Ep. 81: Vaccines Are Required for School

It's time for Vax Top. Let's talk VPDs. We're shaping the conversation about vaccines. To learn more, visit VaxTop.org. Hello and welcome to Vax Top. This is the podcast for people who really actually don't want to see polio come back. Hey, that's funny because that's very related to my around the web. This is definitely this is definitely a post a podcast for people who don't want to give both sides to this discussion. I mean polio is pretty bad, but all that aside, my name is Karen Ernst and I am the director of Voices for Vaccines. And I'm Dr Nathan Boone, I'm a general pediatrician here at Blanktron's Hospital in Des Moines, Iowa and chair of our state immunization coalition, Iowa immunizes. And later in this podcast, we have fascinating interview with our friend and longtime supporter, Dr Paul Offit, all about school vaccine requirements. Why do we have them? Why are they important? Should we just get rid of all of them? Interesting conversation. I'm betting you can guess which side he comes down on. Yeah, I'm sorry that this is another one where my slacker life I am unfortunately was not able to be there for this interview, which is too bad because I really would have liked to have been part of this discussion because it pertains to my work quite a bit. Yeah, you do slack off a lot. Like, oh, I have to save some kids' lives at the hospital. Blah blah blah. Yeah, you know, the glamorous life of a pediatrician. That's true. That's why you make the big bucks. Anyhow, let's go ahead and do our round the web. What they say. Yeah, let's go do it. I'm going to start because you're already, you're already kind of segwaying me in. I'm going to, I'm going to bring up my favorite satirical humorist, Alexandra Petri or Petri. I'm so sorry. I usually do my research when it comes to pronouncing last names. She goes by Petri dishes on Twitter. So I pronounce it Alexandra Petri, but I could be wrong because I've never heard her speak live, I think. So anyway, the title of her latest piece is let's try something different in how we deal with polio finding middle ground is hard. Why not just give ground instead? It's the line underneath. So this is where the read, this is in Washington post, and I'll just kind of read kind of the starting quote to give you a little taste where she says, when I look at how people voted this election, I enforce conclude some of you want polio. Who am I to stand against that desire? Someone with values? Do I think polio is good? No. Of course not. But some people do. And I think it would be a mistake not to give them the opportunity to set the course of vaccine policy for the next four years, which again isn't what I want, but compromise is important. So I love it. I love the way that it frames the both sides of this issue. I want to mention that if I hadn't have seen this recently, there's a recent post from her just a month or two ago called RFK Jr. to head newly formed Department of Disease Efficiency. And I want to call back to one of my favorites of all time. This is how Alexander Petrie got kind of across my radar was in 2015 when the Disneyland Measles Outbreak was going on. And she wrote a piece called, "Please stop vaccinating your children. I want to go to Disneyland written by a Measles virus." And so it is all like you can, there's a number like it's she someone I'd love to talk to you because she really does do a good job of like these satirical, pro vaccine pieces. Maybe we should have her on. I think we should ask. I think we should invite her. Yeah. Why not? Right? She'd be great. Well, I think that's fantastic. I think that sometimes we have to laugh otherwise. Indeed. We would just cry. We would just ball. Yeah, right. You got a bit of a year coming ahead of us. So I think it's worth having a little bit of levity to kind of start out. Absolutely. Absolutely. A little bit of gallows humor. Why not? Well, mine isn't funny. But I think you'll enjoy it. I should end it. That's fine. Well, that's okay. I think we need to laugh, but I also think we need to think about our hero as a little bit. And one of my heroes is of course Jimmy Carter. And we all know he made it to age 100, which is my goal as well. Yep. Yep. A nice even number. Yeah. It's a it's a good goal. He lived his he spent his 100 years really, really well. Mm-hmm. Probably America's best former president. And there was this lovely article last week in the New York Times titled Jimmy Carter's Quiet But Monumental Work in Global Health. And so if you don't know voices for vaccines because we're so tiny, we're part of a larger organization called the Task Force for Global Health. They'd sort of do all of our administrative work for us that we can do our advocacy work. And the Task Force for Global Health was founded by former head of CDC, Dr. Bill Feige. And he has someone in Georgia and who worked at the CDC, he knew Jimmy Carter. So I just want to read this section because they interviewed Dr. Feige about Jimmy Carter and his work in global health. And it's a little bit vaccine adjacent, but it's still really the the ethos behind it, I think is really important for us right now to think about and consider. So here we go. The Carter Center, a nonprofit that Mr. and Mrs. Carter founded in 1982, is admired in countries where it provides development assistance as an organization whose beneficiaries set priorities and lead projects. An ethos that former staffers say originated with the Carter's. Dr. Feige was the director of the Center for Disease Control and Prevention during the Carter presidency. Not long after Mr. Carter left office, he called Dr. Feige and asked him to run the Carter Center, through which he hoped to work on conflict resolution and advancing democracy. Dr. Feige said he told Mr. Carter that there were so few people working in global health at the time that he could not imagine leaving the field. A couple days later, he called me and said, would it make a difference if I became interested in global health? Dr. Feige said. And that's exactly what happened. And he became so interested in it. You could not give him enough material to study. He became better at global health than most almost any global health person I know. Mr. and Mrs. Carter decided to focus on neglected tropical diseases which draw little investment in research or treatment because they infect some of the poorest people in the poorest countries. The Carter's learned about guinea worm, an excruciating and disabling parasitic infection in which a three-foot long worm slowly burrows out through the skin of the person it has infected and for which there is no treatment other than painstakingly drawing out the worm over days and weeks. With Dr. Feige and his team, the Carter set the goal of eliminating the disease. Mr. Carter did not, as he often vowed to do, live long enough to see eradication. But in 1986 when they began their campaign, there were an estimated 3.5 million cases in at least 21 countries. Last year, the Carter Center reported a provisional total of just 11 cases. So that's amazing. Absolutely is. I was just reading about that as you are. Like literally pulled up about the guinea worm and was reading about it. And that is just incredible. I was, what did you say, 86 was 3.5 million cases? Yeah, that's amazing. Yes. And I do think it's one of those things where we don't you know, we don't talk a lot about some of these neglecting tropical diseases in part because there's not vaccines against a lot of them and a lot of them are parasites like that that we don't have vaccines for. But it's a it's a major area of public health that is neglected, not to be redundant. But yeah. Right. And you know, that's some of the work that, for example, Dr. Peter Hotez does is working to find vaccines for neglected tropical diseases. Yep. It used to be that people were even interested in all at all in some of these tropical diseases. Like, for example, yellow fever or Japanese encephalitis because people would get them on their travels. So that's how people became interested in it. And that sort of really spawned the field of global health. But now we have people who are just really dedicated, amazing people like Jimmy Carter and Bill Faggy, but also, you know, modern day folks like Peter Hotez who are really interested in these because they know that they can do a lot of good in the world. And it's really amazing too because you got to think, you know, people who end up with Guineaworm, they don't know who Jimmy Carter is. Right. Right. They don't they don't care that he founded the Carter Center. They don't know who Bill Faggy is. And so all this work that these people have poured themselves into, it's not because they were going to get, you know, adulation about it. It's not like there are parades saying, hooray, there were only 11 cases of Guineaworm in 2024. But I think that makes the work all the more amazing because if you're doing good work for people who can never thank you for it, then you really are on the side of good. You know, I guess for our listeners, that's sort of, you know, in the work that we do with vaccines. do something that no one will ever be able to thank you for. That is a great philosophy and it's great to be able to recognize 100 years of a life well-lived. Absolutely. I'll say too that Jimmy Carter is also credited with helping build gates and Melinda Gates become interested in vaccination too. So, man, to be. All part of the grand conspiracy. Yes, you know Jimmy Carter is for part A, be a peanut farmer. That's the end. That's how you get the peanut allergies into the vaccine. That's right. This is peanut allergies. Part A, be a peanut farmer. We figured it out. We cracked it. Part two, watergate. Part three, president. Part four, Bill Gates. That's what really happened. There we go. All the dots are connected. I see it. It's all clear. Thank you Nathan. So because of watergate and then because Nixon was in a second term anyway though. So he's just watergate paved to the way for the Democrats to win the next election. Is that what you're saying? Yes. Who was it for? Okay. Yeah, Gerald Ford. And then Carter got it. That's it. Fact it. Fact it like a peanut shell. I just want to say to my grandfather. This is nothing you do the vaccines, but we're putting it in the podcast. My grandfather ran for lock Raven PTA president against spirit egg new. Oh wow. And he lost to spirit egg. Yeah. But if you want to do the like, you know, yeah, yeah, so it does have to do with vaccines. Like this could, could have been. So my grandfather had one lock Raven PTA president. Right. He would have become. He always says he would have become honest. John Ernst, vice president of the United States. And he would have stopped watergate. And then actually Jimmy Carter couldn't have put the vaccine oil into the vaccine. Yeah. Yeah. So there you go. So it really is your family. Like you really are the Rothschilds of the vaccine world here. You're you're behind it all. You're the. You got wait till I tell you the story about how my dad did not assassinate John F Kennedy. Wow. Okay. Yeah. That'll be a great story. Yeah. It's just I just keep sprinkling hands. We all we'll have a story of a relative who did not assassinate John F Kennedy. I hope. I hope except for like Lee Harvey Oswald's family. Doesn't have that story. That's true. I'm right. Nito. Never mind. I'm assuming that's some like star Trek thing. It's X-Men and it's has to do with a yeah, one of the X-Men movies. But anyway. All right. Few of you out there got that reference. And I appreciate every one of you. All three of you. And you can find him at Pieds Geek MD. But let's go ahead and turn to Dr. Paul Offit who will talk us through the history of school vaccine requirements and all the good that they do. We are joined now by Dr. Paul Offit who is the head honcho and person who knows everything at the vaccine education center at the Children's Hospital of Philadelphia. Welcome Paul. Thank you, Karen. That is your given title there. Correct. Right. Well, Professor Pediatrics and Penn. But yeah, that's it. The vaccine education center, which is is co-directed by Charlotte Moser who also knows everything she does and she's a fantastic person. Well, we invited you here today to talk a little bit about school entry requirements. It's something that I think has happened so long ago that people don't remember why we require children to get vaccines before they go into school and how that happened and what those requirements do. So I was hoping you could talk us through all of that. So let's start first with going back in time to when schools first began requiring vaccines in order to enroll children in those schools. How did that happen? Right. It's decades ago. I mean, I think by the mid 1960s, about 25 schools had, I'm sorry, 25 states had school mandates by the mid 1970s, that 25 number increased to 40 by 1981, all 50 states had state mandates. And it was in response to to these contagious diseases that often travel in schools, things like measles and moms and German measles or rebella. And because of school mandates, we were able to eliminate some of these disease. And that is because of those mandates, make no mistake about it. That's why we eliminated measles from this country. That's why we eliminated rebella or German measles from this country. We eliminated measles in 2000, German measles in 2005. Measles has come back in large part because a critical percentage of parents have chosen not to vaccinate their children. Rebella still hasn't come back in this country, but it could if we do things like destroy school vaccine mandates. And can you talk to us a little bit about how we really saw in real time those school requirements take measles down in this country? Right. So the first measles vaccine was introduced in 1963. At that time, before that, everyone about three to four million children a year would get infected with measles. There'd be about 48,000 hospitalizations from measles, most typically because of pneumonia and dehydration. There'd be 500 deaths from measles. And there'd be a thousand cases of encephalitis from measles, which is swelling in the brain, about a quarter of which. So 250 people would be left with permanent neurological damage. So measles was to be feared. And anybody who grew up when measles was king, and I'm one of those people is a child of the 50s, people were scared of measles. I think part of the problem now with this erosion in mandates, or at least a pushback against mandates, is not only have we largely forgotten about measles, or we'd largely eliminated measles. I think we've eliminated the memory of measles. And I think that that's the problem. And I worry actually that young physicians working today really haven't seen measles and aren't very constant about how to diagnose and how much they should fear it. And we'll get let's go back to that later too. I'd like to talk about how we can bring the fear of measles back to physicians and parents alike. But I know at one point we started seeing that the level of measles had gone down, but then it spiked up again. So that was in the late 80s and early 90s. And so can you talk a little bit about how that happened and how our public health systems and our education systems and everything are sort of involved in bringing those rates back down again. Right. So we had a single dose measles vaccine introduced in 1963. But really throughout the 60s and 70s, you still see tens of thousands of cases. The real hit came, you're right, between 1989 and 1991 when you had upwards of 55,000 cases and dozens of deaths associated with measles in this country. And with that, we had the birth of the second dose recommendation in 1991. But really that was a second chance to get a first dose. I mean, one dose of measles vaccines, about 93% effective at preventing measles, that second dose gets you up to 97%. But I think had 99% or everyone who could have gotten a measles vaccine, gotten it just as a single dose. I think we could have largely eliminated measles. But that second dose recommendation was really to give people a second chance to get that first dose. And with that, we eliminated the single most contagious vaccine preventable disease in this world, which is measles. Now, let me tell you how contagious this virus is. First of all, you don't have to have face to face contact with someone who's infected. You just have to be in their air space. There's a famous story that was written up in the New England Journal medicine about a 17-year-old girl who was part of a church group. And this church group vaccinated, it wasn't a fundamental group. And she went to Romania. She visited hospital. She visited an orphanage and then unknown to her. She was exposed to measles. Gets on a plane. Comes back. And now she goes to a party of 500 people that are part of her church group, 500 people in the party. Of those 500 people, only 35 people had never been naturally infected or vaccinated. She's at the party for two hours. 31 of those people came down with measles. 31 of 35. They didn't have to have contact with her. They just had to be in her air space. When someone comes into our hospital with measles and we bring them back into a treatment room and examine them, no one can go in that room for two hours. While you have to wait for these small particles, small respiratory particles to settle from to settle like as because they're hanging in the air like a ghost. And you can be exposed to measles that way. I think people don't realize that. We're sort of all used to, you know, SARS-CoV-2, the cause of COVID, where at least even though it can be shed asymptomatically, you know, you have to have contact with the person. That's not true with measles. That's what makes it so scary. Yeah, absolutely. And then you get someone into a situation like a classroom. So why is it that classrooms and child care centers are particularly primed to spread disease? Well, because you're first of all, it's a disease often of this, this is that age group, meaning sort of the five to nine-year-old. When you're in a classroom setting, you know, you're you're interacting constantly, you're always, you know, close and again, all you have to do is be in that person's air space. So measles is frightening. We had a case of measles in our hospital not long ago where the mom came in, brought her child and we, you know, we asked, please, aren't you in this child? Once we discharge them quickly from the hospital, because you don't want measles in the hospital. I mean, it's, you know, it's a highly contagious disease. You have a lot of people who are immune compromised in the hospital. You really don't want measles in the hospital. So unless the person really needs support, meaning is dehydrated to the point they need, intravenous fluid or has pneumonia to the point that they need respiratory support oxygen, you want them out of the hospital. And so we asked her to please quarantine her child for 21 days, but the next day she put her child back and they care because she had to work. And that's something we're not very good at in this country. I don't think we recognize how difficult it is for people to stay home for three weeks. And that's all part of this. It's, I really worry about this. I mean, my personal experience with measles, that my sort of hellish experience with measles was in 1991 in Philadelphia when we had two fundamentalist churches, Faith Tabernacle for a Century Gospel, that didn't believe in medical care. Not that it's a belief system. I've actually seen medical care done. So it's not, you don't have to believe in it. It's real, but they didn't want to, they didn't want to get vaccinated. Do it, they want to go to the doctor when they were sick. And they were sort of the epicenter of this massive measles outbreak in Philadelphia. We're really just in one winter of between 91 and 92. We had 1400 cases of measles at 9 deaths. It was a nightmare. I mean, people canceled trips to the city. Schools closed down. I mean, we're scared to come to Philadelphia. The Commonwealth of Pennsylvania gave us hundreds of thousands of dollars to try and vaccinate. And we've vaccinated down to six months of age, just because, normally, we, you know, 12 months, but, you know, you can still get efficacy down to six months. And we were, people were really, really scared of that disease. That makes sense. It's the first time ever in this country, to my knowledge, we had compulsory vaccination. Many mandatory vaccination is your, you have to get a vaccine. If you don't get it, you pay some sort of societal price. Maybe you don't get to go to school. You want to go to when the old days would be fine. Compulsory vaccinated is your vaccinated, whether you want to be or not. And we, we ultimately got a court order to vaccinate everybody in those two schools, even though they didn't want us to vaccinate. And although they were perfectly compliant, I mean, once it was the law, they were perfectly going to do it. And these were middle class and upper middle class families. These kids were well cared for, state of hygiene and sanitation in the home was excellent. They were well fed, well nurse. They just didn't want medical care. That was a nightmare. And I think it's important that they were well cared for and well nourished. And they still got very, very sick. And some of them still died. I think that's-- Yeah, six in the community in those two church communities. And then three outside those church communities. And all three of those outside the community were too young to be vaccinated. I mean, they were less than six months of age. Or less than nine months of age. And that's what you saw in Samaah with this recent measles outbreak. I mean, 83 of the children that died during that Samaah measles outbreak were less than four years of age. Really, most were less than one year of age. Yeah, that's what we see in Minnesota too. When we have outbreaks, a lot of parents wait till kindergarten to get the MMR vaccine. So our outbreaks are usually kids under five, which is awful. But that reminds me that, well, you talked about compulsory vaccination and mandatory vaccination. But now in schools, we kind of have something else, which is a requirement that's not necessarily something that's a steel trap requirement. It's you can find your way out of it if you have a reason. And it could be a religious reason, or it could just be, I don't like vaccines reasons. So most states have some sort of exemption that you can get to school requirements. And how did we get there? And what has happened because parents can opt out? Right. So we have this notion in this country of medical freedom. And it's interesting. There's a book called Freedom's Dominion, which talks about how we use the word freedom in this country. And it's often to do whatever you want, independent of how it affects other people. That's basically what we've come to mean. With freedom in this particular case, it would be the freedom to catch and transmit a potentially fatal infection. Remembering that there are 9 million people in this country who can't be vaccinated, because they're getting chemotherapy for their cancers, or they're getting immunosuppressive agents for their rheumatologic diseases. They depend on people around them to protect them. But nonetheless, people believe they should have the freedom to get on an elevator with somebody who can't be vaccinated and infect them. So you're right. There was sort of initially it was in New York. There was a bill to essentially mandate the polio vaccine for students in New York state. And there was pushback from a Christian science group that basically said we don't believe in vaccines. And Christian science was founded by Mary Baker. They're ready around 1875. So there actually was a vaccine by then. There was a smallpox vaccine. So she actually has a statement in her religious text. I can't remember the name with the key descriptors. I remember as the second part of their religious science and health with the key descriptors. That's it. So she actually there is a statement then in the major text of Christian science that you shouldn't be vaccinated. She said that basically you get smallpox if you think you're going to get it. You just try and imagine not getting it and you won't get it. That's basically what's where she was coming from. I mean, the other major texts of the religions, like Old Testament, New Testament, never mentioned vaccines because vaccines didn't exist yet. But here they did and so she mentions that. So basically a Christian science group said, we are of the belief that you shouldn't get vaccinated. And so thus was born the religious exemption back then. And from that came the philosophical exemption, which was I believe I shouldn't get a vaccine. And I hold that belief with the strength of religious conviction. And that sort of broke through then with with philosophical exempt. All states with the exception of five have some form of exemption, either philosophical or religious exemption or both. And to me, actually it's it's the both are contradiction in terms. I mean, what they should call these exemptions is I don't want to get a vaccine. I have read a lot of bad stuff on the internet. My friend made me nervous. I think that RFK junior says I shouldn't get vaccinated. And so I don't want a vaccine exemption. Call it that. But philosophical, you know, phyla love, so-fost wisdom, wisdom that says it's better not to get a vaccine and get one. And I would argue that a choice not to get a vaccine is the ultimate, irreligious act. I mean, you're putting your child in harm's way. You're putting those with whom they come in contact in harm's way. It is not a religious thing to do. So I think it's I think both are misnames. Yeah. And you know, during the COVID when the COVID vaccines came out, Hope Francis told all the Catholics in the world that getting a vaccine was an act of love for your neighbor. So, you know, the weight of view of vaccination too is that it is a way of being responsible to your religious faith as well, to care for other people and, you know, be your brother's keeper, where your sister's keeper, I guess. So I'm wondering when these religious and philosophical exemptions started rolling out, was there an outcry from public health or physicians group where people alarmed or was it just seen as this isn't very many people? It's not a big deal. I think as we got more and more in control of these diseases, I think we got less and less forward about trying to prevent them. We were feeling a little more comfortable. And with that, we felt less compelled to push it harder. So no, I think it was sort of bending over backwards to try and be open-minded to the notion of a religious exemption or philosophical exemption. But I think this is an example of sort of being open-minded to the point that your brains fall out. I mean, this is a, these diseases can cause suffering and hospitalization and death and need to be prevented. And I think we need to do everything we can to prevent them. Why do we just have to respond to things after they happen? 'Cause that's what's about to happen. I really fear that with this pushback following the COVID pandemic, pushback against all manner of public health, whether it's the vaccine mandates or masking or whatever, I think you're about to see some of these diseases come roaring back. It is a fear. And it's really a shame that there's all that pushback against masking. 'Cause could you imagine if people just as a matter of course, when they thought they had a respiratory virus started masking, how much healthier we would all be? You know, I think it's, my feeling right now is that if you have an upper respiratory tract infection and you're in a high-risk group for COVID, severe COVID, you should test yourself. If you're positive, take an antiviral. If you're not positive, assume you have respiratory respiratory respiratory respiratory respiratory respiratory, you don't need to test yourself. Just assume you have COVID or influenza respiratory respiratory, I was at an airport in Naples, Florida. And this was a striking moment. So there was a airport worker who was kind of going around and sort of working on the trash cans. And he was also had a vacuum and he was sort of cleaning up in the area where he was. And he was kind of in the area where he was cleaning up. And he was like, "Oh, I'm going to have a respiratory respiratory sort of cleaning up in the area where we were waiting, we were all waiting to get on a plane." And there was a rug that we were standing on, so he was sort of cleaning up. And Snapell's a lair to show it's an older crowd. He had a terrible cold. I mean, he was coughing and sneezing. His nose was running. He was wiping his nose on his sleeve. And finally, an older woman had the courage to say, "Did you test yourself?" This was a couple of years ago talking about COVID. And he proudly said, "Yes, and I'm COVID negative." But he wasn't wearing a mask. So what he was doing was basically saying, "Yes, I'm COVID negative. I'm just going to infect you with one of these other viruses that could kill you." I mean, there's this kind of COVID exceptionalism. All these viruses can kill you, including thousands and thousands of older citizens can die of influenza in respiratory sensational virus. And respiratory sensational virus is the most common reason for children to go to the hospital. So take them all seriously. Absolutely. Absolutely. There's no exception for COVID or measles. but speaking of measles and those philosophical exemptions almost all states had them until Disneyland. What happened? Right now, so that was, that's right. So around 2014, there was an outbreak in Southern California around Disneyland with sort of a left leaning crowd, you know, the kind of all things natural, bib overall, gluten-free, casing-free, dolphin-free crowd. And they just wanted, you know, all things to be natural. And including presumably a natural measles infection, although I really mother nature, I don't know who her public relations team is, they're doing a great job because she has been trying to kill us ever since we crawled out of the ocean on to land. But then they shouldn't call it natural immunity. We should call it survivor immunity because that's more accurate. In any case, there was an outbreak that spread to 25 states involving hundreds of people, and it started in Southern California. And that really made Richard Pan who was a state senator angry. He thought that children should not be put in harm's way that way. And so he wanted to eliminate the philosophical exemption in a state California that didn't have a religious exemption, which means that they would then only have medical exemptions. And he was brave. I mean, he was attacked from a lot of people, and they're on the anti-vaccine crowd, including one for whom he had to get a restraining order. But I think what turned the tide in that, and he was able to successfully do it, he surrounded himself with parents who wanted to keep their children healthy. To make the point that parents care about this, parents care about these issues. And because I think on the anti-vaccine side, they'll often say it's parents against doctors. And that's not true. It's really parents against other parents. And by the way, doctors are also parents. So that's the economy doesn't really work. But in any case, there was a little boy whose name was Rhett Crowett, who was like six or seven years old, had leukemia. And he would go to these meetings, and they would sort of put him up on his stool so he could reach the microphone. And he would say, look, he had acute lymphoblastic leukemia, but he said, I have leukemia. I can't be vaccinated. I depend on you to protect me, don't I count? He was the voice of society. And he really had a lot to do with, I think, the fact that they were able to eliminate that exemption. And that's one of the things that people don't know about a classroom is they don't know who's vulnerable in any given classroom. They don't know if your child's playmate is taking an immunosuppressant or was born with a, you know, not a full functioning immune system, or is just particularly susceptible to diseases because they have asthma or something else. And so it's really one of those things where if you don't know, it's easy to ignore and just say, these kids will all be fine if my kids are unvaccinated and comes to school as measles, but it's not fine. No, I think part of it is that when we loosen restrictions, for example, and then there are outbreaks and there are children who are hospitalized. And in worst case scenario, there are children who die. You don't know their names initially. You don't. You've made a recommendation or loosened a recommendation and now caused the children to suffer. If you knew the names initially, okay, if you do this, here are the names of the children who are going to be hospitalized. Here are the names of in Philadelphia, the nine children who are going to die of this virus. I think we'd feel differently. And it's like the old Stalin line, not that you should quote Stalin in public health podcast. His line, we know one death is a tragedy, a million deaths are a statistic. And I think that's sort of what this is. Although I do wonder, and this is a question for you too, I think it would take a lot of people dying from measles, not just one or two kids. I think you would, I don't know. I don't know how many kids have to die from measles before the public gets on board again with those higher immunization rates and protecting our communities. It's a frightening question. And although frankly, I think it's the only way we are going to again regain trust in public health. Because right now we feel perfectly comfortable rejecting it, rejecting public health. I mean, I just talked to a reporter today from Louisiana who said that, you know, the head of public health in Louisiana has now considering don't offer at a state health clinic influenza vaccine, don't offer COVID vaccine, don't offer Mpox vaccine. If somebody asks for it, you can say you have it, but don't offer it. So we're sort of taking the public out of public health. It's more like an anti-public health than it says. I think we've gotten to the point where people were angry at what they believe this government overrates during the mandates for closing schools or shattering your businesses or respecting travel, testing, isolating, quarantining, social distancing, and then mandating vaccines that we've actually gone way too far in the other side of saying, okay, we're just going to take the public out of public health. And you saw that with the measles outbreak in Florida where the state, surgeon general, Joseph Lidapo basically said that people who were in that school who weren't vaccinated could remain unvaccinated, even though it was a measles outbreak. He didn't push in any sense quarantining the people who were sick. I mean, these are the two major arrows you have in the quiver of public health during a measles outbreak. And he's just saying, let it run wild, which a lot of people said during this COVID outbreak, the Great Barrington Declaration that let's just let natural infection happen and then we'll all be fine. And yes, we'll just try and protect the most vulnerable, which in the Great Barrington Declaration was people are over 80 or people in nursing homes, but a lot of other people are vulnerable. And I just think it was a terrible idea. I realize we should make this clear. We want zero children to die. We want nobody to die from measles. It's completely preventable. Right. No, I mean, there's so much in medicine we don't know. There's so much we can't do this. We know it's like, are we going back to a time when we didn't believe in the germ theory? You know, the specific germs can cause specific diseases. Actually, not a theorem. It's real. And it's just really hard to watch this. I feel like asking that state health representative in Louisiana when he walks into a room of some with tuberculosis who's coughing. Does he wear a mask? Good question, right? Okay. So what are some things that everyday people, not all of us are Paul off it? What are some things that everyday people can do to protect our children in the classroom against measles, polio, all of these infectious diseases? Well, be vaccinated. I think, you know, that the one thing you can do it to protect yourself is be vaccinated, but realize vaccines, no vaccine is 100% effective. Right. Right. No medical process or drug or or antiviral. Nothing is really 100% effective. So realize there's always some level of risk. And so therefore, I think that parents who care about their children and care about other people's children should really stand up for public health here because I think public health is under siege. And I think we are just seeing the beginning of it. I think it's going to be much worse over the next few years because of the people that the Trump administration is at least is trying to put in place who are people that don't trust public health. They don't trust the people who are ahead of NIH or CDC or FDA. Don't trust those agencies. And I think we're going to do much to kind of hurt those agencies. And I really do fear that the vaccine infrastructure is going to be significantly weakened and fewer and fewer children or get vaccines. And we're going to start to see these disease come back. And unfortunately, I fear that the one vaccine that's going to be targeted is the MMR because that's always been a pet favorite of the anti-vaxxers to target when it comes to autism. Right. And so the question was raised. The nicest thing you can say is that 1998 Andrew Wakefield by publishing a paper in the Lancet, which was a Kate series of 12 children, eight of whom had autism within a month of getting the vaccine, which was also not true. By the way, he also misrepresented clinical data. He misrepresented biological data. He was a fraud and that paper was retracted. But nonetheless, it raised the question to which the public health community and the academic community and the pediatric community responded by doing study after study after study in seven countries on three continents, looking at tens of thousands of children costing millions of dollars to see whether that was true. And so you could do those studies. You just had to make sure you controlled for things like health care, seeking behavior, medical background, socioeconomic background. So you could isolate the effect of that one variable receipt of MMR vaccine where you more likely to get autism if you've gotten that vaccine or if you hadn't. And study after study, if your study showed that wasn't true. So there's two ways to interpret that data. One is to say the reason that these researchers never found that was because it wasn't there to be found that autism caused, it was caused by MMR because it or the way in which RFK junior interprets it, which is that there is a massive international conspiracy among thousands of investigators to hide the truth. That's the way he interprets those data. I mean, think about this. It's when the COVID vaccine was released in December of 2020. No one anticipated it would cause microditis. I mean, that was a surprising finding, but it was quickly picked up within months of that vaccine being out there as occurring in roughly one in 50,000 people. Nobody expected the Johnson Johnson vaccine, which was the so-called vectored virus, adenovirus vaccine, it was a cause of clotting, including severe clotting, including fatal clotting, this clotting problem occurred in one in 250,000 people, easily picked up in retrospective analysis. Autism spectrum disorder is said to occur in roughly one in 36 children. This would be picked up in phase two studies before you even have a life-sitter, certainly in phase three studies, meaning the sort of the tens of thousands of people that are studied when a vaccine is submitted for life-sitter, easily picked up. But it's not being picked up because it's not there to be picked up, not because there's this vast conspiracy to hide the truth, which is what RFK junior's point of view is. He believes that only he is going to look behind the curtain and find out what's really going on because he has a non-falsifiable hypothesis, something no scientist should ever have. He holds it onto this with a strength of a religious conviction and nothing will convince him otherwise. He's a science denialist. 1978. was entering kindergarten. I remember part of it was getting my oral polio vaccine. It was part of the school process and the reason it's part of the school process is that especially in those days all children enter a kindergarten and it's a great place to check on their health records. We we check their eyesight, check their hearing. Sometimes we check their speech, we check their developmental, their developmental growth and we check their vaccine records and that used to be something that was just a matter of course and if we decide that we shouldn't check their vaccine records anymore and we are pure medical freedom I really worry about the children in this country not just because of vaccines but all sorts of things that happen at school and are important to happen at school will go away because people are afraid of that sort of social safety net. Yes I agree. I think it's trouble times. I can end on a more positive note so that we don't just completely depress the people that are listening. I think there was once the I'm sure I told you a story before about Galileo in the early 1600s in Italy was observing the planets. He noted that the earth revolved around the sun which contradicted biblical teachings that the earth is the center of the firmament so he was brought up before a Catholic tribunal tribunal where he was found guilty and sort of put in change and then marched away but before he left he sort of looked back at the people who were running the tribunal and said regarding the earth and presumably in Italian and yet he said it still moves so you can you can put me in chains and you can lead me away but the fact remains that the earth revolves around the sun and the fact is that vaccines don't cause autism and the fact is that if we erode immunization rates these diseases are going to come back and I think that good science ultimately wins out and it will win out here I just fear that there may be a price to pay before it wins out. That was kind of a hopeful note. We tried. We tried really hard everybody. The good note is that we have a lot of wonderful really vaccines that mean that our children don't have to suffer the way that generations past children did suffer so that's my hopeful note. I'm with you. Well thank you so much for joining us today. It's always just a pleasure talking to you and you know this is a really important topic. I really wanted people to have that deep understanding of why school vaccine requirements anyhow. If people wanted to look up the vaccine education center of children's hospital Philadelphia do you have an easy way for them to get there? Yeah just just Google vaccine education center. What's you start to get like education where the first thing that comes up but it's vaccine education center at children's hospital. If you immediately come up when you start with vaccine education you'll see it. Excellent. Well thank you so much. Thank you. And thank you to all of you for joining us as well. Our call to action is do something good for vaccines that no one can ever thank you for. Yeah easy peasy you can come up with something. My name is Karen Ernst and I'm the director of Voices for Vaccines you can find us at Voices4vaccines.org. And I'm Dr Nathan Boonstra. I'm a general pediatrician at Blanktron's Hospital in Des Moines and chair of our state immunization coalition Iowa immunizes which you can go to even as an on it. Iowa at iowat immunizes.org or find me on Twitter or blue sky with the handle of Pieds Geek MD. You know what they say about the Iowa immunizes website. It's the best. If you build it they will come. Well we built it so come on over. Give us some traffic. Okay podcast out. Bye.