpful because sometimes it's hard to remember everything. But ask your child's pediatrician about RSV. Go to healthychildren. Org for more information as well. Susan, in terms of, as we're wrapping up here, one question I think I'm getting a lot of is, Well, there's a difference now. There's some disagreement. There's what AAP puts out there. You are a trusted purveyor of health information. A lot of people are now coming to AAP because they are worried about what they're hearing from other traditional sources of information, like the CDC, federal government recommendations. One question we're getting is, if the FDA says that That puts recommendations out there that are different. How is that going to impact access to these vaccines in a pediatrics office?

What about coverage? Can you speak about that?

Yeah, I'm happy to. That's where we moved to. We moved to, we gave our recommendations based on the facts. Now we move to, how do we translate recommendations into care? That means access to all of the vaccines that are recommended according to the pediatric immunizations schedule put out by the AAP. In every community in this entire country. You brought up two issues about access, one of which is what happens to who makes recommendations, et cetera. We know that more than half the children in this country receive their vaccines through the Vaccines for Children program at no cost to families. This is not just kids on Medicaid. This is kids who are underinsured and noninsured because we know that vaccines save lives. So this program was put in place in order to make sure that every child in every community could benefit from the American success story of vaccines. We are unsure, but exploring. Here comes the parental mama and papa bears protecting our children. We're going down every single avenue that we can think of to figure out how do we make sure that we preserve these vaccines for kids in that space. We also have been having multiple conversations with payers about paying for the vaccine.

Look, it's in all of our collective interests to get as many people vaccinated as possible, including the insurance companies. It is far more expensive to care for people who are sick in the hospital for days and weeks than it is to give them a safe and effective vaccines. We remain hopeful and confident But we're going to need to work. Anyone who wants to join us in this work and lift their voice and ask the people in their community, How am I going to get my vaccines? Will it be paid for? Call your insurance company, ask them if they will cover your vaccines. There are different rules in different states about what decisions are hooked to, what the FDA says, what ASIP says, et cetera. We have an upcoming ACIP meeting in September 18th, maybe. That is going to clarify some of these questions. But at the American Academy of Pediatrics, we cannot wait for policymakers to make decisions that They're not in the best interest of children. We will partner with whoever cares about child health to make sure that every child in every community has access to all the care that they need, including vaccines.

Well, I can say as a parent myself and as a clinician, I thank you, Dr. Susan Cresley, for being here, for your leadership, for your advocacy. You've really just stepped up in a way that I think all of us didn't realize we needed, but we're thrilled and thankful that you're meeting the moment, you and the organization that you lead, the American Academy of Pediatrics. Again, for our listeners out there, we are graced with the presence of the President of the American Academy of Pediatrics, Oscar Susan Cresley. Susan, thanks so much for being here.

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