Everything You Need to Know About Vaccinating Your Kids (with Pediatrician Paul Offit)

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Andy calls up pediatrician and vaccinologist Dr. Paul Offit, who just voted to recommend that the FDA approve Pfizer’s vaccine for 5-11 year olds. They discuss the vaccine advisory committee’s deliberations, what the data show about side effects like myocarditis, how to think about the decision from a parent’s perspective, and whether or not schools should require that eligible kids be vaccinated against COVID-19. Plus, Andy breaks down what you need to know about COP26, the global climate summit that is now underway in Glasgow.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Paul @DrPaul Offit on Twitter.

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Paul Offit, Andy Slavitt, John Doerr, Ryan Panchadsaram

Andy Slavitt  00:18

Welcome to IN THE BUBBLE. This is Andy Slavitt, your host here in Philadelphia with Lana. We are visiting one Zach Slavitt. This weekend, some of you who listened to the first season of IN THE BUBBLE will remember that Zach was my sidekick on the show. He’s my 19-year-old son. And he made 15 minutes for his mom and me yesterday before he went out to have a party. And we loved every one of those minutes. We will see him more today. And he’s a wonderful kid. But it is great to see the progress that allows us all to go travel a little bit and see our family, safely, of course, fully vaccinated, boosted if appropriate, masked. And then here on campus, unlike last year, it seems like there’s very, very little COVID, at least in Philadelphia. So it really is good to see the progress. Having said that, I’m sitting in a hotel room about to interview, the mayor of Chicago, Lori Lightfoot for the show coming up on Wednesday. So you get reasonable listen to this show, which is gonna be great. And then Wednesday show, which I’m very excited about. And I’ll come back to that in a minute.

Andy Slavitt 

What’s going on around, let’s just do a quick shake and bake and what’s going around. First of all, speaking of Philadelphia, we are making a gift this week from the show, from you, our listeners to the Black doctors COVID-19 consortium of $8,753. This is a group that went out on their own and built mobile COVID testing and vaccine operations to vaccinate people with no barriers around Philadelphia. We learned about them, we found out about them. And this is a surprise gift to them. And as a reminder to people listening to the show, yes, you have to listen to commercials or at least to speed through them. But we take the money from those commercials the money that would normally go to the host. And that money we donate every month to some set of people who are working in COVID relief and it makes us all feel good. And it makes the commercial sound even better. So that’s that, we have vaccines for kids about to roll off the factory line into pediatrician offices. This is what this episode is about. Paul Offit, who is a world class pediatrician from the Children’s Hospital in Philadelphia.

Andy Slavitt  02:41

He’s the director of Vaccine Education Center there. And he is also a member of the Food and Drug Administrations, they call it the VERB pack. The VERB pack is a group that just voted unanimously with one abstention. He was not the extension on the approval of the Pfizer vaccine for kids, and we’re gonna talk about that vote. But more importantly, we’re going to talk about the real questions involved in kids vaccinations. And you might not think there’s a lot of questions in kids vaccinations, but then again, there are I know this because I studied them. And they’re really actually quite interesting. And it’s quite a different play. And I think you’ll really like the interview, what else is going on? rapid testing availability is ramping up. We had now have a system for being able to get your credentials if you’ve been vaccinated electronically for most people in a digital format that launched officially last week, I think October 28th. So if you want your vaccines digitally, if you’ve got the […] from a pharmacy or hospital, check the website, check with the people who vaccinated you. And it will be possible to get those credentials on your phone, whether it’s a Google phone or an Apple phone.

Andy Slavitt 

You know what I mean? Google phone, I just call them on Google phones. They’re not they’re made by other companies. And of course, there’s increasing pressure on global vaccinations. I think it’s a place where we are most behind. You know, I think fewer than 10% of African nations are scheduled to hit their goal of vaccinations by the end of the year. That’s not good. We’ve had a number of episodes on all these topics. We had Stéphane Bancel. So probably, if you go back to episode or two in your file and listen to that episode, I think you’ll be blown away. It was one of the most interesting interviews on every topic. We did an episode on these credential cards, which you can listen to. We did an episode on rapid testing all of them in the last couple of weeks. What’s the outlook right now? You know, cases are getting better. I think we tend to be rosy and optimistic when cases are getting better. And I think we tend to be pessimistic when case counts are increasing. But of course they can change at any time and that’s the kind of the weird part is you can watch the curve a little bit scarily I had a conversation with folks who are looking at the data and people in the administration and I think we’re gonna kind of be in a hold our breath mode into till January, what’s gonna happen over the holidays? Are we going to see a new variant emerge? And I think it’s probably two and three odds that we’re going to continue to see it back to normal state and probably one in three odds that we’re going to continue to see some sort of disruption. But who knows? That’s kind of what we see out there.

Andy Slavitt  05:24

All right, coming up, we have something I think worth paying attention to. That’s just gotten underway in Glasgow, Scotland, I’m talking about the UN Climate Change Conference 2021. And I thought it would be useful to just give everybody a sense of what it is, what’s it all about, and what we should be paying attention to. So I’ve invited on the show, John Doerr, and Ryan Panchadsaram, who are the co-authors of a book coming out on November 9th, it’s available for pre order, called Speed and Scale, it really is the plan for how to address climate change. But I thought it would be useful if I could have them on to give us all just a sense of what’s going on here what to pay attention to, because it seems like a really big deal. And I can’t explain it myself. So I need some experts. So welcome, John and Ryan.

John Doerr  06:08

Thank you, a privilege to be on your program.

Ryan Panchadsaram 

It’s great. Great to be here.

Andy Slavitt 

So John, what is COP? And what’s it supposed to accomplish? And what do you think it will accomplish?

John Doerr 

Pretty questions, COP is the Conference of the Parties. That’s the United Nations Climate Conference where world leaders come together to set and strengthen and accelerate their national commitments to the climate crisis. I’m hoping for looking for progress in four areas. First, an increase in the commitments by the nations of the world to accelerate their reduction of greenhouse gas emissions. And a way to get there is to a second dream of mine and […] as it turns out, that’s to get a global price on carbon. A third thing would be more aggressive policies and regulations regarding methane emissions. And a fourth would be to bring even more economic incentive to stopping the deforestation. If I could even give me one more wish it would be to stop the use and spread of coal all around the planet. But the COP is the Global Forum, where nations sign up for their climate agendas and make them public.

Andy Slavitt 

So Ryan, how’s all this going to happen? What should people be paying attention to? How will people get a sense of whether the progress John’s talking about is actually happening?

Ryan Panchadsaram 

Totally, COP takes over two weeks. It’s a two-week long conference in Glasgow, and a lot of commitments have been made building up to it, countries will make even more hopefully ambitious ones while they’re there. If John and I are standing outside, we’re going to be standing out with the flag that’s waving speed and scale, we’ve got to move quicker. And we’ve got to be bolder, because policy sets the direction for a nation, right? It gives businesses confidence; it gives consumers confidence. And so what everyone should be looking out for, are the commitments that are being made around how the clean energy transitions happening, right, like John says, ending coal, transitioning away from gas, the public commitments around transportation, right electric vehicles, and then a really big one is around deforestation really ending it. If you go after those three, we aggressively cut the amount of emissions that are happening right now.

Andy Slavitt  08:36

Well, sounds critical. And I happen to have read the book you guys put out, got an early copy, I’ll have a link to the preorder site on our show notes. It’s called Speed and Scale. Thanks for coming on and explaining this. Let’s watch for it. And then we’ll have you back at some point, and maybe you’ll will get a sense of the bigger issues that we’re facing. Thanks for being on.

John Doerr 

Thanks for having us handy. Thanks for not only all you do, but who you are and what you stand for. You’re a hero of mine. And Ryan, I know.

Ryan Panchadsaram 


Andy Slavitt 

So before I get to the interview with Paul, who I think is brilliant, and I’m sure you’ve heard before, no one talks about issues of kids and vaccines and infectious diseases better than Paul does. Before I get to I want to, I don’t want to leave everybody with a sense that everything’s getting back on its axis. And things are back to normal. There’s still craziness going on. And that’s going to be what you’re going to hear in my interview on Wednesday with Lori Lightfoot. As evidence. You know, there is this kind of a major faceoff between the police union in Chicago who is refusing to get vaccinated and the union boss is making a big big deal and going out of his way to make a fight and make a personal fight with the mayor. And the mayor is Saying no more police officers die from COVID than from shootings, we need to protect, you need to protect each other. And you need to either get vaccinated or to get tested. And this is just playing into the shouting match at the moment. And as we get into the politics of the next year, I hate to say it, we got an election year coming up, we’re gonna see this play out even further, we’re gonna see it play out, and the quote unquote origin story of COVID-19, the Republicans in the Wall Street Journal have decided that this is going to be their number one election issue in 2022, is how the Democrats somehow started the COVID bug. So between all of that, we are wrestling with trying to get back to normal and trying to manage the insanity, no better person to help us through all of this than Paul Offit. It’s a real pleasure to have you on, Pau.

Paul Offit  10:56

Thanks for asking me.

Andy Slavitt

You are busy man. You’re the man of the moment.

Paul Offit

Well, certainly, I mean, the FDA Advisory Committee is a lot of work. I mean, it’s, it’s it’s like trying to build the airplane while it’s in the air. You know, we’re presented with data that are not as much as we usually are presented, and so has to make decisions. So it’s a little unnerving.

Andy Slavitt

How challenging was this decision? I think for many Americans, it felt like the outcome was sort of baked in, we assumed that this would be approved for kids five to 11. But you know, it took longer, there were requests for more data, there was more discussion, you know, it was a little bit less than straightforward.

Paul Offit 

Well, it’s the sort of the easy part, and the hard part, the easier part, at least for me was when the virus first came into this country. You know, beginning of last year, children accounted, or at least were said to have accounted for fewer than 3% of cases. And the mantra was children get infected less frequently. And when they get infected, they get infected less severely. And that’s true. But what’s happened over time now, the children account for about 27% of cases. And while it is true, that they’re infected less frequently and less severely, they still can be infected, and they still can suffer and be hospitalized and die. And we know that at least even just in the 5- to 11-year-old age group, you have roughly 8300 hospitalizations, a third of which result in intensive care unit admissions, you know that there’s been about 140 deaths in that age group, you know that about 2000 children have suffered this multi system inflammatory disease, and there’s been almost 2 million cases in that age group so they can suffer.

Paul Offit 

So then the question becomes, can you protect against that disease safely, and that was the bulk of the discussion, because you also know, and that was a surprise with the mRNA vaccines that in the 16- to 25-year-old age group, that there is an increased incidence of myocarditis, and that was the younger age group. So if that’s happening in the younger age group, then what happens if you do an even younger age group, like as we’ve done now, the 12- to 15-year-old, or an even younger age group, the 5- to 11-year-old age group, are we going to have an even greater risk of myocarditis, something that appears generally transient and self-resolving, but I’m sure there’s going to be a spectrum of illness as we move forward. So I think what was what was encouraging for me was that when you look at the 12- to 15-year-old age group, both Israel and us, it looks like the incidence of myocarditis is less than it was in the 16- to 25-year-old age group.

Paul Offit 

So that was encouraging. It’s also for the 5- to 11-year-old a lesser dose, we’re giving 10 micrograms per dose, not 30 micrograms per dose. So much so actually looks like Pfizer now is going to be looking at the 10-microgram dose in the 12- to 15-year-old age group. And also, if you look at classic myocarditis, you know, the kind of myocarditis it’s caused by viruses, that’s usually a post pubertal phenomenon. So that also was somewhat reassuring. So, again, you know, it’s the question we were being asked was, do the risks outweigh the benefits. And for me, it’s never about when you know everything, you never know everything. The question is, do you know enough right now to move forward? And I think the answer was yes.

Andy Slavitt 

And it seemed like the data at least seemed to indicate, or at least the staff indicated that when there is very low levels of COVID in the community, that it becomes less obvious or less clear that the risks outweigh the benefit it which would stand to reason if there’s no COVID there’s no benefit, which actually would be true for adults as well. Why get vaccinated if there’s no COVID? So I didn’t really understand whether that statement was something that parents should pay a lot of attention to, and kind of modulate their decision based upon the COVID rate or whether or not that’s sort of a red herring.

Paul Offit 

No, I think, of course, it all depends on that. I mean, we knew that at least as of a few weeks ago, we would see 150,000 cases in children a week or 200,000 cases a week or 250,000 cases a week associated with 2000 hospitalizations a week, and I was on service a couple of weeks ago, and I can tell you our hospital reflected that national average, we were seeing a lot of children in our house with COVID. I’m talking about in the hospital or in the intensive care unit and so then what happens over time, it looks like we’re starting to come down off this curve, both for infection and for hospitalization and for death doesn’t remain that way. And that we don’t know. We are heading into winter. This is typically a winter virus. Coronaviruses are winter viruses; we see four strains of human Coronavirus. They come into our hospital every winter; they account for probably 15 to 20% of the respiratory diseases we see. So this is typically a winter virus. So what’s going to happen as we hit December, January, February, we’ll see, I mean, if you’re going to tell me if you could tell me that this pandemic will end by January, then yeah, then the risk benefit ratios for vaccines clearly changed. But for right now, I think it makes sense to vaccinate because we’re taking this fully susceptible group of people, these five-to-11-year old’s, we’re putting them all together in one place in schools. And, and incubators, especially with communities where circulation is still fairly high, you need to protect them.

Andy Slavitt  16:08

You know, when it comes to ourselves, I think we’re willing to make societal decisions,  oftentimes, when it comes to our kids, often their safety and what doing what’s right for them as the only thing that matters to us as parents and as a society. So, you know, how do you advise parents who hear all of that and say, you know, on the margin, things are improving. And the risk seems to be going down, and the cases are in severe. So I’m really very much on the fence.

Paul Offit 

Right? Well, as always, there are no risk-free choices, they’re just choices take different risks. So I think given the fact that this virus is still circulating, given the fact that if it does infect your child, it can cause serious illness as we know, with the roughly 8300 hospitalizations just in this five- to 11-year-old age group. And also realize that when you’re infected with COVID, you have a much higher chance of having myocarditis than if you’re vaccinated with a COVID vaccine. The study out of Jama Cardiology looking at older adolescents and young adults who were who were athletes in the big 10 conference, what they did was they took roughly 1600 people who had COVID and did a cardiac heart MRIs on all of them, and found that roughly 2.5% at evidence of myocarditis, so that’s like one in 45. If you compare that even to the highest risk of myocarditis, which was the 16- to 17-year-old, that was one in 5000, which is not trivial, but still exponentially greater than then after the vaccine. And also the thing that scares me the most about this virus actually, and the because we see this a lot in our hospital is the so called […] this multi system inflammatory disease.

Paul Offit 

What’s particularly heinous about this virus is that it has the capacity to have you make an immune response against the endothelial cells that line your blood vessels, which is to say it induces inflammation in the blood vessels and induces vasculitis. Because every organ in your body has a blood supply, every organ is vulnerable. And when we see these kids, it’s the story is always the same. And this is a disease really, of the five- to 13-year-old, with a peak really nine years of age, what the story is always the same. The child has a trivial infection, either an asymptomatic infection that was just picked up serendipitously because the child was exposed to a friend or family member. So got tested, or has a mildly symptomatic infection which resolves, then a month later, they come back, they’re no longer shedding virus. They’re PCR negative, but they’re antibody positive and they have high fever, they have pulmonary disease often have heart disease, often 50% of the time, 75% of the time, a kidney disease, liver disease, and they’re sick. And what respiratory virus does that I mean, this is a novel virus in that sense.

Paul Offit  18:54

It’s no doubt in part associated with why children can have long term sickness, well, I think is at least in part associated with this vasculitis. And so for that reason, I think it’s worth preventing we don’t, there’s much we don’t understand about this virus, but what we do understand is it can cause children to suffer and be hospitalized and die. And although the vaccine is a very rare cause of myocarditis, it appears to be a less common cause in the 12- to 15-year-old and the five- to 11-year-old is even getting a lower dose and is pre pubertal. So there’s a lot of reasons to feel that it would be even rarer to get myocarditis with the vaccine. So it’s always a matter of relative risk. There’s no risk-free choices. But I think what a parent chooses not to get a vaccine, they think they’re not doing anything, but they are doing something there’s something they’re doing is taking a risk of getting this virus. So if you could tell me comfortably that you know, this virus is just about to go away, then I would feel differently, but I don’t think that’s true. And remember also, every year in this country, we vaccinate children with a polio vaccine, why we haven’t had polio in this country since the 1970s. We do it because polio still exists in the world.

Paul Offit 

So I think we’re going to have it still exists in Pakistan. It still exist in Afghanistan, interestingly, we’ve recently had Afghanistan, immigrants, refugees coming into our hospital now, children who have, you know, COVID or other problems and for the first time we’re thinking about, you know, could this child be asymptomatically shedding polio virus, because they’re coming from a country where polio virus is endemic, it’s sort of reawakened our residents into thinking about polio again. So we’re gonna, we’re going to have to have a highly protected population, as long as this virus exists in this world, and it’s going to exist in this world for a while.

Andy Slavitt 

For those listening in, given the strain of this interview, Paul’s now going to be sweating the rest of the interview, we’ve forced him to turn this air conditioning off, it’s part of the interview technique to really get the truth out of very reluctant guests. Thank you for that, in the argument that you just laid out about how parents should think about getting vaccinated. One thing you didn’t mention, and I suspect it was purposeful was that kids can affect others. In fact, others as well. So even if they remain asymptomatic, or have very, very mild symptoms, and don’t develop long term Missy, which is something we should probably come back and talk a little bit more about, you know, they have the ability to affect other kids in school that may have, you know, childhood leukemia, they may infect teachers, they may infect other kids who in fact, parents and grandparents, was that part of the conversation? Was that in the background in the conversation, or not appropriate for the very back to consider

Paul Offit  22:08

What […] considers is do the benefits clearly outweigh the risks for children? Period? I think that that although Dr. Haber is from the CDC did present data showing that children can be a source of infection, not surprisingly, an important source of infection, especially if living in a multi-generational home. I think that and there was a slide actually that was put up by the company that also showed that as a Another important advantage of vaccinating children, children are part of the herd. And therefore, the more of the larger percentage of the herd that we vaccinate the larger, the better chance we have of slowing significantly slowing the spread of this virus. I think the reason it never became an issue is because it’s nothing I think that a pediatrician would ever say, I can’t imagine that, that I would say to a parent, you know that it’s important for you to vaccinate your child to protect people who are older James Hilbert brought that up yesterday as a reason why we shouldn’t you know, necessarily say that we shouldn’t use that as a reason for why to vaccinate the 5 to 11 year old children shouldn’t be a shield for their parents or their grandparents was what he said. And they are I mean; they are in fact that because they can spread the virus. But I think you just can never make the societal argument to a parent for why they should vaccinate their children, vaccinate your child, because it’s for the greater good. I don’t think that parent ever sees it that way. They’ll see it as does this benefit my child, am I protecting my child against getting noticed, I’m not just trying to protect others.

Andy Slavitt 

I think this is really, really important. And maybe it’s a subtlety. But it’s a subtlety that that I hope isn’t lost, which is, you know, there are a lot of people, myself among them, possibly you, but people, plenty people we know who are just want to deliver the message vaccinate, it’s good for all of us, in regardless of people feeling at risk. You know, we don’t want them to show up in the workplace, or at a football game, or in a bar or at a school, a university, I should say, without being vaccinated. And so we have rules and requirements and so forth. Because in part, we want to stop the contagion. And we want to end the pandemic and move on to the next phase that is different than what you just said is different in terms of how we’re thinking about this and talking about it with relate related to kids, and that at least a consideration of the committee. And the way pediatricians think not for nothing is that in the very specific individual of this child? does this benefit him or her? Or does it not?

Paul Offit  24:48

Exactly. I think that’s the way parents see it. I frankly think that’s the way everybody sees it. I think that’s the way adults see it too. But am I protecting myself because cuz that’s how we see it these days, I just don’t think you can make the societal argument like you could before I there’s an old there’s a film by Sarah Colt Productions  productions called the polio crusade. And if you watch that film, you’ll cry, because what you hear in that film are people who suffered polio. And there’s such a societal sense from the in the way that they talk. If you think my polio was bad, you should have seen Joe over there. And maybe it’s we were coming off the shared national tragedy of World War II, or because we saw polio was a shared national tragedy. But this also is a shared national tragedy. But nonetheless, instead of bringing us together, in many ways, I feel like it’s divided us as I feel like this war against this viruses, in many ways become a war against ourselves.

Andy Slavitt 

Without question, and it’s interesting, we have made decisions, though, which have said, if you as an adult, who are capable of making your own decisions, decide not to get vaccinated. No one’s going to require that but we are going to say, at least in certain states, certain situations, certain employer, certain universities, certain schools, certain venues that, no, you shouldn’t be around others breathing freely and infecting them. Lana, yesterday was in a Walgreens, and there are two people she saw getting vaccinated, you know, their first shot, here we are in October, and she overheard them talking. And both of the reason they’re getting vaccinated is because of their employer requiring it, they work for the city of Los Angeles. And in both cases, they said the reason they hadn’t been vaccinated, one of them said they don’t like shots. The other one said they’re scared of shots. And so they weren’t going to do it on their own. But they were doing it because their employer required them to do it. So we have gone further with adults, I think in this, then the logic suggests, we go with children, because we are saying, it doesn’t matter whether you do it for yourself or not. There are other people you’re going to in fact, whereas with kids, that seems to be very clearly not the argument we want to make.

Paul Offit  27:01

I agree with you. I mean, in a better world, we wouldn’t need these mandates, in a better world, people would look at the data, be convinced by the data and we’d all get the vaccine. We’re in a better world, we would trust our medical community, trust the government, trust the pharmaceutical industries to be doing the right thing. It’s not who we are. The Scandinavian countries, for example, don’t have vaccine mandates. Nonetheless, you know, high sort of 90% of people in those countries for children are vaccinated. But probably the best example to me about mandates would be Mississippi, I mean, Mississippi has one of the lowest rates of vaccines against COVID. And as a consequence, has one have one of the highest rates of disease transmission. But the answer to the question, What state in the union has the highest rate of vaccines for children, Mississippi, they’re like a 99%. The reason is, is that they never have philosophical religious exemptions to vaccines, school entry mandates, never. And so they and West Virginia, which also is the only other state that never had a philosophical or religious exemption to vaccine mandates for children and school entry, are in the highest in the country, not that these two states are nationally known for their public health and treatments, but they’re right at the top,

Andy Slavitt  28:09

Well even makes the […] even stronger. Fascinating. So what do you think about schools, mandating vaccines, given what we just said, mandated COVID-19 vaccines? I should say?

Paul Offit

I think it’s a good idea. I wish it didn’t come to that. I wish we had a different word by mandates. Like good health requirements or something. I think every parent who looks at the data now for the 12- to 15-year-old and every teacher who works in the school should know that that what they’re going to do affects others. So for example, I mean, if I think if you asked a parent of a child who was in a classroom where one of the children has a peanut allergy, I don’t think any parent in that class would say, you know, I think it is my right as an American citizen, I think it is my civil liberty to have my child eat a peanut butter and jelly sandwich. I understand that there’s this other child in the classroom, but it is my child’s right to eat a peanut butter sandwich, and no one’s gonna tell me not to do that. I don’t think any parent would ever say that. Well, this is the same thing, except it’s not just one child. It’s many other children who are at risk of these disease. And so if the vaccine is safe and effective, and all evidence to date is that it is then I think they should willingly get that vaccine. It’s a shame that we actually have to go to these requirements

Andy Slavitt 

Help me with this logical conflict I’m having, which is that you just I said, I think said very convincingly, that we should make the decision based upon the individual child. It’s somehow the school mandate, which I also support, but I feel like I wonder if there’s a logical inconsistency given that this is something that many would argue, given that we can’t argue kids should do this for societal benefit, they should only do it based on the risk benefit to them. It makes it less clear cut that you should be able to require this parents to do their children, do you see the point?

Paul Offit  30:01

No, you’re right. It is some level inconsistent it is. So but what you’re requiring of the parent is to do the right thing for their child. I mean, that’s sort of how I see this. So for the same reason you require them to with a child is of a certain weight or age, put them in a car seat, you know. So I think it’s the same thing. That is also a requirement that shouldn’t have to happen, but does. So I see it as a requirement that you shouldn’t have to make for the parent because the parent should do that anyway, because they should be doing what’s best for their child. But parents don’t always do what’s best for their child is the fact that and their parents who choose not to vaccinate their children and put them in harm’s way unnecessarily. And that’s where the mandates for school entry help.

Andy Slavitt

Right. Okay, well, that is at least logically, logically consistent. And I understand it, I could also understand why that feels offensive to some parents, why parents might push back against that. Maybe you’re anti Vax, anyway, or maybe you’re just offended by people requiring you to do something for your kids, which feels quite personal. And I noticed that you made a comment that leading up to the committee meeting you’d received, tell me if I have this wrong, something like an email a minute from someone with an anti-vaccine message. Tell us about that.

Paul Offit

Right. So it actually came from an anti-vaccine person who basically what he did was he posted all the names and email addresses of all voting members of the FDA vaccine Advisory Committee, and asked them to essentially, […] to vote no. So these were all individual messages. I think I got when it was all said and done a few 1000 messages when it was all said and done on my email. They generally were pretty mean spirited. They all had the same information, which this particular anti vaccine activists had posted on his website, too, that that’s the information that we should be provided. So they also basically made the same three points, they pretty much showed the same graphics, and also often made the same sort of analogies to the invariably the Nazi analogy, Norenberg analogy, and how we were horrible people who were doing horrible things to children, which is really the opposite of the truth. I think that the members of that FDA vaccine advisory committee would never make a recommendation for a child unless they would be willing to give it to their own children. So and we take this as an awesome responsibility, because you’re being asked to make a recommendation for children in this country. So they don’t understand us. Maybe if they spend some time with us, they would understand us better, but I doubt it.

Andy Slavitt  32:33

Yeah, they don’t, it feels like the point of the spear, maybe even more emotional point of the spear of what we were talking about a little bit earlier, which is how much COVID has divided us shown where divisions lie, as opposed to rally us. And, you know, the one thing that gives me some amount of hope here is, unlike adult vaccinations, these are largely going to be able to be distributed through the pediatricians themselves. I believe that I, the 25,000, pediatricians have signed up for the program to deliver vaccines. This is where parents are used to getting their vaccines. But more importantly, pediatricians are used to the conversation with parents, with kids about what a vaccine does, about an assessment of the risk of an understanding. And there’s a tremendous amount of trust with pediatricians and parents. I haven’t seen the data. But I think there’s a tremendous amount of trust. Whereas with adult vaccinations, the vaccine process doesn’t go through a trusted source, you could walk in to any one of a number of places to get vaccinated. So you skip that encounter. And it feels like a healthy step in this process for a parent who has these levels of concerns, because unfortunately, for me, not every parent’s going to listen to this show and hear what you just said. And many will not get a chance to see you on TV in the various places where you talk about this. But people have a right to ask in depth questions. They have a right to have their questions answered directly and firmly and clearly with facts, they have a right to be concerned. You know, myocarditis is one of those multi syllabic words that you don’t want to have attached to your kid. And so I think we all get why this is appropriate for a conversation, not a lecture. And I think pediatricians, all the ones that I know, are really quite good at that. And they’ve been, as of course, been doing all kinds of childhood vaccinations before this. So might that give us a less divisive, more rational approach and process here?

Paul Offit  34:44

I certainly hope so. I mean, I completely agree with you. I mean, for the child, the medical homes, the pediatrician’s office, and I think the thing that had to happen, actually, certainly for Pfizer’s vaccine, is they had to create a vaccine where the shipping and storage characteristics were far more compatible with a pediatrician’s office, I mean to ship and store something on dry ice was not something pediatricians were going to easily do. So what the company did was they basically altered the stabilizing agent that was used from something called phosphate buffered saline to a tryst stabilizer, which therefore enable this vaccine to have a 10-week refrigerator life, which makes it much easier for the pediatrician to give it. Also for parents who are worried about the dosing. Remember that the dose for the 12- to 15-year-old is 30 micrograms per dose, the dose for the 5- to 11-year-old is 10 micrograms per dose, that’s a third of the dose. So you want to make sure that the pediatrician doesn’t make a mistake about that, because they basically have two different dosing schedules for two different groups of children. But the company made that easier because one vial is orange, the other vial is yellow, so orange and yellow, which also makes it easier. So I do think that will therefore less than any mistake that would happen, actually, the most common question I get asked is I have an 11-year-old, you know, I’m going to get in and they’ll turn 12, you know, three weeks from now, four weeks from now, you know, what do I do? And I think the answer to that is just stick with the lower dose, I mean, if your child’s 11, get the lower dose and then get the lower doses to boost don’t get a lower dose than a higher dose,

Andy Slavitt  36:14

Right, when you say lower dose are the boost?

Paul Offit 

I’m sorry, I’m sorry. So it’s a two-dose vaccine. The vaccine for the 5- to 11-year-old is 10 micrograms per dose for three weeks apart, for the 12 to 15. It’s 30 micrograms. So how about a child who straddles that. So just stick with the first dose.

Andy Slavitt 

Makes a lot of sense. There’s every case in the world and every everybody’s own cases, the most important case. So it’s great that you have an answer to that.

Andy Slavitt 

Are you concerned about the spillover effect of people’s reactions to vaccine mandates, spilling over to the MMR vaccine? And two other vaccinations? Are you concerned that we might see what has been extraordinarily high rate of MMR vaccinations because of the requirement? I mean, you know, there’s certainly been pockets where people have not vaccinated their kids, as we know. But are you concerned about that growing as people say, Well, I don’t like mandates. And I don’t like this one, either.

Paul Offit 

Yes, I think you’re already hearing certain people, elected representatives who are talking about not only making sure that this vaccine, COVID-19 vaccines aren’t mandate, but that no vaccines are mandated. And we would take a giant step back if that were true. I mean, I think one of the greatest accomplishments in this country that we’ve ever had was basically eliminating measles of this incredibly, highly contagious disease, a disease that really required immunization rates over 90%. To eliminate, we did that we accomplished that by the year 2000. Unfortunately, measles has come back. So we now have a few 1000 cases a year and hospitalizations every year, because people have protested against those mandates and have tried to sort of open up loopholes for that, whether it’s philosophical exemption, or religious exemption, so they don’t have to get the vaccine. And now what you’re seeing is it’s switching to the other side, after that California outbreak where people are starting to, states are starting to eliminate, it’ll get philosophical or religious exemptions, or both.

Paul Offit  38:44

We now have six states that really only have medical exemptions. But it’s again, it’s this constant push and pull in our society, people don’t want vaccines to be mandated, you know, I am a Philadelphian. I’ve been living there ever since I was, you know, in my early 20s. And, and so I experienced the only time in this country we ever had compulsory vaccination. I mean, the term mandatory vaccination means that you are asked to get a vaccine, if you don’t get a vaccine, then you may have to pay some sort of price. You may not be able to work in the place where you’re working, you may not be able to go to a school you want to go to, you may have to pay a fine, you may have to get frequent, you know, testing, whatever. That’s mandatory vaccination, compulsory vaccinations, you’re vaccinated or your child’s vaccinated whether you want them to be or not. In Philadelphia 1991, over a three-month period, we had 1400 cases of measles and nine deaths in our city over a three-month period. I mean, Philadelphia became a fear destination, nobody wanted to come into the city. And to put that in perspective, there were 2300 cases of measles the year before in the United States.

Paul Offit 

We had 1400 cases of measles and nine deaths in one city over a three-month period. It’s centered on two fundamentalist churches, Faith tabernacle and first century gospel that were faith healing churches, so they didn’t vaccinate their children at all. And those groups now had large numbers of children in those communities, those two groups served as an EP The epicenter for an outbreak so that 500 cases were in those groups. 900 cases were in the surrounding community. Seven of the deaths were in those groups, two case, two deaths were in the surrounding community. And we got to the point where we had compulsory vaccination, meaning State Supreme Court said, those children have to be vaccinated. What was interesting to me was that the pastor of one of those churches basically went to the American Civil Liberties Union and said, represent us. I mean, what we’re doing is perfectly legal, there had been a religious exemption to vaccines in our state, or our Commonwealth for 10 years just represent us to do something that is perfectly legal. And the ACLU refused to do it. And the statement that they made, which I’ll never forget is, while you’re at liberty to martyr yourself to your religion, you’re not at liberty to martyr your child. And so those children were eventually vaccinated against their parents will but willing, I mean, the parents were law abiding, they went along with the law.

Andy Slavitt  40:55

Wow. You know, the topic of measles. I hate the fact that they even have to do this. But do you mind just explaining to the audience how severe Measles can be and what the world looked like in 1963? Before we had a measles vaccine?

Paul Offit 

Right, so before there was a measles vaccine every year, there were several million cases of measles in the United States, there were 48,000 hospitalizations, there were about 500 deaths, mostly in children. When people died, they died because measles infected their lungs and cause severe pneumonia or measles infected their brain causing encephalitis which is inflammation of the brain. But at work, measles made us severely dehydrated, that’s what we would see. What’s interesting is that with the Afghanistan, refugees and immigrants coming into our country, we’ve seen actually a couple cases of measles in our hospital and when they come into the hospital, they always ask people like me old people like me to come down and look because I can tell in a minute whether it’s measles, and the way I can tell whether it’s Measles is these kids are sick. It’s they have a rational usually begins at the hairline, and then goes down the face trunk, and then out to the arms legs, they have congestion, cough, red eyes, meaning conjunctivitis, and they’re sick, they look miserable. And it’s interesting that when Jenny McCarthy, who’s sort of an anti-vaccine activists who believe that her son’s autism was caused by vaccines, was on Oprah once, she believed that the measles containing vaccine MMR vaccine had caused her son’s autism. And she said, I’ll never forget this quote, she said, you know, I’ll take the frickin measles every time meaning that you’d much rather have her child have measles than have to get a measles vaccine, which tells me that not only have we largely eliminated measles, we’ve eliminated the memory of measles, we don’t know what measles looks like, we don’t know how sick or dead Measles can make you. It’s not a trivial childhood infection. It’s not some rite of passage for children. It’s a serious and occasionally fatal illness. You don’t play around with that.

Andy Slavitt  42:50

Yeah, I imagined Jenny McCarthy or anybody talking to a parent in 1960. And saying, hey, we have this thing that will take this worry off the table. And apparently 1960, not really fully being able to comprehend how we could be living in a society where people say, would suggest that that’s optional. And you describe what happened in the United States, but the effects of measles around the world was even more devastating. And, of course, we can’t protect people around the world unless we protect ourselves. It’s one of those issues that I’m afraid like you, it’s gonna rear itself back up again. And it really speaks to kind of the last place I want to cover, which is this sort of deep issue that I think challenges all of us, which is that we have some segment of the population, maybe as high as 20%, who really have no trust in science, in experts in institutions, there’s a suspicion that also get turned into conspiracy theory, that is, I think, become deeply ingrained in us. But it’s long before the 2016 election, and causes that have probably only something to do with the science and scientists and experts themselves and, and, and a lot to do with other factors in society. It feels like if we don’t figure that out, then we don’t have much of a hope of this whole question of public health and childhood vaccinations and all these other things, that even post pandemic are likely to haunt us any clues any thoughts on how we as a society, and you all as part of the medical establishment can start to knock down that big divide.

Paul Offit  44:39

I mean, here’s how I think of it. I think that when people use the terms if we use vaccines as an example, this vaccine hesitant, I think I divide this into two groups. One group I would call the skeptic, when you for example, Kaiser Family Foundation did I think it was them that did a survey a few months before the vaccine came out like later September October asked the question, would you get a COVID-19 vaccine? Only 30 or 35% of Americans said yes. Well, I actually would have said no to that. I would have said, let me see the data first, I want to see the data as I feel like I too, am a vaccine skeptic. I think everybody who sits around the table, the FDA vaccine Advisory Committee as a skeptic, show me the data. So once you see the data, and then once you have now this huge platform of safety and efficacy out there, I think when then the survey was done a few months after the vaccine came out that 30% became 70%. Because now they saw the data. So that’s the skeptic to me. Fair enough. It used to be skeptical of anything you put into your body, your child’s body, I get that.

Paul Offit 

But then you have the next group, which I would classify as the vaccine cynic or the scientific cynic where they don’t believe you. They’re conspiracy theorists, largely, I mean, they don’t trust the government. They don’t trust the pharmaceutical companies; they don’t trust the medical community. They just don’t trust you. And how do you convince them as Neil deGrasse Tyson famously says, if someone doesn’t use reason or logic to reach a certain conclusion, reason and logic are not going to talk them out of it. Well, that’s really all you have, reason and logic. If that doesn’t work, then what does work and I sort of feel sympathy for President Biden, his administration, they did the hard part, right mass produce, mass distributed mass, administer it, find a way to mass administer this vaccine in a public health service that really wasn’t geared towards that. And then to do the best you can to get good information out there to decrease bad information. But there’s still a solid, as you say, 20% of people in this country who just say, no, thanks. I mean, Kyrie Irving to me is a poster boy for that, he’s willing to lose up to $17 million to not get two shots of an mRNA vaccine, or one shot of a Johnson and Johnson vaccine. I mean, you’re not asking him to get a heart transplant, you’re just saying, get a vaccine. That’s how dug in he is. I mean, how do you convince people like that? I don’t know the answer. I think what the Biden administration settled on, which is reasonable is, I think you have to compel them with mandates to get the vaccine because nothing else seems to work. I don’t know how to bridge that divide, science and scientific truths have just become another voice in the room, you can now declare your own scientific truth, and it’s just painful to watch. I don’t know what but we certainly suffer it, that’s for sure. And nobody suffers than more our children and our children invariably suffer our ignorance more than any other group.

Andy Slavitt 

So I was on the sports podcast to talk about Kyrie Irving. And, you know, I actually don’t believe we’re going to get everybody, I don’t think you ever get everybody. But 80%. And 80%, by the way, with most things in life is plenty. You know, it’s plenty of for an election, it’s a veto proof majority. It’s 80% of people like anything, it’s pretty darn close to a miracle. And by the way, with last year’s COVID, and even with Alpha, 80% might have been enough. But we have a very unforgiving virus. And it preys on even the slightest cracks in society. And 1 in 5 people is not small. I mean, it’s not Kyrie Irving, it’s deeper. And I feel like one of my missions is to figure out over the next few years, how just to take science off, it’s very high podium of its ivory tower, help people understand what it what it does for people day to day, the many miracles in our life that we take for granted that we don’t crow about in public health, because you can’t crow about things you prevent it from happening. You can’t crow about the things that didn’t happen very effectively. And I think even that’s not enough. I think there’s a gap in society that relates to people who went to college and people who didn’t, people live in urban centers versus people who live in rural centers, people who live in the north versus people live in the south, who knows. I mean, there’s just where we’re cleaved, where we have different life experience. People could vote whoever they want in politics, this is not about politics. This is just about what sort of commonality do we have? And you know, I think if you talk to many social scientists, they would say, well, we’ve never had that level of connection. This is nothing new. It’s a country that went through slavery and civil rights and everything was rebellion, everything was a battle. And we’re now just we’re now just seeing it in new ways because social media puts it in our face.

Paul Offit

You know, one thing you said that it’s upsetting but true, was when you describe science as being sort of on a pedestal or being in an ivory tower. It shouldn’t be that way. There’s no reason for it to be that way. I mean, as a child of the 1950s, I had measles and mumps and German measles and chickenpox and all those diseases. There was the show Mr. Wizard, so Mr. Wizard was a guy who in his sort of short sleeves was in what appeared to be a garage, having standing next to him a 10- or 11-year-old child to who he would explain things like that how vacuum works, you know, by putting a fire in a in a milk bottle and you would see a soft-boiled egg get sucked down through it, or he would use this flashing light to explain how radiation work.

Paul Offit  50:15

And it was accessible. And it was fun. And you could be a member of the Mr. Wizard Science Club, which I was and you can get like his little books and his kits and stuff. And science was accessible and easy and fun. And I think it should always be that way. We shouldn’t hold ourselves back. But it science is communicated much less now than it was before. I think there were, I think news agencies are devoted to science and technology. And now that’s really not true anymore. So I think we’ve lost that lost the ability to communicate science.

Andy Slavitt 

Bill Nye might be actually the guy here. Final thought, just as we wrap it up, much like adults, the Kaiser surveys show that only a third of parents definitely want to get their kids vaccinated. There’s a group in the middle, and then there’s a group that’s opposed. What do you think will be? And do you think it’ll be enough? And I leave it to you to define what enough means in that context.

Paul Offit 

What I suspect what we’ll see in terms of vaccinating children is that that the uptake will be pretty low. If you look, for example, the uptake of the vaccine in those over 65 years of age is great, right? The 85%-90%, but as you work your way down the list, you know, the 40- to 50-year-old, 30- to 40-year-old, the percentage vaccinated tends to be less and less. And you know, what percentage of 12-to-15-year old’s have been vaccinated, this vaccine has been out for months, that 45%. So I think it’s going to be less than that, we tend to see our children as vulnerable, we are very, very cautious about vaccinating them with something and I think it’s going to be not enough. But I do I do think we’re going to get there; I really do think we can get on top of this pandemic; I just think if we could just vaccinate another 30 million people, 35 million people, I really do think we could get there. I mean, I feel sorry, for the Biden administration, they were like 3 million doses a day, if we could have stayed there, I really think we could…

Andy Slavitt  52:00

We got to four.

Paul Offit

I was gonna say three, three and a half, but so that it stayed there, we’d be looking in the rearview mirror at the pandemic, but we could.

Andy Slavitt 

Right, well, I want to just thank you. And I want to make a special note here, not just for your knowledge, and your contribution to the field. But there’s something about your demeanor in your approach and your style and talking to people that I think is exactly what we need, which is, you know, you don’t put this on a high pedestal, you’re very honest about it, you don’t shy away from your views, but I think you very clearly explained them. And you allow for the fact that people are going to have different approaches. So I really hope that more people follow your example. And I think the job that you’ll have to do both as it relates to this pandemic, but unfortunately, coming out of this pandemic, is going to be critical for the country. So thank you. Thanks for coming on IN THE BUBBLE.

Paul Offit 

Thanks for saying that. My pleasure.

Andy Slavitt

Thank you, Paul. Let me tell you what you’re going to get in the next three episodes. It’s really quite a blend. And I’m very excited for these conversations. On Wednesday, as I mentioned, Lori Lightfoot that out of the blockbuster, mayor of Chicago, she’s taking time in the middle of her fight to come speak to us about the major battles that she’s facing there in Chicago over vaccinations. Then on Monday, Kara Swisher we’re going to talk about Facebook, and the Facebook papers and what they really say what we really know how that really impacts our lives. And then Wednesday, an episode that I’m extremely excited about. I probably been working on this episode in one form or another for several months. And it’s with John Doerr and Ryan Panchadsaram. And they are going to come talk to us about the plan to combat climate change. You heard from them earlier in the show. We’re bringing them back for a larger conversation about what is needed if they have a plan, and how we can finally look at and think about the climate. It is a major step forward on the heels of COP in Glasgow. We’ll talk to you Wednesday.


Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, please tell your friends and please stay safe, share some joy and we will definitely get through this together.

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