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episode.
My guest. This week is dr. Peter hotez. This may be a familiar name to a lot of you because this will be Peters, third time as a guest on this podcast and I want to have him back for two.
Almost unrelated reasons. The first is, I wanted to do a follow-up to the discussion last week with Brian deer because in that discussion we focused very heavily on one particular, claim around vaccine and autism, namely the MMR vaccine. But I wanted to have a kind of broader discussion around the evolution of that theme and we get into that in great detail, we explore the controversy around thimerosal and other additives along with the timing of vaccines and specific vaccines. Like the HPV vaccine.
And the concerns surrounding infertility and miscarriages. We then talked about his own personal Journey. As an Autism parent is daughter Rachel who's 28 years old now, has autism and how that if at all changed his thinking and we talked a little bit about the diagnosis of autism and how complicated that is, and also, what could account for the seeming increase in the prevalence and even the incidence of autism, we talked about the genetic
Of autism. And we talked about the likely timeline of development and how this may or may not support the notion that there are environmental triggers at play with respect to autism, be it, vaccines or otherwise. Finally, we talked about the state of affairs with respect to covid vaccination doing a little bit of a deep dive into some of the nerdy details around what we know for months out with respect to the existing vaccines in the United States and abroad, including some concerns over the AstraZeneca
vaccine and what it can tell us about the emerging strains that are of some concern, particularly in South Africa, and Brazil. So there's a lot packed into this and if you have the ability to watch it on video, please do so on our YouTube channel at one point, Peter shares, some very interesting Graphics explaining the mutations of the coronavirus that I found very helpful and I think you will as well. So, without further delay, please enjoy my conversation with dr. Peter hotez.
Hey Peter, it's so great to have you back on the drive. There's so much I want to talk about every time you and I sit down whether it's on the podcast or just on the phone. I get the sense we could go on for hours. I want to really talk about a bunch of things today but I want to start our discussion with a broader topic than just coronavirus or SARS Covey to covid. Things like that, which I know is a topic, you are still frontlines on and I don't think a day goes by that, you're not being sought after for your opinion on things.
Things. And we will certainly get too many of those things later today. But again, I want to start with a topic that it was near and dear to your heart long before the coronavirus emerged in this fashion, which is the topic of vaccines and vaccine safety. Now recently, I had Brian deer on the podcast and I think for many people it was an Illuminating discussion because Brian himself is not particularly a vaccine Advocate. He's very clear about that. He's just an advocate for good science. I think his work uncovering, the Web of Lies.
Is and deceit surrounding the work of Andrew. Wakefield is really unparalleled especially when one considers the depths to, which it was scrutinized both scientifically. And even in the court of law, the first thing I really want to understand Peter
is why is it that after the
complete debunking of everything that Andrew Wakefield did said published etcetera, why is this still an issue? Why
Why is it that in a post Andrew Wakefield? World, most polls would suggest somewhere on the neighborhood. Correct me. If I'm wrong, 20% of Americans, still believe there's a relationship between vaccines and autism,
what's happened? And it's actually a very profound question. And I agree Brian's work was extremely important. And then, the scientific Community, came in a big way, debunking all of the assertions and one of the things about the anti-vaccine.
Be that it's spawned or that it ignited, at least in the modern sense. Is that from then on they kept on moving the goalposts. So it began in its modern form 1998 with the Wakefield paper asserting that measles mumps rubella vaccine causes autism by rep Loop. The live virus, vaccine replicating. In the colon, the scientific Community response in a very vigorous, robust way publishing multiple papers large cohort, studies showing that kids. Who
Who were autistic and I got involved in the cuz I have a daughter with autism. And kids who are autistic are no more likely to have gotten the MMR vaccine, then kids who were not and similarly kids who get the MMR. Vaccines are neural more likely to become autistic than kids who don't and really sound epidemiologic studies. But then they switched they flipped, they said okay well it's not really MMR vaccine the Robert F Kennedy and a group of people say it's the thimerosal preservative in back.
Scene and then it switched again to spacing vaccines too close together, then switched again to alum in vaccines. And now what you're starting to see is even shifting away a bit from autism saying that vaccines cause something called chronic illness or looking at the HPV vaccine for cervical cancer and other Cancers and then seeing a causes infertility, or miscarriages, and each time the scientific Community responds and what they do is to maintain
Jane momentum to re-energize the keep on shifting. And the concern for me, now is they're not even looking at this from a pseudo science point of view. What they're now focusing on, is the politicization of it, we'll talk more about it, but it starting around 2014-2015. They managed to glom onto the Republican tea party and to make it a politicized movement around these concepts of health, freedom, and medical freedom. And that's what we're dealing with.
Today now and you know, that's why you've got all the craziness on Fox News. The last four or five nights with Tucker Carlson going on this rant against vaccines and Laura Ingraham going on this rant against me and Tony fauci. And this is a problem and that they have this adaptability, they create these versions 1.0 2.0 3.0 of the anti-vaccine movement, but the autism piece never entirely left that still its Legacy fake assertion. That still haunts us today.
Given how deep Brian went into the discussion, specifically of MMR and autism that relationship. I don't think anything else needs to be said on that topic and obviously for anybody who's listening to this, that still has questions around that. I would highly recommend that they go back and watch that video. Listen to that podcast, read the book and truthfully. And I don't say this to be, I don't know how to say this delicately, but I think if after assimilating all of that work, you still believe that there's a relationship between
That vaccine and autism. There's probably nothing that can be said that can dissuade you from that and I would just leave it at that agree to disagree. But let's focus on some of the other things that you've brought up. Do you have a preference for where you'd like to begin? Would you like to start with Sy Marisol?
Yeah, I mean you can but it always comes down to the same few things. I mean, what happens in the case of Brian deer and the MMR in addition to the scientific community refuting and on the basis of large cohort studies and prospective studies what he was able to
To do was show nefarious intent, which was extremely helpful because knowing that what's happened since then, is the anti-vaccine movement has grown so much larger than Wakefield. Now you've got dedicated anti-vaccine groups, National anti-vaccine groups, Children's Health defense and I can and those kinds of things. But then you also have a local political action committees packs that are linked to far right-wing extremism. So it's
Become this very complicated ecosystem, or web and now, it's even gone beyond the United States. So, yeah, I mean, we could go into why thimerosal is not linked to autism and then we could go into why spacing vaccines is not related to autism or what autism is now. It begins in early fetal, brain development, but it won't. Stop the momentum of the NT vaccine movement because they light a fire. They cause damage and then they move on and that's their modus operandi.
I
I disagree with that Peter. I guess the way I think about the role I'd like us to play in this discussion is I don't think we're here to stop the anti-vaccine movement. What I'd like to do is help parents who frankly, are inundated with information and can't distinguish between signal and noise. But at least come to a place where we can have an honest discussion about it because I really do want to have a discussion and I think the order in which you actually just went through, them is a very elegant way to talk about this. Let's spend
Few minutes on thimerosal. Let's spend a few minutes on some of these other claims and then let's actually talk about autism because there is no denying, the fact that the incidence and prevalence of autism are increasing. We should talk about what some of the plausible reasons for that are. And why the scientific Community has been able to rule out these claims that are being put forth, I have great empathy for the parent who's listening to this who is confused and that doesn't necessarily mean just the parents.
It's of children with autism, but that's the parent. Who's trying to decide, what am I supposed to do here? Am I supposed to get my kids vaccinated and, and am I supposed to get them vaccinated at this pace? And does my kid really need
3 H
Hep B vaccines in the span of six months? I think just having an open honest discussion about that is by no means going to dissuade the twenty percent of people who are clearly in the camp that says vaccines are evil but I do believe that there's a very confused group of people in the middle and I hope we can talk about that. So is it safe to say that?
The post Wakefield because I'm trying to go back and remember the timeline it was around 2007-2008 that every claim of Wakefield had been pretty much debunked and to your point it wasn't just debunked scientifically. It had been made clear that he had lied and he had manipulated data as head O'Leary and this was one big house of
cards, the Lancet paper was retracted, I think in 2010, although I think there was an expression of concern put out by the
the Lancet a few years before the maybe 2004, I can't remember exactly. So and the basis for the retraction, they didn't really spell it out that much. They basically said the results are no longer valid. I don't think the retraction letter issued by the Lancet, went into all of the investigation that the medical Council had done. And for Wakefield to be struck off the register. I don't think the retraction mentioned anything about the Brian deer paper.
Yeah, I think it was Dire as reporting and
Frankly, the most damning evidence was the lawsuits. It was the complete inability of Wakefield to maintain any legal argument against the people who were accusing him of fraud. So, let's put that aside and let's move forward. Let's start by telling people what thimerosal is and what is it doing in a vaccine?
Well, first of all, if I Marisol is really not in childhood vaccines anymore. So what happens is, if you have a multi-dose vial of vaccines whereby, you've got a vial of
Vaccine, that could be given to six or seven or 20 people. Each time. You're introducing a needle into that vile through a rubber stopper. Potentially, you're introducing bacteria. And the worry is that if you do that enough, that there could be some bacterial growth or overgrowth into the vial. So you need to put some preservative in that's non-toxic that will kill the bacteria and and when thimerosal was discovered, it was considered quite an advanced in terms of allowing
Vaccinate large populations. And the bottom line was, it was taken out the manufacturers took it out of the vials just because of all the bad publicity swarming around it, there was never evidence to show that it was a problem but I think the thinking was we don't really need it. We can give single-dose vials instead let's just take it off the table and fact that was done under still some of the flu. Vaccines still have thimerosal in the US.
And not all of them, you can still get a single-dose vial for flu vaccine and take that as well. But there was never ever any shown an association between thimerosal and any untoward effect. Certainly in terms of
autism, the Marisol was one of the big pushes from Bobby. Kennedy jr. Correct. Wasn't this really his initial cause in his initial
fight? I think so. I think he got into it because he's an environmental law too.
Knee looks at toxic waste and I think when he saw the Mercury word, he probably got a link to minamata disease which is remember back in Japan, several decades ago. There was a lot of mercury exposure and fish and young kids who were exposed to what's called methyl Mercury. I think was during pregnancy and the kids that were born were born with intellectual deficits, and there was a syndrome associated.
It was called minamata disease. And so, I think, probably people in his Camp, put two and two together, and they said, well probably autism must be some form of minamata disease, even though it's not the same. Maybe there's enough there there that it could be due to thimerosal. But again, the large cohort study showed absolutely no linkage with autism. And ultimately, we know why, it's because we know autism is associated with prenatal events.
That's how he got involved and there were books about it through a couple of books, making these assertions. And then once again, it started gaining a lot of momentum very much. Like the way Wakefield did a decade before and I think the first publication, which I write about in my book, vaccines did not cause Rachel's autism.
And while you're looking for that, Peter, I'll just clarify for listeners because you mentioned it quickly, the difference between methyl Mercury, organic Mercury, inorganic Mercury because you made the point that
That Phi Marisol, it's inorganic Mercury, there's sort of a difference between organic and inorganic, Mercury. And most of the toxicity that we see when people are over consuming fish that are high on the food chain, such as large tuna swordfish, shark is organic Mercury. It is methyl Mercury, not inorganic, Mercury,
right. So minamata disease, which was named after a city in Japan. It resulted from a chemical plants, industrial release of methyl Mercury.
Just different from thimerosal, which is a totally different compound. It's ethyl mercury in, it was in Wastewater and it accumulated in the bay where fish and shellfish lived and were consumed as seafood and large-scale. Methyl Mercury ingestions and pregnant mothers caused A congenital syndrome, causing neurologic disease in the form of gate and motor, disturbances and some cases, even coma and death. So there was a paper that was published at that time in a journal called medical hypotheses.
Is that first proposed that maybe autism could be related to thimerosal because even though it's not in methylmercury, maybe ethylmercury doing this and that was in 2001 that the paper got published or three years after the Wakefield assertion. And so, this was a pretty common preservative but then it was subsequently taken out. And what was interesting is even after it was taken out the rates of autism,
Never went down. That's pretty clear. And there were again large cohort study showing absolutely no link with thimerosal. All
of that said, Peter, I certainly wouldn't want to suggest that the paper in 2001 and even the work that followed was anything, but reasonable. I mean that's the purpose of medicine, right? I mean you see something like autism, you look for plausible associations and you see a neurologic disease that is associated with Mercury, it's entirely reasonable.
Reasonable to formulate a hypothesis that says, this other thing that looks kind of like, it could
be it and the paper was published in a journal called medical hypotheses. Exactly. I mean,
it's completely reasonable. It's the stuff that follows that's
challenging. It's after the scientific Community, goes to Great Lengths and grade attempts to seek the truth and publishes paper after paper, after paper and mainstream scientific journals, that the anti-vaccine
Groups refused to acknowledge its cling to their debunked. Hypothesis and their only response is well the scientists must be paid off by the Pharma companies or the journal must be paid off by the Pharma companies, or the editors made must be paid off by the Pharma companies. And so they resort to conspiracies rather than rather than okay, I get it, let's move on, let's try to figure out what really causes autism and
they've never shown that intellectual curiosity about what really does cause autism, and they continually discount. The massive amount of scientific work that's gone into really uncovering what autism is
before we get into, kind of a deeper. Why? Because that's a big part of what I want to understand. And there's two deep wise here, run around, autism, and one around latent distrust, and the path that there's a fork in the road.
Right? Where one person can be very influenced by data, they can think probabilistically, they can think in terms of uncertainty, they can accept and reason their way through these things and then there's another person who's going to cling to a belief in the presence of emerging data that refute that hypothesis and they'll continue to come up with an excuse. And I really want to try hard not to pass a moral judgment in either case but there's clearly an anti-science sentiment that is growing that is
Is fostering this before we get to that. Let's go to the next point, which is thimerosal, I believe was electively removed in about very early in the
2000s. I think it was actually removed two years before the medical hypothesis paper. I think it was removed in 1999, actually, or at least that process was started. It had already been underway.
What was the next position of the goalposts after
thimerosal. So then it was
This concept of Greening our vaccines or making them more, I don't know why they use the word green I guess making them more eco-friendly and that the third major hypothesis. Was that kids were becoming autistic because of antigen overload that somehow they were getting too many vaccines at once, this was overwhelming, the immune system and somehow that led to autism, which again never made a lot of sense to me how they say it's leading to
Animation. And I always would point out that we've seen with the brains of kids on the autism spectrum. Looks like I've seen my own daughters, you know, CT and MRI scans in her workup of autism. And We Know It inflammation. Looks like you can see inflammation are evidence of inflammation or at least blood on a CT or MRI and and we know it herpes. Encephalitis looks like in autism doesn't do that, it's not an inflammatory state of the brain and so that one never made any sense.
Either, there were several other people who came into this people, like the pediatrician, dr. Bob CR started writing books about how we have to space vaccines further apart and had written a number of books about that as well. But again, well, first, I'd never had plausibility and that's the lot there today. And if you go on amazon.com and look at books on vaccinations, I think those books are still a top sellers.
Now in the case of my Marisol, at least, there was
A plausible explanation that was put forth as a hypothesis. When the hypothesis for spacing was put forth. Was there some epidemiologic data that suggested this? I'm not aware
of it. And the problem was, you know, we didn't have clinical trial data to support the spacing of the vaccines, the current vaccine regimen. The schedule is based on years and years of studies confirming immunogenicity and protection
It's also based on years and years of study showing that there's no immunological interference. In other words, if you give pair two vaccines together, that one doesn't interfere with the other. It's a very carefully orchestrated dance. And then these guys come in with these wackos schedules, without any scientific basis and then Force the scientific Community to try to re-evaluate, whether you're still getting the same immunogenicity or not and also the immunological
Appearance. So it's not just a matter of saying well what difference does it? Make is kids are getting the same vaccines. It's unclear whether they're going to be just as effective or safe as that very carefully. Orchestrated dance that was developed jointly by the FDA and CDC.
That's a very interesting point. Peter and frankly not one I'd ever considered. I get asked not infrequently by patients about vaccinating their children on the schedule and these are not people who think vaccine
Causing autism, but they do have some concern. Presumably just based on things that they've read heard Etc. Let's say, hey, does my kid really need to have all of these shots in the first nine months of life? And their belief, which is not. Unreasonable is, isn't this just a way to ensure kids get their vaccines? Because during the first year of Life, the parent is so much more likely to come in for well-baby checks and they're going to have much more frequent contact with their pediatrician and that, that
That's the reason that this schedule is being imposed on us, as opposed to any really biologically necessary. Again, I use the example of Hep B, which most kids are really, not at risk of
Hep B. Let me give you a different H disease as an example. So, hemolysis influenza type B. It's a bacterial cause of meningitis back in the pleistocene era. When I was a house officer, I was a pediatric house officer at Mass General in 87-88. I would be admitting a kid.
So marvelous influenza type B meningitis to my service, every couple of weeks and Mass, General is one of the oldest pediatric, residencies, they called it, the children service and back then the house officer did everything you had to do, the lumbar puncture, you had to look at the cerebral spinal fluid under the microscope, you had to do the Gram stain and eventually sent to the lab but to confirm it, but you would basically make the diagnosis right then and there. And when you did it, your heart sank. Because you knew that
There was a high likelihood that kid was going to have permanent neurologic injury or might not even survive and it took a big emotional toll on me. And, and my fellow house staff to have these young healthy infants. Now, get him off Alice influenza type B meningitis. And at that time, we didn't have a vaccine that worked in infants. There was the capsule of the homophonous, influenza type B, the poly ribose 5-phosphate capsule but it was shown that it wasn't. I mean the genic and infants it was still licenses a vaccine for older kids.
To catch the few older kids that can still make an immune response, but it didn't work in infants.
Why is that? By the way,
turns out need the hapten, eyes that onto protein. And that's what John Robinson. Raquel schneerson did at the National Institute of child health and development and IH. They figured that out and developed a conjugate vaccine that now worked in infants, which now you could start vaccinating at that time, you didn't have anything that worked in young infants, so all you could do it that times pick a prophylactic.
Iata called rifampicin, which had the unpleasant effect of turning your urine orange, reddish, orange. And at that time, I had our first son, born Matthew, and we were living right across the street from Mass General and I was terrified that I was going to bring him off. Listen fluids at type be home. So, I took rifampicin all the time and I peed orange for two years practically to the point where one of the first and only fights have ever had with an was, my wife was permanently staining the toilet bowl.
Orange because I was taking that and I microbial, and then this miracle occurred, the miracle was, you know, John Robbins and Raquel schneerson. Also David Smith and Porter Anderson in Rochester. Figured out that if they attached that Polly rubber phosphate capsule to protein and half denies it. Now you get T Cell responses in infants and it works That vaccine was licensed in 1989. As I was finishing, my house offered training by the for infants for young infants. And now it's part of that early vaccination.
Will by the time I finished my then I went to Yale for my pediatric, infectious disease Fellowship, I had lab there and then I was a junior attending at Yale children's hospital by the time I started rounding as an attending two years later. The disease was gone. It basically I taught the house staff about it purely for historical interest. Just like, you know, the old guys at Mass General taught me about diphtheria and tetanus, that's how dramatic it was.
Cause we added it to the infant schedule. And I think that's a good example of these in fact, scenes to get a vaccine through to be licensed by the FDA file that biologics license application, for those very expensive. Second, it's a hot. Lots of review. It has to go through the biologic. License process of the FDA. It's got to go through the verb pack committee. The FDA for review, it then goes to the Centers for Disease Control and the I CIP the advisory committee.
Immunization practices. There's a lot of smart people that are looking at all of this to say, do we really need this? What's the cost Effectiveness? What's the benefit to society? What's the benefit to child health? These are not decisions that are made lightly, or these are things, which are carefully, thought out.
So you don't think that there's some consideration given to. This is a window in which the probability of vaccination is greater just due to exposure. Again, I bring
Have be just because you and I didn't get our Hep B vaccines until we were adults. And of course I don't know when you got yours but for me I think I got it in medical school. It was just in time given our exposure to have B is enormous. Once you're in medical system because it's transmitted just like HIV and depending on where you trained, you might be in a population.
I think I first got mine when I was, we were keeping a lab in Shanghai, in China for parasitic diseases, I think going off
If the China frequently there's a lot of hepatitis B, I think that may have been when I got mine but you're right back then we weren't giving it to infants. And
so, I guess my question is and again, I'm just saying this to try to take the side of the parent, right? I'm trying to put myself in the shoes of the parent who says this is too much. And again, to be clear. This is not the parent who says vaccines are evil, my kid will never get vaccinated. This is the parent who saying is this a little too much too soon. Does a child really need a hep B vaccine as an infant?
What is the probability that a child will be exposed to Hepatitis B? The only example I can think of is a child, whose parent is in the healthcare system or is an IV drug user, who's themself a high risk for Hep B and who is not vaccinated. But outside of that you could certainly make the case that a person does not need a hep B vaccine Till There, When adolescent, or at least a youngster in school,
correct. Right. But let's take a step back. Let's look at that. Example of the home office, influenza type B.
No doubt, no question in your mind. That that's what we needed to do.
Absolute right, okay? Especially given where the risk is high as to, that patient. That's a, an amazing example of that, right?
Right. And that's why I'm bringing this over the vast majority of vaccines are not given. For trivial reasons, are no vaccine is given for a trivial reason and the need is more apparent for some than the others. The exact reason why Hepatitis B was selected for young infants. I wasn't at the
Well, when that decision was made, it may be that there was enough at-risk populations that, it's very hard to cherry-pick individuals. When there's so many people who absolutely needed that it just becomes easier to vaccinate the whole population rather than say, okay. Well, you're in a specific at risk ethnic group, or you're in a specific at risk occupational. Hazard, and the other hand, when you look at what That vaccine is, it say about as
No risk of vaccine as you can imagine. It's a recombinant. We make vaccines like this all the time. It's a recombinant protein, vaccine produced in yeast. It's been around. Almost four decades. It's been given the hundreds of millions of children and really fabulous safety record. So, what are you losing? I guess is the other way to put it. Let's
talk a little bit about HPV. This is some people hailed. This vaccine is a miracle, given the relationship between the human papillomavirus at least three strains of the human population.
I'm a virus and cervical, cancer. This is not an insignificant cancer for women. Sadly, many of us know, women who have either died as a result of this disease or have lost their reproductive capacity as a result of this disease. So and furthermore, I think many men might even know the anxiety that a pap smear has caused their partner. If it has shown one of the high-risk strains, you know, 1618 a number of these things. So I think for many of us when the HPV vaccine came along
Yeah, it was a really big deal. I mean, this was fantastic. News, can you talk through some of the controversy surrounding it, both from a scientific standpoint but also from a moral, ethical, religious political standpoint because I think to me HPV might be one of the best examples of the intersection of all of those
forces. So, HPV induced cancers like cervical, cancer laryngeal, cancers are predominantly sexually, transmitted cancers,
So if you look at infectious causes of cancer roughly about 16 percent of all, cancers are caused by infectious disease agents like Hepatitis B like HPV and the numbers go up all the time because we get better and better discovering infectious agents that cause cancer. So in Africa, about a third of the cancers are of infectious origin. And this was developed by the National Cancer Institute, including someone who's very dear to
to meet Doug Lowry. They were able to show that vaccinating against this virus can prevent infection of the virus and therefore will likely prevent cancer. And now new Studies have shown indeed. It's born out that indeed. It does prevent cervical cancer and on that basis, the Australian government has now launched a program where they think they can eliminate cervical cancer from the continent of Australia by 2030, so that's really exciting.
Actually eliminate a cancer through the vaccination process. The issue is come up, you have to vaccinate originally. It was mainly focused on cervical, cancers rather than the cancers and that would develop in males. So the recommendation was you want to have those girls vaccinated before their sexual debut before they start having intercourse as they get to be teenagers or young adults. And so, you want to get them when they're nine or
Ten-year-old little girls and time to make certain that everybody gets vaccinated and I think that did not go over well with a lot of people because they not realized there are nice little nine. Ten year old girl is one day going to be a woman who is sexually active and I think that was hard for some people but in fact it has a remarkable ability of saving lives and preventing cervical cancer and that's why Australia has been implementing that in the US and contrast
What's happened? Well, we have a couple of problems. First of all, we're Big Country the access to the vaccine is not everything we'd like and rural areas. It's not everything. We'd like, especially among underrepresented minorities and there's an access issue, but the other big thing is, this has been targeted. Now, by the anti-vaccine lobby, they have tried to come up with fake assertion after fake. Assertion, that's not supported by the scientific data. So they claimed it,
It was causing autoimmunity, they claimed as causing Miss. They think a lot of it to female reproductive health issues. They said it was causing infertility, it was causing miscarriage and again one by one the scientific Community had to do those big cohort studies to refute all of those links
I guess this is as good a time as any Peter to ask the first of several medical questions.
Wait you didn't give me feedback. So was that convincing or or were you still unimpressed? I mean I mean what do you think? The issue is?
I think that's a great point.
And I say that as a father of a 12 year old girl, which I was just sort of joking with my mom this morning. You know how your iPhone that will give you like a flashback picture or video from sometime in the past this morning. It sent me a video of my daughter when she was what she would have been seven. The next guy would have been one so seven-year-old and one year old Anno the beach playing and it's like, the cutest thing on the face of the Earth. And I probably watched the video like seven times.
And then I sent it to my mom and I said, I'll remember when she was this little one, you know, my mom made some comment like yeah, enjoy it now because five six years, she's going to be in college and blah blah blah. So I get that there is nothing to me. That is both simultaneously, amazing and sad as the natural loss of a game of tug-of-war that goes on between a parent and a child, my friend, Rick Elias described it, you're playing tug-of-war and you have to lose by the time the
About 18 so I can see that. Again, I'm trying to put myself in the shoes of the person who thinks this doesn't make sense. And I think there's an argument that they would make that would say, well, I don't want my child, I don't want my daughter. Let's just again, I think this is an important issue that we should Explain why both male and female it's relevant to both. But if we're just taking it through the lens that I think, at first came through, which is my daughter is 12, I do not want her to be sexually active until she is and I come up with some arbitrary age like 18. Therefore, I am not
Going to have her vaccinated until she's 18. Another point of view, is in an Ideal World. I would prefer she's not sexually active until she's mature enough to handle that. I don't know when that is, but it sure. As hell isn't 12. I don't have this vaccine at 12 but the downside of not vaccinating her in time is she could be cursed with a lifetime of asymmetry, right? There's an asymmetric bet here, I can understand why some parents might struggle with that even though I tend to think in terms of risk and probabilities may be more than the average person.
I totally agree with everything you said, I think the problem now is that you've got these anti vaccine groups, specifically targeting HPV. Including I think now you've got children's, I forget which it is, whether it's Kennedy or this organization. Is I saw it on his Twitter, these filing some big class-action suit against Merck & Company for the HPV vaccine, with all sorts of, I don't remember. But again, this is what's going
Right now. And I'm not aware of any evidence to support all of these things like infertility or miscarriages, or autoimmunity. What's really interesting also is the anti-vaccine groups have now copy pasted. There was a sir shinzon to the covid-19 vaccine so they could be pretty lazy. So they're just basically saying the same thing they would because I guess it works for them and that Paraguay but as a result of that and they said it's not the only thing because we have access in Rural and
underrepresented minority groups, but we're going the wrong way. With HPV vaccine, we're not even close to thinking about creating a cervical, cancer, elimination strategy,
you mentioned laryngeal, cancer as well. I don't think enough people understand the threat of that. Frankly. All upper Airway cancer, right? I mean, you're talking about cancers of the soft palate. You're talking about lots of head and neck, cancers are on the rise. I can't remember exactly the stat. I want to say like the
Our third largest growing cancer in young men is head and neck cancer on account of sexually transmitted
disease. Yeah, and if you talk to the head and neck surgeons were right next to MD Anderson Cancer Center within this, Texas Medical Center. It's devastating the, the very aggressive surgeries that you have to do, it's really heartbreaking. By the way, we never finish the one thing about the autism, which was you made the statement autism's on the rise. I think it's important to clarify.
Verify that I think we're clearly getting better at diagnosing autism. I'm not convinced that the incidence of autism is truly increasing.
There's a lot of want to come back to one out. His we're not abandoning that but thank you for clarifying that coming back to this point. I wanted to make which is meta question. Number one, why do call it 20% of the population? And an entire cottage industry of lobbies lobbying groups packs etcetera come out so hard.
Against this one class of drug. Whereas we don't see it for antibiotics. Where are the twenty percent of people who think penicillin is evil and the companies that make Zofran or not Zofran? But you know, similarly, like where are the companies that are coming out against insulin exoticness insulin, that all these diabetics are using like I'm going to be a skeptic for a moment. I don't think there's a greater mismatch between
Between drug companies doing wrong, and profiting overcharging patients for a medication that insulin, I think the economics of insulin are an embarrassment to how Pharma Works? Where's the rage? Like, where are the 20% of Americans that aren't losing their mind, over at what Novo Nordisk is doing?
So, what is it about?
Vaccines in particular, that brings out so much higher, so much skepticism and so much anti-science
rhetoric. Well, I
Don't know that I have all the answers but I think part of it is the fact that you're giving vaccines to not in all cases but in most cases you giving vaccines to well individuals to prevent them from getting sick so you're giving something that's not always intuitively obvious that they need as opposed to insulin. As opposed to penicillin, somebody is sick and somebody needs a treatment. So this is B so the
that you understand, but for a vaccine you're preventing somebody from getting sick and I think that simple feature is a big component of it. I think the other is the fact that so many vaccines are mandatory for school entry. So there's that loss of choice that you feel it's being imposed on you. So those two things become pretty easy to exploit, unless you've got really strong vaccine advocacy activities in your community.
Unity. It's pretty easy for an anti vaccine group to cherry pick those two things. And then when you have conditions like autism and people want to understand how did this happen, particularly the regressive, former kids seem to be developing normally in abnormal milestones. And then regress, this is easy pickings for an anti vaccine group to come
along. So as an
example, for instance, back in the nineteen hundreds in the
The UK, they started anti compulsory vaccination leaks and this extended to the US. So I think it's a combination of the fact that their preventative not therapeutic and the Mandate component. I think those two are a toxic mix that. Get some people upset about vaccines particularly in this environment, which now dominates the internet. I mean, in the past, when you had an authentic compulsory vaccination League, you could go to your physician, The Physician would explain.
That's all nonsense, and why you should get vaccinated. Now, we've got something called the internet now, we've got something called social media that dominates our lives and you've got Amazon now. So single largest promoter if they can t, vaccine covid, conspiracy books. So, most of the information you're getting now on a daily basis is actually anti-vaccine anti-science information.
But again, I'm still trying to understand why the disdain for science is so prevalent. So hear me out another thought.
Experiment. If the president says, I want to cry. I'm using this because it's the current example, right? If the president says, I have a legislative agenda that's going to propose a multi-trillion dollar infrastructure, bill. You may not think that's the best idea, right? You're going to oppose that through legislative action, you're going to oppose that through lobbying maybe that's not a great example. I guess what I'm trying to get at is if you're opposed to vaccines,
I can at least understand the argument around medical freedom because that you could at least stand up and say, look, I'm opposed to being told, I have to take a drug to prevent an illness. I don't have. And then at you could at least argue the merits of the individual versus society. Like, to me. That's a more palatable argument, but the complete anti-science part, maybe because I'm a scientist is just harder for me to empathize with. Like it's harder for me to put my self in those footsteps because I
Can't think that way, but I want to because I think it's important to be able to think that way and not be dismissive of it, if that makes sense.
Here's what I think happened, which is, I think hard because of my activities and I'm not alone. Others were involved in this. There was a lot of effort to debunk. The links between vaccines and autism and HPV vaccine and all the craziness that they asserted to cause. And I think it was taking some steam out of the anti-vaccine movement, but you still had enough parents and
This is like Orange County that were scared about vaccines, the causing autism, that it allowed a measles epidemic to erupt and it was a pretty bad epidemic in Orange County and to 2014-2015, it was linked. I think the origins may have been Disneyland where the epidemic came from what happened was the California legislature responded appropriately I think and said you know what? We're allowing these vaccine exemptions but it's getting out of hand.
Of hand. And now it's causing a measles epidemic and measles is a bad actor, right? It's got a significant mortality and permanent disability deafness and other things and they shut down the vaccine exemption. And I think that helped re-energize the anti-vaccine movement because I think they were losing some steamer on autism and they saw this as an opportunity to rebuild to reinvent themselves and they reinvent themselves as a political movement around health.
Freedom, medical freedom and it really Amplified in Texas where I am. And it took off with, they created political action committees like Texans for vaccine choice and the pack started getting other Pac money. And they, the packs were giving packs, other packs, money. And so there's a lot of money flowing, and it was very powerful. And they were able to convince the Republican tea party in Texas, which is very powerful group, to adopt this issue as a platform issue, and that
That's when it really started to accelerate and you started to see packs form, not only in Texas but also in Oklahoma other Western States as well. So it was more of a western state phenomenon than anywhere else. And and so your political allegiance, your identity actually became tied to not vaccinating your kid or to be skeptical of vaccines. And then it all really blew up last year because those same anti-vaccine groups. Then
Started going up against masks and social distancing again, under this health Freedom, medical Freedom banner and now it became a full-on anti-science movement and you really saw this happen starting around last summer when the epidemic moved into the southern states. And people showed their political allegiance to the Republican Party by defying masks and social distancing, and then it went up in the Upper Midwest as well. And
Then you had that story that awful story of the ICU nurse and tears being interviewed talking about one of her ICU patients. Whose dying words. Were covid-19 is a hoax. That's when you started to see this kind of mainstreaming of what was a fringe group around Health Freedom, medical freedom in 2015 and now become a major platform of the Republican party going up against science. And then you saw the targeting of scientists that's
And they began really going after dr. Fauci, they began going after Bill Gates, they just started going after me quite a bit. And now this thing is steamrolling. I mean, you had Tucker Carlson last week, going on this whole rant about vaccines and questioning vaccines and Laura Ingraham at Fox News. Went after me a couple of nights ago
and specifically saying what you have to forgive me if I don't follow this stuff too
closely. Yeah, well
Well, it's pretty unpalatable stuff. I mean, they would say that we misled the public, that we got it, wrong that we didn't understand the epidemic. And then they would parade out all the Great Barrington stuff about no lockdowns, even though none of us ever said lockdowns, they create these Straw Men that say, were trying to lock everybody down, and we're hurting our economy and along with that. They're saying. What's going on with these vaccines and so tight.
Sing it again. This is a throwback to 2015 when was first linked to political extremism on the far, right? So what was started out as an anti-vaccine movement, is now movement against any kind of Public Health intervention and demonizing scientists and basically calling us the Boogeyman and that and its continuing. Now you've got this was exported last summer to Europe. You had these anti-mask
Vaccine protests, which were the first time use that same American language in Berlin and Paris and Trafalgar Square in London. You had the New York Times reporting how it's linked to queuing on and other far, right-wing extremist groups. And so this really concerns me and then of course to make it all the more complicated is the fact that now you've got the US and British intelligence talking about Putin's government has been lobbying this whole program of what's being called weaponized health, communication?
On our internet, in order to destabilize the country and destabilize other democracies and what was kind of a fringe group arising out of the Tea Party in Texas is now, I don't know what you want to call it. Whether it's a designs Empire or Confederacy that has lots of moving parts to it. But I'm concerned about the fact that it continues to build,
do you think this is just a very vocal part of the
Ian party or do you think this actually represents an entire political party? I mean, it seems hard to me that this could represent an entire political party given a heterogeneity of beliefs that would exist across that from fiscal conservative social conservatives. I mean, all of these things.
Yeah. And the fact that the Republican party is starkly is not been anti-science, right? I mean, the National Academy of Sciences was started in the Lincoln Administration, Eisenhower launch NASA, George W, bush launched pepfar. So
This seems new to me and I don't know how much it's pervasive in the Republican Party. Certainly it's become now a major component of Fox News in the evening and as recently as last year, I was going on Fox News almost every day Hunter, pretty regular basis and and I didn't see it until the disinformation campaign came out of the Trump White House. And when they said covid-19 around year ago last year when they said, covid-19 Oaks or the flu and
You know, tributed the covid deaths to other causes or your Kaylee makani say the hospitalizations were all elective ketchup. And elective, surgeries and discrediting masks. And then later on, in the summer, they brought out Scott Atlas. So there was no question about it. This very deliberate disinformation campaign coming out of the Trump white house and I was one of the first to call it out. Not because I'm so brilliant, but because they've been going up against these anti-vaccine guys for years.
They've become by default an expert in anti-science disinformation campaigns and could recognize that I see it. Accelerating I can't say whether it's across the whole Republican party, but it's a lot more pervasive now among Republicans than it's ever been. And then what's the evidence while the evidence is now, the PBS NewsHour teamed up with NPR and Marist. And they've now found that if you look at the single, most vaccine has been a group in the United States, this was just last
Tweek it's what's called White Republicans? I think was 41%, significant percentage of white Republicans are saying they're not going to get vaccinated. And that's not the first poll and we did one with teca group of Texas A&M. I'm not a social scientist but we teamed up with so a group of social scientists at Texas, A&M led by, Tim Callahan and School of Public Health found the same thing. I think we call them Trump voters and Kaiser Family Foundation. Also found the same thing twice. So this is the number
One vaccine.
Now, I've seen another poll that suggested and it didn't slice the data by race and party it sliced, it by race and party separately. And it found the greatest predictor was indeed, Republican party Association but the second was African-American. What's the best explanation for that?
Lets more? Now it's coming down. So what's happened? That you're absolutely right. So, about two, three months ago, African-American groups and the white Republicans were sort of neck-and-neck and who was the most
Most vaccine hesitant. It's stayed up among Republicans, but it's been coming down among the African-American groups. And one of the things I've been going on, lots of podcasts and radio shows that reach black and brown audiences. And and I was on one last night with the Baptist Church in Richmond, Virginia, and I asked the pastor, I said, are you seeing less of it? Now he goes, definitely, it's coming down. I said, what do you think's happening? Well it goes well doc, I think part of it is people like you, you know, reaching out to black and brown communities.
Unity's, but the other is a lot of the clergy of cratered and sort of an informal Network. Now, and we're really hitting hard on the need to get vaccinated. So I think that may be part of it, but initially it was quite high. And I think what the reasons why I don't entirely understand. What's often said is it's around structural and historic racism and that horrible Legacy of Tuskegee. I think the other thing that I've seen though is deliberate targeting of African-American groups by the anti-vaccine,
Lobby. And and now I just saw on the internet, there's a new quote documentary clicked on the trailer and it's got people getting the Pfizer by and Tech vaccine that it switches right away to Tuskegee experimentation. So by its kind of making that link. So I think it could do a lot of damage. So, but it seems to be somewhat resolving but still really high among those group of Republicans. And you saw it when covid-19 accelerated in the summer and in the southern,
It's in the Upper Midwest in the fall. And so, what's going on? And I'm worried that. Now you've got again people tying their allegiance to the Republican party or their identity to being against scientists and Science and this is not good for the country.
There are a few things I want to say. And one thing to add, the thing that we haven't mentioned yet that I think is worth mentioning is the enormous measles outbreak in Minnesota that occurred in the Somali Community. I think that story doesn't get enough attention.
Tension, because I guess it's now been enough years. But I've always found that to be an unbelievably sad story in some ways more sad than the Orange County outbreak. Because this was really a deliberate targeting of a community of immigrants, not facile with the language and the measles outbreak was terrible there and I guess that's the thing, I've always struggled with, if you just put your common sense hat on every time, a community gets targeted to stop taking in this case. The MMR vaccine a measles outbreak shows up.
Measles is sort of the Paul off and always calls it. The canary in the coal mine and it's, and I think he's right. It's because it's got such a high reproductive number of 12 to 18. As soon as the vaccination coverage, goes down measles finds it. That was the first time, I think that you saw the anti-vaccine groups targeting specific ethnic groups, so Lina son at the Washington Post back in 2017, reported that Wakefield who had kind of disappeared for a while was
a town hall meetings. I don't know if he organized them, or if the Somali immigrant Community organizing. But Dairy was piling on and brought down vaccine coverage from over 90%. Washington Post reported of 40%, guess what's going to happen? There was and I think was 21 kids it landed in the hospital and then it happened again. In 2018, 2019, they began targeting Orthodox, Jewish groups in New York and New Jersey. And what they did was just so offensive. They started parading around.
Around in these phony, yellow Jewish stars like the Holocaust with the word vax written in it and vax was written like Hebrew letters, and started comparing vaccines to the Holocaust and that caused this massive measles epidemic across both in Muncie, New York by the Tampa Zee bridge and then in Brooklyn and I think there are 18 people in the ICU because of that, 50 hospitalizations. So this has become the new modus operandi. Then in 2019, you saw these series of
Harlem vaccine forums that they organized even held one in the Riverside Church which is on the Upper West Side. In New York near Columbia University is one of the iconic churches in the history of the civil rights movement of the Reverend Sloane coffin and somehow God axis there, and held a rally there. So all of that is caused a lot of damage. Now this new document, quote documentary, that's coming out. So I'm very concerned. So you've got as I say these multiple
It's you've got the health Freedom component, expanding our cross, the Republican party now into Western Europe, you've got the Russians fueling this with their systemic weaponized health communication and now you've got the specific targeting of racial or ethnic groups and causing a lot of damage. And and the problem is it takes time to explain. I can't give you a 30 second UNICEF commercial about this you know how long we've been talking, a full?
Flower Now, you kind of get it now, but it takes time to unfold and explain. And the problem is, it makes people very uncomfortable when I was going on CNN and MSNBC, and last year at this time, I didn't want to call out the White House for their disinformation campaign. I mean, what we're told is scientists is, hey, Peter just stick to the science, you know, you're not a political guy, you're not a expert in White House, Washington, politics. What are you doing? Can't do that.
But being an expert in anti-science. Disinformation campaigns by being targeted by these guys I mean Robert F Kennedy jr. Calls me to his Instagram. Call me the OG villain The Original Gangster villain, so that's a year talking to today. I had to look up. What OG meant? I unfortunately became a bit of an expert anti-science disinformation campaigns, and could smell mono mile away. And I saw this, I said, I know what this is, you know, you saw Peter Navarro out there with all the Chinese conspiracies. I said, we're being gaslighted.
Here. And I said to an my wife, I said, I don't know what to do. This is taking me to a very dark place yet. Am I supposed to only talk about the science? And she saw how upset? I was getting. She said Peter, you know, if you don't say anything and you find out all this massive loss of life will covid and didn't do. All you can to stop it. You're going to hate yourself and that's all I needed to hear and then I really went after it, it took me to a very dark place and part at that time you weren't getting a lot of backing. I didn't get a lot of back.
From the academic and professional societies because it's not what they do. And so I really felt out there alone later on. I think when it became safe, whether people came to my support but in the beginning it was very lonely thing to do. I mean I glad I did it but it took emotionally. It really knocked the crap out of me. It was very tough to do that. Because the truth is I'm not that ideologically driven politically, I mean, I was in Washington for 10 years and as chairman
Microbiology W, and one thing I learned in Washington. If you want to get anything done, you reach across the aisle. So we got a lot of neglected tropical disease legislation passed. And now, I would think nothing of going to Sam Brownback. Who was now. He's the governor of Kansas back then. He was just very conservative, senator, from Kansas, he would hold a prayer breakfast meeting and I'd go to that and I would speak and then I'd grow across the way and talked to Senator Leahy's. People whose this very liberal, senator, from Vermont and back, then, no.
We thought twice about those kinds of things, but it's not happening anymore. So, so to be able to have to tear into what was going on with the Trump White House and it was often perceived as I was just being somebody in the Democratic Camp, which wasn't the case. But I understand why it was perceived that way and now it's interesting is whenever I have something with the bind Administration, I think is not quite right then. I get beat up a lot from my colleagues on the left, and there's a lot more of those.
Those who say, you know, what are you doing after? Well, we've been through, how can you criticize the by and white? If I'm really criticizing, I think they're doing a good job, but there are things that need to be changed as well. So it's very tough. If your focus is only on saving lives and doing whatever you can to save lives. The that's very tough. Because it means, if you're sincere about that, you go on Newsmax and you go on Fox News, which I've been doing and you go on Radio podcast and that reach black and brown audiences.
So
what I've been doing so and hopefully the end of it all, I'll be okay but it's not easy doing this
Peter is there a historical precedent for such a distrust of science? I mean that given that the scientific method has only been around for call it 400 years, that doesn't give us a great opportunity to look for such things, but even in the last century or two, have we ever seen such massive distrust for the establishment of
Science.
I haven't seen this distrust systematically certainly there's been a lot of pushback or anger around certain things scientists have said like for instance during colonial times when Cotton Mather tried to vaccinate the Massachusetts, colony against smallpox, people were very aggressive with him. And they actually threw a firebomb into his window, around that particular issue. That's gone up and down in American history. But I've just
Not seen this systematic distrust of Science and scientists in the targeting of scientists and the mainstreaming of anti-science, that's kind of worrisome. And, and, of course, a lot of this is because now we have this new era of the internet and social media, and Amazon, and all those kinds of things doing a lot of damage.
So, kind of want to Pivot a little bit to something very personal for you. How old is Rachel
now now she's 28,
28. So let's go back in time, 28 years, tell me what you remember about her birth and the first few years of her life.
So by the time Rachel was born, I had already had two other kids and I remember an saying always feeling that something was off. She wasn't as Huggy or clingy as the other kids were but didn't really come to medical attention tool around 19 months of age? That's when the pediatrician clearly saw developmental, delays and refusals.
Heard us to special services. And ultimately, I was at Yale. I was an assistant professor then running a lab and that was hard for me because I was going off to China and keeping a lab in China. And and now having a child with the medical issue was really tough, ultimately had to give up going to China and reconfigure our program but it Yale. That's also the home of the yell child study center, which is one of the big thought leader places for autism. And she was referred eventually to the all child study center where the world.
As experts on autism people like Fred volkmar and Donald Cohen and Linda Maze. And there was a child psychiatry fell in Wendy Levine who really looked into this very carefully and she was clear that she was on the autism spectrum and and it's a little tougher to diagnose for girls than boys because girls tend to be more verbal.
Was she verbal at 19 months? Was she appropriately verbal? Well, she wasn't always appropriate but
she was always verbal. I mean, she would repeat, there's a lot of echolalia, she would repeat things.
But she had reason to this day, she's got reasonably normal language skills. It's just her performance IQ is really, really low. And, and that's one of the big issues with Rachel. It's the intellectual disabilities than her case that go with autism. And in fact, that's a very interesting side story about Rachel is the whole ecosystem of girls and women on the autism spectrum because older literature says was ten to one boys to girls and that's because
Boys are so Florida in their presentation and symptoms. Girls can camouflage it better, they can mask it better, they are often verbal, but they are very high rates of comorbidities like obsessive compulsive disorder or ADHD attention deficit hyperactivity disorder or even a lot of the teenage girls with bulimia and eating disorders. Now many of them may be on the autism spectrum so we're getting better at it. So it used to be 10 to
And now, it's think it's moving closer to three, two, one boys, to girls. In some say, it may even approach parody or something close to parody like 1.5. But it's way under diagnosed and Alice and singer has the autism Science Foundation has been supporting efforts to really call great because she has a daughter on the autism spectrum to look at this in more detail because it is so under-diagnosed. And but in Rachel's case, the finally came to diagnosis in 19 months of age and I got very interested in
In that. Because when you look at back then at the CDC definition of autism, I don't think it's on the website anymore, but I guess of a couple of years ago, was still there. It said most kids on the autism spectrum were diagnosed between 18 or 24 months of age. And I got very interested in that because there was a research group at the University of North Carolina Chapel Hill, run by this guy named Piven PIV Yen, who was able to show that that clinical expression of autism.
Some coincided with the big increase in brain volume expansion, so you could actually follow this on cereal MRI and that's important because a lot of parents will remember when their kid was diagnosed with autism, especially the regressive form, because that's so driven. That's just all slowing of Milestones, but actually loss of Milestones. They'll remember that your kid get vaccinated, maybe with measles or something else around that time and want to
Link the two but now this group at UNC Chapel Hill can go back much earlier back to infancy and show that there's already those changes happening in the brain. And now of course we can show prenatally. So Eric were Chesney's group at UCSD and multiple groups. Now the broad Institute Harvard MIT has identified about a hundred genes linked to autism, spectrum disorder all involved in early. Fetal, brain development. Many of them involved in neuronal
Communication. So a lot of neuronal cytoskeleton genes for instance. So we did whole exome sequencing on Rachel Ann and I had at Baylor genetics and identified a neuronal cytoskeleton Gina non Red Cell spectrin a neuronal spectrum which makes a lot more sense in terms of understanding the ronal communications and sort of things. I think what happens is you see the activation of genes and early fetal brain development and that sets into motion of progression but that full clinical
None of it doesn't happen till around 18. 19 months of age, often, that's not unusual for Neuropsychiatric conditions. All right, I mean, look at schizophrenia, for instance, often time kids with schizophrenia are not diagnosed to adolescence or even young adults and so this is how the brain works. I think it I'm not a neuroscientist but that's my take on this.
I mean, just on a personal level. How did you cope with this realization and did it ever caused you to question?
The thing that you were doing like, were you able to sort of distance it or think about it through kind of a scientific lens, even though it was something very personal. It went from being. This is the scientific literature in, its entirety to this is my daughter
back in the 90s, we know a lot less about autism than we know now and all the things that I told you about a lot of it has only come to light in the last few years and then the Wakefield, paper came out. And I remember that because I think Rachel was about 5 years old.
Old the time. And and it was all over the papers and of course an was asking me about it. And to me, it never made sense and said, how can it be? I mean, they called a pervasive developmental disorder back then, for a reason because it was indeed pervasive. And you could see that a lot of these kids were microcephalic, they have enlarged heads. So this was clearly a neuroanatomical condition. I mean, you knew that there were shifts and
Kinji fibers and there were structural alterations in the brain of kids with autism. How can it be that a vaccine? You give it one year of age would cause that it just never made any sense to me. There was never an. So for me there was never the plausibility but the full weight of scientific evidence wasn't there. I mean that was my opinion more than turns out more or less to be true. And so that's why I was one of the early adopters of
Saying, there's no way in hell it's going to be MMR vaccine and, and it just doesn't make any sense.
It's gonna sound like a strange question, but was there a part of you that almost wished it was so that you might be able to say? This would be amazing if we knew this because again, at the time Wakefield propose this he wasn't even saying that all vaccination was bad. He was simply saying they should be separate vaccines. Don't put measles-mumps-rubella in one shot. Give them separately. This was his first.
Cysts. So even wearing your hat is an infectious disease physician, if you could have believed that the answer was MMR combined causes autism and while it won't save my daughter to know that I could spare every other parent because clearly you exude the ethos of wanting to help everyone, all we have to do is separate these vaccines and we could solve it. I mean, was there a part of you that just wanted this to be true?
Not necessarily? I mean if it made sense to me and if
It was a logical explanation and yeah, if we knew there was a simple intervention, sure, but it was just so outrageous at the time, that wasn't even on my radar screen. At that time to think. In that way, I just knew that it had to be genetic or maybe an epigenetic basis and by the way that's a real treat. Trying to explain epigenetics to lay audiences start talking about micro rnas and histone deacetylation. I'm still working on. So,
Epigenetic component is another one that's important. But again, all of that had to be prenatal and I remember having some conversations with some of the anti-vaccine people and then saying had to be prenatal and I said and we yes, we do give some prenatal vaccines like flu vaccine the immediate response was aha and I said, no, I mean, you know again I don't see how an immunization during pregnancy could be linked to that. And now
The scientific data supports shows, there's no link,
autism is still such a complicated thing in terms of people even understanding what it means. So the definition has morphed a little bit. So today we talked about ASD being a
spectrum and it's gotten a very complicated because there's this whole concept after of neurodiversity. So there are many in the autism Community who bristle, if you even try to describe it as a pathologic condition they say,
No, this is just an example of neuro diversity. People are different and and I understand that what I try to emphasize with Rachel, it's not the autism per se that's incapacitating. Its in her case, you know she's got clear profound intellectual disability. She can barely read, she can't do simple math, you know what? If she goes to the store to buy something, she will hand them A Fistful.
I love single dollar bills and say here because she doesn't know how to count the money. She no matter how hard we tried to train her to do that, she doesn't understand the value of things. And so she depends on the goodness of the merchants and our local mantras neighborhood have been great, you know, they kind of know Rachel. So it's in her case, it's profound intellectual disabilities, that make it tough and make us worry. Because the other piece to this is now she's an adult with autism and intellectual
Ladies and the special services and all that kind of stuff. Really falls off the radar screen because we have no plan for her right now. We don't know, we've tried to have her in a residential facility which know I think did an okay job but her behavior was to uncooperative and finally they had to kind of kick her out. And so now she's with us and what worries me is. I don't know what's going to happen after and I are no longer here. There's
No road map for what you do with an adult with intellectual disabilities. And that really worries me especially in Texas. It's just not strong with Services of those kind and maybe it's better up in the Northeast. And we've heard New York and Massachusetts, but trying to work that as a huge, huge heavy burden on us.
How was the diagnosis made today? So if a parent today or a pediatrician today, suspect that something is not normal, whether it be language, delay changes
Behavior emotional regulation, eye contact, all the things that would flag. Someone what is the actual process by which a diagnosis is made? Is this something that shows up in the DSM? What is the criteria for
diagnosis? It's still in the DSM. The DSM is still not as strong as it could be. Especially for girls, especially for little girls. But presumably at the child gets referred to something called Birth to 3 which is an Early Intervention Program. And at some point they get
attention. Typically to a behavioral pediatrician may be a child psychiatrist. Only there only about six of them left in the planet. There's a huge need for more child. Psychiatrists are tell all my medical students to go into child. Psychiatry with the hope that one of them goes into it. That's a real crisis as well. Then the diagnosis is made along the way of limited social interactions in some cases, lack of speech. Although again, with girls and women, it's different. So there are a list.
Of criteria that you can look at
what's on the differential diagnosis. Like, is it a diagnosis of exclusion where they're just basically saying, here are a bunch of things that could present with this pattern. We're going to rule them all out and that which remains is ASD or because when you think about somebody that this thing is like, it's not like down syndrome where there's such a clear phenotype and genotype it's unmistakable this is much more nuanced
and how ears in future years will make whole exome sequencing
Fencing so much more available that I think any time you have a child like that you'll get whole-exome sequencing and we'll actually be able to Target it to a specific Gene. In some cases that may be useful because there could be pharmacological intervention. In case there's something that is impairing abilities and can be targeted,
can you explain why that's important? Why whole exome sequencing is relevant versus just quote unquote, a genetic
sequence well because with whole exome sequencing, you're
The full sequence of every expressed Gene what that does for, you is identifies rare, mutations that you wouldn't pick up just by looking at chromosomes and so it's a very powerful technology at this point. It only picks up around 40 percent, so if you're of autism and you do whole exome sequencing, my understanding is you only see a mutation, maybe, 30, 40 percent of the time because there's other things going on including the non-express.
Gene. So exome sequencing just looks at the express genes but if you do the whole genome potentially you could pick up additional ones as well. So we're still in the early stages of that. What's very interesting in that was some children's hospitals are looking at the possibility of doing whole exome sequencing and every child admit for whatever cause because we're learning so much about the genetics and epigenetics not only of autism, but so many other conditions. Right now, you're left with what I consider to be somewhat rude.
Mentary list of criteria from the DSM and I'll never forget Peter. I once had a lecture from a child psychiatrist, and when I was in medical school at Cornell and I remember him saying we're going to look upon the DSM is such a anachronistic or out-of-touch document for child. Psychiatry, it's just doesn't cut. It's just really falls down for child psychiatric disorders and that was in the 1980s.
Maybe it's moved on since then I'd be curious to hear from a John psychiatrist today, what they think about the DSM, but I'll never forget that comment and and when you look at the DSM criteria, they're just not really robust for so many childhood conditions. And again, this whole concept of neuro diversity is not reflected in the DSM. Like it needs to be, it'll get refined and I think that combining with whole-exome sequencing and that combining with all the developments
In Neuropsychiatric medications, I think things will look very different ten years from now and then 10 years again. From then
do you have a sense ballpark how many children that are born today? What will be the incidence of autism in the cohort of kids? Born in 2021?
Well, I think one is the number that's thrown out there. Now what is it 1 in 62? I can't remember the latest it's
surprising. Yeah, I mean it seems remarkably High
could come.
I'm close to doubling because we're way under counting all the girls and women with autism. So it wouldn't surprise me that. It would go down to something like one in 30 or
what do we think that was in 1980? For example. Yeah, I don't even know,
but very rare because the criteria change before there was a very strict criteria about nonverbal, boys, with certain repetitive behaviors, and we've enlarged so much, and then it's going to get very murky because now, with this whole,
Picture of neuro diversity. At what point is it a condition that warrants criteria under DSM? And what is it? Just being neuro-diverse? And I don't know that there's going to be a cut-off, right? It's always going to be that Gray Zone. So I talked to my oldest daughter a lot, who is an assistant professor at UCLA? She has a pH Emily. She's got a PhD in developmental psychology and works at the center for Disabilities. And this is a real struggle in a difficult to get your arms.
Mess around but I think we still need a lot of Brilliance around these points of what point. Is it something that you diagnosed in the DSM? And at what point is it not and I don't have the answers to that right. Now,
when you consider something like Alzheimer's disease and you look at the change in prevalence, over the last 50 years, there are many factors involved. People are living longer. We have many more tools to make the diagnosis and then, there are also factors that many of us, myself included, believe, are,
Actually, increasing the incidents. So the prevalence is higher because people live longer because we diagnose more but because the true incidence is
increasing, why do you think that is?
Because I think many of the risk factors for Alzheimer's disease are increasing dramatically so vascular disease, metabolic disease, being okay by far, right? So yeah as we see insulin resistance increase, as we see Des lipedema, increase in all of the things that accompany it, I think we're actually creating more neuropathology
So we're
actually working with a group at Baylor. We make vaccines, there's a group at Baylor College of Medicine run by David. Correy who also has a collaboration with Europeans, have shown some evidence of fungal involvement, even candida because there are some of the plaques that you see in the beta. Amyloid is, God, fungal sequences as well. And so, what is the role of aspergillus and other and yeast forming fungi in? This is getting very interesting as well.
I think that Alzheimer's disease is probably for lack of a better word. The final common path. There are many roads to it, right? And I do think that there's absolutely a sort of toxic version of it as well. That may actually include infectious agents or environmental toxins and things like that
with fungal that disease, you could do something about that, you could vaccinate for instance, get fungal disease. Could have fungal vaccine become a help with reducing neurodegenerative disease. So that's one of the things that we're starting to look at
using that as
As a model for thought, how do you now think about autism? Is it that hey, we're clearly more attuned to this. So we're making the diagnosis more, but do you also think there's an increase in the incidence in other words, is there an environmental trigger? That is either triggering this with or without manipulating The genome. So now we're going to have to talk about what epigenetics means. So people understand, you can have an environmental trigger that comes along triggers a condition for which there's a genetic susceptibility.
That does not alter the genome or one that does so and Alters The genome, what do you think is actually happening? And what are some of the plausible
explanations? Before I answer that? Let me just say, just because this is in complicated enough to make it even more complicated. There's a group at Geisinger in Pennsylvania. That's been looking at a number of psychiatric conditions and they've identified groups of families that have the same genetic mutation.
And yet, one individual has been diagnosed with autism, another schizophrenia, and another, some other condition. I forget. It was addictive behavior. Something along those lines, so you're right, genetics is dominant. But I think there are epigenetic factors that could have some influencing role and most likely it's going on in pregnancy. So when you talk about epigenetics that doesn't discount entirely environmental factors.
But if it is, it's environmental factors happening in pregnancy,
explain why it has to be an environmental factor in pregnancy versus an environmental Factor, post utero
because I think again I'm not a neuroscientist but I think there's the structural changes in the brain and or already well underway by the time the baby's born so that at their processes that are set. When you look at all the work coming out of Cortez, knees, lab and other labs.
It's clearly showing that this is going on early on a fetal, brain development, maybe as late as the second trimester but happening in utero and that's where all the action is occurring. If there is environmental influences its most likely something happening in
pregnancy. So if you're a parent or a soon-to-be parent and you're listening to this you're terrified, it's terrifying enough to think that during the first six months of your pregnancy, the first and second trimester, so many things can go.
Wrong. I mean, obviously, during the first trimester, you're mostly just thinking about not miscarrying. And then once you sort of get through, call it week, 8, 9, 10, and you're thinking, okay, well we're almost halfway to the point of knowing being confident. We're not going to miscarry. Then you start to think about big structural stuff is the heart. Okay. Does this thing have four chambers is the brain of normal size to think that there's some environmental trigger that could take a genetically susceptible fetus.
And render them autistic. I can't imagine how that doesn't produce an incredible amount of speculation and
consternation, but I think you have to be careful with your language. So it's not just genetically susceptible and the genes are there and there
are these deterministic
there causing autism. There might be some environmental influences that could affect expression through epigenetics but it's not so simple. As to say genetic susceptibility,
I think it's quite
that straightforward. How to terminus could we think these jeans are them.
I know you're what you're looking for. You're looking for an 80/20 90/10 70/30. I don't think we know that. I mean, it's polygenic. Presumably, what do we think here? Well, in Rachel's case seemed to be a so far as what we know, it's a single Gene and I think that's true, but they're not all the same genes. So the point is the broad Institute at Harvard Mit paper, which I think was in cell and identified about a hundred genes, but the common denominator
Dominator was they seem to be all involved in early, fetal, brain development, all except for one in the cortex of the brain most involved in early, excitatory, and inhibitory neurons. And a lot of them in the neuronal cytoskeleton. So, there's a lot there there. I mean, it's clearly, the genes are dominant whether or not there's some Epi genetic influences that can affect whether it's full-on expression of autism or
There's schizophrenic components to it. I think that may be likely as well, but it's not as simple as saying just genetic susceptibility and it's overwhelming the environmental factor. I think it's the other way around. I think it's overwhelmingly. The genetics is the dominant factor and yes deterministic and maybe there are some Epi genetic influences.
So if that's the case, then there would be really to reasonable explanations for the increase.
In the incidence of autism. I mean, do you believe that there has been an increase in the incidence of autism over the last 40 or 50 years? A true increase in incidents. Not diagnosis.
I have not seen any evidence for that, but I can see that it's tough to prove. So one of the things I asked our teachers, you know, are you seeing more autism? And most teachers will say, yeah, I'm seeing a lot more autism, but I think a lot of that is due to more awareness. I think a lot of things that we now call, autism. We didn't call autism back,
Then I mean we use the r word a lot, right there. Mentally retarded or there, this or that. And now we realize they're on the autistic Spectrum. There's also this component and some teachers have told me of said, well, if you want to get special services for your kid, you have to label it and soft ISM. Otherwise they're not an eligible for special services and how much of that is going on. It's hard for me to know either. And again, as I point out as we get better with diagnosing girls and women with autism, those numbers are
Going to go through the roof yet again,
how heritable do you believe the transmission of this is, is this something where it's sort of like eye color, where a child can be born with green eyes to a parent of blue and brown eyes. How do the jeans transmit? What's the best?
Guess? Yeah, again, not an expert. I mean, in some cases, I think they're spontaneous mutations. I think others, you know, I remember when Rachel was diagnosed with autism,
And said, clearly it's your side of the family and I said, what do you mean? What about your uncle so-and-so? And so there was those kinds of discussions hard to know. I mean, I think clearly you see autism in parents of kids with autism and it may not be fully diagnosed but you definitely see that a lot of times and I think that's quite common and has a theory. That autism is more common among people of intellectual accomplishment.
And maybe there's some truth to that, but I think it's just bias on the basis of people that and I've been at a university my whole life and then is always running into academic. So I can understand why she thinks that. But I don't think that's been well
established, that's really interesting Peter. I actually, I guess I took it as a given that there was a true increase in the incidence of autism, though, not as significant as what the perception is, because the perception is also being driven by, as you say, just
To a tremendous increase in Awareness diagnostic criteria, becoming broader more things, being included. So, for example, what used to be called Asperger's is now technically a part of ASD
where I back, I guess the question is, how would you ever sort it out? I guess what you could look. If you had specific genetic markers that you could look at. That would be something you can. Hang on to, and say is the increase in certain genetic markers, going up, but that's not trivial to look at either. But I've
Always felt that there's been no true increase but there may be some evidence for.
So let's pivot through a little bit of the current around covid. As we stand here today, Peter were well on the path to most Americans who want to be vaccinated are getting pretty close to being vaccinated by the way, what's the latest on the vaccination of children? Where is the CDC on that? What do we know about the vaccine? How many of the current vaccines as we stand here today?
Today really, there are three that are used in the u.s. correct. I think the AstraZeneca one is not used in the United States.
They haven't applied for emergency use authorization. I'm worried about that vaccine for reasons that we can talk about. But then there's the Nova vax vaccine so and there's could be as many as five by the spring in terms of kids. Pfizer, just released data showing high levels of efficacy and adolescents 12 to 15. But there were small numbers or is around 1200 in the vaccine group 1200.
The control group and her 18 cases of covid in the control group, none in the vaccinated group and on that basis and their press releases said a hundred percent efficacy. I'm sure that won't hold up. I mean, it'll probably go down one of the interesting things about the kids, though. Those adolescents the virus neutralizing antibody titers are really high like 1,200 so higher than older adults. So that may be a factor as well and we're now starting to get our arms around Coral.
It's of protection that I really high levels of virus neutralizing. Antibody seem roughly to correlate with efficacy is
that consistent with your belief, Peter that this would be more be cell-mediated than T-cell mediated.
Well, I think T cells have a role. I mean, I think virus neutralizing. Antibody may not be everything, but if you don't have high levels of virus neutralizing antibody, you're not going to get protection. And the problem with comparing those virus neutralizing, antibodies is when you look at the actual papers
They compared it with convalescent serum titers and they're all over the map. So now there's a paper up on met archive. That does something very simple, which is, rather than just give the absolute value for the geometric mean titers, whether it's against pseudo, virus, or whether it's against plaque reduction, neutralization titers what they do is they do a ratio of the virus neutralizing antibody titers against the vaccine versus the virus neutralized.
The antibody titers of the convalescent kind of normalize it, and there's this very nice curve. That's been generated that shows you need to get it. That the level of virus neutralizing, antibodies has to be at least as high as the convalescent and preferably about 1.5 or two to get really high levels of protection and I think that's probably what we're looking at. So it's not quite a true correlative protection but I think we're moving in that direction. The adolescence get really high levels of virus neutralizing.
And did that Pfizer study, give two shots or one and it was too. So now that we're out of the gate and millions of people have been vaccinated, do you have any preference or concern over any of the vaccines? You obviously mentioned AstraZeneca, which I want to hear about but let's start with the US vaccines. Any reason to believe that one is better than the other. In fact, I'll share with you something that I found very interesting, which was the J&J vaccine, which is a single vaccine and That vaccine well.
The headline is lower efficacy. If you actually look at the absolute risk reduction as opposed to the relative risk reduction is at least as efficacious as Pfizer and moderna. I found that to be very interesting and I'm surprised how that was sort of omitted from all the
press. And I also think it's hard to compare because it's a single dose being given a single dose versus the two doses, and it wouldn't surprise me if that change a vaccine ultimately becomes a two dose vaccine down the line.
Cuz you may want to give a booster for one of the variants as well. And in two doses, the virus neutralizing antibody titers is really, really high. And it'll be as good or in terms of protection as Pfizer moderna. Certainly, I think to me the single dose J&J looks better than the single dose Pfizer and Moderne, not by much, the bottom line is. They're all good, Darrell, good vaccines. And I also think don't be surprised if later on, we're going to need a boost for all of them.
They'll be a third dose of the Madeira nerd, Pfizer, vaccine or a second dose of the J&J and what that will do. It'll Elevate virus neutralizing, antibody titers higher. It'll create more durability of protection. I think and that boost will be reconfigured for the South African and the Brazilian variant, which are not here in a big way in the US, but may become a bigger problem down the line right now. It's the UK variant to be 117 variant. That's it
The rating all of the operation warp-speed vaccines work really well against the UK variant and I'm very optimistic.
That's because that variant has not mutated through its Spike
protein. Well, it has so the UK variant has a single amino acid substitution in an aromatic amino acid creating an aromatic amino acid, and that seems to reduce the level of virus neutralizing antibody. I don't know if I have a mechanism to show you pictures. I really think this is, it's a little bit of a
molecular biology but not much. I just showed this at a pediatric Grand rounds at Columbia this morning. I really love this and to me, it helps people understand as I often like to say it's not a 30-second UNICEF commercial but it's
funny. I haven't seen any units of commercials recently
ha. Okay, so now this be 117 variants going up. So this is a paper. It's up and bio archive or preprint server looking at the be 117.
And in the spike protein, what there is there's an amino acid substitution in the 501 Position will win from asparagine to a tyrosine. And a tyrosine is an aromatic amino acid has a ring to it, and they're able to show the model it with the receptor. The Angiotensin converting enzyme that now, there's another tyrosine. It's
got a nice strong bond there.
Yeah, there's a ring, ring interaction. So it's these Pi electrons, that circulate an error.
Aromatic rings that are interacting with each other. In addition, there's a hydrogen bond and the reason I love this so much is all we're talking about this big acceleration of cases, going up in Michigan and affecting younger people and higher mortality and morbidity. It's a bit of a simplification but then again it's not. It's all coming down to Pi interactions between two, aromatic Rings into Tyra scenes.
Let's make sure people understand this because not everybody understands bio.
Mystery right? Each amino acid is coded for. There's a code, right? So you have three nucleotides that code for an amino acid so it sounds like one of those gets changed and it changed the amino acid and I can't remember did you say it started at three inning or which
so this is the wild type or the original lineage is now switching over to a tyrosine.
It went from 300 to tyrosine and then all of a sudden that changes literally changes the shape but
also creates kind of an electro chemical attraction that wasn't there before. And so, all of a sudden, the spike protein has a greater attraction to the ace to receptor,
right? Which presumably translates into better virus entry. May be more virus, replication and that's why you getting more severe disease. And younger people are getting sicker as well. The good news is the virus neutralizing antibodies to the original Spike.
Seems to still work well against this. Be 117 variance. We're going to take this picture now and zoom out a bit. So now this is the spike protein which is a trimer. Actually, let me show you a real picture of it. So you so you can see what it looks like. This is the trimeric spike protein. So these are these little purple flowers on top. Each one is a trimeric spike protein and now we're going to show it again here and they've got each one has its own receptor binding domain.
And and now, what's going to happen is only one of the receptor binding, domains flips up and binds to the receptor to the Ace 2 receptor. And here's that one amino acid substitution again that I blew up on previous slide.
So if you have the wild-type on here, Peter it would show it would look the same but it would look the same. You would just have a lower Affinity there. Yep.
Yep. And you wouldn't see this, it wouldn't be marked as having this mutation, but the point is the antibodies to all of the original
Any edges from the vaccines seem to work just as well because still neutralize this interaction, the problem comes in. Now, with the other variants that are coming up from South Africa and Brazil, the P1 variant from Brazil and the be 135 one, that's got a second amino acid substitution over here, which is creating a lysine. And that I think is creating extra levels of electrostatic interaction. So, The Binding potential is even tighter
derp. And this now is interfering with the ability of antibodies to neutralize. So the virus neutralizing antibody titer goes down, and that translates to decreased an efficacy. So, when you look at the published numbers, these are some of the numbers here, the level of efficacy, against the original. I'll call that original / UK, which is probably roughly about the same versus Za. The South African, very and that's why you see it going
down.
Wow, so this is interesting. Let's digest this for a second. So Pfizer and modernity take an enormous reduction against that
variant well now. No, let's be careful. So, the Nova vaccine change a, that's actual efficacy published efficacy data and the case of Pfizer and moderna. What you're looking at here is declines in levels of virus neutralizing, antibody in
vitro. Thanks for clarifying. That
that's very important and because
Level of virus, neutralizing antibodies. So high to begin with, there's enough. Residual that is, you're still getting good protection and I
but we don't yet have the clinical data to
swell now, Pfizer's issued a press release yesterday saying, they think in this very small set, it seems to work really well against the South African variant. Which makes sense given the high levels of virus neutralizing. Antibody to begin with.
Tell me why you think the AstraZeneca takes the biggest hit here then.
Yeah. So the estrogen
Annika started out, in some cases, not as high levels of virus, neutralizing, antibody, and a study was done in South Africa. Showing only 10%, basically ineffective against South, the South African variant, but talking to the Oxford people. One of the things they say is it's a little unfair because they only tested it against moderate and Mild disease. And they feel that if you were to test against severe illness it would still be very effective and they counter that the J&J.
We're mostly looking at severe illness and if they like J&J had looked at severe illness, they would have come up with similar numbers. But, you know, I guess we have to wait and see what happens with that. The bigger issue with the AstraZeneca vaccine is just public perception around the cerebral. Thrombosis, that is being reported out of Europe, I think that's causing a lot of damage and it goes back and forth. You know the German government through their Paul, Ehrlich Institute, pointed out, you had six, I think was six cases.
Is of sinus, Venous Thrombosis, which is a rare condition in the vaccinated group and they suspended it. And then several other European countries did that had big ramifications especially for Africa, you know, francophone Africa listens to what's going on in France and Etc and I was going on a number of Zoom conferences with groups in Africa. And they were very concerned about the AstraZeneca That was supposed to be a Workhorse vaccine for low and middle income countries. The European medicine agencies came along said no, no it
Looks okay. It's we think this is not related to the vaccine but then in Science magazine to excellent science, journalist Gretchen Vogel and Kai Cooper Schmidt looked at this, and they wrote about 31 cases of cerebral, Venous Thrombosis, and more clearly showing, it could be linked to the vaccine is a very rare event, but still, that can really alter public perception especially in light of all of the very aggressive anti-vaccine at
Activities that are happening. So I don't know what the us is going to do at this point. I hope they do. Authorized it for burden, see release, even if they never use it in the US, and the reason is, if the u.s. declines are of that derails, I think it could have a chilling effect on Latin America and Africa because we don't have a lot of vaccines out there. That's, that's why we came along with our recombinant protein vaccine, because they're not a lot of options. The big issue is, you know, if you look at what's going to be me,
For low and middle income countries. They're not a lot of choices out there. I mean, the to mRNA vaccines, it's still a new technology. We're not going to be able to scale that up in a big way for Africa and Latin America. Yes, I mean, it's great. Pfizer donated two hundred, thirty thousand doses to Rwanda was fantastic. But look at the numbers, there's one point, 1 billion people in sub-Saharan Africa, 650 million people in Latin America. We're going to need four billion doses of vaccines. Where's that going to come from? It's not going to come.
From the MRNA vaccines
is the refrigeration. Also a problem,
they have the fact that they are owner is freezer requirement, and then the J&J is having some issues and scaling up production. The part of the problem was when the science policy makers were looking at this. They went so heavy on the Innovation and they want to producing a lot of really cool vaccines that are highly effective. But in terms of durability for scale up to make four billion doses. I don't think that was high enough on their radar screen.
And didn't realize that when you use a brand new technology, it's really hard to move to 4 billion Doses. And that's why I'm hoping our vaccine comes along, which is in part. A couple of donors came to me after one of the podcasts I did with you and that was game-changing for us because it allowed us to adapt our coronavirus program for vaccines who are making for SARS and mayor's to this recombinant protein vaccine for covid-19.
What's the vehicle?
It's recombinant
protein in yeast, just like the hepatitis B vaccine, you could produce a ton of it. They have capacity for producing a hundred million doses of a month, and it's looking really good in clinical trials and in non-human primate, trials. I can't talk about it yet, but it should be out soon. And hopefully, that will come in and make a big difference because I'm really scared that. We have nothing for African and Latin America. I mean, what's amazing is how I had to struggle for funding. I mean that was spending, you know, good.
Out
of last year, just trying to keep the program going because it was so hard to get funds for what was so obviously needed. Which is a low-cost unfussy, durable vaccine for low and middle income countries. And because of your podcast groups like Tito's, vodka came through with some funding and, you know, they're based in Austin and not a Miss Stoner and a couple of other. So, that now the clayburgh foundation is helping us in a big way. There are Texas foundation and in the JPB foundation and a few others.
So that was game-changing.
So Peter based on everything you're saying, it sounds like the biggest concern right now, would have to be Brazil, followed by Africa unless I missed it. Did you explain the mutation in Brazil and the efficacy that any of the current vaccines would have against it, notwithstanding the scale up limitations.
Yeah, a couple of things. So the P1 varying in Brazil has those same two amino acid changes in the South African. So I kind of think of them as brothers
Issues. So, dealing with South Africa will hopefully take care of Brazil as well. One of the things I wanted to mention is the global policy makers. Did a good job of creating this Kovac sharing facilities, really quite brilliant in this design. I think that's not the issue because they were really worried about Equity. The equity issue. I think was more of the fact that we didn't ensure there was enough vaccine available for the Kovac sharing facility, and that's
Really the problem right now. And hopefully, we can come in and address it and take care of this. Because if we don't figure out a way to vaccinate the rest of the world, if we only vaccinate North America and Europe, it's going to be a catastrophe. This virus is going to continue to circulate and cause tremendous humanitarian destruction, but also, who knows what other variants could evolve as well as a consequence of allowing that to go unfettered?
What drives the evolutionary pressure here of these mutations. It's just standard.
Darwinian Behavior, where mutations occur in, they're escaping because these mutations, how does the immunogenicity of this virus comparative influenza? It seems far less than influenza.
A lot of us were surprised by the variance. We thought that we hadn't really seen this as much in coronavirus has what some people speculate is it happened because of an immunocompromised individual who had a lot more virus replication in their system and that
That combining even possibly with receiving plasma convalescent therapy, that put some kind of selective pressure on it and that's kind of an iPod with assist that's out there, but that's not strong. I don't think we really know that for certain at this point. The good news is the way I see it. As a lot of the viruses are converging to the same mutations. So my hope and it's only a hope. And there's I know me consensus in the scientific Community is that if
Make a booster to this South African / P1, Brazil Varian. We might be done at that point that there won't be this continual Evolution for totally something different, but I don't think we know that for certain. So the good news also is it looks like our vaccine seems to give pretty good levels of virus neutralizing, antibody to the South African variant as well. So we're making the booster for it for the South African just in case, but we may not need it. We'll see.
We don't
know how often we would need the booster. It could be every six months, every 12 months, every 18 months. It's too soon to tell obviously until we have longitudinal data looking at the neutralizing
antibodies. I mean my dream situation is we give this one boost beyond the original vaccine series later this year next year and then we're done that it won't have to be every year but like anything else we'll just have to monitor and follow it but people say is going to be like flu or you have to vaccinate every year and at this point I don't think so. But
Can't say for
certain, because in the case of the flu, that's driven more by the mutagenicity than the lack of b-cell response, isn't it?
Well, in the case of the flu, you're getting these wholesale antigenic shifts. So, really like a totally different virus. And there's this carefully orchestrated dance that we have in place to monitor, flu, virus strains, you know, maybe coming out of Asia. And then quickly, transmitting the message to the pharmaceutical manufacturers, who make a whole different.
Seen every year. It's really quite extraordinary. I don't think we're going to need to do that for Coronavirus vaccines at least. That's my hope. But we'll see how this unfolds. Well, one thing's for certain if you look at what's available for Africa and Latin America, right now, it's not good. And so I've been talking to a colleague, Patrick shim Shin, who's in Los Angeles, and he's really interested to see. Can we build out vaccine development, capacity and Africa or maybe Latin America?
Because right now there's no vaccines made on the African continent. Nearly enough in Latin America not much in the Middle East, we've learned that if you only rely on the multinational companies even with that great Kovac sharing facility, they're not going to make new vaccines for the world at least in Rapid time frame. It's amazing. They do what they do. I mean gavi the gavi Alliance for vaccines in the world's children depends heavily on the multinational companies. They do a great job of. We need parallel mechanisms in place like new
Seen development production facilities in locally in Africa, and Latin America. And that's something that we've been working a lot in this concept of vaccine diplomacy and building that out.
Well, Peter, I know that we have a real hard stop in time because you've got another obligation, but really happy that we were able to spend a couple hours together. We covered a lot of ground and we actually got through half of what I wanted to talk about. So I consider that a win,
it was it only half? Okay, well I'm always happy to come back. I love being
Being on your podcast one because I learned so much from you and the thing I really appreciate is you ask questions that I just never would have thought of on my own and you know after you ask it I say why don't I know that I should have? I mean that's so obvious that I should know that because it's the right question to ask. So you have this amazing talent for asking the right questions and I appreciate that.
Well thanks very much again for everything Peter and I'm sure we will be talking again soon. Okay, thanks so much. Thank you for listening to this.
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