The consequences of declining vaccination rates
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This is On Point. I'm Deborah Becker. The question of routine vaccines was a main focus in the debate over the nation's new top public health official, Robert F. Kennedy Jr. Before he was confirmed as the nation's Health and Human Services Secretary last week, senators asked Kennedy about his anti-vaccine activism, and Kennedy responded with a promise. I support the measles vaccine. I support the polio vaccine. I will do nothing as HHS Secretary.

That makes it difficult or discourages people from taking either of those vaccines. Anybody who believes that on a look at the measles book...

Kennedy's confirmation comes as the nation's vaccination rate is declining and disease outbreaks are rising. In Texas, there are now 48 cases of measles, the largest outbreak there in 30 years. Last year, whooping cough, or pertussis, spread in the U.S. at the highest rate in a decade. And perhaps the biggest fears are about a possible resurgence of

polio, a highly contagious viral disease that can cause paralysis, disability, or death.

Many people may not remember the scare of polio since it was eradicated in the U.S. more than four decades ago and was thought to have been relegated to the history books. But 82-year-old Senator Mitch McConnell remembers. He's a childhood polio survivor and the only Republican who voted against Kennedy, saying that the nation needs a health leader who acknowledges the efficacy of life-saving vaccines.

And 77-year-old Ann Crocker survived polio and has lingering effects from it. She shared her story with us about getting the illness before the vaccine was available. My name is Ann Crocker, and I live right here in Maine.

I had just started kindergarten. This would have been in 1952. Started out like might have been a flu symptom and I felt sluggish. Then when I went to reach for the glass of juice that my mother had left on the coffee table, I couldn't move my arm to reach for the glass. My mother, with all of the risks of polio, was very fearful.

The doctor advised her to take me directly to the hospital, which would have been in Lewiston, central Maine. By the time my mother had questioned the doctor, I had become immobile. I could mumble a little bit and my eyes could move, but nothing else.

My family was quarantined away from me, but they could look through the glass of the door and I could hear them. It was my grandfather that had driven us down as my dad was still at work. And I called him, oh, Gampy, please come in. Please hold me. And he said, I can't. And, you know, you just you can imagine what it must have felt like for the adults who couldn't do what they typically could do.

Thankfully here in Maine, we practice the use of hot wet wool blankets. I think that helped save some of the muscles in my body with that hot wet wool. I can remember even now smelling wet wool gives me the shivers because it was very, very uncomfortable. By the time I left the

the hospital, it was about three weeks, and then I went to the rehab center. I was able to talk. I was able to use one arm enough so that I could kind of feed myself. But everything was affected from part of the mouth all the way down to the toes.

Recovery doesn't mean you recover in a few months or after a year of rehab as I had. For me, I'd had a couple of surgeries and I never could run, you know, extremely well and I never could do a sit-up, but I could...

get along and I was able to have two children and then almost exactly 25 years after I had polio I started having problems. My hand wouldn't hold the pen as well. My writing was shakier. It's as if the areas that

you recovered usage, example a leg, and you found yourself sort of stumbling or having a harder time moving it or lifting it. It was kind of painful. So do you want to wish this on anybody that you know?

For many, they may not have met somebody that might have had polio. But look closely. You might actually see somebody walking along with a limp and you happen to look down and you see one leg a lot smaller or an arm that's twisted. That might be somebody that had struggled with polio as a young person and they may now be experiencing the late effects that could

very easily turn somebody into wheelchair bound or unable to stay cooked as far as stir anything, move anything with their hand, button their shirt. Something that they had been able to do for decades, they are now losing.

This hour on Point, we're talking about more and more people foregoing vaccines and concerns that that could make America sick again. Dr. Paul Offit is with us. He's director of the Vaccine Education Center and a pediatrician specializing in infectious diseases at the Children's Hospital of Philadelphia. Dr. Offit, welcome back to On Point.

Hi, Deborah. So stories like the one we just heard from Anne and the stories that have been published and heard from Senator McConnell, recalling the horrors of living in a time when polio spread wildly and living with the long-term effects of polio. Do you think a resurgence of polio is truly possible?

Yes. And here's why. In 2022, there was a 27-year-old man who had never left this country who was paralyzed by polio. Now, the virus he was paralyzed by wasn't the kind of virus that the person who initially gave that story was paralyzed by or the virus that Mitch McConnell was paralyzed by.

He was paralyzed by a revertant strain that was derived from the oral polio vaccine. So Albert Sabin's polio vaccine was a live weakened form of the virus that was introduced in this country in the early 1960s. And we stopped using it by the year 2000.

And the reason we stopped using it was that although we eliminated polio from this country by 1979, throughout the 1980s and throughout the 1990s, the only polio we saw was polio caused by the oral polio vaccine, specifically the so-called type 2 vaccine revertant virus.

That's the virus that paralyzed that man in Rockland County. And when they looked in wastewater samples in that county or in surrounding counties, they found the virus there. And I think if you looked in Philadelphia or Chicago or LA, you would also find that virus there. This is the virus strain that's causing the outbreak in Gaza. So people think

Well, polio is gone. Wild-type polio virus is gone, but that strain isn't gone. If you lower immunization rates enough, which is what happened in Rockland County when immunization rates dropped to 30%, then you'll see polio come back and remember, polio only paralyzed

paralyzes one of 200 people that it infects. So he was the tip of a much bigger iceberg. And he wasn't immunized then. Is that what you're saying? That's right. Nor were many of the people that were in the county where he lived. Okay. So right now, though, most folks would be immunized against that strain of polio if, in fact, they had the polio vaccine. Right. And that immunization would protect them for the rest of their lives. And we know that for certain. It isn't as if efficacy wanes after a certain period of time.

Well, for diseases like polio, which is a long incubation period disease, meaning from the time when you're exposed to when you develop symptoms, usually all you need is immunological memory cells, which are long-lived. That's why you can eliminate diseases like polio or measles or smallpox or rubella. Those are long incubation period diseases. Mm-hmm.

Now, you know, it's very complex here, right? We're talking about different types of the virus and how people can become infected, how long. But it seems as if

this strain of the virus that could, in fact, cause polio in some cases is something that RFK is very concerned about. In fact, the lawyer helping him through his confirmation petitioned the government to revoke its appeal of the polio vaccine, arguing that it was never tested against a placebo, right? So what do we know about that and other risks from the vaccine itself?

Well, first of all, the strain that we're using now or the vaccine that we're using now is a whole killed viral vaccine, identical to the vaccine that Jonas Salk made in the mid 1950s. And that was subjected arguably to the largest placebo controlled trial in vaccine history. 420,000 children received that vaccine. 200,000 were given placebo. 1.2 million children served as observed uninoculated controls. That was a 1.8 million child

study. So I don't know what RFK Jr. or his lawyer are talking about. That vaccine certainly was subjected to a placebo-controlled trial. So I guess then at this point, what do you look for if you say that, yes, in fact, I'm

a resurgence of polio is possible. Where do vaccination rates have to go to before you think that's a real likelihood of happening? I'm told right now it's about 93% is sort of the average of what the childhood vaccination rate is in this country. What would that number have to be in your mind before we might see some kind of resurgence of disease? Dr.

It's hard to know. I mean, certainly measles, you need to be in roughly the 95% area because it's such a highly contagious virus. Polio is not as contagious. And you saw what happened to this man in Rockland County. Immunization rates really had to drop to about 30% before you started to see case polio. And remember, he was just one of...

probably hundreds of cases because the virus doesn't paralyze everybody. I would imagine probably less than 50%. And although that's not going to happen countrywide, there may be certain sections in this country, communities in this country where that does happen. And that's when you would see polio come back. 50% for polio below 95 for measles. Is that what you're saying? That's what I'm saying. And what about for something like whooping cough?

Your whooping cough too, it's contagious via the respiratory route. Whooping cough is a short incubation period mucosal infection. So you're never going to eliminate that kind of virus. Like you're never going to eliminate COVID-19 or you're never going to eliminate flu or RSV because they're short incubation periods. What you're trying to do is keep up people out of the hospital and keep them out of the intensive care unit and keep them out of the morgue. Those viruses will always circulate.

So you're just trying to prevent hospitalization in those cases. Okay. We're talking about the dropping childhood vaccination rates in this country and the potential that has for public health. Stay with us. I'm Debra Becker. This is On Point.

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This is On Point. I'm Deborah Becker. We're talking about declining childhood vaccination rates and their potential effects on public health.

Vaccine hesitancy, as it's called, is known to be on the rise. According to the Centers for Disease Control and Prevention, measles immunization rates among kindergartners dropped to less than 93 percent. And the CDC wants to keep at least a 95 percent vaccination rate to try to prevent measles outbreaks.

Among those who've expressed concerns about vaccines is the nation's new Health and Human Services Secretary, Robert F. Kennedy Jr. Although he insisted during his recent Senate confirmation hearings that he supports vaccines, he took a different position in 2022. Here he is speaking on the Health Freedom for Humanity podcast. I see somebody on a hiking trail with a caring little baby and I say to them, I'm better not get them vaccinated. You know, maybe he will save that child.

Oh, if you're one of 10 people that goes up to a guy, a man or a woman who's carrying a baby and says, don't vaccinate that baby. When they hear that from 10 people, it'll make an impression on them.

You know, and we all kept our mouths shut. Don't keep your mouth shut anymore. Confront everybody on it. Dr. Paul Offit is our guest this hour. We're talking about the increasing number of people foregoing vaccines for themselves and their families and what that means for public health. And Dr. Offit, what do you think when you hear statements like this from the new Health and Human Services Secretary about vaccines and concerns about potential risks?

Well, he's been exactly who he says he's been for the last 20 years. He's a virulent anti-vaccine activist. He's a science denialist, and he's a conspiracy theorist. What worries me the most is what he did in Samoa. He goes out to Samoa, I mean, an island nation of maybe 200,000 people, right at the beginning of an outbreak of measles. Immunization rates had dropped from like the low 70% range to the 30% range. And so there was an outbreak of measles. There were 5,600 cases of measles and 83 deaths.

He in no sense encouraged vaccination. He doesn't believe in vaccination. He thinks vaccines are harmful. And when that outbreak occurred and 83 people died, mostly children, less than four, he said it wasn't the measles virus that did it. He said it was actually a measles vaccine that did it, even though the so-called D8 strain of wild type virus, measles virus, was isolated from these children.

So he is a science denialist of the first order. So now we're starting to see measles cases in this country, which you would expect to see because it is the most contagious infectious disease, not just vaccine preventable disease, infectious disease. And so you're seeing, you know, dozens of cases in Texas. And remember, those are just confirmed cases, meaning people who've been confirmed to have measles.

by PCR or serology. Assume that also is a tip of a bigger iceberg. It's more likely those are a couple hundred or 300 cases in Texas. And now there are seven states where there are measles outbreaks. And that's what worries me. I think we are about to head into measles land. And we have now someone who is the head of the biggest public health department in the United States, who is a science denialist, who doesn't believe, one, that measles virus actually causes measles, as he claimed when he was in Samoa.

It's a frightening time. But he does say that he is not a vaccine denier, if you will, that he does believe that vaccines have a place. He wouldn't take them away from anyone. He said that during his confirmation hearings. You're just questioning the truthfulness of his testimony?

That's what I'm doing. Yes, I'm questioning the truthfulness of his testimony. When he was said, look, you said this or you wrote this, he said, well, I never said that. I never wrote that. I mean, he's also said that if his children were born now, he would not vaccinate them. He said he wished he could go back in time and he would pay anything.

to go back in time not to vaccinate his children. Believe what he says when he says that. I think when he was in front of the committee and answering questions from Senator Sanders or Senator Cassidy, he was saying what he needed to say to try and get confirmed, but he lied again and again because he denied things that he clearly said. This is his passion.

Anti-vaccine activism is his passion. And now we're about to be in a country where you're going to start to see a virus circulating, measles, which killed 500 children every year before the measles vaccine and caused 1,000 children to have encephalitis, meaning inflammation of the brain, of whom a quarter would end up blind or deaf. This is a scary virus. And I think, sadly, not only have we eliminated measles, I think we've eliminated the memory of measles.

So let's talk about measles land, as you call it, a little bit. Encephalitis, what are some of the risks if there are big outbreaks of measles?

Right. So measles is highly contagious. And let me put it to you this way. There's something epidemiologists have called the contagiousness index, meaning how many people would you infect during the day, assuming you're contagious and everybody you come in contact with is susceptible. So for diseases like SARS-CoV-2, the cause of COVID, influenza, respiratory syncytial virus, the contagiousness index is between two and four, meaning you'll infect two to four people during your day. For measles, it's 18. And

And the reason is you don't have to have direct contact with someone who has measles. You just have to be in their airspace within two hours of them being there. When someone comes into our emergency department and is put in a treatment room who has measles, no one can go into that room two hours even after they've left. This is a high...

highly contagious disease. And when you get sick and you're hospitalized, it's because you have severe measles, pneumonia, or severe dehydration, or both. It's a frightening disease. And I mean, I'm a child of the 1950s. I had measles. I had mumps. I had German measles. I remember all these diseases. But I think most people today don't. They just think it's some mild rash with fever, and it goes away, and everybody's fine. As dangerous for adults as it is for children?

It's actually more dangerous for adults. I think you're 10 times more likely to be hospitalized with pneumonia as an adult than as a child.

But, you know, vaccines are not risk-free, right? It's not just the fact that folks have questioned big pharma, if you will, right? There are risks in any vaccine. And I want to play a little bit of tape from a woman who we spoke with, Joanna Coleman. She's got two boys. She's a former teacher. She's a medical educator living in Colorado. And

Her son stopped breathing after receiving the hepatitis B booster that children typically get at six months. Now, this happened to him. He had symptoms when he got the first dose of the vaccine when he was born.

And then it happened again. Now, she says she and her husband are not anti-vaccines, but both of their children received regular vaccines. But she's very, very concerned about how this was handled and how the risk was explained to her. Doctors told her it was a one in a million chance that there would be side effects. But when you're that one, it can be tough.

So I want to play a little bit of tape from her talking about what concerns she has now about how doctors handled this case of her son having side effects from the hepatitis B vaccine. Let's listen. As an educated person, of course, I want to trust the science, but also at the same time to

to have professionals just be so indoctrinated to push something and not even be able to do a thought experiment with a patient that's like, well, this is, you know, one plausible explanation just seems odd to me. Like why, why wouldn't a medical intervention? I mean, all, in my opinion, all medical intervention has a risk. There's something going into your body or being messed with. Of course, there's an inherent risk to that. And it just seems strange that I think parents are led to believe that there's absolutely no risk. And these are,

100% safe all the time when that's not necessarily the case. The chances are that most children will be fine, but I don't know. It just, it was a wild, wild ride.

That, of course, Joanna Coleman, as we said, a current medical educator, former teacher living in Colorado. Her child had bad side effects from the hepatitis B vaccine. Dr. Offit, I wonder, you know, isn't some skepticism a good thing? And what's the best way for medical professionals to handle that?

Yes. I think you should be skeptical of anything you put into your body, especially a healthy child when you're inoculating them with a biological agent like vaccines. Skepticism is good. And so her issue, for example, that her child stopped breathing following receipt of the hepatitis B vaccine, that was raised very early when the hepatitis B vaccine was first introduced.

hepatitis B vaccine was recommended routinely for newborns, including within the first day of life. Does hepatitis B vaccine, for example, cause severe apnea, meaning you stop breathing, or sudden infant death syndrome? So studies were done trying to look at whether that was true or whether it was just sort of a temporal but not causal association. And so

And it appears to be just a temporal, not causal association. But she's certainly right that you should be skeptical. She's certainly right that every vaccine that has a positive effect, which is every vaccine, can have a negative effect. The issue of safety, at least in medical terminology, is that the benefits clearly and definitively outweigh the risks, not that there are no risks. And I think the issue for us, I think, as academicians, is to look very carefully at anything that comes up to see whether it really is

a causal result of the vaccine and not just something that was temporally associated. I think it's very different, though, when it's your child, right? And you're in an emotional situation and a doctor says, well, the benefits and certainly the public health benefits outweigh the risks. It's a tough thing. And in her, Joanna Coleman's story was that it wasn't really discussed. It was like, well, that's this far off possibility until it wasn't.

And so I guess, how do you present a realistic picture and make sure that folks are in fact getting vaccinated as doctors would like? And could vaccine hesitancy even further the silence here? Because doctors might be afraid to tell folks the full ramification of the potential dangerous effects of vaccines. Yeah.

No, I think you're right. You certainly have to explain that there are benefits and risks. And I don't think you can make a societal argument, meaning that you should be vaccinated so that you're going to protect those around you. I think we should, the only people who should be vaccinated are people who benefit from that vaccine. But I'll give you a story. For example, my wife is a pediatrician. She goes into the office on a weekend. It's busy. She's helping the nurse give vaccines. There's a four-month-old sitting on her mother's lap.

While my wife is drawing the vaccine up into the syringe, the four-month-old has a seizure, goes on to have a permanent seizure disorder, epilepsy, and is dead at age five of a chronic neurological condition. I think if my wife had given that vaccine five minutes earlier...

There are no amount of statistical data in the world that would have convinced that mother of anything other than the vaccine caused it. And this is the problem in some way with vaccines. There's a lot of temporal associations. There's occasional causal associations. The COVID vaccine was a rare cause of myocarditis. And then the Johnson & Johnson COVID vaccine was a rare cause of

clotting, including severe clotting. So of course these vaccines have side effects. And I think it's hard to appreciate the benefits of vaccine because you never imagine that these diseases would happen to you or your child until they happen to you and your child.

And of course, a lot of folks point to COVID and some of those issues with the vaccine, heart disease issues and clotting issues as reasons why there is such increased vaccine hesitancy. Do you think that's why we're seeing the rates drop right now from 95% to about 93% for measles? Is that why they're going down? Or what would be some of the other reasons that might explain why so many people are foregoing vaccinations? Dr.

I think we leaned into a libertarian left hook. I think what happened in 2020 is we didn't have anything to try and stop this virus that was killing hundreds or thousands of people a day. We didn't have antivirals till October. We didn't have monoclonals till November. We didn't have vaccines till December. All we could do was limit human to human contact. So we shuttered schools. We closed businesses. We restricted travel. We isolated, quarantined, social distanced, masked.

And that was seen by some as massive government overreach. And then the following year, when we had a vaccine by 2021, you couldn't go anywhere unless you had your vaccine card. You couldn't go to your favorite bar or restaurant or sporting event or place of worship. And that too was seen as massive overreach. And 30% of the country simply refused to be vaccinated. And I think that's what we're dealing with now. We're dealing with the residual of that punch that came from, I think, what was seen as a

massive government overreach. And I think this libertarian left hook we leaned into it. And it's not just public health agencies. I think it's also just generally this kind of push against any sort of federal institution. Also, though, what about big, big pharma in general? Many Americans watched, you know, a real focus on big pharma profits as opposed to public health. Was that a factor in all of this?

Yes. I mean, to me, the hero of the COVID pandemic was NIH. I mean, NIH started funding research on messenger RNA in 1997 to people like Katie Carrico and Drew Weissman, for which they eventually won the 2023 Nobel Prize in Medicine. And then you had when SARS-1 hit in 2002, 2003, you had in-house people at NIH like Barney Graham or Kizzy Corbett who were doing work. So when this happened, when SARS-CoV-2 happened,

That in combination with President Trump's Operation Warp Speed, which was really a production issue, we made a vaccine very quickly, tested it in 40,000 or 30,000 people for the Pfizer-Moderna vaccines, which is typical of any adult or pediatric vaccine trial, and had a vaccine that was highly effective.

And safe. It wasn't absolutely safe, but it certainly was safe. And it saved probably about 3 million American lives and cost about 230,000 people their lives because they chose not to get it. When we talk about some of the dangers of outbreaks, we mentioned measles, we mentioned polio, a little bit of whooping cough. I mean, are there other diseases that are on your radar to be watching if there are declining vaccination rates in the country?

For me, it's measles, measles, measles. And maybe it's because I'm scarred by having lived through the 1991 Philadelphia measles epidemic, when in a three-month period in one city, we had 1,400 cases of measles and nine deaths. I mean, our city was a feared destination. People canceled trips. Schools canceled trips to the city. We vaccinated down to six months of age. And we had something that has probably never happened before or since in this country, compulsory vaccination.

not mandatory vaccination, compulsory vaccination. There was a court order that children who were not vaccinated had to be vaccinated, even if their parents didn't want them to. And when the American Civil Liberties Union was being asked to sort of step up there, because a lot of these people were choosing religious exemptions, they chose not to represent them for doing something that was perfectly legal. It was legal to exempt yourself for religious reasons, but they said, and I'll never forget this,

The quote from the Pennsylvania chapter of the ACLU was, while you were at liberty to martyr yourself to your religion, you were not at liberty to martyr your child to your religion. It was a troubled time. Wow. Wow. So there's a lot here. There's a lot of vaccination history. But I want to also talk about adults when it comes to measles. You said that adults

would still be protected in a polio outbreak, presumably. It wouldn't be that their childhood vaccine effectiveness had waned, even though there are some public health officials who have suggested that, by the way. Some have said that anybody over the age of 40 should probably get a booster for polio if, in fact, we see a big decline in vaccination rates and a resurgence of the disease.

So what about perhaps differing opinions about that efficacy? And also, what about measles, if that's your number one concern? Would adults need a booster for that?

I think in neither case, really. Because again, all you need is immunological memory. And the measles vaccine is really highly effective. I mean, one dose gives you 93% protection, two doses, 97%. And really, your memory cells are long-lived. I mean, there's examples of these sort of island nations which had sort of measles sweeping through and everybody getting naturally infected. Then like 60 years goes by that

measles goes away and then somebody like a sailor, Portuguese sailor, whatever, comes in, introduces measles again. And all those people who were exposed 60 years ago didn't get infected. It was the people who hadn't been more recently exposed. So I think measles, immunities, long-lived and polio.

Immunity also is long-lived. Those are excellent vaccines that induce memory. All you need is memory. See, that's not true for like COVID or RSV or influenza, where you need, if you're going to try and protect against mild to moderate disease, you need antibodies present in the circulation at the time of exposure, and antibodies are short-lived. And that's not true for measles. Measles, because it's long incubation, memory is short-lived.

There's plenty of time for memory cells to make antibodies to protect you against even mild disease. We're talking with Dr. Paul Offit about the potential public health consequences of dropping childhood vaccination rates. This is On Point. I'm Debra Becker.

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This is On Point. I'm Deborah Becker. Today, we're talking with Dr. Paul Offit about the potential public health consequences of declining childhood vaccination rates. And Dr. Offit, we're talking about this, of course, in light of Robert F. Kennedy Jr.'s confirmation as the nation's Health and Human Services Secretary. And I guess...

Maybe we should clarify, how much of a role does the secretary have over vaccination policy in general? Can Robert F. Kennedy Jr. change how vaccinations are mandated or what exactly would the role of that office be? Well, so he would be in charge of the Vaccine for Children's Program, which purchases about 55% of all vaccines in this country, primarily for those who are either uninsured or underinsured.

And he could decide how that money gets distributed. He could say, you know, I think that this vaccine, the measles, mumps, rubella vaccine hasn't been tested enough. I don't think we've really proven that it hasn't caused autism. Why don't we just take it out of the Vaccine Injury Compensation Program and just expose it to civil litigation? He could change the labeling on vaccines. He could change the list of compensable injuries through the Vaccine Injury Compensation Program.

He has enormous power. He's the head of the FDA, the NIH, and CDC. If a vaccine, for example, a new vaccine comes up before the FDA, and I'm on the FDA Vaccine Advisory Committee, and we sort of recommend licensure authorization and the FDA agrees, he could say, I don't agree with that.

I think there should be more studies. So sure, he could cause massive disruption in the immunization program. And when you realize that this has been a passion for him, that he is a zealot, he's a believer that vaccines are harmful, I can't imagine he wouldn't do everything he can to make vaccines less available or less affordable. And the secretary also has an oversight role with the Food and Drug Administration and the Centers for Disease Prevention and Control. Is that right?

Right. And the NIH. That's right. Right. So a big role here. He could basically affect vaccine policy for some time to come. No, there was a former director of Secretary of Health and Human Services who said, I can't believe how much power I have with a stroke of a pen. And so what do physicians do if they're concerned about that? What do they do? What do they tell their patients?

Well, what worries me is that we're not going to get the kind of information we need. So, for example, the measles outbreak in Texas that you mentioned at the top of the show, which is now somewhere around 50 cases and probably more.

And there are seven other states that have reported this if you read local newspapers. But if you look on the CDC website this morning, it says that there have been 14 cases of measles reported in the United States. I mean, that's just not true. So I worry that they're going to be able to do the sort of surveillance they need to do to let us know what's going on. I mean, as an infectious disease specialist, I need to know what's going on.

in terms of other viruses, like dengue, for example, or chikungunya, or Marburg, or bacteria like tuberculosis. And you're not getting that information because I think there's been disruption in the CDC. 10% of the workforce has been fired.

I just worry that there's really been this attack now on public health agencies and therefore on public health. And so we count on places like the CDC and NIH and FDA to get information. Will we still be able to get that kind of information? Right. And so at this point, it's not clear. It may be restored. Isn't that right?

I guess we'll see. It's a wild time. I guess I want to know, though, what do physicians do? What do they tell their patients at this critical moment when, you know, information may be hard to come by, especially?

Well, I think the science still stands up. I mean, it doesn't matter how many times Robert F. Kennedy Jr. say vaccines cause autism, vaccines don't cause autism. And so the science ultimately wins out. I guess I take solace in the sort of the Galileo story from the early 1600s. So I have to go back that far to take solace. But, you know, when he was, he dared to sort of embrace Copernican values.

astronomy that, you know, the earth revolved around the sun, that the earth wasn't the center of the firmament as was stated in the Bible. And so he was censured by the, this Roman Catholic tribunal, which basically put him in chains and put him in house arrest. And as they were leading him out, and it's probably apocryphal, but I love the story as they were leading him out, he said regarding the earth and presumably in Italian, he said,

And yet, he said, it still moves. Meaning you can put me in jail, but the earth still revolves around the sun. And RFK Jr. can say vaccines cause autism as many times as he wants. That doesn't change the science. Right.

What about, though, explaining some of the risks in such a way that might be perhaps different than what we've been doing now? And when does the vaccination rate get to a point where perhaps a public health campaign, a better awareness campaign, a vaccination campaign might be needed? I mean, what are the recommendations for on-the-ground work if this continues is what I'm really trying to get at here.

I think we, as the previous caller said,

the report that you had from the woman who was upset about the decrease in breathing. I think we have to really sit in a room, either in our office or in their room, and explain ourselves. I'll give you a perfect example. I think if you argue that not only is all politics local, but I think all public health is local. When COVID hit in Philadelphia, there was an African-American surgeon at Temple whose name was Ayla Stanford, who took it upon herself to form the Black Doctors COVID Consortium.

And so she went into homes in North Philadelphia, which is a primarily black and brown community, and proceeded to just sit in their rooms and give them something they didn't have, which was a doctor that they could talk to. And if they still didn't want to get a vaccine or didn't want to get tested, she would come back again and again. And eventually she vaccinated 50,000 people in North Philadelphia who initially chose not to be vaccinated because she answered their questions.

And if they weren't answered adequately, then she would come back again and again. And to me, she's a hero. She was one of those bright lights during this pandemic. And we need thousands of Ayla Stanfords. So, you know, you mentioned there's a lot of power that the Health and Human Services Secretary has here, particularly over vaccine policy. And, you know, a lot of the promises that Robert F. Kennedy Jr. made during his confirmation hearing suggesting that he supports

vaccines. But do you think we will see continuing fights over vaccines and vaccine policy throughout this administration? Is that something that we're just going to have to get used to here? And will that information be public? Or what do you expect?

No, I think that's exactly what's going to happen. As you said at the top of the show, we have had more pertussis cases this past year, 32,000 cases. That's more than we've had in any time really even pre-pandemic. But that was before RFK, right? I mean, I'm talking about going forward. We've got this new secretary who's made conflicting statements. What are we going to see going forward? Are we going to have a lot of fights about vaccine efficacy going forward?

Right. But it's not before the influence of RFK Jr. He's been doing this for 20 years and he has been able to really seed his misinformation and disinformation. And now he'll have a bigger platform to do it even bigger than his famous name or his children's health defense. And so what I see happening is I see people becoming more suspicious of vaccines. I see them. I see vaccine people choosing not to vaccinate at a greater level. And then I see outbreaks occurring and it'll be that tension. When are there enough

children who suffer or are hospitalized or die from vaccine-preventable diseases before we change our ways. How is our vaccine supply regulated at the moment? Who's in charge of that? I mean, it's not HHS, I presume. I think others would have some sort of a role in that. Can you explain?

Well, pharmaceutical companies make vaccines. I mean, there are really four major pharmaceutical companies that make vaccines for America's children, and they make vaccines for the demand. It's the consumer that represents the demand. And then their vaccines make it. But it's a fragile business. People reasonably see Pfizer, Moderna making just

massive profits associated with this COVID outbreak. But for the most part, vaccines are a fragile business because there's something you give once or a few times in a lifetime. They never compete with lipid lowering agents or psychiatric drugs or neurological drugs. So they can leave the business and had. I mean, there were 18 companies that made vaccines in 1980. By the end of the decade, largely due to litigation, there were only four. These companies can leave the business. This is not a big business for them. Mm-hmm.

Yes, but the government then is your main consumer if you're requiring vaccines and certainly sending them around the world. Right. So, sure, I think that's true. But again, if people choose not to get the vaccine, then their companies will make less and less of the vaccine. Right, right. And there will be no incentive for them to change that. So there could be an issue with supply down the road, I guess is what I'm getting at here.

It's possible, yes. And which ones should we be concerned about the most? Again, measles? Would that supply change or would there be others that you think we should watch?

That's the one that worries me the most, just because it's so highly contagious. And it's always the canary in the coal mine whenever there's a fraying of immunization rates. So I think that's the one to watch. What about, though, we heard from Joanna Coleman about the hepatitis B vaccine and some of those vaccines that are required of children. I mean, are those at risk at all here or no? Are those sort of secondary because we're talking about a much smaller number of people who might be affected?

No, I think they're all at risk. I mean, I think people could choose not to get, let's take the hepatitis B vaccine, for example, which was introduced in 1991 as a routine newborn vaccination. At the time, every year there were about 18,000 children less than 10 years of age who would get hepatitis B.

About half of those children, about 9,000 got it when they passed through their mother's birth canal when the mother had hepatitis B. But the other 9,000 got it from relatively casual contact with someone who had hepatitis B that didn't know it. So we introduced that vaccine in the early 1990s and eliminated hepatitis B from children, essentially. But mostly people don't realize that or they don't appreciate that. I think the biggest problem with vaccines is that when you get a vaccine, nothing happens.

And as we eliminate diseases and people don't fear these diseases anymore, then they focus on safety issues, real or imagined.

You know, I want to go back to something you mentioned earlier in the show, and you said that there may be different things happening in different areas of the country, and they may be affected by this declining vaccination rate in vastly unique ways that we may not expect. So can you explain that a little bit more? What areas of the country are more at risk, and why is that?

I think just what you saw in COVID, you were much more likely to acquire COVID and be hospitalized by COVID and die from COVID if you lived in a county that was sort of deeply red as compared to deeply blue. This is probably the first infectious disease in history that was more likely to kill you based on your religious, based on your political affiliations.

So that's one. I think the right has embraced this kind of medical freedom movement, which means don't tell me what to do. I will decide what to do. And therefore, I can choose not to vaccinate myself or my children, even though it doesn't just affect you. It does affect those with whom you come in contact. But then the other thing is religion. If you look, for example, at that outbreak in Texas, it's mostly, I think, in a Mennonite or Anabaptist community, which

is often the source of that. I mean, I live in Philadelphia, so we have in Lancaster, there's a

a large Amish community which often chooses not to get vaccines. And that's often where you see just that Philadelphia outbreak that I mentioned earlier that had 1,400 cases and nine deaths. That's centered on two fundamentalist churches that chose not to vaccinate. But this is a growing medical freedom movement and increased skepticism about the medical field, medical technology. And I think—

Perhaps, is there some sort of revising of the message about vaccines that needs to be done? And I know we touched on this briefly after we heard from Joanna Coleman, but is there a different way to explain to people or a new way to address the safety issues involved with vaccines and let people really do the research and understand the research here?

Yeah, I think I'm fine with skepticism. I think everybody who sits around the table at the FDA Vaccine Advisory Committee is a skeptic, right? Show us the data. Prove that something works. Prove that it's safe. And when that proof is offered, we believe it. I guess what I'm having trouble with is cynicism.

You know, that even though you show data, people say, well, of course, you're going to say that because you're a doctor. Of course, you're going to say that or the pharmaceutical companies are going to say that because they make money. That's where we lose. And I think you just have to what I try and do when people call me, which is often is find out what it is they're worried about. Then present the data that I think, you know, should help ameliorate their fears.

and then hope for the best. But it is hard for people to do this themselves. I mean, not everybody has an expertise in epidemiology or virology or microbiology or immunology. So I think when people say they do their own research, what they really mean is they look at other people's opinions on the internet.

That's what they mean, and that's really not doing your own research. Right, but of course there's a lot of that. And so I think it's something that medical professionals have to know how to deal with. There's a lot of information, a lot of opinions on the Internet, a lot of really scary stories about people who have become sick or perhaps not. Perhaps these are inflated stories from vaccines. And so what do medical professionals do about that? You're talking with a different population of patients.

who knows how to get that research, who knows how to do that. And I think if you're trying to make sure that you have a herd immunity from a number of people, I wonder what medical professionals can do to sort of address that very deep skepticism that's readily available on the internet to be reinforced.

I think you have to be compassionate, and you have to be passionate, and you have to be humble. And you have to do your best to try and explain how science would go about answering a question that they might have. But I think passion's part of it. I do think we tend to stand back a little bit and be humble, realize that we don't know everything.

And we may learn new things. I mean, nobody would have predicted myocarditis as a consequence of the mRNA vaccines or clotting as a consequence of the Johnson & Johnson adenovirus-vectored vaccine. So you always try and be open-minded to the fact that you don't know things. But there are systems in place like the Vaccine Safety Data Link that can pick up very rare side effects, as was true with the clotting. That occurred in 1 in 250,000 people. That was very quickly picked up by the Vaccine Safety Data Link, which is this post-marketing surveillance system.

You know, at the beginning of the show, we talked about polio, the risk of polio, and you said you do think a resurgence is possible, but the rate of childhood vaccination would have to drop so low before we would see an outbreak. I wonder, just very briefly in the last minute we have here,

How can a resurgence of that disease happen if the vaccination rate would have to go so, would have to drop so precipitously? I guess I'm not sure how to square that we might actually see a polio outbreak in this environment right now.

You would see it in various communities across the country. So as for example, the ultra-Orthodox Jewish community where this man in Rockland County got paralyzed, and he represented again the tip of probably a few hundred cases.

In that community, immunization rates dropped to less than 30%. There are communities like that throughout the United States that sort of dot areas of the United States where those kinds of decisions might be made. That was the Texas story, right, where a critical percentage of children in that religious community chose not to vaccinate. That's how you would see it. I don't think you would see it as a massive U.S. thing, but as more sort of sporadic.

Dr. Paul Offit, Director of the Vaccine Education Center and a pediatrician specializing in infectious diseases at the Children's Hospital of Philadelphia. Thanks so much for being with us. Thank you. I'm Deborah Becker. This is On Point.