Thinking About Ob/Gyn
A fresh and evidence-based perspective of all things related to obstetrics and gynecology. Follow us on Instagram @thinkingaboutobgyn or visit thinkingaboutobgyn.com for show notes and more.
Thinking About Ob/Gyn
Episode 10.12 The V-Word
We trace the arc from variolation and Jenner to mRNA, show how vaccines leverage natural immunity, and explain why maternal shots protect both parent and newborn. Data, history, and personal stories make the case that prevention beats cure for OBGYN care.
• pertussis surge in Kentucky and preventable infant deaths
• child mortality then and now and what changed
• variolation to Jenner and the origins of vaccination
• how innate and adaptive immunity learn and remember
• vaccine types and why today’s antigens are fewer
• effectiveness data across polio, measles, rubella, Hib
• sanitation myths versus vaccine impact
• Wakefield’s fraud and why autism claims fail
• three major studies debunking autism myths
• essential pregnancy vaccines and timing
• RSV options and COVID safety during pregnancy
• herd immunity as protection for newborns
0:02 Setting The Stage: Vaccines Under Fire
1:09 Pertussis Surge And Preventable Tragedy
2:20 Child Mortality Then And Now
4:19 What Killed Children In 1850
5:31 Out Of Sight, Out Of Mind
9:51 Origins Of Vaccination: Variolation To Jenner
15:20 Vaccines Use Natural Immunity
20:00 Types Of Modern Vaccines Explained
25:30 Innate And Adaptive Immunity 101
28:40 How Effective Are Vaccines Really
33:40 Polio’s Human Cost And Iron Lungs
39:00 Measles, Rubella, And Pregnancy Risks
44:20 Sanitation Myths Versus Vaccine Impact
47:05 The Wakefield Fraud And Aftermath
52:20 Big Studies Debunk Autism Claims
55:20 Essential Vaccines In Pregnancy
58:00 Takeaways And Next Steps
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Welcome to Thinking About OBGYN. Today's episode features Howard Harrell and Kate Maloney discussing vaccines.
SPEAKER_01:Howard? Kate? What are we thinking about on today's episode?
SPEAKER_02:The V-word, which is vaccines, don't worry. We give them every day, we recommend them to our pregnant patients. But how often we stop and think about the history and the mechanisms of action of these vaccines that we prescribe? And of course, this has never been more relevant than it is today as we see so much misinformation and disinformation that's out there about vaccines.
SPEAKER_01:All right, let's do it.
SPEAKER_02:All right. For our listeners, allow me to introduce Dr. Kate Maloney, who's an infectious disease specialist. We're excited to have her as a guest, and we're going to have her back again because there's a lot to cover. There's so many infectious disease topics that affect our patients in OBGYN that we could talk about. But somehow vaccines are under attack like never before. So let's talk about those first. And I'll bet this won't be our only episode on vaccines. Now, before we get going, Kate, let me ask you if you saw this news in Kentucky last month, and I'll put a link to the state's website. So whooping cough infections are way up, and they've had nearly 600 cases. This is just in Kentucky so far this year in 2025. And unfortunately, three infants have died so far this year. Now, none of the children that died, and none of the mothers in those cases were vaccinated during pregnancy. Of course, some people will point out that as a percentage, that's a very small number, just three kids out of 600 cases. Less than 1% of affected children died, and therefore our treatments must be very effective. But give us your reaction to that sentiment that because the percentage is small or whatever, that we're m magnifying something that we shouldn't magnify, and tell us why an ounce of prevention is better than a pound of cure.
SPEAKER_01:Right. So I did see the articles, and I'm sure many of your listeners have also seen the news. So let me start by saying that vaccines are good. What is not good is when babies and other people are dying. In 1850, a white child had a 21.7% chance of death before the age of one, and a non-white child had a 34% chance of death before age one. Today, infant mortality, which is defined as death before age one, is about 0.5%. Overall, in 1850, about half of children did not make it past the age of five. Today the total number of children who die before age five, including infant deaths, is just over 0.5%. So a couple of items to keep in mind as we discuss vaccines. Treatments are limited. Not every disease state has an antibiotic or an antiviral medication that can be used to treat it. And I'll go out and say of the treatments we have, not all of them are great. They have side effects, they have potential things that can make you feel almost as badly as you do when you have an infection. And the other point is death is not the only native outcome to think about. So just as we move forward and further discuss, keeping in mind not just the vaccine and the singular dose, but the things that go with it or around it, and think about the things that go with an actual infection.
SPEAKER_02:Yeah, let me highlight something that you just said, because it's really like you have to take this. In 1850, nearly half of children died before the age of five. And if you've ever done like genealogy, you'll see that in your family history where they had six kids, but don't three of them died and didn't make it to adulthood, or just walk through a cemetery in East Tennessee and see all of the child graves and things like that. But that death before age five is what we call the child mortality rate. And about a quarter of children died before the age of one or infant mortality rate. So that's just astounding, and I think it's something that people today don't connect to. But this is curious. I've been talking about this stuff for a long time, and let me read something to you that I wrote ten years ago, and and it kind of went sort of like viral because people don't read, they only read the first couple of paragraphs of what you write. So let me read this to you. Imagine living in a different world, a world where our children are not pumped full of dangerous toxins and chemicals at the doctor's office, a world where women aren't forced to give birth in hospitals, pumped full of microbiome destroying antibiotics and love destroying petosin, a world where we don't have to worry about eating genetically modified food, where our crops are growing in a sustainable manner without chemical pesticides and fertilizers, a world where our animals are not pumped full of hormones and antibiotics and they're allowed to range freely instead of being kept pent up in cages eating pesticide ridden genetically modified corn. Imagine a world where our food isn't processed, stripped of nutrients, where we eat whole natural foods, where corn syrup doesn't make most make up most of our calories, and diet drinks and other chemicals don't comprise most of what we drink. Imagine a world where doctors aren't constantly giving us medicines that we don't need and where we aren't exploited by hospitals that want to steal our money and our health. Imagine a world where we haven't destroyed the purity of our water and air with countless chemicals and pollutants and carbon based pollution, where smog doesn't choke our children, a world where they can grow up without being poisoned by the countless chemicals and the plastics that litter our landfills and oceans, where they can truly thrive. Can you imagine this heaven on earth? Well, you don't have to just imagine it. It's a real place. It's called America in eighteen fifty. And I do feel like that encapsulates what I see on social media. Everybody wants to make America healthy again, and they have this idea that we have that modernity and health and science has taken us backwards.
SPEAKER_01:I do think what you've described is an idealized or idyllic society that a lot of people would like to return to, and you see that world of eighteen fifty as the goal of a lot of alternative health trends on social media. But I don't think I would want to live in that world. Also, if I did, just as a side note, my life expectancy would have been about forty years of age. And that was one of the longer ones, noting that white women had one of the best life expectancies based on numbers.
SPEAKER_02:Yeah, they did. White women live longer than white men who live longer than black men who live longer than black women. And so we uh peep peop people again have just really no idea what life was like before modern medicine and before vaccines. Well, tell us what did children die of in 1850? If almost half these kids were dying, what did they die of? Because one of the reasons why total life expectancy was low, honestly, was because it was dragged down by children dying at such a young age.
SPEAKER_01:Right. And so some of the things that get left out of the idyllic pictures are the diseases that were killing people day in and day out. And so the ten leading causes of death in 1850 were tuberculosis, dysentery or diarrhea, cholera, malaria, typhoid fever, pneumonia, diphtheria, scarlet fever, meningitis, and whooping cough or protussis.
SPEAKER_02:And we vaccinate against, well, almost all those things today, right?
SPEAKER_01:Right. But if you're astute, and if you're wondering if you happen to have missed a TB vaccine, you didn't. The BCG vaccine is administered in other countries where there are higher incidences of disseminated TB. So it is not routinely administered in the US, but there is a vaccine for it.
SPEAKER_02:And obviously tuberculosis deaths in the United States, they've taken a different history here with how the CDC and other organizations have helped us eliminate, practically eliminate tuberculosis in the United States. But there is a vaccine we just don't use it.
SPEAKER_01:Yeah, I think that's where some of these things are, we'll use the term out of sight, out of mind. And tuberculosis, though people may not see routinely, I still do see some cases, and I work with the health departments, and as Howard said, that's where these are processed through, that's where they're detected, picked up, and have their contacts traced. So for the most part, the general public really doesn't see many of these cases in the United States.
SPEAKER_02:And I see that whooping cough was number 10 on your the la on your list of top 10. And what it feels like we've almost eliminated that. And now we see three children just in the state of Kentucky in the last few months who've died because parents are being scared out of vaccination.
SPEAKER_01:And that is truly unfortunate and absolutely tragic for those children because the disease they succumbed to was preventable. And that's the, I think, sadder part of the information, misinformation, disinformation, in that, as you said, people are scared to get kids vaccinated, and then this unfortunately is the outcome in some cases.
SPEAKER_02:Aaron Powell And we don't have to go into that, but we could also talk about what the ten leading causes of death are today, because they are things like heart disease and cancer and those sorts of things. And the social media health sphere attributes those causes of death to modernity, to maybe not vaccines specifically, but the things that I listed in that little fictional narrative I wrote. When in fact they're just diseases of older age, and they've moved up the list because we're not we're living long enough to get them. And as we live longer, and not that there aren't other things, and obviously the history of medicine is full of mistakes we've made, and we've learned a lot about public health and we've learned a lot about environmental health and sciences and things like that. But on the whole, those diseases have risen in prevalence simply because life expectancy has risen and ultimately we die of something. Okay. So is it true that the origin of the word vaccine is related to cows?
SPEAKER_01:Well, Howard, you are the Latin and Greek motor.
SPEAKER_02:Okay, sure, but we weren't going to tell everyone that little secret, but okay, yes. The Latin word for cow is waka. Looks like vaca. But tell us the story.
SPEAKER_01:The word vaccination does come from the Latin word for cow, as Howard correctly pronounced waka, as the V's and Ws take on different pronunciations. And it was used because the early cure for smallpox was to give a person cowpox instead.
SPEAKER_02:So a lot of times we'll do a history segment on the podcast, as you know, at the end, but why don't we start here with a history segment and you can tell us about Jenner and the Milkmaid. So I'll let me set the stage. We're living in a world before 1796. We were talking about 1850. It's maybe even worse. The horrible world where you have these episodic pandemics and epidemics and dysentery and cholera, and of course, half the babies dying before the age of five. And for every person that died, of course, there were dozens of near-death illnesses. So we always discount the suffering and poor health associated with surviving one of these diseases. But that's the stage in the 18th century, tells the story.
SPEAKER_01:Alright. So this is going to be a bit of a history segment. The origins of vaccination came from observations made of how people, some people who contracted certain illnesses appeared to be less likely to get other, more severe illnesses. In fact, even before the 1700s, going back to even at least the 15th century, and some sources would even suggest that these practices were taking place as early as 200 BC, people throughout the world have attempted to prevent illness by intentionally exposing healthy people to diseases and we're going to focus on smallpox. And that was a practice that was known as variolation. The name for smallpox was called the La Variole, and that word itself has a Latin derivation because if you hear a similarity to the word various, you can understand how it came to be. People named it such because they saw changes in human skin, and they were described as being speckled or spotted, or variations of the normal. Other symptoms of smallpox smallpox, other symptoms of smallpox included fever, nausea, vomiting, muscle aches, basically same symptoms you can get with a common cold. But it did also include ulcers of the mouth and skin, and the skin ones could later progress to blisters with a central indentation. The skin blisters would then scab over and eventually leave a scar. There were two versions of smallpox, variola major and variola minor. Variola major had a fatality rate of around 30%, while variola minor's mortality rate was about 1%. Of those, there was a higher risk among babies. Often those who survived had extensive scarring of their skin and some were even left blind. In 1721, a female called Lady Mary Wortley Montague is credited with bringing smallpox inoculation to Europe. She was the wife of the British ambassador to Turkey, and while she was living there with him for about two years, she observed a process that was being used called varulation. And she observed a process where pus was taken from a mild smallpox blister and introduced into scratch skin of the arm or leg of a previously uninfected person to promote immunity to the disease. Other variations of the techniques included taking dried scabs and blowing them into noses, or rubbing the content into scratches. She had her son engrafted, which was the term she used for the process, as was found later in letters she wrote to friends, while they were in Turkey, and then three years later had her daughter inoculated during a smallpox outbreak after that they had returned to England. So as early as the 1700s, the world was practicing varulation, where pus or scabs from an infected person were transferred to a healthy person. This was certainly a start in garnering immunity, but it definitely was not without risk. There was still a small chance that people could develop smallpox infection from varulation with about a two to three percent death rate. So that does give you a brief interlude or look into the really early beginnings of seeing how people took potential sources of infection from either these pus or these scabs, and the idea of trying to give an uninfected person some exposure to it. The next version of immunization came later in the latter half of the 1700s with the name that probably most of you are familiar with, Edward Jenner. According to folklore, Jenner observed that milkmaids were known for their clear skin, and they famously did not get those scars associated with smallpox. The theory. Milkmaids contracted cowpox, which was a milder disease from cows, and became immune to smallpox, the experiment. May the 14th, 1796, Jenner took a pusk from a cowpox lesion on the hand of a milkmaid whose name was Sarah Nelms and inoculated an eight-year-old boy, James Phipps, or the son of his gardener, the challenge. Months later, he exposed Phipps to a live smallpox. So the same process we discussed earlier, the varulation. And the boy did not become sick. And the key takeaway is this was the birth of vaccinology, using a less dangerous pathogen to train the immune system against the more serious one, the smallpox.
SPEAKER_02:I think I have some thoughts before I say them. One of the things that I was thinking about when you were telling that story is I think I'm writing a book now about the history of famous women who suffered from various problems in pregnancy and died or had complications and their children. And there's a chapter in there about Mary Shelley. There's a lot around Mary Shelley and her mother, the author, Mary Shelley, of course, the author of Frankenstein. And Frankenstein is sort of a tale about maternal and mortality. And so long story. But I remember that Mary Shelley's sister, named Fanny Emlay, died by suicide. And there's a lot of theories about her suicide, but she'd had smallpox, and her face was deeply scarred from it, and she had survived it, and she had severe mental health problems. And a lot of the biographers believe that the effect of having basically just horrible pox marks all over her face had affected her development and childhood and adolescent psychology, and she struggled with this for years, and she eventually died by suicide. It's complicated, of course, but this was a real part of it. And I was just thinking again about just surviving a disease is not necessarily a badge of merit. Like the prevention of horrible disfigurement has its own value as well. But okay. But the other thing I was thinking about are two important things from your story. The first one is that vaccines have been with us for a very long time. And over that time, of course, we've improved the technology and the science and the safety of vaccines tremendously. You but you do hear stories of accidental deaths from vaccines and from the disease, even in the 20th century, but we've almost eliminated that completely. But even when they these vaccines were untested and unstudied, people saw the great impact that they would have on their lives, and they took up the practice of vaccining each other or exposing each other to an illness like chicken pox for children, because they knew that it prevented death and suffering later in life. And today we've taken that natural process that's been with us for millennia that happened to these milkmaids by happenstance, and we've under we've come to understand how it works through the application of the scientific method, and we've made it more safe and more effective. And I guess that's my second insight is that what we call vaccination or immunization is actually a natural process that uses our immune systems and lets them do what they're supposed to do. And it happens to us every day when we go out Christmas shopping and we're exposed to various viruses or other antigens in our environment, the same process happens, the same immune system happens. I honestly think that most people who are vaccine hesitant don't realize that vaccines just use our natural, innate biologic process, and all of us go through that process every day of our lives if when we go out in the environment.
SPEAKER_01:And that's exactly right. Just because we don't see it happening or go into an office to receive a vaccine routinely, exposure to pathogens is happening constantly. And our immune system is doing exactly that. What it's built to do, to recognize and learn those entities that can potentially infect us. To Howard's point, like he said, we are all exposed every single day. And the beauty of our immune system is that I said we we don't come down with an illness every time go out to the grocery store, or every time we hear somebody cough and maybe walk through the pathway just afterward. So regarding the natural processes, I do understand how people may feel uncomfortable with the idea of singling out one pathogen and injecting it into a human via syringe. But I would also say to think about what we just talked about. If somebody does cough directly in front of you, or if you have a young child that may not have learned to cover their cough yet, and the parent picks up the child and that child coughs directly into his or her face, how much inoculate of that particular virus, such as rhinovirus, do you think gets passed on to the adult? We come in contact with germs every single day and in fairly large amounts sometimes.
SPEAKER_02:Okay, well, we've come a long way since Calpus. So Kate, will you walk us through the main types of vaccines we use today and How do they work? How do they trick our bodies or train our bodies? Maybe a better word into protecting us.
SPEAKER_01:So for all of you interested, this is the list of vaccines coming up. So mark your time if you want to go back and review. Live attenuated vaccines. I'm going to give you the definition. This is a weakened or the word attenuated version of an actual virus. It replicates just enough to train the immune system and usually does not cause disease. Next are inactivated or killed vaccines. This is when the virus is actually killed, whether through heat or chemical treatment. It is dead, so it cannot replicate. The pros is that this is a very safe means of vaccination. It cannot cause disease, and it is safe in pregnancy. The cons the immunity is not quite as strong, and it does often require boosters. So some of the examples are the polio vaccine or the inactivated polio vaccine, hepatitis A, injectable flu shots, and rabies. The next is a subunit, recombinate, polysaccharide, conjugate type of vaccine. This is when we only use a small piece of the germ, such as a protein, a sugar, or capsid, rather than the whole germ. This may be something found on the surface of the cell, but not the entire cell. And think about wanted posters for the immune system. Some examples are the hepatitis B vaccine, the Het PV, the Gardasil vaccine, the shingrix for shingles, hemophilus influenza, and pneumococcal. Next are the toxoid vaccines. These actually target the toxins that certain bacteria produce and not the bacteria itself. So examples are the tetanus, diphtheria vaccine, the T and the D in TDAP. And then finally we have a messenger RNA vaccine. And this is what we would call the new kid on the block and such. The mechanism is that it's in it's basically an instruction manual. So we inject messenger RNA inside of a lipid bubble that tells our own cells how to make a harmless viral protein, like the spike protein. This basically gives us the same pattern and we have something to target, and it confers immunity.
SPEAKER_02:Okay, so allow me to oversimplify perhaps the way vaccines work. We take some inert piece of the virus or germ and we give it to a person so that their immune system can naturally see it and create immunity to it, and that process that the immune system utilizes would be the same process it would utilize if it were exposed to this virus or this germ in real life, except that the patient hopefully also doesn't suffer the consequence of the infection. So we're using this natural process to skip the pain and suffering and death and leave behind a patient who has immunity so that the immune system can respond quickly if it's ever exposed to the real virus or germ and prevent severe disease.
SPEAKER_01:And that's a great summary. For context, when we talk about immunity, the human body's first line of defense against germs, it's considered a natural or innate immunity. And I'm going to just give you a little bit of background if you forgot all those med school lectures, but this is a less specific set of cells and processes that help the body defend against pathogens. It's composed of phagocytes, which are large specialized white blood cells that engulf and digest germs. It's got natural killer cells that are designed to detect cells that have already been infected by a virus, or even abnormal cells that may have already or in the future turn into tumor cells, and it kills them. There are also a series of enzymes that are involved. Then it takes us to the next step, which is considered our adaptive immunity. And that's the one that involves the T cells, the B cells, antibodies that target a specific pathogen because we've our body has made these memory cells so that the next time our body sees or is exposed to a germ, it's basically got a preset instruction on how to kill it before it does get us fully sick. So that's the scientific definition of natural or innate immunity. But for the bigger context, the idea of natural immunity is the way people see where you basically receive protection from your own antibodies and your own immune system when you're exposed to small amounts of pathogen, i.e., the child that coughs towards you, or exposure to an infection, and you'll know it because you actually are sick from that. So with vaccine-induced immunity, you are getting exposure to the germ and you're building that set of memory cells that make a response to it without actually being sick, which is really not unlike the process we've just been talking about, where we throughout the day get these small amounts of exposure to germs and protection based on our immunity without fully becoming sick.
SPEAKER_02:And the mRNA vaccines, they're not altering our DNA or doing anything else to us except using our body to make that spike protein for just a few days to do the same response. And this allows us to avoid many of the things that people are worried about, like vaccine adjuvants, and instead we can provide a highly specific focused protein for our immune system to train on and also avoid impurities and other issues that were historically associated with the process of how some of these other vaccines were made and how they work.
SPEAKER_01:And that is a really good explanation for the messenger RNA vaccine, which I know people are leery about, and we tend to think of this as newer technology, and it is true it's the newest of the vaccines, but messenger RNA was actually being tested for use for the flu virus even back in the 1990s.
SPEAKER_02:Yeah, people are always afraid of new things, aren't they? And it reminds me of this quote I'm always thinking of by Douglas Adams, who wrote The Hitchhiker's Guide to the Galaxy. So he wrote this paper, I think, in 1998 or 1999, about the emergence of the internet, which everybody at the time was saying was going to be the worst thing that ever happened, and it was the end of humanity, and it was just a disaster. And so there's a quote out of that paper that's that you see a lot, and this is it. He says, I've come up with a set of rules that describe our reactions to technologies. Number one, anything that is in the world when you're born is normal and ordinary, and it's just a natural part of the way the world works. Number two, anything that's invented between when you're 15 and 35 is new and exciting and revolutionary, and you can probably get a career in it. And number three, anything invented after you're 35 is against the natural order of things.
SPEAKER_01:I'm laughing because that really is so true. And you see that with vaccines, where a lot of vaccine hesitant parents are okay with the vaccines that they received when they were a child, but they're not okay with the newer vaccines. Even though in reality the newer vaccines actually have better evidence and are safer and more effective. And we've demonstrated a drastically reduced number of antigens that children are being exposed to in the last 40 years, even while protecting against more diseases. So it's actually never been better. And the masturder RNA vaccines are a giant leap forward in safety and efficacy. It's just not what people grew up with. So that's where some of the discomfort comes from. But I definitely do like that quote.
SPEAKER_02:Okay, well, let's put a fine point on just how effective vaccines have been. And we can throw some of these numbers up. People don't have to remember them. We'll put them on the Instagram. But could you review for us sort of the average cases and deaths or whatever for some of these diseases before and after vaccination, so we can get a feel for how impactful they've been?
SPEAKER_01:Yeah, this is going to be kind of a rapid fire, just you'll hear the disease and you're going to hear some numbers. But starting with smallpox, before vaccines, 29,000 cases, 1,500 deaths, post-vaccine, zero cases, zero deaths, diphtheria, twenty-one thousand cases, eighteen hundred deaths, post-vaccination. We're down to less than one case or zero deaths. Measles, five hundred thirty thousand cases reported, four hundred to five hundred deaths. And we basically post-vaccine less than a hundred cases. So that's a 99% decrease. Mumps, 162,000 cases, down to less than a thousand cases post-vaccine. Polio, paralytic polio for to be more specific, which I'll talk about here shortly. 16,000 cases, 1,800 deaths. We are actually at zero cases. This has been a 100% decrease post-vaccination era. Rubella, 47,000 reported cases, less than 10 now post-vaccine. Congenital rubella, 152 cases with peaks of 20,000 cases at certain points, less than one case post-vaccination era. Tetanus, 580 cases and 470 deaths. We are down to less than 30 cases with two to three deaths in the post-vaccine world. Haemophilus influenza B. 20,000 invasive cases. Less than 30 invasive cases post-vaccine. Hepatitis A, 117,000 estimated infections. And we're down to about 4,000 estimated infections. Varicella, 4 million cases, 100 or more deaths. Post-vaccination era, less than 150,000 cases. That may sound like a lot, but it is still a 96% decrease. And finally, whooping cough, pertussis, 174,000 cases. Down 3,000. And just two cases in 2021, post-vaccination era, which is a 99% decrease.
SPEAKER_02:Two deaths in 2021, but we just had three in Kentucky this year, and that's one state. So we Kentucky has had more whooping cough deaths than we had in the whole United States in 2001 or 21 because people aren't vaccinating and these numbers are rising. We've seen that with MMR and other things too that we can talk about. And deaths, that's those are all cases and deaths per year. And again, I would emphasize that it's not just the deaths that matter. So you might not have died from polio, but you might have been left living in an iron lung or paralyzed your whole life, or crippled in some other way with difficulty walking and wheelchair bound or using assistant devices to walk. Or you could have had other serious disabilities or health problems from many of these illnesses for the rest of your life. And each of those numbers, I would also point out, and we can talk about this again in a minute, but they would be dramatically higher today due to population density and travel. We just live in a world that's very connected now, and people commute an hour to work and they fly everywhere and that sort of thing. And so most of those numbers come from a world where we were less connected.
SPEAKER_01:Right. And as we said earlier in this recording, death is not the only outcome of disease. And digress and tell a personal story here, just on the heels of the chart, and I do encourage you to look on the website to look at those numbers. It's visually stunning. But I did mention polio a minute ago, so I'm actually going to tell a personal story. My aunt was born in the year 1952, which was just a few years before the poly vaccine was made widely available in 1955. When she was 18 months old, she contracted the virus or polio and had to be hospitalized. Thankfully, she didn't develop the more severe paralytic form of the disease. And this is where you may be familiar with seeing people in iron lungs or seeing pictures. A small side on the iron lung? It was a negative pressure ventilatory system where the patient would lie in a very large chamber with his or her head exposed, and then had a vacuum seal around the neck, and then the rest of their body was otherwise enclosed in this system. If you ever did an experiment in school where you took one of those two-liter soda bottles and you cut off the bottom portion, and then you would put a balloon over the bottom and then a s uh stretched over the opening and then put a small balloon at the neck, if you pulled down on the bottom balloon, it would cause the upper one to inflate. So this is the exact same idea of the iron lung. It was basically an external bellows that would perform the same function of the diaphragm and then therefore other muscles involved in respiration. If people develop nerve and muscle weakness of the spine and chest, they would lose their ability to enact respiration, therefore ventilation, and could succumb to the virus. Just to be clear, not everybody who contracted polio developed this severe form of paralysis. And even of those who did, not everybody had permanent loss of nerve activity. Not everybody developed the severe paralysis. If you did wonder about people in those iron lungs, they could spend weeks or months in them. But some people were able to recover and regain the use of lung function and be able to come off the external ventilator. In 1952, a record 57,628 cases of polio were reported in the US. And then in the year 1959, 1,200 people were still using the iron lung in the United States alone. So thankfully, my aunt did not have the paralytic form, and she did not have to rely on an iron lung for weeks or months to breathe. She did, however, develop chronic weakness of the muscles in her legs, particularly on the left side. So my mother, her younger sister, would tell me that she remembered several summers when my aunt had to have a cast on her leg. And I learned later that this was because she actually was referred to a pediatric orthopedic surgeon and would undergo the surgeries during the summer when she was out of school to try to correct some of the sequelae of the infection. Unfortunately, she did eventually develop foot drop in her left leg and has worn a brace for most of her life. She still did activities that didn't stop her from doing things she loved, like riding a bike or hiking and generally enjoying life, but she has had to make a lot of adjustments and adapt to things throughout her life just based on that lack of just your regular ambulatory status. So she did have, as we said earlier, some of the sequelae. It's it she didn't die from the disease, but that one infection did affect her for life. And again, she's alive and well and she's made the best of it, but still had to work with a brace, work with making adjustments to getting in and out of vehicles, climbing up and down steps, looking for resources and things to help make her life a little bit easier. Albeit there were potentially worse outcomes of the virus. I do think about what her parents, what my grandparents would have given for her to be able to get a that would have eliminated the outcome of that one infection that caused a lifetime of that chronic lower extremity weakness.
SPEAKER_02:Yeah, out of sight, out of mind, like you said, that the last iron lung patient died last year, a man named Paul Alexander, who was diagnosed with polio the year your aunt was born in 1952. He was six or seven years old at the time, something like that. And so he lived with an iron lung for about 70 years. He went to law school, he practiced law, he had brief periods of time when he could function without it, but he he still used an iron lung every day of his life, and then he died in February or March or so of last year of COVID. Of course, he was more prone to have COVID because of polio and his limited function respiratory-wise and things like that. So and and the March of Dimes was created to get everybody vaccinated, and there we could do a whole episode about that. It's a really fascinating story, but you're asking what your parents or grandparents would have done. Well, people lined up. It was a massive effort. Nobody, no parent in America wanted to see their children go through this, and they were all they all knew people who had suffered. And it's really an amazing story about how Americans came together and we got everybody vaccinated, including the adults, which was actually what put us over the edge. The adults knew they needed to get vaccinated because ultimately that was a way of protecting the children. And they got their little stained sugar cubes by the tens of millions as part of the March of Dimes. Of course, President Roosevelt had polio, and that's why he was wheelchair bound, and the Marcha Dimes and that initiative came out of the early vaccine era there. So a whole other story, but what they would what your grandparents would have done and did was immediately see the value in vaccination. I think there's two other points I was thinking about too. The first is, again, this idea I've been thinking about, the U.S. population is much larger today, and we live so much more densely, and we again we intermingle and we travel greater distances than we did in the 1940s and 50s and 60s. We fly everywhere, we drive everywhere. So the number of cases of these diseases would not just be higher today as a proportion of the population growth, but they would be geometrically higher because of the network effects of population density and travel. And this is understood, a well-understood idea and something you can model in epidemiology. So it's not like if we didn't have the polio vaccine that there would just be 1,800 deaths from polio, which is a number you gave. Our population's doubled since then. So it's not just 3,600 either, because you have to throw in and model these network effects of the population density. And again, we bus kids to schools across town and we drive an hour to work and we jump on planes and fly to another city and massive airports and things like that. And so all of those sort of network effects, the real number of deaths from polio today would probably be closer to 10,000 if we didn't have the polio vaccine.
SPEAKER_01:This is very true. And just as another side note, my mother still remembers that sugar cube that they administered those early polio vaccines in. So let's talk about another disease that's also become more prevalent. Measles. What is it? Measles is a virus. The word maisel, derived from Danish or Germanic language, means blemish or a blood blister. The virus causes fever, cough, congestion, white spots in the mouth or those coplic spots you might remember from med school, and a flat red rash. What is the issue with it? It is extremely transmissible. It's an airborne virus, so it is spread via cough, sneeze, or nasal secretions. What's concerning about it? It's coming back. The mortality rate was one in one thousand cases, so about 500 deaths a year prior to vaccination. Only one death in 2015 after 12 years with no deaths, then no deaths again until this year, with three deaths reported so far. While we're on the topic of measles, I know on this show we like to Harold likes to include some Americana history. I'm also Going to add a segment that we would be considered more modern history than some of the earlier topics we talked about in this recording. And it's tied in with the American cinema for any fans of movies from the 1930s, 40s, and 50s.
SPEAKER_02:We did a whole episode once on movies, so go for it.
SPEAKER_01:I have to say I'm an a fan of some of the older movies. That's what we grew up watching, though some of the themes and theories are outdated. But one of the famous actresses at the time was Jean Tierney. And if you're familiar with some of her more famous movies, they were Laura, The Ghost and Mrs. Muir, Heaven Can Wait. In Los Angeles, in Hollywood, at the time, there was an establishment called the Hollywood Canteen, and that provided food, drinks, dancing, and entertainment to enlisted men and women during World War II. Members of the Hollywood entertainment industry were often asked to make appearances at the canteen. Jean had agreed to go during the time when she was pregnant with her first child, which was June of 1943, and while she was there, she mingled, shook hands, signed autographs. A few days later, she developed red spots on her arms and face, and was diagnosed with German measles or rubella. She recovered from the illness, but unfortunately, her daughter was born prematurely, partially blind and death, and later longer story, but later had to be institutionalized at a very young age. One of the sadder parts of the story was that years later, a fan approached Jean and asked if she remembered her, and told her she had actually broken quarantine to go see her at the Hollywood canteen that night. The reason she broke quarantine was because she was in a women's branch of the Marines where there had been multiple cases of Rubella. If you also happen to be an Agatha Christie fan, this is said to have influenced the book The Mirror Cracked from Side to Side. This was supposed to be the inspiration for the plot for that. But bringing the narrative back to the overall vaccine topic, this demonstrates again that vaccines don't just protect against the act of infection, but also the lifelong sequelae or consequences that can be associated with them.
SPEAKER_02:Yeah, my my modern patients just don't understand the impact that rebella, congenital rebella and measles and things like that had. So this is a popular argument on social media, and the idea is that we reduce the rates of these diseases by things like clean water and sanitation symptom systems. And that's absolutely true. But that has more to do with things like cholera, which we don't vaccinate against, than it does, say, polio. And the proof of that perhaps is the polio vaccine. Because by the time the polio vaccine became widespread in the late mid late 1950s, we had already adopted safe water systems and sanitation systems and milk pasteurization and all of these other things that people cite as the reason why these diseases have kind of gone down. We'd done that 30 to 40 years before. And yet, even with all that, we would still expect to see, as I said, maybe 10,000 children a year dying if it weren't for the polio vaccine. And you also get a sense of this in other developing countries and see the effects of vaccines in more recent times. But yes, sanitation's important, but the polio vaccine is proof that it's not just sanitation.
SPEAKER_01:Yeah, and you make an excellent point, and unfortunately, the point you just made is often not included in the TikTok reels that people see. And to put some context around what you said, each year in the US, there's about 10,000 children between the ages of one and fourteen who die of all causes. That's the population of children that were most affected by polio. So back to the polio vaccine. Without it, the mortality rate would double. And of course, we would have many survivors that were paralyzed, unable to breathe without assistance. And that's just referring to the polio vaccine.
SPEAKER_02:Yeah. So we can't talk about vaccines without addressing some of the skepticism, although we're gonna we're gonna do that more, I think, in another program. But where did this modern vaccines cause autism, Miss Star? We said we'd talk about this with the Tonal episode a bit. So let's at least introduce the idea.
SPEAKER_01:Right. And there have always been some skeptics, even going back to Our Lady Mary when she started to come back to Europe and bring the ideas of virulation back. It was met with skepticism. So let's talk about the 1998 Lancet paper. The author was Andrew Wakefield. His specialty was gastroenterology, not immunology, not infectious diseases. The study, and I maybe hesitate to even call it a study in the terms we think of. It was a case series based on twelve children. The claim, he suggested a link between the MMR vaccine, bowel inflammation, and autism. The flaws. There was no control group. As we said a second ago, it was a case series based on twelve children. Fraud. Medical records were altered to fit the timeline. Some of the children that he looked at actually had symptoms before they ever got a vaccine. Conflicts of interest. Wakefield was being paid by lawyers suing vaccine manufacturers and had a patent for his own rival measles vaccine. The fallout. We had retraction. The Lancet, who originally published his study, retracted it in 2010. The consequences. Wakefield lost his medical license. The data since then. Millions of children studied, zero link found between vaccines and autism. But as you heard, those were just some of the really clear-cut parts of this history. That is basically the onset of where a lot of the skepticism in our modern age had started.
SPEAKER_02:Yeah, and there's a lot of marginalized people like Wakefield himself, who once he lost his medical license, what could he do to make money and restore his sense of worth and ego and whatever, but to go fully in, to just embrace it. And so he came to the United States of Texas and started selling quack cures and all these other things, too. But we're gonna we should do a whole episode where we get into this a little bit. But many of the folks who consume anti-vaccine content on social media and choose not to vaccinate themselves or their children, well, they do so out of fear from content that like that we see on these websites that's designed to provoke fear. But if you look behind the curtain, most of the folks like Wakefield do have huge financial incentives. And it's their business to stoke fear. And this includes RFK Jr., who's made a living off of referrals to plaintiff's attorneys who attempt to see vaccine makers. There's a great story in The Atlantic, a very long-form piece where a reporter spent a lot of time with RFK Jr. And I'd highly recommend it. It's in the current, I think, December, The Atlantic. Now I don't know whether these folks are sincere, meaning the Wakefields and the RFKs, or if they're just doing it for the money. But there's a huge conflict of interest when you make millions of dollars personally off of sewing discord and making these claims. And there's so much money in selling books and products and supplements and autism cures and detoxes and bogus treatments out there that there will always be a healthy grist mill of misinformation and disinformation out there.
SPEAKER_01:So I get questions very regularly from adults now asking about vaccines. And I'll say this there's nothing wrong with asking questions to better educate yourself. And I would much rather people ask me or their primary care doctors or their pediatricians than go to the internet for answers. In these offices, in these settings, it may take an extra five or ten minutes, but hopefully we can provide them with evidence-based or science-based information. What becomes difficult is that we can spend a lot of time providing the information about vaccines, but it is this wave of incorrect information that does continue, which is what people read or see online after their doctor's visit. And then it resows that doubt all over again.
SPEAKER_02:Well, we'll get into some of the specific claims. Maybe we'll have Anna on and she can represent some of the social media claims and we can talk about how to debunk. But we did recently make the episode about Tylenol and autism, and we said we would get into this, so give us the elevator talk, the short talk, what you'd talk to a patient about vaccines and autism.
SPEAKER_01:Alright, so once again, for those of you that want to make a little time mark here, in this segment we're going to talk about three big studies. So the first, the big data, the Denmark study. This was a massive epidemiological power of a Danish cohort study. Researchers looked at over 650,000 children, not just 12, that were born in Denmark between 1991 and 1998. Because Denmark has a national registry, they could track every single child. They compared those who got the MMR vaccine against those who didn't. The result? There was zero difference in autism diagnosis rates between the two groups. In fact, the risk was slightly lower in the vaccinated group, though statistically insignificant. This study is the gold standard because of its sheer size. Next one, the natural experiment, or the Japan case. Second is what we call a natural experiment. In 1993, Japan actually stopped using the MMR vaccine due to concerns about a different side effect, which was aseptic meningitis. If the MMR vaccine caused autism, we should have seen autism rates plummet in Japan after 1993. Instead, the exact opposite happened. Autism rates in Japan continued to rise steadily, and in some cohorts they actually doubled despite the MMR vaccine having been removed from the market. This effectively disproved the causality. And our third, the too many too soon rebuttal, the antigen study. Finally, for parents that are worried about it's not one specific vaccine, but the overload of the immune system, we have the 2013 DeStefano study. They looked at the total amount of antigens or the immunologic components that children received in the first two years of life. They compared children with autism to those without. The result was identical total antigen exposure in both groups. There is simply no evidence that the infant immune system is being overwhelmed to trigger neurological issues.
SPEAKER_02:Yeah, and we can talk more about that when we come back to this, but even though we're preventing more diseases with more safe vaccinations today, the total number of antigens in the vaccines today is less than it was in like 1980, 1990. Because we're better at making pure vaccines and we're targeting the diseases more specifically. So people talk a lot about so many vaccines at once, but we're actually giving fewer than you and I got and our parents got. We're doing a better job of that, but we'll talk more about that later. Okay, but let's end with a focus on our audience for OBGYN's for pregnancy. So tell us about the key vaccines that we give pregnant women.
SPEAKER_01:Alright, so for my last list today, we've got the TDAP, which is the tetanus diphtheria and protussis. The timing is given around 27 to 30 weeks of every pregnancy. Why? This is to pass on antibodies to the fetus to protect the newborn from protussis or whooping cough in those first two months before they can get their own vaccines. Think of the idea of cocooning, which is also where it's been recommended to vaccinate partners or grandparents as well. Next is the influenza vaccine. Pregnant women are considered immune compromised mechanically and physiologically. Flu is dangerous for them. They've got a higher risk of being admitted to ICU or even death. So the rule is go with injectable only, the inactivated for pregnant women. No use of the nasal spray, which is the live version. The benefit? This protects the baby for the first six months of life. Next is the RSV, the respiratory sensational virus. New recommendations coming from 2023-2024. There's the maternal vaccine, a Brycevo at 32 to 36 weeks, or there's an infant monoclonal antibody near Sebimab after birth. And the goal is preventing severe infant pneumonia or bronchiolitis. COVID-19. There is strong safety data. COVID does increase the risk of preterm birth and preocalampsia. This vaccination is recommended. And last we're going to put in a don't give list. So, like we said before, the live vaccines. Now this is to avoid during pregnancy, the MMR, Varicella, and HPV, usually deferred. And just a reminder to check rubella immunity prenatally and vaccinate postpartum before discharge if they're not immune.
SPEAKER_02:Yeah, and there's and again, there's so much more to talk about. I think we'll do another episode where we address specific pieces of misinformation and disinformation about vaccines. And maybe, like I say, we can get our friend Anna back on, and she can present some of the questions, and then you and I can address them. But give us the takeaways. What's our takeaway today?
SPEAKER_01:Yeah, so the takeaway for this vaccines don't just protect you, they protect the vulnerable people that you love through herd immunity as well. And they truly can provide a lifelong benefit of protection from both illness and sequelae of diseases.
SPEAKER_02:Yeah. In weird time we're living in, and the CDC has been repopulated with non-scientists. Many of them have direct financial industries to the trial lawyer groups that are suing. I think that a lot of people don't realize that RFK Jr. has made his money off of suing various companies, and he's he became a big he found out that people would come up to him about the HPV vaccine, and he started a referral business where he's referred patients who claim to have been harmed by the HPV vaccine to some of the biggest trial lawyers in America. And it's very lucrative for him. And we've put him literally in charge of this, a non-scientist, a non-physician who has some own apparently deep psychological problems and things like that anyway, and the financial incentives. It's a perfect combination. And then he fired all of the good people at the CDC and put in folks who have rightfully been marginalized in the scientific community. And I and the COVID, they took away first the COVID vaccination recommendation during pregnancy with no new data, no evidence of harm or anything like that. And we've talked before on the podcast about maternal mortality during the pandemic. And you for all the things you hear in newspapers and on online about maternal mortality in the United States, we added several hundred, like uh I don't remember the exact percentage, but we added a fifty, sixty percent increase in maternal mortality during the height of the pandemic, all due to the COVID to COVID deaths. And so COVID became the leading cause of maternal mortality in the United States for a couple of years. And we've recovered from that as the pandemic has waned. But in those years, the COVID vaccine would have prevented ninety-seven percent of those maternal deaths. And it did. And then there were groups that were scared away from the vaccine or just didn't have an opportunity to get it. It wasn't immediately available, obviously. And so we have the like the most direct proof of all about how successful the COVID vaccine was. We have these real life experiments. And then they just for no reason told women that they shouldn't get it. And now the Hip B vaccine is next. We'll talk about that with Anna. I think a lot of people, including doctors, don't really understand why we give children the Hip B vaccine, even if the mother has tested negative for it, but we'll get into that. And now we should split up the MMR vaccine. And I appreciated your comment about the Japanese sort of real life experiment. They've been going after this moving goalposts of different vaccines. Was it thymrosol? Well, we took that out. Okay, well, maybe then it was the aluminum. Well, it's one thing or the other. Well, we have these MRA vaccines that don't need that. It's always a different thing. And we talked more about obviously the real causes of autism on the Tylenol episode, but I don't know. Do you have any other thoughts?
SPEAKER_01:Yeah, and you summarized really well. And everything you just said here, it's I would say to summarize how does this affect us physicians, most of you doing your OBGYN jobs and trying to keep moms and babies safe. It's as I said earlier, it is just a constant wave. You feel like it's just pressing at your door. Like Howard said, the information about COVID vaccinations. I can tell you from an infectious disease standpoint. Yes, it's not as scary now as it was a few years ago. But go back, rewind five years back. And when those first few cases were coming in the hospital, and I saw young patients, young, otherwise healthy patients, extremely sick and on ventilators in the ICU out of nowhere and dying. It's another case of those first few years, you did have uh probably everybody knew someone that was sick with or very sick with or had died from COVID. And it just, it's another case where yes, COVID is less virulent, which is a good thing, but people are backing off and saying, ah, it wasn't that bad. But if you were there front lines, if you had a family member that you lost, it it was very different. So, and that's just one segment. Like you said, there's plenty of other vaccines to talk about, plenty of other questions that are brought up all the time in media. And I would just say, as a more wrap-up today, hopefully this information has been beneficial. If you are a doc, a resident, a med student, and you are talking with people, talking with patients each and every day, your efforts are still very much appreciated. Keep doing it, keep relying on the science.
SPEAKER_02:All right. Send us questions that you want to have us answer for Anna, and we'll be back maybe in the beginning of the new year with that episode, and we'll go through specific questions and I think help to frame the things that we hear from patients in our office and how we should respond to them and what some of the data is and what some of the facts are. So thanks for being on today, and we've got at least a couple more episodes planned for Kate. So we'll see you guys in a couple of weeks.
SPEAKER_00:Thanks for having me. Thanks for listening. Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram. We'll be back in two weeks.