April 15, 2025 • 57 mins
After last week’s episode, we all know about each of the diseases that we’re protected against thanks to our childhood vaccine schedule here in the US. And after this week’s episode, we’ll understand more about the schedule itself - why it might look different from other schedules around the world, how it gets made, and who makes the recommendations. We’ll also review some of the current outbreaks of vaccine-preventable diseases before leaving you with some of our thoughts on how to talk about vaccines and vaccine hesitancy.
Updates:
At the time of recording, the ACIP meeting originally scheduled in Feb 2025 had not been rescheduled. It is now rescheduled for April 15-16 and the agenda is posted here: https://www.cdc.gov/acip/meetings/index.html
Additionally, the case numbers of current measles outbreaks in the US have grown substantially since the time of our recording. Updated case numbers are reported every Friday here: https://www.cdc.gov/measles/data-research/index.html and at the time of episode release there have been 712 cases reported in the US and 3 deaths.
Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu
See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
I am one of the increasingly rare old timers who
lived during the pre vaccination era. I am the second
to the last of thirteen siblings, five of whom died
of vaccine preventable diseases in infancy, born to poor immigrant parents.
I remember well my mother's account of the causes of
their deaths, three from pertussis and two from measles. Even
(00:23):
after many years had passed, she spoke of the death
of her angels with a great deal of emotion. Imagine
losing not one, two, three, or four, but five babies.
It was common in the pre vaccine era. Like our family,
many families lost several children to these diseases. We forget
(00:45):
time blurs are memories of these common tragedies of yesteryear.
I remember well, during the winter and spring of each year,
hearing the whoop of pertussis in movie theaters, school assemblies,
and assorted gatherings. Today have ever heard this, and those
who have forget. I remember the summer outbreaks of polio,
(01:06):
the crippled children who could no longer walk, or walked
with limb distorted limps. As a third and fourth year
medical student, I remember answering the appeals of hospital administrators
who could not find the nursing staff for special duty
tending to the needs of polio patients in iron lungs.
Speaker 2 (01:23):
We forget.
Speaker 1 (01:24):
I remember the awful cases of measles my own children experienced.
I remember the children with smallpox during the years my
family lived in Pakistan. I remember those who lost their
sight from lesions in their eyes. I remember those who died.
We forget. It's just such an incredibly powerful letter.
Speaker 3 (02:34):
Yes, this is, I mean, this is the second time
that we have included this first hand account. The first
time was in our one of our vaccines episodes back
in eighteen.
Speaker 4 (02:46):
Yeah, and it is.
Speaker 3 (02:48):
It has stuck with me so much, shame same because
it is such a powerful personal story of what we
have gained and what we stand to loose.
Speaker 2 (02:59):
Right actly.
Speaker 1 (03:01):
This was a letter from EJ. Gene Gangorosa to the
Immunization Action Coalition.
Speaker 4 (03:07):
Uh.
Speaker 1 (03:07):
They were a professor emeritus from Emory University and wrote
that letter all the way back in the year two thousand.
Speaker 4 (03:13):
Yeah, and it's still so relevant today.
Speaker 1 (03:15):
It is and such just an important piece of sort
of that like living memory that that we do we
forget yep.
Speaker 3 (03:24):
Yeah, and we have to we have to remember.
Speaker 4 (03:27):
Yeah, Hi, I'm.
Speaker 2 (03:29):
Aaron Welsh and I'm Erin Allman Updyke.
Speaker 3 (03:31):
And this is this podcast will kill you.
Speaker 1 (03:34):
It sure is, and we're the second part as our best.
Speaker 3 (03:39):
Yes. Yeah, So last week we took you through just
a refresher course on vaccines, how they worked, and then
we did a very quick tour through each of the diseases,
the many diseases that these vaccines protect us from.
Speaker 2 (03:52):
We call it quick.
Speaker 4 (03:52):
We called it quick. Yep.
Speaker 3 (03:55):
We closed out that episode with a big picture of
view of why vaccination is so very important, not just
at the individual level, not just for yourself, for your kids,
but also to protect our communities. Vaccines are truly one
of science's greatest achievements, and as our firsthand just demonstrated,
there are increasingly fewer of us who know what it's
(04:17):
like to live in a world without vaccines. And the
amazing thing is that we don't have to.
Speaker 1 (04:23):
Write we have these incredible vaccines, and even better, we
have highly knowledgeable, well trained scientists who consider all the
aspects of the data that we have to tell us
which vaccines we should take and win.
Speaker 2 (04:39):
That's right, everyone, Today we're talking about the ACIP.
Speaker 1 (04:44):
Yes, Advisory Committee on Immanization Practices here in the US YEP.
Speaker 3 (04:49):
In this episode today, we're going to talk so much
more about the ACIP.
Speaker 4 (04:53):
We're going to talk about.
Speaker 3 (04:54):
How we came to have our childhood vaccine schedule that
we do have today, what goes in to making it,
and where things stand with vaccine preventable illness around the
world today, Because despite the existence of safe and effective vaccines,
we are still seeing outbreaks of diseases like measles, like
whooping cough, like rebella, diseases that can seriously injure or
(05:17):
even kill those who get it.
Speaker 1 (05:19):
Yeah, a lot of these outbreaks are happening in regions
of the world that lack access to vaccines or lack
the infrastructure to deliver vaccines to everybody who needs them.
And undoubtedly we'll be seeing more and more of these
outbreaks and preventable death and suffering due to the attacks
and dismantling of USAID, which is a huge problem. But
(05:40):
some of these outbreaks, especially in high income countries like
the US, are directly attributable to the rise in vaccine
hesitancy and declining vaccination coverage.
Speaker 3 (05:50):
Vaccine hesitancy is one of the biggest threats to global health,
and it's not something that's just going to go away
on its own. It needs to be directly addressed in
every possible way, at every possible level. And in this regard,
all of us can truly make a difference. And so
we really can. And that's what we want to round
(06:12):
out this episode with. It's just going through some evidence
based methods. We love evidence still, evidence based things for
having conversations with those who might be wary of vaccines.
Speaker 4 (06:24):
We've got a lot to go through. So should we
start with quanquarantine time?
Speaker 2 (06:29):
We should?
Speaker 4 (06:32):
What are we drinking this week? We're still drinking Boosted.
Speaker 2 (06:35):
We are still drinking getting in those booster shots.
Speaker 3 (06:39):
Yeah it is. It's delicious. It's got gin and raspberries
and lemonade. And we'll post the full recipe for Boosted
the Quarantine as well as our alcohol free plas sy
Barrita on our website This Podcast will Kill You dot Com,
as well as on all of our social media channels,
so make sure you're following us.
Speaker 1 (06:58):
Make sure you are and on our website This Podcast
will Kill You dot Com, you can find just so
many incredible things that you'd love to find we've got
merch We've got transcripts from all of our episodes. We've
got a link to a Goodreads account and a bookshop
dot org affiliate account. We've got our music from Bloodmobile.
We've got sources for evidence from all of our episodes,
(07:20):
including this one.
Speaker 4 (07:22):
So many sources.
Speaker 1 (07:22):
We've got to contact us form. We've got a first
hand account form if you'd like to submit your first
hand account. Just so much there there, There's a lot,
there really is, And if you haven't already, we would
love to encourage you to rate, review, and subscribe so
that you don't miss any of our things. And because
(07:44):
it does really help us when other people can find
our work.
Speaker 2 (07:47):
We like taking this podcast.
Speaker 4 (07:49):
It does. We appreciate it. Uh, are we ready?
Speaker 2 (07:53):
I think so?
Speaker 1 (07:54):
Should I take a quick break? And then Aaron walk
us through the history of the ACP.
Speaker 4 (07:59):
I'm really excited I did.
Speaker 2 (08:00):
To learn about this. Oh.
Speaker 3 (08:02):
I really had a really fun time digging into the details.
So yeah, let's just take a quick break so we
can get right to it. Okay, what goes into creating
(08:24):
a vaccine schedule? Like why do we have the one
that we do here in the US, and who decides that.
Speaker 2 (08:30):
Such a good question, right.
Speaker 3 (08:33):
Vaccine schedules are different in different countries, and they take
into account things like how prevalent a certain diseases and
how much of a threat it poses, and so that
explains why some of high risk countries use the BCG
vaccine for tuberculosis, for instance, and others might not use
that vaccine or include it in routine immunizations. In the US,
(08:54):
the federal body that makes decisions about which vaccines to recommend,
at what ages, and how many doses is the Advisory
Committee on Ammunisation Practices the ACIP. This committee is made
of up to nineteen voting members who vote on vaccine recommendations,
and they include independent medical and public health experts who
(09:15):
do not work at the CDC, as well as one
consumer representative. This is a volunteer position and members serve
staggered four year terms. Prospective members have to apply and
then they have to undergo the screening process that includes
things like disclosing conflicts of interest and this is like
routinely done and maintained that's fairly important. Ultimately, they are
(09:39):
selected by the Secretary of Health and Human Services, who
at the time of recording is RFK junior, who, as
probably most people are aware, has a long and vocal
history promoting anti vaccine propaganda, including during a measle's outbreak
in Samoa that led to the deaths of ai eighty
(10:00):
three children, mostly under the age of five.
Speaker 1 (10:03):
Yep, and they he ultimately is going to be choosing
who sits on ACIP.
Speaker 3 (10:10):
Yeah, and so I will say that, like there are
there are a certain number of people right now whose
terms will be up, and so it might not be
I mean unless ACIP gets completely dismantled.
Speaker 4 (10:23):
Whole right, can of worms arn questions.
Speaker 3 (10:26):
As to like how much damage can someone do who
has mal intent?
Speaker 1 (10:31):
I would hope that there are stop gaps in place.
But tell me more, Aaron.
Speaker 4 (10:35):
Yes, yes, Okay.
Speaker 3 (10:36):
So the ACIP Charter, which allows for its continued functioning,
has to be renewed and approved every two years by
the Department of Health and Human Services.
Speaker 2 (10:45):
Okay, Okay.
Speaker 3 (10:46):
Currently there are fifteen members active members on this committee,
with four whose terms are up.
Speaker 4 (10:52):
In twenty twenty five.
Speaker 3 (10:53):
Okay, okay, So in theory, in twenty twenty five he
could replace four people.
Speaker 2 (10:57):
Okay.
Speaker 3 (10:59):
There are other non voting members of this committee who
represent other federal institutions such as the Centers for Medicare
and Medicaid Services and the Indian Health Service, as well
as organizations like the American Academy of Pediatrics and the
National Foundation for Infectious Diseases and many others.
Speaker 1 (11:15):
Yeah.
Speaker 3 (11:16):
Yeah, ACIP meets three times a year, three times a year.
Speaker 1 (11:20):
Three times a year. Yeah, more than I anticipated.
Speaker 4 (11:24):
I know. It is. It's it's a lot.
Speaker 3 (11:27):
They're constantly viewing data and voting on recommendations. Like this
is a con because things happen. Things have moved very
quickly in medicine.
Speaker 2 (11:36):
Yeah.
Speaker 1 (11:36):
Well, and it's so low at the same time, exactly.
Speaker 4 (11:39):
Yeah, but like to keep up to date.
Speaker 3 (11:40):
This is not just like oh, let's you know, dust
off the piles of data. It's like constant regilance.
Speaker 2 (11:46):
Okay, awesome.
Speaker 4 (11:47):
Yeah.
Speaker 3 (11:48):
So there was a meeting scheduled for February twenty six
to twenty eighth of this year, and it was postponed.
Ok And there has been, as of the time of recording,
no updated meeting date. And maybe maybe it will get rescheduled,
maybe it won't, but you should know that if it
does get rescheduled, and if any one of the subsequent
(12:11):
meetings do take place that I want everyone to know
that there are opportunities, at least at this point in time,
to submit public comments, Okay, and.
Speaker 4 (12:19):
Like, well we can do we can.
Speaker 3 (12:21):
Yes, We'll link to the page that has more info
on this. But in the past, the public was able
to submit a written comment and request to make an
oral public comment during the meeting. So there are written
comments that you can make, and you could also request
to make an oral comment during the meeting itself.
Speaker 2 (12:36):
Awesome, right, So.
Speaker 3 (12:38):
This is an opportunity for all of us to demonstrate
how much vaccines mean to us, right writing, our health,
our safety, our freedom.
Speaker 1 (12:46):
We love them, Thank you love them, Please take them
most yeap.
Speaker 3 (12:51):
If the February meeting does not get rescheduled, there will
be another one, maybe, I guess June twenty sixth, June
twenty fifth, twenty six Okay, okay, So what is what
is the ACIP looking for precisely during these meetings?
Speaker 4 (13:07):
Right? What do they do?
Speaker 1 (13:08):
Right?
Speaker 3 (13:08):
So, broadly speaking, they consider quote, disease epidemiology and burden
of disease, vaccine efficacy and effectiveness, vaccine safety, economic analyzes,
and implementation issues. Okay, so a whole lot of different
things like all.
Speaker 1 (13:23):
Of the different thing picture that you could think of
when it comes to vaccines, the disease itself, how good
the vaccines works, the economics of it all makes sense.
Speaker 3 (13:32):
Yeah, yeah, And so this is what they are looking at.
These are the types of questions that they're looking at. Now,
what are they voting on? Right, So they are voting
on They vote on final recommendations. Right at the end
of this are recommendations and they include quote, the number
of doses of each vaccine, timing between each dose, the
(13:52):
age when infants and children should receive the vaccine, and
precautions and contraindications.
Speaker 4 (13:58):
So who should not.
Speaker 3 (13:59):
Receive the vact scene Okay, that's what they vote on.
And these are just recommendations, recommendations. It is then the
CDC who has to decide whether or not they adopt
the recommendations from ACIP right, right. And then there's also
like the American Academy of Pediatrics also decides what to incorporate.
Speaker 4 (14:15):
It's like there are a lot of the thing is
this is.
Speaker 3 (14:17):
A constant conversation, right that is going on, and there
is one shared goal, which is to how.
Speaker 2 (14:24):
To best ensure the health of the public.
Speaker 3 (14:28):
The public that's that is the goal public health. How
about that.
Speaker 2 (14:32):
That's the goal.
Speaker 4 (14:34):
So the acip is not a new committee.
Speaker 3 (14:37):
It was first organized in nineteen sixty four, and at
the time of its first meeting, the only organization that
was making recommendations on vaccines in the US was the
American Academy of Pediatrics Committee on Infectious Diseases, and their
recommendations were included in a publication called the Red Book,
which you I know, you know the Red Book. Many
(14:58):
people out there may have heard of it and still
exists to It's a really important resource for physicians as
well as the icip Like these, these recommendations that are
included in the Red Book are also considered by the ACIPKA.
At the time of the first Red Book, which was
nineteen thirty eight, the included recommendations were fairly limited. Part
(15:18):
of the reason for this was because there were far
fewer vaccines available than there are today. So the only
ones that they officially recommended in terms of the timing
for when a child should receive them were smallpox. Of course,
before it was eradicated. Diphtheria tetanus pertussis also known as
whooping cough, typhoid fever vericella and tuberculosis. Okay, so I
(15:41):
mean compare that to what we went through yesterday. We
have lot and so so many more. I just don't
We don't include typhoid fever regularly, or smallpox obviously, or
smallpox of course.
Speaker 4 (15:52):
Yeah.
Speaker 1 (15:52):
It's so interesting too, though, that they had versella back then,
because then we didn't have it for so long.
Speaker 2 (15:58):
It's just so interesting.
Speaker 3 (16:00):
I have so many questions, I know, and we may
have even touched on that in our veracell.
Speaker 2 (16:04):
We probably did, you know, I don't remember things same.
Speaker 3 (16:09):
But then the introduction of the polio vaccine in nineteen
fifty three the prompted passage of the Polio Vaccination Act
a couple of years later, and then this provided funds
to what was then the Communicable Diseases Center later became
known as the CDC, and this helped states buy and
distribute polio vaccines. But there was still no formal process
(16:30):
for the federal government to make recommendations for vaccines and
the timing of vaccinations at a national level. Vaccines were
recommended for licensing at the federal level, like by the
Surgeon General. They would say, okay, yes, this, we recommend
this for licensing prove but mostly the government was focused
on vaccines only as far as the military was concerned,
(16:50):
got it tracking efficacy and outbreaks and so on. So
it was like that is where the data collection was,
That's where the decision making was.
Speaker 4 (16:58):
That was the main intro.
Speaker 1 (17:00):
That makes sense, It makes your protecting assets in that case.
Speaker 3 (17:05):
Sorry, and I think especially the timing close to World
War two and then Korea. Yeah, so there was like
a lot of that. Yeah, there was context for that.
But then the polio vaccine was came out in nineteen
fifty two, nineteen fifty three, and then the Musles vaccine
ten years later in nineteen sixty three. It was clear
(17:26):
that there was a need for a national immunization policy,
especially with two more vaccines MOMPS and rubella on the
horizon for the rest of the nineteen sixties, Like they
were like clearly, you know, there was most something. It was, yeah,
these things were going to happen. Yeah, And so things
really got started with the Vaccination Assistance Act in nineteen
sixty two, and this provided support for mass vaccination campaigns,
(17:49):
especially targeting school aged children, which is where most of
the spread and harm from these diseases was concentrated, and
ultimately it led to the formation of the ACI in
nineteen sixty four. So like, instead of having one meeting
for measles and one meeting for polio and one meeting
for this, it.
Speaker 2 (18:06):
Was like, why don't we just do them all at once?
Speaker 4 (18:08):
Do this all at once?
Speaker 2 (18:09):
Yeah?
Speaker 4 (18:10):
Efficiency? How about that?
Speaker 2 (18:14):
I can't.
Speaker 4 (18:15):
I'm sorry.
Speaker 1 (18:15):
I was going to make like a government efficiency joke,
but I because it's too real, too close.
Speaker 4 (18:21):
Yeah, yeah, I know.
Speaker 3 (18:24):
At the first meeting, the committee considered measles, influenza, rubella,
and smallpox vaccines for recommendation. I think there was still
at this point a separate committee for polio. Okay, But
since the beginning, the ACIP has worked closely with professional
organizations like the American Academy of Pediatrics, the American Academy
of Family Physicians, the American College of Ctatricians and Gynecologists,
(18:47):
and others. Together, the ACIP and all of these organizations,
both federal and professional, carefully evaluate all of the available
data to make recommendations on how to best protect the
health of Americans.
Speaker 1 (19:01):
Yeah.
Speaker 4 (19:01):
Again, that is the goal.
Speaker 2 (19:03):
That is the goal.
Speaker 4 (19:04):
That is the goal.
Speaker 3 (19:05):
So what does this look like in practice and I
want to share a real life example of how one
of these recommendations is made and what information is considered
when weighing whether or not to change a recommendation.
Speaker 4 (19:15):
Okay, so let's talk about measles.
Speaker 2 (19:17):
It is timely. Yeah, unfortunately timely topic.
Speaker 3 (19:22):
So since the introduction of the first measles vaccine in
nineteen sixty three, researchers have developed new versions of the vaccine,
each of which has been and continues to be evaluated
for safety, efficacy, ease of administration, and so on. So
like live versus killed with or without certain adjuvants in
a combo shot or solo, the timing for the best
(19:45):
immune stimulation, like all those sorts of things are considered
for each of these vaccines regularly, continuously, and on occasion,
the ACIP has changed their recommendation for which measles vaccine
to include, such as in nineteen sixty eight when they
changed the recommendation from the less attenuated vaccine, which was
the Edmonston B strain, to one that was based on
(20:07):
a more attenuated strain, the Moratin vaccine. The Moratin vaccine,
the more attenuated strain, was as effective as the previous vaccine,
but it produced fewer side effects, right.
Speaker 1 (20:18):
So it was like an even weaker version of a
measles virus compared to an older vaccine, but it protected
you just as well, had fewer side effects, so that.
Speaker 3 (20:29):
They also revisited what age to give the vaccine. So
initially their recommendation was nine months of age, and then
that changed to twelve months and then fifteen months. And
the reason for these changes was not about safety, but
more about efficacy because researchers had found that babies that
were vaccinated earlier tended to lose immunity a bit more
(20:50):
than if they were vaccinated later. It's probably due to
maternal antibodies circulating.
Speaker 1 (20:54):
Yeah, or just like you know, babies in their weird
immune systems.
Speaker 4 (20:58):
Right exactly.
Speaker 3 (20:59):
These are things that they that they will look at monitoring.
They were looking out for, yeah.
Speaker 1 (21:04):
Because of basic scientific research that was going on in
clinical research that's going on where people are actually like
testing people who get these vaccines for their antibody response,
for example, and then collecting and gathering off that data.
Speaker 3 (21:16):
And connecting that to epidemiological research that was monitoring outbreaks
and in what ages and what birth cohorts and all
of these different Yeah, all of these different things.
Speaker 4 (21:26):
All of this amazing research.
Speaker 3 (21:28):
Yep, yes, yeah, okay, okay, But starting in nineteen sixty three,
the ACIP had recommended only one dose of the measles vaccine,
or later a few years later, when mumps and rubella
came along MMRKA, they had recommended one dose, just one dose.
And this is of course different from the two shot
(21:51):
series that we get today that we discussed last week.
How did one shot become to outbreaks? Within the first
five years of the measles vaccine, incidents of the infection
had dropped to five percent of pre vaccine levels within
five years, within five wow years.
Speaker 4 (22:12):
Yeah.
Speaker 3 (22:13):
With this incredible success, measles elimination in North America seemed like.
Speaker 4 (22:16):
A very achievable goal.
Speaker 3 (22:18):
Yeah, yep, I mean like really, like first it was
like a pipe dream, and that it was like, oh wait, actually.
Speaker 4 (22:23):
Wow, we couldn't do this thing, reasonable dream? Yeah okay.
And even as progress towards this goal.
Speaker 3 (22:30):
Was made, a few outbreaks in the late nineteen seventies
and into the nineteen eighties slowed that progress, but they
also provided an opportunity to ask how was measles spreading?
Speaker 1 (22:41):
Right?
Speaker 3 (22:41):
Who was getting the infection. Was it teenagers, was it
young kids? Had they been vaccinated before? And what the
CDC found was that those who were involved in the
outbreaks were often either unvaccinated children under five years old
or older children such as high school and college student
who had been vaccinated but only once, only with one dose.
(23:05):
And that was again the recommendation at the time, and
there had been some debate about whether to include a
second dose. This was, you know, kind of brought up
at different meetings, and it was this trade off, this weighing,
well what are we actually getting with that second dose
of the vaccine, And up until this point, up until
the late well nineteen eighty the late nineteen eighties, really
(23:26):
the decision seemed to fall on, well, one dose is
probably enough. One dose protects you, Like I think you
said erin last week, three ninety three percent, Do we
really need that extra four to five percent? Turns out,
what these outbreaks showed us is that yes, we do,
especially when having that extra four to five percent protects
(23:48):
those who are vulnerable who cannot be vaccinated.
Speaker 4 (23:51):
Right.
Speaker 3 (23:51):
And so there was an outbreak in nineteen eighty nine
that led to a twenty percent hospitalization.
Speaker 2 (23:59):
Rate, which is what we pretty common.
Speaker 3 (24:00):
I've seen I've seen today and one hundred deaths. And
this really demonstrated that waning immunity or under vaccination could
have dire consequences for those who are too young to
be vaccinated. So in nineteen eighty nine, both the ACIP
and the AAP the American Academy of Pediatrics changed their
recommendation to include two doses of MMR for all children,
(24:24):
and that decision is what helped to eliminate measles entirely
from the US in two thousand, yeah, and the Western
hemisphere in twenty sixteen.
Speaker 1 (24:32):
I mean, yeah, that's so interesting too, just in the
context of like the biology of measles, right, because you
need such high vaccination coverage to be able to achieve
herd immunity and protect everyone around you. So it makes
sense that a second dose, where now you're getting ninety
seven percent efficacy in like lifelong at a bodies, that
(24:55):
that is what's going to allow you to achieve herd
immunity rather than a ninety three percent. And yeah, how
interesting and cool, Aaron.
Speaker 3 (25:05):
It was such an enlightening like exercise to go through,
like what does this look like? We know that they're
making decisions. We know that they're considering all of these
different things, but like, how does new data influence a recommendation?
Speaker 1 (25:20):
Yeah, like walking an example of that, it was yeah, yeah,
because it's something we don't think about. We're just like, oh,
here's the schedule.
Speaker 2 (25:27):
And you're like okay, but like what who and why
and how did you come up?
Speaker 1 (25:30):
Why do we need four doses of tea DAP and
then a booster and because that's what the data says
we need.
Speaker 3 (25:36):
What that's I mean, evidence based, evidence based medicine.
Speaker 2 (25:41):
Is that interesting?
Speaker 4 (25:43):
Which? Yeah?
Speaker 2 (25:44):
I mean?
Speaker 1 (25:44):
And then they change their recommendations on adults getting like
a pretess's booster a tea DAP rather than just a
TD a few years back because of circulating protessis I
mean science?
Speaker 4 (25:54):
Science changes by design? It doesn't. It's like right, like
this is part of what.
Speaker 3 (25:58):
Science is, Why why science works is because we evaluate
and consider.
Speaker 1 (26:05):
And consider and then change recommendations.
Speaker 3 (26:08):
And chased on that on that these are not arbitrary decisions.
Like that's the message that we really wanted to get across.
The ACIP takes an evidence based approach that weighs many
different factors to come to a final recommendation. There is
data and reason and logic and evidence backing up each
(26:31):
one of these recommendations, such as timing when to get
the first dose of a vaccine. This is determined by
the disease itself and when a child might be at
highest risk for an exposure to the disease, is at
high risk for complications from the disease, and also how
well they're going to respond to the vaccine in terms
of are they going to mount an adequate immune response
(26:52):
that will protect them long term, Like we talked about
with maternal antibodies sort of circulating in baby for a
while after birth, so that vaccines don't induce this long
term immunity. Right, Typically, it is recommended that a child
gets a vaccine as soon as possible. Multiple doses are
determined by how well one dose induces an immune response.
(27:13):
Some vaccines need too to create long lasting immunity. Others
like t DAP or DETAP require periodic boosters. FLU of
course as annual and I can understand that it feels
like there are a million vaccines and a million jobs,
but each one of these vaccines is so critical and
combo shots like MMR and T DAP helped to cut
(27:34):
down on the number of jabs that your kid gets.
Speaker 1 (27:38):
I love combo vaccine combo, but even each one of
the combo vaccines has to be studied and tested in
all the different age groups and in all the different scenarios,
which is why some are used for some age groups
and not others. Like the MMR vercella vaccine technically is
not recommended to be given to kids at the twelvemonth visit,
but is at the four to five or six year old?
Speaker 2 (28:00):
Is it?
Speaker 1 (28:01):
And it's because of the data on the risks versus benefits.
Speaker 4 (28:05):
These are carefully made decisions.
Speaker 2 (28:08):
Yeah, right, Like.
Speaker 3 (28:09):
The bottom line is that the childhood vaccine schedule that
we have here in the US has been and continues
to be continuously evaluated multiple times a year by a
team of highly qualified individuals who have the best interests
of the American public at heart. That is historically then
its role. Yeah, I hope that that is what its
(28:29):
role will.
Speaker 4 (28:30):
Be in the in the years to come.
Speaker 1 (28:32):
It's protected us for so long. I hope that it
continues to do so.
Speaker 3 (28:37):
The childhood vaccine schedule is safe, it is effective, and
it has saved and continues to save millions, not an exaggeration,
millions of lives of some of the most vulnerable members
of our society every single year.
Speaker 4 (28:51):
Yeah.
Speaker 2 (28:52):
Yeah, it's amazing.
Speaker 4 (28:54):
Eron so erin. Yeah.
Speaker 3 (28:57):
Now that we know the history of the ACIP and
how they make these decisions and why it is so
vital that they do what they do, can you tell
me why we might see some differences in the US
compared to other countries around the world.
Speaker 1 (29:10):
Yeah, I can, And then get into what we know
about what these vaccine preventable diseases look like across the
gub H. We'll take a quick break and then get
into it. So, the World Health Organization has a list
(29:38):
of vaccines that are recommended for all children and that schedule,
and those recommendations are essentially the same as what the
CDC recommended schedule is in the US, which again is
mostly influenced by recommendations from ACIP, except there are a
few big exceptions. One is that we in the US
(30:01):
do not use the BCG vaccine, which is a vaccine
against tuberculosis and is recommended by the World Health Organization
to be given at birth for all children. We don't
do this in the US because historically rates of tuberculosis
have been relatively low. I mean not historically historically, but
in recent times at this point in time. That could
(30:21):
change in the future, but that's the recommendation right now.
So we don't use the BCG vaccine here in the US,
but overall, the World Health Organization recommends vaccines for all
children that include hepatitis B, polio, diphtheria, tetanus, and pertussis,
the detap hib or, the homophlus influenza, new macaucus, rotavirus, measles, rubella,
(30:42):
and HPV, and then the World Health Organization goes on
to have a number of other recommendations because of course,
the World Health Organization is having to kind of stratify
across the globe, where they might recommend certain vaccines only
for children who live in certain regions or who are
(31:02):
in certain high risk populations either geographically or just population wise,
or in countries that have vaccine programs with certain characteristics,
and the US falls into that.
Speaker 4 (31:15):
What does that mean?
Speaker 1 (31:16):
Let me tell you about it.
Speaker 4 (31:18):
Okay, okay, So there are.
Speaker 1 (31:19):
Some vaccines that we went over last week that we
give in the US that weren't on that list. I
just read from the World Health Organization specifically that is mumps, vericella, flu, meningitis,
and HEPA. The reason that we give those vaccines in
the US and they're not on the recommended for every
single child across the globe list is number one. Mumps, veriicella,
(31:43):
and flu are recommended by the World Health Organization for
all kids if they live in a place that has
an immunization program that can actually get at least eighty
percent or more of vaccination coverage, or if they have
access to combination vaccines. So in parts of the world
(32:05):
that are still struggling to even get kids access to vaccines,
or who can't get or can't afford, or maybe can't
like don't have the storage capacity, if vaccines have to
be refrigerated, et cetera, for whatever reason, if they can't
get combination vaccines, or they just don't have the capacity
to vaccinate, then the World Health Organization says prioritize measles, rubella, mumps,
(32:27):
and vericella come later. Essentially, does that make sense. Similarly,
hepatitis A and meningitis, which are on the vaccine schedule
in the US, are on the World Health Organization list
of recommended for high risk populations, which, based on our
data in the US, the US is one of them.
We had really high rates of hepatitis A and meningitis,
(32:48):
enough so that the CDC said, Hey, we're going to
vaccinate all of our kids to prevent morbidity and mortality
from these diseases. And then there are a lot of
other vaccinations that are given in other countries, like for
Jepanese encephalitis or for dange or yellow fever, that we
don't give in the US on an everyone basis because
they do not circulate in as high as numbers here
(33:11):
in the US.
Speaker 4 (33:12):
Yeah, so that's why our.
Speaker 1 (33:13):
Schedule looks a little bit specific to our country.
Speaker 4 (33:16):
Yeah. Yeah, And we've said it a.
Speaker 1 (33:19):
Few times, I think, maybe more than a few times
last week in this week, but I do think it
bears repeating. It is very easy, because of the incredible
success of vaccines to think that these diseases that we
are vaccinating against are a thing of the past. Yeah,
because it is true that the rates of illness and
(33:41):
severe illness and death from almost all of these childhood
vaccine preventable diseases have plummeted, both here in the US
but also across the globe and that is incredible.
Speaker 4 (33:56):
It is, it is amazing. It is such a huge feat.
I think back, like okay.
Speaker 3 (34:02):
You know, like, okay, I'm trying to think of a
time travel movie Kat and Leopold, for instance, which that's
a deep cut. That's a deep cut, right, Okay, somebody
comes from the Hugh Jackman is like a time traveler
from the past.
Speaker 4 (34:16):
Anyway.
Speaker 3 (34:17):
I always think about if someone were able to travel
to the present day from the past. One of the
things that would instantly be so magical is vaccines, Like
not magical, but just profound right in what it has done.
Speaker 2 (34:31):
I'm sure it would feel magical.
Speaker 3 (34:32):
Quite Yeah, Leopold would really have appreciated vaccines.
Speaker 4 (34:35):
Maybe he did. Did they talk about it?
Speaker 3 (34:37):
I have not seen it since it was in theater
at the Dollar Theater like twenty years ago.
Speaker 4 (34:43):
Oh that's hilarious.
Speaker 2 (34:44):
I'm gonna go watch it now.
Speaker 4 (34:46):
But it's true.
Speaker 1 (34:48):
Vaccines save today in twenty twenty five and estimated four
million lives every single year.
Speaker 4 (34:56):
Four million.
Speaker 1 (34:58):
Yeah, the World Health Organization actually estimates three and a
half to five million.
Speaker 2 (35:01):
So, like, I mean, it's.
Speaker 3 (35:02):
Incredible conservatively four million exactly, which.
Speaker 1 (35:05):
Is why conservatively, But The thing is that we could
be saving even more because while we have made huge
strides in reducing the burden of these diseases, we have
not eradicated any of them, aside from smallpox, which we
no longer vaccinate for anywhere across the globe because it
has been eradicated, and also under which is a disease
(35:29):
of cattle like well, actually story I wrote underpest down.
But until we can actually eradicate these other preventable diseases,
a case anywhere represents the risk of disease everywhere, especially
because in the face of growing anti vaccine sentiment in
the US and around the globe, vaccine preventable diseases are
(35:53):
on the rise. As we record this, which is early
March twenty twenty five, in the US, we are in
the midst of a very significant measles outbreak that is
continuing to spread. Yeah.
Speaker 4 (36:06):
Band numbers are way out of date already, I know.
Speaker 1 (36:09):
Yeah, by the time this episode comes out, they will,
unfortunately I'm sure, be much worse. And the current outbreak
is not typical, It is not common. Nope, And like
you mentioned already aarin in the US, measles was declared
eliminated in the year two thousand, which essentially means that
we had had no continuous transmission of measles for an
(36:31):
entire year, which meant that from that point forward, any
cases that popped up, like anything more than three cases
of measles is considered an outbreak in the US. And
that was huge, and it wasn't just the US, like
you said. In twenty sixteen, the World Health Organization declared
measles eliminated from the entire Western Hemisphere, and around that
(36:55):
time the World Health Organization European Region also reached its
lowest point.
Speaker 2 (36:59):
Ever in Europe.
Speaker 1 (37:01):
And then and then things started to get worse again
in the US between two thousand and twenty ten, so
shortly after we were declared eliminated. There were only three
years in that ten year period where we had more
than one hundred measles cases in the US, between twenty
eleven and twenty twenty one. In that ten year period,
(37:25):
seven years had more than one hundred cases, including six
hundred and sixty seven cases in twenty fourteen, three hundred
eighty one cases in twenty eighteen, twelve hundred seventy four
cases in twenty nineteen, and last year in twenty twenty four,
we had two hundred and eighty five cases. Right now,
(37:47):
it's early March, and the CDC last updated their Measles
disease outbreak surveillance on February twenty eighth.
Speaker 5 (37:55):
Not often enough, every one Friday, every Friday, yeah, yeah,
But as of February twenty eighth, there had been one
hundred and sixty four confirmed cases and one child died.
Speaker 1 (38:08):
That is the first time that a child has died
of measles in the US since twenty fifteen in the
current outbreak. And again I know these numbers are outdated
by the time this episode comes out. Twenty percent of
these kids and I say kids because eighty two percent
of these cases are in children, twenty percent of them
have been hospitalized, and ninety five percent of cases were
(38:31):
in either unvaccinated individuals or people whose vaccination status is unknown.
And in every case, whether an individual is vaccinated or unvaccinated,
this is a preventable illness, yes, and it's not just measles, like.
Speaker 4 (38:49):
It's not just measles.
Speaker 3 (38:51):
And before we move on to the other diseases that
are vaccine preventable in these outbreaks that are happening, I
want to talk about something that I think can generate
some confusion when it comes to looking at these numbers.
So you'll see in an outbreak like measles, like these
measles outbreaks, that there is a number of people who
are vaccinated who contract measles. And that could be for
(39:13):
a million different reasons, right, Like some of US measles,
vaccines don't induce a strong of an immune response. Again,
why herd immunity is so important, and because in an
area the general population is much more vaccinated than unvaccinated.
Speaker 1 (39:29):
Right, it can see eighty percent vaccination coverage in the US.
Speaker 3 (39:32):
Yes, it can seem like there is a high number
or an equal number of people who are vaccinated compared
to those who are not vaccinated.
Speaker 4 (39:40):
Does that make sense?
Speaker 3 (39:41):
But that's that is actually disguised as what is truly happening.
And that is, if you look at the proportion of
people who are unvaccinated, what at the likelihood that they
will get that that they will get measles much much
much higher than if you are vaccinated.
Speaker 1 (39:54):
Right, I think you said last week here and it
was like one hundred and seventy times.
Speaker 3 (39:58):
Forty times higher they're unvaccinated. And so but like, just
reporting on these sheer numbers only tells part of the story,
right right, Like we it doesn't tell us what proportion
of unvaccinated individuals in a community are infected compared to.
Speaker 2 (40:11):
Those who are vaccines exactly exactly, And.
Speaker 3 (40:13):
I think it kind of is these numbers are sometimes
used to undermine the power of vaccines in protecting you.
Speaker 1 (40:20):
I remember that happening especially a lot during the mumps
outbreak a few years ago, because especially mumps, we see
more waning immunity than we see with measles as well,
and so it kind of compounded that same problem.
Speaker 4 (40:33):
But it is yeah, that.
Speaker 1 (40:35):
The proportion, the likelihood that you get one of these
illnesses is significantly higher if you are unvaccinated or under
vaccinated compared to if you are vaccinated fully.
Speaker 3 (40:46):
And on top of that complications exactly. This isn't just
about whether or not you are getting the disease. It
is about how sick you are getting in your chances
of dying, and vaccines protect you from these things exactly.
Speaker 1 (40:57):
And it is not just measles, it's not just rtussis cases.
Whooping cough has been on the rise year over year
in twenty twenty four, there were thirty five thousand cases
of pertussis in the US and over twenty seven hundred
of those were babies under one year old, and six
(41:18):
of those babies under one year old died in the
US in addition to four other kids that were over
one year old. That's ten children who died last year
alone in the United States from a vaccine preventable illness.
Speaker 4 (41:36):
Yep, did not have to happen.
Speaker 3 (41:38):
Yeah.
Speaker 2 (41:39):
Yeah.
Speaker 1 (41:40):
Polio is another example that made headlines back in twenty
twenty two here in the US. So we eliminated polio
in the US in nineteen seventy nine, and there is
of course a huge campaign to try and eradicate polio
across the globe and were not there yet, And yet
there was a case of paralytic polio in twenty twenty
two in the US, and in conjunction with that case,
(42:02):
there was enough virus being detected in the wastewater in
surrounding areas that the US was actually added to the
World Health Organization list of countries with endemic circulating vaccine
derived strains of poliovirus. Now, this is a strain of
the virus that has evolved from the vaccine strain of
(42:26):
the oral poliovirus vaccine. So this is a disease that
people get not from the vaccine itself, not from getting
the vaccine, but from a mutated version of this virus
that can persist in the environment, from the vaccine derived
strain that evolves to regain virulence or infectiousness, and then
(42:48):
can infect other people and get them sick. We do
not use this oral polio vaccine in the US, and
we haven't since the year two thousand, but there are
some other countries across the globe that still do because
it's a much less expensive vaccine. It's easier to administer
because it's oral rather than injected. You have to have
less public health investment or infrastructure. And in some other
(43:08):
places that still had circulating like wild typled toliovirus, it
provided good protection, but it comes with this potential cost,
and that cost has now been more vaccine derived strains
circulating and globally. In twenty twenty three, which is the
(43:29):
latest year that the World Health Organization has these global
dashboard numbers, there were over twenty four thousand, seven hundred
reported cases of diphtheria, certainly more that were not reported.
Over six hundred and sixty nine thousand cases of measles globally,
(43:50):
over one hundred and sixty three thousand cases of pertussis,
three hundred and eighty seven thousand cases of mumps, thirty
five thousand cases of rubella, and over twenty one thousand
cases of tetanus, and the list goes on. So all
of these diseases that we are protecting our children against
with vaccines still circulate around the globe. And because of
(44:13):
global travel, that means that many of these diseases can
circulate anywhere. And I mean the case of tetanus, those
bacteria are just everywhere already, right, I.
Speaker 4 (44:22):
Mean, and so much of this is just like it is.
Speaker 3 (44:25):
These numbers are saggering, and they're so hard to absorb,
to like actually wrap your head around. And this I
think speaks to how why it is so important that
an investment in global public health and global health is crucial,
And it's just it's just something that is so obvious.
Speaker 2 (44:45):
I know, so clear. I know.
Speaker 1 (44:47):
Vaccines are not only the best thing that you can
do to protect yourself and your children from infectious disease,
but also the best thing that you can do to
protect your community. Because vaccines are protecting us a against
communicable diseases. These are things that are spread from person
to person. So it is, like we said last week,
our social responsibility to vaccinate, like for the health of ourselves,
(45:11):
yes I don't want to get sick and end up hospitalized,
but also for the health of our communities. And it
is for this reason, because of the health of the public,
that there are vaccine requirements for participation in public life
like public schools. Right, and when these requirements are waived
or changed to recommendations rather than requirements, or if they're
(45:34):
done away with altogether, we are putting both individual and
public health at risk. We then see children hospitalized and dying,
and resurgence of diseases that have previously been eliminated. So
understandably there is a lot of interest in addressing vaccine hesitancy.
Speaker 4 (45:54):
How the heck do we do it, that's a great question.
Speaker 1 (45:58):
The World Health Organization actually named vaccine hesitancy one of
the top threats to global health in twenty nineteen, and
that's alongside like climate change and air pollution, anti microbial resistance,
the next global influenza pandemic. Like big scary things include
vaccine hesitancy hesitancy.
Speaker 2 (46:15):
Yeah, so lucky for us.
Speaker 1 (46:17):
There's a lot of research that has been done and
that continues to be done on how to best try
and address this. And we started out last week's episode
like this whole vaccine series. Part of what we wanted
to be able to talk about is just how prevalent
vaccine misinformation is and how easy it is to believe
(46:39):
it because of the way that misinformation and disinformation praise
on our fears and anxieties, especially when it comes to
our kids. Yes, and we are all susceptible to misinformation.
Speaker 2 (46:52):
Ehudding us do you hate to admit it, But it's true.
Speaker 1 (46:55):
That's true, and we know that when it comes to
vaccine hesitancy, which is defined as the reluctance or refusal
to vaccinate despite the availability of vaccines, there is a
spectrum of belief. But I want to first set the
record straight. The vast majority of parents still vaccinate their
kids on time according to the ACIP schedule period period.
Speaker 3 (47:17):
Yay, that's amazing, And part of that is because we
do have these childhood vaccination requirements for school exact. Yeah, yeah,
it's yeah, it's great, it's amazing.
Speaker 1 (47:28):
But when we are looking at the minority of people
who meet these criteria of vaccine hesitancy. There is a spectrum,
and there are some people, many of whom are the
spreaders of disinformation, who are profiting heavily off of vaccine
hesitancy in one way or another, or who have wrapped
up their identities in these false beliefs to a point
(47:50):
where there really is no changing their mind. But there
are also a lot of people who are vaccine hesitant,
who just have questions or or herd scary things on
TikTok and they just don't know who to believe. And
recognizing this idea that we can all fall prey to misinformation,
(48:11):
what that does is allow us to approach all of
our conversations about vaccines from a place of understanding and empathy.
It allows us to actually have productive conversations about vaccines
rather than just combative ones with my uncles.
Speaker 4 (48:29):
I'm sorry it's.
Speaker 1 (48:30):
True, though, But we also know that a lot of
parents rely on their healthcare providers as primary sources of
information when it comes to their children's health, and that's great.
We should all have a healthcare provider that we can
trust to ask our questions and get answers without fear
of judgment or reprisal, and studies show time and again
(48:51):
that a strong recommendation from your health care provider drives
vaccine uptake, as do strategies like motivational interviewing, which is
a technique that relies on like open ended questions and
affirming and reflecting back statements and concerns and then summarizing
information and then advising, but all in a way that
(49:11):
actually requires that you listen.
Speaker 4 (49:13):
Yeah, I mean google it.
Speaker 3 (49:15):
It's like it's a really important and technique and I
think that there's a lot more to it. Yeah, you're
interested in learning more about it, definitely, And the.
Speaker 1 (49:23):
Search requires that you start from a place of empathy
from where a person is coming from and the concerns
that they legitimately have.
Speaker 4 (49:30):
Ye.
Speaker 1 (49:31):
But a lot of us and a lot of you
listening feel like maybe you feel like you'll never be
in a position to directly like advise someone on whether
or not to get vaccinated. That does not mean that
we can't all be working towards increasing vaccine acceptance in
our own communities. Most parents still vaccinate their kids. The
majority of kids in the US are getting their vaccines
(49:53):
on time, according to the ACIP schedule. If we start
talking about this fact, like normalizing this, talking about getting
your vaccines, about when you got your kids vaccinated, how
you just got your flu shot in your arms a
little bit sore, but you're feeling great about it. That
is one way that we individually can help to move
this needle back towards vaccine acceptance and away from this
(50:16):
idea of vaccine hesitancy.
Speaker 4 (50:19):
Yeah, we collectively talk.
Speaker 1 (50:21):
A lot about vaccine hesitancy, but I think we don't
talk enough about getting vaccinated. And like I normalizing this process.
Speaker 3 (50:29):
I love this because I feel like I have done
this with friends where I'm like, oh, yeah, I got
my flu shot and my arm is still a little
bit sore, and they're like, oh, that reminds me I
have to go get my flu.
Speaker 4 (50:38):
Shot exactly exactly. Something as simple as that, I I
love it.
Speaker 1 (50:43):
I also love things that make it easier, like one
time I got my flu shot and my COVID shot
this year when we went to the YMCA where my
kids are doing gymnastics, and they had a table there
and we went early because we thought my kids wanted
to play in a thing, and then they didn't want
to and we're like, well, we're just going to get
our vaccines.
Speaker 3 (51:01):
Then you made it so easy, yes, yes, but breaking
down those barriers to just make it easy when you're
just out because there are so many other things that
are that that do stand in the way of someone
being able to take time off to go get rationeated
when our clinic hours open. And I know that there
are a lot of different organizations that really push towards this,
(51:22):
Like we're having you know, a van that comes and
does like on site vaccination.
Speaker 4 (51:28):
Yeah, that's great, that's great.
Speaker 1 (51:29):
Talking about this and normalizing this process and talking about
how incredible the benefits of vaccination are is so helpful.
And we can all start having these conversations with our
friends and family who already vaccinate and maybe those who
might be more towards hesitant.
Speaker 3 (51:47):
Yeah, and I think it's important to you wonder what
might that conversation look like? Yeah, what what could it
look like? And I mean who knows, right, Like, there's
a huge spectrum. Yeah, and if it depends a lot
on how receptive someone is to changing their mind or
to hearing conflicting information something that conflicts with what they've
(52:08):
heard or what they hold in their hearts, right, But
it does start, like you said, Aaron, with empathy and
with asking questions. So if you know someone who's vaccine hesitant,
or you learn that someone is, you could start by
asking why, like what what do you know about vaccines?
What specific worries do you have? And then asking you know,
(52:28):
can can I talk with you about this? Can I
share my thoughts there? Can I share some information that
I have learned with that convation? Can we engage in
this way?
Speaker 4 (52:38):
Yeah? And maybe it's a flat no.
Speaker 3 (52:39):
Maybe they're like, not interested, do not talk to me
anymore about this?
Speaker 2 (52:42):
Okay, right, that's fine, But maybe it's not.
Speaker 3 (52:45):
Maybe they're like, actually, yeah, I have been really nervous
and I don't know where to turn.
Speaker 4 (52:49):
And maybe you can help to answer their questions. Or
maybe you can't.
Speaker 3 (52:52):
Maybe you're like I too, I don't know where to turn,
but you can at least look together. You can help
them find where to look. That is how this has
proven to be how progress is actually made on this
front human to human interaction. People who have social capital community, right,
(53:15):
like people who are trusted, people who are like, no,
I get it, I know where you're coming from.
Speaker 4 (53:19):
I can relate to you, and I will relate to you.
Speaker 3 (53:21):
I won't stand here in a position of power and
tell you and look down on you and condescend to
you right like I will say, okay, I hear you right.
And this, all of us having these conversations, is how
we can make progress. Each of you has the most
sway and reach within your own community. And research does
show that this community based activism, even if it's just informal,
(53:44):
even if it's just chatting with a neighbor, this has
the greatest opportunity of making an impact. And one really
important thing to remember and I think that, especially as
our bandwidth grows ever more shorter these days, speaking personally, yes,
is that you you should pick your battles right like
you can pick your battles if you're not in the headspace,
(54:06):
or you feel like someone is just super resistant and
it's only going to drain you further so that you
don't have the emotional bandwidth to take care of yourself.
Or if you feel yourself getting heated and you're like,
this is not going anywhere, I'm just getting angry at
this person. Yeah, don't be afraid to take a step back,
try another day. This is a constant, constant battle. But
(54:27):
we truly can make progress.
Speaker 1 (54:28):
Yeah, we really really can't. We maybe sound very cheesy,
but genuinely we believe that we do.
Speaker 2 (54:36):
Also data backs it up.
Speaker 3 (54:37):
So yeah, evidence based, speaking of evidence, speaking.
Speaker 4 (54:44):
Of evidence, great transition. Thank you. We've got more sources
for this.
Speaker 3 (54:50):
Let me see if I can shout out any in
particular that I found helpful. If I can find this tab,
here we go. Yeah, there is a pa by Walton
at All from twenty fifteen called the History of the
United States Advisory Committee on Immunization Practices, and it was
really insightful in terms of how this committee came to be.
(55:12):
And then I have a bunch of other websites for
our a bunch of other sites from CDC and who
that can help sort of put more context into this.
Speaker 1 (55:20):
I used a lot the World Health Organization Global Dashboard,
their data portal, so we will link to that. I
also really enjoyed a paper by friend of the Pod
Peter Hotes from twenty nineteen titled America and Europe's New
Normal the Return of vaccine preventable Diseases, And I also
(55:41):
had a number on that whole idea of how we
talk about vaccine hesitancy and kind of moving the needle.
So we will post the list of all of our
sources from this episode and every one of our episodes
on our website, this podcast withekille dot com under the
episodes tab.
Speaker 3 (55:57):
We will a big thing YouTube Bloodmobile, who provides the
music for this episode and all of our episodes.
Speaker 2 (56:04):
May sure do you.
Speaker 1 (56:05):
Thank you so much, Bloodmobile. Thank you to Leona Scolacci
and Tom Bright Focal for the incredible audio mixing, and
thank you to Brent and Pete and the whole video
editing team as well.
Speaker 3 (56:16):
Thank you, thank you, and thank you to you listeners
for listening, for listening, please watching or watching, Please do
reach out with more what you want to hear? Yeah,
what you want to learn about?
Speaker 1 (56:27):
I want to know so we can make our season better. Yes, truly,
And thank you as always to our patrons. Your support
means so much to us. Thank you, thank you, thank you.
Speaker 4 (56:40):
Thank you. Well.
Speaker 6 (56:41):
Until next time, wash your hands, you filthy animals.
Speaker 1 (57:00):
Mum
I am one of the increasingly rare old timers who
lived during the pre vaccination era. I am the second
to the last of thirteen siblings, five of whom died
of vaccine preventable diseases in infancy, born to poor immigrant parents.
I remember well my mother's account of the causes of
their deaths, three from pertussis and two from measles. Even
(00:23):
after many years had passed, she spoke of the death
of her angels with a great deal of emotion. Imagine
losing not one, two, three, or four, but five babies.
It was common in the pre vaccine era. Like our family,
many families lost several children to these diseases. We forget
(00:45):
time blurs are memories of these common tragedies of yesteryear.
I remember well, during the winter and spring of each year,
hearing the whoop of pertussis in movie theaters, school assemblies,
and assorted gatherings. Today have ever heard this, and those
who have forget. I remember the summer outbreaks of polio,
(01:06):
the crippled children who could no longer walk, or walked
with limb distorted limps. As a third and fourth year
medical student, I remember answering the appeals of hospital administrators
who could not find the nursing staff for special duty
tending to the needs of polio patients in iron lungs.
Speaker 2 (01:23):
We forget.
Speaker 1 (01:24):
I remember the awful cases of measles my own children experienced.
I remember the children with smallpox during the years my
family lived in Pakistan. I remember those who lost their
sight from lesions in their eyes. I remember those who died.
We forget. It's just such an incredibly powerful letter.
Speaker 3 (02:34):
Yes, this is, I mean, this is the second time
that we have included this first hand account. The first
time was in our one of our vaccines episodes back
in eighteen.
Speaker 4 (02:46):
Yeah, and it is.
Speaker 3 (02:48):
It has stuck with me so much, shame same because
it is such a powerful personal story of what we
have gained and what we stand to loose.
Speaker 2 (02:59):
Right actly.
Speaker 1 (03:01):
This was a letter from EJ. Gene Gangorosa to the
Immunization Action Coalition.
Speaker 4 (03:07):
Uh.
Speaker 1 (03:07):
They were a professor emeritus from Emory University and wrote
that letter all the way back in the year two thousand.
Speaker 4 (03:13):
Yeah, and it's still so relevant today.
Speaker 1 (03:15):
It is and such just an important piece of sort
of that like living memory that that we do we
forget yep.
Speaker 3 (03:24):
Yeah, and we have to we have to remember.
Speaker 4 (03:27):
Yeah, Hi, I'm.
Speaker 2 (03:29):
Aaron Welsh and I'm Erin Allman Updyke.
Speaker 3 (03:31):
And this is this podcast will kill you.
Speaker 1 (03:34):
It sure is, and we're the second part as our best.
Speaker 3 (03:39):
Yes. Yeah, So last week we took you through just
a refresher course on vaccines, how they worked, and then
we did a very quick tour through each of the diseases,
the many diseases that these vaccines protect us from.
Speaker 2 (03:52):
We call it quick.
Speaker 4 (03:52):
We called it quick. Yep.
Speaker 3 (03:55):
We closed out that episode with a big picture of
view of why vaccination is so very important, not just
at the individual level, not just for yourself, for your kids,
but also to protect our communities. Vaccines are truly one
of science's greatest achievements, and as our firsthand just demonstrated,
there are increasingly fewer of us who know what it's
(04:17):
like to live in a world without vaccines. And the
amazing thing is that we don't have to.
Speaker 1 (04:23):
Write we have these incredible vaccines, and even better, we
have highly knowledgeable, well trained scientists who consider all the
aspects of the data that we have to tell us
which vaccines we should take and win.
Speaker 2 (04:39):
That's right, everyone, Today we're talking about the ACIP.
Speaker 1 (04:44):
Yes, Advisory Committee on Immanization Practices here in the US YEP.
Speaker 3 (04:49):
In this episode today, we're going to talk so much
more about the ACIP.
Speaker 4 (04:53):
We're going to talk about.
Speaker 3 (04:54):
How we came to have our childhood vaccine schedule that
we do have today, what goes in to making it,
and where things stand with vaccine preventable illness around the
world today, Because despite the existence of safe and effective vaccines,
we are still seeing outbreaks of diseases like measles, like
whooping cough, like rebella, diseases that can seriously injure or
(05:17):
even kill those who get it.
Speaker 1 (05:19):
Yeah, a lot of these outbreaks are happening in regions
of the world that lack access to vaccines or lack
the infrastructure to deliver vaccines to everybody who needs them.
And undoubtedly we'll be seeing more and more of these
outbreaks and preventable death and suffering due to the attacks
and dismantling of USAID, which is a huge problem. But
(05:40):
some of these outbreaks, especially in high income countries like
the US, are directly attributable to the rise in vaccine
hesitancy and declining vaccination coverage.
Speaker 3 (05:50):
Vaccine hesitancy is one of the biggest threats to global health,
and it's not something that's just going to go away
on its own. It needs to be directly addressed in
every possible way, at every possible level. And in this regard,
all of us can truly make a difference. And so
we really can. And that's what we want to round
(06:12):
out this episode with. It's just going through some evidence
based methods. We love evidence still, evidence based things for
having conversations with those who might be wary of vaccines.
Speaker 4 (06:24):
We've got a lot to go through. So should we
start with quanquarantine time?
Speaker 2 (06:29):
We should?
Speaker 4 (06:32):
What are we drinking this week? We're still drinking Boosted.
Speaker 2 (06:35):
We are still drinking getting in those booster shots.
Speaker 3 (06:39):
Yeah it is. It's delicious. It's got gin and raspberries
and lemonade. And we'll post the full recipe for Boosted
the Quarantine as well as our alcohol free plas sy
Barrita on our website This Podcast will Kill You dot Com,
as well as on all of our social media channels,
so make sure you're following us.
Speaker 1 (06:58):
Make sure you are and on our website This Podcast
will Kill You dot Com, you can find just so
many incredible things that you'd love to find we've got
merch We've got transcripts from all of our episodes. We've
got a link to a Goodreads account and a bookshop
dot org affiliate account. We've got our music from Bloodmobile.
We've got sources for evidence from all of our episodes,
(07:20):
including this one.
Speaker 4 (07:22):
So many sources.
Speaker 1 (07:22):
We've got to contact us form. We've got a first
hand account form if you'd like to submit your first
hand account. Just so much there there, There's a lot,
there really is, And if you haven't already, we would
love to encourage you to rate, review, and subscribe so
that you don't miss any of our things. And because
(07:44):
it does really help us when other people can find
our work.
Speaker 2 (07:47):
We like taking this podcast.
Speaker 4 (07:49):
It does. We appreciate it. Uh, are we ready?
Speaker 2 (07:53):
I think so?
Speaker 1 (07:54):
Should I take a quick break? And then Aaron walk
us through the history of the ACP.
Speaker 4 (07:59):
I'm really excited I did.
Speaker 2 (08:00):
To learn about this. Oh.
Speaker 3 (08:02):
I really had a really fun time digging into the details.
So yeah, let's just take a quick break so we
can get right to it. Okay, what goes into creating
(08:24):
a vaccine schedule? Like why do we have the one
that we do here in the US, and who decides that.
Speaker 2 (08:30):
Such a good question, right.
Speaker 3 (08:33):
Vaccine schedules are different in different countries, and they take
into account things like how prevalent a certain diseases and
how much of a threat it poses, and so that
explains why some of high risk countries use the BCG
vaccine for tuberculosis, for instance, and others might not use
that vaccine or include it in routine immunizations. In the US,
(08:54):
the federal body that makes decisions about which vaccines to recommend,
at what ages, and how many doses is the Advisory
Committee on Ammunisation Practices the ACIP. This committee is made
of up to nineteen voting members who vote on vaccine recommendations,
and they include independent medical and public health experts who
(09:15):
do not work at the CDC, as well as one
consumer representative. This is a volunteer position and members serve
staggered four year terms. Prospective members have to apply and
then they have to undergo the screening process that includes
things like disclosing conflicts of interest and this is like
routinely done and maintained that's fairly important. Ultimately, they are
(09:39):
selected by the Secretary of Health and Human Services, who
at the time of recording is RFK junior, who, as
probably most people are aware, has a long and vocal
history promoting anti vaccine propaganda, including during a measle's outbreak
in Samoa that led to the deaths of ai eighty
(10:00):
three children, mostly under the age of five.
Speaker 1 (10:03):
Yep, and they he ultimately is going to be choosing
who sits on ACIP.
Speaker 3 (10:10):
Yeah, and so I will say that, like there are
there are a certain number of people right now whose
terms will be up, and so it might not be
I mean unless ACIP gets completely dismantled.
Speaker 4 (10:23):
Whole right, can of worms arn questions.
Speaker 3 (10:26):
As to like how much damage can someone do who
has mal intent?
Speaker 1 (10:31):
I would hope that there are stop gaps in place.
But tell me more, Aaron.
Speaker 4 (10:35):
Yes, yes, Okay.
Speaker 3 (10:36):
So the ACIP Charter, which allows for its continued functioning,
has to be renewed and approved every two years by
the Department of Health and Human Services.
Speaker 2 (10:45):
Okay, Okay.
Speaker 3 (10:46):
Currently there are fifteen members active members on this committee,
with four whose terms are up.
Speaker 4 (10:52):
In twenty twenty five.
Speaker 3 (10:53):
Okay, okay, So in theory, in twenty twenty five he
could replace four people.
Speaker 2 (10:57):
Okay.
Speaker 3 (10:59):
There are other non voting members of this committee who
represent other federal institutions such as the Centers for Medicare
and Medicaid Services and the Indian Health Service, as well
as organizations like the American Academy of Pediatrics and the
National Foundation for Infectious Diseases and many others.
Speaker 1 (11:15):
Yeah.
Speaker 3 (11:16):
Yeah, ACIP meets three times a year, three times a year.
Speaker 1 (11:20):
Three times a year. Yeah, more than I anticipated.
Speaker 4 (11:24):
I know. It is. It's it's a lot.
Speaker 3 (11:27):
They're constantly viewing data and voting on recommendations. Like this
is a con because things happen. Things have moved very
quickly in medicine.
Speaker 2 (11:36):
Yeah.
Speaker 1 (11:36):
Well, and it's so low at the same time, exactly.
Speaker 4 (11:39):
Yeah, but like to keep up to date.
Speaker 3 (11:40):
This is not just like oh, let's you know, dust
off the piles of data. It's like constant regilance.
Speaker 2 (11:46):
Okay, awesome.
Speaker 4 (11:47):
Yeah.
Speaker 3 (11:48):
So there was a meeting scheduled for February twenty six
to twenty eighth of this year, and it was postponed.
Ok And there has been, as of the time of recording,
no updated meeting date. And maybe maybe it will get rescheduled,
maybe it won't, but you should know that if it
does get rescheduled, and if any one of the subsequent
(12:11):
meetings do take place that I want everyone to know
that there are opportunities, at least at this point in time,
to submit public comments, Okay, and.
Speaker 4 (12:19):
Like, well we can do we can.
Speaker 3 (12:21):
Yes, We'll link to the page that has more info
on this. But in the past, the public was able
to submit a written comment and request to make an
oral public comment during the meeting. So there are written
comments that you can make, and you could also request
to make an oral comment during the meeting itself.
Speaker 2 (12:36):
Awesome, right, So.
Speaker 3 (12:38):
This is an opportunity for all of us to demonstrate
how much vaccines mean to us, right writing, our health,
our safety, our freedom.
Speaker 1 (12:46):
We love them, Thank you love them, Please take them
most yeap.
Speaker 3 (12:51):
If the February meeting does not get rescheduled, there will
be another one, maybe, I guess June twenty sixth, June
twenty fifth, twenty six Okay, okay, So what is what
is the ACIP looking for precisely during these meetings?
Speaker 4 (13:07):
Right? What do they do?
Speaker 1 (13:08):
Right?
Speaker 3 (13:08):
So, broadly speaking, they consider quote, disease epidemiology and burden
of disease, vaccine efficacy and effectiveness, vaccine safety, economic analyzes,
and implementation issues. Okay, so a whole lot of different
things like all.
Speaker 1 (13:23):
Of the different thing picture that you could think of
when it comes to vaccines, the disease itself, how good
the vaccines works, the economics of it all makes sense.
Speaker 3 (13:32):
Yeah, yeah, And so this is what they are looking at.
These are the types of questions that they're looking at. Now,
what are they voting on? Right, So they are voting
on They vote on final recommendations. Right at the end
of this are recommendations and they include quote, the number
of doses of each vaccine, timing between each dose, the
(13:52):
age when infants and children should receive the vaccine, and
precautions and contraindications.
Speaker 4 (13:58):
So who should not.
Speaker 3 (13:59):
Receive the vact scene Okay, that's what they vote on.
And these are just recommendations, recommendations. It is then the
CDC who has to decide whether or not they adopt
the recommendations from ACIP right, right. And then there's also
like the American Academy of Pediatrics also decides what to incorporate.
Speaker 4 (14:15):
It's like there are a lot of the thing is
this is.
Speaker 3 (14:17):
A constant conversation, right that is going on, and there
is one shared goal, which is to how.
Speaker 2 (14:24):
To best ensure the health of the public.
Speaker 3 (14:28):
The public that's that is the goal public health. How
about that.
Speaker 2 (14:32):
That's the goal.
Speaker 4 (14:34):
So the acip is not a new committee.
Speaker 3 (14:37):
It was first organized in nineteen sixty four, and at
the time of its first meeting, the only organization that
was making recommendations on vaccines in the US was the
American Academy of Pediatrics Committee on Infectious Diseases, and their
recommendations were included in a publication called the Red Book,
which you I know, you know the Red Book. Many
(14:58):
people out there may have heard of it and still
exists to It's a really important resource for physicians as
well as the icip Like these, these recommendations that are
included in the Red Book are also considered by the ACIPKA.
At the time of the first Red Book, which was
nineteen thirty eight, the included recommendations were fairly limited. Part
(15:18):
of the reason for this was because there were far
fewer vaccines available than there are today. So the only
ones that they officially recommended in terms of the timing
for when a child should receive them were smallpox. Of course,
before it was eradicated. Diphtheria tetanus pertussis also known as
whooping cough, typhoid fever vericella and tuberculosis. Okay, so I
(15:41):
mean compare that to what we went through yesterday. We
have lot and so so many more. I just don't
We don't include typhoid fever regularly, or smallpox obviously, or
smallpox of course.
Speaker 4 (15:52):
Yeah.
Speaker 1 (15:52):
It's so interesting too, though, that they had versella back then,
because then we didn't have it for so long.
Speaker 2 (15:58):
It's just so interesting.
Speaker 3 (16:00):
I have so many questions, I know, and we may
have even touched on that in our veracell.
Speaker 2 (16:04):
We probably did, you know, I don't remember things same.
Speaker 3 (16:09):
But then the introduction of the polio vaccine in nineteen
fifty three the prompted passage of the Polio Vaccination Act
a couple of years later, and then this provided funds
to what was then the Communicable Diseases Center later became
known as the CDC, and this helped states buy and
distribute polio vaccines. But there was still no formal process
(16:30):
for the federal government to make recommendations for vaccines and
the timing of vaccinations at a national level. Vaccines were
recommended for licensing at the federal level, like by the
Surgeon General. They would say, okay, yes, this, we recommend
this for licensing prove but mostly the government was focused
on vaccines only as far as the military was concerned,
(16:50):
got it tracking efficacy and outbreaks and so on. So
it was like that is where the data collection was,
That's where the decision making was.
Speaker 4 (16:58):
That was the main intro.
Speaker 1 (17:00):
That makes sense, It makes your protecting assets in that case.
Speaker 3 (17:05):
Sorry, and I think especially the timing close to World
War two and then Korea. Yeah, so there was like
a lot of that. Yeah, there was context for that.
But then the polio vaccine was came out in nineteen
fifty two, nineteen fifty three, and then the Musles vaccine
ten years later in nineteen sixty three. It was clear
(17:26):
that there was a need for a national immunization policy,
especially with two more vaccines MOMPS and rubella on the
horizon for the rest of the nineteen sixties, Like they
were like clearly, you know, there was most something. It was, yeah,
these things were going to happen. Yeah, And so things
really got started with the Vaccination Assistance Act in nineteen
sixty two, and this provided support for mass vaccination campaigns,
(17:49):
especially targeting school aged children, which is where most of
the spread and harm from these diseases was concentrated, and
ultimately it led to the formation of the ACI in
nineteen sixty four. So like, instead of having one meeting
for measles and one meeting for polio and one meeting
for this, it.
Speaker 2 (18:06):
Was like, why don't we just do them all at once?
Speaker 4 (18:08):
Do this all at once?
Speaker 2 (18:09):
Yeah?
Speaker 4 (18:10):
Efficiency? How about that?
Speaker 2 (18:14):
I can't.
Speaker 4 (18:15):
I'm sorry.
Speaker 1 (18:15):
I was going to make like a government efficiency joke,
but I because it's too real, too close.
Speaker 4 (18:21):
Yeah, yeah, I know.
Speaker 3 (18:24):
At the first meeting, the committee considered measles, influenza, rubella,
and smallpox vaccines for recommendation. I think there was still
at this point a separate committee for polio. Okay, But
since the beginning, the ACIP has worked closely with professional
organizations like the American Academy of Pediatrics, the American Academy
of Family Physicians, the American College of Ctatricians and Gynecologists,
(18:47):
and others. Together, the ACIP and all of these organizations,
both federal and professional, carefully evaluate all of the available
data to make recommendations on how to best protect the
health of Americans.
Speaker 1 (19:01):
Yeah.
Speaker 4 (19:01):
Again, that is the goal.
Speaker 2 (19:03):
That is the goal.
Speaker 4 (19:04):
That is the goal.
Speaker 3 (19:05):
So what does this look like in practice and I
want to share a real life example of how one
of these recommendations is made and what information is considered
when weighing whether or not to change a recommendation.
Speaker 4 (19:15):
Okay, so let's talk about measles.
Speaker 2 (19:17):
It is timely. Yeah, unfortunately timely topic.
Speaker 3 (19:22):
So since the introduction of the first measles vaccine in
nineteen sixty three, researchers have developed new versions of the vaccine,
each of which has been and continues to be evaluated
for safety, efficacy, ease of administration, and so on. So
like live versus killed with or without certain adjuvants in
a combo shot or solo, the timing for the best
(19:45):
immune stimulation, like all those sorts of things are considered
for each of these vaccines regularly, continuously, and on occasion,
the ACIP has changed their recommendation for which measles vaccine
to include, such as in nineteen sixty eight when they
changed the recommendation from the less attenuated vaccine, which was
the Edmonston B strain, to one that was based on
(20:07):
a more attenuated strain, the Moratin vaccine. The Moratin vaccine,
the more attenuated strain, was as effective as the previous vaccine,
but it produced fewer side effects, right.
Speaker 1 (20:18):
So it was like an even weaker version of a
measles virus compared to an older vaccine, but it protected
you just as well, had fewer side effects, so that.
Speaker 3 (20:29):
They also revisited what age to give the vaccine. So
initially their recommendation was nine months of age, and then
that changed to twelve months and then fifteen months. And
the reason for these changes was not about safety, but
more about efficacy because researchers had found that babies that
were vaccinated earlier tended to lose immunity a bit more
(20:50):
than if they were vaccinated later. It's probably due to
maternal antibodies circulating.
Speaker 1 (20:54):
Yeah, or just like you know, babies in their weird
immune systems.
Speaker 4 (20:58):
Right exactly.
Speaker 3 (20:59):
These are things that they that they will look at monitoring.
They were looking out for, yeah.
Speaker 1 (21:04):
Because of basic scientific research that was going on in
clinical research that's going on where people are actually like
testing people who get these vaccines for their antibody response,
for example, and then collecting and gathering off that data.
Speaker 3 (21:16):
And connecting that to epidemiological research that was monitoring outbreaks
and in what ages and what birth cohorts and all
of these different Yeah, all of these different things.
Speaker 4 (21:26):
All of this amazing research.
Speaker 3 (21:28):
Yep, yes, yeah, okay, okay, But starting in nineteen sixty three,
the ACIP had recommended only one dose of the measles vaccine,
or later a few years later, when mumps and rubella
came along MMRKA, they had recommended one dose, just one dose.
And this is of course different from the two shot
(21:51):
series that we get today that we discussed last week.
How did one shot become to outbreaks? Within the first
five years of the measles vaccine, incidents of the infection
had dropped to five percent of pre vaccine levels within
five years, within five wow years.
Speaker 4 (22:12):
Yeah.
Speaker 3 (22:13):
With this incredible success, measles elimination in North America seemed like.
Speaker 4 (22:16):
A very achievable goal.
Speaker 3 (22:18):
Yeah, yep, I mean like really, like first it was
like a pipe dream, and that it was like, oh wait, actually.
Speaker 4 (22:23):
Wow, we couldn't do this thing, reasonable dream? Yeah okay.
And even as progress towards this goal.
Speaker 3 (22:30):
Was made, a few outbreaks in the late nineteen seventies
and into the nineteen eighties slowed that progress, but they
also provided an opportunity to ask how was measles spreading?
Speaker 1 (22:41):
Right?
Speaker 3 (22:41):
Who was getting the infection. Was it teenagers, was it
young kids? Had they been vaccinated before? And what the
CDC found was that those who were involved in the
outbreaks were often either unvaccinated children under five years old
or older children such as high school and college student
who had been vaccinated but only once, only with one dose.
(23:05):
And that was again the recommendation at the time, and
there had been some debate about whether to include a
second dose. This was, you know, kind of brought up
at different meetings, and it was this trade off, this weighing,
well what are we actually getting with that second dose
of the vaccine, And up until this point, up until
the late well nineteen eighty the late nineteen eighties, really
(23:26):
the decision seemed to fall on, well, one dose is
probably enough. One dose protects you, Like I think you
said erin last week, three ninety three percent, Do we
really need that extra four to five percent? Turns out,
what these outbreaks showed us is that yes, we do,
especially when having that extra four to five percent protects
(23:48):
those who are vulnerable who cannot be vaccinated.
Speaker 4 (23:51):
Right.
Speaker 3 (23:51):
And so there was an outbreak in nineteen eighty nine
that led to a twenty percent hospitalization.
Speaker 2 (23:59):
Rate, which is what we pretty common.
Speaker 3 (24:00):
I've seen I've seen today and one hundred deaths. And
this really demonstrated that waning immunity or under vaccination could
have dire consequences for those who are too young to
be vaccinated. So in nineteen eighty nine, both the ACIP
and the AAP the American Academy of Pediatrics changed their
recommendation to include two doses of MMR for all children,
(24:24):
and that decision is what helped to eliminate measles entirely
from the US in two thousand, yeah, and the Western
hemisphere in twenty sixteen.
Speaker 1 (24:32):
I mean, yeah, that's so interesting too, just in the
context of like the biology of measles, right, because you
need such high vaccination coverage to be able to achieve
herd immunity and protect everyone around you. So it makes
sense that a second dose, where now you're getting ninety
seven percent efficacy in like lifelong at a bodies, that
(24:55):
that is what's going to allow you to achieve herd
immunity rather than a ninety three percent. And yeah, how
interesting and cool, Aaron.
Speaker 3 (25:05):
It was such an enlightening like exercise to go through,
like what does this look like? We know that they're
making decisions. We know that they're considering all of these
different things, but like, how does new data influence a recommendation?
Speaker 1 (25:20):
Yeah, like walking an example of that, it was yeah, yeah,
because it's something we don't think about. We're just like, oh,
here's the schedule.
Speaker 2 (25:27):
And you're like okay, but like what who and why
and how did you come up?
Speaker 1 (25:30):
Why do we need four doses of tea DAP and
then a booster and because that's what the data says
we need.
Speaker 3 (25:36):
What that's I mean, evidence based, evidence based medicine.
Speaker 2 (25:41):
Is that interesting?
Speaker 4 (25:43):
Which? Yeah?
Speaker 2 (25:44):
I mean?
Speaker 1 (25:44):
And then they change their recommendations on adults getting like
a pretess's booster a tea DAP rather than just a
TD a few years back because of circulating protessis I
mean science?
Speaker 4 (25:54):
Science changes by design? It doesn't. It's like right, like
this is part of what.
Speaker 3 (25:58):
Science is, Why why science works is because we evaluate
and consider.
Speaker 1 (26:05):
And consider and then change recommendations.
Speaker 3 (26:08):
And chased on that on that these are not arbitrary decisions.
Like that's the message that we really wanted to get across.
The ACIP takes an evidence based approach that weighs many
different factors to come to a final recommendation. There is
data and reason and logic and evidence backing up each
(26:31):
one of these recommendations, such as timing when to get
the first dose of a vaccine. This is determined by
the disease itself and when a child might be at
highest risk for an exposure to the disease, is at
high risk for complications from the disease, and also how
well they're going to respond to the vaccine in terms
of are they going to mount an adequate immune response
(26:52):
that will protect them long term, Like we talked about
with maternal antibodies sort of circulating in baby for a
while after birth, so that vaccines don't induce this long
term immunity. Right, Typically, it is recommended that a child
gets a vaccine as soon as possible. Multiple doses are
determined by how well one dose induces an immune response.
(27:13):
Some vaccines need too to create long lasting immunity. Others
like t DAP or DETAP require periodic boosters. FLU of
course as annual and I can understand that it feels
like there are a million vaccines and a million jobs,
but each one of these vaccines is so critical and
combo shots like MMR and T DAP helped to cut
(27:34):
down on the number of jabs that your kid gets.
Speaker 1 (27:38):
I love combo vaccine combo, but even each one of
the combo vaccines has to be studied and tested in
all the different age groups and in all the different scenarios,
which is why some are used for some age groups
and not others. Like the MMR vercella vaccine technically is
not recommended to be given to kids at the twelvemonth visit,
but is at the four to five or six year old?
Speaker 2 (28:00):
Is it?
Speaker 1 (28:01):
And it's because of the data on the risks versus benefits.
Speaker 4 (28:05):
These are carefully made decisions.
Speaker 2 (28:08):
Yeah, right, Like.
Speaker 3 (28:09):
The bottom line is that the childhood vaccine schedule that
we have here in the US has been and continues
to be continuously evaluated multiple times a year by a
team of highly qualified individuals who have the best interests
of the American public at heart. That is historically then
its role. Yeah, I hope that that is what its
(28:29):
role will.
Speaker 4 (28:30):
Be in the in the years to come.
Speaker 1 (28:32):
It's protected us for so long. I hope that it
continues to do so.
Speaker 3 (28:37):
The childhood vaccine schedule is safe, it is effective, and
it has saved and continues to save millions, not an exaggeration,
millions of lives of some of the most vulnerable members
of our society every single year.
Speaker 4 (28:51):
Yeah.
Speaker 2 (28:52):
Yeah, it's amazing.
Speaker 4 (28:54):
Eron so erin. Yeah.
Speaker 3 (28:57):
Now that we know the history of the ACIP and
how they make these decisions and why it is so
vital that they do what they do, can you tell
me why we might see some differences in the US
compared to other countries around the world.
Speaker 1 (29:10):
Yeah, I can, And then get into what we know
about what these vaccine preventable diseases look like across the
gub H. We'll take a quick break and then get
into it. So, the World Health Organization has a list
(29:38):
of vaccines that are recommended for all children and that schedule,
and those recommendations are essentially the same as what the
CDC recommended schedule is in the US, which again is
mostly influenced by recommendations from ACIP, except there are a
few big exceptions. One is that we in the US
(30:01):
do not use the BCG vaccine, which is a vaccine
against tuberculosis and is recommended by the World Health Organization
to be given at birth for all children. We don't
do this in the US because historically rates of tuberculosis
have been relatively low. I mean not historically historically, but
in recent times at this point in time. That could
(30:21):
change in the future, but that's the recommendation right now.
So we don't use the BCG vaccine here in the US,
but overall, the World Health Organization recommends vaccines for all
children that include hepatitis B, polio, diphtheria, tetanus, and pertussis,
the detap hib or, the homophlus influenza, new macaucus, rotavirus, measles, rubella,
(30:42):
and HPV, and then the World Health Organization goes on
to have a number of other recommendations because of course,
the World Health Organization is having to kind of stratify
across the globe, where they might recommend certain vaccines only
for children who live in certain regions or who are
(31:02):
in certain high risk populations either geographically or just population wise,
or in countries that have vaccine programs with certain characteristics,
and the US falls into that.
Speaker 4 (31:15):
What does that mean?
Speaker 1 (31:16):
Let me tell you about it.
Speaker 4 (31:18):
Okay, okay, So there are.
Speaker 1 (31:19):
Some vaccines that we went over last week that we
give in the US that weren't on that list. I
just read from the World Health Organization specifically that is mumps, vericella, flu, meningitis,
and HEPA. The reason that we give those vaccines in
the US and they're not on the recommended for every
single child across the globe list is number one. Mumps, veriicella,
(31:43):
and flu are recommended by the World Health Organization for
all kids if they live in a place that has
an immunization program that can actually get at least eighty
percent or more of vaccination coverage, or if they have
access to combination vaccines. So in parts of the world
(32:05):
that are still struggling to even get kids access to vaccines,
or who can't get or can't afford, or maybe can't
like don't have the storage capacity, if vaccines have to
be refrigerated, et cetera, for whatever reason, if they can't
get combination vaccines, or they just don't have the capacity
to vaccinate, then the World Health Organization says prioritize measles, rubella, mumps,
(32:27):
and vericella come later. Essentially, does that make sense. Similarly,
hepatitis A and meningitis, which are on the vaccine schedule
in the US, are on the World Health Organization list
of recommended for high risk populations, which, based on our
data in the US, the US is one of them.
We had really high rates of hepatitis A and meningitis,
(32:48):
enough so that the CDC said, Hey, we're going to
vaccinate all of our kids to prevent morbidity and mortality
from these diseases. And then there are a lot of
other vaccinations that are given in other countries, like for
Jepanese encephalitis or for dange or yellow fever, that we
don't give in the US on an everyone basis because
they do not circulate in as high as numbers here
(33:11):
in the US.
Speaker 4 (33:12):
Yeah, so that's why our.
Speaker 1 (33:13):
Schedule looks a little bit specific to our country.
Speaker 4 (33:16):
Yeah. Yeah, And we've said it a.
Speaker 1 (33:19):
Few times, I think, maybe more than a few times
last week in this week, but I do think it
bears repeating. It is very easy, because of the incredible
success of vaccines to think that these diseases that we
are vaccinating against are a thing of the past. Yeah,
because it is true that the rates of illness and
(33:41):
severe illness and death from almost all of these childhood
vaccine preventable diseases have plummeted, both here in the US
but also across the globe and that is incredible.
Speaker 4 (33:56):
It is, it is amazing. It is such a huge feat.
I think back, like okay.
Speaker 3 (34:02):
You know, like, okay, I'm trying to think of a
time travel movie Kat and Leopold, for instance, which that's
a deep cut. That's a deep cut, right, Okay, somebody
comes from the Hugh Jackman is like a time traveler
from the past.
Speaker 4 (34:16):
Anyway.
Speaker 3 (34:17):
I always think about if someone were able to travel
to the present day from the past. One of the
things that would instantly be so magical is vaccines, Like
not magical, but just profound right in what it has done.
Speaker 2 (34:31):
I'm sure it would feel magical.
Speaker 3 (34:32):
Quite Yeah, Leopold would really have appreciated vaccines.
Speaker 4 (34:35):
Maybe he did. Did they talk about it?
Speaker 3 (34:37):
I have not seen it since it was in theater
at the Dollar Theater like twenty years ago.
Speaker 4 (34:43):
Oh that's hilarious.
Speaker 2 (34:44):
I'm gonna go watch it now.
Speaker 4 (34:46):
But it's true.
Speaker 1 (34:48):
Vaccines save today in twenty twenty five and estimated four
million lives every single year.
Speaker 4 (34:56):
Four million.
Speaker 1 (34:58):
Yeah, the World Health Organization actually estimates three and a
half to five million.
Speaker 2 (35:01):
So, like, I mean, it's.
Speaker 3 (35:02):
Incredible conservatively four million exactly, which.
Speaker 1 (35:05):
Is why conservatively, But The thing is that we could
be saving even more because while we have made huge
strides in reducing the burden of these diseases, we have
not eradicated any of them, aside from smallpox, which we
no longer vaccinate for anywhere across the globe because it
has been eradicated, and also under which is a disease
(35:29):
of cattle like well, actually story I wrote underpest down.
But until we can actually eradicate these other preventable diseases,
a case anywhere represents the risk of disease everywhere, especially
because in the face of growing anti vaccine sentiment in
the US and around the globe, vaccine preventable diseases are
(35:53):
on the rise. As we record this, which is early
March twenty twenty five, in the US, we are in
the midst of a very significant measles outbreak that is
continuing to spread. Yeah.
Speaker 4 (36:06):
Band numbers are way out of date already, I know.
Speaker 1 (36:09):
Yeah, by the time this episode comes out, they will,
unfortunately I'm sure, be much worse. And the current outbreak
is not typical, It is not common. Nope, And like
you mentioned already aarin in the US, measles was declared
eliminated in the year two thousand, which essentially means that
we had had no continuous transmission of measles for an
(36:31):
entire year, which meant that from that point forward, any
cases that popped up, like anything more than three cases
of measles is considered an outbreak in the US. And
that was huge, and it wasn't just the US, like
you said. In twenty sixteen, the World Health Organization declared
measles eliminated from the entire Western Hemisphere, and around that
(36:55):
time the World Health Organization European Region also reached its
lowest point.
Speaker 2 (36:59):
Ever in Europe.
Speaker 1 (37:01):
And then and then things started to get worse again
in the US between two thousand and twenty ten, so
shortly after we were declared eliminated. There were only three
years in that ten year period where we had more
than one hundred measles cases in the US, between twenty
eleven and twenty twenty one. In that ten year period,
(37:25):
seven years had more than one hundred cases, including six
hundred and sixty seven cases in twenty fourteen, three hundred
eighty one cases in twenty eighteen, twelve hundred seventy four
cases in twenty nineteen, and last year in twenty twenty four,
we had two hundred and eighty five cases. Right now,
(37:47):
it's early March, and the CDC last updated their Measles
disease outbreak surveillance on February twenty eighth.
Speaker 5 (37:55):
Not often enough, every one Friday, every Friday, yeah, yeah,
But as of February twenty eighth, there had been one
hundred and sixty four confirmed cases and one child died.
Speaker 1 (38:08):
That is the first time that a child has died
of measles in the US since twenty fifteen in the
current outbreak. And again I know these numbers are outdated
by the time this episode comes out. Twenty percent of
these kids and I say kids because eighty two percent
of these cases are in children, twenty percent of them
have been hospitalized, and ninety five percent of cases were
(38:31):
in either unvaccinated individuals or people whose vaccination status is unknown.
And in every case, whether an individual is vaccinated or unvaccinated,
this is a preventable illness, yes, and it's not just measles, like.
Speaker 4 (38:49):
It's not just measles.
Speaker 3 (38:51):
And before we move on to the other diseases that
are vaccine preventable in these outbreaks that are happening, I
want to talk about something that I think can generate
some confusion when it comes to looking at these numbers.
So you'll see in an outbreak like measles, like these
measles outbreaks, that there is a number of people who
are vaccinated who contract measles. And that could be for
(39:13):
a million different reasons, right, Like some of US measles,
vaccines don't induce a strong of an immune response. Again,
why herd immunity is so important, and because in an
area the general population is much more vaccinated than unvaccinated.
Speaker 1 (39:29):
Right, it can see eighty percent vaccination coverage in the US.
Speaker 3 (39:32):
Yes, it can seem like there is a high number
or an equal number of people who are vaccinated compared
to those who are not vaccinated.
Speaker 4 (39:40):
Does that make sense?
Speaker 3 (39:41):
But that's that is actually disguised as what is truly happening.
And that is, if you look at the proportion of
people who are unvaccinated, what at the likelihood that they
will get that that they will get measles much much
much higher than if you are vaccinated.
Speaker 1 (39:54):
Right, I think you said last week here and it
was like one hundred and seventy times.
Speaker 3 (39:58):
Forty times higher they're unvaccinated. And so but like, just
reporting on these sheer numbers only tells part of the story,
right right, Like we it doesn't tell us what proportion
of unvaccinated individuals in a community are infected compared to.
Speaker 2 (40:11):
Those who are vaccines exactly exactly, And.
Speaker 3 (40:13):
I think it kind of is these numbers are sometimes
used to undermine the power of vaccines in protecting you.
Speaker 1 (40:20):
I remember that happening especially a lot during the mumps
outbreak a few years ago, because especially mumps, we see
more waning immunity than we see with measles as well,
and so it kind of compounded that same problem.
Speaker 4 (40:33):
But it is yeah, that.
Speaker 1 (40:35):
The proportion, the likelihood that you get one of these
illnesses is significantly higher if you are unvaccinated or under
vaccinated compared to if you are vaccinated fully.
Speaker 3 (40:46):
And on top of that complications exactly. This isn't just
about whether or not you are getting the disease. It
is about how sick you are getting in your chances
of dying, and vaccines protect you from these things exactly.
Speaker 1 (40:57):
And it is not just measles, it's not just rtussis cases.
Whooping cough has been on the rise year over year
in twenty twenty four, there were thirty five thousand cases
of pertussis in the US and over twenty seven hundred
of those were babies under one year old, and six
(41:18):
of those babies under one year old died in the
US in addition to four other kids that were over
one year old. That's ten children who died last year
alone in the United States from a vaccine preventable illness.
Speaker 4 (41:36):
Yep, did not have to happen.
Speaker 3 (41:38):
Yeah.
Speaker 2 (41:39):
Yeah.
Speaker 1 (41:40):
Polio is another example that made headlines back in twenty
twenty two here in the US. So we eliminated polio
in the US in nineteen seventy nine, and there is
of course a huge campaign to try and eradicate polio
across the globe and were not there yet, And yet
there was a case of paralytic polio in twenty twenty
two in the US, and in conjunction with that case,
(42:02):
there was enough virus being detected in the wastewater in
surrounding areas that the US was actually added to the
World Health Organization list of countries with endemic circulating vaccine
derived strains of poliovirus. Now, this is a strain of
the virus that has evolved from the vaccine strain of
(42:26):
the oral poliovirus vaccine. So this is a disease that
people get not from the vaccine itself, not from getting
the vaccine, but from a mutated version of this virus
that can persist in the environment, from the vaccine derived
strain that evolves to regain virulence or infectiousness, and then
(42:48):
can infect other people and get them sick. We do
not use this oral polio vaccine in the US, and
we haven't since the year two thousand, but there are
some other countries across the globe that still do because
it's a much less expensive vaccine. It's easier to administer
because it's oral rather than injected. You have to have
less public health investment or infrastructure. And in some other
(43:08):
places that still had circulating like wild typled toliovirus, it
provided good protection, but it comes with this potential cost,
and that cost has now been more vaccine derived strains
circulating and globally. In twenty twenty three, which is the
(43:29):
latest year that the World Health Organization has these global
dashboard numbers, there were over twenty four thousand, seven hundred
reported cases of diphtheria, certainly more that were not reported.
Over six hundred and sixty nine thousand cases of measles globally,
(43:50):
over one hundred and sixty three thousand cases of pertussis,
three hundred and eighty seven thousand cases of mumps, thirty
five thousand cases of rubella, and over twenty one thousand
cases of tetanus, and the list goes on. So all
of these diseases that we are protecting our children against
with vaccines still circulate around the globe. And because of
(44:13):
global travel, that means that many of these diseases can
circulate anywhere. And I mean the case of tetanus, those
bacteria are just everywhere already, right, I.
Speaker 4 (44:22):
Mean, and so much of this is just like it is.
Speaker 3 (44:25):
These numbers are saggering, and they're so hard to absorb,
to like actually wrap your head around. And this I
think speaks to how why it is so important that
an investment in global public health and global health is crucial,
And it's just it's just something that is so obvious.
Speaker 2 (44:45):
I know, so clear. I know.
Speaker 1 (44:47):
Vaccines are not only the best thing that you can
do to protect yourself and your children from infectious disease,
but also the best thing that you can do to
protect your community. Because vaccines are protecting us a against
communicable diseases. These are things that are spread from person
to person. So it is, like we said last week,
our social responsibility to vaccinate, like for the health of ourselves,
(45:11):
yes I don't want to get sick and end up hospitalized,
but also for the health of our communities. And it
is for this reason, because of the health of the public,
that there are vaccine requirements for participation in public life
like public schools. Right, and when these requirements are waived
or changed to recommendations rather than requirements, or if they're
(45:34):
done away with altogether, we are putting both individual and
public health at risk. We then see children hospitalized and dying,
and resurgence of diseases that have previously been eliminated. So
understandably there is a lot of interest in addressing vaccine hesitancy.
Speaker 4 (45:54):
How the heck do we do it, that's a great question.
Speaker 1 (45:58):
The World Health Organization actually named vaccine hesitancy one of
the top threats to global health in twenty nineteen, and
that's alongside like climate change and air pollution, anti microbial resistance,
the next global influenza pandemic. Like big scary things include
vaccine hesitancy hesitancy.
Speaker 2 (46:15):
Yeah, so lucky for us.
Speaker 1 (46:17):
There's a lot of research that has been done and
that continues to be done on how to best try
and address this. And we started out last week's episode
like this whole vaccine series. Part of what we wanted
to be able to talk about is just how prevalent
vaccine misinformation is and how easy it is to believe
(46:39):
it because of the way that misinformation and disinformation praise
on our fears and anxieties, especially when it comes to
our kids. Yes, and we are all susceptible to misinformation.
Speaker 2 (46:52):
Ehudding us do you hate to admit it, But it's true.
Speaker 1 (46:55):
That's true, and we know that when it comes to
vaccine hesitancy, which is defined as the reluctance or refusal
to vaccinate despite the availability of vaccines, there is a
spectrum of belief. But I want to first set the
record straight. The vast majority of parents still vaccinate their
kids on time according to the ACIP schedule period period.
Speaker 3 (47:17):
Yay, that's amazing, And part of that is because we
do have these childhood vaccination requirements for school exact. Yeah, yeah,
it's yeah, it's great, it's amazing.
Speaker 1 (47:28):
But when we are looking at the minority of people
who meet these criteria of vaccine hesitancy. There is a spectrum,
and there are some people, many of whom are the
spreaders of disinformation, who are profiting heavily off of vaccine
hesitancy in one way or another, or who have wrapped
up their identities in these false beliefs to a point
(47:50):
where there really is no changing their mind. But there
are also a lot of people who are vaccine hesitant,
who just have questions or or herd scary things on
TikTok and they just don't know who to believe. And
recognizing this idea that we can all fall prey to misinformation,
(48:11):
what that does is allow us to approach all of
our conversations about vaccines from a place of understanding and empathy.
It allows us to actually have productive conversations about vaccines
rather than just combative ones with my uncles.
Speaker 4 (48:29):
I'm sorry it's.
Speaker 1 (48:30):
True, though, But we also know that a lot of
parents rely on their healthcare providers as primary sources of
information when it comes to their children's health, and that's great.
We should all have a healthcare provider that we can
trust to ask our questions and get answers without fear
of judgment or reprisal, and studies show time and again
(48:51):
that a strong recommendation from your health care provider drives
vaccine uptake, as do strategies like motivational interviewing, which is
a technique that relies on like open ended questions and
affirming and reflecting back statements and concerns and then summarizing
information and then advising, but all in a way that
(49:11):
actually requires that you listen.
Speaker 4 (49:13):
Yeah, I mean google it.
Speaker 3 (49:15):
It's like it's a really important and technique and I
think that there's a lot more to it. Yeah, you're
interested in learning more about it, definitely, And the.
Speaker 1 (49:23):
Search requires that you start from a place of empathy
from where a person is coming from and the concerns
that they legitimately have.
Speaker 4 (49:30):
Ye.
Speaker 1 (49:31):
But a lot of us and a lot of you
listening feel like maybe you feel like you'll never be
in a position to directly like advise someone on whether
or not to get vaccinated. That does not mean that
we can't all be working towards increasing vaccine acceptance in
our own communities. Most parents still vaccinate their kids. The
majority of kids in the US are getting their vaccines
(49:53):
on time, according to the ACIP schedule. If we start
talking about this fact, like normalizing this, talking about getting
your vaccines, about when you got your kids vaccinated, how
you just got your flu shot in your arms a
little bit sore, but you're feeling great about it. That
is one way that we individually can help to move
this needle back towards vaccine acceptance and away from this
(50:16):
idea of vaccine hesitancy.
Speaker 4 (50:19):
Yeah, we collectively talk.
Speaker 1 (50:21):
A lot about vaccine hesitancy, but I think we don't
talk enough about getting vaccinated. And like I normalizing this process.
Speaker 3 (50:29):
I love this because I feel like I have done
this with friends where I'm like, oh, yeah, I got
my flu shot and my arm is still a little
bit sore, and they're like, oh, that reminds me I
have to go get my flu.
Speaker 4 (50:38):
Shot exactly exactly. Something as simple as that, I I
love it.
Speaker 1 (50:43):
I also love things that make it easier, like one
time I got my flu shot and my COVID shot
this year when we went to the YMCA where my
kids are doing gymnastics, and they had a table there
and we went early because we thought my kids wanted
to play in a thing, and then they didn't want
to and we're like, well, we're just going to get
our vaccines.
Speaker 3 (51:01):
Then you made it so easy, yes, yes, but breaking
down those barriers to just make it easy when you're
just out because there are so many other things that
are that that do stand in the way of someone
being able to take time off to go get rationeated
when our clinic hours open. And I know that there
are a lot of different organizations that really push towards this,
(51:22):
Like we're having you know, a van that comes and
does like on site vaccination.
Speaker 4 (51:28):
Yeah, that's great, that's great.
Speaker 1 (51:29):
Talking about this and normalizing this process and talking about
how incredible the benefits of vaccination are is so helpful.
And we can all start having these conversations with our
friends and family who already vaccinate and maybe those who
might be more towards hesitant.
Speaker 3 (51:47):
Yeah, and I think it's important to you wonder what
might that conversation look like? Yeah, what what could it
look like? And I mean who knows, right, Like, there's
a huge spectrum. Yeah, and if it depends a lot
on how receptive someone is to changing their mind or
to hearing conflicting information something that conflicts with what they've
(52:08):
heard or what they hold in their hearts, right, But
it does start, like you said, Aaron, with empathy and
with asking questions. So if you know someone who's vaccine hesitant,
or you learn that someone is, you could start by
asking why, like what what do you know about vaccines?
What specific worries do you have? And then asking you know,
(52:28):
can can I talk with you about this? Can I
share my thoughts there? Can I share some information that
I have learned with that convation? Can we engage in
this way?
Speaker 4 (52:38):
Yeah? And maybe it's a flat no.
Speaker 3 (52:39):
Maybe they're like, not interested, do not talk to me
anymore about this?
Speaker 2 (52:42):
Okay, right, that's fine, But maybe it's not.
Speaker 3 (52:45):
Maybe they're like, actually, yeah, I have been really nervous
and I don't know where to turn.
Speaker 4 (52:49):
And maybe you can help to answer their questions. Or
maybe you can't.
Speaker 3 (52:52):
Maybe you're like I too, I don't know where to turn,
but you can at least look together. You can help
them find where to look. That is how this has
proven to be how progress is actually made on this
front human to human interaction. People who have social capital community, right,
(53:15):
like people who are trusted, people who are like, no,
I get it, I know where you're coming from.
Speaker 4 (53:19):
I can relate to you, and I will relate to you.
Speaker 3 (53:21):
I won't stand here in a position of power and
tell you and look down on you and condescend to
you right like I will say, okay, I hear you right.
And this, all of us having these conversations, is how
we can make progress. Each of you has the most
sway and reach within your own community. And research does
show that this community based activism, even if it's just informal,
(53:44):
even if it's just chatting with a neighbor, this has
the greatest opportunity of making an impact. And one really
important thing to remember and I think that, especially as
our bandwidth grows ever more shorter these days, speaking personally, yes,
is that you you should pick your battles right like
you can pick your battles if you're not in the headspace,
(54:06):
or you feel like someone is just super resistant and
it's only going to drain you further so that you
don't have the emotional bandwidth to take care of yourself.
Or if you feel yourself getting heated and you're like,
this is not going anywhere, I'm just getting angry at
this person. Yeah, don't be afraid to take a step back,
try another day. This is a constant, constant battle. But
(54:27):
we truly can make progress.
Speaker 1 (54:28):
Yeah, we really really can't. We maybe sound very cheesy,
but genuinely we believe that we do.
Speaker 2 (54:36):
Also data backs it up.
Speaker 3 (54:37):
So yeah, evidence based, speaking of evidence, speaking.
Speaker 4 (54:44):
Of evidence, great transition. Thank you. We've got more sources
for this.
Speaker 3 (54:50):
Let me see if I can shout out any in
particular that I found helpful. If I can find this tab,
here we go. Yeah, there is a pa by Walton
at All from twenty fifteen called the History of the
United States Advisory Committee on Immunization Practices, and it was
really insightful in terms of how this committee came to be.
(55:12):
And then I have a bunch of other websites for
our a bunch of other sites from CDC and who
that can help sort of put more context into this.
Speaker 1 (55:20):
I used a lot the World Health Organization Global Dashboard,
their data portal, so we will link to that. I
also really enjoyed a paper by friend of the Pod
Peter Hotes from twenty nineteen titled America and Europe's New
Normal the Return of vaccine preventable Diseases, And I also
(55:41):
had a number on that whole idea of how we
talk about vaccine hesitancy and kind of moving the needle.
So we will post the list of all of our
sources from this episode and every one of our episodes
on our website, this podcast withekille dot com under the
episodes tab.
Speaker 3 (55:57):
We will a big thing YouTube Bloodmobile, who provides the
music for this episode and all of our episodes.
Speaker 2 (56:04):
May sure do you.
Speaker 1 (56:05):
Thank you so much, Bloodmobile. Thank you to Leona Scolacci
and Tom Bright Focal for the incredible audio mixing, and
thank you to Brent and Pete and the whole video
editing team as well.
Speaker 3 (56:16):
Thank you, thank you, and thank you to you listeners
for listening, for listening, please watching or watching, Please do
reach out with more what you want to hear? Yeah,
what you want to learn about?
Speaker 1 (56:27):
I want to know so we can make our season better. Yes, truly,
And thank you as always to our patrons. Your support
means so much to us. Thank you, thank you, thank you.
Speaker 4 (56:40):
Thank you. Well.
Speaker 6 (56:41):
Until next time, wash your hands, you filthy animals.
Speaker 1 (57:00):
Mum
Hosts And Creators
Erin Welsh
Erin Allmann Updyke
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