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