Pandemic Pearls: Dr. Nina Shapiro Looks Ahead to What Comes Next

The devastating impact of the  COVID-19 pandemic will undoubtedly be with us for years to come. However, we may soon be feeling a wave of aftershocks. Doctors across the country are already reporting their pediatric patients are missing essential immunizations, which could contribute to the rise of vaccine-preventable diseases such as measles, mumps, and whooping cough. With tens of millions of Americans out of work and uncovered by insurance, we could be seeing a perfect storm that eradicates decades of progress in fighting disease and extending life expectancy – not to mention the loss of countless lives.

Dr. Nina Shapiro is not without hope. In fact, quite the opposite. Dr. Shapiro is the Director of Pediatric Ear, Nose, and Throat at the Mattel Children's Hospital UCLA, and Professor of Head and Neck Surgery at the David Geffen School of Medicine at UCLA. She is also author of the best-selling, widely acclaimed book Hype: A Doctor's Guide to Medical Myths, Exaggerated Claims, and Bad Advice - How to Tell What's Real and What's Not. Although she is currently reeling, adjusting to the new normal (“Surgeons thrive on pace, control, and routine, and we just don’t have that now,” she said), she found time to speak with us about the current state of affairs, and shared why she’s optimistic about what needs to happen next.

The Ongoing Importance of  Immunizations

As a pediatric surgeon, Dr. Shapiro is acutely aware that the pandemic could bring a dramatic surge in vaccine-preventable diseases, as parents postpone, cancel, or simply don’t schedule childhood immunizations, thanks in part to shelter-at-home guidelines. She says one of the most critical things healthcare providers can do right now is to communicate with their patients, which includes communication about what’s open. “Most people assume doctors’ offices are closed, when, in fact, they are open. There is always access, and although that access may be different, there’s always an open door, for everybody,” she said.

However, COVID-19 isn’t entirely to blame diminishing vaccination rates. The year 2019 saw the highest number of recorded cases of measles since the CDC declared it eradicated in 2000. Though the 2019 outbreak was likely caused by imported cases of measles, what helped these cases to spread so rapidly was parents who are skeptical of the benefits and need for vaccines.

Talking to Vaccine-Hesitant and Vaccine-Resistant Parents

In some circles, Dr. Shapiro’s reputation precedes her. A large portion of Hype is dedicated to rebutting ‘alternative’ medicine practices – and she explicitly takes on the antivax movement, which has a particularly robust presence in LA’s West Side, where Dr. Shapiro practices.

Despite her frustration, she is not without sympathy – or at least, a willingness to understand parents’ concerns. “People deserve answers, it shouldn’t be as simple as, ‘You have to get a vaccine, and if you don’t, you’re a terrible person,’” she says.

So, what does she say to parents who push back?

“What I say to parents is that vaccines are highly tested and highly researched. Over the years…vaccines are continually studied and modified.” She also admits that, “No vaccine is 100% safe or 100% effective, but they’re about as safe and effective as you can get.”

Why Universal Healthcare is so Urgently Needed

Dr. Shapiro sees another looming threat that has the potential to ripple out far beyond COVID-19. “The reality is that 43 million Americans are going to lose their health insurance, and about 20 million have already lost insurance. That’s a lot of people, just in this country,” she said. And, although it’s too soon to tell, Dr. Shapiro fears the impact will be sizable. “We do not yet know how this will impact our global health or healthcare, but there are so many as yet undetected inequities and illnesses which will continue to progress over the months and even years ahead of us,” she said.

As Dr. Shapiro sees it, “…the simplest answer is universal healthcare. It’s ‘pie in the sky’ for many reasons but to provide basic quality healthcare for anyone who wants it…I think it needs to be ramped up.”

While there has been extensive debate about, and support of, universal coverage during the COVID-19 pandemic, Dr. Shapiro thinks that should just be the starting point. “Yes, we are talking about COVID-19, but what about all the other things, the domino effect, the other aspects of our health? If anything, they’ve gotten worse, how do we support them?” she asks.

How We Can Protect Our Most Vulnerable

Sweeping health coverage reform isn’t the only path to health equity. According to Dr. Shapiro, one potential solution for reaching our most vulnerable may be quite simple: increasing access to care by making it available at public schools.

She recalls her own early school years when, besides education, students received an array of simple preventive health services. For her, it seems like such an obvious and efficient way to dispense vaccines – which will become imperative, once there’s a vaccine for COVID-19.  “You will catch millions of children that way. You will be able to care for so many kids. They are such a large part of the population who will suffer from this. Have them treated at school, where they go every day,” she said

On the Bright Side

Like many of us, Dr. Shapiro has looked both inward and outward to find a silver lining – and what she sees both humbles and inspires her. “One of the positives that I’m seeing, people working in healthcare have come together like never before, not just talking about our own microcosms, but around the world, everyone is looking out for one another. People have raised their levels of empathy like never before.”

Besides empathy, she has seen innovation and resilience at every level of the healthcare system – from doctors embracing social media as a platform for education and connection to the return of the old-fashioned house call. “Pediatricians have stepped up like never before,” she noted, with a willingness to do whatever it takes to keep people healthy.

And, if we want to not only get back to normal but also capitalize on the opportunity to rebuild the health care system so that it works better for everybody, traits like empathy and creativity will be every bit as important as the development of a vaccine.