0:00

I am one of the increasingly rare old

0:02

timers who lived during the pre vaccination

0:04

era. I am the second to

0:07

the last of thirteen siblings, five

0:09

of whom died of vaccine preventable

0:11

diseases in infancy, born

0:14

to poor immigrant parents. I remember

0:16

well my mother's account of the causes

0:18

of their deaths, three from pertussis

0:21

and two from measles. Even

0:23

after many years had passed, she spoke

0:25

of the death of her angels with a great deal

0:27

of emotion. Imagine

0:30

losing not one, two, three,

0:33

or four, but five babies.

0:36

It was common in the pre vaccine era. Like

0:39

our family, many families lost

0:41

several children to these diseases. We

0:44

forget time blurs are memories

0:47

of these common tragedies of yesteryear.

0:50

I remember well, during the winter and spring

0:52

of each year, hearing the whoop of

0:54

pertussis in movie theaters, school assemblies,

0:57

and assorted gatherings. Today

0:59

have ever heard this, and those who

1:01

have forget. I

1:04

remember the summer outbreaks of polio, the

1:06

crippled children who could no longer walk,

1:08

or walked with limb distorted limps. As

1:11

a third and fourth year medical student, I

1:13

remember answering the appeals of hospital

1:15

administrators who could not find the nursing

1:18

staff for special duty tending to the needs

1:20

of polio patients in iron lungs.

1:23

We forget.

1:24

I remember the awful cases of

1:27

measles my own children experienced.

1:29

I remember the children with smallpox during

1:32

the years my family lived in Pakistan. I

1:34

remember those who lost their sight from

1:36

lesions in their eyes. I remember

1:39

those who died. We forget.

2:31

It's just such an incredibly powerful

2:34

letter.

2:34

Yes, this is, I mean, this

2:37

is the second time that we have included

2:40

this first hand account. The first time was in our one

2:42

of our vaccines episodes back in

2:45

eighteen.

2:46

Yeah, and it is.

2:48

It has stuck with me so much, shame

2:51

same because it is such a powerful

2:53

personal story of what

2:56

we have gained and what we stand

2:58

to loose.

2:59

Right actly.

3:01

This was a letter from EJ. Gene

3:03

Gangorosa to the Immunization

3:05

Action Coalition.

3:07

Uh.

3:07

They were a professor emeritus from Emory University

3:10

and wrote that letter all the way back in the year two thousand.

3:13

Yeah, and it's still so relevant

3:15

today.

3:15

It is and such just an important

3:18

piece of sort of that like

3:21

living memory that that we do

3:23

we forget yep.

3:24

Yeah, and we have to we have to remember.

3:27

Yeah, Hi, I'm.

3:29

Aaron Welsh and I'm Erin Allman Updyke.

3:31

And this is this podcast will kill you.

3:34

It sure is, and we're the

3:36

second part as our best.

3:39

Yes. Yeah, So last week

3:41

we took you through just a refresher course

3:43

on vaccines, how they worked, and then we did

3:45

a very quick tour through each of the diseases,

3:48

the many diseases that these

3:50

vaccines protect us from.

3:52

We call it quick.

3:52

We called it quick. Yep.

3:55

We closed out that episode with

3:57

a big picture of view of why vaccination

3:59

is so very important, not just

4:01

at the individual level, not just for yourself,

4:04

for your kids, but also to protect our

4:06

communities. Vaccines are

4:08

truly one of science's greatest

4:10

achievements, and as our firsthand

4:13

just demonstrated, there are increasingly

4:15

fewer of us who know what it's like to live

4:17

in a world without vaccines. And

4:20

the amazing thing is that we don't have

4:22

to.

4:23

Write we have these incredible

4:25

vaccines, and even better, we have

4:28

highly knowledgeable, well trained scientists

4:31

who consider all the aspects

4:33

of the data that we have to

4:36

tell us which vaccines we should take

4:38

and win.

4:39

That's right, everyone, Today we're talking

4:42

about the ACIP.

4:44

Yes, Advisory Committee on Immanization

4:47

Practices here in the US YEP.

4:49

In this episode today, we're going to

4:51

talk so much more about the ACIP.

4:53

We're going to talk about.

4:54

How we came to have our childhood

4:56

vaccine schedule that we do have today,

4:59

what goes in to making it, and where

5:01

things stand with vaccine preventable illness

5:04

around the world today, Because despite

5:06

the existence of safe and effective vaccines,

5:09

we are still seeing outbreaks

5:11

of diseases like measles, like

5:13

whooping cough, like rebella, diseases

5:16

that can seriously injure or even

5:18

kill those who get it.

5:19

Yeah, a lot of these outbreaks

5:21

are happening in regions of the world that lack

5:23

access to vaccines or lack the infrastructure

5:26

to deliver vaccines to everybody who needs

5:28

them. And undoubtedly we'll be

5:30

seeing more and more of these outbreaks

5:32

and preventable death and suffering due

5:35

to the attacks and dismantling of USAID,

5:38

which is a huge problem. But some

5:40

of these outbreaks, especially in high income countries

5:43

like the US, are directly attributable

5:45

to the rise in vaccine hesitancy

5:47

and declining vaccination coverage.

5:50

Vaccine hesitancy is one

5:52

of the biggest threats to global

5:54

health, and it's not something that's just

5:56

going to go away on its own. It

5:59

needs to be directly addressed in

6:01

every possible way, at every

6:03

possible level. And in

6:05

this regard, all of us

6:07

can truly make a difference. And so we

6:10

really can. And that's what we want to round

6:12

out this episode with. It's just going through

6:14

some evidence based methods. We love

6:17

evidence still, evidence based things

6:20

for having conversations with those

6:22

who might be wary of vaccines.

6:24

We've got a lot to go through. So should

6:27

we start with quanquarantine time?

6:29

We should?

6:32

What are we drinking this week? We're still drinking

6:34

Boosted.

6:35

We are still drinking getting in

6:37

those booster shots.

6:39

Yeah it is. It's

6:41

delicious. It's got gin and

6:44

raspberries and lemonade. And

6:46

we'll post the full recipe for Boosted

6:49

the Quarantine as well as our alcohol

6:51

free plas sy Barrita on our website

6:53

This Podcast will Kill You dot Com, as well as on

6:55

all of our social media channels, so make sure you're following

6:58

us.

6:58

Make sure you are and on

7:01

our website This Podcast will Kill You dot Com,

7:03

you can find just so many incredible things that you'd

7:05

love to find we've got merch We've got transcripts

7:08

from all of our episodes. We've got a link to a

7:10

Goodreads account and a bookshop dot org affiliate

7:12

account. We've got our music from Bloodmobile.

7:15

We've got sources for

7:17

evidence from all of our

7:20

episodes, including this one.

7:22

So many sources.

7:22

We've got to contact us form. We've got a first hand

7:25

account form if you'd like to submit your first hand

7:27

account. Just

7:29

so much there there, There's

7:31

a lot, there really is, And

7:34

if you haven't already, we would

7:36

love to encourage you to rate,

7:39

review, and subscribe

7:42

so that you don't miss any of our things. And because

7:44

it does really help us when other

7:46

people can find our work.

7:47

We like taking this podcast.

7:49

It does. We appreciate it. Uh,

7:52

are we ready?

7:53

I think so?

7:54

Should I take a quick break? And then Aaron walk

7:56

us through the history of

7:58

the ACP.

7:59

I'm really excited I did.

8:00

To learn about this. Oh.

8:02

I really had a really fun

8:04

time digging into the details. So yeah,

8:06

let's just take a quick break so we can get right to it. Okay,

8:23

what goes into creating a vaccine

8:25

schedule? Like why do we have the one

8:27

that we do here in the US, and who

8:29

decides that.

8:30

Such a good question, right.

8:33

Vaccine schedules are different in different countries,

8:35

and they take into account things

8:37

like how prevalent a certain diseases and

8:40

how much of a threat it poses, and so

8:42

that explains why some of high risk

8:44

countries use the BCG vaccine

8:47

for tuberculosis, for instance, and others might

8:49

not use that vaccine or include it in routine immunizations.

8:53

In the US, the federal body

8:55

that makes decisions about which vaccines

8:57

to recommend, at what ages, and

8:59

how many doses is the Advisory

9:01

Committee on Ammunisation Practices the ACIP.

9:05

This committee is made of up to nineteen

9:07

voting members who vote on vaccine

9:10

recommendations, and they include independent

9:12

medical and public health experts who

9:15

do not work at the CDC, as well

9:17

as one consumer representative. This

9:20

is a volunteer position and

9:22

members serve staggered four year

9:24

terms. Prospective members

9:27

have to apply and then they have to undergo the

9:29

screening process that includes things

9:31

like disclosing conflicts of interest and

9:33

this is like routinely done and maintained

9:36

that's fairly important. Ultimately,

9:39

they are selected by the Secretary

9:41

of Health and Human Services, who

9:43

at the time of recording is

9:46

RFK junior, who, as probably

9:49

most people are aware, has a long and

9:51

vocal history promoting anti

9:53

vaccine propaganda, including

9:55

during a measle's outbreak in Samoa

9:58

that led to the deaths of ai eighty three

10:00

children, mostly under the age of five.

10:03

Yep, and they he ultimately

10:05

is going to be choosing who

10:07

sits on ACIP.

10:10

Yeah, and so I will say

10:12

that, like there are there

10:14

are a certain number of people

10:16

right now whose terms will be

10:19

up, and so it might not be I mean unless ACIP

10:21

gets completely dismantled.

10:23

Whole right, can

10:25

of worms arn questions.

10:26

As to like how much damage can someone

10:29

do who has mal intent?

10:31

I would hope that there are stop gaps in place.

10:33

But tell me more, Aaron.

10:35

Yes, yes, Okay.

10:36

So the ACIP Charter, which

10:38

allows for its continued functioning, has

10:40

to be renewed and approved every two

10:42

years by the Department of Health and Human Services.

10:45

Okay, Okay.

10:46

Currently there are fifteen members

10:48

active members on this committee, with

10:51

four whose terms are up.

10:52

In twenty twenty five.

10:53

Okay, okay, So in theory,

10:55

in twenty twenty five he could replace four people.

10:57

Okay.

10:59

There are other non voting members

11:01

of this committee who represent other federal institutions

11:03

such as the Centers for Medicare and Medicaid

11:05

Services and the Indian Health Service, as

11:08

well as organizations like the American Academy

11:10

of Pediatrics and the National Foundation

11:13

for Infectious Diseases and many

11:15

others.

11:15

Yeah.

11:16

Yeah, ACIP meets

11:18

three times a year, three times a year.

11:20

Three times a year. Yeah, more

11:23

than I anticipated.

11:24

I know. It is. It's it's

11:27

a lot.

11:27

They're constantly viewing

11:30

data and voting on recommendations. Like this

11:32

is a con because things happen. Things have moved

11:35

very quickly in medicine.

11:36

Yeah.

11:36

Well, and it's so low at the same time, exactly.

11:39

Yeah, but like to keep up to date.

11:40

This is not just like oh, let's you know, dust

11:43

off the piles of data. It's like constant

11:45

regilance.

11:46

Okay, awesome.

11:47

Yeah.

11:48

So there was a meeting scheduled for February

11:51

twenty six to twenty eighth of this year, and

11:53

it was postponed. Ok And there has been,

11:56

as of the time of recording, no updated meeting

11:59

date. And maybe

12:01

maybe it will get rescheduled,

12:03

maybe it won't, but you

12:06

should know that if it does

12:08

get rescheduled, and if any one of the

12:10

subsequent meetings do take place

12:12

that I want everyone to know that there are opportunities,

12:15

at least at this point in time, to

12:17

submit public comments, Okay, and.

12:19

Like, well we can do we can.

12:21

Yes, We'll link to the page

12:24

that has more info on this. But in the past,

12:26

the public was able to submit a written comment

12:28

and request to make an oral public comment

12:30

during the meeting. So there are written comments that you can make,

12:33

and you could also request to make an oral comment

12:35

during the meeting itself.

12:36

Awesome, right, So.

12:38

This is an opportunity for all of us to demonstrate

12:41

how much vaccines mean to us,

12:43

right writing, our health, our safety,

12:46

our freedom.

12:46

We love them, Thank you love them, Please

12:49

take them most yeap.

12:51

If the February meeting does not

12:53

get rescheduled, there will be another

12:56

one, maybe, I guess June

12:58

twenty sixth, June twenty fifth, twenty

13:00

six Okay, okay, So what

13:03

is what is the ACIP looking

13:05

for precisely during these meetings?

13:07

Right? What do they do?

13:08

Right?

13:08

So, broadly speaking, they consider quote,

13:11

disease epidemiology and burden of disease,

13:14

vaccine efficacy and effectiveness, vaccine

13:17

safety, economic analyzes,

13:19

and implementation issues. Okay,

13:21

so a whole lot of different things like all.

13:23

Of the different thing picture that you could think

13:26

of when it comes to vaccines, the disease itself,

13:28

how good the vaccines works, the economics of it

13:30

all makes sense.

13:32

Yeah, yeah, And so this is what

13:34

they are looking at. These are the types

13:36

of questions that they're looking at. Now, what are they voting

13:38

on? Right, So they are voting

13:40

on They vote on final recommendations.

13:43

Right at the end of this are recommendations

13:46

and they include quote, the number

13:48

of doses of each vaccine, timing

13:50

between each dose, the age

13:53

when infants and children should receive the vaccine,

13:55

and precautions and contraindications.

13:58

So who should not.

13:59

Receive the vact scene Okay, that's what

14:01

they vote on. And these are just recommendations,

14:04

recommendations. It is then the CDC

14:06

who has to decide whether or not they adopt the recommendations

14:09

from ACIP right, right. And then

14:11

there's also like the American Academy of Pediatrics

14:14

also decides what to incorporate.

14:15

It's like there are a lot of the thing is this

14:17

is.

14:17

A constant conversation, right that is

14:20

going on, and there is one

14:22

shared goal, which is to

14:24

how.

14:24

To best ensure the health

14:27

of the public.

14:28

The public that's that

14:30

is the goal public health. How about that.

14:32

That's the goal.

14:34

So the acip is not a new committee.

14:37

It was first organized in nineteen sixty

14:39

four, and at the time of its first

14:41

meeting, the only organization that was

14:43

making recommendations on vaccines

14:45

in the US was the American Academy

14:47

of Pediatrics Committee on Infectious

14:50

Diseases, and their recommendations

14:52

were included in a publication called the Red

14:54

Book, which you I

14:56

know, you know the Red Book. Many people out

14:58

there may have heard of it and still exists to It's a

15:00

really important resource for physicians

15:02

as well as the icip Like these,

15:05

these recommendations that are included

15:07

in the Red Book are also considered by the ACIPKA.

15:11

At the time of the first Red Book, which

15:13

was nineteen thirty eight, the included

15:15

recommendations were fairly limited. Part

15:18

of the reason for this was because there were far

15:20

fewer vaccines available than there are today.

15:23

So the only ones that they officially recommended

15:25

in terms of the timing for when

15:27

a child should receive them were

15:29

smallpox. Of course, before it was eradicated.

15:32

Diphtheria tetanus pertussis

15:35

also known as whooping cough, typhoid fever

15:38

vericella and tuberculosis. Okay,

15:40

so I mean compare

15:42

that to what we went through yesterday. We have

15:45

lot and so so many more.

15:47

I just don't We don't include typhoid fever regularly,

15:50

or smallpox obviously, or smallpox of course.

15:52

Yeah.

15:52

It's so interesting too, though, that they had versella

15:55

back then, because then we didn't have it

15:57

for so long.

15:58

It's just so interesting.

16:00

I have so many questions, I know, and

16:02

we may have even touched on that in our veracell.

16:04

We probably did, you know, I don't remember

16:07

things same.

16:09

But then the introduction of the polio vaccine

16:12

in nineteen fifty three the prompted

16:14

passage of the Polio Vaccination Act a

16:16

couple of years later, and then this provided

16:18

funds to what was then the Communicable Diseases

16:21

Center later became known as the CDC,

16:23

and this helped states buy and distribute

16:26

polio vaccines. But there was still

16:28

no formal process for the federal government

16:31

to make recommendations for vaccines

16:33

and the timing of vaccinations at a national

16:36

level. Vaccines were recommended

16:38

for licensing at the federal level, like by the

16:40

Surgeon General. They would say, okay, yes, this, we

16:42

recommend this for licensing prove

16:45

but mostly the government was focused on vaccines

16:48

only as far as the military was concerned,

16:50

got it tracking efficacy

16:52

and outbreaks and so on. So it

16:54

was like that is where the data collection was, That's

16:57

where the decision making was.

16:58

That was the main intro.

17:00

That makes sense, It makes your protecting assets

17:02

in that case.

17:05

Sorry, and I think especially the timing

17:08

close to World War two and

17:10

then Korea. Yeah, so there was like a lot of

17:13

that. Yeah, there was context

17:15

for that. But then

17:18

the polio vaccine was came out in

17:20

nineteen fifty two, nineteen fifty three, and

17:22

then the Musles vaccine ten years later in nineteen

17:24

sixty three. It was clear that there was a

17:26

need for a national immunization policy,

17:30

especially with two more vaccines

17:32

MOMPS and rubella on the horizon for

17:34

the rest of the nineteen sixties, Like they were like

17:36

clearly, you know, there was most something. It

17:39

was, yeah, these things were going to happen. Yeah,

17:41

And so things really got started with the Vaccination

17:44

Assistance Act in nineteen sixty two,

17:46

and this provided support for mass vaccination

17:49

campaigns, especially targeting school

17:51

aged children, which is where most

17:53

of the spread and harm from these diseases

17:55

was concentrated, and ultimately

17:58

it led to the formation of the ACI in

18:00

nineteen sixty four. So like, instead of having

18:03

one meeting for measles and one meeting for polio

18:05

and one meeting for this, it.

18:06

Was like, why don't we just do them all at once?

18:08

Do this all at once?

18:09

Yeah?

18:10

Efficiency? How about that?

18:14

I can't.

18:15

I'm sorry.

18:15

I was going to make like a government efficiency

18:17

joke, but I because it's too real,

18:20

too close.

18:21

Yeah, yeah, I know.

18:24

At the first meeting, the committee considered measles,

18:26

influenza, rubella, and

18:28

smallpox vaccines for recommendation.

18:31

I think there was still at this point a separate committee for

18:33

polio. Okay, But since the beginning,

18:36

the ACIP has worked closely with professional

18:38

organizations like the American Academy of Pediatrics,

18:41

the American Academy of Family Physicians,

18:43

the American College of Ctatricians

18:46

and Gynecologists, and others. Together,

18:49

the ACIP and all of these organizations,

18:52

both federal and professional, carefully evaluate

18:55

all of the available data to make

18:57

recommendations on how to best protect

18:59

the health of Americans.

19:01

Yeah.

19:01

Again, that is the goal.

19:03

That is the goal.

19:04

That is the goal.

19:05

So what does this look like in practice and

19:07

I want to share a real life example of

19:09

how one of these recommendations is made and what

19:12

information is considered when weighing whether

19:14

or not to change a recommendation.

19:15

Okay, so let's talk about measles.

19:17

It is timely. Yeah, unfortunately

19:20

timely topic.

19:22

So since the introduction of the first measles

19:24

vaccine in nineteen sixty three, researchers

19:27

have developed new versions of the vaccine,

19:30

each of which has been and continues

19:32

to be evaluated for safety,

19:34

efficacy, ease of administration, and

19:37

so on. So like live versus

19:39

killed with or without certain adjuvants

19:42

in a combo shot or solo, the

19:44

timing for the best immune stimulation, like

19:46

all those sorts of things are considered

19:48

for each of these vaccines regularly,

19:51

continuously, and on occasion,

19:53

the ACIP has changed their recommendation

19:56

for which measles vaccine to include, such

19:58

as in nineteen sixty eight when they changed

20:00

the recommendation from the less attenuated

20:03

vaccine, which was the Edmonston B strain,

20:06

to one that was based on a more attenuated

20:08

strain, the Moratin vaccine. The

20:10

Moratin vaccine, the more attenuated

20:13

strain, was as effective as

20:15

the previous vaccine, but it produced fewer side

20:17

effects, right.

20:18

So it was like an even weaker version

20:20

of a measles virus compared to an older

20:23

vaccine, but it protected you just as

20:25

well, had fewer side effects, so that.

20:29

They also revisited what

20:31

age to give the vaccine. So initially

20:33

their recommendation was nine months of age,

20:36

and then that changed to twelve months and then fifteen

20:38

months. And the reason for these

20:40

changes was not about safety,

20:43

but more about efficacy because

20:45

researchers had found that babies that were

20:47

vaccinated earlier tended to lose immunity

20:49

a bit more than if they were vaccinated

20:51

later. It's probably due to maternal antibodies

20:54

circulating.

20:54

Yeah, or just like you know, babies

20:57

in their weird immune systems.

20:58

Right exactly.

20:59

These are things that they that they will look at monitoring.

21:02

They were looking out for, yeah.

21:04

Because of basic scientific research that

21:06

was going on in clinical research that's going on

21:08

where people are actually like testing

21:11

people who get these vaccines for their antibody

21:13

response, for example, and then collecting

21:15

and gathering off that data.

21:16

And connecting that to epidemiological research

21:19

that was monitoring outbreaks and

21:21

in what ages and what birth cohorts

21:24

and all of these different Yeah, all of these different

21:26

things.

21:26

All of this amazing research.

21:28

Yep, yes, yeah, okay,

21:32

okay, But starting

21:34

in nineteen sixty three, the ACIP

21:37

had recommended only one dose of

21:39

the measles vaccine, or later a

21:41

few years later, when mumps and rubella came

21:43

along MMRKA, they had

21:45

recommended one dose, just one dose. And

21:48

this is of course different from the two

21:50

shot series that we get today that

21:52

we discussed last week. How

21:55

did one shot become to outbreaks?

21:59

Within the first five years of

22:01

the measles vaccine, incidents

22:04

of the infection had dropped to five

22:06

percent of pre vaccine levels within

22:08

five years, within five

22:11

wow years.

22:12

Yeah.

22:13

With this incredible success, measles elimination

22:15

in North America seemed like.

22:16

A very achievable goal.

22:18

Yeah, yep, I mean like

22:20

really, like first it was like a pipe dream, and that it was

22:22

like, oh wait, actually.

22:23

Wow, we couldn't do this thing, reasonable

22:26

dream? Yeah okay. And even

22:28

as progress towards this goal.

22:30

Was made, a few outbreaks in the late nineteen

22:32

seventies and into the nineteen eighties slowed

22:34

that progress, but they also

22:36

provided an opportunity to ask how

22:39

was measles spreading?

22:41

Right?

22:41

Who was getting the infection. Was it teenagers,

22:44

was it young kids? Had they been vaccinated

22:46

before? And what the CDC

22:49

found was that those who were involved

22:51

in the outbreaks were often either unvaccinated

22:54

children under five years old or

22:57

older children such as high school and

22:59

college student who had been

23:01

vaccinated but only once, only

23:04

with one dose. And that was again

23:06

the recommendation at the time, and there

23:08

had been some debate about whether to include

23:11

a second dose. This was, you know, kind of brought

23:13

up at different meetings, and it was this trade

23:16

off, this weighing, well what are we actually getting

23:19

with that second dose of the vaccine, And

23:21

up until this point, up until

23:23

the late well nineteen eighty the late nineteen

23:25

eighties, really the decision

23:28

seemed to fall on, well, one dose is probably

23:30

enough. One dose protects you, Like I think you said

23:32

erin last week, three ninety three percent, Do

23:35

we really need that extra four to five percent?

23:39

Turns out, what these outbreaks showed us

23:41

is that yes, we do, especially

23:44

when having that extra four

23:46

to five percent protects those who are

23:48

vulnerable who cannot be vaccinated.

23:51

Right.

23:51

And so there

23:54

was an outbreak in nineteen eighty nine that

23:56

led to a twenty percent hospitalization.

23:59

Rate, which is what we pretty common.

24:00

I've seen I've seen today and one

24:03

hundred deaths. And this

24:05

really demonstrated that waning immunity

24:07

or under vaccination could have dire consequences

24:10

for those who are too young to be vaccinated.

24:13

So in nineteen eighty nine, both the ACIP

24:15

and the AAP the American Academy

24:18

of Pediatrics changed their recommendation

24:20

to include two doses of MMR

24:23

for all children, and that decision

24:25

is what helped to eliminate measles

24:28

entirely from the US in two thousand,

24:30

yeah, and the Western hemisphere in twenty sixteen.

24:32

I mean, yeah,

24:36

that's so interesting too, just in the context

24:38

of like the biology of measles, right, because you need

24:40

such high vaccination coverage

24:43

to be able to achieve herd immunity and protect

24:45

everyone around you. So it makes sense that

24:47

a second dose, where now you're getting ninety

24:50

seven percent efficacy in

24:52

like lifelong at a bodies,

24:55

that that is what's going to allow you to achieve

24:57

herd immunity rather than a ninety three

25:00

percent. And yeah,

25:03

how interesting and cool, Aaron.

25:05

It was such an enlightening like

25:08

exercise to go through, like what does

25:10

this look like? We know that they're making decisions.

25:12

We know that they're considering all of these different things,

25:14

but like, how does new

25:17

data influence a

25:19

recommendation?

25:20

Yeah, like walking an example of

25:22

that, it was yeah, yeah,

25:24

because it's something we don't think about. We're just like, oh, here's

25:26

the schedule.

25:27

And you're like okay, but like what who and why

25:29

and how did you come up?

25:30

Why do we need four doses of tea DAP

25:32

and then a booster and because that's

25:34

what the data says we need.

25:36

What that's I mean,

25:38

evidence based, evidence based

25:40

medicine.

25:41

Is that interesting?

25:43

Which? Yeah?

25:44

I mean?

25:44

And then they change their recommendations on adults

25:46

getting like a pretess's booster a

25:48

tea DAP rather than just a TD a

25:50

few years back because of circulating protessis

25:52

I mean science?

25:54

Science changes by design? It doesn't. It's

25:56

like right, like this is part

25:58

of what.

25:58

Science is, Why why

26:00

science works is because we evaluate

26:04

and consider.

26:05

And consider and then change recommendations.

26:08

And chased on that on

26:11

that these are not arbitrary

26:13

decisions. Like that's the message that

26:15

we really wanted to get across. The

26:17

ACIP takes an evidence based

26:20

approach that weighs many

26:22

different factors to come to a final recommendation.

26:25

There is data and reason and

26:28

logic and evidence backing

26:30

up each one of these recommendations,

26:33

such as timing when to get the first

26:36

dose of a vaccine. This is determined

26:38

by the disease itself and when a child might

26:40

be at highest risk for an exposure to

26:42

the disease, is at high

26:44

risk for complications from the disease, and

26:46

also how well they're going to respond

26:49

to the vaccine in terms of are they going

26:51

to mount an adequate immune response that will

26:53

protect them long term, Like we talked about

26:55

with maternal antibodies sort of circulating

26:58

in baby for a while after birth, so that vaccines

27:00

don't induce this long term immunity.

27:02

Right, Typically, it

27:05

is recommended that a child gets a vaccine

27:07

as soon as possible. Multiple doses

27:09

are determined by how well one dose

27:11

induces an immune response. Some vaccines

27:14

need too to create long lasting immunity.

27:17

Others like t DAP or DETAP

27:19

require periodic boosters. FLU

27:21

of course as annual and I

27:23

can understand that it feels like there are a million

27:26

vaccines and a million jobs, but each one

27:28

of these vaccines is so critical

27:31

and combo shots like MMR and

27:33

T DAP helped to cut down on the number

27:35

of jabs that your kid gets.

27:38

I love combo vaccine combo,

27:40

but even each one of the combo vaccines

27:42

has to be studied and tested in

27:44

all the different age groups and in all the

27:46

different scenarios, which is why some

27:49

are used for some age groups and not

27:51

others. Like the MMR vercella vaccine

27:53

technically is not recommended to be given to

27:55

kids at the twelvemonth visit, but is

27:58

at the four to five or six year old?

28:00

Is it?

28:01

And it's because of the data on

28:03

the risks versus benefits.

28:05

These are carefully made

28:07

decisions.

28:08

Yeah, right, Like.

28:09

The bottom line is that the childhood vaccine

28:11

schedule that we have here in the US has

28:13

been and continues to be continuously

28:16

evaluated multiple times a year

28:18

by a team of highly qualified

28:20

individuals who have the best interests

28:22

of the American public at heart. That

28:25

is historically then its role. Yeah,

28:28

I hope that that is what its role will.

28:30

Be in the in the years to come.

28:32

It's protected us for so long. I

28:34

hope that it continues to do so.

28:37

The childhood vaccine schedule is safe,

28:39

it is effective, and it has saved and continues

28:42

to save millions, not an exaggeration,

28:45

millions of lives of some of the

28:47

most vulnerable members of our society

28:49

every single year.

28:51

Yeah.

28:52

Yeah, it's amazing.

28:54

Eron so erin. Yeah.

28:57

Now that we know the history of the ACIP

28:59

and how they make these decisions and why it is

29:01

so vital that they do what they do,

29:04

can you tell me why we might see some differences

29:06

in the US compared to other countries

29:09

around the world.

29:10

Yeah, I can, And then get into what

29:12

we know about what these vaccine

29:14

preventable diseases look like across the gub

29:17

H. We'll take a quick break

29:19

and then get into it. So,

29:36

the World Health Organization has a

29:38

list of vaccines that are recommended

29:41

for all children and

29:44

that schedule, and those recommendations

29:46

are essentially the same as

29:49

what the CDC recommended schedule is

29:51

in the US, which again is mostly influenced

29:54

by recommendations from ACIP, except

29:57

there are a few big exceptions. One

29:59

is that we in the US do not use

30:02

the BCG vaccine, which is a vaccine

30:04

against tuberculosis and is recommended

30:06

by the World Health Organization to be given at birth

30:08

for all children. We

30:10

don't do this in the US because historically

30:13

rates of tuberculosis have been relatively

30:15

low. I mean not historically historically, but in recent

30:18

times at this point in time. That

30:21

could change in the future, but that's the recommendation

30:23

right now. So we don't use the BCG vaccine here in

30:25

the US, but overall,

30:28

the World Health Organization recommends vaccines

30:30

for all children that include hepatitis B, polio,

30:33

diphtheria, tetanus, and pertussis, the

30:35

detap hib or, the

30:37

homophlus influenza, new macaucus,

30:40

rotavirus, measles, rubella, and

30:42

HPV, and

30:44

then the World Health Organization goes on to

30:47

have a number of other recommendations

30:49

because of course, the World Health Organization is

30:52

having to kind of stratify across the

30:54

globe, where they

30:56

might recommend certain vaccines only

30:58

for children who live in certain regions

31:01

or who are in certain high risk

31:03

populations either geographically or

31:05

just population wise, or

31:08

in countries that have vaccine

31:10

programs with certain characteristics,

31:12

and the US falls into that.

31:15

What does that mean?

31:16

Let me tell you about it.

31:18

Okay, okay, So there are.

31:19

Some vaccines that we went over last week that we

31:21

give in the US that weren't on that list.

31:23

I just read from the World Health Organization specifically

31:26

that is mumps, vericella,

31:29

flu, meningitis, and HEPA.

31:33

The reason that we give those vaccines in the

31:35

US and they're not on the recommended

31:37

for every single child across the globe

31:39

list is number

31:41

one. Mumps, veriicella, and

31:44

flu are recommended by the World

31:46

Health Organization for all kids

31:48

if they live in a place

31:51

that has an immunization program

31:53

that can actually get at least eighty percent

31:56

or more of vaccination coverage,

31:59

or if they have access

32:01

to combination vaccines. So

32:04

in parts of the world that are still struggling

32:06

to even get kids access to

32:08

vaccines, or who can't get or can't

32:10

afford, or maybe can't like don't have

32:12

the storage capacity, if vaccines have to

32:14

be refrigerated, et cetera, for whatever

32:16

reason, if they can't get combination vaccines,

32:19

or they just don't have the capacity to vaccinate,

32:22

then the World Health Organization says

32:24

prioritize measles, rubella,

32:26

mumps, and vericella come later. Essentially,

32:29

does that make sense. Similarly,

32:32

hepatitis A and meningitis, which are on

32:34

the vaccine schedule in the US, are

32:36

on the World Health Organization list of recommended

32:38

for high risk populations, which, based

32:41

on our data in the US, the US is

32:43

one of them. We had really high rates of hepatitis

32:45

A and meningitis, enough

32:48

so that the CDC said, Hey, we're going

32:50

to vaccinate all of our kids to prevent morbidity

32:53

and mortality from these diseases. And

32:55

then there are a lot of other vaccinations

32:58

that are given in other countries, like for Jepanese encephalitis

33:01

or for dange or yellow fever, that we don't

33:03

give in the US

33:05

on an everyone basis because

33:08

they do not circulate in as high

33:10

as numbers here in the US.

33:12

Yeah, so that's why our.

33:13

Schedule looks a little bit specific to our

33:15

country.

33:16

Yeah. Yeah, And we've

33:18

said it a.

33:19

Few times, I think, maybe more than a few times last

33:22

week in this week, but I do think it bears repeating.

33:25

It is very easy, because

33:28

of the incredible success of vaccines

33:31

to think that these diseases

33:34

that we are vaccinating against are a thing

33:36

of the past. Yeah, because

33:38

it is true that the rates of illness

33:41

and severe illness and death from

33:43

almost all of these childhood

33:45

vaccine preventable diseases have

33:48

plummeted, both here in the

33:50

US but also across the globe and

33:53

that is incredible.

33:56

It is, it is amazing. It is such

33:58

a huge feat. I

34:00

think back, like okay.

34:02

You know, like, okay, I'm trying

34:04

to think of a time travel movie Kat and Leopold,

34:06

for instance, which that's

34:08

a deep cut. That's a deep cut, right,

34:10

Okay, somebody comes from the

34:13

Hugh Jackman is like a time traveler

34:15

from the past.

34:16

Anyway.

34:17

I always think about if someone were able to travel

34:19

to the present day from the past.

34:22

One of the things that would instantly be so

34:25

magical is vaccines,

34:27

Like not magical, but just profound

34:29

right in what it has done.

34:31

I'm sure it would feel magical.

34:32

Quite Yeah, Leopold would really have appreciated

34:35

vaccines.

34:35

Maybe he did. Did they talk about it?

34:37

I have not seen it since it was in theater at

34:40

the Dollar Theater like twenty

34:42

years ago.

34:43

Oh that's hilarious.

34:44

I'm gonna go watch it now.

34:46

But it's true.

34:48

Vaccines save today in twenty

34:50

twenty five and estimated four

34:52

million lives every

34:55

single year.

34:56

Four million.

34:58

Yeah, the World Health Organization actually estimates three and

35:00

a half to five million.

35:01

So, like, I mean, it's.

35:02

Incredible conservatively four million

35:05

exactly, which.

35:05

Is why conservatively, But

35:08

The thing is that we could be saving

35:10

even more because while

35:12

we have made huge strides in reducing

35:15

the burden of these diseases, we have

35:17

not eradicated any of them,

35:19

aside from smallpox, which

35:22

we no longer vaccinate for anywhere across

35:24

the globe because it has been eradicated, and

35:27

also under which is a disease

35:29

of cattle like well, actually story

35:32

I wrote underpest down. But

35:36

until we can actually eradicate

35:38

these other preventable diseases, a

35:40

case anywhere represents

35:42

the risk of disease everywhere,

35:45

especially because in the face of growing

35:48

anti vaccine sentiment in the US and

35:50

around the globe, vaccine preventable

35:52

diseases are on the rise. As

35:55

we record this, which is early

35:57

March twenty twenty five, in the

35:59

US, we are in the midst of a very

36:01

significant measles outbreak that

36:04

is continuing to spread. Yeah.

36:06

Band numbers are way out of date already, I

36:08

know.

36:09

Yeah, by the time this episode comes out, they will,

36:11

unfortunately I'm sure, be much worse. And

36:14

the current outbreak is not typical,

36:17

It is not common. Nope,

36:20

And like you mentioned already aarin in

36:22

the US, measles was declared eliminated

36:25

in the year two thousand, which essentially means

36:27

that we had had no continuous transmission

36:30

of measles for an entire year,

36:33

which meant that from that point forward,

36:35

any cases that popped up,

36:38

like anything more than three cases of measles

36:41

is considered an outbreak in the US. And

36:44

that was huge, and it wasn't just the US,

36:47

like you said. In twenty sixteen, the World Health Organization

36:49

declared measles eliminated from the entire

36:52

Western Hemisphere, and

36:54

around that time the World Health Organization European

36:57

Region also reached its lowest point.

36:59

Ever in Europe.

37:01

And then and then things

37:03

started to get worse again in

37:06

the US between two thousand

37:08

and twenty ten, so shortly

37:10

after we were declared eliminated. There

37:13

were only three years in that ten year

37:15

period where we had more than one hundred

37:17

measles cases in the US, between

37:21

twenty eleven and twenty twenty one.

37:23

In that ten year period, seven

37:25

years had more than one hundred cases,

37:28

including six hundred and sixty seven

37:30

cases in twenty fourteen, three

37:33

hundred eighty one cases in twenty eighteen,

37:36

twelve hundred seventy four

37:38

cases in twenty nineteen, and

37:41

last year in twenty twenty four, we had two hundred

37:43

and eighty five cases. Right

37:46

now, it's early March, and

37:48

the CDC last updated their Measles

37:51

disease outbreak surveillance on

37:53

February twenty eighth.

37:55

Not often enough, every

37:57

one Friday, every Friday, yeah, yeah,

38:00

But as of February twenty eighth, there had

38:02

been one hundred and sixty four confirmed

38:04

cases and one child

38:07

died.

38:08

That is the first time that a child has died of

38:10

measles in the US since twenty fifteen

38:13

in the current outbreak. And again I

38:15

know these numbers are outdated by the time this episode

38:18

comes out. Twenty percent of

38:20

these kids and I say kids because eighty two

38:22

percent of these cases are in children, twenty

38:25

percent of them have been hospitalized, and

38:28

ninety five percent of cases were

38:31

in either unvaccinated individuals or

38:33

people whose vaccination status is unknown.

38:37

And in every case,

38:39

whether an individual is

38:42

vaccinated or unvaccinated, this

38:44

is a preventable illness, yes,

38:48

and it's not just measles, like.

38:49

It's not just measles.

38:51

And before we move on to the other

38:53

diseases that are vaccine

38:55

preventable in these outbreaks that are happening, I want

38:58

to talk about something that I

39:00

think can generate some confusion when it comes

39:02

to looking at these numbers. So you'll

39:04

see in an outbreak like measles, like these measles

39:07

outbreaks, that there is a number of people

39:09

who are vaccinated who

39:11

contract measles. And that could be for a million

39:13

different reasons, right, Like some of US measles,

39:16

vaccines don't induce a strong of

39:18

an immune response. Again, why

39:20

herd immunity is so important, and

39:22

because in an area the general

39:25

population is much more vaccinated

39:27

than unvaccinated.

39:29

Right, it can see eighty percent vaccination

39:31

coverage in the US.

39:32

Yes, it can seem like there is a high

39:35

number or an equal number of people

39:37

who are vaccinated compared to those who are not vaccinated.

39:40

Does that make sense?

39:41

But that's that is actually disguised

39:43

as what is truly happening. And that is, if

39:45

you look at the proportion of people who are unvaccinated,

39:48

what at the likelihood that they will get that

39:50

that they will get measles much much

39:52

much higher than if you are vaccinated.

39:54

Right, I think you said last week here and it was like one hundred and seventy

39:57

times.

39:58

Forty times higher they're unvaccinated. And

40:00

so but like, just reporting on these sheer numbers

40:03

only tells part of the story, right right, Like

40:05

we it doesn't tell us what proportion of unvaccinated

40:08

individuals in a community are infected compared

40:11

to.

40:11

Those who are vaccines exactly exactly,

40:13

And.

40:13

I think it kind of is these numbers

40:15

are sometimes used to undermine the

40:18

power of vaccines in protecting you.

40:20

I remember that happening especially a lot during

40:22

the mumps outbreak a few years

40:24

ago, because especially mumps, we

40:26

see more waning immunity than

40:29

we see with measles as well, and

40:31

so it kind of compounded that same problem.

40:33

But it is yeah, that.

40:35

The proportion, the likelihood that

40:37

you get one of these illnesses is significantly

40:40

higher if you are unvaccinated or under

40:42

vaccinated compared to if you

40:44

are vaccinated fully.

40:46

And on top of that complications

40:48

exactly. This isn't just about whether or not

40:50

you are getting the disease. It is about how sick you

40:52

are getting in your chances of dying, and vaccines

40:54

protect you from these things exactly.

40:57

And it is not just measles,

40:59

it's not just rtussis cases.

41:01

Whooping cough has been on the rise

41:04

year over year in

41:06

twenty twenty four, there were thirty five

41:08

thousand cases of pertussis

41:10

in the US and over

41:13

twenty seven hundred of those were babies

41:15

under one year old, and

41:18

six of those babies under one

41:20

year old died in the US

41:22

in addition to four other kids that

41:25

were over one year old. That's

41:27

ten children who

41:29

died last year alone in the United

41:32

States from a vaccine preventable

41:35

illness.

41:36

Yep, did not have to happen.

41:38

Yeah.

41:39

Yeah.

41:40

Polio is another example that made

41:42

headlines back in twenty twenty two here

41:44

in the US. So we eliminated

41:47

polio in the US in nineteen seventy

41:49

nine, and there is of course a huge

41:51

campaign to try and eradicate polio across

41:53

the globe and were not there yet, And

41:55

yet there was a case of paralytic polio

41:58

in twenty twenty two in the US,

42:00

and in conjunction with that case, there

42:03

was enough virus being detected

42:05

in the wastewater in surrounding

42:07

areas that the US was actually

42:09

added to the World Health Organization

42:11

list of countries with endemic circulating

42:15

vaccine derived strains of poliovirus.

42:19

Now, this is a strain of

42:21

the virus that has evolved from

42:24

the vaccine strain of the

42:26

oral poliovirus vaccine. So

42:29

this is a disease that people

42:31

get not from the vaccine itself,

42:34

not from getting the vaccine, but from

42:36

a mutated version of this virus

42:39

that can persist in the environment, from

42:41

the vaccine derived strain that

42:43

evolves to regain virulence

42:46

or infectiousness, and then can infect

42:48

other people and get them sick. We do not

42:51

use this oral polio vaccine in the

42:53

US, and we haven't since the year two

42:55

thousand, but there are some

42:57

other countries across the globe that still do because

43:00

it's a much less expensive vaccine. It's

43:02

easier to administer because it's oral rather

43:04

than injected. You have to have less public health

43:06

investment or infrastructure. And in some other places

43:08

that still had circulating

43:11

like wild typled toliovirus,

43:15

it provided good protection, but

43:17

it comes with this potential cost, and that cost

43:19

has now been more vaccine derived

43:22

strains circulating and

43:26

globally. In twenty twenty three,

43:28

which is the latest year that the World Health Organization

43:30

has these global dashboard numbers,

43:34

there were over twenty four thousand,

43:36

seven hundred reported cases

43:39

of diphtheria, certainly more

43:41

that were not reported. Over

43:43

six hundred and sixty nine thousand

43:46

cases of measles globally,

43:50

over one hundred and sixty three thousand cases

43:52

of pertussis, three hundred and eighty

43:54

seven thousand cases of mumps, thirty

43:57

five thousand cases of rubella,

43:59

and over twenty one thousand cases

44:02

of tetanus, and the list goes on. So

44:04

all of these diseases that

44:07

we are protecting our children against

44:09

with vaccines still circulate

44:11

around the globe. And because

44:13

of global travel, that means that many of

44:15

these diseases can circulate anywhere.

44:18

And I mean the case of tetanus, those bacteria

44:20

are just everywhere already, right, I.

44:22

Mean, and so much of this is just

44:24

like it is.

44:25

These numbers are saggering, and they're so hard

44:27

to absorb, to like actually wrap

44:29

your head around. And this

44:32

I think speaks to how why it

44:34

is so important that an investment in

44:36

global public health and global health

44:39

is crucial, And it's just

44:41

it's just something that is so obvious.

44:45

I know, so clear. I know.

44:47

Vaccines are not only the best thing that

44:49

you can do to protect yourself and your children

44:52

from infectious disease, but also the

44:54

best thing that you can do to protect your community.

44:58

Because vaccines are protecting us a against

45:00

communicable diseases. These are things that

45:02

are spread from person to person. So

45:04

it is, like we said last week, our social

45:07

responsibility to vaccinate,

45:09

like for the health of ourselves, yes I

45:11

don't want to get sick and end up hospitalized,

45:14

but also for the health of our communities.

45:17

And it is for this reason, because of

45:19

the health of the public, that there are vaccine

45:21

requirements for participation

45:24

in public life like public schools.

45:26

Right, and when these requirements are

45:28

waived or changed to recommendations

45:32

rather than requirements, or if

45:34

they're done away with altogether, we

45:36

are putting both individual and public

45:38

health at risk. We then

45:40

see children hospitalized and dying,

45:43

and resurgence of diseases that have

45:45

previously been eliminated. So

45:49

understandably there is a lot of interest

45:51

in addressing vaccine hesitancy.

45:54

How the heck do we do it, that's

45:56

a great question.

45:58

The World Health Organization actually named vaccine

46:00

hesitancy one of the top threats to

46:02

global health in twenty nineteen, and that's

46:04

alongside like climate change and air pollution,

46:07

anti microbial resistance, the next global

46:09

influenza pandemic. Like big scary

46:12

things include vaccine hesitancy

46:14

hesitancy.

46:15

Yeah, so lucky for us.

46:17

There's a lot of research that has been done and

46:20

that continues to be done on how to best

46:22

try and address this. And

46:25

we started out last week's episode

46:27

like this whole vaccine series. Part of what we

46:29

wanted to be able to talk about is just

46:32

how prevalent vaccine

46:34

misinformation is and how

46:36

easy it is to believe

46:39

it because of the way that misinformation

46:41

and disinformation praise on our fears

46:44

and anxieties, especially

46:46

when it comes to our kids. Yes,

46:48

and we are all susceptible to misinformation.

46:52

Ehudding us do you hate

46:54

to admit it, But it's true.

46:55

That's true, and we know that when it comes

46:57

to vaccine hesitancy, which

46:59

is defined as the reluctance or refusal

47:02

to vaccinate despite the availability of vaccines,

47:05

there is a spectrum of belief. But

47:08

I want to first set the record straight. The

47:10

vast majority of parents still vaccinate

47:13

their kids on time according to the

47:15

ACIP schedule period period.

47:17

Yay, that's amazing, And

47:20

part of that is because we do have these

47:22

childhood vaccination requirements for school exact.

47:25

Yeah, yeah, it's yeah, it's great,

47:27

it's amazing.

47:28

But when we are looking at the minority

47:30

of people who meet these criteria of

47:33

vaccine hesitancy. There is a spectrum,

47:36

and there are some people, many of whom

47:38

are the spreaders of disinformation,

47:40

who are profiting heavily off

47:43

of vaccine hesitancy in one way or another,

47:46

or who have wrapped up their identities

47:48

in these false beliefs to a point where

47:51

there really is no changing their mind. But

47:54

there are also a lot of people who are

47:56

vaccine hesitant, who just have questions

47:59

or or herd scary things

48:02

on TikTok and they

48:04

just don't know who to believe. And

48:06

recognizing this idea that we can all

48:08

fall prey to misinformation, what

48:11

that does is allow us to approach

48:13

all of our conversations about vaccines

48:15

from a place of understanding and

48:17

empathy. It allows us to

48:20

actually have productive conversations about

48:22

vaccines rather than just combative ones

48:25

with my uncles.

48:29

I'm sorry it's.

48:30

True, though, But we also

48:33

know that a lot of parents rely on their

48:35

healthcare providers as primary sources of

48:37

information when it comes to their children's health, and

48:39

that's great. We should all have a

48:42

healthcare provider that we can trust to ask

48:44

our questions and get answers without

48:46

fear of judgment or reprisal,

48:49

and studies show time and again that a

48:51

strong recommendation from your health care

48:53

provider drives vaccine uptake, as

48:56

do strategies like motivational interviewing,

48:59

which is a technique that relies on like open

49:01

ended questions and affirming

49:04

and reflecting back statements and concerns

49:06

and then summarizing information and

49:08

then advising, but all in a way

49:10

that actually requires that you listen.

49:13

Yeah, I mean google it.

49:15

It's like it's a really important and technique

49:18

and I think that there's a lot more to it. Yeah, you're

49:20

interested in learning more about it, definitely, And

49:22

the.

49:23

Search requires that you start from

49:25

a place of empathy from where a

49:27

person is coming from and the concerns that they legitimately

49:30

have.

49:30

Ye.

49:31

But a lot of us and a lot of you listening

49:34

feel like maybe you feel like you'll never be in

49:36

a position to directly like advise

49:38

someone on whether or not to get vaccinated.

49:41

That does not mean that we can't all

49:43

be working towards increasing vaccine

49:45

acceptance in our own communities. Most

49:49

parents still vaccinate their kids. The majority

49:51

of kids in the US are getting their vaccines

49:53

on time, according to the ACIP

49:55

schedule. If we start talking

49:58

about this fact, like

50:00

normalizing this, talking about getting your vaccines,

50:03

about when you got your kids vaccinated, how

50:05

you just got your flu shot in your arms a little bit sore,

50:07

but you're feeling great about it. That is

50:10

one way that we individually

50:12

can help to move this needle back

50:14

towards vaccine acceptance and away

50:16

from this idea of vaccine hesitancy.

50:19

Yeah, we collectively talk.

50:21

A lot about vaccine hesitancy, but

50:23

I think we don't talk enough about

50:25

getting vaccinated. And like I normalizing

50:28

this process.

50:29

I love this because I feel like I have done

50:31

this with friends where I'm like, oh,

50:33

yeah, I got my flu shot and my arm is

50:35

still a little bit sore, and they're like, oh, that reminds me

50:37

I have to go get my flu.

50:38

Shot exactly exactly.

50:41

Something as simple as that, I I

50:43

love it.

50:43

I also love things that make it

50:45

easier, like one time I got my flu shot and

50:47

my COVID shot this year when we went

50:50

to the YMCA where

50:52

my kids are doing gymnastics, and they

50:54

had a table there and we went

50:56

early because we thought my kids wanted to play in a thing,

50:58

and then they didn't want to and we're like, well, we're just

51:00

going to get our vaccines.

51:01

Then you made it so

51:03

easy, yes, yes, but breaking

51:06

down those barriers to just make it easy

51:09

when you're just out because there are so many other

51:11

things that are that that do

51:13

stand in the way of someone being able to take time

51:16

off to go get rationeated when our clinic hours

51:18

open. And I know that there are a lot of different

51:20

organizations that really push towards this, Like

51:23

we're having you know, a van that comes

51:25

and does like on site

51:27

vaccination.

51:28

Yeah, that's great, that's great.

51:29

Talking about this and normalizing this process

51:32

and talking about how incredible

51:34

the benefits of vaccination are is

51:36

so helpful. And we can all start

51:39

having these conversations with our friends and family

51:42

who already vaccinate and maybe

51:44

those who might be more towards

51:46

hesitant.

51:47

Yeah, and I think

51:50

it's important to you wonder

51:52

what might that conversation look like?

51:54

Yeah, what what could it look like? And I

51:57

mean who knows, right, Like, there's a huge spectrum.

51:59

Yeah, and if it depends a lot on how

52:02

receptive someone is to changing their mind

52:04

or to hearing conflicting information something

52:06

that conflicts with what they've heard or

52:08

what they hold in their hearts, right, But

52:11

it does start, like you said, Aaron, with empathy

52:13

and with asking questions. So if

52:15

you know someone who's vaccine hesitant, or

52:17

you learn that someone is, you could start

52:20

by asking why, like

52:22

what what do you know about vaccines? What

52:24

specific worries do you have? And

52:27

then asking you know, can can I talk

52:29

with you about this? Can I share my thoughts

52:31

there? Can I share some information

52:33

that I have learned with that convation?

52:36

Can we engage in this way?

52:38

Yeah? And maybe it's a flat no.

52:39

Maybe they're like, not interested, do not talk to

52:41

me anymore about this?

52:42

Okay, right, that's fine, But maybe

52:44

it's not.

52:45

Maybe they're like, actually, yeah, I have been really

52:47

nervous and I don't know where to turn.

52:49

And maybe you can help to answer their questions.

52:51

Or maybe you can't.

52:52

Maybe you're like I too, I don't know where

52:54

to turn, but you can at least

52:57

look together. You can help them find where

52:59

to look. That is

53:02

how this has proven to be how

53:04

progress is actually made on this front

53:07

human to human interaction. People

53:09

who have social

53:13

capital community, right,

53:15

like people who are trusted, people who are like, no, I

53:17

get it, I know where you're coming from.

53:19

I can relate to you, and I will relate to you.

53:21

I won't stand here in a position of power and tell

53:23

you and look down on you and condescend

53:25

to you right like I will say, okay,

53:27

I hear you right. And this, all

53:30

of us having these conversations,

53:32

is how we can make progress. Each

53:34

of you has the most sway and reach

53:36

within your own community. And

53:39

research does show that this community

53:41

based activism, even if it's just

53:43

informal, even if it's just chatting with a neighbor,

53:46

this has the greatest opportunity of making

53:48

an impact. And one really important

53:50

thing to remember and I think that, especially

53:53

as our bandwidth grows ever more shorter

53:56

these days, speaking personally, yes,

53:59

is that you you should pick your battles right like you

54:01

can pick your battles if

54:04

you're not in the headspace, or you feel like

54:06

someone is just super resistant and it's

54:09

only going to drain you further so

54:11

that you don't have the emotional bandwidth to take

54:13

care of yourself. Or if you feel yourself

54:15

getting heated and you're like, this is not

54:18

going anywhere, I'm just getting angry at this person.

54:20

Yeah, don't be afraid to take a step back, try

54:22

another day. This is a constant,

54:25

constant battle. But we truly

54:27

can make progress.

54:28

Yeah, we really really can't. We maybe

54:31

sound very cheesy, but genuinely

54:34

we believe that we do.

54:36

Also data backs it up.

54:37

So yeah, evidence based, speaking

54:42

of evidence, speaking.

54:44

Of evidence, great transition. Thank

54:46

you. We've got

54:48

more sources for this.

54:50

Let me see if I can shout out any in particular

54:53

that I found helpful. If I can find

54:55

this tab, here we go. Yeah,

54:59

there is a pa by Walton

55:01

at All from twenty fifteen called the History

55:03

of the United States Advisory Committee on Immunization

55:06

Practices, and it was

55:08

really insightful in terms of how

55:11

this committee came to be. And then I have a bunch

55:13

of other websites for our a

55:15

bunch of other sites from CDC and who that

55:17

can help sort of put more context into this.

55:20

I used a lot

55:23

the World Health Organization Global

55:25

Dashboard, their data

55:28

portal, so we will link to that.

55:30

I also really enjoyed a paper by

55:33

friend of the Pod Peter Hotes from

55:35

twenty nineteen titled America and Europe's

55:37

New Normal the Return of vaccine preventable Diseases,

55:40

And I also had a number on that

55:43

whole idea of how we talk

55:45

about vaccine hesitancy and kind of

55:47

moving the needle. So we will post the list of

55:50

all of our sources from this

55:52

episode and every one of our episodes on our website,

55:54

this podcast withekille dot com under the episodes

55:56

tab.

55:57

We will a big

55:59

thing YouTube Bloodmobile, who provides

56:02

the music for this episode and all of our episodes.

56:04

May sure do you.

56:05

Thank you so much, Bloodmobile. Thank

56:07

you to Leona Scolacci and Tom Bright Focal

56:09

for the incredible audio mixing, and

56:12

thank you to Brent and Pete and the

56:14

whole video editing team as well.

56:16

Thank you, thank you, and thank you to you listeners

56:19

for listening, for listening, please

56:21

watching or watching, Please do reach

56:23

out with more what you want to hear?

56:25

Yeah, what you want to learn about?

56:27

I want to know so we can make

56:29

our season better. Yes, truly,

56:33

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56:35

patrons. Your support means so much

56:38

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56:40

Thank you. Well.

56:41

Until next time, wash your hands, you filthy

56:43

animals.

57:00

Mum