Ep 180: Part 1: Navigating Vaccine Hesitancy with Dr Paul Offit

In this conversation, Dr. Paul Offit and pediatrician Jessica Hochman discuss the importance of vaccinations, the challenges of vaccine hesitancy among parents, and the need for nuanced conversations in public health. They explore the impact of the COVID-19 pandemic on public trust, and the science behind vaccination schedules. The discussion emphasizes the importance of understanding parental concerns while advocating for the safety and efficacy of vaccines. 

About Paul A. Offit, MD!

Paul A. Offit, MD, is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. He is the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania.
Dr. Offit is an internationally recognized expert in the fields of virology and immunology, and was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. He is a member of the Food and Drug Administration Vaccines and Related Biological Products Advisory Committee, and a founding advisory board member of the Autism Science Foundation and the Foundation for Vaccine Research, a member of the Institute of Medicine and co-editor of the foremost vaccine text, Vaccines.
He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, a Research Career Development Award from the National Institutes of Health, and the Sabin Vaccine Institute Gold Medal.
Dr. Offit has published more than 160 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC. For this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases, and he was honored by Bill and Melinda Gates during the launch of their Foundation’s Living Proof Project for global health.
In 2009, Dr. Offit received the President’s Certificate for Outstanding Service from the American Academy of Pediatrics. In 2011, he received the Humanitarian of the Year Award from the Biologic

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Dr Paul Offit, I cannot tell you how much I've been looking forward to this important conversation, and I'm so thankful that you're here with me today. So as a general pediatrician, I'm a strong proponent of vaccines, and I feel quite fortunate to practice medicine in a time when we have such tools. But I'm also seeing more hesitancy in parents. They're worried. They're getting a lot of mixed messages, and they often haven't seen these illnesses firsthand, so I understand their fears, but I also recommend vaccinations. I believe the CDC schedule is safe. I believe it protects kids when they are most vulnerable, but still, I worry that if the medical community is too rigid, we risk alienating families. So I'm hoping that this conversation can help make a strong case for vaccines, while also holding space for empathy and nuance. So maybe we can start with that. Do you think we've lost some of the nuance in our public health messaging? Well, first of all, I agree. I mean, I think that we ask a lot of parents in this country, we ask them to give vaccines to prevent 14 different diseases in the first few years of life, which can mean as many as 25 inoculations during that time, it can mean as many as five shots at one time to prevent disease, as most people don't see, using biological fluids most people don't understand. I think it would be surprising if there wasn't pushback against vaccines. The problem is how we respond to that pushback. I think that that, as you said, I mean, so why do you give a rotavirus vaccine at two, four and six months of age? Why do you give a pneumococcal vaccine or Haemophilus Influenza type B vaccine? You do that because those diseases are prevalent between six and 24 months of age. So you want to make sure children are protected. Then, I mean, when you get into the business trying to sort of separate or space out vaccines using, you know, so called alternative schedules, which really should just be called delayed schedules. All you're doing is increasing the risk of vaccine preventable diseases for no benefit. I mean, I understand how it feels like it's too much I do, but it's not. And I think that's sort of i When people ask me the question, aren't all these vaccines somehow weakening or overwhelming the immune system? How can we handle all this? I try and answer those questions with you know, the science that we have at hand, which hopefully can reassure them that it's not too much. I feel lucky because I practice pediatrics with my father, and he saw a lot of these illnesses, and he reminds me how lucky I am to practice at this day and age. He says, You're so lucky. You've never seen a patient walk in the door with a Haemophilus Influenza B infection. It is scary, and I feel like I'm honestly spoiled as a pediatrician, because he's right. I haven't seen a lot of these scary illnesses, and I think we're taking for granted, to be honest, the value of the vaccinations. Yeah. I mean, my parents were children of the 1920s so their parents, my grandparents, were scared of diphtheria, which would kill 15,000 children a year. They were scared of whooping cough, which was kill eight to 9000 children a year. I'm at the shot of the 1950s my parents were scared of polio, which would paralyze 30,000 children a year and kill as many as 1800 they were scared of measles, which would cause 50,000 hospitalizations and 500 deaths from severe pneumonia or dehydration, or encephalitis, brain swelling, which would leave one quarter of those children with blindness or deafness. They were scared of mumps, which was the most common cause of acquired deafness. They were scared of rubella, or German measles, which went into affected women in the first trimester. Pregnancy would result in 85% of those offspring having blindness or deafness or heart defects. I was a resident in the 1970s between 1977 and 1980 and we had a rotation where you had to be on call in the emergency department for 12 hours, from 12 at night to 12 and the next morning, next day, three state weeks, so 21 days, 12 hours on, 12 hours off. I did two to three spinal taps a night. Why? Because we didn't have a monophysy vaccine, didn't have a pneumococcal vaccine, didn't have a Meningococcal vaccine, and then my children were children of 90 so my me and my wife weren't scared of any of these diseases, which in some ways is part of the problem. I think because we don't fear diseases anymore, we focus on safety issues, real or imagined. I think this may seem contrary to what other people believe. But I actually believe that this day and age, we actually live in the best time in terms of infectious disease health that we ever could have imagined in human history. For sure. Yeah, we live 30 years longer than we did 100 years ago. Why? In large part because of vaccines. I mean, I think we have forgotten what these diseases look like. I'm actually watching a TV series now called 1883 this should scare you. Just watch this series. It starts off with a few people dying from smallpox. I think you just don't remember how devastating these infections were. And I think this is the story with measles. Now you're seeing an outbreak in West Texas. It's described as having about 350 cases. Assume it's 2000 cases, because those are just confirmed cases, confirmed by PCR or confirmed by serology. I talked to someone in West Texas from the health department the other day. She said it's at least 2000 cases. Could be 3000 cases. Why? And I think the reason is it's not largely that we've eliminated measles, which really did by the year 2000 it's that we've eliminated. Today the memory of measles, people don't remember how sick that virus can make you. Yes, and I also think a lot of people talk about how there's a pharmaceutical influence, that pediatricians are making money off of vaccines. But the truth is, I think we're vaccinating ourselves out of business. We don't see a lot of illness anymore that we used to like. There's so many there's a lot fewer ear infections. There's a lot fewer ear tubes that are placed. There's a lot fewer pneumonias that we take care of. We're seeing many fewer sick children, which is amazing, right? It also it is offensive to some extent that people ascribe that kind of motive to pediatricians. I mean, why do pediatricians do it? They do it generally, because they love kids. They care about kids. And the notion that they would say, Okay, I'm going to take this, this money from a pharmaceutical company, and give a vaccine that I know either doesn't work or is unsafe is so dead wrong. It's really amazing that anybody buys it. Yes, I mean, if I'm being perfectly honest, having vaccines in our office ends up being a headache. There's a lot to think about, making sure you have enough in stock, training the nurses to give the vaccines appropriately to make sure you stay on schedule. So no, it is stressful to have vaccines in the office, but I'm happy to do it because I know that it's the right thing to do. I know that it's keeping your kids healthy, right, and it's hard. I mean, I'm not in private practice pediatrics. I work at Children's Hospital Philadelphia, in the infectious disease division, but my wife's in private practice pediatrics, and I've watched her suffer this, and it's hard. I mean, it's hard when people are willing to walk out of the office without a vaccine for her, because she knows I could be sending you into into a world where pneumococcus is still there, which can cause meningitis and bloodstream infections and pneumonia, and Haemophilus Influenza B is still out there. Certainly, measles is out there, and it's very hard. She says, Look, let me love your child. Don't put me in a position where I'm being asked to practice substandard care, where I'm I know that your child could come back with a disease that was preventable. It's just too hard for me. Yes, yes. I mean, honestly, the the local hospital in my neighborhood. It's called Los Robles hospital. They just announced last month that they are going to close the pediatric floor because there's not enough business, and there's not enough business. I think we could say, oh, pediatricians are so great at keeping kids out of the hospital. That would be nice to say, but I don't know if that's true. Maybe, maybe it's a little bit true, but I think a big part of it is that we're just not seeing kids get us sick anymore, and in a large part because of the vaccinations. Well, give it time, I feel like we're going in the wrong direction. So okay, so you've made a good case that with vaccinations, we've eradicated a lot of illness that we don't want to see. And at the same time, I am sympathetic to parents. I think, to be honest, my perspective is I've seen a lot more pushback from families since the COVID 19 vaccine. There was a lot of conversation about mandating the vaccinations, and after that time, I started having a lot of families feel more reluctant to stay on schedule. Would you agree with that? Yes, I think we have lost a lot of trust in the public health community, and I think the COVID pandemic was a big reason for that. I think it for two reasons. I think in 2020 when we didn't have anything, we didn't have antivirals till October of 2020 we didn't have monoclonal till November, didn't have vaccines till December. So what do we have? All we had was to try and figure out ways to avoid human to human to human contact for a virus that could be spread asymptomatically and was killing hundreds of people a day. So we shuttered schools, closed businesses, restricted travel, isolated, quarantine, tested masked, and that was seen by a decent percentage of this country as massive government overreach. And then in 2021 we had a vaccine. We mandated it, and it's certainly understandable why. I mean, what our hospital, you know, we were working double shifts. We had three floors of children with COVID, and I work at a children's hospital, which is, you know, less the disease is generally less severe than, say, for working in adult hospital. But we, the nurses, were wearing bandanas for masks. They were wearing garbage bags for, you know, for gowns. We were working double shifts and and you were 12 times less likely to be hospitalized and 12 times less likely to die if you were vaccinated than if you were unvaccinated. So our thing it was help us out here. I mean, get vaccinated so that you don't overwhelm the healthcare system. Because we stopped optional surgeries, we we were overwhelmed, but nonetheless, from from the standpoint of the public, you know, you're mandating a vaccine, I can't go to my favorite bar or restaurant or sporting event or place of worship, and that, too was seen as massive overreach, and I think we're paying the price for that now. I think we lead into a libertarian left hook, and now we're feeling the punch Yes. And I think, honestly, when the vaccine first came out, it was very compelling to get the vaccine. I remember people were racing to the front of the line to get it because the data looked so good. It was so convincing. And at that time, COVID was it was dominating our lives in terms of what we could do, what we couldn't do, and it was so exciting to look and see that there was a possible end in some. Right? But when it came to the children, I feel like by the time the vaccine was actually available and approved for kids, that's when I think it got a little tricky, because many of the kids by that time had already had the illness, so they had pre existing immunity. We could tell by that time that kids were not getting hospitalized from COVID. By and large, the rates were significantly lower for kids, and the data wasn't clear that it was going to keep kids out of the hospital. So I was very sympathetic to parents that wanted to get the vaccine, and I was very sympathetic to parents that that had questions about getting the vaccine, especially when it was mandated. You know, I think firstly, national infection protects, and I think very early on in remember, we met, there was a group of us that met in February of 2022 to determine whether or not we thought that natural infection should count as a vaccine. Because, you know, people were being mandated to get a vaccine, and they were saying, Look, I've already been infected. I think I'm protected. And they're right. They were. And I really wish early on, we had made that clear that if you'd been naturally infected that you did need to get a vaccine. Some people were mandated to get a vaccine for work and were fired even though they had a natural effect. This was not fair. Children who were certainly had been naturally infected didn't need to be vaccinated, but if you hadn't been vaccinated as a child, I still feel this way, that if you haven't been vaccinated as a child, you should get a vaccine. I don't think that everyone needs a yearly vaccine. I think that the yearly vaccine really should be targeted to those who are most likely to be hospitalized and most likely to go to the ICU and most likely to die, which is really what most countries do. It's really only us in Canada that has a recommendation for everyone over six months of age. And I agree with all those other countries, you know, Western Europe, Scandinavian countries. World Health Organization Australia really vaccinates high risk groups for with the COVID vaccine on a yearly basis. Yes, and I know that for the last two seasons where the COVID 19 vaccine was offered to children, well developed countries such as Sweden, Australia, the UK, Germany, they did not recommend the vaccine for children 12 years of age and older, and I have not read that children in the United States have been any better off, even though we do recommend the vaccine for kids 12 and younger, people over 75 and I just had a birthday yesterday, but I'm not over 75 yet, but I am getting closer and or people who have high risk medical conditions, certainly, obesity is A high risk medical condition, diabetes, chronic lung, liver, heart disease. I mean, so there are certainly high risk groups, and those are the groups that I think should pay special attention to. But to vaccinate a healthy 18 year old who's already been vaccinated or naturally infected, or both, I think doesn't make a lot of sense. I think it's Low risk, low reward. I think you protect yourself for three to six months against mild to moderate disease, and that's pretty much what you get. Yes, no. And that's what I so appreciate about you, is that you leave space for nuance. Because I feel like during the time when COVID was dominating the news, when it was all everyone was thinking about and talking about, there wasn't any room for nuance. And so like you're mentioning having had the illness didn't count for having had a vaccine. And I think a lot of people got turned off from public health recommendations, and what bothered me about it is I was worried that it would lead to a mistrust and what we are recommending. No, I agree. I think, I think that the public health community saw a nuanced message as a garbled message, and they thought it would be simpler to understand vaccinate everybody, because then those who are most at risk would be most likely to get vaccinated. But I don't think that was right. I think it's okay to trust the American public that this is who we think is most at risk and leave it at that. I agree with you. I always think about the term in psychology, control, resist, that when people feel like they're too controlled, they actually push back and resist. And I see it a lot in my office with toddlers, when we're potty training them, when they feel forced to potty train, they go the other way. They don't want anything to do with it. You know, there's so many examples that I can think of with humans, where if you push them too much, it backfires. And I think it's so much better. And I know this is me thinking ideologically, but if you can convince them that it's the right thing to do, that it really is the best thing for them, with good data, with good information, I just think, to me, that feels better. I agree, I think. And I think if there's any chance that we're going to get the public stress, we do have to try and explain the best we can why we're making these decisions. You know, I think that was lost in many ways during the COVID pandemic. I think a lot of those decisions that were being discussed behind closed doors should have been open to the public. And for this reason that you'll do is you'll see people disagreeing. You'll see some people saying, look, I think we should do it this way, and some the other way. And I think the fear about that was that people would think, all right, these people don't know what they're doing. I mean, they just can't even agree on these things, but, but that's the way science works. I mean, you're always should hold the science behind a particular public health policy to the highest standard possible, and open that up to the open that discussion of the public. I mean, I'm on the FDA vaccine Advisory Committee, and have been since 2017 and there was debate about the bivalent vaccine. I mean, I voted no. On that vaccine in June of 2022 because I didn't think the data were showed it was any better than what we already had. And you notice, that was the last time we ever used a bivalent vaccine, the sort of half dose of Omicron and half dose of the ancestral strain. Because it wasn't worse than what we have it. It was no better than what we had. And I think Nonetheless, when it's rolled out, you know, everybody felt compelled to say, look, now it contains Omicron. Now it's clearly better when it really wasn't. And it was a little hard to watch that. I'm just so curious, did you take heat for that, for your stance? There were people in the public health community that were very angry with me because they felt that I had broken from the ranks, but and that people will see us disagreeing will make them trust us even less. And I'm sure that is true for a certain group of people, but I just think stick to the science, at least as you know it, and try and explain it, realizing that during this pandemic, we were building the plane while it was in the air, that we were going to be making mistakes, and we did, and just own up to them and move forward knowing that you are going to upset people. I actually feel the opposite. I think, when you are honest with the public, when you do say what you're finding, what you're noticing, and you evolve as the data evolves, I think that engenders trust. I hope you're right. I always feel like it's the tyranny of transparency. At some level, there are some people go, these people don't know what the hell they're doing. I hope you're right. That's sort of my philosophy is just, it's just so much easier frankly. I mean, first of all, I cannot, personally ever represent something as saying it's better when I don't think it is. So that's also my training. Is really a scientific training. So in science and basic science, when I spent 26 years of my life, you know, trying to understand which proteins on rotavirus evoke neutralizing antibodies, and I think, and so you go to scientific meetings, and what would happen in a scientific meeting is you would you would present your data, and you would reach a conclusion, and people would would either agree or disagree. They would say, Look, your data don't allow you to reach that conclusion, and here's why, and you wanted that feedback, because that's the only way your science got better. So that's really how I see public health, but it's a little different, I think, in the public health rule, yes, and I think now we live at such a different time now with social media and YouTube and information was dispersing so quickly, so fast, and I think a lot of the public felt like, you know, we were not being forthright with all the information that we were finding, like myocarditis and the teen boys. Well, why are we still recommending the COVID vaccine to teenage boys when there was that possible risk. And I think, you know, I What made me nervous about not having those nuanced conversations? Would we see pushback because of it in the future? And so I'm hoping to have good conversations that we can swing back the other direction. You know, I think we certainly democratize was a surprise, I mean, but the good news is, we have safety systems in place, like the vaccine safety data link, which actually very quickly picked that up. But you know, myocarditis is also a consequence of the disease, and we the so called multi system inflammatory disease. 50 to 75% of those kids had severe myocarditis, where you would some of those kids ended up in the ICU, and there were deaths. So it's not, again, a choice not to get a vaccine. It's never a risk free choice, and I just think it's a matter of making people get them to understand the risks of both choices. Yes, I completely agree with you. I think the vaccine suffered from a lot of things. It suffered from the fact that it was a genetic vaccine. We'd never done that before, but I think when people hear the word gene, they think this could somehow alter their genes, even though that's not possible, but that was part of it. The other thing is, because operation there was some bad terminology, I think operation wars a bad terminology, even for Star Wars fans, and you realize that that was faster than the speed of light. That was actually Peter marks at the Center for Biological Evaluation and Research. Was a Star Wars fan. So he came up with Operation warp speed, which made it sound like this is made way too quickly. That's the way it sounds. But the hero of this pandemic, to me, which which never got recognized, was a National Institute of Health. I mean, they were funding mRNA vaccine research, really beginning in 1997 so by the time SARS COVID Two rolled in, COVID rolled in, we had had 25 years of research on that kind of vaccine, and that never got explained. People just thought this vaccine was made in 11 months. I mean, that's way too quickly. Now, do you feel like a lot of the medical community has come around to agree with your your perspective on the vaccination, with regard to not necessarily needing to vaccinate everyone every year? Yes, yes to having some nuance to who who would benefit from the vaccine, high risk groups, those who've never been vaccinated. Yeah, the public has certainly voted that way. I think they, they those who are more likely to be at highest risk are more likely to get a vaccine. So I think that's the way it's it's settled out. Do I think most people in the public health community have done that? Don't know. Yeah, it was interesting to me. I just read that less than 20% of children actually got the COVID 19 booster this year. So I think you're right. The public is voting that way. What worries me is that children less than five are in a highly unvaccinated group. I mean, they're I think their vaccination rates is like 5% and who comes into the emergency department, including our emergency department, about 5% of our visits to the emergency. Department are children less than five who have COVID, not severe COVID, but COVID nonetheless. And it's it is a preventable illness, because you don't want them to get severe disease. Okay, so now I want to pivot this to asking you how we should respond to parents when they have concerns about vaccines. A lot of the same concerns come up to us pediatricians that I think are good questions, and I'm just curious how you would respond to educate hesitant parents. Well, that concludes part one with Dr Paul Offit. I felt so lucky to have him on the podcast. He's an incredible physician educator and overall advocate for children's health. Be sure and tune in to next week for part two, where we talk about the most common questions that I hear from parents like, Do kids really need so many shots so early? What's in these vaccines, and what about spacing them out? If this episode was helpful, please share it with a friend. Leave a review or subscribe. Your support really helps parents find the show. See you next week. You.