Richard Pan, MD, MPH, a pediatrician and California state senator, has made public health and patient safety his life’s work, advocating vaccination long before COVID-19 upended life around the globe. The AMA honored his efforts to advance public health in 2014.

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This type of work has its perils, however. Dr. Pan, who wrote a state law (Senate Bill 276) to prevent fake medical exemptions for childhood vaccinations, has been on the receiving end of many anti-vaccination campaigns and sometimes violent behavior. An image he saw at a 2019 rally outside of the state capital stays with him to this day.

“When you think about a rally, what do you put on the stage where your speakers stand? You’d normally expect a banner that says, ‘No on SB 276.’ Right?” Instead, the rally organizers displayed images of Dr. Pan’s face with blood on it. “They even wore T-shirts with that image as they walked into the hearing” to debate the bill, he recalled.

Allowing these tactics to succeed is akin to giving terrorists ransom money, said Dr. Pan, whose Senate district encompasses parts of Sacramento and Yolo counties.

“You can't back down, even when your life is being threatened,” he said.

In an interview, Dr. Pan—who serves as an alternate delegate representing the California Medical Association (CMA) in the AMA House of Delegates—discussed what drives this behavior and why it’s important for physicians and organized medicine to keep advocating on behalf of their patients despite violent threats.

AMA: Can you tell me about the two vaccine-related bills you've authored (SB 510 and SB 742), which had the CMA’s support and that California Gov. Gavin Newsom signed into law?

Dr. Pan: SB 510 ensures that physicians and other providers are providing testing and vaccinations without cost sharing. This is very important for individuals, but also from a public health perspective. We didn’t want people to say, "Oh, well, I've got to pay money for this test. So maybe I'll just pass on the test." Then we wouldn't know if they were infected or not.

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AMA: Doesn’t federal guidance already state that the vaccine is free, that there’s no copay?

Dr. Pan: Exactly. You aren't supposed to charge a copay. What we did is we took that guidance and enshrined that into state law. Once the federal guidance gets lifted, California state law will say, "By the way, you still can't charge a copay." We also set it for future pandemics as well.

SB 742 is built to ensure that people won’t be harassed or intimidated once they make the decision to get vaccinated. People have done this at vaccination sites. Some anti-vaccine extremists have a history of violence, threatening public health officers and their families at their homes. Others stream into stores without masks and expose people.

In California, a group of anti-vaccine extremists obstructed entry into one of the largest vaccination sites in the country, over at Dodger Stadium in Los Angeles. In Southern California, another extremist drove a car into a vaccination site and struck a health care worker. This also happened in Tennessee.

Some people have raised First Amendment issues about this. We’re not denying them from being able to speak. They can do that in a variety of different locations and different ways. They don't have to threaten people at a vaccination site. They have to maintain a safe distance.

AMA: As a pediatrician, what are you hoping physicians are telling parents about the COVID-19 vaccination?

Dr. Pan: I'm hoping they're telling their patients that the COVID vaccine is safe and effective. It's been thoroughly evaluated, administered to hundreds of millions of people. If their patients have questions, they should encourage them to ask those questions and get accurate answers from either themselves or trusted sources, like the American Academy of Pediatrics or the Centers for Disease Control and Prevention.

If they have children, they could say: "As a pediatrician, I've looked at the information and the data, and I'm getting my own child vaccinated. I've made that decision for my own family.”

If anyone wonders why I’m so passionate about vaccinations, I saw people infected with measles and children dying of measles in Philadelphia during an outbreak in 1991.

AMA: You've been a longtime legislator and AMA delegate. What prompted you to get involved in advocacy and policymaking at such a deep level when so many doctors struggle just to stay afloat in a demanding practice environment?

Dr. Pan: I view my advocacy work, my participation in organized medicine, as an extension of my practice. As a pediatrician, I take care of children. I work with families. Certainly, the things I do for them are important for their health. But I also know their physical and social environments impact their health. It’s important that we, as physicians, advocate for our patients and for healthier communities.

The mission of the AMA, and frankly every physician organization and medical society, is to improve the health of the people, as well as to promote the art and science of medicine. If we're going to do that, we have to advocate.

My goal growing up was to be a doctor, not a legislator or an elected official. But as I was going through my medical training and career, I recognized how important community was to people's health.

As a resident, I got more involved in in educating resident physicians about community health. I served on many community organizations, on a county commission on children and families, and started a not-for-profit to get children health care coverage and to strengthen the safety net.

Having done so much work and recognizing the very important role government played in these social determinants of health, I decided to run for office. And thankfully, with the support of the California Medical Association and my fellow physicians, won an election no one thought I could win.

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AMA: Even before COVID-19, you've pushed for tougher vaccine mandates. But advocacy is no picnic. You faced a physical assault a few years ago from an opponent of vaccination. What sort of courage is required to stand up for what's right in terms of public health?

Dr. Pan: That individual struck me as hard as he could in the back as I was walking past. I think he was hoping I would strike him back. He was livestreaming all of this on Facebook. It was very intentional. I got pushed forward several steps—my companion actually heard the blow.

I certainly recognized him, He's come to the state capital and gone to events in my district to harass me and threaten me. And it’s not just him.

AMA: What do you do to counter that kind of negative energy?

Dr. Pan: First, it's important to realize that this is a fanatical minority. People like this don't have science on their side. So that's why they resort to threats and violence and intimidation. Obviously people have different opinions. That's fine. But it should be made based on facts. And people can have different approaches to solving problems. And we can debate those things.

The answer should not be, "Oh, if I don't get my way, I'm going to try to kill you."

Most people support vaccinations. They want to be safe. They want to be healthy. They don't want to be endangered. And we need to organize the pro-science people. So that's important. Certainly, I really appreciate the support I get from my fellow physicians as well.

AMA: COVID-19 has sickened tens of millions of Americans and killed over 750,000. The hesitation and resistance, if anything, seems stronger than ever before. What's going on, and what can be done to turn the tide?

Dr. Pan: We have an outrage machine that's causing a real problem. If you put something accurate out there, it gets swamped by all the disinformation. We can't come together if people believe in lies, and basically our news cycles are driven by outrage.

One of the things we need to confront in our country is the role social media is playing in pushing division extremism. ... We know that posts with lies and falsehoods spread faster than posts that don't.

AMA: Hate crimes against Asian Americans have reportedly risen during COVID-19. As the child of Taiwanese immigrants, this must hit close to home. What have you been doing to address this?

Dr. Pan: Unfortunately, it’s hate against Asian Americans, and Native Hawaiians, and Pacific Islanders. It's not a new phenomenon. But certainly, with COVID, I have to call it out. When Donald Trump and his followers keep saying "China virus" and "kung flu," they incite attacks on Asian Americans.

In our state budget this year, we included $156.5 million to address hate directed against the AAPI [Asian American and Pacific Islander] community. Most of that is going to survivors, but it’s also to address bullying in schools. We also gave funding to the ethnic media to help get more information out to people as well. This has been a major priority.

There are extremists who are willing to use threats and violence to push their agenda. And that's not what most Americans are about. 

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