Why Doctors and Nurses Can Be Vital Vaccine Messengers

In this Axios column, Drew Altman examines why doctors and nurses are such critical messengers in the effort to build vaccine confidence.

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President’s Message

Explaining KFF Drew E. Altman, Ph.D., President and Chief Executive Officer. Updated: April 2021 Follow Dr. Altman on Twitter: @DrewAltman This essay discusses the choices we have made about our mission and operating style. Of course, I believe deeply in what we are doing at KFF, but I offer this with…

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Dysfunctional websites are making it harder for Americans to get vaccinated. Here’s how to fix that.

In an op-ed for The Washington Post, Drew Altman spells out how COVID-19 vaccination can be simplified to ensure that the public’s rising confidence in the vaccine isn’t thwarted by frustrating and sometimes dysfunctional websites.

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Where To Start To Build Vaccine Confidence

In this Axios column Drew Altman writes about the recent attention to Republican vaccine resisters. “Republicans and rural Americans are among the most resistant vaccine holdouts and some strategies are emerging to reach them.” But “far from all Republicans are resisters” and “the bigger and quicker payoff will come from prioritizing the more moveable group of ‘wait and see’ Americans.”

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Vaccine Confidence Isn’t The Main Obstacle To Reaching Herd Immunity

In this Axios column, Drew Altman paints a more optimistic picture of the prospects for getting to herd immunity as vaccine confidence grows, but underscores the urgency of building vaccine confidence in Black and Latino communities where barriers to access and good information are obstacles to getting vaccinated.

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Seeing Others Vaccinated May Be The Best Cure For Vaccine Hesitancy

In his latest Axios column, Drew Altman shows why vaccine hesitancy will naturally decrease as more and more people see their family members and friends vaccinated without adverse consequences. It’s a hopeful sign about vaccine hesitancy, and should help free up resources to focus on the remaining vaccine hesitant.

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A shorter version of this column has been published by Axios. “Your doctor and your nurse trusts the COVID-19 vaccine; you can too.” It’s one of the most important messages vaccine reluctant Americans can hear. They trust their doctors and their nurses and almost all of them have been vaccinated or plan to get vaccinated. By the numbers:
  • Throughout the coronavirus pandemic, majorities of U.S. adults have said their doctors and nurses were their most trusted sources of information about the coronavirus and eight in ten have said their doctors are the ones they will turn to when deciding whether or not to get a COVID-19 vaccine.
  • Nearly nine in ten physicians (and nurses with graduate degrees) report either already being vaccinated or plan to get a vaccine.
  • A majority of all the other health care professionals who diagnose and treat patients say they are already vaccinated or plan to be (those with bachelor’s degree: 86%; associates degrees: 68%).
Frontline health care workers who provide other forms of care, such as assisting patients with bathing, housekeeping, or clerical work, have lower levels of vaccine uptake and report the same concerns of the public generally including concerns over the possible side effects or wanting to wait and see how it works for other people. Similar to the public overall, the share of these workers who are waiting to see how the vaccine works for others will likely shrink as more of their colleagues get vaccinated. Because they are such trusted messengers doctors and nurses are in a special position to put their voices where their arms have already been. They can get the word out to their communities that they have been vaccinated and encourage community members to get vaccinated too. This is why together with the Black Coalition Against COVID we created The Conversation, a campaign by Black doctors and nurses for Black people, soon to be followed by a similar campaign for the Latino community.
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Explaining KFF

Drew E. Altman, Ph.D., President and Chief Executive Officer. Updated: April 2021 Follow Dr. Altman on Twitter: @DrewAltman
This essay discusses the choices we have made about our mission and operating style. Of course, I believe deeply in what we are doing at KFF, but I offer this with the caveat that our choices are not necessarily the right ones for others. Every organization has a different set of opportunities by virtue of its history, financing, its size, geographic location, its board CEO and staff, and other factors. I have always believed that our society is best served by having a wide range of us doing different things; a truly independent sector. Organizations also evolve and change (and should). And those of us in health care should be very humble about what we can achieve in a three plus trillion dollar health system dominated by money and politics. That should not stop us from asking how we can have the biggest impact, and from making sometimes tough strategic choices in crafting our mission and program strategies.
KFF is an endowed, nonprofit organization filling the need for trusted, independent information on national health issues. Legally we are a public charity — not a foundation — and as I hope you know, we are an independent national organization, headquartered in San Francisco, without any connection to Kaiser Permanente. We are an information organization, and we accomplish our mission through policy analysis, polling, journalism, and social impact media campaigns — the core components of KFF which enable us to play our national role. We do two things well, policy and media; there’s a lot in health care we are not the experts on and we leave to others who are. We don’t think better information is the answer to everything that ails our country or our health system; we do believe it can be a counterweight to the money and politics and misinformation that often dominates health policy. It’s the role we have chosen to play and the niche we have chosen to fill. The hallmark of KFF is our focus on how policy affects people. Our work deals with the intricacies of financing and with policy and public programs. We are experts on Medicaid, Medicare, the ACA, problems like the uninsured or employer health coverage, and many more similar issues. The work is often quite technical. But almost everything we do, no matter how arcane, is at its core also about inequality and economic security, racism and racial equity, and the future of our diverse society. These larger issues that animate and sometimes divide our society lie behind the technical work we do and motivate us. COVID-19, with its disproportionate impact on communities of color and profound economic consequences, is the perfect example of a health issue that surfaces every one of these larger challenges. I am proud of how our organization has pivoted on a dime to devote all of our capabilities to the pandemic. We believe in the importance of evidence and facts – these are core values for us – but we also approach our job with respect for diverse views about health and social policy and more than a little humility about the role we or any one organization can play in our giant health care system. We cannot change what’s broken in the American political system by ourselves, but we can and do try to be a constructive force in it. We are a voice for people, we want to hold both government and the health system accountable for its failures, but we never try to achieve any particular outcome, or take positions or advocate for policies or programs. We want to ensure that debate is informed by credible and timely information — whether it’s an analysis, a poll, or a Kaiser Health News (KHN) story or investigation or a COVID-19 information campaign on vaccines. I had an opportunity to come to California, and build the current day organization with this mission in my head, when the board of the Henry J. Kaiser Family Foundation made a decision around 1990 to start over after what were then contentious times at the organization. We established the new mission, recruited staff, developed programs, became an operating foundation, and then later, a public charity, choosing the legal status that fit us best and most honestly represented what we are. Nowadays we simply refer to ourselves as KFF. Special gratitude is owed to the first board who empowered me to conduct such a crazy experiment, especially the late Hale Champion my first board chair and early co-conspirator, Congresswoman Barbara Jordan, and Secretary Joseph Califano. We have a Board of Trustees of up to 14 — including myself — with backgrounds in public service, academia, nonprofits, health care, and media. They serve two, five-year terms. Ours is a true governing board that exercises ultimate authority over everything at KFF and is very engaged in the organization, but it is not a board involved in program or operations, funding KFF, or fundraising, as is the case in some nonprofits. Our current Chair is the former governor of Wisconsin, Jim Doyle. As a student of these things I can say that no nonprofit organization enjoys a healthier partnership between its staff and board, and no board operates more effectively or more democratically. The relationship between the CEO and board at KFF, and the commitment everyone involved with KFF has to our mission, has been an essential ingredient to our success over many years and one of the things that has made this job so enjoyable. We made a fundamental decision to remain a California-based organization. However, with our core audiences largely in D.C., we have maintained a substantial presence there, constructing a building in 2000 with our Barbara Jordan Conference Center and basing a large staff contingent there as well. We moved our headquarters from the Silicon Valley — where we had long owned a nine-building office complex full of venture capitalists — to San Francisco in 2018, feeling the city would offer a stronger future for our organization. We are thrilled with our new location. We have not changed our legal name — the Henry J. Kaiser Family Foundation — even though it can cause occasional confusion because we are neither a foundation, a family foundation, nor are we associated with Kaiser Permanente. We keep the name to honor the legacy of our original benefactor, the great industrialist Henry J. Kaiser, whose motto “find a need and fill it,” we have adapted into our motto: “Filling the need for trusted information on national health issues.” HJK did many things differently, as have we, and we feel a real affinity with him and honor his legacy. Our expert staff is our principal organizational asset. They conduct the analyses you see us produce, our KFF polls and surveys, and produce the great journalism distributed by KHN and run our media campaigns on HIV and COVID-19. Each part of KFF makes a slightly different contribution to our overall role as an information organization. We try to balance policy debate with facts and new information through our policy analysis, working in real time, or as close to it as we can. We try to give people a voice with our gold-standard polling, maintaining the highest methodological standards in a changing industry. We try to decode and dissect health policy and hold government and the health system accountable for that same public through in-depth reporting from KHN. There are some other dimensions of our work we are very proud of, all of which are also about producing information. For over 20 years we have operated Emmy and Peabody Award-winning, very targeted information campaigns aimed at the groups most at risk of HIV. You can check out the Greater Than AIDS website to learn more. Now we have added a new campaign called Greater Than COVID, featuring THE CONVERSATION, Between Us, About Us, a joint effort with the Black Coalition Against COVID and a vehicle for Black doctors and nurses to reach out to the Black community about the COVID-19 vaccines. A Latino campaign will follow. And we have a substantial Global Health Policy Program that mirrors the work we do in domestic health policy. Our newest and fastest-growing program is Kaiser Health News, which I started in 2009. The idea was to establish a nonprofit national news service inside KFF dedicated to in-depth reporting on complex health policy issues, unencumbered by the incentives that sometimes affect commercial news organizations or destination websites. KHN would produce original, in-depth coverage of complex national health issues and bring it to the American people. To do that we built KHN on a distribution — not destination — website model. KHN is a core line item in our operating budget. It is also editorially independent with regard to story ideas and content, but otherwise operates like all of our other programs with its mission, budget, and personnel decisions controlled centrally by me and ultimately our Board. KHN is now the largest health policy newsroom in the country, producing a wide range of journalism for print, radio, and TV, from explanatory stories to features and deep investigations. We now operate several regional bureaus and look to stand up a southern bureau next to lead our reporting across the South. Several  years ago we lowered the rate at which we spend from our endowment to about 5.5% annually in order to maintain the real value of our spending power and assets over time. We spent at a much higher rate while we were building a new organization and now want to sustain what we have built. Our operating budget is just north of $44 million a year, which is not big, but adequate for us to do what we need to do with our operating organization style. When we lowered our payout rate to a more typical level we changed our financing model (a big change for the organization). Overall, we now support ourselves about 70% from our endowment and 30% from external funds, which mostly come from foundations, and state and local health departments with whom we partner on Greater Than AIDS. We use external funds chiefly for the incremental costs of mission- critical projects we could not otherwise undertake. We greatly value our funders, without whom we could not do vital work, but maintain full, independent control of everything we do in our funding relationships. That’s us in a nutshell. An information organization trying to play a special role on the national health care scene, with no delusions about how hard that is to do. We keep changing and evolving as an organization and would rather make mistakes then stand pat. Since we operate our own programs, if something isn’t working as planned, we can adapt and fix it. We change and adapt constantly to try to be more effective – changing our financing model to bring in external funds, changing our legal status twice, building a DC building, moving to San Francisco, starting our news service KHN and much more. We love the work, and along the way we have created a family of colleagues who truly enjoy working together and are devoted to our unique mission. We have handled virtual work as well as possible, thanks largely to our staff who are always ready to reach out and support one another. We are looking forward eagerly to the day when we can get back together in our offices again. [post_title] => President's Message [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => presidents-message [to_ping] => [pinged] => [post_modified] => 2021-04-12 13:09:48 [post_modified_gmt] => 2021-04-12 17:09:48 [post_content_filtered] => [post_parent] => 0 [guid] => http://staging.kff.alley.ws/?page_id=54937 [menu_order] => 0 [post_type] => page [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 517849 [post_author] => 36621681 [post_date] => 2021-03-31 15:03:58 [post_date_gmt] => 2021-03-31 19:03:58 [post_content] => In an op-ed for The Washington Post, KFF President Drew Altman spells out how COVID-19 vaccination can be simplified to ensure that the public’s rising confidence in the vaccine isn’t thwarted by frustrating and sometimes dysfunctional websites.  He writes, “Americans who are on the fence about getting vaccinated might be more willing if they heard the process for making appointments was easier to navigate. As the country works to simplify eligibility, it can also improve the process for actually getting shots into arms." [post_title] => Dysfunctional websites are making it harder for Americans to get vaccinated. Here’s how to fix that. [post_excerpt] => In an op-ed for The Washington Post, Drew Altman spells out how COVID-19 vaccination can be simplified to ensure that the public’s rising confidence in the vaccine isn’t thwarted by frustrating and sometimes dysfunctional websites. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => dysfunctional-websites-are-making-it-harder-for-americans-to-get-vaccinated-heres-how-to-fix-that [to_ping] => [pinged] => [post_modified] => 2021-03-31 15:39:44 [post_modified_gmt] => 2021-03-31 19:39:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=517849 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 516755 [post_author] => 36621681 [post_date] => 2021-03-22 05:00:01 [post_date_gmt] => 2021-03-22 09:00:01 [post_content] => A shorter version of this column has been published by Axios. Lots of attention has been given recently to Republican vaccine resisters, and while far from all Republicans are vaccine resisters, Republicans are among the groups likely to say they will not get vaccinated.  But the group to really focus on to make rapid progress is the “wait and see group”. It includes about equal shares of Democrats, Independents and Republicans who are more persuadable than the harder core vaccine resisters are. The “no” group hasn’t changed in size in months while the wait and see group has been shrinking. The wait and see group also includes larger shares of people of color hardest hit by the pandemic. One reason to emphasize the more persuadable as part of a broader effort: as more people get vaccinated it will build public confidence in the vaccines as well as progress towards herd immunity. Vaccine resisters say either they will not get the vaccine unless they are required to, or flat out say they will not get vaccinated no matter what. Three groups of resisters stand out: Republicans, (38% of them are resisters), rural Americans (28%), and essential workers who do not work in health (32%). They have various reasons for not wanting to get the vaccine: among them, denying the severity of the pandemic. Strategies are emerging to address their concerns. But if you look at those who are waiting to decide - the wait and see group - Black adults (34% of Black adults) and young adults (33%) stand out, with Latinos not too far behind (26%). Their concerns, among many, center around worries about side effects from the vaccine and its cost (it is free). The wait and see group has been shrinking, suggesting they can be moved as they see others vaccinated and as informational and access barriers are addressed. The size of the group dropped from 39% in December to 22% in February. By contrast, the harder core resistance has not budged since December. Building vaccine confidence is a multi dimensional challenge and no group can be ignored, including of course Republicans. Rural Americans in particular deserve their fair share of attention and so far they are not getting it. But the best strategy for building vaccine confidence would focus heavily on the wait and see groups to produce early results to build on. And, the wait and see groups include larger shares of people color who are disproportionately affected by the pandemic. [post_title] => Where To Start To Build Vaccine Confidence [post_excerpt] => In this Axios column Drew Altman writes about the recent attention to Republican vaccine resisters. “Republicans and rural Americans are among the most resistant vaccine holdouts and some strategies are emerging to reach them." But “far from all Republicans are resisters” and “the bigger and quicker payoff will come from prioritizing the more moveable group of 'wait and see' Americans.” [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => where-to-start-to-build-vaccine-confidence [to_ping] => [pinged] => [post_modified] => 2021-03-22 05:50:19 [post_modified_gmt] => 2021-03-22 09:50:19 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=516755 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 514126 [post_author] => 36621681 [post_date] => 2021-03-01 05:00:17 [post_date_gmt] => 2021-03-01 10:00:17 [post_content] => A shorter version of this column has been published by Axios. The share of the overall population that does not want to get vaccinated is small enough already that the U.S. should be able to reach herd immunity even if Americans who are most reluctant to get the vaccine do not change their minds. New data from our KFF Vaccine Monitor show that 55% of adults are either already vaccinated at least once or plan to get vaccinated as soon as they can, and another 22% are in a “wait and see” group. That group has been shrinking. Think of them like persuadable swing voters. Many are likely to get vaccinated as they see family members and friends and neighbors vaccinated without adverse effect. The “wait and see group” should be the focus of vaccine confidence building efforts, especially in Black and Latino communities where the need for building vaccine confidence and addressing information needs and barriers to access is the most urgent. Seven percent say they will only get vaccinated if they are required to at work and another 15% – the real hard core no vote – say they don’t want to get vaccinated. These numbers haven’t really budged since December. Employers can't require vaccination while vaccines are operating under emergency authorizations but can with limitations once they have final approval. Even if the vaccine resisters don’t switch – some of whom have been infected and may carry some degree of protection -- it’s pretty easy to see how the country could get to 70% of adults vaccinated or more. That doesn’t include kids, who are not yet eligible to receive the vaccine. Once they are, we can imagine them getting vaccinated at similar or greater rates than adults given the pressure for them to return to school as safely as possible. Many lower income and working people are not vaccine hesitant so much as they can’t access vaccine sites, aren’t on the internet or don’t have a laptop, are not internet savvy or just don’t have hours every day to sit by the computer tying to navigate websites. Sharing family stories of problems getting a vaccine appointment on a website may be the new America pastime, but in some ways it’s a mark of privilege as well. [post_title] => Vaccine Confidence Isn’t The Main Obstacle To Reaching Herd Immunity [post_excerpt] => In this Axios column, Drew Altman paints a more optimistic picture of the prospects for getting to herd immunity as vaccine confidence grows, but underscores the urgency of building vaccine confidence in Black and Latino communities where barriers to access and good information are obstacles to getting vaccinated. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => vaccine-confidence-isnt-the-main-obstacle-to-reaching-herd-immunity [to_ping] => [pinged] => [post_modified] => 2021-03-01 11:21:19 [post_modified_gmt] => 2021-03-01 16:21:19 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=514126 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 511123 [post_author] => 36621681 [post_date] => 2021-02-10 05:00:58 [post_date_gmt] => 2021-02-10 10:00:58 [post_content] => A shorter version of this column has been published by Axios. Knowing someone who has been vaccinated and seeing that the vaccine does not produce any significant adverse effects is emerging as the leading reason people are willing to get vaccinated themselves. It means that vaccine hesitancy will diminish naturally as more and more people are vaccinated, leaving smaller groups of the remaining vaccine hesitant to focus more resources on. Less than ten percent of us have been vaccinated so far. But the share of us who know someone who has been vaccinated is much higher, at 41 percent in mid-January. That really matters because half (52%) of those who know someone else who has been vaccinated say they will get the vaccine “as soon as they can” compared to 37% of those who do not know someone who’s been vaccinated. People also tell us they are closely watching those they know. When we ask people who they want to see get vaccinated before doing it themselves, their close friends and family members are at the top of the list. As with everything COVID this varies by race and income. White adults (51%) are more likely than their Black and Latino counterparts (38% and 37%, respectively) to say they’ve either been vaccinated or know someone who has. And those with incomes of $90,000 or more are almost twice as likely as those with incomes below $40,000 to say they’ve been vaccinated or know someone who has (65% vs. 33%). As vaccine hesitancy diminishes, efforts can focus most on the groups most likely to be persistently vaccine resistant, including in the Black community and rural America. And messaging in ads can emphasize regular people everyone can relate to like they do to their friends and family, getting vaccinated without adverse consequences. [post_title] => Seeing Others Vaccinated May Be The Best Cure For Vaccine Hesitancy [post_excerpt] => In his latest Axios column, Drew Altman shows why vaccine hesitancy will naturally decrease as more and more people see their family members and friends vaccinated without adverse consequences. It’s a hopeful sign about vaccine hesitancy, and should help free up resources to focus on the remaining vaccine hesitant. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => seeing-others-vaccinated-may-be-the-best-cure-for-vaccine-hesitancy [to_ping] => [pinged] => [post_modified] => 2021-02-10 05:37:04 [post_modified_gmt] => 2021-02-10 10:37:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=511123 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 518028 [post_author] => 36621681 [post_date] => 2021-04-05 05:00:31 [post_date_gmt] => 2021-04-05 09:00:31 [post_content] =>
A shorter version of this column has been published by Axios. “Your doctor and your nurse trusts the COVID-19 vaccine; you can too.” It’s one of the most important messages vaccine reluctant Americans can hear. They trust their doctors and their nurses and almost all of them have been vaccinated or plan to get vaccinated. By the numbers:
  • Throughout the coronavirus pandemic, majorities of U.S. adults have said their doctors and nurses were their most trusted sources of information about the coronavirus and eight in ten have said their doctors are the ones they will turn to when deciding whether or not to get a COVID-19 vaccine.
  • Nearly nine in ten physicians (and nurses with graduate degrees) report either already being vaccinated or plan to get a vaccine.
  • A majority of all the other health care professionals who diagnose and treat patients say they are already vaccinated or plan to be (those with bachelor’s degree: 86%; associates degrees: 68%).
Frontline health care workers who provide other forms of care, such as assisting patients with bathing, housekeeping, or clerical work, have lower levels of vaccine uptake and report the same concerns of the public generally including concerns over the possible side effects or wanting to wait and see how it works for other people. Similar to the public overall, the share of these workers who are waiting to see how the vaccine works for others will likely shrink as more of their colleagues get vaccinated. Because they are such trusted messengers doctors and nurses are in a special position to put their voices where their arms have already been. They can get the word out to their communities that they have been vaccinated and encourage community members to get vaccinated too. This is why together with the Black Coalition Against COVID we created The Conversation, a campaign by Black doctors and nurses for Black people, soon to be followed by a similar campaign for the Latino community.
[post_title] => Why Doctors and Nurses Can Be Vital Vaccine Messengers [post_excerpt] => In this Axios column, Drew Altman examines why doctors and nurses are such critical messengers in the effort to build vaccine confidence. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => why-doctors-and-nurses-can-be-vital-vaccine-messengers [to_ping] => [pinged] => [post_modified] => 2021-04-05 05:49:31 [post_modified_gmt] => 2021-04-05 09:49:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=518028 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 264 [max_num_pages] => 44 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_privacy_policy] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_favicon] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 88d143b905ecf4f36b399aedd44b1a56 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

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