April 14, 2025 • 21 mins
In this conversation, Dr. Paul Offit and pediatrician Jessica Hochman discuss the importance of vaccinations, the challenges of vaccine hesitancy among parents, and the need for nuanced conversations in public health. They explore the impact of the COVID-19 pandemic on public trust, and the science behind vaccination schedules. The discussion emphasizes the importance of understanding parental concerns while advocating for the safety and efficacy of vaccines.
About Paul A. Offit, MD!
Paul A. Offit, MD, is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. He is the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania.
Dr. Offit is an internationally recognized expert in the fields of virology and immunology, and was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. He is a member of the Food and Drug Administration Vaccines and Related Biological Products Advisory Committee, and a founding advisory board member of the Autism Science Foundation and the Foundation for Vaccine Research, a member of the Institute of Medicine and co-editor of the foremost vaccine text, Vaccines.
He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, a Research Career Development Award from the National Institutes of Health, and the Sabin Vaccine Institute Gold Medal.
Dr. Offit has published more than 160 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC. For this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases, and he was honored by Bill and Melinda Gates during the launch of their Foundation’s Living Proof Project for global health.
In 2009, Dr. Offit received the President’s Certificate for Outstanding Service from the American Academy of Pediatrics. In 2011, he received the Humanitarian of the Year Award from the Biologic
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com
-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20
-To test your child's microbiome and get recommendations, check out:
Tiny Health using code: DRJESSICA
Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.
The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:00):
Dr Paul Offit, I cannot tell you how much I've been
(00:02):
looking forward to thisimportant conversation, and I'm
so thankful that you're herewith me today. So as a general
pediatrician, I'm a strongproponent of vaccines, and I
feel quite fortunate to practicemedicine in a time when we have
such tools. But I'm also seeingmore hesitancy in parents.
They're worried. They're gettinga lot of mixed messages, and
they often haven't seen theseillnesses firsthand, so I
(00:22):
understand their fears, but Ialso recommend vaccinations. I
believe the CDC schedule issafe. I believe it protects kids
when they are most vulnerable,but still, I worry that if the
medical community is too rigid,we risk alienating families. So
I'm hoping that thisconversation can help make a
strong case for vaccines, whilealso holding space for empathy
and nuance. So maybe we canstart with that. Do you think
(00:46):
we've lost some of the nuance inour public health messaging?
Well, first of all, I agree. Imean, I think that we ask a lot
of parents in this country, weask them to give vaccines to
prevent 14 different diseases inthe first few years of life,
which can mean as many as 25inoculations during that time,
it can mean as many as fiveshots at one time to prevent
disease, as most people don'tsee, using biological fluids
(01:07):
most people don't understand. Ithink it would be surprising if
there wasn't pushback againstvaccines. The problem is how we
respond to that pushback. Ithink that that, as you said, I
mean, so why do you give arotavirus vaccine at two, four
and six months of age? Why doyou give a pneumococcal vaccine
or Haemophilus Influenza type Bvaccine? You do that because
those diseases are prevalentbetween six and 24 months of
(01:29):
age. So you want to make surechildren are protected. Then, I
mean, when you get into thebusiness trying to sort of
separate or space out vaccinesusing, you know, so called
alternative schedules, whichreally should just be called
delayed schedules. All you'redoing is increasing the risk of
vaccine preventable diseases forno benefit. I mean, I understand
how it feels like it's too muchI do, but it's not. And I think
(01:52):
that's sort of i When people askme the question, aren't all
these vaccines somehow weakeningor overwhelming the immune
system? How can we handle allthis? I try and answer those
questions with you know, thescience that we have at hand,
which hopefully can reassurethem that it's not too much. I
feel lucky because I practicepediatrics with my father, and
he saw a lot of these illnesses,and he reminds me how lucky I am
(02:14):
to practice at this day and age.
He says, You're so lucky. You'venever seen a patient walk in the
door with a HaemophilusInfluenza B infection. It is
scary, and I feel like I'mhonestly spoiled as a
pediatrician, because he'sright. I haven't seen a lot of
these scary illnesses, and Ithink we're taking for granted,
to be honest, the value of thevaccinations. Yeah. I mean, my
parents were children of the1920s so their parents, my
(02:35):
grandparents, were scared ofdiphtheria, which would kill
15,000 children a year. Theywere scared of whooping cough,
which was kill eight to 9000children a year. I'm at the shot
of the 1950s my parents werescared of polio, which would
paralyze 30,000 children a yearand kill as many as 1800 they
were scared of measles, whichwould cause 50,000
hospitalizations and 500 deathsfrom severe pneumonia or
(02:58):
dehydration, or encephalitis,brain swelling, which would
leave one quarter of thosechildren with blindness or
deafness. They were scared ofmumps, which was the most common
cause of acquired deafness. Theywere scared of rubella, or
German measles, which went intoaffected women in the first
trimester. Pregnancy wouldresult in 85% of those offspring
having blindness or deafness orheart defects. I was a resident
in the 1970s between 1977 and1980 and we had a rotation where
(03:23):
you had to be on call in theemergency department for 12
hours, from 12 at night to 12and the next morning, next day,
three state weeks, so 21 days,12 hours on, 12 hours off. I did
two to three spinal taps anight. Why? Because we didn't
have a monophysy vaccine, didn'thave a pneumococcal vaccine,
didn't have a Meningococcalvaccine, and then my children
were children of 90 so my me andmy wife weren't scared of any of
(03:47):
these diseases, which in someways is part of the problem. I
think because we don't feardiseases anymore, we focus on
safety issues, real or imagined.
I think this may seem contraryto what other people believe.
But I actually believe that thisday and age, we actually live in
the best time in terms ofinfectious disease health that
(04:09):
we ever could have imagined inhuman history.
For sure. Yeah, we live 30 yearslonger than we did 100 years
ago. Why? In large part becauseof vaccines. I mean, I think we
have forgotten what thesediseases look like. I'm actually
watching a TV series now called1883 this should scare you. Just
watch this series. It starts offwith a few people dying from
smallpox. I think you just don'tremember how devastating these
(04:31):
infections were. And I thinkthis is the story with measles.
Now you're seeing an outbreak inWest Texas. It's described as
having about 350 cases. Assumeit's 2000 cases, because those
are just confirmed cases,confirmed by PCR or confirmed by
serology. I talked to someone inWest Texas from the health
department the other day. Shesaid it's at least 2000 cases.
Could be 3000 cases. Why? And Ithink the reason is it's not
(04:53):
largely that we've eliminatedmeasles, which really did by the
year 2000 it's that we'veeliminated.
Today the memory of measles,people don't remember how sick
that virus can make you. Yes,and I also think a lot of people
talk about how there's apharmaceutical influence, that
pediatricians are making moneyoff of vaccines. But the truth
is, I think we're vaccinatingourselves out of business. We
(05:16):
don't see a lot of illnessanymore that we used to like.
There's so many there's a lotfewer ear infections. There's a
lot fewer ear tubes that areplaced. There's a lot fewer
pneumonias that we take care of.
We're seeing many fewer sickchildren, which is amazing,
right? It also it is offensiveto some extent that people
ascribe that kind of motive topediatricians. I mean, why do
pediatricians do it? They do itgenerally, because they love
(05:38):
kids. They care about kids. Andthe notion that they would say,
Okay, I'm going to take this,this money from a pharmaceutical
company, and give a vaccine thatI know either doesn't work or is
unsafe is so dead wrong. It'sreally amazing that anybody buys
it. Yes, I mean, if I'm beingperfectly honest, having
vaccines in our office ends upbeing a headache. There's a lot
to think about, making sure youhave enough in stock, training
(05:58):
the nurses to give the vaccinesappropriately to make sure you
stay on schedule. So no, it isstressful to have vaccines in
the office, but I'm happy to doit because I know that it's the
right thing to do. I know thatit's keeping your kids healthy,
right, and it's hard. I mean,I'm not in private practice
pediatrics. I work at Children'sHospital Philadelphia, in the
infectious disease division, butmy wife's in private practice
(06:18):
pediatrics, and I've watched hersuffer this, and it's hard. I
mean, it's hard when people arewilling to walk out of the
office without a vaccine forher, because she knows I could
be sending you into into a worldwhere pneumococcus is still
there, which can causemeningitis and bloodstream
infections and pneumonia, andHaemophilus Influenza B is still
(06:39):
out there. Certainly, measles isout there, and it's very hard.
She says, Look, let me love yourchild. Don't put me in a
position where I'm being askedto practice substandard care,
where I'm I know that your childcould come back with a disease
that was preventable. It's justtoo hard for me. Yes, yes. I
mean, honestly, the the localhospital in my neighborhood.
It's called Los Robles hospital.
(07:02):
They just announced last monththat they are going to close the
pediatric floor because there'snot enough business, and there's
not enough business. I think wecould say, oh, pediatricians are
so great at keeping kids out ofthe hospital. That would be nice
to say, but I don't know ifthat's true. Maybe, maybe it's a
little bit true, but I think abig part of it is that we're
just not seeing kids get us sickanymore, and in a large part
(07:25):
because of the vaccinations.
Well, give it time, I feel likewe're going in the wrong
direction. So okay, so you'vemade a good case that with
vaccinations, we've eradicated alot of illness that we don't
want to see. And at the sametime, I am sympathetic to
parents. I think, to be honest,my perspective is I've seen a
lot more pushback from familiessince the COVID 19 vaccine.
(07:46):
There was a lot of conversationabout mandating the
vaccinations, and after thattime, I started having a lot of
families feel more reluctant tostay on schedule. Would you
agree with that? Yes, I think wehave lost a lot of trust in the
public health community, and Ithink the COVID pandemic was a
big reason for that. I think itfor two reasons. I think in 2020
(08:10):
when we didn't have anything, wedidn't have antivirals till
October of 2020 we didn't havemonoclonal till November, didn't
have vaccines till December. Sowhat do we have? All we had was
to try and figure out ways toavoid human to human to human
contact for a virus that couldbe spread asymptomatically and
was killing hundreds of people aday. So we shuttered schools,
closed businesses, restrictedtravel, isolated, quarantine,
(08:31):
tested masked, and that was seenby a decent percentage of this
country as massive governmentoverreach. And then in 2021 we
had a vaccine. We mandated it,and it's certainly
understandable why. I mean, whatour hospital, you know, we were
working double shifts. We hadthree floors of children with
COVID, and I work at achildren's hospital, which is,
you know, less the disease isgenerally less severe than, say,
(08:52):
for working in adult hospital.
But we, the nurses, were wearingbandanas for masks. They were
wearing garbage bags for, youknow, for gowns. We were working
double shifts and and you were12 times less likely to be
hospitalized and 12 times lesslikely to die if you were
vaccinated than if you wereunvaccinated. So our thing it
was help us out here. I mean,get vaccinated so that you don't
(09:13):
overwhelm the healthcare system.
Because we stopped optionalsurgeries, we we were
overwhelmed, but nonetheless,from from the standpoint of the
public, you know, you'remandating a vaccine, I can't go
to my favorite bar or restaurantor sporting event or place of
worship, and that, too was seenas massive overreach, and I
(09:34):
think we're paying the price forthat now. I think we lead into a
libertarian left hook, and nowwe're feeling the punch Yes. And
I think, honestly, when thevaccine first came out, it was
very compelling to get thevaccine. I remember people were
racing to the front of the lineto get it because the data
looked so good. It was soconvincing. And at that time,
COVID was it was dominating ourlives in terms of what we could
(09:55):
do, what we couldn't do, and itwas so exciting to look and see
that there was a possible end insome.
Right? But when it came to thechildren, I feel like by the
time the vaccine was actuallyavailable and approved for kids,
that's when I think it got alittle tricky, because many of
the kids by that time hadalready had the illness, so they
had pre existing immunity. Wecould tell by that time that
(10:17):
kids were not gettinghospitalized from COVID. By and
large, the rates weresignificantly lower for kids,
and the data wasn't clear thatit was going to keep kids out of
the hospital. So I was verysympathetic to parents that
wanted to get the vaccine, and Iwas very sympathetic to parents
that that had questions aboutgetting the vaccine, especially
when it was mandated. You know,I think firstly, national
(10:37):
infection protects, and I thinkvery early on in remember, we
met, there was a group of usthat met in February of 2022
to determine whether or not wethought that natural infection
should count as a vaccine.
Because, you know, people werebeing mandated to get a vaccine,
and they were saying, Look, I'vealready been infected. I think
I'm protected. And they'reright. They were. And I really
(10:58):
wish early on, we had made thatclear that if you'd been
naturally infected that you didneed to get a vaccine. Some
people were mandated to get avaccine for work and were fired
even though they had a naturaleffect. This was not fair.
Children who were certainly hadbeen naturally infected didn't
need to be vaccinated, but ifyou hadn't been vaccinated as a
child, I still feel this way,that if you haven't been
vaccinated as a child, youshould get a vaccine. I don't
(11:20):
think that everyone needs ayearly vaccine. I think that the
yearly vaccine really should betargeted to those who are most
likely to be hospitalized andmost likely to go to the ICU and
most likely to die, which isreally what most countries do.
It's really only us in Canadathat has a recommendation for
everyone over six months of age.
And I agree with all those othercountries, you know, Western
Europe, Scandinavian countries.
World Health OrganizationAustralia really vaccinates high
(11:42):
risk groups for with the COVIDvaccine on a yearly basis. Yes,
and I know that for the last twoseasons where the COVID 19
vaccine was offered to children,well developed countries such as
Sweden, Australia, the UK,Germany, they did not recommend
the vaccine for children 12years of age and older, and I
have not read that children inthe United States have been any
(12:04):
better off, even though we dorecommend the vaccine for kids
12 and younger, people over 75and I just had a birthday
yesterday, but I'm not over 75yet, but I am getting closer and
or people who have high riskmedical conditions, certainly,
obesity is A high risk medicalcondition, diabetes, chronic
lung, liver, heart disease. Imean, so there are certainly
high risk groups, and those arethe groups that I think should
(12:27):
pay special attention to. But tovaccinate a healthy 18 year old
who's already been vaccinated ornaturally infected, or both, I
think doesn't make a lot ofsense. I think it's Low risk,
low reward. I think you protectyourself for three to six months
against mild to moderatedisease, and that's pretty much
what you get. Yes, no. Andthat's what I so appreciate
about you, is that you leavespace for nuance. Because I feel
like during the time when COVIDwas dominating the news, when it
(12:48):
was all everyone was thinkingabout and talking about, there
wasn't any room for nuance. Andso like you're mentioning having
had the illness didn't count forhaving had a vaccine. And I
think a lot of people got turnedoff from public health
recommendations, and whatbothered me about it is I was
worried that it would lead to amistrust and what we are
recommending. No, I agree. Ithink, I think that the public
(13:10):
health community saw a nuancedmessage as a garbled message,
and they thought it would besimpler to understand vaccinate
everybody, because then thosewho are most at risk would be
most likely to get vaccinated.
But I don't think that wasright. I think it's okay to
trust the American public thatthis is who we think is most at
risk and leave it at that. Iagree with you. I always think
(13:31):
about the term in psychology,control, resist, that when
people feel like they're toocontrolled, they actually push
back and resist. And I see it alot in my office with toddlers,
when we're potty training them,when they feel forced to potty
train, they go the other way.
They don't want anything to dowith it. You know, there's so
many examples that I can thinkof with humans, where if you
push them too much, itbackfires. And I think it's so
(13:53):
much better. And I know this isme thinking ideologically, but
if you can convince them thatit's the right thing to do, that
it really is the best thing forthem, with good data, with good
information, I just think, tome, that feels better. I agree,
I think. And I think if there'sany chance that we're going to
get the public stress, we dohave to try and explain the best
(14:15):
we can why we're making thesedecisions. You know, I think
that was lost in many waysduring the COVID pandemic. I
think a lot of those decisionsthat were being discussed behind
closed doors should have beenopen to the public. And for this
reason that you'll do is you'llsee people disagreeing. You'll
see some people saying, look, Ithink we should do it this way,
and some the other way. And Ithink the fear about that was
(14:35):
that people would think, allright, these people don't know
what they're doing. I mean, theyjust can't even agree on these
things, but, but that's the wayscience works. I mean, you're
always should hold the sciencebehind a particular public
health policy to the higheststandard possible, and open that
up to the open that discussionof the public. I mean, I'm on
the FDA vaccine AdvisoryCommittee, and have been since
2017and there was debate about the
(14:56):
bivalent vaccine. I mean, Ivoted no.
On that vaccine in June of 2022because I didn't think the data
were showed it was any betterthan what we already had. And
you notice, that was the lasttime we ever used a bivalent
vaccine, the sort of half doseof Omicron and half dose of the
ancestral strain. Because itwasn't worse than what we have
it. It was no better than whatwe had. And I think Nonetheless,
(15:17):
when it's rolled out, you know,everybody felt compelled to say,
look, now it contains Omicron.
Now it's clearly better when itreally wasn't. And it was a
little hard to watch that. I'mjust so curious, did you take
heat for that, for your stance?
There were people in the publichealth community that were very
angry with me because they feltthat I had broken from the
ranks, but and that people willsee us disagreeing will make
(15:38):
them trust us even less. And I'msure that is true for a certain
group of people, but I justthink stick to the science, at
least as you know it, and tryand explain it, realizing that
during this pandemic, we werebuilding the plane while it was
in the air, that we were goingto be making mistakes, and we
did, and just own up to them andmove forward knowing that you
are going to upset people. Iactually feel the opposite. I
(16:00):
think, when you are honest withthe public, when you do say what
you're finding, what you'renoticing, and you evolve as the
data evolves, I think thatengenders trust. I hope you're
right. I always feel like it'sthe tyranny of transparency. At
some level, there are somepeople go, these people don't
know what the hell they'redoing. I hope you're right.
That's sort of my philosophy isjust, it's just so much easier
(16:20):
frankly. I mean, first of all, Icannot, personally ever
represent something as sayingit's better when I don't think
it is. So that's also mytraining. Is really a scientific
training. So in science andbasic science, when I spent 26
years of my life, you know,trying to understand which
proteins on rotavirus evokeneutralizing antibodies, and I
think, and so you go toscientific meetings, and what
would happen in a scientificmeeting is you would you would
(16:42):
present your data, and you wouldreach a conclusion, and people
would would either agree ordisagree. They would say, Look,
your data don't allow you toreach that conclusion, and
here's why, and you wanted thatfeedback, because that's the
only way your science gotbetter. So that's really how I
see public health, but it's alittle different, I think, in
the public health rule, yes, andI think now we live at such a
different time now with socialmedia and YouTube and
(17:05):
information was dispersing soquickly, so fast, and I think a
lot of the public felt like, youknow, we were not being
forthright with all theinformation that we were
finding, like myocarditis andthe teen boys. Well, why are we
still recommending the COVIDvaccine to teenage boys when
there was that possible risk.
And I think,you know, I What made me nervous
about not having those nuancedconversations? Would we see
(17:27):
pushback because of it in thefuture? And so I'm hoping to
have good conversations that wecan swing back the other
direction. You know, I think wecertainly democratize was a
surprise, I mean, but the goodnews is, we have safety systems
in place, like the vaccinesafety data link, which actually
very quickly picked that up. Butyou know, myocarditis is also a
(17:47):
consequence of the disease, andwe the so called multi system
inflammatory disease. 50 to 75%of those kids had severe
myocarditis, where you wouldsome of those kids ended up in
the ICU, and there were deaths.
So it's not, again, a choice notto get a vaccine. It's never a
risk free choice, and I justthink it's a matter of making
people get them to understandthe risks of both choices. Yes,
(18:08):
I completely agree with you. Ithink the vaccine suffered from
a lot of things. It sufferedfrom the fact that it was a
genetic vaccine. We'd never donethat before, but I think when
people hear the word gene, theythink this could somehow alter
their genes, even though that'snot possible, but that was part
of it. The other thing is,because operation there was some
bad terminology, I thinkoperation wars a bad
(18:29):
terminology, even for Star Warsfans, and you realize that that
was faster than the speed oflight. That was actually Peter
marks at the Center forBiological Evaluation and
Research. Was a Star Wars fan.
So he came up with Operationwarp speed, which made it sound
like this is made way tooquickly. That's the way it
sounds. But the hero of thispandemic, to me, which which
never got recognized, was aNational Institute of Health. I
(18:50):
mean, they were funding mRNAvaccine research, really
beginning in 1997 so by the timeSARS COVID Two rolled in, COVID
rolled in, we had had 25 yearsof research on that kind of
vaccine, and that never gotexplained. People just thought
this vaccine was made in 11months. I mean, that's way too
quickly. Now, do you feel like alot of the medical community has
come around to agree with youryour perspective on the
(19:13):
vaccination, with regard to notnecessarily needing to vaccinate
everyone every year? Yes, yes tohaving some nuance to who who
would benefit from the vaccine,high risk groups, those who've
never been vaccinated. Yeah, thepublic has certainly voted that
way. I think they, they thosewho are more likely to be at
highest risk are more likely toget a vaccine. So I think that's
the way it's it's settled out.
(19:35):
Do I think most people in thepublic health community have
done that? Don't know. Yeah, itwas interesting to me. I just
read that less than 20% ofchildren actually got the COVID
19 booster this year. So I thinkyou're right. The public is
voting that way. What worries meis that children less than five
are in a highly unvaccinatedgroup. I mean, they're I think
their vaccination rates is like5% and who comes into the
emergency department, includingour emergency department, about
(19:57):
5% of our visits to theemergency.
Department are children lessthan five who have COVID, not
severe COVID, but COVIDnonetheless. And it's it is a
preventable illness, because youdon't want them to get severe
disease. Okay, so now I want topivot this to asking you how we
should respond to parents whenthey have concerns about
vaccines. A lot of the sameconcerns come up to us
(20:19):
pediatricians that I think aregood questions, and I'm just
curious how you would respond toeducate hesitant parents. Well,
that concludes part one with DrPaul Offit. I felt so lucky to
have him on the podcast. He's anincredible physician educator
and overall advocate forchildren's health. Be sure and
tune in to next week for parttwo, where we talk about the
most common questions that Ihear from parents like, Do kids
(20:42):
really need so many shots soearly? What's in these vaccines,
and what about spacing them out?
If this episode was helpful,please share it with a friend.
Leave a review or subscribe.
Your support really helpsparents find the show. See you
next week. You.
Dr Paul Offit, I cannot tell you how much I've been
(00:02):
looking forward to thisimportant conversation, and I'm
so thankful that you're herewith me today. So as a general
pediatrician, I'm a strongproponent of vaccines, and I
feel quite fortunate to practicemedicine in a time when we have
such tools. But I'm also seeingmore hesitancy in parents.
They're worried. They're gettinga lot of mixed messages, and
they often haven't seen theseillnesses firsthand, so I
(00:22):
understand their fears, but Ialso recommend vaccinations. I
believe the CDC schedule issafe. I believe it protects kids
when they are most vulnerable,but still, I worry that if the
medical community is too rigid,we risk alienating families. So
I'm hoping that thisconversation can help make a
strong case for vaccines, whilealso holding space for empathy
and nuance. So maybe we canstart with that. Do you think
(00:46):
we've lost some of the nuance inour public health messaging?
Well, first of all, I agree. Imean, I think that we ask a lot
of parents in this country, weask them to give vaccines to
prevent 14 different diseases inthe first few years of life,
which can mean as many as 25inoculations during that time,
it can mean as many as fiveshots at one time to prevent
disease, as most people don'tsee, using biological fluids
(01:07):
most people don't understand. Ithink it would be surprising if
there wasn't pushback againstvaccines. The problem is how we
respond to that pushback. Ithink that that, as you said, I
mean, so why do you give arotavirus vaccine at two, four
and six months of age? Why doyou give a pneumococcal vaccine
or Haemophilus Influenza type Bvaccine? You do that because
those diseases are prevalentbetween six and 24 months of
(01:29):
age. So you want to make surechildren are protected. Then, I
mean, when you get into thebusiness trying to sort of
separate or space out vaccinesusing, you know, so called
alternative schedules, whichreally should just be called
delayed schedules. All you'redoing is increasing the risk of
vaccine preventable diseases forno benefit. I mean, I understand
how it feels like it's too muchI do, but it's not. And I think
(01:52):
that's sort of i When people askme the question, aren't all
these vaccines somehow weakeningor overwhelming the immune
system? How can we handle allthis? I try and answer those
questions with you know, thescience that we have at hand,
which hopefully can reassurethem that it's not too much. I
feel lucky because I practicepediatrics with my father, and
he saw a lot of these illnesses,and he reminds me how lucky I am
(02:14):
to practice at this day and age.
He says, You're so lucky. You'venever seen a patient walk in the
door with a HaemophilusInfluenza B infection. It is
scary, and I feel like I'mhonestly spoiled as a
pediatrician, because he'sright. I haven't seen a lot of
these scary illnesses, and Ithink we're taking for granted,
to be honest, the value of thevaccinations. Yeah. I mean, my
parents were children of the1920s so their parents, my
(02:35):
grandparents, were scared ofdiphtheria, which would kill
15,000 children a year. Theywere scared of whooping cough,
which was kill eight to 9000children a year. I'm at the shot
of the 1950s my parents werescared of polio, which would
paralyze 30,000 children a yearand kill as many as 1800 they
were scared of measles, whichwould cause 50,000
hospitalizations and 500 deathsfrom severe pneumonia or
(02:58):
dehydration, or encephalitis,brain swelling, which would
leave one quarter of thosechildren with blindness or
deafness. They were scared ofmumps, which was the most common
cause of acquired deafness. Theywere scared of rubella, or
German measles, which went intoaffected women in the first
trimester. Pregnancy wouldresult in 85% of those offspring
having blindness or deafness orheart defects. I was a resident
in the 1970s between 1977 and1980 and we had a rotation where
(03:23):
you had to be on call in theemergency department for 12
hours, from 12 at night to 12and the next morning, next day,
three state weeks, so 21 days,12 hours on, 12 hours off. I did
two to three spinal taps anight. Why? Because we didn't
have a monophysy vaccine, didn'thave a pneumococcal vaccine,
didn't have a Meningococcalvaccine, and then my children
were children of 90 so my me andmy wife weren't scared of any of
(03:47):
these diseases, which in someways is part of the problem. I
think because we don't feardiseases anymore, we focus on
safety issues, real or imagined.
I think this may seem contraryto what other people believe.
But I actually believe that thisday and age, we actually live in
the best time in terms ofinfectious disease health that
(04:09):
we ever could have imagined inhuman history.
For sure. Yeah, we live 30 yearslonger than we did 100 years
ago. Why? In large part becauseof vaccines. I mean, I think we
have forgotten what thesediseases look like. I'm actually
watching a TV series now called1883 this should scare you. Just
watch this series. It starts offwith a few people dying from
smallpox. I think you just don'tremember how devastating these
(04:31):
infections were. And I thinkthis is the story with measles.
Now you're seeing an outbreak inWest Texas. It's described as
having about 350 cases. Assumeit's 2000 cases, because those
are just confirmed cases,confirmed by PCR or confirmed by
serology. I talked to someone inWest Texas from the health
department the other day. Shesaid it's at least 2000 cases.
Could be 3000 cases. Why? And Ithink the reason is it's not
(04:53):
largely that we've eliminatedmeasles, which really did by the
year 2000 it's that we'veeliminated.
Today the memory of measles,people don't remember how sick
that virus can make you. Yes,and I also think a lot of people
talk about how there's apharmaceutical influence, that
pediatricians are making moneyoff of vaccines. But the truth
is, I think we're vaccinatingourselves out of business. We
(05:16):
don't see a lot of illnessanymore that we used to like.
There's so many there's a lotfewer ear infections. There's a
lot fewer ear tubes that areplaced. There's a lot fewer
pneumonias that we take care of.
We're seeing many fewer sickchildren, which is amazing,
right? It also it is offensiveto some extent that people
ascribe that kind of motive topediatricians. I mean, why do
pediatricians do it? They do itgenerally, because they love
(05:38):
kids. They care about kids. Andthe notion that they would say,
Okay, I'm going to take this,this money from a pharmaceutical
company, and give a vaccine thatI know either doesn't work or is
unsafe is so dead wrong. It'sreally amazing that anybody buys
it. Yes, I mean, if I'm beingperfectly honest, having
vaccines in our office ends upbeing a headache. There's a lot
to think about, making sure youhave enough in stock, training
(05:58):
the nurses to give the vaccinesappropriately to make sure you
stay on schedule. So no, it isstressful to have vaccines in
the office, but I'm happy to doit because I know that it's the
right thing to do. I know thatit's keeping your kids healthy,
right, and it's hard. I mean,I'm not in private practice
pediatrics. I work at Children'sHospital Philadelphia, in the
infectious disease division, butmy wife's in private practice
(06:18):
pediatrics, and I've watched hersuffer this, and it's hard. I
mean, it's hard when people arewilling to walk out of the
office without a vaccine forher, because she knows I could
be sending you into into a worldwhere pneumococcus is still
there, which can causemeningitis and bloodstream
infections and pneumonia, andHaemophilus Influenza B is still
(06:39):
out there. Certainly, measles isout there, and it's very hard.
She says, Look, let me love yourchild. Don't put me in a
position where I'm being askedto practice substandard care,
where I'm I know that your childcould come back with a disease
that was preventable. It's justtoo hard for me. Yes, yes. I
mean, honestly, the the localhospital in my neighborhood.
It's called Los Robles hospital.
(07:02):
They just announced last monththat they are going to close the
pediatric floor because there'snot enough business, and there's
not enough business. I think wecould say, oh, pediatricians are
so great at keeping kids out ofthe hospital. That would be nice
to say, but I don't know ifthat's true. Maybe, maybe it's a
little bit true, but I think abig part of it is that we're
just not seeing kids get us sickanymore, and in a large part
(07:25):
because of the vaccinations.
Well, give it time, I feel likewe're going in the wrong
direction. So okay, so you'vemade a good case that with
vaccinations, we've eradicated alot of illness that we don't
want to see. And at the sametime, I am sympathetic to
parents. I think, to be honest,my perspective is I've seen a
lot more pushback from familiessince the COVID 19 vaccine.
(07:46):
There was a lot of conversationabout mandating the
vaccinations, and after thattime, I started having a lot of
families feel more reluctant tostay on schedule. Would you
agree with that? Yes, I think wehave lost a lot of trust in the
public health community, and Ithink the COVID pandemic was a
big reason for that. I think itfor two reasons. I think in 2020
(08:10):
when we didn't have anything, wedidn't have antivirals till
October of 2020 we didn't havemonoclonal till November, didn't
have vaccines till December. Sowhat do we have? All we had was
to try and figure out ways toavoid human to human to human
contact for a virus that couldbe spread asymptomatically and
was killing hundreds of people aday. So we shuttered schools,
closed businesses, restrictedtravel, isolated, quarantine,
(08:31):
tested masked, and that was seenby a decent percentage of this
country as massive governmentoverreach. And then in 2021 we
had a vaccine. We mandated it,and it's certainly
understandable why. I mean, whatour hospital, you know, we were
working double shifts. We hadthree floors of children with
COVID, and I work at achildren's hospital, which is,
you know, less the disease isgenerally less severe than, say,
(08:52):
for working in adult hospital.
But we, the nurses, were wearingbandanas for masks. They were
wearing garbage bags for, youknow, for gowns. We were working
double shifts and and you were12 times less likely to be
hospitalized and 12 times lesslikely to die if you were
vaccinated than if you wereunvaccinated. So our thing it
was help us out here. I mean,get vaccinated so that you don't
(09:13):
overwhelm the healthcare system.
Because we stopped optionalsurgeries, we we were
overwhelmed, but nonetheless,from from the standpoint of the
public, you know, you'remandating a vaccine, I can't go
to my favorite bar or restaurantor sporting event or place of
worship, and that, too was seenas massive overreach, and I
(09:34):
think we're paying the price forthat now. I think we lead into a
libertarian left hook, and nowwe're feeling the punch Yes. And
I think, honestly, when thevaccine first came out, it was
very compelling to get thevaccine. I remember people were
racing to the front of the lineto get it because the data
looked so good. It was soconvincing. And at that time,
COVID was it was dominating ourlives in terms of what we could
(09:55):
do, what we couldn't do, and itwas so exciting to look and see
that there was a possible end insome.
Right? But when it came to thechildren, I feel like by the
time the vaccine was actuallyavailable and approved for kids,
that's when I think it got alittle tricky, because many of
the kids by that time hadalready had the illness, so they
had pre existing immunity. Wecould tell by that time that
(10:17):
kids were not gettinghospitalized from COVID. By and
large, the rates weresignificantly lower for kids,
and the data wasn't clear thatit was going to keep kids out of
the hospital. So I was verysympathetic to parents that
wanted to get the vaccine, and Iwas very sympathetic to parents
that that had questions aboutgetting the vaccine, especially
when it was mandated. You know,I think firstly, national
(10:37):
infection protects, and I thinkvery early on in remember, we
met, there was a group of usthat met in February of 2022
to determine whether or not wethought that natural infection
should count as a vaccine.
Because, you know, people werebeing mandated to get a vaccine,
and they were saying, Look, I'vealready been infected. I think
I'm protected. And they'reright. They were. And I really
(10:58):
wish early on, we had made thatclear that if you'd been
naturally infected that you didneed to get a vaccine. Some
people were mandated to get avaccine for work and were fired
even though they had a naturaleffect. This was not fair.
Children who were certainly hadbeen naturally infected didn't
need to be vaccinated, but ifyou hadn't been vaccinated as a
child, I still feel this way,that if you haven't been
vaccinated as a child, youshould get a vaccine. I don't
(11:20):
think that everyone needs ayearly vaccine. I think that the
yearly vaccine really should betargeted to those who are most
likely to be hospitalized andmost likely to go to the ICU and
most likely to die, which isreally what most countries do.
It's really only us in Canadathat has a recommendation for
everyone over six months of age.
And I agree with all those othercountries, you know, Western
Europe, Scandinavian countries.
World Health OrganizationAustralia really vaccinates high
(11:42):
risk groups for with the COVIDvaccine on a yearly basis. Yes,
and I know that for the last twoseasons where the COVID 19
vaccine was offered to children,well developed countries such as
Sweden, Australia, the UK,Germany, they did not recommend
the vaccine for children 12years of age and older, and I
have not read that children inthe United States have been any
(12:04):
better off, even though we dorecommend the vaccine for kids
12 and younger, people over 75and I just had a birthday
yesterday, but I'm not over 75yet, but I am getting closer and
or people who have high riskmedical conditions, certainly,
obesity is A high risk medicalcondition, diabetes, chronic
lung, liver, heart disease. Imean, so there are certainly
high risk groups, and those arethe groups that I think should
(12:27):
pay special attention to. But tovaccinate a healthy 18 year old
who's already been vaccinated ornaturally infected, or both, I
think doesn't make a lot ofsense. I think it's Low risk,
low reward. I think you protectyourself for three to six months
against mild to moderatedisease, and that's pretty much
what you get. Yes, no. Andthat's what I so appreciate
about you, is that you leavespace for nuance. Because I feel
like during the time when COVIDwas dominating the news, when it
(12:48):
was all everyone was thinkingabout and talking about, there
wasn't any room for nuance. Andso like you're mentioning having
had the illness didn't count forhaving had a vaccine. And I
think a lot of people got turnedoff from public health
recommendations, and whatbothered me about it is I was
worried that it would lead to amistrust and what we are
recommending. No, I agree. Ithink, I think that the public
(13:10):
health community saw a nuancedmessage as a garbled message,
and they thought it would besimpler to understand vaccinate
everybody, because then thosewho are most at risk would be
most likely to get vaccinated.
But I don't think that wasright. I think it's okay to
trust the American public thatthis is who we think is most at
risk and leave it at that. Iagree with you. I always think
(13:31):
about the term in psychology,control, resist, that when
people feel like they're toocontrolled, they actually push
back and resist. And I see it alot in my office with toddlers,
when we're potty training them,when they feel forced to potty
train, they go the other way.
They don't want anything to dowith it. You know, there's so
many examples that I can thinkof with humans, where if you
push them too much, itbackfires. And I think it's so
(13:53):
much better. And I know this isme thinking ideologically, but
if you can convince them thatit's the right thing to do, that
it really is the best thing forthem, with good data, with good
information, I just think, tome, that feels better. I agree,
I think. And I think if there'sany chance that we're going to
get the public stress, we dohave to try and explain the best
(14:15):
we can why we're making thesedecisions. You know, I think
that was lost in many waysduring the COVID pandemic. I
think a lot of those decisionsthat were being discussed behind
closed doors should have beenopen to the public. And for this
reason that you'll do is you'llsee people disagreeing. You'll
see some people saying, look, Ithink we should do it this way,
and some the other way. And Ithink the fear about that was
(14:35):
that people would think, allright, these people don't know
what they're doing. I mean, theyjust can't even agree on these
things, but, but that's the wayscience works. I mean, you're
always should hold the sciencebehind a particular public
health policy to the higheststandard possible, and open that
up to the open that discussionof the public. I mean, I'm on
the FDA vaccine AdvisoryCommittee, and have been since
2017and there was debate about the
(14:56):
bivalent vaccine. I mean, Ivoted no.
On that vaccine in June of 2022because I didn't think the data
were showed it was any betterthan what we already had. And
you notice, that was the lasttime we ever used a bivalent
vaccine, the sort of half doseof Omicron and half dose of the
ancestral strain. Because itwasn't worse than what we have
it. It was no better than whatwe had. And I think Nonetheless,
(15:17):
when it's rolled out, you know,everybody felt compelled to say,
look, now it contains Omicron.
Now it's clearly better when itreally wasn't. And it was a
little hard to watch that. I'mjust so curious, did you take
heat for that, for your stance?
There were people in the publichealth community that were very
angry with me because they feltthat I had broken from the
ranks, but and that people willsee us disagreeing will make
(15:38):
them trust us even less. And I'msure that is true for a certain
group of people, but I justthink stick to the science, at
least as you know it, and tryand explain it, realizing that
during this pandemic, we werebuilding the plane while it was
in the air, that we were goingto be making mistakes, and we
did, and just own up to them andmove forward knowing that you
are going to upset people. Iactually feel the opposite. I
(16:00):
think, when you are honest withthe public, when you do say what
you're finding, what you'renoticing, and you evolve as the
data evolves, I think thatengenders trust. I hope you're
right. I always feel like it'sthe tyranny of transparency. At
some level, there are somepeople go, these people don't
know what the hell they'redoing. I hope you're right.
That's sort of my philosophy isjust, it's just so much easier
(16:20):
frankly. I mean, first of all, Icannot, personally ever
represent something as sayingit's better when I don't think
it is. So that's also mytraining. Is really a scientific
training. So in science andbasic science, when I spent 26
years of my life, you know,trying to understand which
proteins on rotavirus evokeneutralizing antibodies, and I
think, and so you go toscientific meetings, and what
would happen in a scientificmeeting is you would you would
(16:42):
present your data, and you wouldreach a conclusion, and people
would would either agree ordisagree. They would say, Look,
your data don't allow you toreach that conclusion, and
here's why, and you wanted thatfeedback, because that's the
only way your science gotbetter. So that's really how I
see public health, but it's alittle different, I think, in
the public health rule, yes, andI think now we live at such a
different time now with socialmedia and YouTube and
(17:05):
information was dispersing soquickly, so fast, and I think a
lot of the public felt like, youknow, we were not being
forthright with all theinformation that we were
finding, like myocarditis andthe teen boys. Well, why are we
still recommending the COVIDvaccine to teenage boys when
there was that possible risk.
And I think,you know, I What made me nervous
about not having those nuancedconversations? Would we see
(17:27):
pushback because of it in thefuture? And so I'm hoping to
have good conversations that wecan swing back the other
direction. You know, I think wecertainly democratize was a
surprise, I mean, but the goodnews is, we have safety systems
in place, like the vaccinesafety data link, which actually
very quickly picked that up. Butyou know, myocarditis is also a
(17:47):
consequence of the disease, andwe the so called multi system
inflammatory disease. 50 to 75%of those kids had severe
myocarditis, where you wouldsome of those kids ended up in
the ICU, and there were deaths.
So it's not, again, a choice notto get a vaccine. It's never a
risk free choice, and I justthink it's a matter of making
people get them to understandthe risks of both choices. Yes,
(18:08):
I completely agree with you. Ithink the vaccine suffered from
a lot of things. It sufferedfrom the fact that it was a
genetic vaccine. We'd never donethat before, but I think when
people hear the word gene, theythink this could somehow alter
their genes, even though that'snot possible, but that was part
of it. The other thing is,because operation there was some
bad terminology, I thinkoperation wars a bad
(18:29):
terminology, even for Star Warsfans, and you realize that that
was faster than the speed oflight. That was actually Peter
marks at the Center forBiological Evaluation and
Research. Was a Star Wars fan.
So he came up with Operationwarp speed, which made it sound
like this is made way tooquickly. That's the way it
sounds. But the hero of thispandemic, to me, which which
never got recognized, was aNational Institute of Health. I
(18:50):
mean, they were funding mRNAvaccine research, really
beginning in 1997 so by the timeSARS COVID Two rolled in, COVID
rolled in, we had had 25 yearsof research on that kind of
vaccine, and that never gotexplained. People just thought
this vaccine was made in 11months. I mean, that's way too
quickly. Now, do you feel like alot of the medical community has
come around to agree with youryour perspective on the
(19:13):
vaccination, with regard to notnecessarily needing to vaccinate
everyone every year? Yes, yes tohaving some nuance to who who
would benefit from the vaccine,high risk groups, those who've
never been vaccinated. Yeah, thepublic has certainly voted that
way. I think they, they thosewho are more likely to be at
highest risk are more likely toget a vaccine. So I think that's
the way it's it's settled out.
(19:35):
Do I think most people in thepublic health community have
done that? Don't know. Yeah, itwas interesting to me. I just
read that less than 20% ofchildren actually got the COVID
19 booster this year. So I thinkyou're right. The public is
voting that way. What worries meis that children less than five
are in a highly unvaccinatedgroup. I mean, they're I think
their vaccination rates is like5% and who comes into the
emergency department, includingour emergency department, about
(19:57):
5% of our visits to theemergency.
Department are children lessthan five who have COVID, not
severe COVID, but COVIDnonetheless. And it's it is a
preventable illness, because youdon't want them to get severe
disease. Okay, so now I want topivot this to asking you how we
should respond to parents whenthey have concerns about
vaccines. A lot of the sameconcerns come up to us
(20:19):
pediatricians that I think aregood questions, and I'm just
curious how you would respond toeducate hesitant parents. Well,
that concludes part one with DrPaul Offit. I felt so lucky to
have him on the podcast. He's anincredible physician educator
and overall advocate forchildren's health. Be sure and
tune in to next week for parttwo, where we talk about the
most common questions that Ihear from parents like, Do kids
(20:42):
really need so many shots soearly? What's in these vaccines,
and what about spacing them out?
If this episode was helpful,please share it with a friend.
Leave a review or subscribe.
Your support really helpsparents find the show. See you
next week. You.
Popular Podcasts
Are You A Charlotte?
In 1997, actress Kristin Davis’ life was forever changed when she took on the role of Charlotte York in Sex and the City. As we watched Carrie, Samantha, Miranda and Charlotte navigate relationships in NYC, the show helped push once unacceptable conversation topics out of the shadows and altered the narrative around women and sex. We all saw ourselves in them as they searched for fulfillment in life, sex and friendships. Now, Kristin Davis wants to connect with you, the fans, and share untold stories and all the behind the scenes. Together, with Kristin and special guests, what will begin with Sex and the City will evolve into talks about themes that are still so relevant today. "Are you a Charlotte?" is much more than just rewatching this beloved show, it brings the past and the present together as we talk with heart, humor and of course some optimism.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com