In this episode, I sit down with neurodiversity advocate and autism advocate, Dr. Kelly, to discuss the controversial topic of vaccines and autism. We talk about the science behind autism diagnosis and treatment, how autism has changed over the years, and the role that autism plays in our understanding of mental retardation and dyslexia. We also talk about how autism affects the way we think about mental health and how it affects our perception of mental health, and how we can work together to improve it. We also discuss the role of autism in shaping the way that we see mental health issues in the media and society, and what it means for the future of the field of autism research and treatment. Thanks to our sponsor, Goodwill Industries, for sponsoring this episode. We are a proud supporter of Goodwill and the autism research organization, Autism Research, and Autism Research and Development Center at the University of Wisconsin-Madison. The Autism Research Institute. To find a list of our sponsors and show-related promo codes, go to gimlet.fm/OurAdvertisers and use the promo code: "WEBSITE" to receive $5 and receive 10% off your first purchase when you enter the offer ends on October 31st, 2019. Thank you for supporting our sponsorships! We'll see you next week with a new ad-free version of the show on October 30th! Subscribe to our new podcast, "The Autism Project" on Apple Podcasts! Subscribe, Rate, review, and subscribe to our podcast, and leave us your thoughts on the show! Thanks for listening! and share the podcast! if you like what you're listening to this podcast and what you think of it? and what do you think about our podcast? and rating us on iTunes! we'll be listening to us on your review and rating and reviewing it on your reviews and reviewing us on Apple Music, and we'll leave us a review and reviewing our podcast review and review it on the next week's review and what your thoughts are your thoughts and reviews are you're reviewing it's a review on it's the best listening experience! etc. and review we'll also review us on the podcast is a review or review you're a review? :) Thanks again for listening and review is a big thanks to you're rating and review and your feedback is also a review! - Thank you so much for your feedback!
00:00:14.000I should tell people before we get started, I did not know when I asked you to come back on that you were heavily involved in this whole vaccine debate.
00:00:23.000What I wanted to have you on to talk about is tropical diseases, because I remember when we did that sci-fi show, you explained to me that some ungodly percentage of people that live in tropical climates are infected by parasites.
00:00:36.000Well, my day job is developing vaccines for tropical diseases.
00:00:40.000We develop the vaccines no one else will make because they're for the world's poorest people.
00:00:44.000So we call them tropical diseases, but they really are diseases of poverty.
00:00:48.000The vaccine issue, the advocacy issue around vaccines and autism is kind of a new thing that I got drawn into just because I'm a parent of an adult daughter with autism and I make vaccines, so it was a natural that I'd get drawn into it.
00:01:03.000Yeah, so when I said that you were going to come on, then I got inundated by people that are...
00:01:10.000You know, the vaccine thing is such a polarizing issue.
00:01:43.000One thing's for sure, we're diagnosing people with autism who we diagnosed as something else in the past, you know, whether it was, you know, really horrible diagnosis.
00:01:54.000We'd use pejorative terms like mental retardation.
00:03:03.000Well, although one of the interesting side pieces to this is there's a group of people out there who self-identify themselves as the autistics.
00:03:14.000And they get very resentful or hurt when they're called a disease or a disorder.
00:03:20.000Because they say, well, we're not an epidemic, we're a person.
00:03:24.000And it's part of this whole neurodiversity movement, which is quite interesting.
00:03:30.000They say they're neurodiverse, that they, you know, maybe think differently from others and they respond differently than others, but they're not, quote, abnormal.
00:03:38.000And I think they have a good argument.
00:03:41.000I heard a crazy argument once with someone that was...
00:03:44.000So the point is that it's, you know, the impairment, like Rachel, my daughter, it's not so much her autism that thwarts her, you know, ability to have partners or to have a meaningful career.
00:03:59.000It's the fact that she has profound, in her case, profound intellectual disability that goes along with it.
00:04:27.000Yeah, with Rachel's case, my daughter, she has a pretty good verbal IQ, 80-90, but she has a very low performance IQ in 40. She can't do simple math.
00:04:37.000Fortunately, Goodwill Industries came to her rescue and our rescue, and now she works there two hours a day sorting clothes, and that's been really meaningful for her to get a paycheck.
00:05:03.000Although now, as I say, that's why I don't like using those terms because it puts people on the autism spectrum as though they have a disease or a disorder, which I don't like to do.
00:05:56.000To say there's no issue is kind of ridiculous.
00:05:58.000I mean, there's a reason why so many people are so concerned about autism and vaccines and just autism in general, whether it's environmental pollution factors or whatever.
00:06:06.000Right, but what they like to do is they like to make the distinction between autism...
00:06:10.000That neurodiversity thing and actually having intellectual disabilities that go along with it.
00:06:28.000There was a very important paper produced by...
00:06:31.000written by a group at the Broad Institute at Harvard at MIT, which is one of the premier genetics genomics organizations in the country, And they've now identified 99 genes.
00:06:42.000It's a huge team of scientists, not only at the Broad, including scientists at Baylor College of Medicine.
00:06:47.00099 genes involved in autism, all involved in early fetal development, early brain development in the first and second trimester of pregnancy.
00:07:00.000So now we're starting to really get our arms around what autism is.
00:07:03.000And that's one of the things I talk about in the book.
00:07:05.000I mean, We have learned so much in the last couple of years about autism, how it begins early fetal development well before kids ever see vaccines.
00:07:14.000And that's one of the reasons I say vaccines did not cause Rachel's autism.
00:07:18.000Vaccines don't cause autism because autism is already underway in early brain development.
00:07:24.000Is it possible that some people have this tendency towards autism and it's exacerbated by vaccines?
00:07:32.000I think what happens is the Sequence of events happens during pregnancy, but the full clinical expression of autism often doesn't happen until 18 or 19 months of age.
00:07:45.000Like Rachel, for instance, wasn't actually diagnosed until 19 months of age.
00:07:49.000And there's some fabulous studies now showing that that clinical expression of autism actually coincides with a big increase in the volume of the brain.
00:08:01.000You can actually show on serial Magnetic Resonance Imaging, serial MRI, how the brain volume starts to increase.
00:08:10.000And that's very important because parents will often remember, oh my kid got vaccinated around 18 months of age or 15 months of age.
00:08:40.000We can go into detail in the paper, but they can see certain things on signatures on MRI that tell them that this kid is going to go on to Okay, so in fact there is a way to test positive for autism then with this serial MRI. That's what they think, right.
00:08:55.000And now we have the 99 genes, so we can even take it back further by doing what's called whole exome sequencing.
00:09:02.000Sequencing all the DNA, all the expressed DNA. Of an individual.
00:09:07.000And in Rachel's case, we did that and we actually found a mutation in a gene controlling neuronal connections, which makes a lot of sense if you think about what autism is.
00:09:17.000So there is a way to show whether children will be more likely to develop autism and there is a way to look at their brain through fMRI at a very early age.
00:09:36.000We're getting much better at getting arms around the diagnosis.
00:09:40.000Why do you think there's so many people that have these anecdotal stories of their child getting vaccinated, especially large doses of vaccines when they hit them with like 10 in a row, and then all of a sudden, or measles, mumps, and rebellious, the one that gets repeated over and over again.
00:09:54.000That's the one that made my child have autism.
00:09:58.000And I've heard it from friends, from friends that have children that have autism.
00:10:02.000They had a child, their child got the measles, mumps, rebellious shot, and then immediately there was a very distinct change in the child's behavior.
00:10:09.000Well, no question when you get the measles, mumps, rubella vaccine, many times kids cry and things like that.
00:10:15.000And then autism will then begin sometime between the first and second year of life.
00:10:19.000So it's logical to want to connect the two.
00:10:22.000But now we know it's not even plausible because we know If you go back to that MRI at six months of age or go back prenatally, we can even determine which kids are going to go on to develop autism.
00:10:33.000And then complementing it, our massive epidemiologic studies done on over one million kids.
00:10:41.000In fact, a new paper was just released this week showing that kids who get the MMR vaccine are no more likely to get autism than kids who don't get the MMR vaccine.
00:10:57.000Kids on the autism spectrum are no more likely to have gotten the MMR vaccine than kids not on the autism spectrum.
00:11:04.000So it's a combination of those big studies of over one million kids together with knowing what autism is that completely rules out the possibility.
00:11:14.000Right, so these genes, and the issue with these genes, and then the ability to scan the brain with the serial MRI, so you can tell which children have the propensity.
00:11:28.000Is it possible that children have all these issues and then do not get autism, or do 100% of those children with those issues get autism?
00:11:51.000Okay, so what you're saying though is that if a child does not have these mutations and does not have these issues that are present during a serial MRI, that they will not go on to develop autism.
00:12:06.000So children without those issues who get vaccinated have no problems, which most children have no problems, right?
00:12:16.000Yeah, I mean, you know, we've learned a lot about the risk of vaccines and the numbers are extraordinary.
00:12:23.000I mean, the risk of a severe adverse event happening After getting a vaccine is roughly on the order of 1 in a million between between 1 in a million and 1 in 10 million.
00:12:35.000So and I found an internet report once that the likelihood of getting struck by lightning is 1 in 700,000.
00:12:42.000So it's, you know, the likelihood of having a severe event after a vaccine is your odds are better of getting struck by lightning than And when you say severe event, what do you mean by severe event, though?
00:12:53.000Well, there's actually a table that's put out by the National Vaccine Compensation Act that includes shoulder injury, that's one, encephalitis.
00:13:32.000I think in some cases, inadvertently, if it's a live virus vaccine, like the measles, mumps, rubella vaccine, and you have an underlying immune deficiency that wasn't picked up before, then that virus can replicate better.
00:13:46.000So, as far as you know, children who are healthy who get a vaccine, it's not biologically possible for them to develop these traits, these mutations in the genes, and these issues that you see present?
00:14:01.000As best we can tell right now, that seems to be the case, right?
00:14:05.000As best you can tell right now, it's a great thing to say.
00:14:09.000But for people that are like, hmm, on the outside, what does that mean?
00:14:41.000And then I'll do a deeper dive on each of them.
00:14:44.000The second part shows not only is there massive evidence that there's no link between vaccines and autism, there's no plausibility because we know so much about autism and how it begins in pregnancy.
00:14:58.000The first part is studies on over one million children.
00:15:00.000One of the things that the anti-vaccine lobby does It's not really a game, but what they do is play this kind of thing of vaccine whack-a-mole because at first they alleged it was the MMR vaccine.
00:15:14.000And that came out of the study that was published in The Lancet in 1998. Then another group came along and said, no, no, no, we didn't mean the MMR vaccine.
00:15:22.000We meant the thimerosal preservative that used to be in vaccine.
00:15:26.000And the scientific community not only debunked the MMR link, they debunked the thimerosal link.
00:15:32.000Then the anti-vaccine lobby came along and said, no, no, we didn't mean that.
00:15:36.000We're spacing vaccines too close together.
00:15:38.000Then they changed it around again, saying now it's the alum or aluminum in vaccines.
00:15:44.000And then each time the scientific community responds with massive epidemiologic studies showing just absolutely none of those things are true.
00:15:51.000And do you think that it's just, when you look at, say if there's one in a million that has an issue with this, and it's not autism, by the way.
00:16:01.000So whatever those issues are, that they hear these stories and these stories do accumulate because there's 300 plus million people in this country and over 10, 20 years of one in a million, you develop a significant history of cases where children did have issues with vaccines.
00:16:22.000So these people hear about these stories, and people are terrified.
00:16:46.000We can vaccinate against diphtheria, pertussis, tetanus, polio, haemophilus influenzae type B, which is a terrible cause of meningitis, and in some cases not even hepatitis.
00:18:05.000What that means is they've put out now, by some estimates, 500 anti-vaccine websites so that every time you put the word vaccine into a search engine, whether it's Yahoo or Google, you're going to get anti-vaccine misinformation.
00:21:51.000So how much of this is being driven by By financial motivation peddling these phony autism therapies, I can't say.
00:22:00.000My sense is that's not the big piece of this.
00:22:03.000There's also some reports now of Russian bots and trolls that are amplifying this and sowing political instability in the country.
00:22:11.000But again, you add that all up, the phony autism therapies, the Russian bots and trolls, in my mind, That really doesn't get our arms around the big driver of this thing.
00:22:22.000So I think we really need some good investigative journalists to look into this.
00:22:26.000Well, do you think that there's some sort of a concerted effort, or do you think that it's just a bunch of people that really believe that vaccines do cause autism, they don't truly understand the science, they haven't talked to someone like you, and maybe they have this idea that's cemented in their mind and they're not willing to...
00:22:43.000Look at it objectively and look at the full spectrum of possibilities and look at the science behind what you guys are saying.
00:22:49.000Because in their head they've been saying vaccines cause autism.
00:22:53.000They've been saying it for so long that once someone gets that and they're connected to that, it's very difficult for them to shift gears.
00:23:01.000People have a really hard time not being married to an idea.
00:23:06.000You know, when I talk and I spend a lot of time going around the country giving what are called grand rounds lectures to hospitals and medical schools, pediatric grand rounds, so I've had the chance to talk to a lot of pediatricians and nurses and nurse practitioners and more than a few parents.
00:23:23.000My impression is most of the parents Who are called to be so-called vaccine hesitant, is the word of the day, are not really deeply dug in.
00:23:34.000I mean, you can have a conversation with them and explain to them, like we're talking now in a very, you know, non-technical way, you know, the evidence showing vaccines don't cause autism and the lack of plausibility given...
00:23:47.000That it begins in pregnancy and they'll vaccinate their kids.
00:23:51.000There is another percentage, and I don't know what the percentage is, but there's 10, 15 percent that are deeply dug in and are wholly invested in this conspiracy theory that the government is in cahoots with the pharmaceutical companies and blah, blah, blah.
00:24:07.000And then if you try to talk them out of it, they just think you're part of the conspiracy.
00:24:12.000So it's sort of a no-win approach there.
00:24:14.000But most parents you can have a good conversation with.
00:24:19.000It's not necessarily even most parents, right?
00:24:21.000I mean, what you're dealing with is these people that maybe they're into a bunch of different alternate therapies, a bunch of different kinds of cleansing.
00:24:29.000There's a lot of that nonsense that you find online where, I mean, look, there's legitimate...
00:24:35.000But I guess my point is parents don't get the chance because they're so inundated with phony anti-vaccine information.
00:25:09.000But who's to say whether they're wrong or right?
00:25:11.000It seems like there should be some sort of a debate, right?
00:25:14.000Like if there's someone who's saying that there's some evidence that vaccines cause debate, you're saying there's no evidence that vaccines cause autism, and you're saying there's no evidence that vaccines cause autism, there should be a debate where there's some sort of a monitored conversation Where you can have you versus someone else and break this down.
00:25:39.000Yeah, but that's a two-edged sword, too, because then it gives some false legitimacy to the anti-vaccine side.
00:25:47.000It's like debating does smoking cause cancer?
00:25:49.000Yeah, but isn't there already a problem?
00:25:51.000I mean, it seems like if there's this many...
00:25:54.000If you do a Google search and you're just overwhelmed with anti-value, it seems like the fight has already been lost, if that's the case.
00:26:03.000It's not necessarily giving them legitimacy.
00:26:05.000It's giving them, you rather, a forum to dismiss their legitimacy.
00:26:10.000Yeah, I mean, I think, you know, part of what has to be done is, I mean, and this gets into all sorts of First Amendment issues, and I'm not a lawyer, but, you know, the idea that Amazon now is putting out all of these phony books and phony documentaries.
00:26:26.000Well, they're just a distributor, right?
00:26:28.000I mean, they don't have to go over every book that they sell with a fine-toothed cone.
00:26:32.000I mean, not a fine-toothed cone, but maybe there should be some screening.
00:26:35.000Maybe Amazon, maybe Facebook should all be hiring chief scientific officers to...
00:26:40.000You know, putting some stops on the dissemination of information because it's harming children.
00:26:46.000I mean, the reason I get passionate about it, the reason I actually wrote the book is kind of interesting.
00:26:53.000It actually happened before all of these big measles outbreaks that we've been having.
00:26:58.000I noticed that in Texas, my laboratories at Texas Children's Hospital and Baylor College of Medicine, we noticed that there was a steep increase I think we're good to go.
00:28:53.000We've got 80,000 measles cases in 2018 in Europe, and now it's coming back to the US. And so my worry is this anti-vaccine media empire started out as a fringe group, but now it's really affecting public health, allowing a deadly disease like measles to come back.
00:29:10.000Do you think if there's some sort of definitive evidence that shows to the general public, like you could show it to them, like this is what causes autism, we've narrowed it down to these genes, and it has nothing to do with vaccines.
00:29:23.000If you give these vaccines to people without these genes, there is no way they're going to get autism.
00:29:27.000They get autism specifically because of these variations in their genes.
00:30:08.000We had some, you know, wherever, and this can get onto a whole other topic, wherever there's collapse, In health systems, infrastructure, such as from war, political instability, these diseases can come back.
00:30:20.000They can come back, and the people that are vulnerable are the children that are not immunized.
00:30:28.000It's a really confusing thing for people because on the outside, people always want to think that big pharma...
00:30:35.000I've said some terrible things about big pharma, and the reason being is painkillers.
00:30:40.000Because painkillers and antidepressants, and there's SSRIs, which are overprescribed, and the painkiller one kills me because I know people directly that have been addicted to these goddamn things, and the doctors are passing them out like candy.
00:31:27.000I get paid by the university and some of my salaries offset by grants from non-profit foundations.
00:31:38.000And then they say, I'm secretly making millions of dollars for our vaccines for Hook, Gorman, Schistosomiasis, and Chagas.
00:31:44.000What are you doing with all that money?
00:31:45.000Because my wife says, if only that were the case, right?
00:31:48.000These are diseases of the poorest of the poor.
00:31:50.000I'll never make a penny on these diseases.
00:31:52.000In fact, you know, one of the frustrations I have with the big pharmaceutical companies Is we've gotten, made a lot of progress with our vaccines.
00:32:00.000We've gone all the way from discovery through early phase process development and manufacturing and IND filing with the FDA, Investigational New Drug Applications, but we're getting kind of stuck at phase one, phase two clinical trials because we don't have the big pharma money to take us all the way to licensure.
00:32:16.000So I've had a lot of meetings with the big pharmaceutical companies to see if they can partner with us, and so far that hasn't happened.
00:32:23.000So has there ever been any discussion or any interest in creating some sort of a compelling documentary that's pro-vaccination that can counter all these things?
00:32:34.000Because there's quite a few health-related documentaries that I know are horseshit.
00:32:39.000Because I've talked to actual real scientists and clinical researchers that say, like, all these things they're saying are wrong, and this is why they're wrong, and you could show this if they're wrong.
00:32:49.000And then when someone says, hey, I saw this documentary, it says that all you should eat is toast, you could say, listen, man, you've got to go here and watch this, and it'll show you why that's nonsense.
00:32:59.000Is there anything like that right now, or is there any discussion?
00:33:03.000There are some discussions, but we're a long way off from that.
00:33:07.000And the problem is the anti-vaccine documentaries are being widely distributed, widely sold.
00:33:13.000And those people that are talking about it, here's the other problem.
00:33:16.000Whenever I talk to someone about, I've been doing this a lot lately, where I talk to someone about something they're passionate about, I go, what books have you read on it?
00:33:23.000And it's like, well, I saw this documentary.
00:33:33.000Books that are written by actual researchers, people that have spent decades in labs understanding what's going on, you don't really, you know, you don't get a lot of that from the people that are anti-anything.
00:33:47.000Well, that's why I wrote the new book.
00:33:49.000It's a very confusing thing for parents, because you're scared.
00:33:52.000You know, you have this little tiny baby that you love more than anything in this world, and then the doctors say, hey, we've got this round of vaccines coming, and you're just terrified that you're going to do something to your child that's going to turn your child into a Someone who's compromised.
00:34:05.000Yeah, and the point is, the problem is these diseases are back now, and so the urgency to vaccinate is now more than ever.
00:34:13.000I mean, remember, right now, look what's going on in Vancouver, Washington right now where the measles outbreak is underway.
00:34:19.000The ones who are at greatest risk are infants under the age of 12 months, not yet old enough to get their vaccine.
00:34:27.000So that if you're a parent right now living in Vancouver, Washington, you're terrified.
00:34:31.000You're terrified about taking your baby out to Walmart or the public library.
00:34:34.000Because they can't get that vaccine yet.
00:34:38.000So now the disease is coming back because the older kids are catching it.
00:34:41.000Yeah, and the anti-vaccine lobby uses terms like personal liberties and medical freedom.
00:34:47.000Well, we're the personal liberties of this parent now who's terrified to take his or her infant.
00:34:52.000When you say anti-vaccine lobby, now I know that Robert Kennedy Jr., he's a big one.
00:35:39.000I mean, you have to ask him, what's his motivation?
00:35:41.000Would he be a guy that you would want to have a debate with or have a discussion with?
00:35:44.000But again, I mean, I'm uncomfortable with the idea of a debate because it's like debating, I don't know, it's like debating a Holocaust denier, whether the Holocaust exists.
00:35:54.000I mean, not that this rises to the same level.
00:35:56.000I understand what you're saying, but if you're, again, I want to bring this up, if you're complaining there's 19 books ahead of yours that are anti-vaccine books, you've already lost the battle.
00:37:04.000Again, we need somebody who really wants to do a deep dive in this and kind of dissect out the pieces to understand.
00:37:12.000But it's impressive what you've got out there in terms of the hundreds of websites and the amplification on social media and everything else.
00:37:20.000Are there just one or two or three groups behind it, or is it a random collection of Right.
00:37:29.000Now, what do you think is causing autism?
00:37:33.000And in your personal estimation, do you think that there's a rise in the factors that are causing autism or do you think that it's a rise in the understanding of these variables that contribute to it that you could diagnose people with and that before they were previously undiagnosed?
00:37:53.000I think most of it is that, that we're just diagnosing it more, we're including individuals in the autism category that we didn't before.
00:38:00.000And by the way, the numbers are about to go up even more because we're getting better at diagnosing girls and women with autism.
00:39:16.000And he publishes about five or six chemicals in the environment, which if you're exposed to for long periods of time during early pregnancy, Your child will be born with some features that resemble autism.
00:39:55.000It's a common medication, but now that we know this information, we don't use it anymore.
00:39:59.000And so one of the things that I've been saying to people like Bobby Kennedy and everything else, if you really think there's some environmental link to autism, We've got a list of at least six chemicals during early exposure and pregnancy that are probably causing mutations and things like that that are leading to autism.
00:40:20.000I mean, so all the focus goes into vaccines and it kind of sucks all the oxygen out of the room so that, you know, really understanding the search for autism gets delayed or in some cases doesn't get pursued at all.
00:40:34.000Or the other thing that happens in many state legislatures and things like that, the focus is so much about vaccines that we don't talk about what autism parents really need.
00:41:16.000And I can completely understand why this would upset you, especially as a scientist.
00:41:20.000Now, when you're talking about these various chemicals that you think do contribute to or possibly cause autism, maybe we should really concentrate on that and publish something about this.
00:41:34.000Is there an article that people can go to that says something about this?
00:41:49.000You know, one of the problems that we face in this country is that we put a lot of scientific articles behind paywalls, which is a real source of frustration for me.
00:41:58.000Well, one of the things that I've done now is I'm one of the I founded an open access journal called the Public Library of Science Neglected Tropical Diseases so that anybody with a computer, you know, an internet connection and a printer can download the articles free of charge.
00:43:20.000Last year, there was not a perfect match between the virus and the vaccine, the killed virus and the vaccine, and the wild-type flu strain that was out there.
00:43:32.000But it was good enough to prevent you from dying, and it was good enough to likely prevent you from being hospitalized.
00:43:40.000So it would have an effect even if you did get the flu?
00:43:42.000That's right, because there was enough cross-protection so that it would mitigate the symptoms.
00:43:46.000That's confusing to people because if they have the flu, they say, oh, well, then it didn't work.
00:43:50.000That's right, but it did, because it prevented you from getting sick and dying.
00:43:54.000And again, that was a message that never really got out in 2018. Okay, well let's talk about someone like me, who's a healthy person.
00:44:01.000I've had the flu before, but I don't usually get a flu shot.
00:45:50.000Some people do get a vaccine and then they have an adverse reaction to it?
00:45:54.000Well, sometimes, you know, after getting your vaccine, you can get some soreness and you can feel maybe a slight fever for a few hours or a day, but usually you're fine.
00:47:18.000Rachel, my daughter with autism, that's like our thing is to go to the, it's called the burger joint, or to Shake Shack to get a cheeseburger.
00:52:10.000So, you know, when we think about, so I, you know, led this big campaign to raise awareness of something called neglected tropical diseases or NTDs.
00:52:21.000These are the most common afflictions of people living in poverty.
00:52:26.000I call them the most important disease you've never heard of.
00:52:28.000There are diseases like schistosomiasis and Chagas disease and Leishmaniasis.
00:52:34.000And I've been devoting my life to seeing if we could develop vaccines for those diseases in the nonprofit sector, because the big pharmaceutical companies just aren't going to take these on.
00:52:47.000So we're trying to do it in the nonprofit sector.
00:52:49.000But this book, the Blue Marble Health book, came out of some number crunching that I did using data from the World Health Organization or something called the Institute for Health Metrics and Evaluation, which is based in Seattle, Washington.
00:53:03.000I found something very surprising, and that is most of the world's poverty-related diseases are not necessarily in the poorest, most devastated countries of Africa, meaning like Democratic Republic of Congo or Central African Republic.
00:53:19.000They're there, but on a numbers basis, Most of these poverty-related diseases are actually in the G20 economies, the 20 wealthiest economies, together with Nigeria, which is not a G20 country but has an economy bigger than the bottom three or four.
00:53:36.000So that was pretty amazing for me to find that out because At first, I didn't believe the numbers because I said, well, how could it be if they're poverty-related diseases?
00:53:46.000Why are they in the 20 wealthiest economies?
00:53:49.000Then I realized that it's among the poor living in wealthy countries.
00:53:54.000So the poorest of the rich today now account for most of the world's poverty-related diseases.
00:54:13.000I mean clearly in some cases if you live in poor dilapidated housing without window screens, Things like mosquitoes and kissing bugs and sand flies can get inside the house.
00:54:24.000Or if you look in poor neighborhoods like in and around Houston, you see a lot of environmental degradation around the neighborhood.
00:54:33.000You see discarded tires that breed 80s gypti mosquito or standing water.
00:55:11.000You know, I moved into a house once in Encino, down the street from here, in fact, and no one had lived in the house for about a year and a half, two years, and the pool had not been taken care of, and I went out into the pool and it was green and there were schools of mosquito larvae.
00:56:12.000You get out of your car and they attack you like a horde of birds.
00:56:16.000That's because you only get one month of the year to do it.
00:56:19.000So they're super aggressive and they're also very large.
00:56:22.000The big problem is along the Gulf Coast of the U.S. We have that Aedes aegypti mosquito and that's why I got so worried about Zika virus hitting the Gulf Coast of the U.S. Yeah.
00:56:32.000Mosquitoes in other countries obviously contain malaria.
00:56:36.000I mean, we've been very fortunate that that's never made it over to here.
00:56:40.000Malaria used to be widespread in the United States.
00:56:44.000Both the one that was a real killer disease called falciparum malaria on the Gulf Coast and even up into Illinois in the Ohio River Valley we had a lot of malaria caused by VIVAX in the 1800s.
00:56:57.000In fact, there's a book Written by Dickens when he visited the United States called Martin Chuzzlewit when he describes all these sickly people in Illinois and Cairo, Illinois and the confluence of the Mississippi and the Ohio River.
00:57:18.000So there's actually a very nice book written by a medical historian at Duke University named Margaret Humphries called Malaria, Race and Poverty.
00:57:27.000And she has a hypothesis, but I think she's onto something, that malaria dropped in association with aggressive economic development.
00:57:39.000So that the FDR's New Deal included something called the Agricultural Adjustment Act that got people off with agrarian pursuits and put them into factories.
00:57:51.000Quality housing went up and that's probably what caused a lot of the reduction in these tropical diseases.
00:57:58.000Remember, they're really diseases of poverty.
00:58:00.000In fact, I spent a lot of time working in China and I'm seeing that play out right now in China.
00:58:06.000It's a very aggressive program of economic development, mostly in the eastern part of the country.
00:58:12.000But in the southwest part of the country, you go into Yunnan, Sichuan provinces, you go back in time 75 years and you still see those diseases.
00:58:20.000So do you think that the best cure or the best way to stop malaria would be just to increase the economy of these areas in Africa where they're experiencing it?
00:58:29.000Clearly, economic development is a very potent driver.
00:58:32.000Now, what it is about economic development, we still don't have our arms around that yet, but economic development is very important, just like for the neglected tropical diseases we studied.
00:58:41.000But, you know, unfortunately for many countries, economic development is still decades away, so that's the rationale for developing these vaccines.
00:58:50.000Is it because economic development moves people into more urban environments where there's less tropical diseases?
00:58:55.000I think that's part of it, although now we're seeing some tropical diseases thrive in urbanized environments like yellow fever and Zika and dengue as well.
00:59:09.000That outstrips the infrastructure in terms of water and sanitation.
00:59:13.000So this brings me to the thing that I wanted to talk to you about in the first place, because this is what you brought up to me when we were doing this sci-fi show, and you said something to me that has been haunting me ever since, that the vast majority of people that live in tropical climates have parasites.
01:00:17.000The point is almost every single person who is in extreme poverty has one of these what I call neglected tropical diseases.
01:00:26.000And one of the interesting features about them is they're very debilitating.
01:00:30.000So they not only occur in the setting of poverty, but I think they reinforce poverty because they make people too sick to go to work.
01:00:38.000We can show they shave IQ points off of kids when they have them.
01:00:42.000Well, this is the hookworm connection to the idea of the slack-jawed, dumb southerner in the United States of America.
01:00:50.000And now one of the things that we have found, so Rogelio Mejia on my faculty, working with an environmental activist named Katherine Coleman Flowers, In Alabama found that hookworm is still present in Alabama.
01:01:02.000Explain that to people so they understand what we're talking about because for the longest time there was this stereotype about people that live in the South that they were dull-minded and that this could be directly connected to hookworm infection which had run rampant.
01:01:19.000Right, there was even the term given, they called it the germ of laziness, that hookworm infection because it causes severe anemia.
01:01:27.000So if you're walking around with terrible anemia, of course, you're not feeling up to working a full day and all that sort of stuff.
01:01:35.000Hookworm was widely present in the southeastern United States at the turn of the 20th century.
01:01:40.000And then as malaria went on with economic development, so did hookworm infection as well.
01:01:46.000But we still have pockets in this country.
01:01:47.000And this wasn't understood at the time, right?
01:01:50.000They didn't know that these people were infected with hookworm?
01:02:27.000Because for the longest time, there was that stereotype.
01:02:30.000And then when you find out that it's directly connected to a massive infection of this disease, this worm.
01:02:36.000So these are the diseases that are holding back people who live in poverty.
01:02:40.000Originally, I thought only in places like The poorest countries in sub-Saharan Africa or Southeast Asia, but now I realize it's these pockets of poverty across the entire planet that people are affected by these diseases.
01:03:26.000And actually most of the studies suggest that it actually worked pretty well.
01:03:30.000The problem was there were a number of people who felt that the vaccine made them worse or they said they had chronic Lyme disease, that it wasn't effective.
01:03:39.000So it was really a market perception problem more than anything else and ultimately it hurt the bottom line of the company and they withdrew it from the market.
01:03:48.000A good friend of mine's dad got the vaccine and then got Lyme disease.
01:03:51.000They think he got Lyme disease from the vaccine.
01:04:02.000Impossible, because Lyme disease is caused by the Lyme bacteria, the spirochete, called Borrelia burgdorferi, and the vaccine is not a live vaccine.
01:04:11.000It's a recombinant protein-based vaccine, so it's not possible.
01:04:15.000So there's nothing in that vaccine that could have caused this adverse reaction that they directly attribute to that vaccine?
01:04:29.000I mean, that's the narrative of that household.
01:04:31.000Well, again, you know, it's reinforced by a lot of negative information out there on the internet.
01:04:35.000Yeah, but it's also reinforced by the fact they pulled the vaccine.
01:04:38.000Well, they pulled the vaccine not because it wasn't working but because of market perception and all that sort of – and that was a time before the number of cases of Lyme disease have really taken off.
01:04:49.000That seems strange to me because they didn't pull the measles, mumps, rembellia vaccine because of perception.
01:04:55.000Why would they pull the Lyme disease vaccine because of perception?
01:04:58.000I think the reason was because the cost-benefit equation works a little differently.
01:05:05.000With measles, measles is a killer disease.
01:05:08.000Lyme disease was not a killer disease.
01:05:10.000But goddammit, it's wrecking people now.
01:05:28.000And this gets into another controversial rabbit hole.
01:05:33.000I'm not sure we want to get into or not today.
01:05:34.000But the Infectious Disease Society of America, for instance, has come out with a strong statement saying that there's really no such thing as chronic Lyme disease.
01:05:44.000And the scientific evidence does not support something called chronic Lyme disease, yet there are lots of people suffering with chronic debilitating illness who claim that it's caused by Lyme disease.
01:05:56.000So this is something that is out there right now.
01:06:27.000Right, but they do have this chronic inflammation and pain in their joints and their body starts breaking down.
01:06:32.000They have something, but it doesn't seem to be.
01:06:35.000The Infectious Disease Society of America, which is one of the lead infectious disease bodies in our country, and I'm not an expert on Lyme disease, so I'm not too comfortable going there with you, are saying that there's no evidence that that's actually associated with active infection with Lyme disease.
01:07:01.000But isn't it bizarre that these same people got Lyme disease first and then had all these host of issues afterwards?
01:07:08.000Well, I guess part of the problem is in some cases they had Lyme disease first, in some cases they really didn't have Lyme disease.
01:07:14.000Unfortunately, there are a number of unscrupulous healthcare providers and even physicians out there that are making a misdiagnosis of Lyme disease or in some cases they're actually taking everyone who comes through the door and diagnosing them with Lyme disease.
01:07:33.000I'm sure you're aware of the Lone Star Tick and the allergy to red meat.
01:07:42.000Well, actually, all tick-borne diseases are on the rise now, possibly because of climate change, which is another factor in our country that's doing that.
01:07:50.000So we're seeing, you know, if you look now at what are the big drivers of infectious diseases right now, not only in the U.S., but globally.
01:08:01.000There are really some interesting forces, and a lot of them are social determinants.
01:08:08.000The other big one is political instability in war because it interrupts public health control measures.
01:08:14.000So, for instance, Venezuela, which was leading public health control in Latin America for decades, You know, with the collapse of the economy in the Chavez era now into the Madura area, we've got a terrible situation where we've had measles return in a big way,
01:08:35.000We've had all the neglected tropical diseases come back, as well as malaria, Chagas disease, Leishmaniasis.
01:08:43.000So it's really interesting how that is destabilizing the whole region because now Venezuela As one of the largest diasporas of people, as big as the diaspora coming out of Syria and Iraq.
01:08:54.000So now the diseases are moving into adjacent areas of Brazil and Colombia and Ecuador.
01:08:59.000And so it's really – and that's another big driver is political instability.
01:09:03.000The third one we think is climate change may be very important.
01:09:08.000So why did we see this big surge of chikungunya virus infection in the Western Hemisphere or Zika?
01:09:16.000We don't really understand the forces of that.
01:09:18.000And what's going on in southern Europe right now is quite concerning.
01:09:21.000We've had malaria return to Greece after it's been gone for 70 years.
01:10:03.000There's a malaria vaccine, it's called Mosquerix, that's the trade name that was developed, supported with a lot of funding from the Bill and Melinda Gates Foundation and working in partnership with GlaxoSmithKline.
01:10:19.000And that malaria vaccine now has been approved for use in children by the European Medicine Agency.
01:10:26.000And it's being introduced now in three countries in Africa, Malawi, Ghana, and I forgot the third one.
01:10:48.000And so when you say children, how old are the children that they're vaccinating with this?
01:10:53.000Well, the problem that you get into with malaria is that before six months of age, you have maternal antibodies.
01:11:01.000Remember, you're born with antibodies from your mother and they'll start to wane by six months of age.
01:11:06.000So the ones who get hospitalized with what's called cerebral malaria, which is a devastating condition, or severe malaria anemia, which is also a killer, are those children between six months of age and five years of age.
01:11:22.000So those are the ones that we want to protect.
01:11:25.000And it's one of the leading killers of children globally, right?
01:11:52.000It's not really immunity, but it's a natural protection.
01:11:55.000So individuals who have the sickle cell trait seem to be partially resistant to malaria.
01:12:03.000And that's the thinking why the gene for sickle cell has been preserved in Africa Yeah, we were actually discussing it because a friend that I grew up with died from it.
01:12:21.000So it seems to only exist in African Americans or Africans.
01:12:50.000It's a real big problem among people with HIV-AIDS, for instance, because it reactivates your toxoplasmosis and I even see it in kids sometimes.
01:13:02.000Well, what happens is in some countries up to 30% of people are actually infected with toxoplasma.
01:13:11.000And the parasite has the ability to undergo a dormancy state in the body until your immune system gets compromised either because of AIDS or because if you get some kind of medicine that suppresses your immune system and then it can reactivate it and cause what's called cerebral toxoplasmosis,
01:13:30.000So most people handle their toxoplasmosis very well.
01:13:34.000You know, you die with it and don't even know you have it, but in some cases it gets reactivated.
01:13:40.000Right now, there doesn't seem to be a lot of incentive for developing a toxoplasmosis vaccine, although I'd be very interested to work on something like that.
01:14:14.000Well, there's a good chance you are infected, but as long as your immune system is intact, then you're okay.
01:14:19.000Now there is a related disease from cats called Toxicoriasis and that's a parasitic worm infection we're finding in the United States among the poor.
01:14:29.000So what happens is if you go into poor neighborhoods, you see a lot of feral cats and dogs in poor neighborhoods, almost 100% of them have this worm in their intestines and they're seeding the environment with eggs in their feces and the feces are spread.
01:14:44.000All over the poor neighborhoods, kids come into contact with them, and the worm has the ability to migrate through the brain across cerebral toxicoriasis.
01:14:53.000And I think it's an important cause of developmental delays.
01:14:56.000It's one of those neglected diseases in the U.S. I talk about in the book.
01:15:01.000And there's no vaccine for that either?
01:15:42.000And it's been linked now to developmental delays.
01:15:45.000So, you know, everybody wants to know why, you know, kids living in poverty have developmental delays and people just assume it's because they live in deprived environments and that sort of thing.
01:15:55.000But I think Toxicoriasis is an important underlying reason for it.
01:15:59.000And this is an example of a neglected disease.
01:16:02.000You know, we, I mean, everybody's heard of Ebola, right?
01:16:05.000And everyone's worried about Ebola and the truth is Ebola is never going to come to the United States.
01:16:38.000But it's very hard to get people to care about diseases of poverty.
01:16:42.000And this is one of the striking things about when I wrote the book, was I've had a lot of success getting people to care about neglected tropical diseases in Africa and worked with the U.S. Agency for International Development, To support a package of medicines that's now being administered to over a billion people annually.
01:17:02.000And that, you know, is one of my proudest accomplishments is helping to raise awareness about neglected tropical diseases like we've been talking about, hookworm and schistosomiasis in Africa, Asia, Latin America.
01:17:12.000But the minute I talk about poverty-related diseases in the U.S., The lights go out.
01:18:14.000What we're seeing is a general rise in all economies.
01:18:20.000Some African countries have 8% or 9% economic growth, but it's all leaving behind a bottom segment of society.
01:18:26.000And so I don't care where you show me poverty, whether it's in Texas or Alabama or Nigeria or Bangladesh, I will show you these poverty-related diseases.
01:18:36.000And, you know, I know – what's her name?
01:18:40.000AOC, the congresswoman from New York, has talked a little bit about hookworm in Alabama.
01:18:45.000So last time I was in Washington, I dropped off a copy of the book in her office, but no response yet.
01:19:11.000One, we need to actually look for these diseases because the problem is the diseases that cause are very subtle, like developmental delays.
01:19:19.000So that if you're a kid who lives in poverty with developmental delays, the pediatrician doesn't even think to do a test for toxicoriasis.
01:19:30.000We need to go into poor communities across the country and actually take a blood test and actually measure for the presence of that disease or that parasite.
01:19:40.000Once you find that disease, what would you do then?
01:20:02.000is really trying to understand how these diseases are transmitted.
01:20:07.000What is it about poor neighborhoods that is facilitating transmission?
01:20:11.000I think the third problem is the diagnostic tests themselves because they're very complicated tests.
01:20:17.000Sometimes they're done at the Centers for Disease Control and Prevention, our lab, our National School of Tropical Medicine does a few of them.
01:20:25.000But it's not like when you go for blood work in your doctor and you get a little lab slip from Quest Diagnostics with the blood chemistries, the blood counts.
01:20:34.000There's no box there for toxicoriasis and chagas.
01:20:38.000So we need more improved tests, point of care diagnostic tests.
01:20:43.000Not just improved tests, but just letting people know it's something.
01:20:46.000Yeah, and so they don't have to send it off to the CDC or to our National School of Tropical Medicine.
01:21:41.000Members of our faculty were actually able to track down individuals who had donated blood And the Gulf Coast Regional Blood Authority actually found people positive for Chagas disease.
01:21:56.000They were told to go see their primary health care provider.
01:22:00.000And unfortunately, the primary health care provider is not educated about these diseases, and they just assume it must be a false positive.
01:22:06.000So, you know, our faculty had tracked them down and were able to get them into treatment.
01:22:10.000And what is the treatment for Chagas disease?
01:22:12.000It's an antiparasitic agent called benzidazole.
01:23:23.000There's been no effort whatsoever by the federal government to step in and try to rehabilitate, like a large-scale approach to rehabilitating places like the ghettos of Houston or Baltimore or Detroit.
01:23:38.000You know, I thought I knew what poverty – before I moved to Texas in 2011, I was chair of microbiology at George Washington University.
01:23:46.000And I thought I knew what poverty looked like.
01:23:48.000I moved down to the Gulf Coast, and it's a different animal.
01:23:51.000I mean, the depth and breadth of poverty in the Gulf Coast and the southern part of the United States is just extraordinary.
01:23:58.000And it's been very hard to get people to want to really take it on and really address these poverty-related diseases.
01:24:36.000It was written by a fantastic social activist named Michael Harrington.
01:24:44.000I think someone told me he's a very devout Catholic actually.
01:24:47.000And he wrote this book called The Other America.
01:24:50.000It talks about the hidden poverty off the road.
01:24:53.000And the actual number of people who live in extreme poverty hasn't changed since that book was written in the early 60s.
01:24:59.000That book was what helped first Kennedy then Lyndon Johnson Yeah,
01:25:17.000that is a very strange thing, our acceptance of these communities.
01:25:23.000I mean, I've always said that if you want to make America a better place, The best thing to do is not invade other countries or intervene.
01:25:33.000The best thing to do is try to rebuild these impoverished communities.
01:25:38.000Yeah, well, Gandhi once said, a civilization is judged by the treatment of its minorities.
01:25:44.000And by that criteria, we're not doing so well.
01:25:48.000You know, our country was visited by the United Nations Special Rapporteur on Poverty in 2017. And his numbers came up with, we have 19.4 million Americans who live in what's called extreme poverty.
01:26:02.000That is at half the U.S. poverty line.
01:26:04.000And roughly around 5 million Americans living on less than $2 a day.
01:26:08.000The same benchmark you'd use for global poverty.
01:26:27.000The University of Michigan Center on Poverty has also shown that we have, I forget the number, 2.7 million families living on less than $2 a day, which is probably about the same as the 5 million number.
01:26:59.000And sometimes in my frustration, I say, you know, these are imaginary diseases, and yet here we've got widespread diseases of the poor in the U.S., and the lights go out.
01:27:09.000You remember when that woman came back from Africa, and she was a nurse, and she had been in some connection, contacted with Ebola?
01:27:19.000She didn't have it, and they wanted to quarantine her?
01:27:21.000Oh, yeah, and they stuck her out in some...
01:27:36.000Well, actually, Ebola, you know, it turns out is the opposite of measles.
01:27:39.000Measles is one of the most contagious diseases known.
01:27:41.000It has a reproductive number of 12 to 18. What that means, if a single individual gets measles, 12 to 18 others get it because the virus hangs around in the environment and it's so easily transmissible.
01:27:54.000Hangs around like if you touch this table.
01:28:17.000Ebola is a reproductive number of two or three.
01:28:20.000So unless you're taking care of a dead or dying Ebola patient or someone who's recently died because it's only towards the end stage of the disease that you really get large numbers of virus particles in the body, you're not going to get Ebola.
01:28:33.000So the reason it's being so hard right now to contain the Democratic Republic of Congo Yeah,
01:29:14.000Well, one of the things I say in the book is because these diseases are so widespread among the poor in the G20 countries, if we could get The elected or the leaders of those G20 countries together at a G20 summit and say, we're really going to do something about the neglected diseases in our own borders,
01:29:31.000and I'll include the United States, we could get rid of two-thirds of the world's poverty-related neglected diseases right off the bat.
01:29:38.000So a lot of it is political will, ignorance or lack of awareness and political will.
01:29:46.000Well, it seems like in this country, ignorance is a big part of it because this is something I've thought about many times, but I didn't know about chaga.
01:29:53.000I didn't know about a lot of these other diseases you're describing.
01:29:56.000Yeah, no, I mean, so we need to raise awareness about these.
01:30:00.000That's why I'm so thrilled to come here because I've just amplified the number of people who've heard of this concept of blue marble health, which is a name that I've given a different name from global health to separate it from the two.
01:30:14.000So, you know, coming on here is so powerful in terms of amplifying that message.
01:30:20.000So again, back to the magic wand, what could be done?
01:30:24.000I mean, is it a funding issue or is it at first, before that, an education issue?
01:30:29.000Well, I think there's multiple issues.
01:30:32.000So, I mean, again, the drivers we've been talking today about promoting these diseases, really tough to do anything about extreme poverty, war and conflict, climate change.
01:30:45.000Climate change, clearly there are some things we can do.
01:31:13.000But it's not nearly as good as having access to getting the pharmaceutical companies involved as well.
01:31:20.000It also seems like this would cost an insane amount of money to just go through all these poor communities, test everyone and start distributing these drugs and what would pay for all that stuff.
01:31:33.000Well, you know, some people have asked me, well, would the Affordable Care Act take care of this?
01:31:37.000And I said, well, we're two steps away from the Affordable Care Act.
01:31:40.000We're two degrees of separation away from the Affordable Care Act because we're not even recognizing these diseases.
01:31:49.000Yeah, you've got to know about it first.
01:31:51.000I mean, what percentage of the population even knows about all these parasite-created diseases?
01:32:00.000Or know that vaccines don't cause autism.
01:32:03.000Yeah, well, that's the biggest one, right?
01:32:17.000Part of the problem, we're in this boat with a bunch of people who are scientifically illiterate, like myself, who are discussing these issues who don't really know what they're talking about.
01:32:26.000I saw someone talking about tetanus Because some boy had tetanus and he was in the hospital for a long time and his hospital bill was like a million dollars.
01:33:39.000Well, the other name is lockjaw, where your muscles go into spasm, including the muscles involved in breathing, so you can't even breathe as a result of it.
01:34:06.000And I think one of the things that the anti-vaccine group or lobby, as I call it, does is they try to be very dismissive of these diseases.
01:34:14.000They try to deliberately downplay the effects.
01:34:46.000Becoming popular is because we do kind of helicopter parent our kids a little bit too much.
01:34:52.000They should come in contact with a bunch of different things because it does build their immune system, correct?
01:34:56.000Well, that's an interesting hypothesis called the hygiene hypothesis.
01:35:00.000It says, you know, if your kids are living in too sterile an environment, then this can also result in autoimmune diseases and things like that.
01:35:12.000And I have mixed feelings about the hypothesis.
01:35:14.000To me, it's not airtight by any means.
01:35:17.000You're tight, but there's some sort of a correlation, particularly between peanut allergies and keeping peanuts away from children.
01:35:23.000And there was a study, Jonathan Haidt's work, in one of his books, talked about how there was a study done in communities where they didn't protect kids from peanut allergies and the much smaller percentage of people developing peanut allergies versus kids that they did.
01:35:41.000Well, this is also one of the things that the anti-vaccine lobby is doing now, that they're When I write a book like this, Vaccines Don't Cause Autism, now what you're seeing, remember I told you about that whack-a-mole business where they went from MMR to thimerosal to spacing vaccines too close together to aluminum.
01:35:59.000Now there's some groups that are moving away from autism altogether, and now they're saying, well, vaccines cause autoimmune disease or vaccines cause other neurologic deficits.
01:36:24.000So, you know, it was, for instance, if you look over a 10-year period, I think it is between, I haven't looked at the numbers in a while, I think it's between 2008 and 2014 and 2015. Over that period of time,
01:36:39.000there were 2.5 billion doses of vaccine given, 2.5 billion, of which the vaccine courts identified around 200 that were a list of serious injuries that they have a table of that they could attribute to vaccines.
01:36:58.000So there were 2,000 payouts, and of those 2,080%, they didn't really think were attributed to vaccines, but they paid it out anyway because that's how the courts work, and then 200 where they could really say, yeah, it looks like this could be related to vaccines.
01:37:13.000So you divide 200 by 2.5 billion, that's 1 in 10 million.
01:37:22.000And these cases, what was happening to these people other than the shoulder injury that you were talking about?
01:37:27.000Yeah, there's a list, and I talk about it in the book.
01:37:30.000There's actually a table you can download on the web for each vaccine, a list of potential injuries that they allow.
01:37:37.000And these potential injuries, is it, as we were talking about earlier, is this just biological variability that some people just react differently to different things?
01:37:47.000In other cases, you know, with the live virus vaccines, If you have a severe genetic immune deficiency and maybe it wasn't picked up, then there's that risk.
01:38:00.000But, you know, what's a one in a million?
01:38:04.000As I said, we have to keep that in perspective because the odds of getting hit by lightning is one in a 700,000, if you believe that number.
01:38:10.000Or, you know, what's the risk every time you – Take your child out in a car and drive around the neighborhood.
01:38:16.000I'm sure the risk is far higher than one in a million.
01:38:19.000And the real danger is these actual infectious diseases spreading and the damage they could do, damage things like tetanus.
01:39:08.000But, you know, people accounted for that and said, well, part of the problem is people don't trust their government.
01:39:12.000And I said, well, that's true of some.
01:39:13.000But I think most people, you know, if we had a more visible public health force out there, people would listen to it.
01:39:22.000Well, I think that what you're talking about in terms of these poor neighborhoods and these parasites getting into people's system and affecting cognitive development.
01:40:34.000There's some of the viruses transmitted by mosquitoes.
01:40:38.000One of the ones we don't talk about a lot, which is a very serious infection, Is West Nile virus infection.
01:40:44.000That's got very high rates of not only encephalitis, but also one of our faculty members, Christy Murray, is showing very high rates of depression and other neurologic debilitation for, and that's another one.
01:40:57.000We could probably use a vaccine for, but there isn't the market incentive to do it.
01:42:12.000Well, so in response to that, what happened was after the Ebola fiasco in 2014, where we didn't have an Ebola vaccine in Guinea, Liberia, and Sierra Leone, A group of individuals came together at Davos, the World Economic Forum, including the Gates Foundation.
01:42:31.000They developed this concept of an organization called CEPI, the Coalition for Epidemic Preparedness Innovation, to incentivize biotechs and pharmaceutical companies to embark on diseases of pandemic potential.
01:42:49.000Like Ebola, like Lassa fever, like Mayor's coronavirus infection.
01:42:54.000And that was great, but the problem was they didn't address these poverty-related diseases.
01:42:58.000So those of us who are working on poverty-related diseases are still kind of on the outside looking in.
01:43:04.000It just seems like Having everything managed by private companies that need to have some sort of financial incentive to attack these diseases, that seems like a crazy way to deal with health crisis.
01:43:20.000And so what I've recommended, as I said, that organization, CEPI, is great for what it's doing, but we need another mechanism.
01:43:27.000What I've proposed is that since these diseases are so common among the poor in the G20 countries, These are the 20 largest economies to put together public sector funds for that purpose.
01:43:41.000Aaron Powell Public sector funds for investing in developing vaccines and treatments?
01:43:45.000For poverty-related diseases, these chronic debilitating diseases.
01:43:49.000In fact, we can show that working with health economists, we actually work with a terrific health economist whose name is Bruce Lee of all names.
01:44:03.000He's been able to show that our vaccines are not only cost-effective, they're cost savings, meaning that they're economically dominant, that they'll actually save money.
01:44:15.000The problem is it doesn't help you with the fact that you still need some, but the return is on public health.
01:44:20.000You still need somebody to come along and provide that investment.
01:44:24.000So what's happened is our technical ability to develop vaccines has outstripped our financial instruments that we have to do it.
01:44:35.000So I get a stream of young people In my office, wanting to go into global health, I mean, the commitment for this next generation, I know they get a lot of bad press, but my impression is this next generation, their commitment to public service is at an all-time high.
01:44:49.000And they say, you know, Dr. Hotez, I'm all in.
01:44:53.000And they're a little bit disappointed when I tell them, get an MBA. Or get a law degree because where we need the innovation now is in the finance sector.
01:45:04.000There must be a business model out there that would work, that would figure out how to do this.
01:45:10.000I just don't have the background to do it.
01:45:12.000It seems like once the momentum is in the corner of this being handled by the private sector, And that the private sector has to develop these vaccines and these treatments, and they have to do it with some sort of a financial incentive.
01:45:25.000If they don't have a bucket of gold at the end of the rainbow, they're not going to take a ride.
01:45:44.000Right now that we're in clinical trials, I don't know what the roadmap is to get to licensure and getting these vaccines out to the public.
01:45:51.000The terrifying thing, the thing that keeps me up at night, is there's no roadmap.
01:45:57.000How much does it cost to get a vaccine, in general, from developmental period to actual application?
01:46:06.000Well, the pharmaceutical companies have traditionally said billions, but I don't think that's the case.
01:46:12.000I think one of the reasons they're doing that is because they're also recovering their R&D costs.
01:46:21.000They're putting money into R&D that they charge in order to either make a profit or at least stay even.
01:46:32.000The cervical cancer vaccine, the HPV vaccine, that when I last looked was $420 for the three doses.
01:46:39.000It doesn't cost $420 to make that vaccine.
01:46:45.000It's just that they're recovering their R&D costs, which is fair enough.
01:46:50.000So one of the things that we're proposing to do for our neglected disease vaccines is we'll delink the R&D costs.
01:46:57.000In other words, if we've gotten Grants, whether it's from the Gates Foundation in the past or the NIH or the European Union or the Dutch government or the Carlos Slim Foundation, we're not going to pass those costs on.
01:47:10.000We'll just, you know, that was used for R&D and we would just cause for the cost of goods.
01:47:14.000So at least we can get it down to just a couple of dollars a dose, a few dollars a dose.
01:47:19.000Now, for anybody that's listening to this conversation and they have additional questions, where's the best place that you should guide them?
01:47:32.000I mean, somebody with a university education.
01:47:36.000I mean, they're not, you know, they're published by Johns Hopkins University Press, and they are kind of, they're uneven in terms of how weighty they get into the science, but certainly the vaccines do not cause racials autism.
01:47:52.000I wrote it with the idea of parents, vaccine-hesitant parents, and also the pediatricians.
01:47:56.000Because the other problem with pediatricians is, you know, they're there in their office and parents are reading this stuff on the internet.
01:48:03.000And they come and loaded for bear into the pediatrician's office with all these factoids.
01:48:08.000And the pediatrician's like, well, gee, I never heard that before.
01:48:11.000And then the pediatrician is made to feel stupid, like he's not keeping up with the science.
01:48:16.000But it's just they're not keeping up with the misinformation.
01:48:19.000So I provide talking points in the epilogue of the book.
01:48:22.000And Blue Marble Health is the best resource for people to understand these… About diseases of the poor in wealthy countries.
01:48:30.000Then I have a third book that I wrote a few years ago called Forgotten People, Forgotten Diseases that describes the neglected tropical diseases.
01:48:37.000Well, I really hope that what comes out of this is someone gets motivated to create some sort of a documentary really on both subjects.
01:48:45.000I mean, I think that we'd greatly benefit from some clarity for people that do have concern about autism that's in a digestible form.
01:48:54.000For good or for bad, people like to watch documentaries.
01:48:58.000And I hope you don't get too beat up over this because I know the anti-vaccine groups are very passionate and Well, I mean, I don't have a position.
01:49:07.000I mean, I don't know why they would beat me up.
01:49:29.000So you get beat up no matter what if you're talking.
01:49:32.000But I really think it would do a good service if somebody did put together a documentary because I think most people are just relying on this fear that vaccines do cause autism.
01:49:47.000There's also this connection between people that are older, correct?
01:49:50.000When they're older and they have children, there seems to be more likely...
01:50:10.000I mean, what you've been saying today about these diseases and how many of them exist and how many of them are almost unknown, untreated, undiagnosed, and just how many people are unaware.
01:50:23.000I really hope that someone does something about that too.
01:50:25.000But in the meantime, people can buy your books.