Vaccination in the Crosshairs: Paul Offit Sounds the Alarm

In this Instagram Live discussion, MedPage Today editor-in-chief Jeremy Faust, MD, talks with Paul Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia, about the growing threat to public health posed by new HHS Secretary Robert F. Kennedy Jr.

Faust and Offit break down the Trump administration's recent actions, the resurgence of vaccine skepticism, and the implications of Kennedy's history of spreading vaccine misinformation.

Following is a partial transcript of the video (note that errors are possible):

Faust: Dr. Offit, how are you?

Offit: I'm good. Can you hear me OK?

Faust: Yeah, perfect. I'll just reset the room for everyone who knows you and people who do not. Dr. Offit is the director of the Vaccine Education Center and the professor of pediatrics, Division of Infectious Diseases at CHOP, that's Children's Hospital of Philadelphia, and one of the inventors of the rotavirus vaccine, which has saved, I don't know, millions of lives, Paul? But beyond that, just one of the clearest, most direct and honest thinkers you're going to find on assessing vaccine science. It's not just, yay, everything is perfect and we have to go along with the flow. It's look at the science and it's follow the data, and that's what I think so many of us admire about you, including myself. So thank you for coming on the show here.

Offit: Thank you, Jeremy. It's nice of you to say that. Thank you.

Faust: Well, it's true. I mean, I will say we're about to talk about how important vaccines are, but I think to do that, it doesn't hurt just to remind people that Paul and I are two people who have occasionally gotten heat when we didn't go with the flow. And I'll say that we're sometimes we're shading the details saying, look, here's a tough call and let's figure it out. But on the overall project, I mean, is there anything in human history that saved more lives than vaccines?

Offit: Maybe purifying the drinking water, but certainly vaccines are right up there. And sanitation. I mean, digging toilets probably in developing world countries also was a value. But yeah.

Faust: See already the nuance comes out with this man. But today, if you have a population living here, is there anything people can do for their kids that's safer than that action?

Offit: No, I think we live 30 years longer than we did 100 years ago, in large part because of vaccines.

Faust: Which is an incredible accomplishment. During your career, you've really seen the pendulum. The good old days weren't so good. There were always issues, but how does today feel compared to, say, 1998 when -- I think it was '98 -- when The Lancet published this sort of now just infamous garbage, not only bad study, but fraudulent study making a supposed linkage between vaccinations and autismopens in a new tab or window. Tell us, how does today feel versus then?

Offit: It's interesting. I would even date it a little before that. I think that the moment to me where a line was crossed was in 1982 when there was a special on NBC called "DPT [diphtheria, tetanus, pertussis] Vaccine Roulette" that tried to make the claim that the whole-cell pertussis vaccine caused permanent brain damage.

And I think that really surprised people because now for the first time, there was a public notion, at least among some, that vaccines were doing more harm than good. There were committee hearings that were held. Paula Hawkins, I remember, Republican from Florida, held community hearings looking into whether vaccines were doing more harm than good. And there was a flood of litigation in the early 1980s.

And so we went from 18 pharmaceutical companies that made vaccines to by the end of the decade four, because there was this perception that a whole-cell pertussis vaccine caused harm.

And I think what we learned from that -- but it was the hard way -- was that don't be surprised by this, because we assumed everybody thought vaccines were safe and effective, so not to worry. So that when 1998 hit and Andrew Wakefield published that paper in The Lancet, we were much quicker to do the studies immediately instead of just standing back and going, I can't believe people don't think vaccines are safe.

So I think that was the moment, because that flood of litigation led to the National Childhood Vaccine Injury Actopens in a new tab or window and the Vaccine Injury Compensation Programopens in a new tab or window. But I think that the second punch was the Wakefield punch.

Faust: Something that I think is so fascinating about the "Wakefield punch" as you call it, is that after that happened, it took quite some time for the community to properly respond. And one of the things that I found so amazing is that Congress actually looked into this, and if I remember my history correctly, Congress actually came up with the fact that that paper was trash way before The Lancet even got around to retracting it. Is that right?

Offit: That's for sure. I mean, The Lancet didn't get around to retracting it for like 10 years. It took forever for them to retract it. And the person who was the editor in chief, Richard Horton, was asked far more before that to please retract this paper because it was still having such an impact. I'm not sure the retraction really made much difference, but it was way too late. I completely agree.

Faust: Well, when you think about the fact that the United States Congress looked into that on its own, this was, I believe in 2003, if I remember -- it seems like that's a generation ago, but it seems like five generations ago -- to imagine Congress doing that and getting that right. Do you remember that process?

Offit: Yeah, it was a different time. Sure. I mean, it's funny, I'll tell you, there was a time when I would sort of go around and talk to Congressmen about the importance of creating a vaccine program -- which tells you this was decades ago -- for children who were uninsured or underinsured so that we could make sure they got vaccines.

And the Republicans were so much easier for me than the Democrats because the Republicans were institutionalists. I mean, they believed in the CDC, the FDA, the NIH, whereas the Democrats were much more sort of in line with personal injury lawyers. And I was always having these fights with the Democrats trying to make the argument, no, the pertussis vaccine doesn't cause permanent brain damage. No, the measles-containing vaccine doesn't cause autism. The Democrats were much harder for me than the Republicans.

Faust: And there was this whole thing about -- and I think it's true, but it's one of these just-so stories -- where if you wanted to know where vaccine hesitancy was highest, you asked how far were you from a Whole Foods. Because this was where all the liberal enclaves were, and it was the crunchy liberals about 10 years ago who were kind of the problem. You had some sort of very far right kind of libertarian types, but mostly it was really a sort of fringe, crunchy liberal thing that was anti-vax.

Offit: I think there really wasn't a politics of the anti-vaccine movement then. You're right, there were certainly the crunchy liberals. That was that 2014/2015 measles epidemic in Southern California. That was that group. But there was always the libertarian "government off my back, don't tell me what to do." I think that was the other part of the anti-vaccine movement, which has become much more prominent now associated with the COVID pandemic.

Faust: I'm curious what you think happened there, because I remember coming up and noticing that, it was not just one side. It was really both sides, and there were different kind of shades of the same color, if you will, or different flavors of the same dish. But really vaccine skepticism and vaccine hesitancy coming from a very sort of very left sort of fringe left. That's gone for the most part. What do you think actually, what was the success there? Because maybe there's something to learn.

Offit: It just seems that the left was more willing to buy into the institutions. I think that was it, which didn't used to be true. I think the opposite was true, but I think that's where that is now. I think what happened during the pandemic that made this so much worse, I mean not just a rejection of vaccines, but sort of rejection of science. I think science is losing its place as a source of truth. I think people are just declaring their own scientific truths.

But I think there were two things that happened. I think during 2020 before we had vaccines, which wasn't until December of 2020, so we didn't have anything to prevent a virus that was causing hundreds and thousands of people to die every day and was spreading asymptomatically, so everybody that you came in contact with potentially could transmit a virus to you that could kill you. And so we didn't have vaccines until December. We didn't have monoclonals until November. We didn't have antivirals until October, so we didn't have anything that year. So what did we do? We shuttered schools, we closed businesses, we restricted travel, we isolated, quarantine masked.

And I think people really felt that was government overreach, especially the shuttering of schools. People were really angry about that. And at some level, justifiably, I think especially for children who had special needs who now aren't getting the services they need, I think that was part of it.

And then the following year, now you had a vaccine, and so you mandated vaccines for everything -- for bars, restaurants, and places of worship, I think, and sporting events. And people saw that as government overreach. So we just leaned into this libertarian left hook, and I think that's what we're feeling. We're feeling the results of that left hook.

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