Episode 4: AIMing to Inform Guest Dave McCormick

Brent Ewig 0:03
Welcome to AIMing to Inform. I’m Brent Ewig, your host for this limited series podcast produced by the Association of Immunization Managers. We started this podcast so we could talk to immunization managers across the US to understand how they have overcome challenges and become a champion for vaccines. Before we’re done today, we hope you’ll experience at least one aha moment, enjoy a few dad jokes and leave the episode feeling motivated to carry on your work as a public health leader. Let’s get started.

So welcome to the latest episode of AIMing to Inform. I’m your host Brent Ewig and really excited today to be joined by David McCormick, longtime immunization program manager for the state of Indiana. And Dave, I know you may recall when we first talked, I mentioned we have some common Indiana roots. I went to college there – Valparaiso University in Northwest Indiana. Listeners might know Valparaiso as the hometown also of Orville Redenbacher, popcorn king known worldwide, but I found Orville actually didn’t go to school right in Valparaiso. Do you know where he went to college, Dave?

Dave McCormick 1:12
I do not know.

Brent Ewig 1:13
He went to Corn-L-University. And with that, ladies and gentlemen, we’ve got our first dad joke of the podcast. And so we can jump right into it. Again, Dave McCormick, immunization program manager for Indiana. Dave, can you get just kind of get started – tell us a little bit about how you got into public health. What your career path has been?

Dave McCormick 1:32
Sure. I just finished up my 33rd year in public health. I’ve worked both at a local health department and the state health department. My first 18 years in public health were spent at a local health department doing direct service right out of college, thinking that I would do it for, you know, a year or so. I was actually accepted into an MBA program, was going to go on to law school. And I really fell in love with public health. I worked in the WIC program, I worked in environmental health for a while, I worked on lead and healthy homes issues. And then lastly, the last 11 years, I’ve been with the immunization program.

Brent Ewig 1:38
What local health department was that at, by the way?

Dave McCormick 2:08
That was the Marion County Public Health Department, so the city of Indianapolis.

Brent Ewig 2:19
Okay.

Dave McCormick 2:19
I at one point, I actually did housing inspections. And I would, I would suggest that to anyone. It is a very eye-opening experience to see how people live and the sights, the smells, the whole piece, but you know, a very rewarding career because you were helping people improve their, you know, their living arrangements. I think a lot of times we take safe and affordable housing as a…as a right, that you know, whether it’s not a right for everybody that it’s a it’s definitely a privilege for some. So, you know, that was that was very eye opening.

Brent Ewig 2:55
Chance to see those social determinants and action and make some linkages. So that’s very cool. Can you tell us a little bit about what motivates you to do the work, particularly in immunization?

Dave McCormick 3:05
Yeah, I really love the patient experience. I love knowing that we’re making a difference, that we’re improving the health of the citizens of Indiana. You know, I’ve had some opportunity to work clinics to develop policy to really try to make some change in my tenure here with the immunization program. We’ve seen mandatory reporting of vaccination information into our state registry. We’ve also, have increased our school requirements, so we really require just about everything, except Flu and HPV, for school entry. Probably one of the biggest things has been, you know, the the interaction with people, and you know, during the course of COVID, I kind of stepped away from the immunization program a little bit. I spearheaded our targeted testing programs in the early days of COVID and then went in, of course, to vaccination when the vaccine became available. But I got to spend some time doing vaccination services as well. And, you know, one of the things that that really has been one of the highlights of my career and kind of…has really filled my bucket, as far as job satisfaction, has been going at helping those people that they couldn’t receive vaccines otherwise. We have a program called Homebound Hoosiers, and that’s a program where we actually got to go out and vaccinate individuals that were homebound but couldn’t get to …either one of our drive-thru clinics or to a provider. And you know, I’m always reminded of going into a home of a couple. The gentleman was 99, the lady was 95. They couldn’t leave the home. This gentleman had left Pearl Harbor just a week before it was bombed, and so he had some great stories. But as I’m sitting there taking information from him, this 99-year-old man gets up and goes into the kitchen and gets a chair, brings it out for me to sit in because he didn’t want anybody in his home to have to stand. You know, he saw me as a guest, and, you know, it’s just so heartwarming to know that we made a difference in his life. Also, the countless number of people through COVID that were so thankful to receive that vaccine because then they could go and see their new grandbaby that they hadn’t seen or their grandkids or they were able to go back to work or to, you know, have some normalcy in their lives. That was a real rewarding piece. You know, and I try to focus on that so much more than the long hours and time away from my family during that piece.

Brent Ewig 5:27
Yeah. That’s a really cool story and, like I said, could fill your bucket and keep you motivated. I want to turn to some of your work specifically around the Indiana program, but quickly, you mentioned flu there. I was going to ask, Do you know the difference between bird flu and swine flu?

Dave McCormick 5:42
I know I don’t, but I’m looking forward to this next dad joke here.

Brent Ewig 5:46
So bird flu requires a tweetment, while swine flu requires an oinkment.

Dave McCormick 5:51
Oh, gosh, I should have seen that coming. Yeah. So actually, I’ve got one for you.

Brent Ewig 5:57
Sure.

Dave McCormick 5:58
Okay. Do you know what you call a chicken that is well-versed in algebra?

Brent Ewig 6:04
No.

Dave McCormick 6:06
A mathe-ma-chicken.

Brent Ewig 6:08
Excellent, excellent. Putting that into my archive. Thank you. So let’s turn to some of your work in Indiana and widely admired. Can you just tell me a little bit more about your program, how big your team is, and so forth?

Dave McCormick 6:20
Yeah, well, so we have a team of right around 30 people. And like most state programs, you know, we have staff not only in our immunization program, but we also find staff in our state lab, in our resource center, and also in our HIV and viral hepatitis program. So we really, you know, try to make sure that we’re covering all lifespans of vaccinations. We’re definitely looking at that, you know, cradle-to-grave lifespan.

Brent Ewig 8:33
And can you talk a little bit about some of the biggest opportunities and challenges that you faced here leading the program?

Dave McCormick 6:55
Yes. So, you know, opportunity is a…is a really neat word. So, I’ll tell you, coming out of COVID and looking at our just routine immunization rates, I was very disheartened and really discouraged. And someone pulled me aside and said, you know, you’re looking at this wrong. You’re, you’re looking at the glass half empty. Really, the opportunity here is we’ve got a lot of kids that need to be vaccinated, and we can catch them up with all vaccines. So it’s not just an opportunity to catch them up on what they need for school, but it could be those others they missed. And so one of our biggest opportunities right now that we’re facing is kind of debunking those myths of vaccines not being safe. We lost a lot of ground with COVID. And so we’re, we’re doing a lot of, I think, kind of innovative things to increase vaccine touchpoints, ease of vaccination for parents and for, for the clients do we have a lot of electronic registrations, electronic consents, going to them rather than having them come to our providers. But one of the biggest challenges is people are just, they’re weary from, from the outbreak. Had a lot of staff turnover. I’ve had a lot of people that are, you know, before, I felt like gave 150% and, myself included, now I just don’t have the 150% to give. We’re tired, you know, that just happens. Some of the other great opportunities are building the circle of trust back for immunizations. You know, before COVID, we talked about this being one of the biggest and best public health interventions in the 20th century. And, you know, people have seemed to have forgotten that. They forget that we don’t have measles, we don’t have polio, we don’t really even see chickenpox anymore. Because we’ve done such a great job of vaccinating. Meningococcal is another great example. You know most, most providers fear meningococcal. They fear that’s going to be something they missed, but they see very few cases of it. You know, with, with our rates going so low, that’s one of, in my mind, that’s one of our biggest challenges is to make sure that we keep that herd immunity so that we don’t see those those illnesses coming back or those diseases coming back. And, you know, we have the opportunity now to really do some strong advocacy to ensure the vaccines are safe and reliable.

Brent Ewig 9:08
Yeah, yeah, I couldn’t agree more. Let’s talk a little bit about the policy landscape. How much support do you have in the state legislature for vaccination policy in Indiana, and how do you navigate that? What would be your advice to your colleagues on how to navigate some sometimes highly political environment?

Dave McCormick 9:38
Yes. So I think, like most programs before COVID, I felt like we got a very strong, positive relationship with our general assembly and with our legislators. I think because of the uncertainty of COVID vaccines, we’ve lost some ground on that, you know, we, we have legislation, right now, that we are not able to create a QR code for vaccines because that’s deemed as a vaccine passport. And so that’s really hampering a lot of travel both for for leisure and for business far and wide. I would say we have a very supportive state for vaccines. We have an amazing state health commissioner who spent 30 years plus as an OBGYN. And so Indiana, at one point, was one of the lowest states for HPV coverage rates, we’ve been able to really make some ground up with that having that support of the State Health Commissioner and really pushing that issue because she saw firsthand what, you know, not having strong vaccination rates for HPV could do she saw those cancer outcomes at the end of someone’s life, or later in life. You know, one of the things that that we tried to do was really work with our coalition. There’s a lot of places that we cannot do education and advocacy just because, you know, state guidelines, but having a strong coalition, they can, they can go and be our voice when we cannot. We actually fund our coalition at a fairly high level. I think they’re a staff of about 10 to 12 individuals. And a lot of their funding comes through us, you know, they are able to really push the issues. They do HPV Summits, they do legislative breakfasts, and I forget the other term that they use for some of their legislative events. They do, but you know, they’re really able to spend a lot of time at the Statehouse. I know, they get called on to testify for a pending legislation, both, you know, in support and against. And so, they’ve really been an arm that that we haven’t been able to have. You know, one of the things that I would encourage all state program managers is, if you don’t have a coalition, really look at how you can start one. Because they can do a lot of things that you’re not able to do. Procurement is another thing. We’re able, you know, we had some money when we wanted to build storage capacity throughout the state. For us to buy providers, local health departments, if you will, storage units, to buy them refrigerators or freezers, or even continuous temperature monitors, we would have to go through state procurement. We were able to give money to the coalition and have them buy those storage units to build capacity across the state. And so, then there were no ties back to the states where you know, it was our equipment, or we had to do maintenance on it. So you know, going back to your original question, what would my advice be? My advice would be if you…if you have a coalition, support it as much as you can. If you don’t have a coalition, you need to build one today.

Brent Ewig 12:34
Sounds very sage advice. You talked about COVID a little bit. So let’s…let’s focus on that. I know your program has worked really hard to bring more pharmacies on-site for COVID vaccination. Can you tell us more about that? How long have you seen them as a key access point? And why do you think they’re a key to increase vaccination?

Dave McCormick 12:52
Sure, that’s a great question. Actually, that’s one of the topics I like to talk about the most. Even before COVID, I was a big proponent of bringing pharmacy into the immunization landscape. So, you know, we’ve been working at trying to bring pharmacies into the VFC program. And I’ve had a little bit of, of success with that, I’ve had some failure with that. I mean, we we brought in a box store and started with flu, went to routine vaccinations, and it kind of fell apart, just didn’t work. But it was a good lesson, and it gave us a good platform to build for other things. We’ve used that. But even before COVID, we were looking at strong access points. And as I mentioned before, at one point, Indiana was the lowest state in the nation for HPV vaccination rates. And so we started looking at where can individuals go. And you know, even my own personal story. I have two sons, and when they, when the HPV vaccine came out for males, was licensed for males, they were both in high school. They were both in involved in sports and other activities. And for me to take them out of an activity to go get a vaccine that they were uncomfortable talking about, which would then it, then mean that they could not participate in, you know, a sports practice or maybe even at a sporting event, was torture. But if I could take them after sports practice or after an event, to a pharmacy at 8:30 at night and get a vaccine, they were all in. But I argue the fact that I have insurance and I can do that, and that doesn’t seem fair that that I am able to do that. But that someone that is on publicly funded vaccine is not able to do that. And so that’s really been my push, is trying to level the playing field with pharmacy so that anybody could go on a Saturday or Sunday to a pharmacy and get a vaccine, whether they’re a VFC-eligible vaccine individual or whether they’re private insurance, and COVID, really, in my mind brought that to light. Because you know, before COVID, we heard, well, pharmacies don’t have storage capacity. They don’t do temperature monitoring. They don’t have the interest, or people don’t will go to a pharmacy to get vaccine. Well, in Indiana, almost 30% of all COVID vaccine was administered through a pharmacy. And then I would argue that, in my mind, it’s hard for CDC to say pharmacy can’t be a VFC program when we trusted them to properly store, administer and track vaccine, that was probably the most important vaccine that we’ve seen in the last, you know, 20-25 years. I know. So we really need to work on on making that change. And that’s what I’m pushing for here is to, you know, find out what the barriers are for bringing pharmacy on. A lot of it is, it’s perception, it’s not really reality. And it’s addressing that perception and making sure that everybody knows what the current reality state is, and then moving forward. And by doing that, we’ve had some pretty good success. Another piece about pharmacy is that there’s this fear that the VFC program is going to find them or they’re going to be in trouble. You know, I keep talking with pharmacies and saying we’re all about increasing immunization rates, bringing a fine against somebody doesn’t work. It doesn’t, you know, doesn’t benefit people getting vaccines. We want you to be viable partners and administer vaccine, not worry about, you know, if you’re going to be fined, we’ll work with you to make sure that you’re in compliance, where it’s not a regulatory militant state if you will.

Brent Ewig 16:25
That’s great. And, did I hear this right – you’re actually working on a national pilot program? Was there anything you can share about that?

Dave McCormick 16:32
Yeah, so we’ve there’s a couple different things. One is the navigator program. It is it started through a group of individuals through STC Health, and it’s really expanded to include a lot of pharmacies, and state partners, and just individuals that are interested in working with bringing pharmacy into the immunization community and having a strong foothold in that community. And through that, we’ve been able to work with some other partners, to, as you mentioned, to talk about doing a pilot to, let’s see how we can make this work. I mean, really, the whole premise behind bringing the pharmacy on is we need to prove that it can happen. It can work effectively, and there’s a good return on investment and benefit. And I think once we get one big chain working in that direction, and prove that’s making a difference, that they’re not losing money, that they’re not being fined, that it’s not a, you know, a negative business impact practice, that others will follow suit. You know, if you think about access in rural communities, sometimes the Walmarts and the grocery store pharmacy are the main touch points in that community. And they, you know, we have a lot of places, I’m sure Indiana has is not unique. In some of our rural counties, we may only have one or two VFC providers, but we do have a Walmart, or we do have, in Indiana, there are Krogers that have a pharmacy. You know those are, those would be touch points that everybody goes to, and why not make it a place where everybody could receive vaccine, regardless of whether you’re a publicly funded or privately funded vaccine recipient.

Brent Ewig 18:13
That’s awesome. So we wish you luck on that. And please, you know, I’m sure you’ll keep the AIM community informed. I know you’ve already had a chance to, to give some some overview of that. So that’s really exciting. You mentioned the rural areas of Indiana, which reminded me I mean, I’m from Wisconsin, rural areas to a lot of cows out there. Do you know what cows like to read? Cattle logs.

Dave McCormick 18:35
Oh, my gosh.

Brent Ewig 18:36
I know. I did. I didn’t say there’ll be good. I just said that. jokes.

Dave McCormick 18:41
Jokes. Yeah. Okay. All right.

Brent Ewig 18:42
But let’s keep this rolling. So you’ve worked for over a decade in vaccination? Can you share a few of your past leadership positions and kind of some of the leadership lessons from those experiences?

Dave McCormick 18:53
Sure, you know, leadership in the immunization program is, is unlike any other kind of leadership role I’ve had because there are so many different pieces that, that fit into the immunization world. I mean, when you’re dealing with providers, you’re more regulatory. When you’re dealing with your staff, it’s, you know, really, communication is the key because so much information comes out and so many things change. You know, we’ve had, I can tell you personally, in my program, we’ve had some fails like communication. That we haven’t gotten information out to all of our staff members about changes and different things. And so, as all things, this has evolved. You know, instead of having monthly staff meetings, we still have a quarterly staff meeting, but we have weekly briefings. So every Wednesday morning, we have a half an hour set aside where the whole staff comes together through a teams…teams meeting. But we we keep communication up, and it’s a time for me to share information of what’s going on but also to hear what’s going on in fields. I’ve also found that as a manager, I have to be willing to accept what’s going on on the field, and I’m willing to hear what’s not working right and try to adapt to that. I think, as an early manager, I was pretty rigid. And you know, these are the rules, we have to follow the rules, was pretty black and white. And I’ve realized now as I’ve gotten older, maybe I’m more tired, I’m not sure. But you know, there is some room for some gray area. You know, when we look at the operations guide, and you know, what we have to follow, I think there is some wiggle room in there, and we want to work to get providers, you know, we have a set of standards we have to meet, but how we get to those standards is not totally laid out. And so, you know, working to be creative and figure out how we can make it a win-win for everybody. And I think that’s been, you know, probably, the last five years been a lot more of my management style. It’s what’s the win-win for everybody, and how can we get compliance on all levels?

Brent Ewig 20:49
Great. Creativity and management. So important. You touched on this pretty clearly about your advice around starting or supporting coalition. What other advice would you have for for your fellow immunization managers? How do you best navigate these challenges that you’re faced with today?

Dave McCormick 21:06
My thing is, you have to laugh. You know, especially coming out of COVID, I think we’ve seen a lot of emotion. So I mean, I think about the two years there were, the laughter, the anger, there were tears, but I think you have to remember that we’re doing, we’re doing great work for the people of our states, whichever state you’re in, and, you know, we’re protecting the health of them, but you have to have fun while doing it. And it’s a pretty daunting task. I mean, there’s a lot of information that we have to give out. I remember when I started in immunizations, I came, as I mentioned, I came from the Lead & Healthy Homes world. And I felt like when I left the Lead & Healthy Homes world, like I really knew pretty much all there was about lead poisoning and lead remediation. And I thought I’m going to start working in immunizations. And I’m gonna give myself a month or six weeks to learn immunizations. And, you know, a year later, I was like, when am I going to master all the stuff here in immunizations? And 11 years later, I’m still saying that same thing, I think you have to kind of laugh at that. And it’s ever-changing. There’s a lot of moving parts, and you just have to be willing to roll with the punches. You know the other thing is we have a vast network of immunization managers at varying levels of experience. I know when I first started, I went to my first, my first program managers’ meeting, and I remember hearing, like Bob Swanson from Michigan, talk about things that he was doing. And I remember thinking, am I ever going to be that smart and ever, you know, understand the program so well? And Bob’s listening. I’m still thinking about it, Bob, you know, it was, it was very intimidating if you will, but I learned so much from talking with those other program managers, and I would encourage new program managers to do the same. One, give yourself some grace. It’s gonna take a while to learn the program, and the program is ever-changing. So what, you know, the program I learned 11 years ago was not the same program today but reach out to those other program managers or reach out to, you know, the, the AIM membership committee, and try to get connected with a mentor, or, you know, we have, we still have a lot of past program managers that are involved and want to be involved and use that as a resource. You’re not alone out there, you know, don’t be afraid to ask questions. And I’ve found I, I’ve been a mentor to a few different new program managers. And I’ve learned a lot from them as well. And so you know, it’s a rewarding experience, you know, both ways.

Brent Ewig 23:32
Great. I love that the two-way learning, and you mentioned Bob Swanson. I know he’s, I talked to him for a different project. He’s retired up in Michigan, but we’ll we’ll make sure we make, sure we have flag this for him because I’m sure he’d love to hear that. And then you mentioned the importance of laughing, so you asked for it. I’ll try my last one before we go to wrap up here. It’s Daffy Duck and Elmer Fudd were breaking into the Jack Daniels factory, and Daffy Duck turned to Elmer Fudd, and he said, is this whiskey? And Elmer Fudd said it’s whiskey, but not as whiskey as robbing a bank.

Dave McCormick 24:07

Oh, my, I’m glad that your last one.

Brent Ewig 24:10

There’s the last one. In every episode, we have three questions of all of our guests, kind of rapid fire. Are you ready?

Dave McCormick 24:16
I’m ready.

Brent Ewig 24:17
Good. What is one thing you wish you could tell your younger professional self?

Dave McCormick 24:21
I think to, to laugh more, to not be so serious about things. I spent a lot of time worrying about outcomes and realized that you know, you can always fix whatever is, whatever is done.

Brent Ewig 24:34
What are you looking forward to professionally in the next year?

Dave McCormick 24:36
Professionally in the next year? I would say this is not a shameless plug for the AIM Leadership Conference, but meeting with coworkers again, being face to face, getting to meet some of the new program managers and, you know, catch up with some of, some of the older program managers, see how things are going. The AIM Leadership Conference is one of my really, one of my favorite conferences. I…I always come away with a lot. I use some things that I gleaned from one of the very first conferences that I want to just about every day.

Brent Ewig 25:08
That’s from my experience, is that conference is so energizing. Like I said, there’s something you can use every day. And it’s the relationships with people that can go throughout your whole professional career. So I’m glad…I’m glad you flagged that one. And then, finally, what’s the greatest value you get from the AIM community?

Dave McCormick 25:23
You know, I think it’s, it’s that peer conversation. You know, I’ll come home at the end of the day and talk with my wife about things that happened to work and, and she does a great job of listening but really doesn’t understand that, but the AIM member meetups on Wednesday afternoon are a great time. You feel like you have others out there that are experiencing the same thing. It’s almost like a sanity check. You know, AIM has been such a great support system on many levels. And I’ve had the opportunity to be involved in both a leadership role and just a member level. And you know, I’ve gleaned so much from being a part of that organization, and I continue, to this, really value the information that comes out of the AIM community.

Brent Ewig 26:04
Super. Dave McCormick, immunization program manager from Indiana, want to thank you for joining the AIMing to Inform podcast. I really enjoyed talking with you, and thanks for joining our program.

Dave McCormick 26:15
Thank you, Brent.

Brent Ewig 26:15
Thank you for listening. If you want to get all the episodes as we release them, please subscribe on your favorite podcast app, or visit the AIM website to join our mailing list. The Association of Immunization Managers, AIM is dedicated to establishing a nation free of vaccine-preventable diseases. Visit our website at immunizationmanagers.org to get resources and attend events to keep you aiming to inform.

This podcast series was made possible through the independent financial support from Merck. AIM controls all content on this podcast. All episodes were recorded and produced in 2022.