TheVaccinator

Adam - I met you at a signing at TMobile in DC. You were very friendly despite so many people. I brought an Orioles painting I keep in my office. You were always my favorite modern player. We miss you on the O’s so much. Keep enjoying life!

Four questions:

1. What’s your best story getting confused with Adam Jones, guitarist for Tool?

2. What are your thoughts on Bmore-style crab feasts? You come from a seafood town on the west coast and we have a particular style out here.

3. Any fun Buck Showalter stories we wouldn’t know about?

4. How many OPACY crab dogs can you eat in one sitting?

Haha thank you for such a thoughtful reply!

Can’t believe you got routed to the wrong Adam Jones’ hotel room and it was the Tool guitarist haha. I’m sure he remembers.

I’ll just forget that you aren’t a big crab feast fan ;) but keep on doing your thing!

Much love and YES PLEASE COME COACH THE O’S!!!

Dr. Vandelaer,

First off - it's a pleasure to speak with you. My MSPH was International Health with a minor in Vaccine Science and Policy, and I spent a year working on vaccine policy for the US federal government before beginning my PhD in Health Policy and Demography (almost finished my first year!), so I am very interested in your work. Just check out my reddit account name... I guess you could say it's my passion :). I have a few questions:

• In the US, the anti-vaccine movement is fairly powerful, at least in the sense that it has a significant following and has been linked temporally to several outbreaks. It seems that the media just makes it worse. Giving equal (or more) air time to anti-vaccine persons as to, say, the head of ACIP. Also, several federal vaccine advisory committees have anti-vaccine persons ON THEIR COMMITTEES AS VOTING MEMBERS. I understand giving a voice to opposition, but I feel it's not safe nor fair to give voting rights to people in blatant ignorance of the mountain of evidence as to everyone else on the board (mostly experts on the science behind the policy). What are your thoughts about possible ways to improve how we communicate about vaccination and increase it's mass appeal? Do you encounter such problems in other countries?

(On a related note, in light of how powerful anecdotes seem to be in propelling the anti-vaccine culture, I think countering those anecdotes with anecdotes of parents and family members whose loved ones died or were permanently disabled from vaccine-preventable diseases, urging people to vaccinate could be effective. Serious vaccine-preventable outcomes occur at a much higher rate than do the "fake" vaccine adverse events, and especially the serious but extremely rare serious adverse events that are actually known to occur, so it seems that this could be an effective strategy).

• In the United States (and in other countries, I did my Master's thesis on this work), the rate of healthcare personnel influenza vaccination is unacceptably low, despite (in many cases) GREAT efforts to educate, make the vaccine convenient (often free), etc. It seems to be a culture issue here in the US, at least partly. In recognition of the failure of such extensive (and costly) efforts in the US, it has become increasingly popular for healthcare organizations to make the annual vaccination mandatory as a condition of employment, without exemptions (other than documented medical contraindications). This has been extremely successful, resulting in rates approaching 100% vaccination, with termination of employees occurring often at only a fraction of a percent. However, this topic still remains controversial. What are your thoughts on how to improve this issue on a larger scale? The US Supreme Court has ruled that States have the ability to mandate such things, but not the federal government (unless during a public health emergency), but so far, no states have touched it, it's just been up to individual organizations who feel proactive).

• Another influenza question - how close do you think we are to developing a universal influenza vaccine?

• One issue I struggle with is the role of the free market in vaccine research and development (especially in the US, with its patent laws). On one hand, patent laws (and free market pricing) allow vaccine manufacturers to have SOME financial security on the payout of their investments in R&D. The estimates I've heard from the US are that it costs anywhere from $100 million to $1 billion to get a vaccine from Phase I through licensure, and that less than 1 in 80 make it to licensure, so it's a risky endeavor. That being said, as we well know in the US, manufacturers have little financial incentives to invest in effective, preventive drugs/treatments in comparison to expensive medications that must be taken many times over one's life, so there is an imperfect market here. Further, we have seen examples, such as with the HPV vaccine in the US, where manufacturer price affected the ACIP's recommendation - in that case, in which the vaccine is more cost-effective in women (considering they have the additional benefit of cervical cancer prevention, which makes up a lot of the disease burden of HPV), and the manufacturers determined their market price to be cost-effective in women, but not in men. When ACIP was trying to make their recommendations, they couldn't find it cost-effective in men at the high price that was set, even though it prevents many cancers and warts in men, so they only made a passive recommendation to males. If the price were not so high, it would have been recommended to both sexes. I know there are alternative pay structures out there - the airline excise tax that France uses, GAVI's model, productRED, but wanted your insight on these matters.

Thank you for all of your work and effort. I would love to speak with you some day!

TL;DR:

• You're awesome; I love vaccines.

• The anti-vaccine movement: Possible ways to improve how we communicate about vaccination and increase it's mass appeal? Do you encounter such problems in other countries?

• Low rates of HCP influenza vaccination: how to improve on a larger scale than relying on individual institutions to make it a condition of employment?

• How close do you think we are to developing a universal influenza vaccine?

• The difficult case of making vaccine R&D more attractive: trade-offs between role of the free market/patent systems vs. regulated market vs. newer payment models... thoughts?

EDIT: added some questions EDIT 2: added TL;DR, since my questions are complicated and required a lot of text. EDIT 3: spelling/grammar

Hi Derek.

First, I'm from Baltimore and also went to THS (and also love Mr. Stange). I just wanted to say hi and thank you. Every time I see you on TV with your Orioles hat on it makes me happy. I love that Baltimoreans (or Baltimorons, depending on the circumstances) show love for their city no matter where they are. Truth be told, I'm currently wearing a 2013 Super Bowl jersey (Ngata) in central PA right now (in Steelers country). It's especially funny that your last name is Waters - just like another quite famous Baltimore native. (Speaking of him, I grew up in the neighborhood where Serial Mom was filmed. Good times). Anyhow - keep up the good work. Ravens and Old Bay, O's and Boh's, hon!

Second - my question. Have you asked John Waters to direct an episode? Because you should ask John Waters to direct an episode. Would be the best. Just don't go eating any dog poop.

Sincerely,

Another Baltimore local and enthusiast

I would like nothing other than to tell Poe's story while drunk in Fell's Point, which would be the most appropriate place to tell the story. Possibly at Max's or The Horse You Came In On or The Waterfront Hotel - probably attended by Poe at some point.

I don't know how but I want to make this possible. Let's summon up our B4LT1M0RE powers. And possibly bring with us Mr. Stange.

LET'S DO IT DEREK. LET ME IN ON THIS, PLEASE!

EDIT: I also have an actor friend in LA who could play an excellent Poe. And do stage combat or stunt work, if necessary. This is his specialty.