The Peter Attia Drive - #159 - Peter Hotez, M.D., Ph.D.： Evolution of the anti-vaccine movement, the causes of autism, and COVID-19 vaccine state of affairs

00:00:00.000 Hey, everyone. Welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

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00:00:41.720 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay,

00:00:47.740 here's today's episode. My guest this week is Dr. Peter Hotez. This may be a familiar name to a lot

00:00:54.640 of you because this will be Peter's third time as a guest on this podcast. And I wanted to have him

00:00:58.380 back for two almost unrelated reasons. The first is I wanted to do a follow-up to the discussion

00:01:03.280 last week with Brian Deer, because in that discussion, we focused very heavily on one

00:01:08.760 particular claim around vaccine and autism, namely the NMR vaccine. But I wanted to have a kind of

00:01:14.540 broader discussion around the evolution of that theme. And we get into that in great detail. We

00:01:19.240 explore the controversy around thimerosal and other additives, along with the timing of vaccines

00:01:25.500 and specific vaccines like the HPV vaccine and the concerns surrounding infertility and miscarriages.

00:01:33.880 We then talk about his own personal journey as an autism parent. His daughter, Rachel, who's 28 years

00:01:39.980 old now, has autism and how that, if at all, changed his thinking. And we talk a little bit about the

00:01:47.260 diagnosis of autism and how complicated that is. And also what could account for the seeming increase

00:01:54.480 in the prevalence and even the incidence of autism. We talk about the genetics of autism and we talk

00:02:01.220 about the likely timeline of development and how this may or may not support the notion that there

00:02:07.660 are environmental triggers at play with respect to autism, be it vaccines or otherwise. Finally,

00:02:12.560 we talk about the state of affairs with respect to COVID vaccination, doing a little bit of a deep

00:02:17.140 dive into some of the nerdy details around what we know four months out with respect to the existing

00:02:25.040 vaccines in the United States and abroad, including some concerns over the AstraZeneca vaccine and what

00:02:31.880 it can tell us about the emerging strains that are of some concern, particularly in South Africa and

00:02:39.680 Brazil. So there's a lot packed into this. And if you have the ability to watch it on video,

00:02:43.600 please do so on our YouTube channel. At one point, Peter shares some very interesting graphics explaining

00:02:49.380 the mutations of the coronavirus that I found very helpful. And I think you will as well. So without further

00:02:53.460 delay, please enjoy my conversation with Dr. Peter Hotez.

00:03:01.900 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

00:03:07.360 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.

00:03:12.100 I want to really talk about a bunch of things today, but I want to start our discussion with a broader

00:03:16.860 topic than just coronavirus or SARS-CoV-2, COVID, things like that, which I know is a topic you are

00:03:22.760 still front lines on. And I don't think a day goes by that you're not being sought after for your

00:03:28.840 opinion on things. And we will certainly get to many of those things later today. But again, I want to

00:03:32.900 start with a topic that was near and dear to your heart long before the coronavirus emerged in this

00:03:38.340 fashion, which is the topic of vaccines and vaccine safety. Now, recently I had Brian Deer on the

00:03:43.700 podcast. And I think for many people, it was an illuminating discussion because Brian himself is

00:03:50.680 not particularly a vaccine advocate. He's very clear about that. He's just an advocate for good science.

00:03:55.900 I think his work uncovering the web of lies and deceit surrounding the work of Andrew Wakefield

00:04:04.480 is really unparalleled, especially when one considers the depths to which it was scrutinized,

00:04:10.280 both scientifically and even in the court of law. The first thing I really want to understand,

00:04:15.800 Peter, is why is it that after the complete debunking of everything that Andrew Wakefield

00:04:23.720 did, said, published, et cetera, why is this still an issue? Why is it that in a post-Andrew

00:04:31.560 Wakefield world? Most polls would suggest somewhere on the neighborhood, correct me if I'm wrong,

00:04:36.980 20% of Americans still believe there's a relationship between vaccines and autism.

00:04:43.100 What's happened? And it's actually a very profound question. And I agree, Brian's work was

00:04:47.760 extremely important. And then the scientific community came in in a big way, debunking all of

00:04:55.380 the assertions. And one of the things about the anti-vaccine lobby that it spawned or that it

00:05:01.860 ignited, at least in the modern sense, is that from then on, they kept on moving the goalposts. So it

00:05:08.620 began in its modern form in 1998 with the Wakefield paper asserting that measles, mumps, rubella vaccine

00:05:15.560 causes autism by the live virus vaccine replicating in the colon. The scientific community

00:05:21.380 response in a very vigorous, robust way, publishing multiple papers, large cohort studies showing that

00:05:29.120 kids who were autistic, and I got involved in it because I have a daughter with autism, and kids

00:05:34.500 who are autistic are no more likely to have gotten the MMR vaccine than kids who are not. And similarly,

00:05:40.260 kids who get the MMR vaccines are no more likely to become autistic than kids who don't. And really

00:05:47.200 sound epidemiologic studies, but then they switched. They flipped. They said, okay, well, it's not really

00:05:53.760 MMR vaccine. They had Robert F. Kennedy and a group of people saying it's the thimerosal preservative

00:05:59.380 in vaccine. And then it switched again to spacing vaccines too close together. Then it switched again

00:06:06.220 to alum and vaccines. And now what you're starting to see is even shifting away a bit from autism,

00:06:12.520 saying that vaccines cause something called chronic illness or looking at the HPV vaccine for cervical

00:06:18.500 cancer and other cancers, and then saying it causes infertility or miscarriages. And each time the

00:06:26.160 scientific community responds. And what they do is to maintain momentum, to re-energize, they keep on

00:06:33.000 shifting. And the concern for me now is they're not even looking at this from a pseudoscience point of

00:06:41.320 view. What they're now focusing on is the politicization of it. We'll talk more about it,

00:06:45.920 but starting around 2014, 2015, they managed to glom onto the Republican Tea Party and to make it a

00:06:53.340 politicized movement around these concepts of health freedom and medical freedom. And that's what we're

00:06:59.000 dealing with today now. And that's why you've got all the craziness on Fox News the last four or five

00:07:05.380 nights with Tucker Carlson going on this rant against vaccines and Laura Ingram going on this rant against

00:07:10.740 me and Tony Fauci. And this is a problem in that they have this adaptability. They create these

00:07:18.160 versions 1.0, 2.0, 3.0 of the anti-vaccine movement, but the autism piece never entirely left.

00:07:25.540 That's still its legacy fake assertion that still haunts us today.

00:07:30.080 Given how deep Brian went into the discussion specifically of MMR and autism, that relationship,

00:07:38.200 I don't think anything else needs to be said on that topic. And obviously for anybody who's

00:07:41.700 listening to this that still has questions around that, I would highly recommend that they go back

00:07:47.120 and watch that video, listen to that podcast, read the book. And truthfully, and I don't say this to

00:07:52.620 be, I don't know how to say this delicately, but I think if after assimilating all of that work,

00:07:57.460 you still believe that there's a relationship between that vaccine and autism, there's probably

00:08:01.980 nothing that can be said that can dissuade you from that. And I would just leave it at that.

00:08:05.940 Agree to disagree. But let's focus on some of the other things that you've brought up.

00:08:10.860 Do you have a preference for where you'd like to begin? Would you like to start with thimerosal?

00:08:14.440 Yeah, I mean, you can, but it always comes down to the same few things. I mean, what happens

00:08:19.280 in the case of Brian Deere and the MMR, in addition to the scientific community refuting it on the basis

00:08:25.500 of large cohort studies and prospective studies, what he was able to do was show nefarious intent,

00:08:32.060 which was extremely helpful because knowing that what's happened since then is the anti-vaccine

00:08:39.280 movement has grown so much larger than Wakefield. Now you've got dedicated anti-vaccine groups,

00:08:46.020 national anti-vaccine groups, Children's Health Defense, and ICANN, and those kinds of things. But

00:08:51.280 then you also have local political action committees, PACs, that are linked to far-right-wing

00:08:58.260 extremism. So it's become this very complicated ecosystem or web, and now it's even gone beyond

00:09:05.240 the United States. So yeah, I mean, we could go into why thimerosal is not linked to autism. And

00:09:12.540 then we could go into why spacing vaccines is not related to autism or what autism is and how it begins

00:09:17.520 in early fetal brain development. But it won't stop the momentum of the anti-vaccine movement because

00:09:23.120 they light a fire, they cause damage, and then they move on. And that's their modus operandi.

00:09:29.500 I don't disagree with that, Peter. I guess the way I think about the role I'd like us to play in

00:09:34.040 this discussion is I don't think we're here to stop the anti-vaccine movement. What I'd like to do is

00:09:39.580 help parents who frankly are inundated with information and can't distinguish between signal

00:09:46.320 and noise at least come to a place where we can have an honest discussion about it. Because I really

00:09:52.440 do want to have that discussion. And I think the order in which you actually just went through them

00:09:57.280 is a very elegant way to talk about this. Let's spend a few minutes on thimerosal. Let's spend a

00:10:02.320 few minutes on some of these other claims. And then let's actually talk about autism. Because there is

00:10:07.080 no denying the fact that the incidence and prevalence of autism are increasing. We should talk about what

00:10:13.360 some of the plausible reasons for that are and why the scientific community has been able to rule

00:10:19.140 out these claims that are being put forth. I have great empathy for the parent who's listening to

00:10:25.480 this who is confused. And that doesn't necessarily mean just the parents of children with autism, but

00:10:31.480 that's the parent who's trying to decide, what am I supposed to do here? Am I supposed to get my kid

00:10:36.100 vaccinated? And am I supposed to get them vaccinated at this pace? And does my kid really need

00:10:41.320 three HB vaccines in the span of six months? I think just having an open, honest discussion about

00:10:46.640 that is by no means going to dissuade the 20% of people who are clearly in the camp that says

00:10:52.500 vaccines are evil. But I do believe that there's a very confused group of people in the middle. And

00:10:56.900 I hope we can talk about that. So is it safe to say that post-Wakefield, because I'm trying to go

00:11:02.040 back and remember the timeline. It was around 2007, 2008 that every claim of Wakefield had been pretty

00:11:08.220 much debunked. And to your point, it wasn't just debunked scientifically. It had been made clear

00:11:13.200 that he had lied and he had manipulated data as had O'Leary. And this was one big house of cards.

00:11:21.840 The Lancet paper was retracted, I think, in 2010. Although I think there was an expression of concern

00:11:28.640 put out by the Lancet a few years before the maybe 2004, I can't remember exactly. And the basis for the

00:11:35.080 retraction, they didn't really spell it out that much. They basically said the results are

00:11:40.020 no longer valid. I don't think the retraction letter issued by the Lancet went into all of the

00:11:46.700 investigation that the medical council had done for Wakefield to be struck off the register. I don't

00:11:53.140 think the retraction mentioned anything about the Brian Deer paper. Yeah, I think it was Deer's

00:11:58.500 reporting. And frankly, the most damning evidence was the lawsuits. It was the complete inability of

00:12:04.780 Wakefield to maintain any legal argument against the people who were accusing him of fraud. So let's

00:12:11.040 put that aside and let's move forward. Let's start by telling people what thimerosal is and what is it

00:12:15.760 doing in a vaccine? Well, first of all, thimerosal is really not in childhood vaccines anymore. So what

00:12:22.600 happens is if you have a multi-dose vial of vaccines, whereby you've got a vial of vaccine that could be

00:12:30.520 given to six or seven or 20 people, each time you're introducing a needle into that vial through

00:12:38.220 a rubber stopper, potentially you're introducing bacteria. And the worry is that if you do that

00:12:44.820 enough, that there could be some bacterial growth or overgrowth into the vial. So you need to put some

00:12:50.240 preservative in that's non-toxic that will kill the bacteria. And when thimerosal was discovered,

00:12:56.200 it was considered quite an advance in terms of allowing you to vaccinate large populations. And

00:13:02.100 the bottom line was it was taken out. The manufacturers took it out of the vials just

00:13:08.120 because of all the bad publicity swarming around it. There was never evidence to show that it was a

00:13:14.300 problem. But I think the thinking was, we don't really need it. We can give single-dose vials

00:13:19.800 instead. Let's just take it off the table. In fact, that was done. There's still some of the flu

00:13:25.540 vaccines still have thimerosal in the US. Not all of them. You can still get a single-dose vial

00:13:32.660 for flu vaccine and take that as well. But there was never, ever any shown association between

00:13:40.220 thimerosal and any untoward effect, certainly in terms of autism.

00:13:45.940 Thimerosal was one of the big pushes from Bobby Kennedy Jr., correct? Wasn't this really

00:13:51.340 his initial cause in his initial fight?

00:13:53.740 I think so. I think he got into it because he's an environmental law attorney,

00:14:00.780 looks at toxic waste. And I think when he saw the mercury word, he probably got a link to

00:14:08.700 Minamata disease, which is, remember, back in Japan several decades ago, there was a lot of mercury

00:14:16.940 exposure in fish. And young kids who were exposed to what's called methylmercury, I think it was during

00:14:23.400 pregnancy. And the kids that were born were born with intellectual deficits. And there was a syndrome

00:14:28.780 associated with it. It was called Minamata disease. And so I think probably people in his camp put two

00:14:36.820 and two together and they said, well, probably autism must be some form of Minamata disease, even though

00:14:43.380 it's not the same. Maybe there's enough there that it could be due to thimerosal. But again, the large

00:14:49.180 cohort studies showed absolutely no linkage with autism. And ultimately, we know why. It's because

00:14:55.700 we know autism is associated with prenatal events. That's how he got involved. And there were books

00:15:02.520 about it. There were a couple of books making these assertions. And then once again, it started gaining a

00:15:08.720 lot of momentum, very much like the way Wakefield did a decade before. And I think the first publication,

00:15:15.360 which I write about in my book, vaccines did not cause Rachel's autism.

00:15:20.260 And while you're looking for that, Peter, I'll just clarify for listeners, because you mentioned it

00:15:23.920 quickly, the difference between methylmercury, organic mercury, inorganic mercury, because you made the

00:15:28.980 point that thimerosal is an organic mercury. There's sort of a difference between organic and inorganic

00:15:34.380 mercury. And most of the toxicity that we see when people are over-consuming fish that are high on the

00:15:40.560 food chain, such as large tuna, swordfish, shark, is organic mercury. It is methylmercury, not inorganic

00:15:47.800 mercury.

00:15:48.940 Right. So Minamata disease, which was named after a city in Japan, it resulted from a chemical plants

00:15:57.120 industrial release of methylmercury, which is different from thimerosal, which is a totally different

00:16:02.060 compound. It's ethylmercury. And it was in wastewater and it accumulated in a bay where fish and shellfish

00:16:07.880 lived and were consumed as seafood. And large-scale methylmercury ingestions in pregnant mothers caused

00:16:14.240 a congenital syndrome, causing neurologic disease in the form of gait and motor disturbances, in some

00:16:19.900 cases, even a coma and death. So there was a paper that was published at that time in a journal called

00:16:27.920 Medical Hypotheses that first proposed that maybe autism could be related to thimerosal because even

00:16:37.600 though it's not methylmercury, maybe it's ethylmercury doing this. And that was in 2001 that the paper got

00:16:45.320 published for three years after the Wakefield assertion. And so this was a pretty common preservative,

00:16:52.100 but then it was subsequently taken out. And what was interesting is even after it was taken out,

00:16:58.300 the rates of autism never went down. That's pretty clear. And there were, again, large cohort studies

00:17:04.220 showing absolutely no link with thimerosal. All of that said, Peter, I certainly wouldn't want to

00:17:09.580 suggest that the paper in 2001 and even the work that followed was anything but reasonable. I mean,

00:17:16.440 that's the purpose of medicine, right? I mean, you see something like autism, you look for plausible

00:17:21.580 associations, and you see a neurologic disease that is associated with mercury. It's entirely

00:17:29.300 reasonable to formulate a hypothesis that says this other thing that looks kind of like it could be it.

00:17:35.460 And the paper was published in a journal called Medical Hypotheses.

00:17:38.920 Exactly. I mean, it's completely reasonable. It's the stuff that follows that's challenging.

00:17:43.720 It's after the scientific community goes to great lengths and great attempts to seek the truth and

00:17:52.520 publishes paper after paper after paper in mainstream scientific journals that the anti-vaccine groups

00:18:00.260 refuse to acknowledge its cling to their debunked hypotheses. And their only response is, well,

00:18:09.080 the scientists must be paid off by the pharma companies or the journals must be paid off by

00:18:14.100 the pharma companies or the editors must be paid off by the pharma companies. And so they resort to

00:18:21.060 conspiracies rather than, rather than, okay, I get it. Let's move on. Let's try to figure out what

00:18:26.980 really causes autism. And they've never shown that intellectual curiosity about what really does cause

00:18:35.020 autism. And they continually discount the massive amount of scientific work that's gone into really

00:18:42.700 uncovering what autism is. Before we get into kind of the deeper why, because that's a big part of what

00:18:49.660 I want to understand. And there's two deep whys here run around autism and one around latent distrust

00:18:56.580 and the path that there's a fork in the road, right? Where one person can be very influenced by

00:19:02.780 data. They can think probabilistically. They can think in terms of uncertainty. They can accept

00:19:08.720 and reason their way through these things. And then there's another person who's going to cling

00:19:13.420 to a belief in the presence of emerging data that refute that hypothesis. And they'll continue to come up

00:19:20.760 with an excuse. And I really want to try hard not to pass a moral judgment in either case,

00:19:24.780 but there's clearly an anti-science sentiment that is growing, that is fostering this.

00:19:30.980 Before we get to that, let's go to the next point, which is thimerosal, I believe,

00:19:36.140 was electively removed in about very early in the 2000s.

00:19:39.040 I think it was actually removed two years before the medical hypothesis paper. I think it was

00:19:45.620 removed in 1999, actually, or at least that process was started. It had already been underway.

00:19:53.900 What was the next position of the goalpost after thimerosal?

00:19:58.100 So then it was this concept of greening our vaccines or making them more, I don't know why

00:20:04.260 they used the word green, I guess, making them more eco-friendly. And that the third major hypothesis

00:20:10.740 was that kids were becoming autistic because of antigen overload. That somehow they were getting too

00:20:17.400 many vaccines at once. This was overwhelming the immune system. And somehow that led to autism,

00:20:24.880 which again, never made a lot of sense to me how they say it's leading to inflammation.

00:20:30.160 And I always would point out that we've seen what the brains of kids on the autism spectrum

00:20:35.760 looks like. I've seen my own daughter's CT and MRI scans in her workup of autism. And we know what

00:20:42.200 inflammation looks like. You can see inflammation or evidence of inflammation or at least blood on a CT

00:20:47.680 or MRI. And we know what herpes encephalitis looks like. And autism doesn't do that. It's not

00:20:53.640 an inflammatory state of the brain. And so that one never made any sense either. There were several

00:21:01.460 other people who came into this. People like the pediatrician, Dr. Bob Sear started writing books

00:21:06.980 about how we have to space vaccines further apart and had written a number of books about that as

00:21:13.860 well. But again, well, first it never had plausibility and that's still out there today.

00:21:19.620 And if you go on amazon.com and look at books on vaccinations, I think those books are still top

00:21:24.760 sellers. Now, in the case of thimerosal, at least there was a plausible explanation that was put forth

00:21:32.600 as a hypothesis. When the hypothesis for spacing was put forth, was there some epidemiologic data

00:21:38.820 that suggested this? I'm not aware of it. And the problem was, you know, we didn't have clinical trial

00:21:44.820 data to support the spacing of the vaccines. The current vaccine regimen, the schedule, is based on

00:21:52.760 years and years of studies confirming immunogenicity and protection. It's also based on years and years of

00:22:01.580 studies showing that there's no immunological interference. In other words, if you give pair

00:22:06.800 two vaccines together, that one doesn't interfere with the other. It's a very carefully orchestrated

00:22:12.280 dance. And then these guys come in with these wacko schedules without any scientific basis. And then

00:22:19.300 it forces the scientific community to try to reevaluate whether you're still getting the same

00:22:24.820 immunogenicity or not, and also the immunological interference. So it's not just a matter of saying,

00:22:31.980 well, what difference does it make because kids are getting the same vaccines? It's unclear whether

00:22:36.780 they're going to be just as effective or safe as that very carefully orchestrated dance that was

00:22:42.920 developed jointly by the FDA and CDC.

00:22:45.260 That's a very interesting point, Peter, and frankly, not one I'd ever considered. I get asked

00:22:50.700 not infrequently by patients about vaccinating their children on the schedule. And these are not

00:22:57.580 people who think vaccines are causing autism, but they do have some concern, presumably just based on

00:23:04.560 things that they've read, heard, et cetera, that say, hey, does my kid really need to have all of

00:23:10.360 these shots in the first nine months of life? And their belief, which is not unreasonable, is isn't

00:23:16.140 this just a way to ensure kids get their vaccines? Because during the first year of life, the parent

00:23:22.360 is so much more likely to come in for well baby checks, and they're going to have much more frequent

00:23:27.400 contact with their pediatrician, and that that's the reason that this schedule is being imposed on us,

00:23:32.820 as opposed to any really biologically necessary. Again, I use the example of Hep B, which most kids are

00:23:39.680 really not at risk of Hep B.

00:23:41.800 Let me give you a different H disease as an example. So Haemophilus influenzae type B. It's a bacterial

00:23:48.280 cause of meningitis. Back in the Pleistocene era, when I was a house officer, I was a pediatric house

00:23:54.340 officer at Mass General. In 87, 88, I would be admitting a kid with Haemophilus influenzae type B meningitis

00:24:02.300 to my service every couple of weeks. And Mass General was one of the oldest pediatric residencies.

00:24:07.020 They called it the children's service. And back then, the house officer did everything. You had

00:24:12.780 to do the lumbar puncture. You had to look at the cerebral spinal fluid under the microscope. You had

00:24:18.120 to do the gram stain and eventually sent to the lab, but to confirm it, but you would basically make

00:24:23.500 the diagnosis right then and there. And when you did it, your heart sank because you knew that there

00:24:29.560 was a high likelihood that kid was going to have permanent neurologic injury or might not even survive.

00:24:35.140 And it took a big emotional toll on me and my fellow house staff to have these young,

00:24:41.540 healthy infants now get Haemophilus influenzae type B meningitis. And at that time, we didn't have a

00:24:47.740 vaccine that worked in infants. There was the capsule of the Haemophilus influenzae type B,

00:24:52.360 the polyribophosphate capsule, but it was shown that it wasn't immunogenic in infants. So it was still

00:24:56.840 licensed as a vaccine for older kids to catch the few older kids that could still make an immune

00:25:01.900 response, but it didn't work in infants.

00:25:03.500 Why is that, by the way?

00:25:05.280 Turns out you need to haptenize it onto protein. And that's what John Robbins and Rachel Schneerson

00:25:10.080 did at the National Institute of Child Health and Development, NIH. They figured that out and

00:25:16.160 developed a conjugate vaccine that now worked in infants, which now you could start vaccinating.

00:25:21.780 At that time, you didn't have anything that worked in young infants. So all you could do at that time

00:25:27.820 was take a prophylactic antibiotic called rifampicin, which had the unpleasant effect of turning your

00:25:33.740 urine orange, reddish orange. And at that time, I had our first son born, Matthew, and we were living

00:25:40.720 right across the street from Mass General. And I was terrified that I was going to bring Haemophilus

00:25:45.160 influenzae type B home. So I took rifampicin all the time. And I peed orange for two years,

00:25:51.920 practically, to the point where one of the first and only fights I've ever had with Ann was my wife

00:25:57.360 was permanently staining the toilet bowl orange because I was taking that antimicrobial. And then

00:26:02.900 this miracle occurred. The miracle was, you know, John Robbins and Rachel Schneerson, also David Smith

00:26:08.280 and Porter Anderson in Rochester figured out that if they attach that polyrobophosphate capsule to protein

00:26:14.920 and haptenize it, now you get T cell responses in infants and it works. That vaccine was licensed in

00:26:21.580 1989 as I was finishing my house offer training for infants, for young infants. And now it's part of

00:26:27.880 that early vaccination schedule. By the time I finished my, and then I went to Yale for my pediatric

00:26:34.000 infectious disease fellowship. I had a lab there. And then I was a junior attending at Yale Children's

00:26:39.400 Hospital. By the time I started rounding as an attending two years later, the disease was gone.

00:26:46.780 It basically, I taught the house staff about it purely for historical interest, just like, you know,

00:26:53.060 the old guys at Mass General taught me about diphtheria and tetanus. That's how dramatic it was

00:26:59.180 because we added it to the infant schedule. And I think that's a good example of these infant vaccines.

00:27:05.880 To get a vaccine through, to be licensed by the FDA, to file that biologics license application,

00:27:13.940 first of all, it's very expensive. Second, it's lots of review. It has to go through the biologic

00:27:19.040 license process of the FDA. It's got to go through the VRPAC committee, the FDA for review. It then goes

00:27:24.800 to the Centers for Disease Control and the ICIP, the Advisory Committee on Immunization Practices.

00:27:30.420 There's a lot of smart people that are looking at all of this to say, do we really need this? What's

00:27:37.740 the cost effectiveness? What's the benefit to society? What's the benefit to child health?

00:27:44.040 These are not decisions that are made lightly, or these are things which are carefully thought out.

00:27:50.040 So you don't think that there's some consideration given to this is a window in which the probability

00:27:56.100 of vaccination is greater just due to exposure. Again, I bring up hep B just because you and I

00:28:01.640 didn't get our hep B vaccines until we were adults. And of course, I don't know when you got yours,

00:28:06.740 but for me, I think I got it in medical school. It was just in time, given our exposure to hep B

00:28:13.080 is enormous once you're in medical system because it's transmitted just like HIV. And depending on where

00:28:18.840 you trained, you might be in a population.

00:28:20.720 I think I first got mine when we were keeping a lab in Shanghai in China for parasitic diseases.

00:28:28.520 And I think going off to China frequently, there's a lot of hepatitis B. I think that may have been

00:28:32.960 when I got mine. But you're right. Back then, we weren't giving it to infants.

00:28:37.080 So I guess my question is, and again, I'm just saying this to try to take the side of the parent,

00:28:42.580 right? I'm trying to put myself in the shoes of the parent who says, this is too much. And again,

00:28:48.060 to be clear, this is not the parent who says vaccines are evil. My kid will never get vaccinated.

00:28:52.740 This is the parent who's saying, is this a little too much too soon? Does a child really need a hep B

00:28:57.860 vaccine as an infant? What is the probability that a child will be exposed to hepatitis B? The only

00:29:02.780 example I can think of is a child whose parent is in the healthcare system or is an IV drug user who is

00:29:11.280 themselves a high risk for hep B and who is not vaccinated. But outside of that, you could certainly

00:29:17.260 make the case that a person does not need a hep B vaccine until they're an adolescent or at least

00:29:22.140 a youngster in school, correct? Right. But let's take a step back. Let's look at that example of

00:29:27.420 the homophilus influenza type B. No doubt, no question in your mind that that's what we needed to do.

00:29:33.440 Absolutely. Right. Okay.

00:29:34.760 Especially given where the risk is highest to that patient. I mean, that's an amazing example of that,

00:29:40.680 right? Right. And that's why I'm bringing this. So the vast majority of vaccines

00:29:44.740 are not given for trivial reasons or no vaccine is given for a trivial reason. And the need is

00:29:51.040 more apparent for some than the others. The exact reason why hepatitis B was selected for

00:29:57.160 young infants, I wasn't at the table when that decision was made. It may be that there was enough

00:30:03.120 at-risk populations that it's very hard to cherry pick individuals when there's so many people who

00:30:10.480 absolutely need it, that it just becomes easier to vaccinate the whole population rather than say,

00:30:17.200 okay, well, you're in a specific at-risk ethnic group or you're in a specific at-risk occupational

00:30:22.860 hazard. On the other hand, when you look at what that vaccine is, it's about as low risk of vaccine

00:30:30.280 as you can imagine. It's a recombinant. We make vaccines like this all the time. It's a recombinant

00:30:34.940 protein vaccine produced in yeast. It's been around almost four decades. It's been given

00:30:40.800 hundreds of millions of children, a really fabulous safety record. So what are you losing,

00:30:47.040 I guess, is the other way to put it. Let's talk a little bit about HPV. Some people hailed this

00:30:52.600 vaccine as a miracle given the relationship between the human papillomavirus, at least three strains of

00:30:58.860 the human papillomavirus and cervical cancer. This is not an insignificant cancer for women. Sadly,

00:31:04.280 many of us know women who have either died as a result of this disease or have lost their

00:31:09.700 reproductive capacity as a result of this disease. And furthermore, I think many men might even

00:31:15.300 know the anxiety that a pap smear has caused their partner if it has shown one of the high-risk

00:31:22.440 strains, 16, 18, a number of these things. So I think for many of us, when the HP vaccine came along,

00:31:29.080 it was a really big deal. I mean, this was fantastic news. Can you talk through some of

00:31:35.080 the controversy surrounding it, both from a scientific standpoint, but also from a moral,

00:31:41.160 ethical, religious, political standpoint? Because I think, to me, HPV might be one of the best examples

00:31:46.500 of the intersection of all of those forces. So HPV-induced cancers like cervical cancer,

00:31:53.260 laryngeal cancers are predominantly sexually transmitted cancers. So if you look at infectious

00:32:01.480 causes of cancer, roughly about 16% of all cancers are caused by infectious disease agents,

00:32:07.620 like hepatitis B, like HPV. And the numbers go up all the time because we get better and better

00:32:14.160 at discovering infectious agents that cause cancer. So in Africa, about a third of the cancers are

00:32:20.640 of infectious origin. And this was developed by the National Cancer Institute, including someone

00:32:28.140 who's very dear to me, Doug Lowry. They were able to show that vaccinating against this virus can

00:32:36.760 prevent infection of the virus and therefore will likely prevent cancer. And now new studies have

00:32:42.480 shown, indeed, it's borne out that, indeed, it does prevent cervical cancer. And on that basis,

00:32:47.940 the Australian government has now launched a program where they think they can eliminate

00:32:53.880 cervical cancer from the continent of Australia by 2030. So that's really exciting to actually

00:32:59.680 eliminate a cancer through the vaccination process. The issue has come up, you have to vaccinate.

00:33:07.060 Originally, it was mainly focused on cervical cancers rather than the cancers that would develop in

00:33:12.380 males. So the recommendation was you want to have those girls vaccinated before their sexual debut,

00:33:20.780 before they start having intercourse as they get to be teenagers or young adults. And so you want to

00:33:27.660 get them when they're nine or 10-year-old little girls in time to make certain that everybody gets

00:33:32.560 vaccinated. And I think that did not go over well with a lot of people because they now realized

00:33:39.660 their nice little nine, 10-year-old girl is one day going to be a woman who is sexually active. And

00:33:45.700 I think that was hard for some people. But in fact, it has a remarkable ability of saving lives

00:33:52.600 and preventing cervical cancer. And that's why Australia has been implementing that in the U.S.

00:33:57.960 in contrast. What's happened? Well, we have a couple of problems. First of all, we're a big country.

00:34:03.460 The access to the vaccine is not everything we'd like in rural areas. It's not everything we'd like,

00:34:11.400 especially among underrepresented minorities. And there's an access issue. But the other big thing

00:34:17.100 is this has been targeted now by the anti-vaccine lobby. They have tried to come up with fake

00:34:23.340 assertion after fake assertion. That's not supported by the scientific data. So they claimed it was causing

00:34:29.860 autoimmunity. They claimed it's causing, they linked a lot of it to female reproductive health

00:34:35.060 issues. They said it was causing infertility. It was causing miscarriage. And again, one by one,

00:34:40.520 the scientific community had to do those big cohort studies to refute all of those links.

00:34:46.140 I guess this is as good a time as any, Peter, to ask the first of several meta questions.

00:34:51.240 Wait, you didn't give me feedback. So was that convincing or were you still unimpressed? I mean,

00:34:56.380 what do you think the issue is? I think that's a great point. And I say that as a father of a 12

00:35:02.040 year old girl, which I was just sort of joking with my mom this morning. You know how your iPhone,

00:35:08.460 it'll give you like a flashback picture or video from some time in the past. This morning, it sent me

00:35:14.280 a video of my daughter when she was, well, she would have been seven. The next guy would have been one.

00:35:21.880 So seven-year-old and one-year-old and they're at the beach playing. And it's like the cutest thing

00:35:25.720 on the face of the earth. And I probably watched the video like seven times. And then I sent it to

00:35:30.080 my mom and I said, I'll remember when she was this little. You know, my mom made some comment like,

00:35:35.100 yeah, enjoy it now because five, six years she's going to be in college and blah, blah, blah. And

00:35:39.660 so I get that. There is nothing to me that is both simultaneously amazing and sad as the natural

00:35:49.620 loss of a game, a tug of war that goes on between a parent and a child. My friend, Rick Elias described

00:35:55.940 it. You're playing tug of war and you have to lose by the time the kid's about 18. So I can see that.

00:36:01.320 Again, I'm trying to put myself in the shoes of the person who thinks this doesn't make sense.

00:36:06.320 And I think there's an argument that they would make that would say, well, I don't want my child.

00:36:10.940 I don't want my daughter. Let's just, again, I think this is an important issue that we should

00:36:14.160 explain why both male and female it's relevant to both. But if we're just taking it through the

00:36:18.480 lens that I think it first came through, which is my daughter is 12. I do not want her to be

00:36:23.680 sexually active until she is, and I come up with some arbitrary age like 18. Therefore, I am not

00:36:29.140 going to have her vaccinated until she's 18. Another point of view is in an ideal world,

00:36:33.960 I would prefer she's not sexually active until she's mature enough to handle that. I don't know

00:36:37.820 when that is, but it sure as hell isn't 12. I don't want her to have this vaccine at 12.

00:36:42.140 But the downside of not vaccinating her in time is she could be cursed with a lifetime of asymmetry,

00:36:48.720 right? There's an asymmetric bet here. I can understand why some parents might struggle with

00:36:53.980 that, even though I tend to think in terms of risk and probabilities, maybe more than the average person.

00:36:59.360 I totally agree with everything you've said. I think the problem now is that you've got

00:37:04.300 these anti-vaccine groups specifically targeting HPV, including I think now you've got children's,

00:37:11.840 I forget which it is, whether it's Kennedy or this organization is, I saw it on his Twitter,

00:37:17.460 he's filing some big class action suit against Merck and company for the HPV vaccine with all sorts of,

00:37:25.740 I don't remember. But again, this is what's going on right now. I'm not aware of any evidence to

00:37:32.900 support all of these things like infertility or miscarriages or autoimmunity. What's really

00:37:38.420 interesting also is the anti-vaccine groups have now copy-pasted those assertions onto the COVID-19

00:37:46.660 vaccine. So they could be pretty lazy. So they're just basically saying the same thing they did with,

00:37:51.280 because I guess it works for them in that Pyrrhic way. But as a result of that, and like I said,

00:37:56.640 it's not the only thing because we have access and rural and underrepresented minority groups,

00:38:01.260 but we're going the wrong way with HPV vaccine. We're not even close to thinking about creating

00:38:07.000 a cervical cancer elimination strategy. You mentioned laryngeal cancer as well.

00:38:12.400 I don't think enough people understand the threat of that. Frankly, all upper airway cancer,

00:38:18.660 right? I mean, you're talking about cancers of the soft palate. You're talking about

00:38:22.200 lots of head and neck cancers are on the rise. I can't remember exactly the stat. I want to say

00:38:28.820 like the second or third largest growing cancer in young men is head and neck cancer on account of

00:38:36.800 sexually transmitted disease. Yeah. And if you talk to the head and neck surgeons, we're right next to

00:38:42.540 MD Anderson Cancer Center within this Texas Medical Center. It's devastating. The very aggressive

00:38:48.020 surgeries that you have to do. It's really heartbreaking. By the way, we never finished the

00:38:53.060 one thing about the autism, which was you made the statement autism's on the rise. I think it's

00:38:58.780 important to clarify that. I think we're clearly getting better at diagnosing autism. I'm not convinced

00:39:05.940 that the incidence of autism is truly increasing. There's a lot I want to come back to on autism.

00:39:12.020 We're not abandoning that, but thank you for clarifying that. Coming back to this point I wanted

00:39:15.340 to make, which is meta question number one, why do call it 20% of the population and an entire

00:39:23.280 cottage industry of lobbies, lobbying groups, PACs, et cetera, come out so hard against this one class

00:39:31.900 of drug, whereas we don't see it for antibiotics. Where are the 20% of people who think penicillin

00:39:39.900 is evil and the companies that make Zofran or not Zofran, but similarly, where are the companies

00:39:48.800 that are coming out against insulin, exogenous insulin that all these diabetics are using?

00:39:54.140 Look, I'm going to be a skeptic for a moment. I don't think there's a greater mismatch between

00:40:00.040 drug companies doing wrong and profiting overcharging patients for a medication than insulin.

00:40:05.920 I think the economics of insulin are an embarrassment to how pharma works. Where's

00:40:12.660 the rage? Where are the 20% of Americans that aren't losing their mind over what Nova Nordisk

00:40:19.060 is doing? So what is it about vaccines in particular that brings out so much ire, so much skepticism,

00:40:25.640 and so much anti-science rhetoric?

00:40:29.240 Well, I don't know that I have all the answers, but I think part of it is the fact that you're

00:40:34.280 giving vaccines to, not in all cases, but in most cases, you're giving vaccines to well

00:40:40.900 individuals to prevent them from getting sick. So you're giving something that's not always

00:40:48.800 intuitively obvious that they need. As opposed to insulin, as opposed to penicillin, somebody

00:40:55.000 is sick and somebody needs a treatment. So this is being so that you understand. But for a vaccine,

00:41:01.300 you're preventing somebody from getting sick. And I think that simple feature is a big component of

00:41:07.840 it. I think the other is the fact that so many vaccines are mandatory for school entry. So there's

00:41:15.720 that loss of choice that you feel it's being imposed on you. So those two things become pretty easy to

00:41:23.660 exploit. Unless you've got really strong vaccine advocacy activities in your community, it's pretty

00:41:30.940 easy for an anti-vaccine group to cherry pick those two things. And then when you have conditions like

00:41:38.840 autism and people want to understand how did this happen, particularly the regressive form where kids

00:41:45.360 seem to be developing normally and have normal milestones and then regress, this is easy pickings for

00:41:52.320 an anti-vaccine group to come along. So as an example. For instance, back in the 1900s,

00:41:58.740 in the UK, they started anti-compulsory vaccination leaks and this extended to the US. So I think it's

00:42:07.580 a combination of the fact that they're preventative, not therapeutic, and the mandate component. I think

00:42:13.840 those two are a toxic mix that get some people upset about vaccines, particularly in this environment,

00:42:20.320 which now dominates the internet. I mean, in the past, when you had an anti-compulsory vaccination

00:42:25.480 league, you could go to your physician, the physician would explain why that's all nonsense

00:42:30.480 and why you should get vaccinated. Now we've got something called the internet. Now we've got

00:42:35.280 something called social media that dominates our lives. And you've got Amazon now as the single

00:42:40.520 largest promoter of fake anti-vaccine COVID conspiracy books. So most of the information you're getting now

00:42:47.600 on a daily basis is actually anti-vaccine, anti-science information.

00:42:52.760 But again, I'm still trying to understand why the disdain for science is so prevalent. So hear me out

00:42:58.680 on another thought experiment. If the president says, I want to... I'm using this because it's the current

00:43:06.360 example, right? If the president says, I have a legislative agenda that's going to propose a

00:43:11.020 multi-trillion dollar infrastructure bill, you may not think that's the best idea, right?

00:43:15.580 You're going to oppose that through legislative action. You're going to oppose that through

00:43:21.120 lobbying. Maybe that's not a great example. I guess what I'm trying to get at is if you're

00:43:27.300 opposed to vaccines, I can at least understand the argument around medical freedom because you

00:43:33.980 could at least stand up and say, look, I'm opposed to being told I have to take a drug to prevent an

00:43:39.540 illness I don't have. And then you could at least argue the merits of the individual versus society.

00:43:44.880 To me, that's a more palatable argument. But the complete anti-science part, maybe because I'm a

00:43:52.320 scientist, is just harder for me to empathize with. It's harder for me to put myself in those

00:43:58.120 footsteps because I can't think that way. But I want to because I think it's important to be able

00:44:03.020 to think that way and not be dismissive of it, if that makes sense.

00:44:05.820 Here's what I think happened, which is I think part because of my activities, and I'm not alone,

00:44:11.540 others were involved in this. There was a lot of effort to debunk the links between vaccines and

00:44:17.100 autism and HPV vaccine and all the craziness that they asserted to cause. And I think it was taking

00:44:24.320 some steam out of the anti-vaccine movement. But you still had enough parents in places like Orange

00:44:30.180 County that were scared about vaccines, the causing autism, that it allowed a measles epidemic to

00:44:38.400 erupt. And it was a pretty bad epidemic in Orange County. End of 2014, 2015, it was linked. I think

00:44:45.160 the origins may have been Disneyland, where the epidemic came from. What happened was the California

00:44:51.080 legislature responded appropriately, I think, and said, you know what? We're allowing these vaccine

00:44:57.800 exemptions, but it's getting out of hand. And now it's causing a measles epidemic. And measles is a

00:45:03.580 bad actor, right? It's got a significant mortality and permanent disability, deafness, and other things.

00:45:09.960 And they shut down the vaccine exemption. And I think that helped re-energize the anti-vaccine movement

00:45:17.220 because I think they were losing some steam around autism. And they saw this as an opportunity to

00:45:22.940 rebuild, to reinvent themselves. And they reinvented themselves as a political movement around health

00:45:29.360 freedom, medical freedom. And it really amplified in Texas, where I am. And it took off with, they

00:45:35.520 created political action committees like Texans for Vaccine Choice. And the PACs started getting other PAC

00:45:41.340 money. And the PACs were giving PACs, other PACs money. And so there was a lot of money flowing.

00:45:47.160 And it was very powerful. And they were able to convince the Republican Tea Party in Texas,

00:45:53.800 which is a very powerful group, to adopt this issue as a platform issue. And that's when it

00:45:59.880 really started to accelerate. And you started to see PACs form not only in Texas, but also in Oklahoma,

00:46:06.060 other Western states as well. So it was more of a Western state phenomenon than anywhere else. And so

00:46:12.740 your political allegiance, your identity actually became tied to not vaccinating your kid or to be

00:46:20.600 skeptical of vaccines. And then it all really blew up last year because those same anti-vaccine groups

00:46:28.820 then started going up against masks and social distancing again under this health freedom,

00:46:35.660 medical freedom banner. And now it became a full-on anti-science movement. And you really saw this

00:46:42.420 happen starting around last summer when the epidemic moved into the Southern states and people

00:46:48.900 showed their political allegiance to the Republican Party by defying masks and social distancing.

00:46:56.380 And then it went up in the upper Midwest as well. And then you had that story, that awful story of the

00:47:02.040 ICU nurse in tears being interviewed, talking about one of her ICU patients who's dying words where COVID-19

00:47:10.180 is a hoax. That's when you started to see this kind of mainstreaming of what was a fringe group around

00:47:17.320 health freedom, medical freedom in 2015, and now become a major platform of the Republican Party

00:47:23.940 going up against science. And then you saw the targeting of scientists. That's when they began

00:47:30.160 really going after Dr. Fauci. They began going after Bill Gates. They've started going after me

00:47:36.700 quite a bit. And now this thing is steamrolling. I mean, you had Tucker Carlson last week going on

00:47:44.220 this whole rant about vaccines and questioning vaccines. And Laura Ingram at Fox News went after

00:47:52.240 me a couple of nights ago. Specifically saying what? You'll have to forgive me if I don't follow

00:47:57.280 this stuff too closely. Yeah. Well, it's pretty unpalatable stuff. I mean, they would say that

00:48:03.140 we misled the public, that we got it wrong, that we didn't understand the epidemic. And then they

00:48:08.680 would parade out all the great Barrington stuff about no lockdowns, even though none of us ever

00:48:15.060 said lockdowns. They create these straw men that say, we're trying to lock everybody down and we're

00:48:22.220 hurting our economy. And along with that, they're saying, what's going on with these vaccines? And so

00:48:28.860 tying, and again, this is a throwback to 2015 when it was first linked to political extremism on the

00:48:36.900 far right. So what was started out as an anti-vaccine movement is now a movement against any kind of

00:48:43.760 public health intervention and demonizing scientists and basically calling us the boogeyman in that.

00:48:51.640 And it's continuing. Now you've got, this was exported last summer to Europe. You had

00:48:56.580 these anti-mask, anti-vaccine protests, which for the first time used that same American language

00:49:03.300 in Berlin and Paris and Trafalgar Square in London. You had the New York Times reporting how it's linked

00:49:10.020 to QAnon and other far right-wing extremist groups. And so this really concerns me. And then,

00:49:16.520 of course, to make it all the more complicated is the fact that now you've got the US and British

00:49:21.480 intelligence talking about Putin's government has been lobbying this whole program of what's being

00:49:27.160 called weaponized health communication on our internet in order to destabilize the country and

00:49:32.320 destabilize other democracies. And what was kind of a fringe group arising out of the Tea Party in Texas

00:49:39.940 is now, I don't know what you want to call it, whether it's a anti-science empire or confederacy

00:49:46.420 that has lots of moving parts to it. But I'm concerned about the fact that it continues to

00:49:52.100 build. Do you think this is just a very vocal part of the Republican Party? Or do you think

00:50:00.060 this actually represents an entire political party? I mean, it seems hard to me that this could

00:50:04.200 represent an entire political party, given the heterogeneity of beliefs that would exist across

00:50:09.980 that from fiscal conservatives, social conservatives, I mean, all of these things.

00:50:13.600 Yeah. And the fact that the Republican Party historically has not been anti-science, right?

00:50:18.520 I mean, the National Academy of Sciences was started in the Lincoln administration.

00:50:24.200 Eisenhower launched NASA. George W. Bush launched PEPFAR. So this seems new to me. And I don't know how

00:50:32.520 much it's pervasive in the Republican Party. Certainly, it's become now a major component of Fox News in the

00:50:39.580 evening. And as recently as last year, I was going on Fox News almost every day on a pretty regular

00:50:45.480 basis. And I didn't see it until the disinformation campaign came out of the Trump White House. And

00:50:52.500 when they said COVID, around a year ago last year, when they said COVID was a hoax or the flu and

00:50:59.120 attributed the COVID deaths to other causes, or you had Kayleigh McEnany say the hospitalizations were

00:51:06.080 all elective catch up in elective surgeries and discrediting masks. And then later on in the

00:51:11.980 summer, they brought out Scott Atlas. So there was no question about it, this very deliberate

00:51:18.720 disinformation campaign coming out of the Trump White House. And I was one of the first to call

00:51:23.660 it out, not because I'm so brilliant, but because I've been going up against these anti-vaccine guys

00:51:28.160 for years and have become by default an expert in anti-science disinformation campaigns and could

00:51:34.180 recognize it. I see it accelerating. I can't say whether it's across the whole Republican Party,

00:51:39.760 but it's a lot more pervasive now among Republicans than it's ever been. And then what's the evidence?

00:51:46.560 Well, the evidence is now the PBS NewsHour teamed up with NPR and Marist, and they've now found that if

00:51:55.120 you look at the single most vaccine hesitant group in the United States, this was just last week,

00:52:00.100 it's what's called white Republicans. I think it was 41%. A significant percentage of white

00:52:05.760 Republicans are saying they're not going to get vaccinated. And that's not the first poll. I mean,

00:52:10.880 we did one with a group of Texas A&M. I'm not a social scientist, but we teamed up with a group of

00:52:16.420 social scientists at Texas A&M led by Tim Callahan and the School of Public Health found the same thing.

00:52:21.840 I think we called them Trump voters. And Kaiser Family Foundation also found the same thing twice.

00:52:27.940 So this is the number one vaccine. Now, I've seen another poll that suggested,

00:52:33.140 and it didn't slice the data by race and party, it sliced it by race and party separately. And it found

00:52:39.780 the greatest predictor was indeed Republican Party Association, but the second was African American.

00:52:46.320 What's the best explanation for that? What's more, now it's coming down. So what's happened,

00:52:50.800 you're absolutely right. So about two, three months ago, African American groups and the white

00:52:56.620 Republicans were sort of neck and neck in who was the most vaccine hesitant. It stayed up among

00:53:01.900 Republicans, but it's been coming down among the African American groups. And one of the things I've

00:53:07.320 been going on, lots of podcasts and radio shows that reach black and brown audiences. And I was on one

00:53:13.740 last night with a Baptist church in Richmond, Virginia. And I asked the pastor, I said,

00:53:19.720 are you seeing less of it now? He goes, definitely, it's coming down. I said, what do you think is

00:53:23.420 happening? Well, he goes, well, doc, I think part of it is people like you, you know, reaching out to

00:53:28.020 black and brown communities. But the other is a lot of the clergy have created in sort of an informal

00:53:33.820 network now, and we're really hitting hard on the need to get vaccinated. So I think that may be

00:53:39.680 part of it, but initially it was quite high. And I think what the reasons were, I don't entirely

00:53:45.380 understand what's often said is it's around structural and historic racism and that horrible

00:53:51.100 legacy of Tuskegee. I think the other thing that I've seen though, is the liberal targeting of

00:53:56.440 African American groups by the anti-vaccine lobby. And now I just saw on the internet, there's a new

00:54:02.840 quote documentary clicked on the trailer and it's got people getting the Pfizer-BioNTech vaccine that

00:54:09.600 it switches right away to Tuskegee experimentation. So by it's kind of making that links, I think it

00:54:15.720 could do a lot of damage. So, but it seems to be somewhat resolving, but it's still really high among

00:54:22.240 those group of Republicans. And you saw it when COVID-19 accelerated in the summer and in the

00:54:28.820 Southern States and in the upper Midwest in the fall. And so what's going on? And I'm worried that

00:54:35.260 now you've got, again, people tying their allegiance to the Republican party or their

00:54:41.820 identity to being against scientists and science. And this is not good for the country.

00:54:48.160 There are a few things I want to say. And one thing to add, the thing that we haven't mentioned

00:54:52.080 yet that I think is worth mentioning is the enormous measles outbreak in Minnesota that occurred in the

00:54:56.520 Somali community. I think that story doesn't get enough attention because I guess it's now been

00:55:00.820 enough years, but I've always found that to be an unbelievably sad story in some ways, more sad than

00:55:06.300 the Orange County outbreak, because this was really a deliberate targeting of a community of immigrants,

00:55:12.460 not facile with the language. And the measles outbreak was terrible there. And I guess that's

00:55:17.300 the thing I've always struggled with. If you just put your common sense hat on, every time a community

00:55:22.600 gets targeted to stop taking, in this case, the MMR vaccine, a measles outbreak shows up.

00:55:28.840 Yeah. And measles is sort of the, Paul Offit always calls it the canary in the coal mine. And I think

00:55:36.120 he's right. It's because it's got such a high reproductive number of 12 to 18. As soon as the

00:55:41.700 vaccination coverage goes down, measles finds it. That was the first time, I think, that you saw the

00:55:47.020 anti-vaccine groups targeting specific ethnic groups. So Lena Sun at the Washington Post back in 2017

00:55:53.860 reported that Wakefield, who had kind of disappeared for a while, was at town hall meetings. I don't know

00:56:00.900 if he organized them or if the small immigrant community organized them, but there he was piling

00:56:05.780 on and brought down vaccine coverage from over 90%, the Washington Post reported, to 40%. Guess what's

00:56:13.280 going to happen? And I think it was 21 kids that landed in the hospital. And then it happened again in

00:56:18.740 2018, 2019. They began targeting Orthodox Jewish groups in New York and New Jersey. And what they did was just so

00:56:26.740 offensive. They started parading around in these phony yellow Jewish stars, like the Holocaust, with the word

00:56:33.880 vax written in it. And vax was written like Hebrew letters and started comparing vaccines to the Holocaust. And that

00:56:41.200 caused this massive measles epidemic across both in Muncie, New York, by the Tampan Zee Bridge, and

00:56:48.000 then in Brooklyn. And I think there were 18 people in the ICU because of that, 50 hospitalizations.

00:56:54.680 So this has become the new modus opera. And then in 2019, you saw these series of Harlem vaccine forums

00:57:00.440 that they organized, even held one in the Riverside Church, which is on the Upper West Side of New York,

00:57:08.460 near Columbia University. It's one of the iconic churches in the history of the civil rights

00:57:12.720 movement, the Reverend Sloan Coffin, and somehow got access there and held a rally there. So all of

00:57:19.560 that has caused a lot of damage. Now this new quote, documentary that's coming out. So I'm very

00:57:25.680 concerned. So you've got, as I say, these multiple facets. You've got the health freedom component

00:57:31.780 expanding now across the Republican Party, now into Western Europe. You've got the Russians

00:57:37.520 fueling this with their systematic weaponized health communication. And now you've got the

00:57:44.700 specific targeting of racial and ethnic groups and causing a lot of damage. And the problem is it

00:57:52.040 takes time to explain. I can't give you a 30-second UNICEF commercial about this. How long have we been

00:57:57.940 talking a full hour now? You kind of get it now, but it takes time to unfold and explain. And the

00:58:04.700 problem is it makes people very uncomfortable. When I was going on CNN and MSNBC last year at this

00:58:12.320 time, I didn't want to call out the White House for their disinformation campaign. I mean, what we're

00:58:18.080 told as scientists is, hey, Peter, just stick to the science. You're not a political guy. You're not

00:58:23.700 an expert in White House Washington politics. What are you doing? You can't do that. But being an expert

00:58:30.340 in anti-science disinformation campaigns by being targeted by these guys. I mean, Robert F. Kennedy,

00:58:36.180 Jr. calls me on his Instagram, called me the OG villain, the original gangster villain. So that's

00:58:41.780 who you're talking to today. I had to look up what OG meant. I unfortunately became a bit of an expert

00:58:47.480 in anti-science disinformation campaigns. I could smell one a mile away. And I saw this and I said,

00:58:51.960 I know what this is. You saw Peter Navarro out there with all the Chinese conspiracies. I said,

00:58:57.680 we're being gaslighted here. And I said to Ann, my wife, I said, I don't know what to do. This is

00:59:02.760 taking me to a very dark place. You know, I'm supposed to only talk about the science. And

00:59:07.060 she saw upset I was getting. She said, Peter, you know, if you don't say anything and you find out

00:59:12.800 all this massive loss of life from COVID and didn't do all you can to stop it, you're going to hate

00:59:17.380 yourself. And that's all I needed to hear. And then I really went after it. It took me to a very dark

00:59:23.340 place. And part at that time, you weren't getting a lot of backing. I didn't get a lot of backing

00:59:29.160 from the academic and professional societies because it's not what they do. And so I really

00:59:34.540 felt out there alone. Later on, I think when it became safe, other people came to my support. But

00:59:42.240 in the beginning, it was a very lonely thing to do. I mean, I'm glad I did it, but it took emotionally,

00:59:48.140 it really knocked the crap out of me. It was very tough to do that because the truth is I'm not

00:59:53.220 that ideologically driven politically. I mean, I was in Washington for 10 years and as chair of

00:59:59.000 microbiology at GW. And one thing I learned in Washington, if you want to get anything done,

01:00:03.440 you reach across the aisle. So we got a lot of neglected tropical disease legislation passed.

01:00:08.800 And, you know, I would think nothing of going to Sam Brownback, who is now he's the governor of

01:00:13.960 Kansas. Back then, he was a very conservative senator from Kansas. He would hold a prayer

01:00:17.940 breakfast meeting. And I'd go to that and I would speak. And then I'd go across the way and talk to

01:00:23.000 Senator Leahy's people, who's this very liberal senator from Vermont. And back then, nobody thought

01:00:29.500 twice about those kinds of things, but it's not happening anymore. So to be able to have to tear into

01:00:36.340 what was going on with the Trump White House, and it was often perceived as I was just being

01:00:42.920 somebody in the Democratic camp, which wasn't the case. But I understand why it was perceived that

01:00:48.540 way. And now what's interesting is whenever I have something with the Biden administration,

01:00:53.180 I think is not quite right. Then I get beat up a lot from my colleagues on the left. And there's

01:00:58.360 a lot more of those who say, you know, what are you doing? After a while, we've been through,

01:01:02.200 how can you criticize the Biden White House? I'm really criticizing. I think they're doing a good

01:01:06.400 job, but there are things that need to be changed as well. So it's very tough.

01:01:10.420 If your focus is only on saving lives and doing whatever you can to save lives, that's very tough

01:01:17.000 because it means if you're sincere about that, you go on Newsmax and you go on Fox News, which I've

01:01:22.760 been doing. And you go on radio podcasts and that reach black and brown audiences. That's what I've

01:01:29.540 been doing. So, and hopefully the end of it all, I'll be okay, but it's not easy doing this.

01:01:35.820 Peter, is there a historical precedent for such a distrust of science? I mean,

01:01:42.800 given that the scientific method has only been around for, call it 400 years, that doesn't give

01:01:48.960 us a great opportunity to look for such things. But even in the last century or two, have we ever

01:01:55.180 seen such massive distrust for the establishment of science?

01:01:59.400 I haven't seen this distrust systematically. Certainly there's been a lot of pushback or

01:02:06.400 anger around certain things scientists have said. Like for instance, during colonial times,

01:02:11.160 when Cotton Mather tried to vaccinate the Massachusetts colony against smallpox, people were very aggressive

01:02:19.220 with him and they actually threw a firebomb into his window around that particular issue. That's

01:02:25.760 gone up and down in American history, but I've just not seen this systematic distrust of science

01:02:33.920 and scientists and the targeting of scientists and the mainstreaming of anti-science. That's kind

01:02:40.140 of worrisome. And then of course, a lot of this is because now we have this new era of the internet

01:02:46.080 and social media and Amazon and all those kinds of things doing a lot of damage.

01:02:51.240 So I kind of want to pivot a little bit to something very personal for you. How old is Rachel now?

01:02:57.640 Now she's 28.

01:02:58.920 28. So let's go back in time, 28 years. Tell me what you remember about her birth and

01:03:03.940 the first few years of her life.

01:03:06.260 So by the time Rachel was born, I had already had two other kids. And I remember Anne saying,

01:03:11.440 always feeling that something was off. She wasn't as huggy or clingy as the other kids were,

01:03:17.740 but didn't really come to medical attention until around 19 months of age. That's when the

01:03:24.160 pediatrician clearly saw developmental delays and referred us to special services. And ultimately,

01:03:31.640 I was at Yale. I was an assistant professor then running a lab. And that was hard for me because I

01:03:35.860 was going off to China and keeping a lab in China. And now having a child with a medical issue was

01:03:41.980 really tough. Ultimately, I had to give up going to China and reconfigure our program. But at Yale,

01:03:49.120 that's also the home of the Yale Child Study Center, which is one of the big thought leader places for

01:03:54.400 autism. And she was referred eventually to the Yale Child Study Center, where the world's experts on

01:03:59.740 autism, people like Fred Volkmar and Donald Cohen and Linda Mays. And there was a child psychiatry

01:04:06.400 fellow in Wendy Levine, who really looked into this very carefully. And it was clear that she was on

01:04:12.420 the autism spectrum. And it's a little tougher to diagnose for girls than boys, because girls tend

01:04:18.080 to be more verbal. Was she verbal at 19 months? Was she appropriately verbal?

01:04:22.840 Well, she wasn't always appropriate, but she was always verbal. I mean, she would repeat. There's a lot

01:04:26.780 of echolalia. She would repeat things. But she had reason. And to this day, she's got reasonably normal

01:04:33.840 language skills. It's just her performance IQ is really, really low. And that's one of the big

01:04:40.480 issues with Rachel. It's the intellectual disabilities, in her case, that go with autism.

01:04:46.560 And in fact, that's a very interesting side story about Rachel, is the whole ecosystem of girls and

01:04:52.380 women on the autism spectrum. Because older literature says it was 10 to 1, boys to girls.

01:04:57.780 And that's because boys are so floored in their presentation and symptoms. Girls can

01:05:03.080 camouflage it better. They can mask it better. They are often verbal. But they have very high

01:05:08.680 rates of comorbidities, like obsessive compulsive disorder, or ADHD, attention deficit hyperactivity

01:05:16.440 disorder, or even a lot of the teenage girls with bulimia and eating disorders. Now, many of them may

01:05:24.400 be on the autism spectrum. So we're getting better at it. So it used to be 10 to 1. Now, I think it's

01:05:30.500 moving closer to 3 to 1, boys to girls. And some say it may even approach parity or something close

01:05:35.300 to parity, like 1.5. But it's way underdiagnosed. And Alison Singer heads the Autism Science Foundation

01:05:42.380 has been supporting efforts to really call great, because she has a daughter on the autism spectrum,

01:05:47.840 to look at this in more detail because it is so underdiagnosed. But in Rachel's case, it finally came

01:05:54.500 to diagnosis at 19 months of age. And I got very interested in that, because when you look back

01:06:02.140 then at the CDC definition of autism, I don't think it's on the website anymore, but I guess

01:06:08.120 a couple of years ago, it was still there. It said most kids on the autism spectrum were diagnosed

01:06:12.920 between 18 or 24 months of age. And I got very interested in that because there was a research

01:06:19.260 group at the University of North Carolina, Chapel Hill, run by this guy named Piven, P-I-V-E-N,

01:06:25.060 who was able to show that that clinical expression of autism coincided with a big increase in brain

01:06:31.940 volume expansion. So you could actually follow this on serial MRI. And that's important because

01:06:38.380 a lot of parents will remember when their kid was diagnosed with autism, especially the regressive

01:06:46.340 form, because that's so driven, not just all slowing of milestones, but actually loss of

01:06:50.940 milestones. They'll remember that their kid got vaccinated, maybe with measles or something else

01:06:56.700 around that time and want to link the two. But now this group at UNC Chapel Hill can go back

01:07:02.880 much earlier, back to infancy, and show that there's already those changes happening in the brain.

01:07:10.460 And now, of course, we can show prenatally. So Eric Korchesny's group at UCSD and multiple groups,

01:07:17.720 now the Broad Institute at Harvard and MIT, has identified about 100 genes linked to autism spectrum

01:07:24.000 disorder, all involved in early fetal brain development. Many of them involved in neuronal

01:07:28.880 communication. So a lot of neuronal cytoskeleton genes, for instance. So we did whole exome sequencing

01:07:34.580 on Rachel and Ann and I at Baylor Genetics and identified a neuronal cytoskeleton gene, a non-red

01:07:41.860 cell spectrum, a neuronal spectrum, which makes a lot more sense in terms of understanding neuronal

01:07:47.380 communications and that sort of thing. So I think what happens is you see the activation of genes in

01:07:52.940 early fetal brain development, and that sets into motion a progression. But that full clinical expression

01:07:58.840 of it doesn't happen until around 18, 19 months of age often. That's not unusual for neuropsychiatric

01:08:06.300 conditions, right? I mean, look at schizophrenia, for instance. Oftentimes, kids with schizophrenia are

01:08:12.260 not diagnosed to adolescents or even young adults. And so this is how the brain works, I think. I'm not

01:08:19.020 a neuroscientist, but that's my take on this. I mean, just on a personal level, how did you cope with

01:08:25.180 this realization? And did it ever cause you to question anything that you were doing? Like, were you

01:08:30.940 able to sort of distance it or think about it through kind of a scientific lens, even though it was

01:08:37.640 something very personal? It went from being, this is the scientific literature in its entirety, to this

01:08:44.000 is my daughter. Back in the 90s, we knew a lot less about autism than we know now. And all the things that

01:08:49.820 I told you about, a lot of it has only come to light in the last few years. And then the Wakefield

01:08:54.280 paper came out. And I remember that because I think Rachel was about five years old at the time. And

01:09:00.120 it was all over the papers. And of course, Anne was asking me about it. And to me, it never made sense.

01:09:06.860 I said, how can it be? I mean, they called it pervasive developmental disorder back then for a

01:09:12.180 reason, because it was indeed pervasive. And you could see that a lot of these kids were macrocephalic.

01:09:19.780 They had enlarged heads. So this was clearly a neuroanatomical condition. I mean, you knew that

01:09:27.400 there were shifts in Purkinje fibers, and there were structural alterations in the brain of kids

01:09:33.840 with autism. How can it be that a vaccine you give at one year of age would cause that? It just never

01:09:40.920 made any sense to me. There was never any... So for me, there was never the plausibility.

01:09:45.480 But the full weight of scientific evidence wasn't there. I mean, that was my opinion more than

01:09:52.900 it turns out more or less to be true. And so that's why I was one of the early adopters of

01:09:58.780 saying there's no way in hell it's going to be MMR vaccine. And it just doesn't make any sense.

01:10:05.720 It's going to sound like a strange question, but was there a part of you that almost wished it was

01:10:09.300 so that you might be able to say, this would be amazing if we knew this? Because again, at the

01:10:14.860 time Wakefield proposed this, he wasn't even saying that all vaccination was bad. He was simply saying

01:10:22.040 they should be separate vaccines. Don't put measles, mumps, rubella in one shot, give them

01:10:26.860 separately. This was his first thesis. So even wearing your hat as an infectious disease physician,

01:10:32.820 if you could have believed that the answer was MMR combined causes autism. And while it won't save

01:10:39.540 my daughter to know that I could spare every other parent, because clearly you exude the ethos of

01:10:45.900 wanting to help everyone. All we have to do is separate these vaccines and we could solve it.

01:10:50.920 I mean, was there a part of you that just wanted this to be true?

01:10:53.440 Not necessarily. I mean, if it made sense to me and if there was a logical explanation and yeah,

01:11:01.020 if we knew there was a simple intervention, sure, but it was just so outrageous at the time

01:11:05.980 that wasn't even on my radar screen at that time to think in that way. I just knew that it had to be

01:11:12.600 genetic or maybe an epigenetic basis. And by the way, that's a real treat trying to explain

01:11:18.280 epigenetics to lay audiences. I started talking about microRNAs and histone deacetylation

01:11:26.180 that I'm still working on. So the epigenetic component is another one that's important. But

01:11:31.880 again, all of that had to be prenatal. And I remember having some conversations with

01:11:38.400 some of the anti-vaccine people and then saying it had to be prenatal. And I said, yes, we do give

01:11:45.720 some prenatal vaccines like flu vaccine. The immediate response was, aha. And I said, no,

01:11:52.320 I mean, you know, again, I don't see how an immunization during pregnancy could be linked

01:11:58.140 to that. And now the scientific data supports shows there's no link.

01:12:02.440 Autism is still such a complicated thing in terms of people even understanding what it means. So

01:12:06.940 the definition has morphed a little bit. So today we talk about ASD being a spectrum.

01:12:12.160 And it's gotten very complicated because there's this whole concept out there of neurodiversity.

01:12:19.460 So there are many in the autism community who bristle, if you even try to describe it as a

01:12:27.120 pathologic condition, they say, no, this is just an example of neurodiversity. People are different.

01:12:32.600 And I understand that. What I try to emphasize with Rachel, it's not the autism per se that's

01:12:41.900 incapacitating. It's in her case, you know, she's got clear, profound intellectual disability.

01:12:49.480 She can barely read. She can't do simple math. You know, when she goes to the store to buy something,

01:12:56.800 she will hand them a fistful of single dollar bills and say, here, because she doesn't know how to count

01:13:03.100 the money. She, no matter how hard we've tried to train her to do that, she doesn't understand the

01:13:07.820 value of things. And so she depends on the goodness of the merchants in our local Montrose neighborhood

01:13:14.700 have been great. You know, they kind of know Rachel. So it's in her case, it's profound intellectual

01:13:20.440 disabilities that make it tough and make us worry because the other piece to this is now she's an

01:13:26.860 adult with autism and intellectual disabilities and the special services and all that kind of stuff

01:13:32.540 really falls off the radar screen because we have no plan for her right now. We don't know.

01:13:39.120 We've tried to have her in a residential facility, which, you know, I think did an okay job, but her

01:13:45.620 behavior was too uncooperative. And finally they had to kind of kick her out. And so now she's with

01:13:51.420 us. And what worries me is I don't know what's going to happen after Anna and I are no longer here.

01:13:58.280 There's no roadmap for what you do with an adult with intellectual disabilities. And that really

01:14:03.820 worries me, especially in Texas. It's just not strong with services of those kind. And maybe it's

01:14:09.400 better up in the Northeast. And we've heard New York and Massachusetts, but trying to work that as a

01:14:14.900 huge, huge, heavy burden on us. How is the diagnosis made today? So if a parent today or a

01:14:21.940 pediatrician today suspects that something is not normal, whether it be language delay, changes in

01:14:28.920 behavior, emotional regulation, eye contact, all the things that would flag someone, what is the

01:14:36.020 actual process by which a diagnosis is made? Is this something that shows up in the DSM? What is the

01:14:40.800 criteria for diagnosis? It's still in the DSM. The DSM is still not as strong as it could be,

01:14:46.880 especially for girls, especially for little girls. But presumably the child gets referred to something

01:14:52.700 called birth to three, which is an early intervention program. And at some point they get medical attention

01:14:59.340 typically to a behavioral pediatrician, maybe a child psychiatrist. There are only about six of them

01:15:06.340 left in the planet. There's a huge need for more child psychiatrists. I tell all my medical students

01:15:12.840 to be going to child psychiatry with the hope that one of them goes into it. That's a real crisis as

01:15:17.460 well. Then the diagnosis is made along the way of limited social interactions. In some cases,

01:15:24.300 lack of speech. Although again, with girls and women, it's different. So there are a list of criteria

01:15:29.440 that you can look at. What's on the differential diagnosis? Like, is it a diagnosis of exclusion where

01:15:34.620 they're just basically saying, here are a bunch of things that could present with this pattern.

01:15:39.280 We're going to rule them all out. And that which remains is ASD or... Because when you think about

01:15:44.620 so many of those things, it's not like Down syndrome where there's such a clear phenotype

01:15:49.540 and genotype. It's unmistakable. This is much more nuanced.

01:15:54.120 And out years, in future years, will make whole exome sequencing so much more available that I think

01:16:02.180 anytime you have a child like that, you'll get whole exome sequencing and we'll actually be able

01:16:06.800 to target it to a specific gene. In some cases, that may be useful because there could be

01:16:12.800 pharmacological intervention in case there's something that is impairing abilities and can

01:16:19.000 be targeted. Can you explain why that's important? Why whole exome sequencing is relevant versus just

01:16:24.500 quote unquote, a genetic sequence? Well, because with whole exome sequencing,

01:16:28.080 you're getting the full sequence of every expressed gene. What that does for you is identifies rare

01:16:34.820 mutations that you wouldn't pick up just by looking at chromosomes. And so it's a very powerful

01:16:40.920 technology. At this point, it only picks up around 40%. So if you're of autism and you do whole exome

01:16:48.840 sequencing, my understanding is you'll only see a mutation maybe 30, 40% of the time because there's

01:16:54.380 other things going on, including the non-expressed genes. So exome sequencing just looks at the

01:17:00.980 expressed genes. But if you do the whole genome, potentially you could pick up additional ones as

01:17:05.380 well. So we're still in the early stages of that. And what's very interesting in that was some

01:17:10.040 children's hospitals are looking at the possibility of doing whole exome sequencing on every child they

01:17:16.380 admit for whatever cause, because we're learning so much about the genetics and epigenetics,

01:17:22.420 not only of autism, but so many other conditions. Right now, you're left with what I consider to be a

01:17:28.220 somewhat rudimentary list of criteria from the DSM. And I'll never forget, Peter, I once had a lecture

01:17:35.900 from a child psychiatrist when I was in medical school at Cornell. And I remember him saying,

01:17:43.360 we're going to look upon the DSM as such an anachronistic or out-of-touch document for child

01:17:49.560 psychiatry. It just doesn't cut. It's just really falls down for child psychiatric disorders. And

01:17:56.140 that was in the 1980s. Maybe it's moved on since then. I'd be curious to hear from a child psychiatrist

01:18:02.200 today what they think about DSM. But I'll never forget that comment. And when you look at the DSM

01:18:08.160 criteria, they're just not really robust for so many childhood conditions. And again, this whole

01:18:14.420 concept of neurodiversity is not reflected in the DSM like it needs to be. It'll get refined. And I

01:18:21.040 think that combining with whole exome sequencing and that combining with all the developments in

01:18:29.080 neuropsychiatric medications, I think things will look very different 10 years from now and then 10

01:18:35.200 years again from then. Do you have a sense, ballpark, how many children that are born today,

01:18:41.080 what will be the incidence of autism in the cohort of kids born in 2021?

01:18:47.600 Well, I think one is the number that's thrown out there now. What is it? One in 62? I can't

01:18:54.180 remember the latest. It's surprising. Yeah. I mean, it seems remarkably high.

01:18:58.240 Could come close to doubling because we're way undercounting all the girls and women with autism.

01:19:02.760 So it wouldn't surprise me that it would go down to something like one in 30 or...

01:19:07.020 What do we think that was in 1980, for example?

01:19:09.420 Yeah, I don't even know. But very rare because the criteria change. Before, there was a very

01:19:15.680 strict criteria about nonverbal boys with certain repetitive behaviors, and then we've enlarged it so

01:19:23.500 much. And then it's going to get very murky because now with this whole picture of neurodiversity,

01:19:30.560 at what point is it a condition that warrants criteria under DSM? And what is it just being

01:19:37.900 neurodiverse? And I don't know that there's going to be a cutoff, right? It's always going to be

01:19:44.160 that gray zone. So I talked to my oldest daughter a lot, who's an assistant professor at UCLA. She has

01:19:48.740 a PhD, Emily. She's got a PhD in developmental psychology and works at the Center for Disabilities.

01:19:55.380 And this is a real struggle and a difficult to get your arms around. But I think we still need a lot

01:20:01.080 of brilliance around these points. At what point is it something that you diagnose in the DSM? And

01:20:07.340 at what point is it not? And I don't have the answers to that right now.

01:20:10.920 When you consider something like Alzheimer's disease and you look at the change in prevalence

01:20:16.500 over the last 50 years, there are many factors involved. People are living longer. We have many

01:20:22.740 more tools to make the diagnosis. And then there are also factors that many of us, myself included,

01:20:28.040 believe are actually increasing the incidence. So the prevalence is higher because people live

01:20:33.540 longer, because we diagnose more, but because the true incidence is increasing.

01:20:37.900 Why do you think that is?

01:20:38.880 Because I think many of the risk factors for Alzheimer's disease are increasing dramatically.

01:20:43.280 So vascular disease, metabolic disease being the two among them by far, right? So yeah,

01:20:48.300 as we see insulin resistance increase, as we see a dyslipidemia increase and all of the things

01:20:53.820 that accompany it, I think we're actually creating more neuropathology.

01:20:59.180 We're actually working with a group at Baylor. We make vaccines. There's a group at Baylor College

01:21:05.140 of Medicine run by David Corey, who also has a collaboration with Europeans, have shown some

01:21:10.180 evidence of fungal involvement, even candida, because there are some of the plaques that you

01:21:16.520 see in the beta amyloid has got fungal sequences as well. And so what is the role of aspergillus

01:21:23.280 and yeast-forming fungi in this is getting very interesting as well.

01:21:28.060 I think that Alzheimer's disease is probably, for lack of a better word, the final common path.

01:21:33.180 There are many roads to it.

01:21:34.480 Right, right.

01:21:35.180 And I do think that there's absolutely a sort of toxic version of it as well that may actually

01:21:40.340 include infectious agents or environmental toxins and things like that.

01:21:44.240 With fungal disease, you could do something about it. You could vaccinate, for instance,

01:21:48.080 get fungal disease. Could a fungal vaccine become a help with reducing neurodegenerative disease?

01:21:55.420 So that's one of the things that we're starting to look at.

01:21:58.180 Using that as a model for thought, how do you now think about autism? Is it that, hey,

01:22:04.180 we're clearly more attuned to this, so we're making the diagnosis more. But do you also think

01:22:09.540 there's an increase in the incidence? In other words, is there an environmental trigger that is

01:22:15.120 either triggering this with or without manipulating the genome? So now we're going to have to talk about

01:22:20.780 what epigenetics means so people understand. You can have an environmental trigger that comes

01:22:25.280 along, triggers a condition for which there's a genetic susceptibility that does not alter the

01:22:30.260 genome or one that does so and alters the genome. What do you think is actually happening and what

01:22:35.700 are some of the plausible explanations?

01:22:38.220 Before I answer that, let me just say, just because this isn't complicated enough to make

01:22:43.060 it even more complicated, there's a group at Geisinger in Pennsylvania that's been looking

01:22:49.040 at a number of psychiatric conditions. And they've identified groups of families that have the same

01:22:56.700 genetic mutation, yet one individual has been diagnosed with autism, another schizophrenia,

01:23:04.420 and another, some other condition. I forget it was addictive behavior or something along those lines.

01:23:10.560 So you're right, genetics is dominant. But I think there are epigenetic factors that could

01:23:16.900 have some influencing role, and most likely it's going on in pregnancy. So when you talk about

01:23:23.500 epigenetics, that doesn't discount entirely environmental factors. But if it is, it's

01:23:30.580 environmental factors happening in pregnancy.

01:23:33.480 Explain why it has to be an environmental factor in pregnancy versus an environmental factor post-utero.

01:23:40.780 Because I think, again, I'm not a neuroscientist, but I think the structural changes in the brain

01:23:46.580 are already well underway by the time the baby's born. So there are processes that are set. When

01:23:53.620 you look at all the work coming out of Korchesny's lab and other labs, it's clearly showing that this

01:24:00.540 is going on early on in fetal brain development, maybe as late as the second trimester, but happening

01:24:07.480 in utero. And that's where all the action is occurring. If there is environmental influences,

01:24:12.740 it's most likely something happening in pregnancy.

01:24:15.960 So if you're a parent or a soon-to-be parent and you're listening to this, you're terrified.

01:24:21.200 It's terrifying enough to think that during the first six months of your pregnancy, the first and

01:24:25.920 second trimester, so many things can go wrong. I mean, obviously during the first trimester,

01:24:31.440 you're mostly just thinking about not miscarrying. And then once you sort of get through,

01:24:35.500 call it week eight, nine, 10, and you're thinking, okay, well, we're almost halfway to the point of

01:24:41.040 knowing, being confident we're not going to miscarry. Then you start to think about big

01:24:44.860 structural stuff. Is the heart okay? Does this thing have four chambers? Is the brain of normal

01:24:50.500 size? To think that there's some environmental trigger that could take a genetically susceptible fetus

01:24:58.260 and render them autistic. I can't imagine how that doesn't produce an incredible amount of speculation

01:25:05.960 and consternation.

01:25:07.720 But I think you have to be careful with your language. So it's not just genetically susceptible.

01:25:12.680 I mean, the genes are there and they're-

01:25:14.760 Are these deterministic?

01:25:16.140 They're causing autism. There might be some environmental influences that could affect expression

01:25:22.380 through epigenetics, but it's not so simple as to say genetic susceptibility. I don't think it's

01:25:29.040 quite that straightforward.

01:25:30.420 How deterministic do we think these genes are then?

01:25:32.260 I know what you're looking for. You're looking for an 80, 20, 90, 10, 70, 30. I don't think we

01:25:38.140 know that.

01:25:38.800 I mean, it's polygenic, presumably. What do we think here?

01:25:42.100 Well, in Rachel's case, it seemed to be so far as what we know. It's a single gene,

01:25:46.320 and I think that's true, but they're not all the same genes. So the point is the Broad Institute

01:25:51.160 at Harvard-MIT paper, which I think was in Cell, identified about 100 genes. But the common

01:25:57.520 denominator was they seemed to be all involved in early fetal brain development, all except for one

01:26:04.060 in the cortex of the brain, most involved in early excitatory and inhibitory neurons, and a lot of them

01:26:12.640 in the neuronal cytoskeletons. So there's a lot there there. I mean, it's clearly the genes are dominant.

01:26:19.540 Whether or not there's some epigenetic influences, that can affect whether it's full-on expression of autism

01:26:28.260 or whether there's schizophrenic components to it. I think that may be likely as well, but it's not as simple

01:26:36.040 as saying just genetic susceptibility, and it's overwhelming the environmental factor. I think it's the other way around.

01:26:41.880 I think it's overwhelmingly the genetics is the dominant factor, and yes, deterministic, and maybe

01:26:48.120 there are some epigenetic influences. So if that's the case, then there would be really

01:26:54.300 two reasonable explanations for the increase in the incidence of autism. I mean, do you believe that

01:27:00.680 there has been an increase in the incidence of autism over the last 40 or 50 years? A true increase in

01:27:04.480 incidence, not diagnosis. I have not seen any evidence for that, but I concede it's tough to

01:27:10.880 prove. So one of the things I ask are teachers, you know, are you seeing more autism? And most teachers

01:27:16.060 will say, yeah, I'm seeing a lot more autism, but I think a lot of that is due to more awareness. I think

01:27:22.380 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,

01:27:31.280 right? They're mentally retarded, or they're this or that, and now we realize they're on the

01:27:36.200 autism spectrum. There's also this component, and some teachers have told me, you've said,

01:27:41.660 well, if you want to get special services for your kid, you have to label it as autism. Otherwise,

01:27:46.960 they're not eligible for special services. And how much of that is going on is hard for me to know

01:27:52.600 either. And again, as I point out, as we get better with diagnosing girls and women with autism,

01:27:57.680 those numbers are going to go through the roof yet again. How heritable do you believe the

01:28:02.780 transmission of this is? Is this something where it's sort of like eye color, where a child can be

01:28:09.820 born with green eyes to a parent of blue and brown eyes? How do the genes transmit? What's the best

01:28:18.540 guess? Yeah, again, not an expert. I mean, in some cases, I think there's spontaneous mutations. I think

01:28:24.100 others, you know, I remember when Rachel was diagnosed with autism, Ann said, clearly, it's your

01:28:30.520 side of the family. And I said, what do you mean? What about your uncle so-and-so? And so there was

01:28:35.120 those kinds of discussions. Hard to know. I mean, I think clearly, you see autism in parents of kids

01:28:44.460 with autism, and it may not be fully diagnosed, but you definitely see that a lot of times. And I think

01:28:51.040 that's quite common. Ann has a theory that autism is more common among people of intellectual

01:28:57.760 accomplishment. And maybe there's some truth to that, but I think it's just bias on the basis of

01:29:04.820 people that Ann, I've been at a university my whole life, and Ann is always running into

01:29:09.280 academics. So I can understand why she thinks that, but I don't think that's been well established.

01:29:14.880 That's really interesting, Peter. I actually, I guess I took it as a given that there was a true

01:29:18.860 increase in the incidence of autism, though not as significant as what the perception is,

01:29:25.420 because the perception is also being driven by, as you say, just a tremendous increase in awareness,

01:29:31.320 diagnostic criteria becoming broader, more things being included. So for example,

01:29:36.640 what used to be called Asperger's is now technically a part of ASD.

01:29:40.900 Right. But I guess the question is, how would you ever sort it out? I guess what you could look,

01:29:44.620 if you had specific genetic markers that you could look at, that would be something you can hang on to

01:29:50.900 and say is the increase in certain genetic markers going up. But that's not trivial to look at either.

01:29:58.420 But I've always felt that there's been no true increase, but there may be some evidence for it.

01:30:04.180 So let's pivot to a little bit of the current around COVID. As we stand here today, Peter,

01:30:10.540 we're well on the path to most Americans who want to be vaccinated are getting pretty close to being

01:30:16.800 vaccinated. By the way, what's the latest on the vaccination of children? Where is the CDC on that?

01:30:23.800 What do we know about the vaccine? How many of the current vaccines as we stand here today,

01:30:29.020 really there are three that are used in the US, correct? I think the AstraZeneca one is not used in

01:30:33.740 the United States. They haven't applied for emergency use authorization. I'm worried about

01:30:37.480 that vaccine for reasons that we can talk about. But then there's the Novavax vaccine. So there could

01:30:43.640 be as many as five by the spring. In terms of kids, Pfizer just released data showing high levels of

01:30:52.000 efficacy in adolescents, 12 to 15. But there were small numbers. There was around 1,200 in the vaccine

01:30:57.920 group, 1,200 in the control group. And there were 18 cases of COVID in the control group, none in the

01:31:04.760 vaccinated group. And on that basis, and their press releases had 100% efficacy. I'm sure that won't

01:31:10.340 hold up. I mean, it'll probably go down. One of the interesting things about the kids, though,

01:31:15.540 those adolescents, the virus neutralizing antibody titers are really high, like 1,200, so higher than

01:31:21.100 older adults. So that may be a factor as well. And we're now starting to get our arms around correlates

01:31:28.860 of protection that really high levels of virus neutralizing antibody seem roughly to correlate

01:31:34.840 with efficacy. Is that consistent with your belief, Peter, that this would be more B cell mediated than

01:31:41.000 T cell mediated? Well, I think T cells have a role. I mean, I think virus neutralizing antibody may not

01:31:46.600 be everything. But if you don't have high levels of virus neutralizing antibody, you're not going to get

01:31:51.100 protection. And the problem with comparing those virus neutralizing antibodies is when you look at

01:31:57.620 the actual papers, they compare it with convalescent serum titers, and they're all over the map. So now

01:32:06.160 there's a paper up on MedArchive that does something very simple, which is rather than just give the

01:32:11.300 absolute value for the geometric mean titers, whether it's against pseudovirus or whether it's against

01:32:17.860 plaque reduction neutralization titers. What they do is they do a ratio of the virus neutralizing

01:32:24.620 antibody titers against the vaccine versus the virus neutralizing antibody titers on the convalescent to

01:32:30.760 kind of normalize it. And there's this very nice curve that's been generated that shows you need to

01:32:36.760 get it that the level of virus neutralizing antibodies has to be at least as high as the convalescent

01:32:42.480 and preferably about 1.5 or 2 to get really high levels of protection. And I think that's probably

01:32:49.660 what we're looking at. So it's not quite a true correlative protection, but I think we're moving

01:32:54.300 in that direction. And the adolescents get really high levels of virus neutralizing the antibody.

01:32:59.620 And did that Pfizer study give two shots or one?

01:33:02.520 I think it was two.

01:33:03.120 So now that we're out of the gate and millions of people have been vaccinated,

01:33:07.780 do you have any preference or concern over any of the vaccines? You obviously mentioned AstraZeneca,

01:33:14.260 which I want to hear about, but let's start with the US vaccines. Any reason to believe that one is

01:33:19.960 better than the other? In fact, I'll share with you something that I found very interesting,

01:33:23.480 which was the J&J vaccine, which is a single vaccine. And that vaccine, while the headline is

01:33:29.720 lower efficacy, if you actually look at the absolute risk reduction, as opposed to the

01:33:35.620 relative risk reduction, is at least as efficacious as Pfizer and Moderna. I found that to be very

01:33:41.520 interesting, and I'm surprised how that was sort of omitted from all the press.

01:33:45.220 And I also think it's hard to compare because it's a single dose. It's being given a single dose versus

01:33:51.800 the two doses. And it wouldn't surprise me if that J&J vaccine ultimately becomes a two-dose vaccine

01:33:57.600 down the line, because you may want to give a booster for one of the variants as well. And in

01:34:03.540 two doses, the virus neutralizing antibody titers is really, really high, and it'll be as good or

01:34:10.060 in terms of protection as Pfizer and Moderna. Certainly, I think to me, the single dose J&J looks

01:34:15.820 better than the single dose Pfizer and Moderna, not by much. The bottom line is they're all good.

01:34:20.440 They're all good vaccines. And I also think, don't be surprised if later on we're going to need a

01:34:27.260 boost for all of them. There'll be a third dose of the Moderna or Pfizer vaccine or a second dose

01:34:32.940 of the J&J. And what that will do, it'll elevate virus neutralizing antibody titers higher. It'll

01:34:39.520 create more durability of protection, I think. And that boost will be reconfigured for the South

01:34:48.160 African and the Brazilian variant, which are not here in a big way in the US, but may become a bigger

01:34:54.100 problem down the line. Right now, it's the UK variant, the B.1.1.7 variant that's accelerating.

01:34:59.640 All of the operational warp speed vaccines work really well against the UK variant. And I'm very

01:35:04.560 optimistic. That's because that variant has not mutated through its spike protein?

01:35:10.300 Well, it has. So the UK variant has a single amino acid substitution in an aromatic amino acid,

01:35:17.940 creating an aromatic amino acid. And that seems to reduce the level of virus neutralizing antibody.

01:35:23.520 I don't know if I have a mechanism to show you pictures. I really think this is a little bit

01:35:28.560 of molecular biology, but not much. I just showed this at Pediatric Grand Rounds at Columbia this

01:35:36.340 morning. I really love this. And to me, it helps people understand. As I often like to say,

01:35:42.520 it's not a 30-second UNICEF commercial, but... It's funny. I haven't seen any UNICEF commercials

01:35:46.900 recently. Okay. So now this B.1.1.7 variant's going up. So this is a paper that's up in BioArchive,

01:35:55.400 a preprint server, looking at the B.1.1.7 variant. And in the spike protein, what there is,

01:36:01.720 there's an amino acid substitution in the 501 position where it went from an asparagene

01:36:07.660 to a tyrosine. And a tyrosine is an aromatic amino acid. It has a ring to it. And they're able

01:36:15.360 to show, model it with the receptor, the angiotensin-converting enzyme, that now there's

01:36:20.480 another tyrosine. It's got a nice strong bond there.

01:36:23.520 Yeah. There's a ring-ring interaction. So it's these pi electrons that circulate in aromatic rings

01:36:29.520 that are interacting with each other. In addition, there's a hydrogen bond. And the reason I love this

01:36:35.040 so much is all we're talking about with this big acceleration of cases going up in Michigan and

01:36:41.180 affecting younger people and higher mortality and morbidity, it's a bit of a simplification,

01:36:46.440 but then again, it's not. It's all coming down to pi-pi interactions between two aromatic rings

01:36:53.360 in two tyrosines. Let's just make sure people understand this because not everybody understands

01:36:58.380 biochemistry, right? Each amino acid is coded for... There's a code, right? So you have

01:37:05.000 three nucleotides that code for an amino acid. So it sounds like one of those gets changed

01:37:11.480 and it changed the amino acid. And I can't remember, did you say it started at threonine or which...

01:37:16.940 So this is the wild type or the original lineage is now switching over to a tyrosine.

01:37:21.460 It went from threonine to tyrosine. And then all of a sudden that changes, literally changes the shape,

01:37:28.360 but also creates kind of an electrochemical attraction that wasn't there before. And so all of a sudden,

01:37:34.220 the spike protein has a greater attraction to the ACE2 receptor.

01:37:40.700 Right. Which presumably translates into better virus entry, maybe more virus replication. And that's

01:37:48.520 why you're getting more severe disease and younger people are getting sicker as well. The good news

01:37:54.800 is the virus neutralizing antibodies to the original spike protein seems to still work well against this

01:38:01.880 B.1.1.7 variant. So we're going to take this picture now and zoom out a bit. So now this is the

01:38:07.800 spike protein, which is a trimer. Actually, let me show you a real picture of it so you can see what

01:38:12.920 it looks like. This is the trimeric spike protein. So these are these little purple flowers on top.

01:38:19.700 Each one is a trimeric spike protein. And now we're going to show it again here. And they've got,

01:38:26.220 each one has its own receptor binding domain. And now what's going to happen is only one of the

01:38:31.940 receptor binding domains flips up and binds to the receptor, to the ACE2 receptor. And here's that one

01:38:39.100 amino acid substitution again that I blew up on previous slide.

01:38:43.760 So if you had the wild type on here, Peter, it would show...

01:38:47.520 It would look the same, but...

01:38:48.580 It would look the same. You would just have a lower affinity there. Yep.

01:38:51.740 Yep. And you wouldn't see this, it wouldn't be marked as having this mutation.

01:38:55.340 But the point is the antibodies to all of the original lineages from the vaccines

01:39:00.260 seem to work just as well and can still neutralize this interaction.

01:39:05.320 The problem comes in now with the other variants that are coming up from South Africa

01:39:10.520 and Brazil, the P1 variant from Brazil and the B1351. That's got a second amino acid substitution

01:39:18.440 over here, which is creating a lysine. And that I think is creating extra levels of

01:39:24.760 electrostatic interaction. So the binding potentially is even tighter. And this now is interfering

01:39:30.940 with the ability of antibodies to neutralize. So the virus neutralizing antibody titer goes down

01:39:38.340 and that translates to decrease in efficacy. So when you look at the published numbers,

01:39:45.200 these are some of the numbers here, the level of efficacy against the original, I'll call that

01:39:50.280 original slash UK, which is probably roughly about the same versus ZA, the South African variant.

01:39:57.080 And that's why you see it going down. Wow. So this is interesting. Let's digest this for a second.

01:40:02.260 So Pfizer and Moderna take an enormous reduction against that variant.

01:40:08.860 Well, no, no, let's be careful. So the Novavax and J&J, that's actual efficacy, published efficacy data.

01:40:14.820 In the case of Pfizer and Moderna, what you're looking at here is declines

01:40:20.140 in levels of virus neutralizing antibody in vitro.

01:40:24.920 Ah, thanks for clarifying that.

01:40:26.840 That's very important. And because the level of virus neutralizing antibody is so high to begin with,

01:40:32.420 there's enough residual that you're still getting good protection.

01:40:36.120 But we don't yet have the clinical data to see.

01:40:38.740 Well, now Pfizer's issued a press release yesterday saying they think in a very small

01:40:43.980 set, it seems to work really well against the South African variant, which makes sense given

01:40:49.700 the high levels of virus neutralizing antibody to begin with.

01:40:53.560 Tell me why you think the AstraZeneca takes the biggest hit here then.

01:40:57.540 Yeah. So the AstraZeneca started out in some cases, not as high levels of virus neutralizing

01:41:02.500 antibody. And a study was done in South Africa showing only 10% basically ineffective against

01:41:08.160 the South African variant. But talking to the Oxford people, one of the things they say is

01:41:13.740 it's a little unfair because they only tested it against moderate and mild disease. And they feel

01:41:21.440 that if you were to test against severe illness, it would still be very effective. And they

01:41:26.540 counter that the J&J results were mostly looking at severe illness. And if they, like J&J, had looked

01:41:32.920 at severe illness, they would have come up with similar numbers. But, you know, I guess we have to wait

01:41:37.260 and see what happens with that. The bigger issue with the AstraZeneca vaccine is just public

01:41:42.900 perception around the cerebral thrombosis that is being reported out of Europe. I think that's

01:41:48.920 causing a lot of damage. And it goes back and forth. You know, the German government through

01:41:54.540 their Paul Ehrlich Institute pointed out you had six, I think it was six cases of sinus venous

01:42:00.520 thrombosis, which is a rare condition in the vaccinated group. And they suspended it. And then several other

01:42:05.840 European countries did. That had big ramifications, especially for Africa. You know, Francophone

01:42:11.200 Africa listens to what's going on in France and et cetera. And I was going on a number of

01:42:16.980 Zoom conferences with groups in Africa. And they were very concerned about the AstraZeneca because

01:42:21.260 that was supposed to be a workhorse vaccine for low and middle income countries. The European

01:42:26.360 medicine agencies came along and said, no, no, it looks okay. We think this is not related to the

01:42:32.560 vaccine. But then in Science Magazine, two excellent science journalists, Gretchen Vogel and Kai

01:42:39.880 Kupperschmidt looked at this and they wrote about 31 cases of cerebral venous thrombosis and more clearly

01:42:48.040 showing it could be linked to the vaccine. It's a very rare event, but still that can really alter

01:42:53.880 public perception, especially in light of all of the very aggressive anti-vaccine activities that are

01:43:00.080 happening. So I don't know what the U.S. is going to do at this point. I hope they do authorize it for

01:43:05.300 emergency release, even if they never use it in the U.S. And the reason is if the U.S. declines or if

01:43:11.920 that derails, I think it could have a chilling effect on Latin America and Africa because we don't

01:43:17.000 have a lot of vaccines out there. That's why we came along with our recombinant protein vaccine

01:43:22.240 because there are not a lot of options. The big issue is, you know, if you look at what's going to be

01:43:28.260 made for low and middle income countries, there are not a lot of choices out there. I mean,

01:43:33.200 the two mRNA vaccines, it's still a new technology. We're not going to be able to scale that up in a

01:43:38.780 big way for Africa and Latin America. Yes. I mean, it's great. Pfizer donated 230,000 doses to Rwanda.

01:43:45.920 It was fantastic. But look at the numbers. There's 1.1 billion people in sub-Saharan Africa,

01:43:51.500 650 million people in Latin America. We're going to need 4 billion doses of vaccines. Where's that going to

01:43:57.420 come from? It's not going to come from the mRNA vaccines. Is the refrigeration also a problem?

01:44:02.960 Yeah. The fact that that onerous freezer requirement and then the J&J is having some

01:44:07.800 issues in scaling up production. Part of the problem was when the science policymakers were

01:44:13.900 looking at this, they went so heavy on the innovation and they wound up producing a lot of

01:44:18.880 really cool vaccines that are highly effective. But in terms of durability for scale up to make 4 billion

01:44:25.500 doses, I don't think that was high enough on their radar screen and didn't realize that when you use

01:44:30.140 a brand new technology, it's really hard to move to 4 billion doses. And that's why I'm hoping our

01:44:35.880 vaccine comes along, which is in part, a couple of donors came to me after one of the podcasts I did

01:44:42.280 with you. And that was game-changing for us because it allowed us to adapt our coronavirus program for

01:44:50.220 vaccines we're making for SARS and MERS to this recombinant protein vaccine for COVID-19.

01:44:56.860 What's the vehicle?

01:44:58.480 It's recombinant protein in yeast, just like the hepatitis B vaccine. You could produce a ton of it.

01:45:04.280 They have capacity for producing 100 million doses a month. And it's looking really good in clinical

01:45:10.280 trials and in non-human primate trials. I can't talk about it yet, but it should be out soon.

01:45:15.120 And hopefully that will come in and make a big difference because I'm really scared that we

01:45:20.720 have nothing for Africa and Latin America. I mean, what's amazing is how I had to struggle for

01:45:26.440 funding. I mean, I was spending a good part of last year just trying to keep the program going

01:45:31.460 because it was so hard to get funds for what was so obviously needed, which is a low-cost,

01:45:36.920 unfussy, durable vaccine for low- and middle-income countries. And because of your podcast groups,

01:45:42.300 like Tito's Vodka came through with some funding. They're based in Austin and anonymous donor and

01:45:49.120 a couple of others. So now the Claybrook Foundation is helping us in a big way.

01:45:53.820 They're a Texas foundation and the JPB Foundation and a few others. So that was game-changing.

01:46:01.360 So Peter, based on everything you're saying, it sounds like the biggest concern right now would

01:46:04.680 have to be Brazil followed by Africa. Unless I missed it, did you explain the mutation in

01:46:12.040 Brazil and the efficacy that any of the current vaccines would have against it, notwithstanding

01:46:16.560 the scale-up limitations? Yeah, a couple of things. So the P1 variant in Brazil has those same two

01:46:23.380 amino acid changes in the South African. So I kind of think of them as brother-sister issues. So

01:46:30.180 dealing with South Africa will hopefully take care of Brazil as well. One other thing I wanted to mention

01:46:36.300 is the global policymakers did a good job of creating this COVAX sharing facility. It's really

01:46:41.960 quite brilliant in its design. I think that's not the issue because they were really worried about

01:46:47.540 equity. The equity issue, I think, was more of the fact that we didn't ensure there was enough vaccine

01:46:54.460 available for the COVAX sharing facility. And that's really the problem right now. And hopefully

01:47:00.280 we can come in and address it and take care of this. Because if we don't figure out a way to

01:47:06.620 vaccinate the rest of the world, if we only vaccinate North America and Europe, it's going to be a

01:47:11.180 catastrophe. This virus is going to continue to circulate and cause tremendous humanitarian

01:47:16.120 destruction, but also who knows what other variants could evolve as well as a consequence of

01:47:21.980 allowing that to go unfettered. What drives the evolutionary pressure here of these mutations?

01:47:27.020 It's just standard Darwinian behavior where mutations occur and they're escaping because

01:47:32.720 these mutations... How does the mutagenicity of this virus compare to influenza? It seems far less

01:47:38.020 than influenza. A lot of us were surprised by the variants. We thought that we hadn't really seen

01:47:44.200 this as much in coronaviruses. What some people speculate is it happened because of an immunocompromised

01:47:52.240 individual who had a lot more virus replication in their system and that combining even possibly with

01:48:00.540 receiving plasma convalescent therapy that put some kind of selective pressure on it. And that's kind

01:48:06.720 of a hypothesis that's out there, but that's not strong. I don't think we really know that for certain

01:48:12.280 at this point. The good news is the way I see it is a lot of the viruses are converging to the same

01:48:20.040 mutations. So my hope, and it's only a hope, and there's by no mean consensus in the scientific community,

01:48:27.840 is that if we make a booster to this South African slash P1 Brazil variant, we might be done at that point.

01:48:36.460 That there won't be this continual evolution for totally something different, but I don't think we know

01:48:42.660 that for certain. So the good news also is it looks like our vaccine seems to give pretty good levels of

01:48:49.360 virus neutralizing antibody to the South African variant as well. So we're making the booster for it for the

01:48:54.900 South African just in case, but we may not need it. We'll see.

01:48:58.220 We don't know how often we would need the booster. It could be every six months, every 12 months, every 18 months.

01:49:02.780 It's too soon to tell, obviously, until we have longitudinal data looking at the neutralizing antibodies.

01:49:07.640 I mean, my dream situation is we give this one boost beyond the original vaccine series later this year

01:49:15.000 or next year, and then we're done, that it won't have to be every year. But like anything else, we'll

01:49:20.420 just have to monitor and follow it. But people say, is it going to be like flu where we have to vaccinate

01:49:25.100 every year? And at this point, I don't think so, but I can't say for certain.

01:49:30.240 Because in the case of the flu, that's driven more by the mutagenicity than the lack of BESOL response,

01:49:35.580 isn't it? Well, in the case of the flu, you're getting these wholesale antigenic shifts. So

01:49:41.820 really like a totally different virus. And there's this carefully orchestrated dance

01:49:46.080 that we have in place to monitor flu virus strains, maybe coming out of Asia, and then

01:49:53.380 quickly transmitting the message to the pharmaceutical manufacturers who make a whole

01:49:57.460 different vaccine every year. It's really quite extraordinary. I don't think we're going to need

01:50:02.300 to do that for coronavirus vaccines. At least that's my hope, but we'll see how this unfolds.

01:50:07.780 But one thing's for certain, if you look at what's available for Africa and Latin America right now,

01:50:12.540 it's not good. And so I've been talking to a colleague, Patrick Shung Shin, who's in Los Angeles,

01:50:19.480 and he's really interested to see, can we build out vaccine development capacity in Africa or maybe

01:50:27.280 Latin America? Because right now there's no vaccines made on the African continent. Nearly

01:50:32.120 enough in Latin America, not much in the Middle East. We've learned that if you only rely on the

01:50:37.520 multinational companies, even with that great COVAX sharing facility, they're not going to make new

01:50:42.440 vaccines for the world, at least in rapid timeframe. It's amazing they do what they do. I mean, Gavi,

01:50:48.220 the Gavi Alliance for Vaccining the World's Children depends heavily on the multinational companies.

01:50:53.040 They do a great job, but we need parallel mechanisms in place like new vaccine development

01:50:59.340 production facilities locally in Africa and Latin America. And that's something that we've been

01:51:05.760 working a lot in this concept of vaccine diplomacy and building that out.

01:51:11.080 Well, Peter, I know that we have a real hard stop in time because you've got another obligation,

01:51:15.960 but really happy that we were able to spend a couple hours together. We covered a lot of ground and

01:51:20.240 we actually got through half of what I wanted to talk about. So I consider that a win.

01:51:24.140 It was an only half. Okay. Well, I'm always happy to come back. I love being on your podcast

01:51:29.500 one, because I learned so much from you. And the thing I really appreciate is you ask questions that

01:51:36.280 I just never would have thought of on my own. And, you know, after you ask it, I say, why don't I

01:51:41.020 know that I should have, I mean, that's so obvious that I should know that because it's the right

01:51:45.380 question to ask. So you have this amazing talent for asking the right questions and I appreciate

01:51:50.320 that. Well, thanks very much again for everything, Peter. And I'm sure we will be talking again soon.

01:51:55.140 Okay. Thanks so much.

01:51:57.340 Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper

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The Peter Attia Drive - April 26, 2021

#159 - Peter Hotez, M.D., Ph.D.： Evolution of the anti-vaccine movement, the causes of autism, and COVID-19 vaccine state of affairs

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