ASTHO Q&A: Mary Selecky

Sep 18, 2012, 11:17 AM

Crowds of public health officials thronged Mary Selecky, Secretary of the Washington State Department of Health since 1999 and a former ASTHO president, at the ASTHO annual meeting, likely for her wisdom as a long time health director grappling with some of the most critical problems facing public health.

NewPublicHealth caught up with Mary Selecky at the recent ASTHO meeting.

NewPublicHealth: What is the rest of the country learning from the recent pertussis (whooping cough) outbreak in Washington State?  

Mary Selecky: We have more than 4,000 cases confirmed. Sixty percent of cases are in school age kids, 20 percent in adults and 20 percent in kids under age five. The most worrisome statistics are the numbers of babies hospitalized. [Editor’s Note: Babies get whooping cough vaccines at ages two, four and six months and don’t have full immunity until after the last vaccine.] Most adults get a mild case—they don’t know they have it, they have a dry hacky cough and they’re spreading pertussis germs. One of our very fundamental pieces of information is to make sure your kids are vaccinated and up to date, and that teens and adults have gotten a booster shot. We know we’re reaching the public because our insurance companies are telling us that double the  amount of people have gotten the booster from last year. We know we’re getting some penetration there, but clearly not enough.  

It has not really gone away. We’re still seeing about 100 new cases every week. We are slowing down—it’s a little bit less every week. Nevertheless, 100 cases per week is still ten times more than it was a year ago. We reached out to the CDC to have their epidemiology investigators to come in and look at our data and see what is happening. They were able to show us that our 13- and 14-year-olds are getting hit hardest and many were vaccinated, so we are evaluating when the booster shot was given and how soon after they got pertussis and what we can learn.

We’re seeing more whooping cough in the U.S. than we have seen in multiple decades. Our own numbers are more than we’ve seen since 1941. It’s a bug, easily passed person to person. We do have an effective vaccine but what the CDC is able to glean may indicate that we need to give a booster more often.

NPH: While the CDC investigates, what’s your recommendation as a state health director? 

Mary Selecky: Get vaccinated. Don’t avoid it because you wonder if the vaccine is effective—it is. We need to find out how long it is, which we’ll know once the CDC has completed its investigation. But there are a lot of people who don’t have whooping cough, so there is some protection, clearly from the vaccine.

We declared an epidemic.  We did it to get peoples’ attention, to have them take action, to hear our message that they can do something to protect themselves and their kids. For example, most people don’t think pregnant women can get a pertussis booster, but they can and it provides some immunity to their newborns. Pregnant women should get a flu shot, and if they didn’t have one, they should get a pertussis booster. Getting it more than once is not a problem.

NPH:  Your state has been working on the Agenda for Change—ideas for what public health should look like in the future. Tell us about that.

Mary Selecky: We’ve been asking, “what does public health need to be in the future? How do we protect our successes and tackle our challenges? How do we do business differently because the health department of today looks very different than it did ten years ago?” For example, with whooping cough, the health department’s role hasn’t necessarily been having nurses conduct public health [and give vaccines directly]—it has been working with the community including medical reserves and physicians and clinics. Public health oftentimes is the facilitator of action, because we have the information and an intervention we need to have happen, but we need to have multiple partners doing it. It is different than the way we worked in the past.

We’ll have results on the Agenda for Change late this fall and we’re talking about what needs to be in place anywhere for people to be protected everywhere. A new way of providing services may be buddying up. Maybe not every county has to have everything, and instead we can share, when possible, across borders.

NPH: How will you share that information?  

Mary Selecky: We have great partners. Everything we do is about both state and local. John Wiessman, current president of the National Association of County and City Health Officials, is from Washington State and is co-chairing the Agenda for Change. We have been talking about it wherever we go, and as a result sparked some interest in other states. It’s a matter of sharing the wealth. There’s nothing extraordinary about Washington State. We learn from each other all the time. We plan to get the word out as much as we can.

NPH: How can we help new state health officers coming into a new public health get up to speed?

Mary Selecky: Leaders in public health may have very different life experiences, but once we find ourselves in an authorizing environment that requires political savvy—and, indeed, every day learning that there is some new challenge. You really have to be nimble on your feet, seek out information from the best sources and partner, partner, partner and communicate, communicate, communicate. There are some basic tools you have to keep in mind: What partnerships do you have and which do you need to find?

And communication is so critical. How do I communicate information and have people do what I ask? I have to gain trust every day. For example, I tell the population one day not to drink the water because there’s a bacterium in it, and then several days later, magically, you’re saying the water is safe to drink. I need the public to trust me when I make either of those announcements. The public’s trust is precious.  

>>Read our previous Q&A with Mary Selecky about her advice for up and coming public health officials and more.


This commentary originally appeared on the RWJF New Public Health blog.