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Dr Vickers:    Good afternoon. Dr. Tamera Coyne-Beasley is our guest today, and we want to welcome her to The Checkup. I've been thinking about this and I'm excited that she can join us today, and we're looking forward to talking with her. Like most of our time, we'll start by understanding a little bit about her.

Dr. Beasley, I will make mention, is professor of pediatrics and Director of the Division of Adolescent Medicine as well as Vice Chair to the Department of Pediatrics at UAB. It took us almost two and a half years to get her here from North Carolina. Now that we finally got her here, we are doing our best to keep her.

So tell me a little bit about your journey in medicine and your background. I know the part of getting you from Carolina to UAB, but our listeners don't know what has been your journey in medicine and eventually your role in growth in academic medicine.

Dr Coyne-Beasley: Yeah. Well, thank you so much for that question and for allowing me to be on this segment with you. I have to say my desire to be in medicine really came from a desire to help people. I found that a lot of people in my community were ill, including members of my family. And I didn't have a doctor within my family. And so when I went to Duke for medical school, I then decided that I would do a med-peds residency with the goal of being able to take care of all people, including children and adolescents as well as adults. And so I had envisioned in fact that I would work in a community health center because that's where I've gotten my care. And I also knew that in that setting I could provide for people who were underserved.

And so while I was actually a junior resident and moonlighting at Kaiser, I actually started working with some other fellows who were moonlighting and they were Robert Wood Johnson clinical scholars. They actually introduced me to this idea of clinical research and engagement in academic medicine. And so I thought, "Hmm, this sounds something that might be able to bring together all of my needs and desires to participate in medicine." And so I did a clinical scholars program. I understood that I could work in community health. I could do community engagement and do research. And so I stayed there and actually did a lot of research in adolescent health that focused not only on sexual health, but also injury prevention.

And one of the things I did is allowed science to actually guide how I would do my research. And so, in fact, when I started out in sexually transmitted infections, we didn't know that HPV was a sexually transmitted disease and we certainly didn't know that it caused cancer. But as I continued along that path, ended up doing vaccine-related work. And then really got on the advisory committee for immunization practices based on a nomination from someone at my institution. And that's actually how I had my first contact with UAB.

Little known to me that this would be what would happen, but there was an individual who was also on the advisory committee of immunization practice and that's the body that makes a vaccine policy. He was from UAB and we became good colleagues and good friends over a period of about four to six years. And so again, I had already been at UNC for 23 years and never really thought about necessarily moving anywhere at that time. But I had finished The Society for Adolescent Health and Medicine. I was the president at that time. And he called me and he asked me to take a look at it. I'm really glad that he had it and that in fact we had developed that relationship, because I might not have looked at UAB prior to that. And the reason why that was important, I came down and visited and I had no idea the wealth of opportunities that I would see here.

It allowed me to do those things that were important to me. One, there was a commitment to adolescent health, there was a commitment to underserved populations and there was a commitment to health equities. And so, yeah, it might've took me two and a half years to get here. But I was also waiting for my adolescents and young adults to graduate from high school as well as college.

Dr Vickers: I don't want to skip over this before we got into the sort of medical meaty questions, you participated in some athletics in college, right? We skipped over your college days. Tell us about where did you go to college and what'd you do there?

Dr Coyne-Beasley: So I went to college at Brown University, a university that I absolutely loved and would make that decision to go there all over again. And I was pre-med at that time. I knew again before going to college that I wanted to go into medicine because of my desire to help people from a medical perspective. And I did play varsity basketball. And I'm pleased to say that I played on the team that for our school won the first Ivy League championship.

And I like to just say that I think that for young people, people often discount sports, but you can do sports and you can do it in a scholarly way. And I think that participating actually in sports allowed me to have the drive that's motivated me today, allowed me to be able to work in diverse teams and allowed me to never give up despite adversity.

Dr Vickers: I know, meeting you and your family, how important sports were, where the evolution of the development of both your career. And there's certainly plenty of data of how young women who participated in competitive sports are really giving them a sense of purpose and drive because of those interactions. That's a great story. And I hope Brown has won a championship since you left.

Dr Coyne-Beasley: Absolutely, they have.

Dr Vickers: All right. Great. Glad to hear that. So your specialty, as you've highlighted, spans the full demographic of our communities, adults and children. So you've chosen that space. How did you get focused on adolescent medicine? What were the pivotal things that said, "This is the area that I'm going to focus on," those tweeners somewhere between adults and children?

Dr Coyne-Beasley: So that's a really important question because it focuses not only on my discipline, but also the context of what was happening at that time. So as a Robert Wood Johnson clinical scholar, within that fellowship, it's a health services research fellowship, as well as allows you to specialize in a subspecialty if you choose, you really have to focus on a research agenda and portfolio. And so for me, I thought adolescent medicine was the perfect opportunity to marry pediatrics and adult medicine.

At that time also, young people were being classified and actually called superpredators. And in fact, that's actually what they were called and the framework from which many people viewed them. And I really wanted to change that framework. I wanted people to be able to recognize adolescents and young people for their talents and what they could bring to the world. I also knew that their activities or what we may call as risk behaviors were really a reflection of what they themselves were seeing in society from adults.

I also knew that many of the things that they were experiencing, the leading causes of death were preventable, whether it was motor vehicle accidents, or it was firearm related injuries. And so I decided that I would focus on adolescent health with the opportunity to try to make life better for them, as well as be in a position to create policies that gave them opportunities to succeed. And so really that's how I came into adolescent medicine,

Dr Vickers: Well, that's a powerful mission, to be able to understand that role in the uniquely powerful position that both as a physician and advocate, you could serve for those individuals. I think that's huge. Does this challenge, bias and racism, exist in the context of taking care of adolescents? We certainly think about it in the context of adults, but does it in your mindset exist in that population and effect how they develop in our society?

Dr Coyne-Beasley: Yeah. This is an incredibly important question and there are lots of important social contexts for young people that societies, where there are bias, particularly impact them. Many of us have heard about adverse childhood experiences, part of that also refers to adverse cultural exposures. And so young people during the period of adolescence are trying to determine their social identity, their moral identity and their sexual identity. And when they receive negative cues and messages in their society about who they are or who they want to become, this can actually be incredibly detrimental to them.

So when you're in societies that have views that are negative about sexual gender identity or are negative about someone's race or gender or even whether or not they are poor or rich. These are things that weigh heavily on young people. And not only do they cause psychological distress, there's actually real physical distress that can happen to young people impacting their self-esteem and how they not only feel about themselves, but about their communities.

Dr Vickers: Yeah, I can imagine that it has a huge impact on their growth and that research will never grow old. It will always be a part of us and maybe even more so now. But like most of us, obviously there has been a change in how we do business. How has your research and your focus pivoted with the onset of COVID-19?

Dr Coyne-Beasley: Yeah, so COVID-19 has actually brought lots of realizations for some and illuminations for other disparities that we've already known for many times have existed. But what it's done is it pressed on those social systems that were already in unequal distributions for people within our country.

And so COVID had many implications, not only for women, but also for young people. And let's start with women first. When we think about women compared to men, they generally have some of the more traditional roles that are taxed in a situation such as COVID-19. And that may be rearing their families, raising their children, being primary caretakers for other members in their family, as well as being involved in childcare, tourism, restaurants, a lot of the industries that made them actually be frontline workers.

So in this situation, many of them also lost jobs while at the same time, trying to manage and maneuver their children and making sure their children and families are doing well while at the same time being asked to homeschool where they've never necessarily had the resources and training to do that. And that's an incredibly difficult task. They may have even lost their jobs and along with losing their jobs, in addition to lost wages, have lost insurance.

And there are also many young people, including women who are in environments that aren't safe, so that they may actually be in a home with someone who is an abuser to them. And so at the same time, not having the resources to reach out to their support systems or even the resources for them.

For young people, we're just beginning to understand the impact on them. Clearly, there have been increases in psychosocial distress, such as things like depression and anxiety. There are also many young people who aren't able to learn as well as they could in a virtual platform. But as we talked a little bit about kind of the socialization of young people and the need to develop their identities during the period of adolescence, so much of that is based on their peer to peer interaction, which they're not able to have during this time period. So that's also affecting them negatively. Not being able to have graduations or birthday parties or to celebrate those milestones in their lives also impacted them in many ways.

And quite honestly, many of us were appalled when we saw the COVID parties that young people were having when they were going back to college. However, it's completely developmentally unsurprising. It's actually developmentally not appropriate to think that they would not get together and gather, because that's where they are in their developmental stages.

But I'd like to say that it doesn't impact everyone the same. And so the other things that COVID brought out was the inequities in our health, the inequities in our social determinants of health. Where we live, what resources we have for healthcare. Do we live in a home that's multi-generational? And so our young people and our families of color were detrimentally and disproportionately impacted not only with rates of infection, hospitalizations, but also death. And so when you think about our young people of color, they not only had to deal with all the things that I mentioned and all the stresses that they had, but they also disproportionately were more likely to have the death or hospitalization or infection within their own home. And in fact may have had less resources to help them through that period.

Dr Vickers: I've often said to people that COVID linked lethality to a smoldering ember called health disparities, like nothing we've ever seen. We were able to tolerate it and watch it and not feel like any need. And I hope we won't look at this and not change, because of the huge disparities that we've seen in our parts of our communities largely based on, as you said, the social determinants of health that ended up largely being in the minority race in our country, particularly Latinx and African-Americans and native Americans and Pacific Islanders and native Alaskans.

Dr Coyne-Beasley: I think the only other thing I'd like to add to that is that also, unfortunately, COVID-19, didn't occur in a vacuum. There was also significant racial unrest in the country at that time. And specifically talking about unequal treatment by law enforcement and many people across all races and genders and all these things that we classify ourselves, got to see it in real live time.

So the other real issue that was difficult and remains difficult for people because as we know, COVID infections are continuing to rise, young people are witnessing and seeing very vivid images of hate, of bigotry, of dissatisfaction with whom they may be coming in terms of their social and gender identity. And so I think this has been a time that has been particularly difficult for young people and stressful, and it's really added an element of fear to their lives and really fear for their lives for many young people of color.

Dr Vickers: Before we go further, let me ask you this. What might we expect to see as fallout and challenges of the lack of in-person education and the inability or the lack of resources in our urban schools, both from teacher training, broadband capacity, what might be the impact on the populations in urban schools that are already behind? What do you perceive this COVID process will actually do? Some would say it will further push them behind.

Dr Coyne-Beasley: Yeah. So I'm hoping this provides opportunities in addition to the challenges. I think just like COVID did for many other aspects of our lives, it highlighted the disparities within education. It highlighted the resource disparities within education. And so some of the things that have happened, particularly that I'm aware about in the Birmingham schools, is providing young people with computers so that they can have computer access, providing them with also broadband access. And so that's wonderful that they now have this as a new access, but things I still am concerned about is who's in the room with you helping you to actually get your assignments done? How do you get your assignments done when you have difficulty? Do you even have the space and privacy if you live in a multi-generational home to get things done that you need to get done?

But I also believe and hope that this is also going to help us to determine things that we need to go in the future. So I'm hoping that those computers that young people got, that they'll be able to keep, that they'll be able to maintain their broadband access, that we'll be able to look at our educational system and to see where the deficiencies are. I'm also hoping that as a result of COVID in many young parents and parents of all ages, including grandparents, all have a better recognition of the importance of teachers. And so that we will not only increase teacher pay, but also teacher training. And that we'll be prepared in the future to figure out, if there's another epidemic, how do we actually address it?

But I think it's also really important to make sure that individuals get what they need from their education. And I'm really concerned about the widening of disparities. And so I'm hoping that through this process, we can identify where those disparities lie.

Dr Vickers: That's a great insight. And I do think you're right. We can never want to see the repeat of the human tragedy that's occurred for any crisis or pandemic, which has been immense in this one. But there are some silver linings. And you just highlighted it. One is just the access to technology that short of COVID-19, many of our kids may never have gotten until they got to college, their own computer, which has been huge that companies have stepped up to get them the devices and then realize that broadband is something that's just not for some, but it should be available for everybody.

Dr Coyne-Beasley: Yeah. And I think the other thing that we often forget, particularly for young students who may be disadvantaged, and when I say young students, I'm talking about all the way up through high school and even college, and I know UAB focuses on some of these things as well, is just the additional social determinants of health or resources that school and institutions of higher learning provide for young people. They provide shelter during the day. There are some young people who are homeless. There are some people in college who when they're not in school, don't have a place to live. It provides the only meals that some young people have, their breakfast and their lunch, and their psychological services. And so I'm hoping that we recognize all that schools provide and enhance those resources and continue to make sure that young people have them.

Dr Vickers: You make a good point. It's important. And it brings me to mind to speak to some of our leaders. We're ending in-person education on the 20th of this month. Normally that would be as late as the middle of December for some, but you're highlighting that for many who are now ending that process, some of these basic things of life that we don't think about what college provides, a place to stay, that running water, warmth and meals, lights. Those things may have gone away from their world that they go back to, and that's something that we really do need to be thoughtful about.

You began to speak briefly on this issue of racial injustice and that had also compounded our world this pandemic. How has this impacted your perspective on the area that you lead in adolescent care, but your role as an academic, full professor woman in American society?

Dr Coyne-Beasley: Great question. One of the things that certainly has come about with the highlighting of racial injustice, again, I say highlighting because it was not like it was never there before, is a greater recognition from the wider population. And what that has also allowed to happen within some groups is to really have a strong desire to be partners, to work to dismantle racism, to identify areas of structural racism and where it exists and how to dismantle it.

And so I've been involved fortunately in a number of ways to try to aid in that process and I'll talk a little bit about some of them. So when you think about structural racism, one of the things or aspects that you can look at is organizational aspects. And so I'm involved with a number of organizations who over time have been doing a variety of different things, but clearly there's been a big push and an effort this year from the American Academy of Pediatrics, from the Society for Adolescent Health and Medicine, and also from the American Pediatric Society, which is the highest honorific, but also service and research organization in pediatrics. And I'm on the committee of diversity inclusion and equity. And this year we actually made racism the issue of the year. And also in a journal that is a very basic science journal, we actually had a section that was completely dedicated towards race.

So I mentioned those three examples, those organizations as examples. The American Public Health Association is another one that is actually looking at its organizational structures, its memberships, its offerings at scientific conventions, and the institution of pediatrics to actually try to figure out how can we do things better? How can we identify areas where structural racism exists? How can we change those policies, which are inherently limiting for some individuals and gave advantages to others to actually make the field of pediatrics better?

You also see this happening in many departments within UAB and UAB, under your leadership, has also had a variety of efforts to actually make this institution-wide priority. I think the other thing that was really important and one of the things that made it very appealing to me to come here is also the commitment to community engagement.

And clearly, there's lots of work that still needs to be done with our partnerships and our abilities to engage each other in meaningful ways. It's been really something that's been developing as well. And I can say one of my most fruitful partnerships is with the Birmingham Civil Rights Institute, where I serve on the board of directors. And in fact, our whole goal is to help people, one, first, understand racism and understand the history of racism. And those two things are key to being able to dismantle racism. And then also having powerful community conversations when people can look at their own biases and reflect on themselves to be able to then utilize that work and looking at the things that are happening in their workplaces, to be able to speak up when they see or hear micro or macro aggressions. And to also understand that this is a continuing learning process.

I think when I talk to people about racism, one of the things that I also try to discuss is the fact that racism is one of many isms. And in fact, if you work on racism and if you work on the hate that distinguishes us based on the color of our skin, it actually will also help us think about those isms related to class, those isms related to gender. And so we all benefit by recognizing the biases that we have in our lives and hate doesn't isolate.

Most people who hate someone because of the color of their skin generally hate for some other reason as well. And it's hard to hate someone that you love. It's hard to hate someone that you care about. And so building relationships is also a really important part of racism and one of the things that I think is really important among the organizations that we belong to, whether they be community-based or they be academic, but also our institutions in places where we work. And that is a real important emphasis at UAB.

Dr Vickers: Yeah. I fully agree, Dr. Coyne-Beasley, that this issue of proximity. If you get close enough to individuals to understand who they are, you will see less differences, but also appreciate the world they live in and realize that the place in their life may not have been at all about self-determination. It may have been about a multiple factor, but it's hard to not like people who you get to know and care about. I think you're a hundred percent. And I think that's a phenomenal opportunity.

And I think too, my former hometown. in many ways I was sad to see, the George Floyd-- always, I was sad to see George Floyd's life taken from him. In many ways, I was sad to see it in Minneapolis, but in some ways, I realized had it occurred somewhere else, it could be seen just as a regional problem. But because it occurred in Minneapolis, the country realized that more than ever, it's probably a national problem.

Dr Coyne-Beasley: I honestly think people really became aware of what was happening, because it wasn't just happening in the South as people would stereotype the South. It was happening all over the country and it was undeniable. It was actually occurring on camera. And it was the kind of things that were happening, again, these aren't new activities, but it was happening in the context of COVID it was happening in the context of people recognizing there might've been alternative ways to handle the situations and it was captured on camera. And for many of those instances, in particular we'll talk about George Floyd, it was captured by a young adolescent woman. And what are those images going to do to her for the next several years? What are they going to do to all of us who witnessed it and were traumatized by those images that we saw?

Dr Vickers: Absolutely. So the other area of your expertise that affects us now, and we've just heard this positive news about vaccines, the Moderna vaccine has just released their early efficacy data showing it to be nearly 95% efficacious. So can you speak about now that we know part of the challenge, we had was that we didn't know if we were going to have an efficacious vaccine? In fact, the bar was only at 50%, but now we know we have vaccines that are arguably nearly 90% or greater effective in potentially preventing COVID infections.

The next big hurdle is who gets the vaccine and how many people. What are your thoughts and what would you say to the communities in Birmingham, both majority and minority, rural and urban, about the value of vaccination and why this vaccine is going to be important, but just the process of vaccination to our society?

Dr Coyne-Beasley: Yeah. Well, wow. Thank you. That's such an important question. And we could probably spend 30 minutes talking about that, but I think that one of the things I want people to know, because I think there's a lot of mistrust about vaccines, I think the speed with which this vaccine has come out has caused some trepidation, but I really want people to understand that there really is nothing in our medical repertoire that has been able to eradicate disease or even reduce health disparities to the extent that vaccines have.

Many of us or many people who may be listening to you may not remember polio or remember smallpox or getting a vaccination for smallpox. I do. And so vaccines have a history of eradicating disease, smallpox and polio being examples, and as such reducing any health disparities that were related to them. The measles, mumps and rubella vaccine, in fact, eliminated significant health disparities as it related to the measles vaccine.

And so there is no other-- oh, well, there are top ten public health achievements in the world and vaccines are really one of them. They've not only eradicated disease, but they actually have improved our lives and our survival. And just to give an example about the potential of vaccines that's really important is when we think about the human papilloma virus vaccine. What many people don't understand because you heard so much about cervical cancer, but human papillomavirus also causes, in addition to cervical cancer, vaginal and vulvar, anal and oropharyngeal cancer, which is the most common type of cancer.

Without going into a lot of description, it's important to know that there are disparities, even within all those types of cancers. Disparities that are different by male and female, as well as race disparities. And I think it's also important, when we think about disparities, it's not always individuals of color who actually have the worst outcomes.

So for instance, for vulva and anal cancer is largest among white women. We have the potential, with the vaccine, to eradicate or reduce those health disparities. When it comes to COVID, this is incredibly important and you asked me about my research. My research has led me to think about and to research, particularly with adolescents, how to increase vaccine uptake. But during COVID, not only am I doing some work with COVID vaccines, I actually serve on advisory boards for two of the manufacturers who are manufacturing the COVID vaccine.

And so what I can tell you from that close view or tell the audience certainly is that a lot of care is being developed and utilized to try to make this vaccine safe, try to make sure that it's efficacious, enrolling young people, as well as enrolling people of color to make sure that there's a safe vaccine.

Why is it important and why do people need to utilize the COVID-19 vaccine? It is important because of the disparities that we see in hospitalizations, that are in deaths among people of color. It's important because we know that we don't want to stress the healthcare system and, while we're thinking about COVID, also recognizing that we may not be able to treat your hypertensive episode or your heart attack or your stroke, because there are COVID beds that are overrun, or they're taking all the beds within the hospital.

So it's anticipated to be incredibly safe, but also to work with communities to try to increase uptake. And so the community has a lot of concerns. Safety and efficacy should not be them, but we want to work with communities to help make sure that they feel comfortable. But it's an important vaccine, because we believe it will be lifesaving coupled with other public health measures. So we still want to wear a mask. We still want to exercise, good hand washing. But we're hoping just like with smallpox or polio that we may actually be able to dramatically reduce the incidence of this disease as well as reduce the health disparities that come from it.

Dr Vickers: Well, you highlight one of the challenges is going to be, as we get vaccinations done, there is going to be this gray zone of when do you stop the public health measures and when do you have enough people vaccinated? And I can imagine there will be those who will be wanting to end those public health measures early some times before we've gotten enough of our population truly immunized against this virus. And that's going to be not easy. That'll be a challenge for us to stay vigilant until the vast majority or at least north of 50 to 60% of our population has had the vaccine.

Dr Coyne-Beasley: Yeah. I think one of the things that's important for people to know too, I started to talk about how there's nothing like vaccines, whether it's been therapeutics or drugs in the lay terminology or medical devices, nothing has ever decreased or eliminated heart disease or anything related to kind of the therapeutics that we use or even medical devices. And the other real difference about vaccines compared to medical devices and therapeutics is that they are continually evaluated and under surveillance for the lifetime of that vaccine. And I can tell you that from serving on the advisory committee for immunization practices. So there are always opportunities to reevaluate vaccines to pull vaccines from the market and safety signals are always monitored. So there's not anything that you can take that is under a greater surveillance than vaccines.

Dr Vickers: So let me ask you a hard and personal question, are you going to take the vaccine?

Dr Coyne-Beasley: Yes. And I can say that. Thank you for asking that question. And it's a very similar question to I gave my son HPV vaccine when it was permissive for young people. And the vantage point that I have and maybe what makes me more likely to take it than perhaps someone else is that I have been able to look at the data. I've been able to be an advisor on what should happen and what protocols look like.

But I want people to know that vaccine manufacturers are really trying to do the best job. I understand fear and mistrust. I understand being confused because there's also conflicting information that is out there. But there are a lot of scientists who will be monitoring not only the vaccine, but monitoring the disease. So there will be an informed and scientific decision about when we can stop the public health measures. And so none of this stuff is random and happens in a vacuum if you listen to the scientists.

Dr Vickers: Yeah. I think you make a great point and that the rigor around it hasn't been reduced because of the speed of getting it. The advances in science are really what have shortened the gap of getting a vaccine ready for trial and then the urgency of people being willing to enroll. Sometimes to get 30,000 people, it may have taken two and a half years.

Dr Coyne-Beasley: Yeah. And I have to say, I completely understand that because when I was nominated for the advisory committee that was actually in 2010 and I remembered how long those trials were taking and how long it would take us to make recommendations. The urgency has really created a change in the way we do science, not by cutting corners, but by the innovations. And in fact, this won't be the only vaccine that was made quicker than usual. The Ebola vaccine was actually manufactured and distributed within 12 months, which was razor speed science at that point in time. But as people know, the Ebola outbreak has been relatively contained and that vaccine is safe and effective, but that was a record time at that particular time as well.

Dr Vickers: Dr. Coyne-Beasley, thank you so much for joining me on this episode of The Checkup. We have enjoyed since the first day that you and your family moved to Birmingham. And I am excited that you're here, but terribly, even more so excited about the work that you're doing at UAB for our state and the nation. Thank you again.

Dr Coyne-Beasley: Thank you. It's a pleasure being here.