Measles, pertussis, influenza. Not long ago, incidence of these and other childhood diseases had been dramatically reduced, thanks to vaccines — with measles virtually eradicated in the United States. Now, cases of measles and pertussis (whooping cough) are surging and childhood flu deaths have risen.
While several factors contribute to the spread of diseases, Paul Offit, MD, one of the nation’s premier infectious disease experts, sees a common culprit in the latest trends: the spread of misinformation about the risks of vaccines, fueling a rise in vaccine hesitancy. As a result, more Americans are declining vaccines for their children as well as for themselves.
“Our children are suffering needlessly,” says Offit, a professor of vaccinology and of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and a member of the Food and Drug Administration’s (FDA’s) Vaccines and Related Biological Products Advisory Committee.
Offit, a pediatrician, speaks frequently and adamantly about the importance and safety of FDA-approved vaccines, and criticizes rhetoric that undermines public confidence in vaccines, while he acknowledges the validity of concerns about possible but rare side effects.
Offit previously served as a member of the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices and is recognized for coinventing the rotavirus vaccine RotaTeq.
Offit recently spoke with AAMCNews about the enormous impact of vaccines over the past century, some reasons for vaccine hesitancy and its implications, and how scientists can restore trust in vaccines and in science overall.
This interview has been edited for clarity and brevity.
You’ve talked about the health impacts of vaccines over the past century. What would you tell people — say, medical students, physicians who are facing doubts from patients, or those very patients — about the value of vaccines?
If you look at the late 1800s and compare that to now, we live 40 years longer than we used to. Arguably the biggest reason for that is vaccines.
My grandparents were scared of diphtheria, which would kill 15,000 people, mostly children, a year. They were scared of pertussis, which would kill 8,000 children a year. I was born in the 1950s; my parents were scared of polio, which every year would cause as many as 50,000 children to be paralyzed and 1,800 to die. They were scared of measles, which would cause 48,000 hospitalizations and 500 deaths a year, mostly in children. My children were born in the 90s; I was scared of diseases like rotavirus, which would cause 70,000 babies to be hospitalized every year.
My grandchildren were born in the past few years, and my daughter-in-law and my son aren’t scared of any of those diseases. We’ve virtually eliminated those diseases. We’ve eliminated the fear of those diseases.
That elimination of fear can be a problem, right?
Last year, the CDC published a report in Morbidity and Mortality Weekly showing that more parents are choosing to exempt their children from vaccination for nonmedical reasons than ever before. And as a consequence, you’re seeing diseases come back.
Measles has caused at least 1,100 cases this year, as reported by the CDC [in late May], but people on the ground tell me it’s much more than that. It’s probably closer to 3,000. And we’ve had three deaths from measles in the last year. That’s more than the total number of deaths from measles over the last 25 years. Our child deaths from pertussis more than doubled last year. We’ve had 216 children die of influenza over the last year. We haven’t seen that [such a high number] since the 2009 swine flu pandemic.
So the consequences of not fearing these diseases, the consequences of this medical-freedom movement, of this pushback, is that our children are suffering needlessly.
At the same time, you’ve spoken out about rare but real side effects, particularly the risk of myocarditis from the COVID shot in young men. How do you communicate the value of vaccines while acknowledging the potential harms?
The potential harms from vaccines are infinitesimal compared with the harms from the diseases. Myocarditis following the COVID vaccine is generally short-lived, transient, and self-resolving without sequelae. Myocarditis as a consequence of the disease is far more common and more likely to cause permanent harm and even death.
That brings up a broader point: You’ve said science is losing its place as a source of truth. What do you see as the reasons for that loss of trust?
Science and scientists and public health officials took a hit during the early stages of COVID. For most of 2020 we didn’t have antivirals, monoclonal antibodies, or vaccines. All we had to prevent someone getting infected with a virus that was killing hundreds or thousands of people a day was to restrict travel, to shutter schools, to close businesses, to isolate, quarantine, mask, test. Some people saw that as massive government overreach. We leaned into this libertarian left hook, and we are still feeling the punch of that.
When I talk to people who are angry about the restrictions and mandates that you just cited, it’s not the scientists in the lab that they don’t trust. It’s the science leaders who insisted on those restrictions. Do you agree, and did those leaders make the best decisions they could with the information they had at the time?
I think that’s right. You learn as you go, and that’s very hard for [the public] to accept. When you make a decision, you base it on the fact that you think you know enough to make that decision, not because you think you know everything.
We could have done a better job very early in explaining this. To say, “The purpose of this vaccine is to keep you out of the hospital, keep you out of the intensive care unit, keep you out of the morgue, and it’s not going to protect you against mild or moderate disease for long. When people were mandated to get a vaccine, and they would still get a moderate infection, where they’re home with coughing and chills and high fever, they would think, “They lied to me, told me this vaccine was going to protect me.” We could have explained that better, but it’s always easy to see that in retrospect.
You’ve noted that vaccine hesitancy was there before COVID; it’s been around a long time.
Vaccine hesitancy goes back to the first vaccine [smallpox], developed by Edward Jenner in the late 1700s. That gave birth to so-called anti-vaccination leagues. There’s a cartoon by James Gillray where you see this disinterested Edward Jenner standing among a group of people who are fearful because they’re starting to develop these bovine-like characteristics; they’re developing snouts and ears. [The vaccine used the cowpox virus, from cattle, which immunized people from smallpox.] They felt that this cowpox virus would do that to them.
Many of the fears people have about vaccines today are about as biologically likely as that. But the minute you ask someone to get injected with a biological agent that they don’t understand, you’re going to get pushback.
The birth of the modern anti-vaccine movement occurred in 1982 with the airing of a compelling story [“DPT: Vaccine Roulette”] by an NBC affiliate that showed children who had withered arms and legs, who were staring up at the ceiling, drooling, seizing. The parents all told the same story: “My child was fine, then they got this pertussis vaccine, and now look at them.” That led to a flood of litigation that drove many vaccine makers out of business. That gave birth to the notion that vaccines might be doing more harm than good.
The only thing that stopped the bleeding was the passage in 1986 of the National Childhood Vaccine Injury Act, which included the Vaccine Injury Compensation Program.
What do you see as the foundation of the current measles outbreak, in terms of vaccine hesitancy?
The publication [of a paper] in 1998 by Andrew Wakefield in The Lancet — claiming that the MMR vaccine [measles, mumps, rubella] caused autism — gave birth to [vaccine hesitancy] in a major way. It wasn’t a study. It was eight children who had recently received an MMR vaccine who then developed signs and symptoms of autism. You might as well publish a study of eight children who had recently eaten their first peanut butter and jelly sandwich and later developed autism.
The paper was horribly flawed. There was a misrepresentation of clinical studies, misrepresentation of biological data.
But [Wakefield] was a very good communicator. He was attractive. He was well-spoken. He had that British accent. He was everywhere: on morning shows, on evening shows, testifying in front of Congress. He had an enormous impact.
Ultimately, The Lancet retracted that paper, but they couldn’t retract the harm that was done. That gave birth to the notion that vaccines could cause this permanent, lifelong disability.
Since then, there have been 24 studies looking at whether or not you were more likely to get autism if you’ve received that vaccine than if you hadn’t, and the results have always been the same: “No.” I think most parents of children with autism don’t believe that MMR vaccines caused their child’s autism, but about 10 percent or 15 percent do. And now, with some public figures saying vaccines cause autism, that has emboldened parents who were suspicious [of vaccines] to not vaccinate their children.
In this atmosphere, how do scientists rebuild trust?
Most parents still embrace vaccines, still see their importance, but there has been a loss of trust.
We have to try and find people in their communities that they do trust, make sure that they’re out there explaining the importance of vaccines. During the COVID pandemic, an African American surgeon, Ala Stanford, took it upon herself to form the Black Doctors COVID-19 Consortium and go into North Philadelphia, predominantly Black and brown communities, and convince people about the importance of testing, about the importance of vaccination. She vaccinated, with her colleagues, 50,000 people.
You have to try and figure out the best way to get your information out there. It’s hard. Social media has made it really hard to get above the noise of the misinformation and disinformation. It’s a new game, and we have to get better at playing it.
But science is a powerful thing to have on your side. Although we may feel like science is losing its place as a source of trust, we live longer, better lives because of advances in science and technology. And that’s not going to change.
