Command & Couture

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Anyway, it sure was fun talking with you all about how I developed a dynamic functional framework for meeting standards-based readiness objectives. I know this is one of those ongoing, nuanced, informed discussions we all LOVE to have about national security these days, so don’t be a stranger! /fin

And finally, the standards themselves have to be both measurable and dynamic to meet constantly shifting requirements and address capabilities fluctuations. 8/

But wait! You gotta align it and level it too! Can’t have a flat assed framework, that’s not leathal. Gotta give her some dynamic range and aggregation. 7/

If you like thresholding and math to destroy your foreign adversaries like I do, you can pull composite metrics together for a ✨Master Dashboard✨ of KPIs and thresholds. 6/

But then you have to actually measure where you are to know where you need to go. 5/

But Dr. C2, what’s the framework breakdown into readiness domains and elements, you ask? 4/

Readiness = degree to which Total Force prepped to achieve mission obj. in expected conditions.
•Inputs(resources):personnel metrics, training status, materiel, etc.
•Processes(maintaining):train cycles, sustainment, doctrinal compliance.
•Outputs (capability):ability to execute METs to standard. 3/

The male PT standards are one element in subdomain “deployability”. The element is a composite metric I developed across the Joint Force w/recruit baseline → average line force → SOF/elite weighted roughly equally.

It counts for 2.6% of its subdomain, which counts for 7% of its domain. Pew pew. 2/

Huh. It seems my niche personal passion project of 11 years has become a topic of national interest. Enjoy my strat-level snapshot of a standards-based framework for readiness based on a decade of research & evaluation on readiness? I guess? Or is this about ponytails again? 1/

Just got my HepB booster this week. Looks it’s a good time to communicate the benefits of doing so for folks who may become pregnant or give birth in the foreseeable future to help disrupt that transmission chain. May want to focus on testing as well…

Deference can be compelled. Respect cannot. It's earned. #OnObedience

I’m grateful too, and overall they performed admirably. As I just threaded to my following of 2, my hope is that this historical moment in public health also includes a gathering in and course correction on our behalf, too. ⚕️❤️

To all 3 of you who read this, please learn from our fail. Recognize our entire scientific & public health infrastructure is built on trust, and while data supersedes ideology as evidence, it doesn't absolve us of our ethical duties. Now. Back to our regularly scheduled NATSEC programming. 15/end

Moral & ethical accountability are only self-enforceable. Integrity is what builds trust. So, the anti-vaxxers get this one point: we don't have the right to compel and it's craven, desperate bullshit to shame anyone in our care. I doubt the public apology will be forthcoming soon. 14/

But I've been deeply pained watching some scientific colleagues build wealth & platforms, win awards, and seek accolades by acting divisively, coercively, and martyring themselves by seeking conflict & appealing to shaming tactics. They're equally responsible for rejecting science & ethics. 13/

Like every epidemiologist-cum-Fed in the US, I've had my life threatened & my integrity, qualifications, ideology, intelligence, and sanity questioned by members of the public. And it sucks. I've been frustrated and angry at the ideological attacks on vaccination & its supporters. 12/

10 years later, I'm watching vax confidence and herd immunity collapse in a haze of violent conflict & contention. My well-meaning ideological & professional allies are losing a fundamental "debate" in great irony: they ignored the science & ethics of vaccine hesitancy. 11/

In youthful exuberance for this new-to-me logic, I thought that the weight of our ethics, the science, & common sense was a legitimate challenge to the hegemony. Maybe "bullying the anti-vaxxers back" was going to end badly for us. My ideas were entertained, to be fair. But they were rejected. 10/

If our aim was to reduce morbidity & mortality, shouldn't we support at least partial vax/modified schedules as long as they weren't ineffective or dangerous to avoid escalation & conflict? Shouldn't we build trust by being honest that there are SOME SMALL risks associated with vaccination? 9/

If the *science* said vax hesitancy wasn't about info or data but about worldview, the coverage risks were manageable, and we were honor bound to respect the medical decisions of individuals, couldn't we focus on vax access or series completion in folks that actually *wanted* what we offered? 8/

As I contemplated & weighed this, I came to a conclusion I hold today: if we're oath bound to allow the exercise of autonomy, informed consent, or refusal, AND the coverage gaps were relatively minor, AND if we pursued aggressive advocacy it could backfire - shouldn't we reconsider our tactics? 7/

The most fascinating thing I began to glean from the research was that the kind of emotionally-loaded, choice restrictive, data-touting communication we built the vax communication enterprise on could have backfiring effects. That the more we "battled" the hesitant, the more they'd double down. 6/

As I read & synthesized the lit, the evidence suggested a few things to me. 1st, that vax hesitancy was a bi-partisan issue with SES features. 2nd, that trust, emotion & worldview moderate vax uptake in critical ways. 3rd, that access to facts & info didn't have the impact we assumed or wanted. 5/

The consensus & chatter then was that hesitancy was a massive, growing problem. At the time, vax coverage rates and VPD incidence & prevalence were pretty untroubling save what seemed to me to be minor hesitance-related incidence. But the alarm bells were rung loud and clear even in 2015. 4/

My duty largely included systematic lit review and report drafting for the WG. This involved months of painstaking work reviewing the scientific, social science, eval, and policy lit on vaccine confidence/hesitancy/risk response to inform and frame the WG's deliberations and recommendations. 3/

10 years ago I worked on the National Vaccine Advisory Committee at HHS; a fresh epidemiology PhD on the Vaccine Confidence Working Group. Now a grizzled technocratic center-left curmudgeon, I was the shiniest of idealistic mini-Obamacrats then. The most annoying Hill staffer species, I know. 2/

I'm listening to the "CDC Restoring Trust" hearing as I work. Most of it's mortifying, but I'm utterly unsurprised at the sorry state of vaccine affairs. True to the two oaths I swore, one Hippocratic and one to the US Constitution, I admit: there's one thing the anti-vaxxers are dead on about. 🧵

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I made it just under the wire. No sleep, but that wasn’t going to come anyway…

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I mean, how badly do you need the grant?

Same, friend. Same.