Ep 181: Part 2 Childhood Vaccines--common parent questions explained with Dr. Paul Offit

In Part 2 of my conversation with vaccine expert Dr. Paul Offit, we take a deep dive into the most frequent vaccine questions families ask pediatricians today. We cover concerns like giving multiple vaccines at once, whether it’s safer to space out shots, why certain vaccines are given at birth, and how to explain the roles of preservatives like aluminum and thimerosal. Dr. Offit offers clear, evidence-based answers while also showing understanding for the emotions and uncertainty many parents feel.

Dr. Paul Offit is a pediatric infectious disease specialist at Children’s Hospital of Philadelphia, a professor of pediatrics at the University of Pennsylvania, and the co-inventor of the RotaTeq vaccine. He’s served on the FDA Vaccine Advisory Committee and is one of the leading voices in vaccine education. His guidance has helped shape vaccine policy worldwide—and I couldn’t be more thankful he joined me for this conversation.

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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Transcript

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Welcome back to your child is normal. I'm Dr Jessica Hochman, and today we continue our conversation with Dr Paul Offit, one of the leading voices in vaccine education and a renowned pediatric infectious disease specialist. Dr offit is the CO inventor of the roto tech vaccine. He's been a longtime member of the FDA vaccine Advisory Committee, and he's a professor at the University of Pennsylvania. He has spent his career advocating for evidence based vaccine practices and communicating with empathy, clarity and deep scientific knowledge. I feel so grateful to have had the opportunity to ask Dr offit the questions that I hear most often from parents in my office, like questions about spacing out vaccines, concerns over preservatives like aluminum and mercury, and why the hepatitis B vaccine is recommended at birth. We also explore whether all vaccines are truly necessary, and also how to respond thoughtfully when parents are unsure. Whether you're a pediatrician trying to find the right words, or you're a parent looking for trustworthy information, this episode is for you. And as a quick reminder, if you are enjoying your child as normal, I would be so grateful if you could take a moment and leave a five star review wherever it is you listen to podcasts, good reviews really do make my day. Now on to part two of my conversation with Dr Paul Offit. I would love 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 would, I'm just curious how you would respond to educate hesitant parents. So the first thing that I hear all the time is a lot of parents want a delayed schedule. They they feel like it's too many, too soon for a young child. What do you think about that? Well, it's not. I'll explain why. And so we give 14 vaccines, or vaccines to prevent 14 different diseases in the first years of life. And people look at that and they think, well, like 100 years ago, we just got one vaccine. Now we're getting all these vaccines and and really another few vaccines. And adolescents are really close to 17, or vaccines to prevent 17 different diseases. And that number is greater than one, but it's really that's not the number that counts. The number that counts is the number of immunological components in vaccines, because that's what you're worried about. You're worried about somehow overwhelming or weakening the immune system by giving immunological challenges. So so for example, the hepatitis B vaccine contains one protein, the SARS cov two vaccine contains one protein. The diphtheria, the tetanus vaccines contain one protein. And if you add up, then you have the viruses, you know, like measles, mumps, rubella, if you add up those three vaccines, it's 24 proteins. So when you add up all the vaccine, all the all the immunological challenges in vaccines that children get today, it adds up to about 160 or so immunological challenges, either viral proteins, bacterial proteins, or the complex sugar coating of a bacteria called a polysaccharide. So let's look at that one vaccine you got 100 years ago, the smallpox vaccine, that is the largest of the mammalian viruses. It's the only virus that can be seen by light microscopy. Okay, it's that big, and it has 200 separate immunological components, meaning structural and non structural proteins. It is much greater immunological challenge to get the smallpox vaccine than to get all the vaccines today. And if you don't believe that, just look at what happens to people that get the smallpox vaccine. Because I had to do that for for the Wistar Institute, which is a Research Institute in Philadelphia. So I gave those vaccines. I gave the smallpox vaccines. I mean, those people invariably had fairly large swelling of the lymph node underneath the arm, the so called axillary lymph node, fever, chills. And one person's veteran sort of smallpox vaccine inoculator said, looked at and said, Good take meaning, this is what happens. And the difference is, we've had advances in protein chemistry, protein purification, recombinant DNA technology. I mean, that is why we can make sort of these single protein vaccines. And I just think that's what I try and explain, that that it's, it's actually a lesser immunological challenge now than it was then. And also, I feel like when children are little, they're more vulnerable to a lot of these illnesses that we're trying to protect them against. For example, the whooping cough. Kids that are under six months of age have a much harder time getting through the whooping cough than an older child. So for that reason, if we've deemed it safe to give it to a young kid, that would be my preference. Also, you know, when you're in the womb, in theory, you're in a sterile environment when you enter the birth canal, and then the world, you're not and you have, very quickly, living on the surface of your body, trillions of bacteria. You have, actually 10 times more bacteria on the surface of your body than you have cells in your body. I think if somebody came from outer space and saw us, they would think we were just a way of transporting bacteria from one place to the next. And you make an immune response to those bacteria, because you want to make sure that they stay on the surface of your body and don't cause harm, that they are so called commensal so So you make roughly 10 to the ninth, new B and T cells, immunological cells every day pours out of your bone marrow to handle the onslaught that happens every day, the food you eat in sterile the dust. You inhale, as in sterile, or what do you drink? Isn't sterile. You're constantly being exposed back. If you really want to scare yourself, just take a swab. You swab the inside the nose, put it on a microscope slide and look at it under the microscope. It's teeming with bacteria, too much of what you make an immune response, honestly, literally, the vaccines that you get are not just figuratively, but literally, a drop in the ocean of what you encounter and manage every day. I mean, if we couldn't handle the immune response from vaccines, we wouldn't survive as a species. That's such an interesting perspective. So what you're saying is, it may feel to parents like we're getting a lot early in life, but we already are, and getting a lot more, we're exposed constantly, which is healthy for our immune systems. That's how we grow stronger, exactly, right. So what do you think myself as a pediatrician, should say when a family says that it just feels like a lot all at once, our preference is to space it out. And it is true that if we do more vaccines in one day, they're more likely to have a fever, which, in my view, is not a bad response. It's a normal, natural immunologic response, but nevertheless, I'm sympathetic that that makes them nervous. Do you think that we should be permitting spacing of vaccines or allowing it? I don't, and here's why, it's it feels better. It feels better to space them out. It feels better for the parent, but it isn't better. I mean, you're, you're you're the minute you a alternative schedule, if you will, is really just a delayed schedule. So now you're increasing the period of time during which children are now more susceptible to these diseases with no benefit. I mean, it feels better, but there really is no actual benefit. And you're right about fever. I mean, why do we make fever? Why does the mammalian species us make fever because your your immune system works better at a higher temperature, that's why. But you pay a metabolic price for fever. It's not fun to have fever. You don't feel good having fever, and you burn off more calories, etc. Sometimes you get dehydrated, so you need it's it's you pay a price for fever, but your immune system works better at a higher temperature, that's why. There's probably 20 studies showing that when you treat fever, you actually can delay or prolong or even worsen certain infections. Yes, I know they used to give Tylenol at the same time that they gave vaccinations, thinking that it would be easier and more gentler on the on the child, but then they found that the pneumococcus vaccine didn't mount as much of an immune response when you gave it at the same time. So to your point, you want your immune system to show that it's working, which I think a lot of people got that concept during COVID, that it was explained to the public that a fever was a good thing, that meant the vaccine was working. Yeah, no. I had a friend in North Carolina who volunteered for one of the COVID trials. So, you know, you don't know what you're getting. You're getting either vaccine or placebo. This was in like 2020, and so he gets a shot, doesn't know what it is then, like the next day, or the day after that, he wakes up and he has, he has fever, and he is, you know, it just does have sort of achiness. And he looks at his wife and he said, Yes, I got the vaccine. That's right, you know, it's working. You know, he got something. Now, the other question that I hear a lot parents want to know about the preservatives that are found in the vaccines. Specifically, I hear a lot about concerns for the aluminum that's in the vaccinations and the thimerosal or mercury, or mercury. How would you respond to that concern? Alright, so, so thimerosal is ethyl mercury. That's a preservative has that has been removed from vaccines given to less than four year olds since, really 2000 2001 so that's gone for the most part, for young children, but, but take it on its face. I mean, the the ethyl mercury never sounds good. It's not like there's a national center for the appreciation of heavy metals standing up in defense of mercury. And certainly large quantities of of methyl mercury are harmful, no doubt about it. And but remember that we Mercury's in nearest crust on there, and mercury gets methylated by bacteria, so now it's organic mercury, so it can cross cell membranes. You drink methylmercury every day, assuming you make you're drinking anything made from water, including infant formula or breast milk, you are ingesting methylmercury every day. And so the ethyl mercury is not methylmercury. Ethyl mercury has a much shorter half life, so it's eliminated from the body much more quickly. So ethyl mercury was never harmful, but it just didn't sound good, so they sort of took it out in early 2000s the aluminum is not not a preservative. It's an adjuvant, which is to say it, it helps the immune system make a better immune response, which enables you to give fewer doses or lesser quantities of the antigen. Again, aluminum is a the most abundant light metal you're exposed to, aluminum all the time. This is it. I mean, the minute you say that anything with a chemical name, everybody feels you know that. Oh, my God, I am avoiding that. Well, if you've only want to avoid these things for the most part, you have to move to another planet. I was actually on. Had to testify in front of Congress once, and I think was Frank Pallone. It was one of the congressman said I was Democrat from I think it was Democrat from New Jersey. But any case, he said, hey, when it comes to Mercury, I have zero tolerance. Well, you got zero tolerance. Got to move to another planet. On this planet, there's mercury, and you're just ingesting it all the time. So it's always a perception issue more than a reality issue. So I but I understand it. I mean, Mercury isn't going to sound good. Aluminum doesn't sound good, but it's. Is, you're exposed to it all the time. And when people ask, I wish we could make these vaccines without aluminum, I think what's not communicated well enough is that the aluminum, as you're saying, it potentiates the vaccine. It actually makes it work better, and it's at such it's such a small amount that we found it's not doing any harm, right? So live attenuated viral vaccines live, weakened viral vaccines, like measles, mumps, German measles, rotavirus, none of those contain an adjuvant, because the virus is replicating. But when you when you have to go to this sort of single protein, vaccines like, you know, hepatitis B or human Papillon virus, that you need a little bit more of a because you're just giving one protein, so you need to sort of boost that response a little more, and that's what the adjuvants do. They enable you to give fewer doses and lesser quantity of the antigen, meaning the immunogen. So when you explain it like that, it sounds like a plus, and it makes sense. Okay, so the Now another question that I get all the time, and I think this is because this is the first vaccine that we introduce to children, but it's recommended that we give the hepatitis B vaccine right after birth. At the hospital that I work at, they like to give it within the first 12 hours. And I think a lot of parents, that makes them nervous, and I understand that they've just had a baby. Do we really need this? You know, the mothers in the area where I work at good prenatal care, they've all been screened for hepatitis B, and they're negative, and they want to know is this necessary? And I will say, for me as a pediatrician, what I find difficult is I want to I want to convince them that our vaccine schedule is a trusted good idea. And I have a hard time when this is the first one that we recommend, to be honest, because I think they have some valid points. And at the same time, the counter to that is, when I do give the hepatitis B vaccine, I don't think I've ever seen a bad reaction from it. It's very well tolerated to kids, and it's nice to know that they're vaccinated and protected from the beginning. And I know it's more of a public health concern that not every mother in the United States can get screened for hepatitis B, but what do you think about that perspective on the Hepatitis B that's recommended right out the gate. Well, I certainly understand the feeling. I mean, I mean, I remember, my son was born, you know, it's like, within the first 24 hours he got that vaccine. It's like, sort of the first scratch when you do car. I mean, come on, give this kid a break. He was just born, and now you're injecting him with something. And injection, you know, when you give a vaccine, it's sort of a violent act. I mean, kids are pinned down against their will, their job with a needle. I mean, it certainly doesn't look good. But hepatitis B, if you acquire Hepatitis B in the first by the way, and I so appreciate that you show that empathy. Because I think that's right, it's I can understand where parents are coming from. The kids just born, giving a vaccine makes the child cry. We feel bad. Do they really need this? So I, I do want to help, like a case for, for why, for why this should be, and if it shouldn't be, have some consideration for that. The problem with Hepatitis B is, it is, if you get it in the first few months of life, you have a very high chance of going on to develop chronic liver disease, I cirrhosis or liver cancer, a very high chance. And so you would argue, Well, I mean, the mother screen that makes two assumptions. One is that the screening test is 100% effective, which isn't, which is two of no screening test. Two, that she doesn't acquire Hepatitis B after the she was screened, which is also possible. And three, that Uncle Bob comes and kisses the baby when he's when the child's little and and, you know, Hepatitis B is known as a silent epidemic. A lot of people have Hepatitis B and don't know it. I mean, before there was a routine recommendation for the hepatitis B vaccine, in 1991 with the, you know, the so called recombinant DNA hepatitis B vaccine, every year in this country, there were 18,000 children less than 10 years of age that would get hepatitis B 18,000 not half of them would get it from their mother passing through the birth canal of their mother. The other half got it from relatively casual contact with sharing toothbrushes or washcloths or Uncle Bob coming and giving a kiss. And with that recommendation in 1991 we have basically eliminated Hepatitis B in children less than 10. It is a remarkable achievement, and with that, have lessened the instance of cirrhosis and liver cancer. That is, was one of our more remarkable achievements that really few people pay attention to. But it's a dangerous time. If you get hepatitis B in those first couple months, you're in trouble. And so as much as that was hard for me to watch my son get that vaccine. I knew in my heart it was the right thing to do. And in Asia, it's a tremendous issue. There's hundreds of 1000s that have Hepatitis B from birth that that they acquired from birth. Yes, about 9000 in this country, it was about 9000 a year prior to the vaccine. It was like, 9000 you write in known Asia, it's much, much higher. Yeah, absolutely. Okay, all right. So as as a pediatrician and as someone who understands infectious disease, and as a grandparent, you're sympathetic to not wanting to get the hepatitis B or to have some hesitancy, but there's a still, but there still is a good case for it that why not have a zero risk chance of getting some? That could cause a lot of problems to a baby. I have a granddaughter and a grandson, and with my granddaughter, I actually went to her visit at two months of age. I went with my son and daughter in law to watch that, but it was hard. It was hard to watch her get all those vaccines. And one of them was, you know, the rotavirus, actually, which we developed at Children's Hospital Philadelphia, which was sort of fun, right? Because it's sort of going full circle. Here I'm holding her while she's getting her rotavirus vaccine, which is by mouth, and it's also suspended in sucrose, so it's delicious, but congratulations about that, by the way, I I'm so proud of you for for being for playing such a large role in developing such an important vaccination. Thank you. And okay, and I want to ask you more about that, because I find that so fascinating. But just to finish the other parent concerns that I hear, and then I want to ask you more. And then the other question I get, I have some families that move to the United States from other countries, and they compare and contrast the United States with the country that they came from. So specifically, I had a family that moved here from the UK, and they said, Oh, well, why? Why do you guys give four Prevnar vaccines and we give three? Why do you give four hip vaccines and we give three? Can we just stick to the schedule from the country that we came from? I think the feeling is that we continue to add more and more vaccines to the schedule. We never can. We hardly ever consider taking away some of those vaccines. Do you think that's a valid point to bring up? So sometimes, so there are differences, and it's sort of what the country was willing to do. So for example, the there, should I say, Do you think that's a valid consideration? Yeah, no, I think it's valid. But let me tell you where it comes from. It comes from some countries. Most of those countries, like the UK, for example, have a national health service so that so how much they so how much they spend, matters that that is a consideration. In this country. We really don't consider that if we think that we just give the best vaccine in terms of number of doses, and if we think that X that additional dose gives you another five or 10% protection, then we do it, whereas another country may not choose to do it that way, because they think 90% is good enough. We don't need to have 98% you know. So I think that's where that comes from. So my general bias is to stick to what we do here, because we that's why we do it. I remember reading that one Prevnar dose, you got about 20% protection. The second one boosted it up to 40% the third to 70% the fourth to 90% so that fourth dose did make an impact, right? And we value that. UK didn't give the varicella vaccine for chicken box vaccine for a long time. Finally, I think they do now, but they just thought, Okay, we'll just grandfather in that disease. They just want to pay for it. They do now. That's another question I get a lot from parents. Why do we need to get the chicken pox vaccine? We all have the chicken pox. What's the big deal? We had a chicken pox party. How would you respond to families that share that concern? I'm sure you've heard that a million times as well. Well. So every year, chicken pox would cause about 10,000 hospitalizations, usually from things like chicken pox pneumonia, from something called necrotizing fasciitis, which is, you know that that flesh eating bacteria under the skin, because you disrupt skin integrity with the with the chicken pox blisters, and there'd be 100 to 150 people who would die every year from chicken pox in this country, many of them children. So when people say that that, look, they had chicken pox and they were fine, the people who didn't survive aren't around to say that anymore. So who represents them? I think we represent them because we it's preventable. It's safely preventable, and so we should prevent it. I mean, which is to say it's survivor bias. I think when you say I had it was fine, you're biased, because you did survive, as myself, a child from the 80s who had the chicken pox and had a chicken pox party and got over it. And I remember getting, you know, missing a week of school. It wasn't so bad. It was uncomfortable, but not so bad. I was sympathetic to that perspective. But then, when I was in residency, I remember treating a baby who had a tracheotomy, could not eat, could not talk, was neurologically devastated, because their mother, who had not had the chicken pox in childhood, got it as an adult, and then passed it on to the baby in utero, and the baby had severe complications from it. And after I saw that child and treated that child, I was convinced that if there was a way to eradicate this illness, we should, right? We're, you know, we're compelled by our experiences and and that's a part of the problem now, is we don't see this disease right now. So people think that's they're just no big deal because they don't remember them. I mean, when you look at polio, for example, everybody thinks of sort of black and white pictures. But there was a 27 year old man in Rockland County, New York, who never left this this country, who got polio, got paralyzed by poliovirus. And remember, polio only paralyzed one of every 200 people that infect. So he was the tip of a much bigger iceberg, and the they could detect the virus in wastewater samples, not only in his county, but surrounding counties. And if you looked in Philadelphia. Or Chicago or Los Angeles, you will find that virus, which is to say a reverent type two vaccine virus, that is in the water supply. And it's because people come in from this, from other countries that get oral polio vaccine. People are very complacent about these things, but they shouldn't be. And the reason that happened in his Rockland County area was immunization rate had dropped to less than 30% and that wasn't very long ago, 2022 Yes, I think, I think we're so lucky. I mean, the polio in the 1950s was really scary. And I went with my family to the CDC once we saw the iron the iron lung. And after I saw that apparatus, I thought, I want to see this. I don't want to, I really don't want polio to come back into this country. Well, here's how old I am, right? So I was at age five. I was in a polio ward. I was at hospitalized in CO man's hospital for Crippled Children. That was what it was called, because that was back in the days when you could use words like crippled and feeble minded to describe children's hospitals. But I didn't have polio. Had a failed operation on my right foot. I was born with club feet, so I was in a polio ward for about six weeks. And I remember iron lungs. I remember the so called Sister Kenny hot pack treatments, where they would take these excruciating of the hot packs and put them on withered arms and legs. I remember children screaming out in pain. There was one visiting hour a week on Sundays from two to three. And so I just remember lying there and looking at these children screaming out in pain, watching children in iron lungs, and I felt like I was in a Dickens novel. And I think if you ask me the question, Why did I choose pediatrics, I think that's why I think this scars of our childhood invariably become the passions of our adulthood, and that's why I think I became a pediatrician. Well, I'll say for the world, for anybody that's listened to Dr offit and realizes very quickly what, what a gem you are, I would say that's lemonade from lemons, for sure. We all benefited from you going into pediatrics. Thank you. Now, what about the other question I get from parents all the time is they want to know, What does my child really need? Can I pick the grade a most important vaccines? They can't all possibly be equally as important. So what do I think they really need? And maybe we could put the other ones to the side. Are you sympathetic to that perspective, and how should I respond as a pediatrician? It's sort of like a Sophie's Choice. I mean, what you know which which ones do you want to put yourself at risk for? I mean, vaccines are safe and effective. They're not absolutely safe. They are certainly the benefits clearly and definitively outweigh the risk. I mean, there were times when that wasn't true. I mean, so for example, with if you look at the polio vaccine, we gave the Jonas Salk vaccine, starting in 1955 A killed viral vaccine. We did that into the early 60s. Then we chose the oral vaccine, the Sabin vaccine, the Sabin vaccine, right? And so that was a live weekend form of the virus. Now, that virus was a that vaccine was a rare cause of polio. Did I miss rare one per 2.4 million doses, but real. So we eliminated polio by 1979 in this country, but throughout the 80s and throughout the 90s, every year, eight to 10 children in this country would get polio from the polio vaccine. For 20 years, the only polio in this country was caused by the polio vaccine, which is to say its benefits were clearly outweighed by its risks. So when I came onto the Advisory Committee for Immunization Practices in 1998 my task, my interest was in getting us away from the oral polio vaccine. So I used to be the head of the the polio Working Group and and was and for those two years, I tried very hard, and ultimately successfully, to have that happen. And the thing that was the key there was there was a guy named John Salomon, whose son had gotten polio paralyzed by the polio vaccine, ultimately died, and I brought him on the committee, even sort of the birth of consumer representatives, and brought him on the Committee, said, Okay, if you think it's too expensive, because it was much less expensive to give the oral vaccine as a squirt in the mouth than to give a shot. But, you know, tell him that. So there's an example where a vaccine's risks had outweighed its benefits, and good for you for being honest about that. I think that's what people so much respect about you. What I so appreciate from you is your willingness to acknowledge that there are side effects from vaccines, which I think, if you think about it, if you want a vaccine to actually work, to mount an immune response, to do enough benefit, you're going to see some side effects. But the question, as you pointed out, is, do the benefits outweigh the risk? And I do believe the benefits outweigh the risks. Yes, clearly, I mean, or else we shouldn't give them. And I think so. Look at the J and J vaccine. The that vaccine was the J and J Johnson. Johnson COVID vaccine was authorized in February of 2021 so it was that's such a good memory for dates. It's impressive. That's because I was on the FDA vaccine Advisory Committee. They're like bare little burn in my brain the and so we recommended that. So there was the way that vaccine worked. It was an adenovirus that was live but couldn't reproduce itself. Kind of an odd sounds like it's contradictory, but it was a live virus that could. Do itself into which you would clone. Now the gene that code for it coded for the SARS COVID Two surface protein, or spike protein. So that vaccine came on the market in February, 2021 and it was found pretty quickly to be an extremely rare cause of clotting. Like one in 250,000 people could suffer clotting, including clotting in the brain, including fatal clotting in the brain. So there were a handful of deaths associated with that vaccine, which ultimately drove it off the market by March of 2023, when that became clear, because the mRNA vaccines were safer. So I think you're always considering that, and sadly, you always learn as you go. I mean, there's invariably a human price to be paid for knowledge, and that's something we have a hard time accepting. Of course, science isn't perfect. We're not perfect. Science isn't perfect. We have to learn as we go. So what do you think if you were to give advice to pediatricians on how we could better communicate the benefit of vaccines to parents, what do you think we should say? What is the approach we should take? Well, that first, we have a lot of experience with vaccines. I certainly understand how hard it is to watch your child be laid down and against their will, jabbed. I think that is hard to watch and but again, what's harder to watch is children suffering preventable illnesses. I mean to me, the thing that breaks my heart and makes me want to cry is that six year old girl in West Texas who was perfectly healthy, who died for measles. That is just, I mean, it is the worst thing in the world is to lose a child. What's even worse is if you lose a child because of something you did or didn't do, and that's that's something that mother and father have to live with, is that this was a preventable death. And I think, you know what, what I guess, most impresses me are these sort of parent advocacy groups, you know, like families fighting flu, meningitis, angels, national meningitis Association. These are parents who children have suffered and died occasionally from vaccine preventable disease. And God bless them. I mean, they get up in front of the puppy and think, Okay, this happened to me for a reason. I'm going to explain the importance of the vaccine. I'm going to explain how devastating this illness can be, because they all tell the same story. I can't believe this happened to me until it happens to you. I mean, I certainly not surprisingly, vaccinated my children. But do I ever, could I ever imagine that they would ever suffer these diseases? No, it's too horrible to imagine, but it's so it's a game of brush and roulette. I mean, it's not five empty chambers in one bowl. It's probably 100,000 empty chambers in one bowl. But why play that game? Do you also feel like we should impress upon people that for immunity to work, it takes the community to be all involved, that if enough people opt out, we're going to start to see problems. That's what's happening. I mean, Texas, some of you, that's exactly what's happening. You have a Mennonite community that had about 80% immunization rates. That's not enough to stop measles, which really requires about 95% of people to be immune, to provide herd immunity. But I don't think the societal argument ever works, not today. I think it did 50 years ago. I don't think it does today. I think you can't say to somebody care about the person next to you, because I think they largely don't. I remember, during the there was a measles epidemic in California, 2014 2015 and it spread to seven other states, as well as Canada and Mexico. But it started in Southern California, so sort of the it was that was not the libertarian crowd. That was more like the all natural crowd. Don't inject me with anything that has a chemical name, the all natural crowd. So that was the epicenter of the outbreak. So Richard Pan was a state senator who took it upon himself to eliminate the philosophical exemption to vaccination in a state that never had a religious exemption, therefore eliminating all non medical exemptions. So the anti vaccine folks were there in force. This is the worst thing to them, is the notion that they would be mandated to get vaccines. So there was a little boy named Rhett crowd, who was seven years old, had acute lymphoblastic leukemia. So he went to these me. Said, you can see this on video. It's on YouTube. You can see him. So they put him up on a stool so he can reach the microphone. And he says, he looks right at them. He's so brave. This is older now, because this was like 10 years ago. He looks at them and he says, I'm My name is Luke. I have leukemia. I can't be vaccinated. I depend on you to protect me, don't I count that's that tugs at your heartstrings. To me, that's very compelling. And do you, do you feel like the pharmaceutical industry has too big of an influence on the vaccinations that we give? Or do you feel like there's enough independence and the way that we view the schedule and what we administer to kids. First of all, pharmaceutical companies are the only group that have the resources and expertise to make a vaccine. I mean, usually these are billion and a half dollar programs, and not all of them end up in vaccines. So only they can make vaccines and then they submit their data. I think if their data are compelling, then that's influential. I mean, as on the FDA vaccine Advisory Committee, when I was on the CDC vaccine Advisory Committee, you just look at the data, you have no relationship with the pharmaceutical company. You can't You're not allowed to have a relationship with the pharmaceutical companies if, for example, you were part of a data safety monitoring board. You can't vote on that product or any product that that company makes. So I think there's a firewall there, and I think the people are. They're serious. They're all, you know, virologists and immunologists and epidemiologists, infectious disease specialists, etc. They're there to they take the job seriously. So I think there's that catchment system. And then once the vaccines are out, there's things like the vaccine safety data link that can pick up even the rarest of side effects. So there's no lying. I mean, if you choose to lie in your in your submission to the FDA, for example, there's no hiding. It'll be found out later. So it's never to your advantage to lie. It's never to your advantage to lie anyway. I mean, if you lie to the FDA, you're screwed. So I don't, I don't, I don't buy it. I know it's an easy pharmaceutical companies are never going to sound like the good guys. There's always big pharma, but they, they, they're the only ones that can make them and you know, you know, you can't. On the one hand, praise vaccine. It's not, at some level, praise those who make them, and it is a fragile industry. I don't think people realize that it's they see COVID, which was a windfall for Pfizer, a windfall for moderna, but for most of vaccines are something you give just a once or a few times in your lifetime, and they never compete with like lipid lowering agents or psychiatric drugs or neurological drugs, etc. So there were 27 companies that made vaccine in 1955 there were 18 companies that made vaccines for American children in 1980 today, there's four, and it's less than 10% of what any of these companies do. They could drop it in a second. They could make it difficult enough, and they will, yes, and the truth is, to to be properly incentivized. You do? You do want people to make some money from what they're doing. So it's not all bad. We're benefiting from it. That's right. I mean, take out the problem, we wouldn't have vaccines. I mean, that's why we have them. I mean, it's not an altruistic act. Now, if you could leave parents with one clear message about childhood vaccinations, what would it be that they're they're well tested, that there are systems in place to detect even the rarest of safety problems, and that your job as a parent, my job as a parent now grandparent, is to put your child in the safest position possible. That's your job, and that's what vaccines do. They put you in the safest position possible? And just one last thing before we finish up, I would love to can you tell everybody your role in the roto tech vaccine? Because I find this so impressive, and I'm so grateful to the work that you've done in roto tech. Can you tell everybody what the disease burden was and and how often we see rotavirus now since creation of roto tech. Well, so rotavirus is a virus that affects the small intestine, primarily it causes fever, vomiting and diarrhea. That's three ways to lose water, fever, vomiting, diarrhea, it's also very hard to rehydrate children who are vomiting, and so it was a common cause of dehydration. It would cause about 70 to 75,000 hospitalizations a year in this country, about 20 to 60 deaths a year, but it dominated my residency. I mean, I would see, I worked, I was a resident Children's Hospital in Pittsburgh. We'd see 400 children every winter with this, this was the winter vomiting virus. And so when I came to Children's Hospital in Philadelphia, they had, the year before, started to work on rotaviruses, just in general, with an interest in a vaccine. But, but when you when, when I for the 25 years or so that I did that, you never really think you're making a vaccine. To super clear, my interest was in trying to understand the virus, which part of the virus makes you sick, what part of the virus is induced an immune response that is protective. How can you construct viruses that can can do the both, both which can induce immune response without confirming virulence, meaning making you sick. So that was just summarizing 25 years of effort in 30 seconds. But that was that effort. But you, you, let's like say, I never, although we in the first paragraph of my grants, and I was funded for 26 years by NIH, you would always say, look, it's a terrible disease. It causes in the world. It is the biggest single killer of infants, in young children. This virus killed before the vaccine, 500,000 children in the every year in the world. You know, we're I'm lucky, because where I work, my kid, the kids in my community, have access to IV fluids. But if you live in Africa, or certain areas of the world where that's not so accessible, it really is possibly a life or death illness, and that's why they're done for exactly that reason. So, so, so, you know, I was fortunate enough to be part of a team with Stanley Plotkin, who's the inventor of the rubella, German measles vaccine, and Fred Clark, who was a veterinarian and PhD, to create these strains that became roto tech, which is sort of a combination between a bovine rotavirus, which doesn't cause disease in children, and human rotavirus which does, but we took out the virulence factor, so therefore we had a vaccine. But again, just so we're clear, my goal was in getting my papers published and getting my grants funded, and with always a goal toward a vaccine, but you never think you're making a vaccine. Just so we're clear, but it happened to be that the strains that that we made did become a vaccine road attack, and that was obviously, but even then, I just like say, because I remember, this is February, 2006 you know, you it's like, you know the guys are angry. They grant your wish. You know you're still your hearts and your throat. Is there going to be a rare safety side effect that we don't know about now that the phase three probably was a 70. 1000 baby trial, but that only means 35,000 babies got that vaccine, and you know now 10s of millions, hundreds of billions, are going to get it. Is there something you didn't think about? And so you're sort of always tortured at some level. What I so appreciate about the way you think and about the way you talk is that you're humbled. You're open to the idea that we are hopeful that this vaccine is going to do what we want it to do, but there are also possibilities that it might not work as we were hoping. But I have to tell you, as a general pediatrician, I love giving the roto tech vaccine. I love starting with it because the babies love the way it tastes. It feels nicer to give something oral rather than an injection. So I'm very grateful. I'm very I'm very I'm very grateful for multiple reasons. Thank you. The Sucrose is the stabilizing agent. It's delicious, and it's the only oral vaccine that we give to children. So that's my that's my gift to children, right? What a wonderful contribution. Well, thank you. Thank you so much for all that you do. I am so grateful for your time. You really are a doctor, hero of mine. I've listened to hours and hours of you on podcasts. I read a lot of your work, and I'm so thankful that you took the time to be here on this podcast. Thank you. It's my pleasure, Jessica, thank you. Thank you for listening, and I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica, see you next Monday. Bye.