May 13, 2025 • 52 mins
For the past few months, measles has been in regular rotation in the news cycle here in the US, with outbreaks occurring across the country in regions with low vaccine uptake. These outbreaks represent a worrying trend in the rejection of scientific and medical expertise, with long-term consequences not only for those individuals refusing vaccines but also the communities to which they belong. In this TPWKY book club episode (recorded March 14, 2025), Dr. Adam Ratner joins us to discuss his book Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children's Health. With his firsthand experience treating children with measles and other vaccine-preventable diseases, Dr. Ratner provides a powerful perspective on the dangers of the measles virus and vaccine hesitancy. What can we learn from the history of measles and the measles vaccine rollout? Why is measles such a dangerous virus? Where do we go from here? Tune in for all this and more.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:44):
Hi, I'm Aaron Welsh and this is this Podcast will
Kill You. You're listening to the latest episode in the
tp w k Y book Club series, where I interview
authors of popular science and medicine books about their latest work.
Speaker 2 (00:59):
It has this has.
Speaker 1 (01:00):
Been so much fun to put these episodes together, and
I am really thrilled to be bringing you more of
these this season. If you'd like to get a sneak
peek of the books that we'll be featuring throughout the
rest of this season, or to check out the books
that have been featured on past episodes, head over to
our website This Podcast will Kill You dot com. There
(01:20):
under the extra tab, you'll find a link to our
bookshop dot org affiliate account, which has a few different
lists of books that we've featured on the podcast, including
a book club list. I'll be adding more books to
that list throughout the season, so check in regularly for updates.
We always appreciate hearing from you all which books you're enjoying,
and so if there are any book Club episodes that
(01:42):
you particularly loved, or if there's a book that you'd
like to see featured, shoot us a message through the
contact us form on our website. Also, did you know
that you can now find full videos of most new
episodes of this podcast Will Kill You on YouTube. Subscribe
to Exactly Write Media's YouTube channel so you never miss
an episode. One last thing, and that is a request
(02:05):
to please take a minute if you haven't already, to rate, review,
and subscribe. It really does help us out. A worrying
trend has emerged in the United States over the past
few years, as well as in other regions around the globe.
Vaccine uptake rates, both in children and adults, have started
to decline, due in large part to increasing vaccine hesitancy.
(02:27):
As a result, we've seen more and more outbreaks of
vaccine preventable diseases that had once been on their way
to elimination in the US, diseases such as measles which
actually had been eliminated. While I'm recording this on March seventeenth,
there is an ongoing measles outbreak in West Texas with
(02:50):
cases numbering in the hundreds, and the infection has been
popping up in other states as well. And although we
can't predict exactly what will happen with this particular output break,
we can use our knowledge of measles as a guide
to understand how it spread so fast and causes such devastation,
and why people are reluctant to get themselves or their
(03:13):
children vaccinated. In this Book Club episode, pediatric infectious disease specialist,
professor of pediatrics and microbiology and author, doctor Adam Ratner
joins me to discuss his latest book, Booster Shots, The
Urgent Lessons of Measles and the Uncertain future of children's health.
With his experience treating children that are gravely ill with
(03:36):
vaccine preventable diseases like measles, doctor Ratner provides a powerful
perspective on the dangers of this virus and the harm
caused by myths and disinformation. In Booster Shots, he takes
readers through the biography of this virus, its transmissibility, its lethality,
(03:57):
its long and devastating history, and the factors contributing to
its re emergence. What results is a compelling and comprehensive
portrait of a disease that should be found only in
history books, but of course is not. Crucially, doctor Ratner
demonstrates that minds can be changed, that progress can be
(04:19):
made in the fight against vaccine hesitancy, and that what
it takes is empathy and understanding. If things keep going
the way they are, if vaccine hesitancy continues to mount,
and if people continue to turn away from science and
towards unproven quote unquote cures that are at best neutral
and at worst harmful, this current outbreak will be far
(04:43):
from the last. The lessons of measles, as doctor Ratner
describes in booster Shots, apply well beyond this one infection.
They are lessons in public health, in prioritizing prevention, and
in understanding that individual choices can have far reaching civic consequences.
(05:04):
I'm very excited to share this conversation with you all,
so let's take a quick break and get right into it.
(05:35):
Doctor Ratner, thank you so much for joining me today.
Speaker 2 (05:39):
Oh so excited to be here.
Speaker 1 (05:41):
I can't tell you just how much I loved your
book Booster Shots, and I feel like part of the
reason that it was so impactful is because you're coming
from the front lines about this, like you have seen
firsthand the devastation that measles and other vaccine preventable illnesses
can cause. When did you decide that you want to
write a book about this topic, and then why measles
(06:03):
in particular.
Speaker 2 (06:05):
The turning point for me was really in twenty eighteen
and twenty nineteen when we had this big measles outbreak
in New York City. And at that point I had
been doing this for a long time. I had been
seeing patients for a long time. I trained as a
pediatrician and then an infectious disease expert, and I thought
I had seen most stuff. And this was really interesting
(06:29):
to me because it measles was something that I had
learned about, of course, but it was something I had
seen a handful of cases of over the course of
my career a returning traveler, a little cluster of cases
in Northern Manhattan when I worked there. But all of
a sudden, this disease that I kind of filed under
solved problems in my mind, was something where we were
(06:52):
seeing four or five kids a day, and it was
interesting from just a learning point of view for me,
because I think I had read about it in books
but had never really understood what it was to take
care of kids with measles. And it also really changed
my perspective on vaccines and the anti vaccine movement and
(07:16):
things where I obviously I knew about the anti vaccine movement.
I had dealt with parents who had questions or were
frankly anti vaccine. But we were then in a situation
where we had kids getting admitted to the hospital with
a disease that, for the most part, their parents had
been vaccinated again, so the grandparents had chosen to vaccinate
(07:37):
the parents. The parents had made a different decision, and
we were seeing the consequences of that. And it made
me think more about how I talked to these families,
and it made me want to dig into the history
of measles, which I did and I found it fascinating.
And then, you know, this was twenty eighteen, twenty nineteen,
So after twenty nineteen comes twenty twenty, and all of
(08:00):
a sudden, as I was starting to do this work,
we were in the middle of a brand new pandemic
and dealing with questions of public health and masking and
eventually vaccination and all of these other things, and I
just I saw echoes of what I had learned about
measles everywhere in that and so that turned it once
(08:21):
again into a totally different project.
Speaker 1 (08:24):
Right, Yeah, I feel like I've been saying something similar
where It's like, it's not about measles. It's not even
about vaccines, it's not about you know, it's just like
these issues, the drivers of them are so widespread, and
I want to get to sort of talking about the
vaccine hesitancy or anti vaccine movement in a bit, but
first let's talk about measles. The measles virus itself is remarkable.
(08:48):
I mean, it's the most infectious virus ever discovered and
has a lot of other qualities that make it quite
dangerous and contagious. Can you take me through some of
those characteristics?
Speaker 2 (09:00):
Sure? And I agree with you. I mean, I think
it's the bias, but I think it's the most interesting
virus out there. And you know, it really is incredibly contagious,
and that's kind of the thing that people talk about
first with it, and it just it moves through crowds
incredibly quickly, and in unvaccinated populations like we're seeing now
(09:23):
in West Texas, it has a very high rate of
infecting people who are not vaccinated or haven't had measles
in the past. It's an airborne virus, like lots of
other viruses we know, like flu and other things. You know,
you get it by inhaling it, and instead of infecting
(09:43):
the cells that kind of make up the bulk of
the lungs, the measles virus infects the immune cells in
the lungs, the ones that live there, and it traffics
to lymph nodes and then it spreads widely throughout the body.
You get these huge viral loads before it comes back
to the lungs, and then people cough it out and
they are just coughing out enormous amounts of virus. It's
(10:06):
this very particular clinical presentation where kids are sick with
cold like symptoms at first, and then it turns into
this rash that is really characteristic of the disease. And
the reason we worry about it so much is not
the rash and is not the fever and stuff. It's
that there are these rare bad outcomes where most kids
(10:28):
with measles will be fine, but five or ten percent
will develop pneumonia and will need to be hospitalized. One
in a thousand will develop encephalitis or brain swelling and
that risks deafness or blindness or seizure disorders. And one
in a thousand will die, which sounds like a small
number and it is for any particular kid with measles.
(10:49):
But when you scale that to a whole population, and
it used to be before there was a vaccine, that
everybody in the population got measles, that was a lot
of deaths. That was a lot of dead kids every year. Yeah.
Speaker 1 (11:01):
Yeah, off the top of my head, I can't do
this math in my head. I'm too reliant on calculators.
But if it's like four million children every year pre
vaccine would get the measles that I mean, that is
a staggering number of complications, of deaths. It's a permanent
disability because of now a vaccine preventable disease virus.
Speaker 2 (11:22):
And I mean, I think that people often talk about
it like it was a rite of passage in childhood.
That's certainly how you know, politicians talk about it. It's
how some people who lived through that time will talk
about it. And for most kids, that's true. But it's
also true that there were a significant number of families
that were devastated by the complications of measles.
Speaker 1 (11:44):
One of the things that you mentioned when it comes
to measles today and kind of relates back to some
of these characteristics of measles is that you describe it
as a bell weather. Can you tell me more about
what you mean by that.
Speaker 2 (11:56):
Sure, So that comes from the fact that measles is
both incredibly contagious and now eminently vaccine preventable. And you know,
the combination of those two things means that when you
see measles outbreaks somewhere like we're seeing in West Texas now,
like you have to pay attention to that, not just
(12:17):
because of measles, and like, yes, you have to pay
attention because of measles. Measles is risky for children, and
we have to take care of the people who have measles,
but also because that is telling you something about that community.
It is telling you that you're not getting vaccine to
the people who you need to be getting vaccine to.
It's often indicating that either you know, you have a
(12:39):
delivery problem with vaccines or more often in the United States,
that you have a problem with trust in public health
and medicine. And it's an indicator that other things will follow.
And this is one of the things I'm most worried
about now, is that you know, like, we have the
complications of measles, but there are othercine preventable diseases that
(13:02):
you don't want, that nobody wants, you know. And I
worry about whooping cough, which pertassis or you know, I
worry about diphthery. I worry about all sorts of other
things that we don't think about that much.
Speaker 1 (13:15):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(13:39):
been chatting with doctor Adam Ratner about his book booster Shots,
The Urgent Lessons of Measles and the Uncertain Future of
Children's Health. Let's get back into things. Measles also has
this direct effect on immune memory, and I think that
the measles induced immune amnesia is probably, throughout all of
(13:59):
the years of doing the podcast, one of the top
five most fascinating and bizarre things I have ever learned
about and also terrifying. Can you give me a refresher
on how this works in some of the implications.
Speaker 2 (14:11):
Yeah, So to start, I'll just say, you know, I,
in addition to seeing patients and I teach medical students,
and when I teach about measles induced immune amnesia, I
say you should listen to this. This is the coolest
thing I know about measles. It's actually probably the coolest
thing I know about any infectious disease.
Speaker 1 (14:30):
Yes, I agree.
Speaker 2 (14:31):
It really has just been figured out in the last
decade or so. There are like, there are observations that
go back, you know, long before that that are now
explained by this. But you know, measles does something that
other viruses don't do, which is that when you breathe
it in, it targets those immune cells in the lungs.
It does that by binding to a receptor called SLAM
(14:54):
on those cells. And viruses care deeply about what receptor
they bind too, not that they really care, they're not,
you know, they're not thinking about it. But but like
that affects everything about how viruses manifest. It affects you
which which organs they affect, It affects how contagious they are. Everything.
So measles binds to SLAM in the you know, in
(15:16):
the way that SARS COB two binds to the ACE
two receptor, and we have you know, medicines that that
disrupt that interaction. So measles bind SLAM. It gets into
those immune cells. The immune cells go to the lymph nodes.
There are lots of other cells with SLAM there it
starts infecting and killing those cells. It spreads throughout the blood.
It is encountering lots of cells that express SLAM. There,
(15:38):
it's entering and killing those cells. And the cells that
express SLAM are mostly memory B and T cells. And
so that's your encyclopedia of all of the things that
you've encountered, everything that you every cold you've ever gotten
that you've gotten rid of, every you know, for a kid,
any virus that causes diarrhea or you know, and upper
(16:00):
respiratory infection. Anything you've been vaccinated against, like measles, kills
those cells. It doesn't wipe them out completely, but the
studies that they've done that have looked at the amount
of antibody producing cells you have left. It's a pretty
big depletion, and it happens quickly you end up with it. Interestingly,
(16:21):
you develop immunity to measles that clears the infection, and
you have lifelong immunity to measles after you have the measles,
but you're left with less immunity to things that you
already had immunity to. And you see that manifest in
some of the early vaccine trials for measles, where what
they say is that the vaccine overperformed, meaning that they
(16:44):
rolled out the vaccine in places with high rates of
measles deaths. They calculated how many deaths they thought would
be averted by measles vaccine, and it did much better
because it wasn't just that they were saving kids from measles.
It was that there were kids who would have gotten measles,
recovered and then died due to measles induced immune amnesia.
(17:05):
So that's called the measles shadow and it is bonkers,
and yeah, it happens even with mild cases of measles.
You don't have to be one of the unlucky kids
who ends up in the hospital or something like that.
And it's we're still, i think, figuring out all of
the consequences of this. But the best thing about it
(17:25):
is that the vaccine does not do that, and the
vaccine protects you against that because it protects you against
getting measles.
Speaker 1 (17:32):
The implications of immune amnesia are huge, and the measle
shadow and just the broader public health impact of the
measles vaccine, I think is so apparent with this, and
you talk about this in your book that This immune
amnesia is a really kind of a neat parallel to
our society's own forgetfulness when it comes to how devastating
(17:53):
and deadly the measles virus can be. How are vaccines
a victim of their own success in this way?
Speaker 2 (18:01):
Yeah, it's I mean, this is a problem for public
health in general, but I think you see it most
acutely in with vaccines, where the whole job of a
vaccine is to make nothing happen. It's to make it
so that life goes on, and you don't you know,
you don't even know what the vaccine has done. You
see this when you look at a population and you say,
(18:24):
oh my god, we introduced the dip theorya vaccine and
children don't die from diph theoria anymore. But kids don't
walk around with a sign that says I would have
died of diph theoria obviously, Like they just look like
kids who get to grow up, and that's amazing. But
then you have this generation of kids and parents who
don't experience that disease. And so that's what I saw
(18:46):
at the beginning of the New York City measles outbreak,
is there were all of these parents who said, well,
you know, there's bad information online. There's this information out
there that the vaccine might be dangerous, and I've never
known anyone with measles, And I mean the response to
that is obviously, why do you think that is? You know,
(19:06):
but in fairness, they really have never known anyone with measles,
and so as a parent weighing those things, you might say, well,
measles doesn't seem like that big of a problem. And
they might even say, you know, polio doesn't seem like
that big of a problem. When was the last time
I met someone with polio? But if you ask the
parents of those kids, and these are some of the
(19:28):
multi generational discussions that I had at that time, the
parents are like, are you kidding me? Like, because they
knew people with polio, and you know, I know a
handful of people in the generation before mine who still
live with the effects of polio. I was not around
at the time when polio was literally killing people and
where people were staying home at the peak of the
(19:50):
polio epidemics, but like that was that was something that
was perspective shifting, I think for the people who lived
through it, and it's something that we don't experience anymore,
and so and it even applies to doctors where it
was interesting. You know, I had a teeny tiny bit
of experience taking care of measles. Most of the people
(20:13):
I was working with at that time did not have
any experience taking care of measles. We learned quickly, and
I mean the people you know who I worked with
did an incredible job. But it's it is interesting, and
you could see how someone might see a kid with measles,
see a kid with something else and not even know
what they're dealing with.
Speaker 1 (20:31):
Right, So many of the doctors have either been trained
in a world where these vaccine preventable diseases are not
commonly seen because the vaccines, or they've been fortunate to,
you know, live in regions where these diseases are not common.
And how do you think that that affects their ability
to not only recognize, as you point out, these cases
(20:52):
or these diseases themselves and see, like see a measles
case for what it is, but also to communicate the
dangers of these diseases.
Speaker 2 (21:00):
Yeah, I think that's hard. And I think I'll start
by saying I am not a primary care pediatrician and
they're the ones who are usually having like the sort
of longitudinal, long term conversations with families, and that can
be a sticking point. And I think most pediatricians are
you know, are in favor of the normal vaccine schedule,
(21:23):
But most pediatricians, if they're asked by a family, well,
have you ever seen a child with diphtheria or polio
or something like that, would have to say no. And
they can follow that up and say and I never
want to because I learned about it in school and
I've seen pictures of these things and they're not things
that you want to come back. But that doesn't have
(21:44):
the same I think impact for the for either person
in the conversation. Like I think it can be harder
for the doctor to really have their heart in it,
and it can be harder for the parent to really
buy what the doctor is saying.
Speaker 1 (21:57):
Lacking that that firsthand, that witness experience of that and
the devastation. But I think it's also lacking sometimes the
context and the historical big picture of what these diseases
did before vaccines, or in populations that were already you know,
oppressed and then had never experienced an outbreak of you know,
(22:19):
the measles virus, for instance, and so you know, you
describe one of these outbreaks in your book in the
Faroe Islands in eighteen forty six, and there was one
person in particular who really kind of changed our the
medical understanding of measles at the time. How did this
really shift what we understood measles to be and how
(22:40):
did that change I guess how people treated it in
the future.
Speaker 2 (22:44):
Yeah, it's an interesting story, and it's one that I
knew sort of the very broad outlines of before I started,
and then I dug into it and I was like,
this is incredible.
Speaker 1 (22:53):
Yeah.
Speaker 2 (22:55):
I think because measles is so contagious, there is a
huge difference in the way that a population first experiences
measles and then a population that has been exposed to
it and it's become an endemic disease in the population,
meaning that it's sort of always there, but you see
seasonal and yearly variations in how much there is. And
(23:17):
to look at what happens in terms of brand new
exposures of populations that have never seen measles, you can
look at what happened in meso America with the colonizers
who came over and that this was true of smallpox,
it's true of measles, and there were incredible infection rates
because no one had immunity, and so it wasn't just
(23:38):
that kids were getting sick, It was that all the
adults were getting sick at once. And there were multiple
overlapping diseases, and the people who brought the diseases with
them were trying to plunder and top all societies, and
so all of those things together I think made it
so that I mean, you saw a loss of about
ninety five percent of the population in meso America, and
(24:00):
that was partially measles, partially small pox, and we saw
the you know, we see this in other island outbreaks.
In contrast, the places where the colonizers came from were
these big population centers in Europe where they were big
cities where measles had come in before then it had
infected the whole population at some point, and then you
(24:23):
reached kind of a steady state where you know, most
adults had had it in childhood. The ones who didn't
survive didn't survive to be adults, but then most adults
had had it before, and then new kids were born
who didn't have immunity, and sometimes people would come in
from less densely populated places and they wouldn't have immunity,
but you had sort of this constant hum of measles,
(24:46):
but it was mostly a childhood disease. So they went
from a place like that to a place where nobody
had immunity, and that the difference was stark. So with
the pharaoh Islands. The pharaoh Islands were a colony of Denmark.
Copenhaea had endemic measles at the time. The Pharaohs had
had an outbreak of measles about sixty five years earlier,
(25:07):
but that just meant that only people who were over
age sixty five and the Pharaohs had ever encountered measles,
so most of their population had never encountered it before. Politically,
the Pharaohs were completely dependent on Denmark. The only trade
route was from Copenhagen to Torcheon, which is the capital
(25:27):
of the Pharaohs. And someone who lived in the Pharaohs
went to Copenhagen, got exposed to measles, didn't realize it,
came back to the Pharaohs, got sick, someone realized. The
doctors eventually realized what he had and then within several
weeks there were cases all over the place, and they
(25:50):
the folks in the Pharaoh Islands called to Denmark and said, hey,
you know, we really need help. And so the ruling
authorities in Denmark two people, both medical students, so not
exactly the CDC Epidemic Intelligence Service, Yeah, exactly. They were good,
but there's still only two of them, right, And they
(26:14):
went and you know, they provided some help. They did
what they could to nurse the sick, and they brought
some food and things like that, but really there's not
a whole lot you can do for people who already
have measles. But the main one of the two was
this guy named Peter PanAm, and he was a big
believer in the new way that medicine was being thought about,
(26:37):
meaning that you could observe things, you could think about
them scientifically, and you could come to these broad conclusions.
And he was like, I'm going to do that. I
think the geography is important. I think that the fact
that this place is isolated is important. And I think
we don't know everything about measles yet. Because people were
very sure that measles had a miasma component and a
(26:59):
can pages component. People were very sure that you were
contagious with measles at the very end of the disease,
when your skin was peeling from the rash, because that's
where the measles lived. And it turned out none of
those things were true. And he was able to figure
that out because he went from village to village to
village and he just talked to everybody, wrote everything down.
(27:22):
He found this one village, Chornovig, where ten people had
gone from that village, which had no measles, to another
village nearby to help with a whale hunt on this
one particular day. They came back on the same day.
They all got sick fourteen days later, and he was like, oh,
right and right. He figured out the incubation period of measles,
(27:45):
which is about fourteen days from exposure to rash. He
figured out, you know, that it was spread from person
to person, and that the miasma theory did not explain
any part of it. He did all of these things
that we now take for granted when we talk about measles,
and he drew this incredible map where you see the
(28:06):
ship coming in, you see the contagion going out, the
different cases coming up, and It's the thing that was
most shocking to me about it was when he presented
this to the folks back in Denmark. He basically said,
here's this map. Here's what happened. I figured out all
these things about measles. This is basically a new kind
of science where you observe things and you can figure
(28:31):
out stuff about diseases and you can draw maps. And
this is eight years before John Snow's collar map. So
I give credit to PanAm over Snow, but that's a
fringe opinion.
Speaker 1 (28:44):
I love it. I love it. He's like, here's his
new science. You're welcome, right exactly, do with it what
you will.
Speaker 2 (28:49):
Yeah, Now, can I graduate from medicals?
Speaker 1 (28:53):
Can I be a talktor around? That's amazing. Let's take
a quick break here. We'll be back before you know it.
(29:15):
Welcome back, everyone, I'm here chatting with the wonderful doctor
Adam Ratner about his book Booster Shots. Let's get into
some more questions the story of this outbreak in the
Faroe Islands, as well as some of the other ones
that you described historically where we're seeing massive rates of mortality.
I think that it's it's in direct contrast to the
(29:35):
way that Measles and a lot of other infectious diseases
are described as being these great levelers of society. They
affect the rich and the poor equally, and no one
is at you know, no one is safe from it,
which is that part is true to some degree, But
measles is not a great leveler, right. It definitely has
affected people who are living in crowded conditions, malnourished people
(29:58):
in very different ways, both historical as well as today.
Can you talk a little bit more about that.
Speaker 2 (30:03):
Yeah, measles has never ever ever affected the rich and
the poor equally. It affected both the rich and the poor.
That part is true, but it is it is stunning,
and that was something I didn't appreciate going in Like
I appreciated that there were population level differences now in
how countries experienced the measles, but I didn't realize the
(30:25):
magnitude of it going back through history. And so you
look at the Pharaohs, which was a colony. You look
at Fiji in the eighteen seventies where there was this
measles outbreak right after they became part of the British Empire,
and it killed a quarter of the native Fijians over
the course of like just a couple of months, which
(30:45):
is insane to think about. It's just a tremendous amount
of death. You look in the eighteen hundred, the late
eighteen hundred of Jacob Breeze who went through the tenements
in New York City and took pictures of people that
most people didn't want to look at or think about.
His book is called How the Other Half Lives and
(31:06):
he writes about measles in that book, and he basically
says on the avenues, meaning where the rich people live,
this is something that is made light of that you know,
people just think is part of regular life. And in
the tenements, it kills right and left. And he talked
about seeing, you know, multiple kids in individual families die
(31:27):
of measles, and then you know, on the other side
of it, you have cartoons from the time, and then
you know Brady Bunch episodes a couple of decades later
that are like, isn't it great to have the measles?
Speaker 1 (31:39):
What a strange like pr thing for measles? Like seriously, yeah,
interesting choice with that, with that plotting there. Yeah, And
that's what brings me to sort of this this era
right before the vaccine the measles vaccine was introduced. In
the decades leading up to that, in the US specifically,
how was measles perceived? How did parents especially view this?
Speaker 2 (32:03):
Yeah, so I think it depends which population you're talking about,
because certainly, among well off families it was like we
were talking about like the Brady Bunch type thing. Like,
I think that people really did feel that way, that
it was part of life. But you still had these
occasional horrific tragedies, and I think that people just saw
(32:24):
those as random events. But Roald Dahl, the author of
Charlie and the Chalcoln Factory, lost a daughter at age
I think age nine to measles in nineteen sixty two,
the year before the vaccine was licensed, And so there
were famous people who had this happened to them. And
(32:44):
then in crowded populations in cities where in poor areas
of cities you had death rates that were much higher.
But that wasn't those were not the stories that were
making it into the media and the way that most
people experienced measles. And then you had the vaccine come out,
(33:06):
and there were a lot of issues with that vaccine rollout,
and one of them was that people had to pay
for it on their own. So unlike the polio vaccine,
there was no central financing for the measles vaccine, which
meant that people were supposed to just go to their doctor.
And the vaccine cost about ten dollars a dose, and
that's about one hundred dollars a dose today in scale dollars.
(33:30):
And so you had a system that set it up
so that the rich people who needed protection less were
the ones who were able to access protection and the
people who needed it most may not have had a
doctor to begin with and certainly may have made the
decision not to spend the ten dollars.
Speaker 1 (33:48):
That is such I think a key aspect because yeah,
you think or real least I thought back at that
time and I thought it, well, people were lining up
around the block to get polio vaccine. But when you
have to pay for this vaccine and you have to
make the appointment and it's not you know, I think
that brings to light how important access is, like costs
as a barrier and ease as a barrier, Like were
(34:11):
there vaccine clinics the way that there were for polio?
You know, in the gymnasium, everyone gets a polio shot today,
were there similar things for measles.
Speaker 2 (34:21):
Not to the same extent. Like there was tremendous excitement
when the polio vaccine came out, and the main policy
question was how do we get every child vaccinated against polio?
The measles vaccine rollout was confusing. There were two vaccines licensed.
There was a recommendation for the live attenuated one, which
is like the one that we use today, but there
was the There was the killed virus vaccine, which we
(34:42):
now know didn't work as well but had fewer side effects,
and so some parents were like, well, I want the
one with fewer side effects, and that makes sense. And
then there was the access issue. And part of the
problem was, you know, states would have vaccine drives and
then rates would go down, the desire to spend money
(35:03):
on measles vaccine drives would go down, case rates would
go back up. They'd have a year where they had
vaccine drives, and so it was not a recipe for
really controlling measles in the population. There was this waxing
and waning of access to vaccines, and then the thing
that we realized in the nineteen nineties. In the eighty
nine to ninety one, there were all of these huge
(35:25):
outbreaks in mostly in big city so New York, Chicago, LA.
And a lot of those cases were kids in crowded
conditions in cities who the parents were not able to
access vaccines because there was limited clinic availability, because they
had to shell out money for the vaccines, and those
(35:46):
were you know, I think people finally realized at that
time that those were some of the biggest drivers of
people being unvaccinated. And then finally in ninety four we
got the Vaccines for Children program, which helped with access
and certainly helped with financing.
Speaker 1 (36:03):
It's fascinating to think about today if we did a
pie chart, and I know statisticians hate pie charts, but
if we did a pie chart anyway, and we broke
it down into who was not vaccinated, how big of
the slice is for access, and how big of the
slice is for hesitancy, and then how different that was historically.
Speaker 2 (36:21):
Yeah, it's so interesting because I was reading congressional testimony
from the nineties and were when they were making the
decisions about what to do after the eighty nine to
ninety one measles at breaks, and they interviewed someone from
Los Angeles, who had dealt with the with measles outbreaks
over several decades there, and she was insistent that the
(36:44):
problem was not vaccine hesitancy. The problem was access. What
states needed were free vaccines for kids and enough funding
that they could have clinics that were open late and
open on weekends and stuff, which all makes perfect sense.
But I was reading this in twenty twenty and like,
this does not resonate at all because it's totally different now,
(37:08):
and you know, I think it's a number of things,
Like I think part of the reason that the proportions
have shifted is that not that vaccines for children solved everything,
but I think the access problem in this country at
this time it is mostly under control with the with
the federal programs that currently exist. At the same time,
(37:29):
you had this growth of the anti vaccine movement, and
I think that there there have been questions about vaccines
and people and some people who are hesitant or anti
vaccines since there have been vaccines. There are the cartoons
about the smallpox vaccine where people turn into cows, and
so it's not like that was one hundred percent new,
(37:51):
and there were concerns about the dip theoria tetanus pertussis
vaccine in the seventies and eighties. That led to your
decreased up take in the UK and then a big
Pertussis outbreak and then you know, so like that all
also predates, you know, the current vaccine hesitancy. And then
in ninety eight you had the Wakefield paper where the
(38:13):
hypothesized link between MMR and autism, which we're still fighting
against now. I mean, despite the fact that the paper
was a could never have answered the question that was
being asked because it was essentially a case series B.
It was horribly conflicted, and he was paid by plaintiff's attorneys,
and there's you know, there are a million reasons that
that paper is. To quote Paul Off, it not just
(38:36):
wrong but spectacularly wrong. But it raised a scientifically testable hypothesis,
which is, you know, vaccines cause autism, and then you
had science that followed it, dozens of studies, multiple continents,
tens of thousands of children. Vaccines do not cause autism.
We know that and can say that definitively now, and
(38:56):
yet that idea persists. I think some of that is
that the idea is sort of tailor made for something
that you can tweet about or post about on social media.
It is three words, vaccines cause autism. It provides an
explanation for something that I, as a pediatrician, or any
of us as pediatricians, cannot provide a comparable three word
(39:19):
explanation for. Because if a parent goes to a pediatrician
and says, well, then what does cause autism if vaccines don't,
a good pediatrician will say, well, it's complicated. Like there
are some genetic causes of autism. That's a lot of it.
There are some environmental causes. There are some infections that
cause autism. Congenital rebella is one of them. Congenital side
(39:40):
of megavirus infection is another. So it kind of depends
on the kid you're talking about, and you've lost the
parent at that point because you're way over your three words.
So it is very hard to push back against that
kind of messaging. And then there's also since social media,
it's just the flooding the zone of the with that
(40:04):
information makes it very hard.
Speaker 1 (40:06):
Also, oh yeah, and then there's the social media bubble
that people are in. Not to mention the people who
are directly profiting off of the spread of this vaccine disinformation.
Can you talk about the important distinction between these two groups.
Speaker 2 (40:21):
I think it's important to separate the people who are
kind of the leaders of the vaccine information movement, who yes,
it's for them, it's a grift, Like for them it
is you know, they're making a ton of money. They're
selling their books, they're selling their onesies that say, you know,
my get isn't vaccinated or whatever, so like, yes, that exists,
and that is part of it. And then I think
(40:42):
there are the vast majority of the parents who are
vaccine hesitant or anti vaccine. And yeah, I've said this
in a lot of settings recently, but it's still true.
Is these are people who love their kids, like these
are not people who want kids to suffer. They've been
lying too, you know, they have bad information and they
(41:03):
are believing the information. But I believe that for most
of them, they're passing on information that they believe to
be true and that they believe to be important information
for other parents, which is almost worse. You know, it's
hard to break into that. It's hard to bring people
around to understand the value of vaccines and the lives
(41:25):
that are out there. But I do think those are
different populations of anti vaccine folks.
Speaker 1 (41:32):
Absolutely, No, there's the people who are benefiting off of
spreading the information and the people who are spreading the
information because they think that it's the best thing for
their kid. Yeah, And I'm wondering how your experience, you know,
over your career, how have you seen this change?
Speaker 2 (41:48):
I mean, it's all so much more politicized now than
it used to be. I mean I even think back
to earlier during my training, Like there were certainly parents
with questions about vaccines and that was fine, and you
could sit and talk to people. There were not these
entrenched views that became people's identities. Like I think that
(42:10):
is what's different now. And I mean some of that
is COVID, some of it predates COVID, but there have
been a bunch of analyzes of this. But your political
party affiliation affected. It was an independent risk factor for
your risk of dying of COVID because you were less
likely to get vaccinated if you were a Republican than
if you were a Democrat. That's insane because vaccines and
(42:33):
protecting kids against against vaccine preventable diseases did not used
to be a political issue, Like there were legitimate disagreements
about like how much what one might spend on a
vaccine campaign, or whether school mandates were the right thing
to do they are, or anything else like that. But
those were legitimate disagreements with the background of vaccines are good.
(42:58):
They controlled the spread of the disease in populations. And
now it's like, I think, in many cases can't have
conversations because it is so much a part of people's identities.
I heard someone quoted a parent quoted from the West
Texas measles outbreak the other day say she was asked
about measles vaccine and then was asked about COVID vaccine
(43:20):
and she said, oh, we don't do that here. This
is West Texas. It was not. Then I've thought about this,
I've made the decision that it's not for my family.
It was you know, we don't do that here. It
was a piece of identity for.
Speaker 1 (43:35):
Her, Yes, a signal of like, this is who I am.
This is part yeah that is. I think that it
is really daunting to know what to do about it
and what works and what doesn't. And I was wondering
if if there's anything that you could share about what
we have, you know, evidence based methods that work both
(43:55):
on the more infrastructure side of things, like school mandates
or increasing access of course works increasing funding, and also
on the communication side of things.
Speaker 2 (44:07):
Yeah, So to address the policy piece first, I mean,
there are things that we know work and that are
very important. School mandates are one of them, especially for
measles vaccine, where because measles is so contagious you need
about ninety five percent of the population vaccinated. You do
not get there without school mandates, and you can't control
measles in the population without that, And it is good policy.
(44:32):
It prevents deaths from measles. It is something that we've
had in this country for decades at this point, and
that most other places have as well. So school mandates
are important. And then the other piece of it, access
federal financing has to go along with that, because it's
impossible to ask people to to vaccinate their kids in
(44:52):
order for their kids to be able to go to school,
but then not provide them a way to easily get
those vaccines for free. That's the policy side. The communication
side's much harder. And I'll start by saying that I
am a hospital based consultant. I see kids only in
the hospital. I am not a general pediatrician. They are
(45:13):
the superheroes of these conversations. They are the ones who
are having the long term relationship with families and having
these discussions, and it's really hard and it's individualized. I mean,
there are some evidence based things, especially for particular vaccines.
There are motivational interviewing techniques. There are specific bundles of
(45:35):
things for the HPV vaccine that have been shown to
to help with hesitancy and to increase uptake. I have
sort of different conversations because it's mostly kids who've been
hospitalized due to a vaccine preventable disease, and those conversations
can be sort of fraught because it's very easy for
(45:56):
parents to feel like they're being blamed, which is not
the intention. But I think it's an important conversation to
have because how they walk away from their child being
hospitalized and hopefully then being okay and going home is
really important. It's important to what they do for that
kid going forward in terms of vaccinating or not, what
(46:18):
they do for their other kids, and the story that
they tell within their community. And so I try hard
to be curious and understand what their hesitancy was leading
up to this. Try to be careful about the words
that I choose. I try to have empathy because these
(46:38):
are people with a hospitalized child, which is the worst
thing in the world, and they're terrified and that is reasonable.
And I try to be clear. And this is part
of what I think any pediatrician does, which is that
I think having a clear and a strong recommendation for
vaccines is important because parents understand and the recommendation that's
(47:01):
being given is not if you don't have your heart
in it and so and you know, I don't know
how well these things work, but it's what I've got
at this point.
Speaker 1 (47:13):
I just can't imagine how hard that must be to
be the person who is taking care of this sick
child who did not have to be there.
Speaker 2 (47:22):
No, it is. It is frustrating and sad, and I
mean I hearing about the child who died in West
Texas from measles. No child should die. No child should
die of measles anywhere on earth now, like there's no
reason we have had a safe, effective vaccine that prevents
(47:43):
measles for sixty years. Measles should have gone the way
of smallpox already. That's an extreme position. But I think
we hope, maybe can agree that no child should die
of measles in the United States where there's easy access
to vaccines in twenty twenty five. It doesn't make any sense.
Speaker 1 (48:03):
It doesn't make any sense. It's so hard, and I
can't imagine how difficult that must be. As we're speaking
right now, it's March fourteenth, twenty twenty five. We're in
the middle of this and maybe at the beginning of
this measles outbreak. I mean, who knows where it'll go
from here. I just every headline I see is a
new state, a new case, a new growth of this.
(48:23):
What are some of the other lessons that we can
take from past measles outbreaks post vaccine that can help
us manage this current one.
Speaker 2 (48:32):
Yeah, I mean, I think the other thing that I'll say,
which maybe seems obvious now after COVID, but I think
wasn't obvious at the time, was there was this measles
outbreak in a city that straddles Texas and Arkansas, Texas
Arcana and basically the Texas side of the city. Kids
went to school based on where their home was, but
(48:55):
there was a ton of mixing of people. Movie theaters
and churches and things like that, and Texas had no
school vaccine mandates. Arkansas had vaccine mandates and had big
vaccination drives. There was this big measles outbreak in nineteen
seventy ninety five percent of the cases we're on the
Texas side of the border, five percent we're on the
Arkansas side. And what I learned from that was, you know,
(49:20):
vaccines work and school mandates work, which is not surprising either,
but also just from a more general point of view,
that policy decisions really really matter. Yes, and you know
where you lived in that city, which side of state
line avenue you lived on, mattered for the health of
your kid. And I think we're seeing all sorts of
(49:43):
stuff now in the US where a lot of policies
that it has taken us a lot of time to
get to, things like vaccines for children like we were
talking about. These are incredible things, and kids are healthier
today as a result of them than they were even
a couple of decades ago. And that's not guaranteed, Like,
(50:04):
none of that progress is guaranteed. I don't know if
it's a hopeful message or not, but it's a message
of something to pay attention to.
Speaker 1 (50:11):
That's an important message and I really appreciate you taking
the time to chat with me today. This was so
so fascinating. I mean honestly, I could just talk Measles
for hours, so.
Speaker 2 (50:21):
I appreciate it. Thank you so much for having me.
This is a dream. I've been a fan of the
podcast for a long long time.
Speaker 1 (50:30):
Oh my god, thank you amazing big thanks again to
(50:53):
doctor Adam Ratner for taking the time to chat with me.
If you also enjoyed this conversation and want to learn more,
check out our website this podcast will kill You dot com,
or I'll post a link to where you can find
booster shots, the urgent lessons of Measles and the Uncertain
Future of Children's Health, as well as a link to
doctor Ratner's website. And don't forget you can check out
(51:13):
our website for all sorts of other cool things, including
but not limited to, transcripts, Quarantini and Plaicybrita recipes, show
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(51:34):
thank you to Bloodmobile for providing the music for this
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to you listeners for listening. I hope that you like
this episode and our loving being part of the TPWKY
book Club. A special thank you, as always to our
(51:54):
fantastic patrons. We truly appreciate your support so very much. Well,
until next time, Keep washing those hands, U.
Hi, I'm Aaron Welsh and this is this Podcast will
Kill You. You're listening to the latest episode in the
tp w k Y book Club series, where I interview
authors of popular science and medicine books about their latest work.
Speaker 2 (00:59):
It has this has.
Speaker 1 (01:00):
Been so much fun to put these episodes together, and
I am really thrilled to be bringing you more of
these this season. If you'd like to get a sneak
peek of the books that we'll be featuring throughout the
rest of this season, or to check out the books
that have been featured on past episodes, head over to
our website This Podcast will Kill You dot com. There
(01:20):
under the extra tab, you'll find a link to our
bookshop dot org affiliate account, which has a few different
lists of books that we've featured on the podcast, including
a book club list. I'll be adding more books to
that list throughout the season, so check in regularly for updates.
We always appreciate hearing from you all which books you're enjoying,
and so if there are any book Club episodes that
(01:42):
you particularly loved, or if there's a book that you'd
like to see featured, shoot us a message through the
contact us form on our website. Also, did you know
that you can now find full videos of most new
episodes of this podcast Will Kill You on YouTube. Subscribe
to Exactly Write Media's YouTube channel so you never miss
an episode. One last thing, and that is a request
(02:05):
to please take a minute if you haven't already, to rate, review,
and subscribe. It really does help us out. A worrying
trend has emerged in the United States over the past
few years, as well as in other regions around the globe.
Vaccine uptake rates, both in children and adults, have started
to decline, due in large part to increasing vaccine hesitancy.
(02:27):
As a result, we've seen more and more outbreaks of
vaccine preventable diseases that had once been on their way
to elimination in the US, diseases such as measles which
actually had been eliminated. While I'm recording this on March seventeenth,
there is an ongoing measles outbreak in West Texas with
(02:50):
cases numbering in the hundreds, and the infection has been
popping up in other states as well. And although we
can't predict exactly what will happen with this particular output break,
we can use our knowledge of measles as a guide
to understand how it spread so fast and causes such devastation,
and why people are reluctant to get themselves or their
(03:13):
children vaccinated. In this Book Club episode, pediatric infectious disease specialist,
professor of pediatrics and microbiology and author, doctor Adam Ratner
joins me to discuss his latest book, Booster Shots, The
Urgent Lessons of Measles and the Uncertain future of children's health.
With his experience treating children that are gravely ill with
(03:36):
vaccine preventable diseases like measles, doctor Ratner provides a powerful
perspective on the dangers of this virus and the harm
caused by myths and disinformation. In Booster Shots, he takes
readers through the biography of this virus, its transmissibility, its lethality,
(03:57):
its long and devastating history, and the factors contributing to
its re emergence. What results is a compelling and comprehensive
portrait of a disease that should be found only in
history books, but of course is not. Crucially, doctor Ratner
demonstrates that minds can be changed, that progress can be
(04:19):
made in the fight against vaccine hesitancy, and that what
it takes is empathy and understanding. If things keep going
the way they are, if vaccine hesitancy continues to mount,
and if people continue to turn away from science and
towards unproven quote unquote cures that are at best neutral
and at worst harmful, this current outbreak will be far
(04:43):
from the last. The lessons of measles, as doctor Ratner
describes in booster Shots, apply well beyond this one infection.
They are lessons in public health, in prioritizing prevention, and
in understanding that individual choices can have far reaching civic consequences.
(05:04):
I'm very excited to share this conversation with you all,
so let's take a quick break and get right into it.
(05:35):
Doctor Ratner, thank you so much for joining me today.
Speaker 2 (05:39):
Oh so excited to be here.
Speaker 1 (05:41):
I can't tell you just how much I loved your
book Booster Shots, and I feel like part of the
reason that it was so impactful is because you're coming
from the front lines about this, like you have seen
firsthand the devastation that measles and other vaccine preventable illnesses
can cause. When did you decide that you want to
write a book about this topic, and then why measles
(06:03):
in particular.
Speaker 2 (06:05):
The turning point for me was really in twenty eighteen
and twenty nineteen when we had this big measles outbreak
in New York City. And at that point I had
been doing this for a long time. I had been
seeing patients for a long time. I trained as a
pediatrician and then an infectious disease expert, and I thought
I had seen most stuff. And this was really interesting
(06:29):
to me because it measles was something that I had
learned about, of course, but it was something I had
seen a handful of cases of over the course of
my career a returning traveler, a little cluster of cases
in Northern Manhattan when I worked there. But all of
a sudden, this disease that I kind of filed under
solved problems in my mind, was something where we were
(06:52):
seeing four or five kids a day, and it was
interesting from just a learning point of view for me,
because I think I had read about it in books
but had never really understood what it was to take
care of kids with measles. And it also really changed
my perspective on vaccines and the anti vaccine movement and
(07:16):
things where I obviously I knew about the anti vaccine movement.
I had dealt with parents who had questions or were
frankly anti vaccine. But we were then in a situation
where we had kids getting admitted to the hospital with
a disease that, for the most part, their parents had
been vaccinated again, so the grandparents had chosen to vaccinate
(07:37):
the parents. The parents had made a different decision, and
we were seeing the consequences of that. And it made
me think more about how I talked to these families,
and it made me want to dig into the history
of measles, which I did and I found it fascinating.
And then, you know, this was twenty eighteen, twenty nineteen,
So after twenty nineteen comes twenty twenty, and all of
(08:00):
a sudden, as I was starting to do this work,
we were in the middle of a brand new pandemic
and dealing with questions of public health and masking and
eventually vaccination and all of these other things, and I
just I saw echoes of what I had learned about
measles everywhere in that and so that turned it once
(08:21):
again into a totally different project.
Speaker 1 (08:24):
Right, Yeah, I feel like I've been saying something similar
where It's like, it's not about measles. It's not even
about vaccines, it's not about you know, it's just like
these issues, the drivers of them are so widespread, and
I want to get to sort of talking about the
vaccine hesitancy or anti vaccine movement in a bit, but
first let's talk about measles. The measles virus itself is remarkable.
(08:48):
I mean, it's the most infectious virus ever discovered and
has a lot of other qualities that make it quite
dangerous and contagious. Can you take me through some of
those characteristics?
Speaker 2 (09:00):
Sure? And I agree with you. I mean, I think
it's the bias, but I think it's the most interesting
virus out there. And you know, it really is incredibly contagious,
and that's kind of the thing that people talk about
first with it, and it just it moves through crowds
incredibly quickly, and in unvaccinated populations like we're seeing now
(09:23):
in West Texas, it has a very high rate of
infecting people who are not vaccinated or haven't had measles
in the past. It's an airborne virus, like lots of
other viruses we know, like flu and other things. You know,
you get it by inhaling it, and instead of infecting
(09:43):
the cells that kind of make up the bulk of
the lungs, the measles virus infects the immune cells in
the lungs, the ones that live there, and it traffics
to lymph nodes and then it spreads widely throughout the body.
You get these huge viral loads before it comes back
to the lungs, and then people cough it out and
they are just coughing out enormous amounts of virus. It's
(10:06):
this very particular clinical presentation where kids are sick with
cold like symptoms at first, and then it turns into
this rash that is really characteristic of the disease. And
the reason we worry about it so much is not
the rash and is not the fever and stuff. It's
that there are these rare bad outcomes where most kids
(10:28):
with measles will be fine, but five or ten percent
will develop pneumonia and will need to be hospitalized. One
in a thousand will develop encephalitis or brain swelling and
that risks deafness or blindness or seizure disorders. And one
in a thousand will die, which sounds like a small
number and it is for any particular kid with measles.
(10:49):
But when you scale that to a whole population, and
it used to be before there was a vaccine, that
everybody in the population got measles, that was a lot
of deaths. That was a lot of dead kids every year. Yeah.
Speaker 1 (11:01):
Yeah, off the top of my head, I can't do
this math in my head. I'm too reliant on calculators.
But if it's like four million children every year pre
vaccine would get the measles that I mean, that is
a staggering number of complications, of deaths. It's a permanent
disability because of now a vaccine preventable disease virus.
Speaker 2 (11:22):
And I mean, I think that people often talk about
it like it was a rite of passage in childhood.
That's certainly how you know, politicians talk about it. It's
how some people who lived through that time will talk
about it. And for most kids, that's true. But it's
also true that there were a significant number of families
that were devastated by the complications of measles.
Speaker 1 (11:44):
One of the things that you mentioned when it comes
to measles today and kind of relates back to some
of these characteristics of measles is that you describe it
as a bell weather. Can you tell me more about
what you mean by that.
Speaker 2 (11:56):
Sure, So that comes from the fact that measles is
both incredibly contagious and now eminently vaccine preventable. And you know,
the combination of those two things means that when you
see measles outbreaks somewhere like we're seeing in West Texas now,
like you have to pay attention to that, not just
(12:17):
because of measles, and like, yes, you have to pay
attention because of measles. Measles is risky for children, and
we have to take care of the people who have measles,
but also because that is telling you something about that community.
It is telling you that you're not getting vaccine to
the people who you need to be getting vaccine to.
It's often indicating that either you know, you have a
(12:39):
delivery problem with vaccines or more often in the United States,
that you have a problem with trust in public health
and medicine. And it's an indicator that other things will follow.
And this is one of the things I'm most worried
about now, is that you know, like, we have the
complications of measles, but there are othercine preventable diseases that
(13:02):
you don't want, that nobody wants, you know. And I
worry about whooping cough, which pertassis or you know, I
worry about diphthery. I worry about all sorts of other
things that we don't think about that much.
Speaker 1 (13:15):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(13:39):
been chatting with doctor Adam Ratner about his book booster Shots,
The Urgent Lessons of Measles and the Uncertain Future of
Children's Health. Let's get back into things. Measles also has
this direct effect on immune memory, and I think that
the measles induced immune amnesia is probably, throughout all of
(13:59):
the years of doing the podcast, one of the top
five most fascinating and bizarre things I have ever learned
about and also terrifying. Can you give me a refresher
on how this works in some of the implications.
Speaker 2 (14:11):
Yeah, So to start, I'll just say, you know, I,
in addition to seeing patients and I teach medical students,
and when I teach about measles induced immune amnesia, I
say you should listen to this. This is the coolest
thing I know about measles. It's actually probably the coolest
thing I know about any infectious disease.
Speaker 1 (14:30):
Yes, I agree.
Speaker 2 (14:31):
It really has just been figured out in the last
decade or so. There are like, there are observations that
go back, you know, long before that that are now
explained by this. But you know, measles does something that
other viruses don't do, which is that when you breathe
it in, it targets those immune cells in the lungs.
It does that by binding to a receptor called SLAM
(14:54):
on those cells. And viruses care deeply about what receptor
they bind too, not that they really care, they're not,
you know, they're not thinking about it. But but like
that affects everything about how viruses manifest. It affects you
which which organs they affect, It affects how contagious they are. Everything.
So measles binds to SLAM in the you know, in
(15:16):
the way that SARS COB two binds to the ACE
two receptor, and we have you know, medicines that that
disrupt that interaction. So measles bind SLAM. It gets into
those immune cells. The immune cells go to the lymph nodes.
There are lots of other cells with SLAM there it
starts infecting and killing those cells. It spreads throughout the blood.
It is encountering lots of cells that express SLAM. There,
(15:38):
it's entering and killing those cells. And the cells that
express SLAM are mostly memory B and T cells. And
so that's your encyclopedia of all of the things that
you've encountered, everything that you every cold you've ever gotten
that you've gotten rid of, every you know, for a kid,
any virus that causes diarrhea or you know, and upper
(16:00):
respiratory infection. Anything you've been vaccinated against, like measles, kills
those cells. It doesn't wipe them out completely, but the
studies that they've done that have looked at the amount
of antibody producing cells you have left. It's a pretty
big depletion, and it happens quickly you end up with it. Interestingly,
(16:21):
you develop immunity to measles that clears the infection, and
you have lifelong immunity to measles after you have the measles,
but you're left with less immunity to things that you
already had immunity to. And you see that manifest in
some of the early vaccine trials for measles, where what
they say is that the vaccine overperformed, meaning that they
(16:44):
rolled out the vaccine in places with high rates of
measles deaths. They calculated how many deaths they thought would
be averted by measles vaccine, and it did much better
because it wasn't just that they were saving kids from measles.
It was that there were kids who would have gotten measles,
recovered and then died due to measles induced immune amnesia.
(17:05):
So that's called the measles shadow and it is bonkers,
and yeah, it happens even with mild cases of measles.
You don't have to be one of the unlucky kids
who ends up in the hospital or something like that.
And it's we're still, i think, figuring out all of
the consequences of this. But the best thing about it
(17:25):
is that the vaccine does not do that, and the
vaccine protects you against that because it protects you against
getting measles.
Speaker 1 (17:32):
The implications of immune amnesia are huge, and the measle
shadow and just the broader public health impact of the
measles vaccine, I think is so apparent with this, and
you talk about this in your book that This immune
amnesia is a really kind of a neat parallel to
our society's own forgetfulness when it comes to how devastating
(17:53):
and deadly the measles virus can be. How are vaccines
a victim of their own success in this way?
Speaker 2 (18:01):
Yeah, it's I mean, this is a problem for public
health in general, but I think you see it most
acutely in with vaccines, where the whole job of a
vaccine is to make nothing happen. It's to make it
so that life goes on, and you don't you know,
you don't even know what the vaccine has done. You
see this when you look at a population and you say,
(18:24):
oh my god, we introduced the dip theorya vaccine and
children don't die from diph theoria anymore. But kids don't
walk around with a sign that says I would have
died of diph theoria obviously, Like they just look like
kids who get to grow up, and that's amazing. But
then you have this generation of kids and parents who
don't experience that disease. And so that's what I saw
(18:46):
at the beginning of the New York City measles outbreak,
is there were all of these parents who said, well,
you know, there's bad information online. There's this information out
there that the vaccine might be dangerous, and I've never
known anyone with measles, And I mean the response to
that is obviously, why do you think that is? You know,
(19:06):
but in fairness, they really have never known anyone with measles,
and so as a parent weighing those things, you might say, well,
measles doesn't seem like that big of a problem. And
they might even say, you know, polio doesn't seem like
that big of a problem. When was the last time
I met someone with polio? But if you ask the
parents of those kids, and these are some of the
(19:28):
multi generational discussions that I had at that time, the
parents are like, are you kidding me? Like, because they
knew people with polio, and you know, I know a
handful of people in the generation before mine who still
live with the effects of polio. I was not around
at the time when polio was literally killing people and
where people were staying home at the peak of the
(19:50):
polio epidemics, but like that was that was something that
was perspective shifting, I think for the people who lived
through it, and it's something that we don't experience anymore,
and so and it even applies to doctors where it
was interesting. You know, I had a teeny tiny bit
of experience taking care of measles. Most of the people
(20:13):
I was working with at that time did not have
any experience taking care of measles. We learned quickly, and
I mean the people you know who I worked with
did an incredible job. But it's it is interesting, and
you could see how someone might see a kid with measles,
see a kid with something else and not even know
what they're dealing with.
Speaker 1 (20:31):
Right, So many of the doctors have either been trained
in a world where these vaccine preventable diseases are not
commonly seen because the vaccines, or they've been fortunate to,
you know, live in regions where these diseases are not common.
And how do you think that that affects their ability
to not only recognize, as you point out, these cases
(20:52):
or these diseases themselves and see, like see a measles
case for what it is, but also to communicate the
dangers of these diseases.
Speaker 2 (21:00):
Yeah, I think that's hard. And I think I'll start
by saying I am not a primary care pediatrician and
they're the ones who are usually having like the sort
of longitudinal, long term conversations with families, and that can
be a sticking point. And I think most pediatricians are
you know, are in favor of the normal vaccine schedule,
(21:23):
But most pediatricians, if they're asked by a family, well,
have you ever seen a child with diphtheria or polio
or something like that, would have to say no. And
they can follow that up and say and I never
want to because I learned about it in school and
I've seen pictures of these things and they're not things
that you want to come back. But that doesn't have
(21:44):
the same I think impact for the for either person
in the conversation. Like I think it can be harder
for the doctor to really have their heart in it,
and it can be harder for the parent to really
buy what the doctor is saying.
Speaker 1 (21:57):
Lacking that that firsthand, that witness experience of that and
the devastation. But I think it's also lacking sometimes the
context and the historical big picture of what these diseases
did before vaccines, or in populations that were already you know,
oppressed and then had never experienced an outbreak of you know,
(22:19):
the measles virus, for instance, and so you know, you
describe one of these outbreaks in your book in the
Faroe Islands in eighteen forty six, and there was one
person in particular who really kind of changed our the
medical understanding of measles at the time. How did this
really shift what we understood measles to be and how
(22:40):
did that change I guess how people treated it in
the future.
Speaker 2 (22:44):
Yeah, it's an interesting story, and it's one that I
knew sort of the very broad outlines of before I started,
and then I dug into it and I was like,
this is incredible.
Speaker 1 (22:53):
Yeah.
Speaker 2 (22:55):
I think because measles is so contagious, there is a
huge difference in the way that a population first experiences
measles and then a population that has been exposed to
it and it's become an endemic disease in the population,
meaning that it's sort of always there, but you see
seasonal and yearly variations in how much there is. And
(23:17):
to look at what happens in terms of brand new
exposures of populations that have never seen measles, you can
look at what happened in meso America with the colonizers
who came over and that this was true of smallpox,
it's true of measles, and there were incredible infection rates
because no one had immunity, and so it wasn't just
(23:38):
that kids were getting sick, It was that all the
adults were getting sick at once. And there were multiple
overlapping diseases, and the people who brought the diseases with
them were trying to plunder and top all societies, and
so all of those things together I think made it
so that I mean, you saw a loss of about
ninety five percent of the population in meso America, and
(24:00):
that was partially measles, partially small pox, and we saw
the you know, we see this in other island outbreaks.
In contrast, the places where the colonizers came from were
these big population centers in Europe where they were big
cities where measles had come in before then it had
infected the whole population at some point, and then you
(24:23):
reached kind of a steady state where you know, most
adults had had it in childhood. The ones who didn't
survive didn't survive to be adults, but then most adults
had had it before, and then new kids were born
who didn't have immunity, and sometimes people would come in
from less densely populated places and they wouldn't have immunity,
but you had sort of this constant hum of measles,
(24:46):
but it was mostly a childhood disease. So they went
from a place like that to a place where nobody
had immunity, and that the difference was stark. So with
the pharaoh Islands. The pharaoh Islands were a colony of Denmark.
Copenhaea had endemic measles at the time. The Pharaohs had
had an outbreak of measles about sixty five years earlier,
(25:07):
but that just meant that only people who were over
age sixty five and the Pharaohs had ever encountered measles,
so most of their population had never encountered it before. Politically,
the Pharaohs were completely dependent on Denmark. The only trade
route was from Copenhagen to Torcheon, which is the capital
(25:27):
of the Pharaohs. And someone who lived in the Pharaohs
went to Copenhagen, got exposed to measles, didn't realize it,
came back to the Pharaohs, got sick, someone realized. The
doctors eventually realized what he had and then within several
weeks there were cases all over the place, and they
(25:50):
the folks in the Pharaoh Islands called to Denmark and said, hey,
you know, we really need help. And so the ruling
authorities in Denmark two people, both medical students, so not
exactly the CDC Epidemic Intelligence Service, Yeah, exactly. They were good,
but there's still only two of them, right, And they
(26:14):
went and you know, they provided some help. They did
what they could to nurse the sick, and they brought
some food and things like that, but really there's not
a whole lot you can do for people who already
have measles. But the main one of the two was
this guy named Peter PanAm, and he was a big
believer in the new way that medicine was being thought about,
(26:37):
meaning that you could observe things, you could think about
them scientifically, and you could come to these broad conclusions.
And he was like, I'm going to do that. I
think the geography is important. I think that the fact
that this place is isolated is important. And I think
we don't know everything about measles yet. Because people were
very sure that measles had a miasma component and a
(26:59):
can pages component. People were very sure that you were
contagious with measles at the very end of the disease,
when your skin was peeling from the rash, because that's
where the measles lived. And it turned out none of
those things were true. And he was able to figure
that out because he went from village to village to
village and he just talked to everybody, wrote everything down.
(27:22):
He found this one village, Chornovig, where ten people had
gone from that village, which had no measles, to another
village nearby to help with a whale hunt on this
one particular day. They came back on the same day.
They all got sick fourteen days later, and he was like, oh,
right and right. He figured out the incubation period of measles,
(27:45):
which is about fourteen days from exposure to rash. He
figured out, you know, that it was spread from person
to person, and that the miasma theory did not explain
any part of it. He did all of these things
that we now take for granted when we talk about measles,
and he drew this incredible map where you see the
(28:06):
ship coming in, you see the contagion going out, the
different cases coming up, and It's the thing that was
most shocking to me about it was when he presented
this to the folks back in Denmark. He basically said,
here's this map. Here's what happened. I figured out all
these things about measles. This is basically a new kind
of science where you observe things and you can figure
(28:31):
out stuff about diseases and you can draw maps. And
this is eight years before John Snow's collar map. So
I give credit to PanAm over Snow, but that's a
fringe opinion.
Speaker 1 (28:44):
I love it. I love it. He's like, here's his
new science. You're welcome, right exactly, do with it what
you will.
Speaker 2 (28:49):
Yeah, Now, can I graduate from medicals?
Speaker 1 (28:53):
Can I be a talktor around? That's amazing. Let's take
a quick break here. We'll be back before you know it.
(29:15):
Welcome back, everyone, I'm here chatting with the wonderful doctor
Adam Ratner about his book Booster Shots. Let's get into
some more questions the story of this outbreak in the
Faroe Islands, as well as some of the other ones
that you described historically where we're seeing massive rates of mortality.
I think that it's it's in direct contrast to the
(29:35):
way that Measles and a lot of other infectious diseases
are described as being these great levelers of society. They
affect the rich and the poor equally, and no one
is at you know, no one is safe from it,
which is that part is true to some degree, But
measles is not a great leveler, right. It definitely has
affected people who are living in crowded conditions, malnourished people
(29:58):
in very different ways, both historical as well as today.
Can you talk a little bit more about that.
Speaker 2 (30:03):
Yeah, measles has never ever ever affected the rich and
the poor equally. It affected both the rich and the poor.
That part is true, but it is it is stunning,
and that was something I didn't appreciate going in Like
I appreciated that there were population level differences now in
how countries experienced the measles, but I didn't realize the
(30:25):
magnitude of it going back through history. And so you
look at the Pharaohs, which was a colony. You look
at Fiji in the eighteen seventies where there was this
measles outbreak right after they became part of the British Empire,
and it killed a quarter of the native Fijians over
the course of like just a couple of months, which
(30:45):
is insane to think about. It's just a tremendous amount
of death. You look in the eighteen hundred, the late
eighteen hundred of Jacob Breeze who went through the tenements
in New York City and took pictures of people that
most people didn't want to look at or think about.
His book is called How the Other Half Lives and
(31:06):
he writes about measles in that book, and he basically
says on the avenues, meaning where the rich people live,
this is something that is made light of that you know,
people just think is part of regular life. And in
the tenements, it kills right and left. And he talked
about seeing, you know, multiple kids in individual families die
(31:27):
of measles, and then you know, on the other side
of it, you have cartoons from the time, and then
you know Brady Bunch episodes a couple of decades later
that are like, isn't it great to have the measles?
Speaker 1 (31:39):
What a strange like pr thing for measles? Like seriously, yeah,
interesting choice with that, with that plotting there. Yeah, And
that's what brings me to sort of this this era
right before the vaccine the measles vaccine was introduced. In
the decades leading up to that, in the US specifically,
how was measles perceived? How did parents especially view this?
Speaker 2 (32:03):
Yeah, so I think it depends which population you're talking about,
because certainly, among well off families it was like we
were talking about like the Brady Bunch type thing. Like,
I think that people really did feel that way, that
it was part of life. But you still had these
occasional horrific tragedies, and I think that people just saw
(32:24):
those as random events. But Roald Dahl, the author of
Charlie and the Chalcoln Factory, lost a daughter at age
I think age nine to measles in nineteen sixty two,
the year before the vaccine was licensed, And so there
were famous people who had this happened to them. And
(32:44):
then in crowded populations in cities where in poor areas
of cities you had death rates that were much higher.
But that wasn't those were not the stories that were
making it into the media and the way that most
people experienced measles. And then you had the vaccine come out,
(33:06):
and there were a lot of issues with that vaccine rollout,
and one of them was that people had to pay
for it on their own. So unlike the polio vaccine,
there was no central financing for the measles vaccine, which
meant that people were supposed to just go to their doctor.
And the vaccine cost about ten dollars a dose, and
that's about one hundred dollars a dose today in scale dollars.
(33:30):
And so you had a system that set it up
so that the rich people who needed protection less were
the ones who were able to access protection and the
people who needed it most may not have had a
doctor to begin with and certainly may have made the
decision not to spend the ten dollars.
Speaker 1 (33:48):
That is such I think a key aspect because yeah,
you think or real least I thought back at that
time and I thought it, well, people were lining up
around the block to get polio vaccine. But when you
have to pay for this vaccine and you have to
make the appointment and it's not you know, I think
that brings to light how important access is, like costs
as a barrier and ease as a barrier, Like were
(34:11):
there vaccine clinics the way that there were for polio?
You know, in the gymnasium, everyone gets a polio shot today,
were there similar things for measles.
Speaker 2 (34:21):
Not to the same extent. Like there was tremendous excitement
when the polio vaccine came out, and the main policy
question was how do we get every child vaccinated against polio?
The measles vaccine rollout was confusing. There were two vaccines licensed.
There was a recommendation for the live attenuated one, which
is like the one that we use today, but there
was the There was the killed virus vaccine, which we
(34:42):
now know didn't work as well but had fewer side effects,
and so some parents were like, well, I want the
one with fewer side effects, and that makes sense. And
then there was the access issue. And part of the
problem was, you know, states would have vaccine drives and
then rates would go down, the desire to spend money
(35:03):
on measles vaccine drives would go down, case rates would
go back up. They'd have a year where they had
vaccine drives, and so it was not a recipe for
really controlling measles in the population. There was this waxing
and waning of access to vaccines, and then the thing
that we realized in the nineteen nineties. In the eighty
nine to ninety one, there were all of these huge
(35:25):
outbreaks in mostly in big city so New York, Chicago, LA.
And a lot of those cases were kids in crowded
conditions in cities who the parents were not able to
access vaccines because there was limited clinic availability, because they
had to shell out money for the vaccines, and those
(35:46):
were you know, I think people finally realized at that
time that those were some of the biggest drivers of
people being unvaccinated. And then finally in ninety four we
got the Vaccines for Children program, which helped with access
and certainly helped with financing.
Speaker 1 (36:03):
It's fascinating to think about today if we did a
pie chart, and I know statisticians hate pie charts, but
if we did a pie chart anyway, and we broke
it down into who was not vaccinated, how big of
the slice is for access, and how big of the
slice is for hesitancy, and then how different that was historically.
Speaker 2 (36:21):
Yeah, it's so interesting because I was reading congressional testimony
from the nineties and were when they were making the
decisions about what to do after the eighty nine to
ninety one measles at breaks, and they interviewed someone from
Los Angeles, who had dealt with the with measles outbreaks
over several decades there, and she was insistent that the
(36:44):
problem was not vaccine hesitancy. The problem was access. What
states needed were free vaccines for kids and enough funding
that they could have clinics that were open late and
open on weekends and stuff, which all makes perfect sense.
But I was reading this in twenty twenty and like,
this does not resonate at all because it's totally different now,
(37:08):
and you know, I think it's a number of things,
Like I think part of the reason that the proportions
have shifted is that not that vaccines for children solved everything,
but I think the access problem in this country at
this time it is mostly under control with the with
the federal programs that currently exist. At the same time,
(37:29):
you had this growth of the anti vaccine movement, and
I think that there there have been questions about vaccines
and people and some people who are hesitant or anti
vaccines since there have been vaccines. There are the cartoons
about the smallpox vaccine where people turn into cows, and
so it's not like that was one hundred percent new,
(37:51):
and there were concerns about the dip theoria tetanus pertussis
vaccine in the seventies and eighties. That led to your
decreased up take in the UK and then a big
Pertussis outbreak and then you know, so like that all
also predates, you know, the current vaccine hesitancy. And then
in ninety eight you had the Wakefield paper where the
(38:13):
hypothesized link between MMR and autism, which we're still fighting
against now. I mean, despite the fact that the paper
was a could never have answered the question that was
being asked because it was essentially a case series B.
It was horribly conflicted, and he was paid by plaintiff's attorneys,
and there's you know, there are a million reasons that
that paper is. To quote Paul Off, it not just
(38:36):
wrong but spectacularly wrong. But it raised a scientifically testable hypothesis,
which is, you know, vaccines cause autism, and then you
had science that followed it, dozens of studies, multiple continents,
tens of thousands of children. Vaccines do not cause autism.
We know that and can say that definitively now, and
(38:56):
yet that idea persists. I think some of that is
that the idea is sort of tailor made for something
that you can tweet about or post about on social media.
It is three words, vaccines cause autism. It provides an
explanation for something that I, as a pediatrician, or any
of us as pediatricians, cannot provide a comparable three word
(39:19):
explanation for. Because if a parent goes to a pediatrician
and says, well, then what does cause autism if vaccines don't,
a good pediatrician will say, well, it's complicated. Like there
are some genetic causes of autism. That's a lot of it.
There are some environmental causes. There are some infections that
cause autism. Congenital rebella is one of them. Congenital side
(39:40):
of megavirus infection is another. So it kind of depends
on the kid you're talking about, and you've lost the
parent at that point because you're way over your three words.
So it is very hard to push back against that
kind of messaging. And then there's also since social media,
it's just the flooding the zone of the with that
(40:04):
information makes it very hard.
Speaker 1 (40:06):
Also, oh yeah, and then there's the social media bubble
that people are in. Not to mention the people who
are directly profiting off of the spread of this vaccine disinformation.
Can you talk about the important distinction between these two groups.
Speaker 2 (40:21):
I think it's important to separate the people who are
kind of the leaders of the vaccine information movement, who yes,
it's for them, it's a grift, Like for them it
is you know, they're making a ton of money. They're
selling their books, they're selling their onesies that say, you know,
my get isn't vaccinated or whatever, so like, yes, that exists,
and that is part of it. And then I think
(40:42):
there are the vast majority of the parents who are
vaccine hesitant or anti vaccine. And yeah, I've said this
in a lot of settings recently, but it's still true.
Is these are people who love their kids, like these
are not people who want kids to suffer. They've been
lying too, you know, they have bad information and they
(41:03):
are believing the information. But I believe that for most
of them, they're passing on information that they believe to
be true and that they believe to be important information
for other parents, which is almost worse. You know, it's
hard to break into that. It's hard to bring people
around to understand the value of vaccines and the lives
(41:25):
that are out there. But I do think those are
different populations of anti vaccine folks.
Speaker 1 (41:32):
Absolutely, No, there's the people who are benefiting off of
spreading the information and the people who are spreading the
information because they think that it's the best thing for
their kid. Yeah, And I'm wondering how your experience, you know,
over your career, how have you seen this change?
Speaker 2 (41:48):
I mean, it's all so much more politicized now than
it used to be. I mean I even think back
to earlier during my training, Like there were certainly parents
with questions about vaccines and that was fine, and you
could sit and talk to people. There were not these
entrenched views that became people's identities. Like I think that
(42:10):
is what's different now. And I mean some of that
is COVID, some of it predates COVID, but there have
been a bunch of analyzes of this. But your political
party affiliation affected. It was an independent risk factor for
your risk of dying of COVID because you were less
likely to get vaccinated if you were a Republican than
if you were a Democrat. That's insane because vaccines and
(42:33):
protecting kids against against vaccine preventable diseases did not used
to be a political issue, Like there were legitimate disagreements
about like how much what one might spend on a
vaccine campaign, or whether school mandates were the right thing
to do they are, or anything else like that. But
those were legitimate disagreements with the background of vaccines are good.
(42:58):
They controlled the spread of the disease in populations. And
now it's like, I think, in many cases can't have
conversations because it is so much a part of people's identities.
I heard someone quoted a parent quoted from the West
Texas measles outbreak the other day say she was asked
about measles vaccine and then was asked about COVID vaccine
(43:20):
and she said, oh, we don't do that here. This
is West Texas. It was not. Then I've thought about this,
I've made the decision that it's not for my family.
It was you know, we don't do that here. It
was a piece of identity for.
Speaker 1 (43:35):
Her, Yes, a signal of like, this is who I am.
This is part yeah that is. I think that it
is really daunting to know what to do about it
and what works and what doesn't. And I was wondering
if if there's anything that you could share about what
we have, you know, evidence based methods that work both
(43:55):
on the more infrastructure side of things, like school mandates
or increasing access of course works increasing funding, and also
on the communication side of things.
Speaker 2 (44:07):
Yeah, So to address the policy piece first, I mean,
there are things that we know work and that are
very important. School mandates are one of them, especially for
measles vaccine, where because measles is so contagious you need
about ninety five percent of the population vaccinated. You do
not get there without school mandates, and you can't control
measles in the population without that, And it is good policy.
(44:32):
It prevents deaths from measles. It is something that we've
had in this country for decades at this point, and
that most other places have as well. So school mandates
are important. And then the other piece of it, access
federal financing has to go along with that, because it's
impossible to ask people to to vaccinate their kids in
(44:52):
order for their kids to be able to go to school,
but then not provide them a way to easily get
those vaccines for free. That's the policy side. The communication
side's much harder. And I'll start by saying that I
am a hospital based consultant. I see kids only in
the hospital. I am not a general pediatrician. They are
(45:13):
the superheroes of these conversations. They are the ones who
are having the long term relationship with families and having
these discussions, and it's really hard and it's individualized. I mean,
there are some evidence based things, especially for particular vaccines.
There are motivational interviewing techniques. There are specific bundles of
(45:35):
things for the HPV vaccine that have been shown to
to help with hesitancy and to increase uptake. I have
sort of different conversations because it's mostly kids who've been
hospitalized due to a vaccine preventable disease, and those conversations
can be sort of fraught because it's very easy for
(45:56):
parents to feel like they're being blamed, which is not
the intention. But I think it's an important conversation to
have because how they walk away from their child being
hospitalized and hopefully then being okay and going home is
really important. It's important to what they do for that
kid going forward in terms of vaccinating or not, what
(46:18):
they do for their other kids, and the story that
they tell within their community. And so I try hard
to be curious and understand what their hesitancy was leading
up to this. Try to be careful about the words
that I choose. I try to have empathy because these
(46:38):
are people with a hospitalized child, which is the worst
thing in the world, and they're terrified and that is reasonable.
And I try to be clear. And this is part
of what I think any pediatrician does, which is that
I think having a clear and a strong recommendation for
vaccines is important because parents understand and the recommendation that's
(47:01):
being given is not if you don't have your heart
in it and so and you know, I don't know
how well these things work, but it's what I've got
at this point.
Speaker 1 (47:13):
I just can't imagine how hard that must be to
be the person who is taking care of this sick
child who did not have to be there.
Speaker 2 (47:22):
No, it is. It is frustrating and sad, and I
mean I hearing about the child who died in West
Texas from measles. No child should die. No child should
die of measles anywhere on earth now, like there's no
reason we have had a safe, effective vaccine that prevents
(47:43):
measles for sixty years. Measles should have gone the way
of smallpox already. That's an extreme position. But I think
we hope, maybe can agree that no child should die
of measles in the United States where there's easy access
to vaccines in twenty twenty five. It doesn't make any sense.
Speaker 1 (48:03):
It doesn't make any sense. It's so hard, and I
can't imagine how difficult that must be. As we're speaking
right now, it's March fourteenth, twenty twenty five. We're in
the middle of this and maybe at the beginning of
this measles outbreak. I mean, who knows where it'll go
from here. I just every headline I see is a
new state, a new case, a new growth of this.
(48:23):
What are some of the other lessons that we can
take from past measles outbreaks post vaccine that can help
us manage this current one.
Speaker 2 (48:32):
Yeah, I mean, I think the other thing that I'll say,
which maybe seems obvious now after COVID, but I think
wasn't obvious at the time, was there was this measles
outbreak in a city that straddles Texas and Arkansas, Texas
Arcana and basically the Texas side of the city. Kids
went to school based on where their home was, but
(48:55):
there was a ton of mixing of people. Movie theaters
and churches and things like that, and Texas had no
school vaccine mandates. Arkansas had vaccine mandates and had big
vaccination drives. There was this big measles outbreak in nineteen
seventy ninety five percent of the cases we're on the
Texas side of the border, five percent we're on the
Arkansas side. And what I learned from that was, you know,
(49:20):
vaccines work and school mandates work, which is not surprising either,
but also just from a more general point of view,
that policy decisions really really matter. Yes, and you know
where you lived in that city, which side of state
line avenue you lived on, mattered for the health of
your kid. And I think we're seeing all sorts of
(49:43):
stuff now in the US where a lot of policies
that it has taken us a lot of time to
get to, things like vaccines for children like we were
talking about. These are incredible things, and kids are healthier
today as a result of them than they were even
a couple of decades ago. And that's not guaranteed, Like,
(50:04):
none of that progress is guaranteed. I don't know if
it's a hopeful message or not, but it's a message
of something to pay attention to.
Speaker 1 (50:11):
That's an important message and I really appreciate you taking
the time to chat with me today. This was so
so fascinating. I mean honestly, I could just talk Measles
for hours, so.
Speaker 2 (50:21):
I appreciate it. Thank you so much for having me.
This is a dream. I've been a fan of the
podcast for a long long time.
Speaker 1 (50:30):
Oh my god, thank you amazing big thanks again to
(50:53):
doctor Adam Ratner for taking the time to chat with me.
If you also enjoyed this conversation and want to learn more,
check out our website this podcast will kill You dot com,
or I'll post a link to where you can find
booster shots, the urgent lessons of Measles and the Uncertain
Future of Children's Health, as well as a link to
doctor Ratner's website. And don't forget you can check out
(51:13):
our website for all sorts of other cool things, including
but not limited to, transcripts, Quarantini and Plaicybrita recipes, show
notes and references for all of our episodes, links to
merch our bookshop, dot orgaffiliate account, our Goodreads list, a
first hand account form, and music by Bloodmobile, Speaking of which,
(51:34):
thank you to Bloodmobile for providing the music for this
episode and all of our episodes. Thank you to Leona
Scolacci and Tom Bryfogel for our audio mixing, and thanks
to you listeners for listening. I hope that you like
this episode and our loving being part of the TPWKY
book Club. A special thank you, as always to our
(51:54):
fantastic patrons. We truly appreciate your support so very much. Well,
until next time, Keep washing those hands, U.
Hosts And Creators
Erin Welsh
Erin Allmann Updyke
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