Vaccination Efforts at Risk Under RFK Jr.'s HHS Tenure
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From KQED. From KQED in San Francisco, this is Forum. I'm Nina Kim. In a speech to his new Health and Human Services staff yesterday, Robert F. Kennedy said he planned to investigate childhood vaccines. Among other things, nothing would be off limits. This as a measles outbreak in Texas grows. And as Louisiana's top health official says the state will no longer promote mass vaccination.

Pediatrician and infectious disease specialist Adam Ratner is worried about the nation's vaccination program under Kennedy and has long been worried about measles as a harbinger of other public health crises. Ratner joins us after this news. Welcome to Forum. I'm Mina Kim.

A measles outbreak in a West Texas community with low vaccination rates has grown to nearly 60 known cases, the state's largest in three decades, and has now spread to neighboring New Mexico. More than a dozen of those cases has required hospitalization. Pediatric infectious disease specialist Adam Ratner says measles is the first disease to reemerge when vaccination rates decline, a lesson California learned in December 2014 when an outbreak centered at Disneyland led to more than 140 cases.

We'll talk to Ratner about why measles is considered the canary in the coal mine for public health and what it means that Robert F. Kennedy Jr., a vaccine skeptic, has taken the helm of the federal agency in charge of, among other things, determining the nation's vaccine schedule. Dr. Adam Ratner joins me now, head of the Pediatric Infectious Disease Unit at MWU Langone's Hassenfeld Children's Hospital. Though he's speaking today in his personal capacity, Dr. Ratner, really glad to have you.

Delighted to be here. Thanks so much. So your book is called Booster Shots, The History and Future of Measles Vaccines. How are you thinking about what's happening in West Texas? Is it directly linked to low vaccination rates? It is. This is a sort of a typical way that post-elimination measles outbreaks have occurred. And what I mean by post-elimination is...

Through a lot of effort, a lot of policy, a lot of investment, in the year 2000, the United States was declared to have eliminated measles. And that doesn't mean that there were no cases of measles anywhere. It meant that there was no ongoing spread of measles in the population for a duration of longer than a year. And so...

What we've seen since that time are periodic outbreaks that happen generally when someone who's unvaccinated travels to another country where measles is circulating, returns to a community with low vaccination rates, and you have person-to-person spread cases.

here. So West Texas, while I don't think there's been an announcement of exactly what the initial exposure is, it kind of fits that bill where there's an initial case and then instead of the outbreak dying out because we've built a strong wall of immunity in the population, because the vaccination rates are low, we're now seeing person to person spread.

I read vaccination rates in the low 80s, and it needs to be 95% for herd immunity. Is that right? Yeah. Measles is the most contagious disease we know. It's more contagious than flu or COVID or polio or Ebola or anything else that you can think of. One person with measles can give that disease to 90% of the people they come into contact with if those people are not contagious.

vaccinated against measles. And so when you have something that is that contagious, you need to vaccinate a very high percentage of the population to reach herd immunity or community immunity. With measles, that number is about 95%. So we look at, we often look at kindergarten vaccination rates, and we hope to see those above 95%.

We've had an issue nationwide since the COVID pandemic where, you know, prior to the pandemic, most years we had rates of over 95%. We're now in a situation nationwide where we're under 93% and falling. So it's not unique to Texas. It's not unique to Gaines County.

But what we do see in Gaines County is a much lower rate, a rate of about 82 percent in kindergarten vaccination and a large percentage of kids coming from families that have sought exemptions to vaccination requirements. And I believe when the Disneyland outbreak happened here in California in December of 2014 and through the early spring of 2015, that it was at about 92 percent.

Dr. Retner, how serious is measles? How dangerous is it? What complications are associated with it? It's interesting. Measles is potentially very serious, but it's

Most cases are, you know, kids recover over the course of about a week. And so a child with measles is miserable, certainly. I've taken care of many children with measles and they have high fevers, they have rash, they have red, painful eyes where it hurts to look at the light. But for almost all kids, especially in a high-income country like the United States, most of them recover over the course of about a week.

The problem is that measles is very good at spreading in the population, and a small percentage of children will have more severe disease than that. And so what we saw last year in the U.S. is we had about 285 cases. Forty percent of those needed hospitalization. And that's in part because there were a large number of very young children.

children who were affected and the youngest children are at higher risk of complications. Generally we talk about rates of 10 to 20 percent of kids needing hospitalization. That's usually for pneumonia. And then you have rarer outcomes like

One in a thousand kids, give or take, will have encephalitis, which is swelling of the brain that can lead to blindness, it can lead to deafness, it can lead to seizure disorders that are long-lasting. So those are serious outcomes. And then roughly one in a thousand children with measles will die, unfortunately. And prior to vaccination in the United States,

essentially everyone got the measles in childhood. So there were literally millions of cases of measles in the U.S. every single year, and that meant that those low probability events were meaningful numbers of children. And so there were tens of thousands of hospitalizations. There were hundreds of kids who developed encephalitis and potential real long-term problems, and there were hundreds of deaths every year as a result of measles.

So part of the reason that we vaccinate is to prevent those things. And then another part of the reason that we vaccinate is to protect the community at large from the spread of measles. You've called measles a bellwether. Why is it a bellwether?

Yeah, so measles is incredibly interesting and incredibly important to pay attention to for two reasons. The first is one that I've mentioned, which is that it's the most contagious disease that we know. And the second is that we have and have had for decades a highly effective vaccine to prevent it.

So what that means is that measles outbreaks like the one we're seeing in West Texas now, like the one that happened in New York City where I'm based in 2018 and 2019, like the Disneyland one in 2014 and 2015, when vaccination rates drop,

measles is the first sign. You see measles outbreaks appearing, and they can be difficult and expensive and very challenging to get under control. But they're not the end of the story in the sense that other vaccine-preventable diseases often follow measles because it's an indicator of which populations have these low vaccine rates. And they also, I think, reveal

Areas where there's been erosion of public trust in public health authorities, in vaccination, these are places where misinformation is taking hold and where people either aren't accessing vaccines, which would be a breakdown in a vaccine delivery system or something like that, or more often these days where disinformation has taken hold and parents are refusing vaccines.

Listeners, let me ask you to join the conversation. Do you have questions about measles, about future disease outbreaks? Do you have questions about Robert F. Kennedy Jr.'s impact on vaccines? As Health and Human Services Secretary, you can tell us by emailing forum at kqed.org, finding us on our social channels, Blue Sky, Facebook, Instagram, or threads at KQED Forum. You can call us at 866-733-6786, 866-733-6786.

Dr. Ratner, you mentioned that we eliminated measles in 2000. Have we ever eradicated a vaccine-preventable disease?

Yes, smallpox. So with incredible effort requiring international collaboration and investment and time, we were able to wipe smallpox off the planet. It was finally certified in 1980. And that was, I would argue, one of humanity's greatest

public health achievements. We took a disease that used to kill millions of people, and using a vaccine and using political will and investment, we were able to eliminate it from the face of the earth. And people now, you know, kids today do not need to be vaccinated against smallpox because there is no smallpox circulating.

That's in contrast to elimination, which I talked about in the U.S., which is an incredible achievement and prevents severe disease and prevents death from measles. But it's a state that requires constant vigilance. You still have to vaccinate. You still have to look for cases. There's always the risk of importation. You've called vaccines, to an extent, a chronic victim of their own success. So what do you mean?

Yeah, so I think one of the major issues that we have, we the public health folks have, is that when you're talking to parents who are making the decision to vaccinate their kids and parents ask questions as they should about anything that involves their child's health, you know, why should I do this? What are the risks and what are the benefits?

And we talk about the risks, which are small, of licensed vaccines. And we can go through those, and that is understandable information. And then we talk about what we're trying to prevent, what these diseases are. And we live in a very different time now than we did in the '50s or '60s or '70s, where

It was a population that understood polio, where families had people who had had polio. Everyone had the measles, and most families knew someone whose child had had a severe case and needed to be in the hospital. Many families knew someone who had lost a child to measles. You could see the effects of polio every day. That has been lost, which is

wonderful in some sense, of course, because these diseases have been controlled by vaccines. And

Parents today have been lucky enough to grow up in a world where, or at least in a country, where these things are rare. And it is easy to find families, I think this is most families, who have never known anyone who had measles. They've never known anyone who had polio. They might have read about it in a book. But that's very different. And, I mean, this...

was striking to me during the measles outbreak in 2018 and 2019 when we had conversations with parents and with grandparents who were old enough to have known polio, and they were very different conversations. Yeah. We're talking about a measles outbreak in West Texas, what's driving it, and the future of the nation's vaccine program. More after the break. I'm Mina Kim.

Turing with Tia is the quirky YouTube talk show where Tia Creighton is the host and all her guests are talking AI chatbots. Whether it's health and beauty, science and technology, pop culture, or current events, Turing with Tia delivers answers about everything. That's T-U-R-I-N-G, Turing with Tia, a funny and fascinating way to experience artificial intelligence. Only on YouTube at Turing with Tia.

Welcome back to Forum. I'm Mina Kim. We're talking about vaccine-preventable diseases this hour and why Dr. Adam Ratner is worried they're making a comeback. A recent measles outbreak in West Texas has sickened nearly 60 people.

Adam Ratner is an infectious disease specialist and pediatrician, and his new book is called Booster Shots, the History and Future of Measles Vaccines. And listeners, join with your questions about measles or concerns about future disease outbreaks, questions about our vaccine schedule and about Robert F. Kennedy taking the helm as Health and Human Services Secretary and what impact he may have. And I'll also add, if you have a personal experience related to measles or polio or some of the other things that

Dr. Ratner has been talking about. Feel free to share those as well. The email address is forum at kqed.org. The phone number is 866-733-6786. And you can find us on our social channels at KQED Forum on Blue Sky, Instagram, Threads, Facebook, and so on. Jan writes, what happens if an unvaccinated adult gets measles? Dr. Ratner?

So measles is more dangerous at the extremes of age, and I'm not even talking about people who are elderly. I'm talking about young children, and I'm talking about adults.

So adults get measles. It looks much like measles in children, but they are substantially more likely to have complications to require hospitalization to develop pneumonia and to risk severe disease and death. So that's why it's important for adults who haven't been vaccinated to get vaccinated against measles because adults can certainly get it.

Let me go to caller Susan in San Francisco. Hi, Susan, you're on. Hi, good morning. Thanks for this great show. For adult people, doctor, people who were vaccinated as children for measles, but now may be in their 50s, 60s, 70s, do they need a booster? Are they at risk? What's your feeling about that cohort of people? Thank you.

Sure. Thank you for the question. So there is no one-fits-all answer to that question because it depends in part on when you were vaccinated as a child because there were different measles vaccines in use at different times. And there was a time in the U.S. where people were getting a single dose of measles vaccine and then a time around 1989-1989

to 1990 where we transitioned to doing two doses of measles containing vaccines. And so for people who've gotten two doses in childhood, you don't need a booster, you don't need to be revaccinated. For anyone else, what I would say is you should ask your doctor that question because they will be able to look back at your records and give you a sort of personalized recommendation for that because it depends on age cohorts and stuff.

Thank you, Susan, for the call. So, Dr. Ratner, the measles outbreak in Texas, these questions about measles and its resurgence, it's occurring just as Robert F. Kennedy Jr. takes office as Trump's Health and Human Services Secretary. And now during his confirmation hearings, he repeatedly said that he is, quote, not anti-vaccine. And we have a cut here of an exchange between RFK and Oregon Senator Ron Wyden during his Senate committee hearing. Let's give that a listen.

I support the measles vaccine. I support the polio vaccine. I will do nothing as HHS secretary and makes it difficult or discourages people from taking it. Anybody who believes that ought to look at the measles book you wrote saying parents have been misled into believing that measles is a deadly disease. That's not true. So, Dr. Renner, do you do you believe Kennedy here?

I do not. I think that RFK has spent a large portion of his adult life

fighting against vaccines. He has repeatedly talked about measles as a benign disease and the measles vaccine as a dangerous vaccine. He has said that the COVID vaccine is more dangerous than the disease it is trying to prevent. He has said there is no such thing as a safe and effective vaccine. This has been sustained over time. You can look at his activities in

Samoa around the time of the measles outbreak there in 2019 to get a sense of his feelings specifically about the measles vaccine. I'm gravely concerned about what is going to happen to vaccine availability and vaccine confidence in the United States in the coming years. Would you say that Kennedy has incentives to question vaccines, financial or

Otherwise, versus, say, a parent, right, who loves their child, is genuinely afraid, even if not necessarily for evidence-based reasons or broadly evidence-based reasons. Or maybe they are reluctant because of historical trauma and so on. Somebody like that versus someone like an RFK?

Absolutely. And you've drawn a very important distinction there. I believe, and I think my pediatrician colleagues believe this as well, that parents who are questioning vaccines, parents who are anti-vaccines, these are not people who don't love their kids. These are people who love their children, and they want exactly what their pediatrician wants, which is for their child to grow up happy and healthy.

And so there's a point of connection there. There is a shared goal and there's a conversation that can be had. And I think that even parents who are sharing anti-vaccine information on social media sites and things like that, I believe that the vast majority of them agree.

are doing that in good faith in the sense that they think that they are spreading important health information for other people to see.

They are unfortunately misguided in that thought, and they, I think, have been misled by a very sophisticated anti-vaccine group that we have in the United States and now internationally. But I do not think for the vast majority of families that that is done out of malice.

The distinction is with the leaders of the anti-vaccine movement, and RFK is one, but there are certainly others, and these are people who directly profit from that anti-vaccine messaging. So as was revealed in the Senate questioning and testimony, RFK has a variety of conflicts of interest. He makes a tremendous amount of money from his work with

children's health defense and the books that he has written with them and the merchandise that they sell. He

He has conflicts of interest with lawsuits against vaccine manufacturers that date back many years and referral fees from which he directly profits. And so I think there is a financial conflict there. I do not know whether he actually believes the things that he is saying, but I think that is in many ways besides the point because they are...

And there is good science and good surveillance systems that back up the safety and the efficacy of the vaccine schedule in children in the United States. But I think that he and many others at the leadership level of the anti-vaccine movement are very conflicted.

What was your reaction to, um, RFK Jr. saying he will investigate the nation's childhood vaccine schedule? This is of course, after telling Senator Bill Cassidy, a doctor whose vote was key in advancing Kennedy's nomination, that he would not make any changes and that he would maintain recommendations put forth by the advisory committee on immunization practices. So, so what was your reaction to that? Um, I wish that I could tell you that I was shocked, uh,

But I was not. I mean, I think that most people in pediatrics and public health have expected this. I mean, I think that this is a person who is bent on tearing down the vaccine infrastructure that has been built over decades, the systems that are set up to deliver safe and effective vaccines to families to provide reassurance that

vaccines are safe. And I think that if I thought that this was in good faith and it was a look at how we can more effectively do those jobs, then that would be fine. But I do not think that. And I should probably step back. In broad strokes, who is on the Advisory Committee on Immunization Practices or ACIP? What role does it play in setting vaccine guidelines? Dr.

Right. So ACIP is a crucial part of the vaccine infrastructure in the United States. It is an advisory committee to the CDC. It is made up of experts who are not government employees. They are people who are experts in vaccines.

pediatrics, infectious diseases, epidemiology. There are a number of slots on the committee for people who are members of the public who are not expert in these things to make sure that concerns are addressed there. There are liaison members to the ACIP who do not vote but who represent other

groups such as the American Academy of Pediatrics to make sure that the ACIP members have access to information and input from important outside groups. And what ACIP does is it reviews

Studies that are done by pharmaceutical companies and by academic investigators and all of the data that are out there, they ask the question, is this vaccine that's under consideration safe? Does it prevent the disease that it is designed to prevent? And is it safe?

something that makes sense to include in a routine vaccination schedule for children in the United States. And you can watch ACIP meetings, old meetings on YouTube, and they are, they're long, they're detailed. These are folks who take their job very, very seriously. Because it's, these are decisions with consequences. The Vaccines for Children program, which provides funding for

vaccines for kids who either do not have insurance or who have insurance that does not fully cover vaccine costs.

The decision for what goes into the Vaccines for Children program is based largely on ACIP recommendations and then CDC director approval. So it's an important piece of that ecosystem, and it is filled with people who are looking to do their best for the health of the kids of the United States. Right. You use their recommendations to determine what vaccines...

you should tell parents to get and so forth, I'm sure as a pediatric infectious disease specialist. Now, RFK has said that right after he was confirmed, he told Fox News he did not trust the ACIP advisors. Does he have the power to just get rid of them?

I actually don't know the details of that. I imagine that he does. Senator Patty Murray of Washington suggested that he did as well. Yeah. I mean, I think that he has very broad power as the head of...

HHS, and he is, you know, he may be able to dictate the composition of that committee. He certainly can dictate how the CDC responds as they report to him. So I think he has broad power over the outcome of that committee's composition and its recommendations.

We're talking about Robert F. Kennedy Jr. stepping into his role as Health and Human Services Secretary and what that could mean for the nation's vaccine program and also

A broader decline in vaccinations that's been happening in several states. Dr. Adam Ratner is an infectious disease specialist and pediatrician and has written a new book called Booster Shots, The History and Future of Measles Vaccines and has talked about measles as a harbinger of other disease outbreaks. And of course, we are now seeing that outbreak in West Texas. Listeners, you are joining the conversation at 866-733-6786.

at the email address forum at kqed.org and on our social channels at KQED Forum. Bonnie writes, I grew up in San Francisco in the 1950s, but I never had measles as a kid. This, of course, was prior to the development of the vaccine. While traveling in Europe in 1975, I contracted measles and was very sick. I recovered, but it appeared to suppress my immune system for some time, getting pneumonia four months later. Let me go to caller Anne in Berkeley. Hi, Anne, you're on.

Hi. I just wanted to thank you for the program and really appreciate all this information. It's great to get the measles update on my vaccines and what I might need to talk to my doctor about. But I wanted to bring up the point that, you know, a lot of this conversation ends up being black and white. And I fully appreciate your guest, you know, kind of saying that, you know, parents who may have concerns aren't bad parents. And I think that, you know, it's interesting.

It's hard because when you go and you talk to someone, if you want to vaccinate, and I'm a supporter of vaccines, I've been vaccinated, vaccinated all my kids. But I think that when you have that conversation, oftentimes it's just kind of very dismissive or, oh, these are safe. And there's not really an explanation that comes out and helps people to feel more secure in getting these vaccines, even if they're already going to do them. So you kind of default to, oh, I'm going to do it. But...

there's just not a safe space, you know, for lack of better words, to allow people to ask questions. And, you know, the United States government has been shown to do awful things at certain points. And so, you know, perhaps there is a space to hold, you know, the makers of vaccines and big pharma accountable.

in a way that we're not already doing. And we see how sometimes that lack of regulation gets a bit of a runaway. So I just wanted to offer that, that there could be opportunities for us to improve vaccines, to make them even more safe, not that they're not safe now, but just that ability to have that kind of conversation that's very nuanced and more intelligent is lacking.

Thanks for offering that, Anne. And of course, Dr. Reiner, Anne is absolutely right. Vaccines are not perfect. And there have been some very serious moments in history when vaccines failed. I'm even thinking about polio, which is a very successful one, but it went through a very difficult period, right? Yeah.

Sure. So I think that's important, which is that there is no medical intervention. There's no medicine. There's no vaccine that is 100% perfect, 100% safe all of the time. And I think that any reasonable doctor will have that discussion. I think that parents should ask questions about anything that involves their child's health and

You know, I think it's unfortunate that we have a medical system that kind of minimizes the amount of time that doctors have with patients. I think that these are conversations that pediatricians, especially primary pediatricians, are very...

very good at having, and it's somewhere where I think that families can feel safe and get their questions answered. It doesn't always work that way, and people are rushed, and I recognize that that system needs improvement, and there's certainly no doubt that

about that. The issue with the polio vaccine that you raised comes from very early in the history of the polio vaccine, where there were the trials of the Salk vaccine, the killed vaccine in 1955. Those trials, which were randomized controlled trials, showed that the vaccine worked and prevented polio, which was an incredible relief to many families who were terrified of polio.

Instead of being made by a single pharmaceutical company, there was a big push to get polio vaccine out to as many children as possible. So there were five different companies that were allowed to start making polio vaccine and one lot of vaccine from one company that was based in California.

was insufficiently killed in the sense of what you, the way that you make the Salk vaccine is you grow polio, you grow poliovirus and then you kill it with a chemical and that is your killed virus vaccine. And you have to make sure that that killing process of the virus is complete. And that wasn't done in that case from that one company. That was called the Cutter Incident.

It resulted in a number of children having paralysis, which was a tragedy. It was a disaster. It was quickly recognized. Those lots of vaccine were pulled. The process in all of the companies was looked at again. And once people were sure that safety was back to where it should be, polio vaccine distribution continued. But there was...

There was concern about that. And I think that it is a tragedy, but it is also an example of a surveillance system working and a system jumping into action when there were potential complications. Dr. Adam Ratner, infectious disease specialist and pediatrician, taking your questions about measles vaccines, future disease outbreaks and...

We're getting his thoughts on RFK's impact on vaccines as Health and Human Services Secretary. We'll have more with him and with you. Stay with us. Turing with Tia is the quirky YouTube talk show where Tia Creighton is the host and all her guests are talking AI chatbots. Whether it's health and beauty, science and technology, pop culture or current events, Turing with Tia delivers answers about everything. That's

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You're listening to Forum. I'm Mina Kim. We're talking with Dr. Adam Ratner, who's worried about...

Vaccine preventable disease is making a comeback. We're already seeing a recent measles outbreak in West Texas that's going on and spreading at this very moment. At the same time, we also have a prominent vaccine critic taking the helm at the nation's Health and Human Services Agency, Robert F. Kennedy Jr. And we're talking about that with Dr. Ratner, whose new book is Booster Shots, and also with you, our listeners. What are your questions about measles or future disease outbreaks? What are your questions about RFK and its impact on the world?

on vaccines and our nation's vaccine program, essentially the authority that he has over that particular program. You can call us 866-733-6786. You can email us, forum at kqed.org, and you can find us on our social channels at KQED Forum. This listener, Katrina, writes, I'm a pediatrician and thankfully have never seen SSPE, subacute cancer,

sclerosing penencephalitis. I don't know if I'm saying that correctly, but I have colleagues who have. This is a devastating fatal neurological disease that can occur 10 years after a child has recovered from a measles infection. It's rare, but there is absolutely nothing that can be done. My pediatrician colleagues have watched children die from this helplessly. There has never been a case in vaccinated people.

David on Discord writes, if you undermine the value of science and expertise, fewer people will be swayed by arguments that rely on them. Dr. Ratner, you've talked about the COVID-19 pandemic seeming to sort of supercharge vaccine reluctance and anti-vaccination views. Why? Why do you think it did this?

You know, it is still mind-boggling to me that this is the place that we have gotten to at this point after the beginning of the pandemic because I see the COVID-19 pandemic and the development of the COVID mRNA vaccines as a tremendous scientific triumph. Like, we went from having a brand-new disease that no one had any experience with

a disease that was killing millions of people, to having a vaccine that prevented hospitalization and disease in under a year. That is unprecedented. It's an incredible accomplishment, and I think it is

not presented that way now and I think not remembered that way by many people. And that is a shame. I think what we do remember as a population from the COVID pandemic is the ways in which public health voices got things wrong and some things that were absolutely right but are remembered as

overreach. And I'm thinking of mask mandates and homeschooling and things like that. And I think that under the conditions that we were in with a brand new, highly dangerous pathogen circulating unchecked in the population, these were reasonable things to do. And I think that

Another way of looking at the COVID pandemic is as a scientific triumph and as a public health triumph. And I thought that we were going to come out of the COVID pandemic with a new respect for what vaccines could do. They delivered us from something that was terrifying and that was killing large numbers of people. The COVID vaccines have been calculated to have saved millions of lives.

And what we've gotten instead of that is a hyperpolarization around all public health topics and medical topics in general. We have a situation where political party affiliation seems to affect people's feelings about vaccines and vaccine mandates. And these are things that used to be

Yeah. I mean, the same day that RFK was confirmed, Louisiana's health department said that it would no longer promote vaccines.

Mass vaccines. And interestingly, the health department in New Orleans has said that it will not follow the state's lead on this. So you are seeing differences there. But Dr. Brander, what does it mean for a health department to stop promoting vaccines?

That is a tremendous dereliction of duty. Vaccines are one of our greatest public health interventions, inventions that have ever been found. These are things that have saved hundreds of millions, maybe billions of lives over time. It's up there with clean water and sanitation.

And these are things that shouldn't be controversial. And I think that having public health departments that are falling in line with the prevailing political winds and are saying they're not going to promote one of the most important public health tools that we have is chilling. And it is worrisome for our future.

Paula writes, please allow a voice for the thousands of scientific vaccine skeptics who have invested often years and careers to follow evidence-based findings and dare to critique officials. There is an extensive body of history and research about the causes and treatment of measles. And remember when scientists and doctors and the media widely promoted tobacco or DDT? What say you to that? I don't know if you have a response to Paula there. I think that...

Questions about vaccine safety are reasonable to raise, and they are, for the most part, scientific questions that can be answered with scientific studies. And if you look at the studies that have been done for the vaccines that are in the routine vaccination schedule in the United States,

These are things that are safe and effective. And if they were not, they would not be on the vaccine schedule. It is reasonable to ask

what the underlying basis for this is. You can watch the ACIP meetings, you can watch the FDA VRBPAC meetings where people go through the data. And these are the high-quality studies that have been done. There are many lower-quality, small, non-reproducible studies that talk about, you know,

vaccine issues, and it's not that there are no risks to vaccination, but the overwhelming body of scientific evidence suggests that the vaccines that we use are safe and they are effective.

We're seeing now new state bills that would allow for personal belief exemptions from vaccine mandates. One of the things that California did after the measles outbreak was it actually banned personal belief exemptions. Certainly, of course, the state has medical exemptions and so on for vaccines, but it did away with those. And so I'm wondering if

you know, how you're responding to this rise in legislation that would allow for, you know, philosophical exemptions. And what do you think accounts for this? Because I know you've talked about sort of a distrust in public health institutions and even in science these days, probably driving this. But your thoughts, Dr. Ratner?

Right. So, you raised the point about medical exemption. So, all 50 states have vaccine requirements for school attendance, at least as of now.

And that means that all 50 states also have a way that some children can be exempted from those requirements. Because let's say you have a child who has a severe allergy to a component of one vaccine. This happens rarely, but it can happen.

of course that child should not be mandated to receive the vaccine to which they're allergic. So there has to be a way of excluding children from a mandate for something that they may have an allergy to. That's fine.

So all 50 states have that. And then some states allow for non-medical exemptions, and those are usually broken down into either religious exemptions or personal belief exemptions. And the requirements for each of those vary from state to state.

In most places, up until not that long ago, medical exemptions are always rare because being allergic in that way to vaccine components is rare. Non-medical exemptions also used to be rare, be they religious or religious.

or personal belief. We're in a situation where we've seen steady growth over the last few years in non-medical exemptions. What we saw in California prior to

SB 277 and the elimination of the non-medical exemptions was clustering of non-medical exemptions in specific communities that had low vaccination rates. And I think that it is concerning that there's a trend toward more states allowing non-medical exemptions.

and for the growth of non-medical exemptions overall. We vaccinate kids for a variety of reasons, and one reason is to provide protection, direct protection to the child who we are vaccinating, and that's important. You vaccinate a child against the flu, and your expectation is that their risk of getting severe disease from the flu is now lower. That is a reasonable piece of the decision-making for parents.

The other reason that we vaccinate ourselves and that we vaccinate our children is to provide some measure to contribute a little bit to

to resistance in the community to infections, to community immunity or to herd immunity. And that is really important because there are always going to be kids in the population who are unvaccinated or a small percentage of kids who maybe have been vaccinated but there's primary vaccine failure where they don't get high enough levels of antibody.

What have you seen as effective at rebuilding trust in vaccines or in science in the public health system?

It is very hard. The best example that I can give you comes from the 2018-2019 measles outbreak in New York City, where we saw large numbers of cases in communities in Brooklyn that were reasonably isolated communities. The spread was in those communities and very little outside of those communities because the surrounding vaccination rate was high.

And these were communities that had longstanding distrust of the public health department in New York for reasons that initially had nothing to do with vaccination. But it sort of bled over into the idea that no public health recommendation should be followed.

And when the outbreak started and the New York City Public Health Department, which is an incredible group of people, put out messaging saying, hey, vaccination is important, they were met with a lot of resistance.

There were groups of nurses from the community who went literally door to door, family to family, sat with people, had long discussions in safe spaces like we were talking about earlier in the show, let parents ask their questions, and

And they made progress family by family. But it was slow. And I don't know how you scale that. I mean, I think that's the major issue. Yeah. We're talking with Dr. Adam Ratner. And this is a fundraising period for many public radio stations. You are listening to Forum. I'm Mina Kim. Let me go to caller Peter in Fairfax. Hi, Peter. You're on.

Yeah, hi. Yeah, I have two, a point and a recommendation. My recommendation, I just happened by sheer chance to read, sorry, to watch a documentary, which is a documentary about Maurice Hilleman, who is the developer of many of the vaccines that children receive. I understand he is the author of the measles vaccine. And

it's a really well-developed documentary. And one of the things that really impressed me about it was that it showed how responsible not only he, but all of his colleagues were, and especially going back to the point that was just made about Cutter Labs and so on, is that...

His incredible meticulousness and seriousness about doing good should be something that might affect at least a small number of skeptics if they watched this film. The other thing is just a question I'd like to ask the doctor there to talk a little bit about probability, because I think that would allow us

not only of vaccines, but things like climate change, don't understand is the way that probability and statistics are used effectively to say this is safe or this is not safe. Because otherwise, people would get on airplanes and they would have the same kind of fear maybe of a vaccine. But no, they're able to put some of this fear aside. So anyway, I'd like to

Peter, thanks.

So I agree about the film. It's fantastic. And the story of Maurice Hilleman's life is interesting and inspirational. There's a book about him called Vaccinated, which is by Paul Offit. And it's a wonderful book. So I think that story is certainly a story worth telling. I think it is often hard...

to communicate about probability because I think for many people it is not even, I was going to say easier, but not even easier. It is more intuitive to make

decisions, especially decisions that have an emotional component to it, based on your own experience. And I think that you're right. We do make decisions about vaccines based on probabilities. We look at how frequently someone who gets a dose of a particular vaccine develops a fever or how frequently they develop

You know, they may have trouble sleeping the night of the vaccine or something like that. And we can quantify all of those things. We look at the risk of them developing the disease that we're trying to protect, and we look at that risk in an unimmunized group, and we compare those things. That's how we know that the COVID mRNA vaccines worked.

When people go to their doctor, when they go to their pediatrician and they say, "Okay, this thing that you want to give to my child, does it work? Is it safe?" They're not asking about probabilities. They are, they're asking for certainty, which you can't give them, of course, because, you know, it's, there is nothing in the world that is 100% safe and 100% effective. The problem is that the decision not to vaccinate is also not 100% safe.

And I think we're seeing that in Texas now. We certainly saw that during the COVID pandemic where unvaccinated people were much, much more likely to die from COVID. And that's hard to communicate. And that's where you need the trust that we were talking about. And that has to be built over time. Even if we were to mandate vaccines, yeah, that is a big piece of it. The other piece of it is the disinvestment in public health. How...

How dire do you think that combination is that we're facing now? So public health has been dealing with that problem for probably as long as there's been public health. Well, let me ask you a more specific question if I would, and I'm so sorry, just because we're coming up to the end of the hour here.

There are so many of the people that you speak about who are science-based who are in the Health and Human Services Department, right? Do you see them holding the line against things that are anti-science? Right.

It's so hard. I mean, the people who work at NIH and work at CDC, these are incredible people. These are some of my most talented colleagues, people who I respect, and people who have devoted their lives to trying to keep the rest of us safe.

I think there's only so much that individuals can do. I mean, and we saw this with the development of the measles vaccine and then the lag between that and elimination in the U.S., which is that it doesn't require, it does require individuals, but individuals are not sufficient. And then policy really matters. And support at the federal government level for, you know, vaccine distribution, vaccine funding really matters in children's health.

Yeah. And then the purges, too, that we're seeing. Well, Dr. Brandner, thank you so much for your very timely book. My pleasure. Thank you so much for having me. This was great. The book is Booster Shots, the History and Future of Measles Vaccines. And my thanks to Mark Nieto and Susie Britton for producing today's segment. You've been listening to Forum. I'm Nina Kim.

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