The Joe Rogan Experience - #1261 - Peter Hotez

Episode Date: March 11, 2019

Peter Hotez, M.D., Ph.D. is Dean of the National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine where he is also the Director of the Texas Children’s Center for Vaccine Development (CVD) and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics.

and we're live how are you sir how are you good to see you again i'm thrilled to be here thanks for doing this man thanks for having me i know i should tell people before we get started i did not know when i asked you to come back on that you were heavily involved in this whole vaccine debate what i wanted to have you on to talk about is tropical diseases because I remember when we did that sci-fi show, you explained to me that some ungodly percentage of people that live in tropical climates are infected by parasites. That's right.

Well, my day job is developing vaccines for tropical diseases. We develop the vaccines no one else will make because they're for the world's poorest people. So we call them tropical diseases, but they really are diseases of poverty. The vaccine issue, the advocacy issue around vaccines and autism is kind of a new thing that I got drawn into just because I'm a parent of an adult daughter with autism and I make vaccines. So it was a natural that i'd get drawn into it yeah so when i said that you were going to come on then i got inundated by people that are you know the the vaccine thing is such a polarizing issue yeah it's awful and so many people seem to think they absolutely know

what causes what especially when it comes to something like autism, which is a huge issue in this country, it's a huge issue around the world, and it didn't used to seem to be. The question is, was that because it was undiagnosed? Was that because it's more prevalent today? What do you think? What is your take on this? Well, I don't think we really know. One thing's for sure, we're diagnosing people with autism who we diagnosed as something else in the past, whether it was really horrible diagnosis.

We'd use pejorative terms like mental retardation. What's the matter, Jamie? Just telling you the clock was off. Oh, okay. Sorry. Sorry. Should we start again? No, no, no.

It's okay. He was just telling me that our clock is screwed up because of the daylight savings off. Oh, okay. Sorry. Sorry. Should we start again? No, no, no. It's okay. He was just saying, he was just telling me that our clock is screwed up because of the daylight savings time. Oh, right. Sorry. Totally unrelated to what you were saying. The whole country's clock is screwed up because of daylight savings. Yeah. Right.

So we don't know. We don't. Well, you know, one thing's clear. The number of diagnoses is going up. clear the number of diagnoses is going up but part of that is because what we used to call pejorative things like mental retardation now get thrown into the autism category the other thing they do absolutely how so well you know now we call it as part of the autism spectrum um we also because autism often has a lot of associated intellectual disabilities. Not always, but sometimes. The other is that – Can I pause for a second?

Is that based on aptitude tests? Like how do they decide? How do they decide what's autism? Yes. They have a list of diagnostic categories. But it's not like you could test someone if they test positive for a disease. That's right. That's right.

someone if they test positive for a disease. That's right. That's right. Well, although, you know, one of the interesting side pieces to this is, you know, there's a group of people out there who self-identify themselves as the autistics, and they get very resentful or hurt when they're called a disease or a disorder because they say, well, we're not an epidemic. We're a person, And it's part of this whole neurodiversity movement, which is quite interesting.

Darrell Bock Neurodiversity movement. Peter Robinson Right. They say they're neurodiverse, that they maybe think differently from others, and they respond differently than others, but they're not, quote, abnormal. And I think they have a good argument. Darrell Bock I heard a crazy argument once with someone that was- Peter Robinson So the point is that it's – the impairment – like Rachel, my daughter, it's not so much her autism that thwarts her ability to have partners or to have a meaningful career. It's the fact that she has profound – in her case, profound intellectual disability that goes along with it.

I forget what I was going to say. So when they say that people have, there's a spectrum, right? And some people who are autistic have incredible abilities. That's right. They have incredible mathematical abilities, musical abilities, language abilities, and then some people do not, and some people have legitimate issues. Yeah, with Rachel's case, my daughter, she has a pretty good verbal IQ, 80, 90, but she has a very low performance IQ in 40.

She can't do simple math. She can't count money. Fortunately, Goodwill Industries came to her rescue and our rescue, and now she works there two hours a day sorting clothes. And that's been really meaningful for her to get a paycheck. Oh, that's great. Even if it's minimum wage, yeah. Right, just to do something and feel.

Right. And feel part of the mix. Yeah. That's huge. That's huge for everyone, right? Absolutely. Yeah. Absolutely.

But so there's no, it's not like you could test positive for syphilis or you can test positive for the flu. Right. Although now, you know, as I say, you know, so that's why I don't like using those terms because it puts people on the autism spectrum as though they have a disease or a disorder, which I don't like to do. But if it is a disorder, no? Well, now we know there are 99 genes that are linked to autism. But why is it a bad thing to say that you have a disorder if it's just a disorder? People have disorders.

It's a fact. Well, you know, a lot of the individuals that self-identify themselves as the autistics don't like to think of themselves as a disorder. They like to think of themselves as different, but not necessarily as a disorder. Right. But that doesn't help us when we're trying to discuss it, does it? Yeah. It gets hard to talk about.

Well, also, they're trying to stop you from talking about it in a certain fashion, which is actually accurate, right? They have an issue. There is an issue. To say there's no issue is kind of ridiculous. I mean, there's a reason why so many people are so concerned about autism and vaccines and just autism in general, whether it's environmental pollution factors or whatever. What they like to do is they like to make the distinction between autism, that neurodiversity

thing, and actually having intellectual disabilities that go along with it. Okay. And maybe it's a bit of semantics also, but they feel strongly about it. Right. Now, if we don't know what causes autism. Well, we do. We do. Well, we're. We do.

Well, we're getting there very closely. So we've now, there was a very important paper produced, written by a group at the Broad Institute at Harvard at MIT, which is one of the premier genetics, genomics organizations in the country. And they've now identified 99 genes. It's a huge team of scientists, not only at the Broad, including scientists at Baylor College of Medicine. 99 genes involved in autism, all involved in early fetal development, early brain development in the first and second trimester of pregnancy. So now we're starting to really get our arms around what autism is. And that's one of the things I talk about in the book. I mean, we have learned so much in the last couple of years about autism, how it begins early fetal development well before kids ever see vaccines. And that's one of the reasons I say vaccines did not cause Rachel's autism.

Vaccines don't cause autism because autism is already underway in early brain development. Is it possible that some people have this tendency towards autism and it's exacerbated by vaccines? I don't think so. I think what happens is the sequence of events happens during pregnancy, but the full clinical expression of autism often doesn't happen until 18 or 19 months of age. Like Rachel, for instance, wasn't actually diagnosed until 19 months of age. And there's some fabulous studies now showing that that clinical expression of autism actually coincides with a big increase in the volume of the brain. You can actually show on serial magnetic resonance imaging,

serial MRI, how the brain volume starts to increase. And that's very important because parents will often remember, oh, my kid got vaccinated around 18 months of age or 15 months of age and want to link the two. But now you can go back to six months of age. And this is studies done at the University of North Carolina, Chapel Hill, showing so that you could do an MRI at six months of age. And they can predict now, they say with 90 percent accuracy, which of the kids will go on to develop autism. And then you could take it – What are they seeing? What?

What are they seeing? They can see – we can go into detail in the paper, but they can see certain things on signatures on MRI that tell them that this kid is going to go on to develop autism. Okay. So, in fact, there is a way to test positive for autism then with this serial MRI. That's what they think, right. That's what they think. And now we have the 99 genes, so we can even take it back further by doing what's called whole exome sequencing, sequencing all the DNA, all the expressed DNA of an individual. And in Rachel's case, we did that, and we actually found a mutation in a gene controlling neuronal connections,

which makes a lot of sense if you think about what autism is. Yeah, of course. So there is a way to show whether children will be more likely to develop autism, and there is a way to look at their brain through fMRI at a very early age. And also do genetic sequencing. So it's not simply a matter of how they perform on cognitive tests. That's right. That's right.

We're getting much better at getting arms around the diagnosis. Why do you think there's so many people that have these anecdotal stories of their child getting vaccinated, especially large doses of vaccines when they hit them with like 10 in a row, and then all of a sudden, or measles, mumps, and rebellious, the one that gets repeated over and over again. That's the one that made my child have autism. I've heard that so many times, and I've heard it from friends, from friends that have children that have autism. They had a child. Their child got the measles, mumps, and rebellious shot, and then immediately there was a very distinct change in the child's behavior. Well, no question when you get the measles, mumps, rubella vaccine, many times kids

cry and things like that. And then autism will then begin sometime between the first and second year of life. So it's logical to want to connect the two. But now we know it's not even plausible because we know that if you go back to that MRI at six months of age or go back prenatally, we can even determine which kids are going to go on to develop autism. And then complementing it are massive epidemiologic studies done on over one million kids. on over 1 million kids. In fact, a new paper was just released this week showing that kids who get the MMR vaccine are no more likely to get autism than kids who don't get the MMR vaccine. And the converse is also true. Kids on the autism spectrum are no more likely to have gotten the MMR vaccine than kids not on the autism spectrum. So it's a combination of that, those big studies of over 1 million kids together with knowing what autism is that completely rules out the possibility.

Right. So these genes, excuse me, and the issue with these genes, and then the ability to scan the brain with the serial MRI, and so you can tell which children have the propensity. Is it possible that children have all these issues and then do not get autism, or do 100% of those children with those issues get autism? That's a good question. I don't know. I'm a vaccine scientist, so I'm, you know, the—

You're not a biologist. Well, I'm a biologist, but I'm a vaccine scientist who's really tried to do a deep dive in autism doing research on the book. Versus human development. Right. Okay, so what you're saying, though, is that if a child does not have these mutations and does not have these issues that are present during a serial MRI, that they will not go on to develop autism. Is that true? As far as we can tell. As far as we can tell.

As far as we can tell. So children without those issues who get vaccinated have no problems, which most children have no problems, right? Yeah. I mean, we've learned a lot about the risk of vaccines, and the numbers are extraordinary. I mean, the risk of a severe adverse event happening after getting a vaccine is roughly on the order of one in a million, between one in a million and one in 10 million. And I found an internet report once that the likelihood of getting struck by lightning is one in 700,000. So it's, you know, the likelihood of having a severe event after a vaccine is your odds are better of getting struck by lightning than... And when you say severe event, what do you mean by severe event, though?

Well, there's actually a table that's put out by the National Vaccine Compensation Act that includes shoulder injury. That's one. Encephalitis. Shoulder injury. Yeah injury that's one encephalitis shoulder injury yeah that's actually from the actual injection point put getting injecting it in the wrong place oh so it goes into the joint or something like that yeah yeah is that common no no so there there have been issues where children have adverse effects and reactions to vaccines. What do you attribute those to? One in a million. I think in some cases—

Biological variability? I think in some cases, inadvertently, if it's a live virus vaccine like the measles, mumps, rubella vaccine, and you have an underlying immune deficiency that wasn't picked up before, then that virus can replicate better, but very rare things like that. Right. So as far as you know, children who are healthy who get a vaccine, it's not biologically possible for them to develop these traits, these mutations in the genes, and these issues that you see present.

As best we can tell right now, that seems to be the case, right? As best you can tell right now, seems to be the case right as best you can tell right now is a it's a great thing to say i i but for people that are like hmm on the outside like what does that mean i'm not a doctor i'm not smart enough to understand what dr hotez is saying here what is he saying as best as we can tell how much can we tell so here's what we can tell we know um studies number one million children that there's no link between vaccines and autism that's number one and and so let me parse how do they let me let me parse this out in two bits so there's there's the studies on of one million children showing that vaccines do not cause autism that's part one the second and then i'll do and then i'll do a deeper dive on each of them.

The second part shows not only is there massive evidence that there's no link between vaccines and autism, there's no plausibility because we know so much about autism, how it begins in pregnancy. So let's go back to the first part. The first part is studies in over 1 million children. One of the things that the anti-vaccine lobby does is they play this game of what I, well, it's not really a game, but what they do is play this kind of thing of vaccine whack-a-mole because at first they alleged it was the MMR vaccine and that came out of the study that was published in The Lancet in 1998. Then another group came along and said, no, no, no, we didn't mean the MMR vaccine. We meant the thimerosal preservative that used to be in vaccine. And the scientific community not only debunked the MMR link, they debunked the thimerosal link.

Then the anti-vaccine lobby came along and said, no, no, we didn't mean that. We're spacing vaccines too close together. Then they changed it around again, saying now it's the alum or aluminum in vaccines. And then each time the scientific community responds with massive epidemiologic studies showing there's absolutely none of those things are true and do you think that it's just when you look at say if there's one in a million that has an issue with this and there's and it's not autism by the way so whatever whatever those issues are that they hear these stories and these stories do accumulate because there's 300 plus million people in this country.

And over 10, 20 years of one in a million, you develop a significant history of cases where children did have issues with vaccines. So these people hear about these stories and people are terrified obviously you're i have children you become very overprotective of your children you worry a lot right and then you also don't know like why do they get so many shots all in a row like that why does a baby get 10 shots in a day that seems crazy well they don't get 10 shots in a day most of the most of the vaccines are now combined so for instance in one, we can vaccinate against diphtheria, pertussis, tetanus, polio, haemophilus influenzae type B, which is a terrible cause of meningitis, and in some cases, not even hepatitis. So one shot is protective. So it's like a soup of all these things?

Well, it's combined. And there's all sorts of studies showing that it's safe to combine them. And it's fantastic. Now you can vaccinate with one shot against six diseases. And these are life-threatening diseases. Right. So the only concern is the child's immune system when they're bombarded with this one. So a lot of times it causes them to be tired or they get sick or they don't feel very good.

But the point is the immune system is not bombarded. I think that's another kind of a misnomer or a misunderstanding that's put out by the anti-vaccine lobby. Remember, the child's gut, the intestines, and the respiratory tree is this organs of antigen presentation. A baby, on average, is exposed to hundreds of new antigens every day. So the idea that you're going to, quote, overwhelm the immune system with a vaccine against six diseases just doesn't make any sense. Again, this is all phony baloney stuff put out by the anti-vaccine lobby. Let's be clear. The anti-vaccine lobby owns the internet right now. What does that mean?

What that means is they've put out now, by some estimates, 500 anti-vaccine websites, so that every time you put the word vaccine into a search engine, whether it's Yahoo or Google, you're going to get anti-vaccine misinformation. That's number one. Second, we know now it's amplified on social media like Facebook, other forms of social media. So third, look at the Amazon site. I mean, it's incredible. So my book, this book, the good news is it's – I think right now it's the highest rated pro-vaccine book on Amazon. The bad news is overall it's ranked about 20 because there's 19 other phony baloney

anti-vaccine books. So the Amazon is the biggest purveyor now of anti-vaccine books. And wait, it gets even worse. Then you also have now they've become politicized. They have political action committees in multiple states lobbying state legislators about fault but with applying them with false information about what facts vaccines do so and and the problem is we don't have a robust system of pro vaccine advocacy

to counter it so we don't really hear as much as we need to from the federal government from the CDC from the Surgeon General. So unfortunately, in this country, the defense of vaccines falls to a handful of academics like myself. And, you know, I'm an academic. I wrote a book. What chance do I stand against this major media empire? Why do you think that exists?

Why do you think there is this major media empire that's against vaccines? That's a great question. What's the motivation, number one? And number two, where's the money coming from? Right. There's real money behind this, millions of dollars behind this to put out phony documentaries and phony books. What's a good phony documentary to point to? Well, I'm a little reluctant to say it because they're so litigious. Okay. And I don't have the means to defend a lawsuit and things like that. But they're out there. So these documentaries – That's why I usually don't name specific names.

Sure. I understand. These documentaries, what do you think their motivation is? Do you think they earnestly believe that vaccines do cause harm or vaccines do cause diseases? Or excuse me, autism? I don't know. I mean, is there some kind of other agenda that they have? I mean, we do know in some cases that some elements of the anti-vaccine lobby are promoting phony autism therapies, right? They're doing terrible things like this thing called mms

which are bleach enemas what yeah bleach giving bleach enemas to kids you can to children the children bleach why bleach because they're cleansing the immune system they're cleansing them of toxin though it's really awful stuff um and they're doing chelation therapy which is very dangerous what is that that's where they they where they claim kids are overdosed with toxic metals, so they give a chemical that actually can chelate the metal. But it can chelate your calcium and then put you into a fatal arrhythmia as well. They're also – Who is doing this chelation therapy?

You can Google it or whatever. But are these doctors? In some cases, they're doctors, unfortunately, or other health professionals. And what is – I mean, I'm sure you've studied this. What is the evidence? Wait, it gets worse. There's no evidence. And then they're doing hyperbaric therapy, which is really bad.

So in some – Hyperbaric therapy is bad? Well, it doesn't do anything for autism. That's for sure. But it's good for recovering from injuries and – Yeah, under certain selected – but who knows what it's doing to a young kid, right? I mean, so you shouldn't be doing that. Then the other – then that's one.

So how much of this is being driven by financial motivation peddling these phony autism therapies? I can't say. My sense is that's not the big piece of this. Yeah. I can't say. My sense is that's not the big piece of this. There's also some reports now of Russian bots and trolls that are amplifying this and sowing political instability in the country. But again, you add that all up, the phony autism therapies, the Russian bots and trolls. In my mind, that really doesn't get our arms around the big driver of this thing. So I think we really need some good investigative journalists to look into this. Well, do you think that there's some sort of a concerted effort? Or do you think that

just a bunch of people that really believe that vaccines do cause autism, they don't truly understand the science, they haven't talked to someone like you, and maybe they have this idea that's cemented in their mind, and they're not willing to look at it objectively and look at the full spectrum of possibilities and look at the science behind what you guys are saying because in their head they've been saying vaccines cause autism they've been saying it for so long that once someone gets that and they're connected to that it's very difficult for them to shift gears people have a really hard time not being married to an idea. Yeah, no, I agree that. And, you know, when I talk, and I spend a lot of time going around the country, giving what are called grand rounds lectures to hospitals and medical schools,

pediatric grand rounds. So I've had the chance to talk to a lot of pediatricians and nurses and nurse practitioner, and even more and more than a few parents. My impression is, and more than a few parents. My impression is most of the parents who are called to be so-called vaccine hesitant, as the word of the day, are not really deeply dug in. I mean, you can have a conversation with them and explain to them, like we're talking now in a very non-technical way, the evidence showing vaccines don't cause autism and the lack of plausibility given that it begins in pregnancy, and they'll vaccinate their kids. There is another percentage,

and I don't know what the percentage is, whether it's 10%, 15% that are deeply dug in and are wholly invested in this conspiracy theory that the government is in cahoots with the pharmaceutical companies and bloody, bloody, bloody. And then if you try to talk them out of it, they just think you're part of the conspiracy. So it's sort of a no-win approach there. But most parents you can have a good conversation with. Most parents, yeah. It's not necessarily even most parents, right?

I mean, what you're dealing with is these people that maybe they're into a bunch of different alternate therapies, a bunch of different kinds of cleansing. And, you know, there's a lot of that nonsense that you find online where, I mean, look, there's legitimate. But I guess my point, sorry. That's okay. Please, go ahead. No, but I guess my point is parents don't get the chance because they're so inundated with phony anti-vaccine information. Like they do a Google search.

Yeah, or whatever, you know, whatever search they do. So what do you think should be done? Should there be a pro-vaccine documentary that makes sense? Thanks for that question. I think there's three things that need to be done. I think, first of all, some of this anti-vaccine media empire needs to be dismantled dismantled dismantled and and then who's to say whether they're wrong or right like shouldn't i mean it seems like there should be some sort of a debate right like if there's someone who's saying that there's some evidence of vaccines cause

debates you're saying there's no evidence of vaccines cause debate uh no excuse me that vaccines cause autism and you're saying there's no evidence that vaccines cause autism, and you're saying there's no evidence that vaccines cause autism, there should be a debate where there's some sort of a monitored conversation where you can have you versus someone else and break this down. Yeah, but that's a two-edged sword, too, because then it gives some false legitimacy to the anti-vaccine side. It's like debating does smoking cause cancer. Yeah, but isn't there already a problem?

I mean, it seems like if there's this many – if you do a Google search and you're just overwhelmed with anti-vax, it seems like the fight has already been lost, if that's the case. That's right. So giving them legitimacy, it's right so giving them legitimacy let's say it's not necessarily giving them a legitimacy it's giving them if you give you rather a forum to dismiss their legitimacy yeah i mean i think you know part of what has to be done is i mean and and this gets into all sorts of first amendment issues and i'm not a lawyer uh but you know the the idea that amazon now is putting out all of these phony books and phony documentaries. Well, they're just a distributor, right? Yeah.

They don't have to go over every book that they sell with a fine-tooth comb. Well, but maybe they should. I mean, not a fine-tooth comb, but maybe there should be some screening. Maybe Amazon, maybe Facebook should all be hiring chief scientific officers to, you know, putting some stops on the dissemination of information because it's harming children. Right. I understand. I mean, this is – the reason I get passionate about it, the reason I actually wrote the book is kind of interesting. It actually happened before all of these big measles outbreaks that we've been having.

I noticed that in Texas, there was where I – my laboratory is at Texas Children's Hospital and Baylor College of Medicine, we noticed that there was a steep increase in the number of kids whose parents were opting them out of getting vaccinated to the point where in Texas we have over 60,000 kids not getting their vaccines in the state of Texas. about the 325,000 homeschooled kids. So we probably have over 100,000 kids not getting vaccinated, all because of this misinformation campaign. And I was really troubled by the fact that there was no response to it, and that's what drove me to write the book. So the point is now Texas is very vulnerable to measles outbreaks. And I say measles more than the others because that's the most highly contagious disease. What's the danger of a child getting measles outbreaks and i say measles more than the others because that's the most highly contagious disease what's the danger of a child getting measles so is there any benefit to a

child getting measles in terms of their immune system no there's no benefit and that's one of the phony books they put out it's called melanie's marvelous measles i mean it's it's awful so um what do they say in that book they say build build your immune system. It does not. It does not. Remember, after, so let's go back a little bit. Smallpox was eradicated in the late 1970s through vaccination. Once smallpox was eradicated, measles was arguably the single leading killer of children globally. 2.6 million children died every year of measles because it causes measles pneumonia, measles encephalitis. Talk about permanent neurologic injury. That's a bad actor, measles. And then deafness and all. And then through global vaccination campaigns, we brought it down by the year 2000 to about

half a million kids dying. And then the Gates Foundation put up $750 million to create the GAVI Alliance, the Global Alliance for Vaccines and Immunization. We've brought it down now to 100,000. But now measles is coming back. Europe's a disaster right now. We've got 80,000 measles cases in 2018 in Europe, and now it's coming back to the U.S. And so my worry is this anti-vaccine media empire. It started out as a fringe group, but now it's really affecting public health, allowing a deadly disease like measles to come back. Do you think if there's some sort of definitive evidence that shows to the general public, like you could show it to them, like this is what causes autism. We've narrowed it down to these

genes and it has nothing to do with vaccines vaccines if you give these vaccines to people without these genes there is no way they're going to get autism they get autism specifically because of these variations in their genes you just you just summarize the book right yeah but i mean that we but need more than a book right yeah it does disturb me when i hear about all these kids getting measles and and not just measles but means in some places polio has made a resurgence well polio you know we're down to about three three countries that still have transmission of wild type polio it's nigeria pakistan afghanistan so hopefully we're getting arms around polio but measles has now come back roaring back with a vengeance but haven't people

contracted polio outside of those areas i mean those are the areas where it's common every now and then some cases pop up we had some you know wherever and this can get onto a whole another topic wherever there's collapse in health systems infrastructure such as during to from war political instability these diseases can come back they can come back and the people that are vulnerable the children that are not immunized that's right and when you're immunized, you're not vulnerable. That's right. Yeah. It's a really confusing thing for people because on the outside, people always want to think that big pharma –

I've said some terrible things about big pharma, and the reason being is painkillers. Because painkillers and antidepressants and there's ssris which are over prescribed and the painkiller one kills me because i've no people directly that have been addicted to these goddamn things and the doctors are passing them out like candy so people look at big pharma as being oh these are the monsters that push this they're also the people that give you things that save people's lives yeah there's a lot going on there yeah Yeah, I'm no big defender of the big pharmaceutical companies. I mean, one of the things that the anti-vax, the insults that anti-vaxxers hurl at me is they say I'm a shill for industry. They say I'm

secretly taking money from Merck and GlaxoSmithKline. It's all crap. I don't take a penny from them and it's not even realistic. How do you get paid? Just from the university? I get paid by the university, and some of my salary is offset by grants from nonprofit foundations. And this is because of tropical diseases? Right. And then they say I'm secretly making millions of dollars for our vaccines for Hookworm and Schistosomiasis and Chagas.

What are you doing with all that money? Because my wife says, if only that were the case, right? These are diseases of the poorest of the poor. I'll never make a penny on these diseases. In fact, you know, one of the frustrations I have with the big pharmaceutical companies is we've gotten, made a lot of progress with our vaccines. We've gone all the way from discovery through early phase process development and manufacturing and IND filing with the FDA, investigational new drug applications, but we're

getting kind of stuck at phase one, phase two clinical trials because we don't have the big pharma money to take us all the way to licensure. So I've had a lot of meetings with the big pharmaceutical companies to see if they can partner with us, and so far that hasn't happened. So has there ever been any discussion or any interest in creating some sort of a compelling documentary that's pro-vaccination that can counter all these things? Because there's quite a few health-related documentaries that I know are horseshit because I've talked to actual real scientists and clinical researchers that say, like, all these things they're saying are wrong. And this is why they're wrong. And you could show this that they're wrong. And then when someone says, hey, I saw this documentary, it says that all you should eat is toast.

You could say, listen, man, you've got to go here and watch this, and it will show you why that's nonsense. Is there anything like that right now? Not right. Or is there any discussion? Not right now. There are some discussions discussions but we're a long way off from that and the problem is the anti-vaccine documentaries are being distribute widely distributed widely sold and and those people that are talking about it here's the

other problem whenever i talk to someone about i've been doing this a lot lately or i'll talk to someone about something they're passionate about i go what books have you read on it and it's like well i saw this documentary well very and and there are books yeah in fact there's 19 and 19 ahead of mine right but books that are written by actual researchers people that have spent decades in labs understanding what's going on you don't really you know you don't get a lot of that from the people that are anti anything right well that's that's why i wrote the new book it's a very confusing thing for parents because you're scared you know you have this little tiny baby that you love more than anything in this world and then the doctors say hey we've got this round of vaccines coming and you're just terrified

that you're going to do something to your child that's going to turn your child into someone who's compromised. Yeah, and the point is, the problem is these diseases are back now, and so the urgency to vaccinate is now more than ever. I mean, remember, right now, look what's going on in Vancouver, Washington right now, where the measles outbreak is underway. The ones who are at greatest risk are infants under the age of 12 months, not yet old enough to get their vaccine. So that if you're a parent right now living in Vancouver, Washington, you're terrified.

You're terrified about taking your baby out to Walmart or the public library. Because they can't get that vaccine. Because they're not old enough to get the vaccine. Right. So now the disease is coming back because the older kids are catching it. Yeah. And the anti-vaccine lobby uses terms like personal liberties and medical freedom. Well, we're the personal liberties of this parent now who's terrified to take her in, his or her infant.

When you say anti-vaccine lobby, now I know that Robert Kennedy Jr. is a – He's a big one. He's a big one. And he seems like a very intelligent guy. How could he not be aware of the science behind this? And what is he getting wrong? What he's getting wrong is just about everything. You know, he's formed an organization called Children's Health Defense. And he had a press conference about it, I think it was September, October of last year. It is probably one of the best organized anti-vaccine

groups out there. And he's doing other things other than vaccines. He's doing a lot of things about environmental health and things like that. I don't know any part of that business. I've only followed what he does with vaccines, but it's all nonsense. Why is he doing this about vaccines? I don't know. I mean, you have to ask him. What's his motivation? Would he be a guy that you would want to have a debate with or have a discussion with? But again, I mean, I'm uncomfortable with the idea of a debate because it's like it's like debating i don't know it's like debating a holocaust denier whether the holocaust exists i mean not that this rise i understand what you're saying but if you're

again i want to bring this up if you're you're complaining there's 19 books ahead of yours that are anti-vaccine books you you've already lost the battle. Like, it's time to regroup. And maybe regrouping would be confronting someone with actual scientific information. I mean, you are a real doctor. You're a guy who actually studies this. And you're a man who understands the science. You're a legitimate academic.

You could actually put a dent in this with a real conversation. Yeah, potentially. Potentially. Pot conversation yeah potentially potentially yeah i mean what would he be able to say like what is his take on it well remember he's uh he's an attorney and he's uh he's very clever right and you know he knows how to presumably knows how to do arguments in court and what am i i'm a scientist right but do you think that he wants to deceive people or do you think that maybe he's just incorrect in his accumulation of data? Yeah, I can't say what his motivation is, but his information is highly misleading. Now, what else is, when you say the lobby, is this an organized thing?

Good question. Again, we need somebody who really wants to do a deep dive in this and kind of dissect out the pieces to understand. But it's impressive what you've got out there in terms of the hundreds of websites and the amplification on social media and everything else. Are there just one or two or three groups behind it? Or is it a random collection of organizations? That needs to be looked at. That does need to be looked at. Now, what do you think is causing autism? And in your personal estimation, do you think that it is a, that there's a rise in the factors that are causing autism? Or do you think that it's a rise in the understanding

of these variables that contribute to it that you could diagnose people with and that before they were previously undiagnosed? So I think most of it is that, that we're just diagnosing it more and we're including individuals in the autism category that we didn't before. And by the way, the numbers are about to go up even more because we're getting better at diagnosing girls and women with autism, which is also quite interesting. We used to say it was 10 to 1 boys to girls. And now we know there are a lot more girls and women on the autism spectrum, it's just that they're usually more verbal and they can camouflage it better. But they have very

high rates of comorbidities like obsessive compulsive disorder, attention deficit hyperactivity disorder. A lot of the teenage girls with eating disorders now they're finding could actually be on the autism spectrum. So the numbers are about to go up again. I mean, that's just an example. I mean, I guess what you're really trying to get at is, is it beyond that? Is there a bona fide increase beyond the number of diagnosis? And that one I'm still not sure about.

Yeah, I read an article about early onset gender dysphoria being connected to young girls with autism. There's a disproportionate number of girls with gender dysphoria who turn out to be also autistic. Right, I've heard that as well. Yeah. So it's really fascinating to think about. Unfortunate and fascinating at the same time, right? Yeah. There's a nice paper by a very good environmental scientist named Phil Landrigan who used to be at Mount Sinai now. I think he's at Boston College now.

chemicals in the environment, which if you're exposed to for long periods of time during early pregnancy, your child will be born with some features that resemble autism. Do you know what those chemicals are? So I have to remember, I talk about them in the book. One of them is Depakote, valproic acid, which is a psychiatric medicine used as a mood stabilizer or an antidepressant. psychiatric medicine used as a mood stabilizer or an antidepressant. So prolonged use of Depakote during pregnancy has been linked to something that resembles autism. Is this a common medication? It's a common medication. But now that we know this information, we don't use it anymore. And so one of the things that I've been saying to people like Bobby Kennedy and everything else,

if you really want, if you really think there's some environmental link to autism, we've got a list of at least six chemicals during early exposure and pregnancy that are probably causing mutations and things like that, that are leading to autism. Why isn't anybody looking into that? It's just crazy. I mean, so all the focus goes into vaccines, and it kind of sucks all the oxygen out of the room. So that, you know, really understanding the search for autism gets delayed or in some cases doesn't get pursued at all. Or the other thing that happens in many state legislatures and things like that, the focus is so much about vaccines that we don't talk about what autism parents really need. I mean, what do I need for Rachel?

We need, you know, employment counseling and help. We need mental health counseling. What do we do after we're gone? Rachel right now is living with us. I turned 60. My wife is, you know, 58. What happens to us 10, 15, 20 years from now? There's no roadmap. So all of that gets shunted aside because of these phony baloney anti-vaccine arguments. And that's why I get angry. That's when I start to realize these guys, in addition to affecting public health, are actually hurting autism families as well. Well, that makes sense. I mean, and I can completely understand why this would upset you, especially as a scientist.

a scientist. Now, when you're talking about these various chemicals that you think do contribute to or possibly cause autism, maybe we should really concentrate on that and publish something about this. Is there an article that people can go to that says something about this? There is. I talk about it in the book. In the book. If I opened up the book, I could provide it for you. Is there anything that people can read online about this without going to your book? Probably.

You know, one of the problems that we face in this country is that we put a lot of scientific articles behind paywalls, which is a real source of frustration for me. Why do they do that? done now is I'm one of the, I founded an open access journal called the Public Library of Science Neglected Tropical Diseases so that anybody with a computer, you know, an internet connection and a printer can download the articles free of charge. And we need more of that. That's great. But right now, if someone wants to find out these chemicals, they have to buy your book or buy some sort of access to scientific papers i'm not sure with that particular paper whether it's behind a paywall or not i'll have to look yeah i mean besides measles uh what other diseases are more prevalent

now because of people not vaccinating the kids the ones that there's three diseases that i worry about the most actually four well whooping cough is another one so that that's one but the other one i worried about is the flu vaccine kids aren't getting their flu vaccine last year in the 2018 flu epidemic 150 unvaccinated kids died of influenza despite the recommendation to vaccinate can you enlighten me on this because what i've been told is that sometimes they get the flu vaccine wrong. So you can get vaccinated, but it doesn't protect you for the strain of flu that everybody's getting. Well, so that's, again, an idea that was heavily pushed by the anti-vaccine lobby. Here's the story.

You're right, partially right. Last year, there was not a perfect match between the virus and the vaccine, the killed virus and the vaccine, and the wild-type flu strain that was out there. But it was good enough to prevent you from dying, and it was good enough to likely prevent you from being hospitalized. So it would have an effect even if you did get the flu? That's right, because there was enough cross-protection so that it would mitigate the symptoms. That's confusing to people because if they have the flu, they say, oh, well, then it didn't work. That's right, but it did because it prevented you from getting sick and dying. And again, that was a message that never really got out in 2018.

Okay, but let's talk about someone like me who's a healthy person. I've had the flu before, but I don't usually get a flu shot that's crazy you should especially now especially now as you're getting older why is that um because flu is uh one of the leading is probably the single leading infectious disease killer of of adults in the united states but every time i've had it it's really been like just a couple of days out i rest well you got a lot of fluids you got lucky lucky, my friend. Is that what it is? Is it luck or is it health? Well, sure, taking care.

Maintaining your immune system. So if you look at the 80,000 adults who died in the influenza epidemic of 2018 in the United States, you're right. underlying um uh things like diabetes or or non-communicable you know cardiovascular disease or underlying respiratory disease maybe they were smokers but that there's still but there's still thought but there's still thousands of individuals who are perfectly healthy who died of influenza that we know so when you don't get your flu vaccine you're taking a terrible check and and why not well i mean what what are you risking by getting the flu vaccine i'm busy bro you know what you know you know where i you know where i get my vaccinations walgreens uh even better like we have a big grocery store chain in texas a big supermarket called heb you get it up the nose i get no i get it i get the injection

right the pharmacist the farm all of my vaccines I've gotten for the last few years have been given by the pharmacist. Interesting. Couldn't be easier. Have you ever gotten the flu since you've been getting the vaccine every year? Well, you know, I've gotten sick with like a sore throat and feeling crummy. Was that a mild case of flu? I can't really tell. But you've never gotten sick right after you got a vaccine.

Some people do, right? No. Some people do get a vaccine and then they have an adverse reaction to it? Well, sometimes after getting your vaccine, you can get some soreness and you can feel maybe a slight fever for a few hours or a day, but usually you're fine. What is that? What is that? Yeah, what is that fever? Why few hours or a day, but usually you're fine. What is that? What is that?

Yeah, what is that fever? Why are you getting a fever? Because the vaccine is stimulating the immune system and stimulating the inflammatory system. So even though you feel like you're getting sick because of the vaccine, it's actually good for your immune system. That's right, and you're not really sick. I mean, it's nothing like nearly as bad as getting the flu.

The other vaccine, now that you're getting up there, you have to start considering is the shingles vaccine, Shingrix. And that's a great vaccine. It hurts, though, for a couple of days. Do you take care of your immune system in other ways? Do you take probiotics? Are you cautious about your diet um i'm not as cautious about my diet as i should be i'm a junk foodaholic uh actually well that seems like a terrible thing for your health it is a terrible thing for my health and something my wife is

working on but that seems ridiculous for someone who works with health yeah yeah sometimes man i just don't get it right. How often? What? How often? How often do I steal a bag of chips or something like that? How often do you eat garbage? Every day? I don't know.

No, no. Hopefully not every day. Hopefully not every day. Maybe a couple of times a week. Oh. That's what it's with Rachel, my daughter with autism. That's like our thing is to go to the, it's called the burger joint or to Shake Shack to get a cheeseburger.

We'll sneak some fries. Living large, we call it. Like that mouth pleasure so much, you're willing to sacrifice a little bit of health. I am, yeah. I have to concede that's the case. Well, there's, I mean, I don't have to tell you, but there's a large body of data that connects poor diet to a host of diseases. That seems like a crazy decision for a guy in your line of work. There you go.

Sometimes it's not all brain. It's something else. But, I mean, if you ate healthy food, I mean, the thing is your body starts craving healthy food. You start feeling positive results. Yeah, no question. No question about it. Do you take vitamins? I don't take vitamins.

Really? Yeah. Wow. I don't think they do. I don't think they're needed. What? What? Hold up.

Hold up. Hold up. You don't think they're needed while you're eating junk food? Well, hopefully I'm not only eating junk food. You know there's a large body of clinical research on the efficacy of vitamins, especially vitamins D, vitamins B. I have taken vitamin D for periods, the recommendation of my internist, yeah.

What about essential fatty acids, which are great for your brain, fish oil, all these different things that are fantastic for inflammation. I'm not going to argue with you. What is going on with you, doctor? You got it over me. Listen, but you would have a much better argument, don't you think? You're making my wife stay here. If you're taking care of yourself 100% instead of just concentrating.

But you still need your vaccines. I'm sure you do, but vaccines aren't going to prevent cancer. No, that's true. Right. That's true. There's a lot of diseases. Or diabetes or cardiovascular disease. And a lot of these diseases are connected directly to diet.

Right. Yeah. Come on. And other lifestyle changes. Yeah. You've got to get to exercising. Sedentary life. I try to go on the treadmill for 30 minutes every morning.

I do. Actually, I'm pretty good about that. Yeah? 30 minutes every morning. Why don't you just go for an actual walk? It's more interesting. I do that, too. You have a dog?

No, but I do them for 30 minutes on the treadmill in the morning, and then I take a long walk with my wife in the evening. Oh, that's good. But the thing that knocks the crap out of you is the travel. Yes. I find that very frustrating because you don't exercise And then you eat You don't eat well And you don't control the diet as well So that's

Well I have a solution to that And eat well and exercise Those are solutions to that Just do it You know I treat it like I'm brushing my teeth I brush my teeth every day Yeah I exercise every day too

Yeah So when I travel I don't have an option When I land I go to the gym This is is how it goes. I land, I get in my hotel room, I put my shorts on. Yeah, I do that too. I do that too. It's the only way. If you have to do it, if you say this is just what gets done, this is how you do it. Yeah, I try to be really compulsive about that.

Yeah, I have it written out. I know what I'm going to do, especially if it's great if the hotel has a good gym. If they have weights and a bunch of different things. Or I'll run outside if we don't have it. You run? Yeah. Do you? Not very well. No, but you do?

Okay. We've got to get you healthy, buddy. Yeah. Can't be pushing only chemicals and injectable forms to facilitate health. Fair enough. Yeah. Not chemicals. They're vaccines.

Oh, I'm sorry. What's in them? What? I mean, it's some sort of chemical now. No, they're antigens, right? What's the fluid? Macromolecules. What's the liquid stuff?

Typically, it would be saline or salt water. Now, what is missing from today's vaccine protocol, if anything? In terms of diseases we should be vaccinating for, but we're not. Is there anything? Yeah, there certainly are. One of them is a big problem among young infants, especially premature infants, called RSV, respiratory syncytial virus infection. What does that come from? It's a respiratory virus that peaks around the same time that flu does. So it's a very severe respiratory illness.

So this is, again, one of those vaccines that's not a big moneymaker. So the Bill and Melinda Gates Foundation is trying to provide grants for supporting that one. That's a good one. And then there are all the diseases that affect poor people both in developing countries and even among the poor in the united states that we're trying to make this book that's that's the next one called marble health the next one so this is not released yet no this is out this actually this actually preceded the okay this one now this book is all about poor people and infectious diseases and the rise of these infectious diseases, even in the United States.

That's right. So, you know, when we think about – so I, you know, led this big campaign to raise awareness of something called neglected tropical diseases or NTDs. These are the most common afflictions of people living in poverty. I call them the most important disease you've never heard of. They're diseases like schistosomiasis and Chagas disease and Leishmaniasis. And I've been devoting my life to seeing if we could develop vaccines for those diseases in the nonprofit sector, you know, because the big pharmaceutical companies just don't see, just aren't going to take these on. So we're trying to do it in the nonprofit sector. But

this book, the Blue Marble Health book, came out of some number crunching that I did using data from the World Health Organization, or something called the Institute for Health Metrics and Evaluation, which is based in Seattle, Washington, that found something very surprising, and that is most of the world's poverty-related diseases are not necessarily in the poorest, most devastated countries of Africa, meaning like Democratic Republic of Congo or Central African Republic. They're there, but on a numbers basis, most of these poverty-related diseases are actually in the G20 economies, the 20 wealthiest economies, together with Nigeria, which is not a G20 country, but it has an economy bigger than the bottom three or four. So that was pretty amazing for me to find that out because, you know, at first I didn't believe the numbers because I said, well, how could it be if they're poverty-related diseases?

Why are they in the 20 wealthiest economies? And then I realized that it's among the poor living in wealthy countries. So the poorest of the rich today now account for most of the world's poverty-related diseases. And what's the cause of this? So why the link with poverty? So that's a great question. So one of the things I do in the book is I ask that, well, what is it about poverty that's making you susceptible? I don't think we really know.

I mean, clearly in some cases, if you live in poor dilapidated housing without window screens, things like mosquitoes and kissing bugs and sand flies can get inside the house. mosquitoes and kissing bugs and sand flies can get inside the house or if you look um in in poor neighborhoods like in and around houston you see a lot of environmental degradation around the neighborhood um you see discarded tires that breed these gypti mosquito or standing water but i don't think what what what did the tires, yeah. So one of the best habitats for the mosquito that transmits dengue and Zika and chikungunya and yellow fever are discarded tires. That's what they love. So if you go into poor neighborhoods, you'll see a lot of tire dumping, for instance. And those are habitats for that Aedess egyptian mosquito including here in southern california so is it when the water gets in the tire that's right a little bit of water

that's exactly it yeah you know i moved into a house once in uh encino down the street from here in fact and um no one had lived in the house for about a year and a half two years and the pool had not been taken care of and i went out out into the pool, and it was green, and there were schools of mosquito larvae. Mosquito heaven. Mosquito heaven, yeah. It was so strange. So, yeah, absolutely. You go into poor neighborhoods, abandoned swimming pools, things like that.

That's where we're getting a number of these diseases. We don't have very many mosquitoes in Southern California. I mean, it's really kind of amazing in that regard. Well, it depends. So, you know, in some counties where they do aggressive spraying and things like that, you won't. But in many counties, you probably – probably in some of the poorer counties, poorer districts, you still do. Well, I mean, in terms of the way it is on the East Coast. Like, I grew up in Boston, and in the summertime, you just have fucking mosquitoes everywhere.

You just can't get away from them. And then I've been to Alaska, which is the craziest place I've ever been to in my life in terms of mosquitoes. Have you been? I haven't been to Alaska. It's hilarious. You get out of your car, and they attack you like a horde of birds. That's because they only get one month of the year to do it. So they're super aggressive, and they're also very large.

The big problem is along the Gulf Coast of the U.S. We have that Aedes gypti mosquito, and that's why I got so worried about Zika virus hitting the Gulf Coast of the U.S. Yeah. Mosquitoes in other countries obviously contain malaria. I mean, we've been very fortunate that that's never made it over to here. Well, no. We used to have malaria.

It used to be widespread in the United States. Malaria used to be widespread in the United States, both the one that was a real killer disease called falciparum malaria on the Gulf Coast and even up into Illinois in the Ohio River Valley. We had a lot of malaria caused by vivax in the 1800s. Dickens, when he visited the United States, called Martin Chuzzlewit, when he describes all these sickly people in Illinois, in Cairo, Illinois, on the confluence of the Mississippi and the Ohio River, he's clearly describing malaria. Wow. I did not know. So what stopped it? So that's a great question.

So there's actually a very nice book written by a medical historian at Duke University named Margaret Humphreys called Malaria, Race, and Poverty. And she has a hypothesis, but I think she's on to something, that the decrease – the malaria dropped in association with aggressive economic development. The FDR's new deal included something called the Agricultural Adjustment Act that got people off with agrarian pursuits and put them into factories. Quality of housing went up. And that's probably what caused a lot of the reduction in these tropical diseases. Remember, they're really diseases of poverty. In fact, I spent a lot of time working in China, and I'm seeing that play out right now in China. China has had this very aggressive program of economic development, mostly in the eastern part of the country. But in the southwest part of the country, you go into Yunnan, Sichuan provinces, you go back in time 75 years, and you still see those diseases.

So do you think that the best cure or the best way to stop malaria would be just to increase the economy of these areas in Africa where they're experiencing it? Clearly, economic development is a very potent driver. Now, what it is about economic development, we still don't have our arms around that yet. But economic development is very important, just like for the neglected tropical diseases we studied. But, you know, unfortunately for many countries, economic development is still decades away. So that's the rationale for developing these vaccines. Is it because economic development moves people into more urban environments where there's less tropical diseases?

I think that's part of it. Although now we're seeing some tropical diseases thrive in urbanized environments like yellow fever and Zika and dengue as well so it's not only urbanization you have has to be urbanization with good planning that's not done unchecked that outstrips the infrastructure in terms of water and sanitation so this brings me to the thing that i wanted to talk to you about in the first place because this is what you brought up to me when we were doing this sci-fi show and uh you said something to me that has been haunting me ever since that the vast majority of people that live in tropical climates have parasites vast majority yeah that's right that's right there's things like toxoplasma gondii and so let's look at the let's look at the

hit parade right the top one is one called Ascariasis intestinal roundworm. The estimates are around 800 million people have Ascarius roundworms in their bellies. Whoa. So 800 million. So more than 1 in 10 people on the planet, mostly people who live in extreme poverty. 400 million have hookworm infection. 400 million have whipworms. A lot of these are wormy diseases. 200 million people with scabies, which is an ectoparasite on the skin that causes terrible itching and secondary bacterial infections.

Schistosomiasis is another one. The point is almost every single person who is in extreme poverty has one of these what I call neglected tropical diseases. And one of the interesting features about them is they're very debilitating. So they not only occur in the setting of poverty, but I think they reinforce poverty because they make people too sick to go to work. They actually shave. We can show they shave IQ points off of kids when they have them. Well, this is the hookworm connection to the idea of the slack-jawed, dumb southerner in the United States of America.

And now one of the things that we have found, so Rahelia Mejia on my faculty, working with an environmental activist named Catherine Coleman Flowers in Alabama, found that hookworm is still present in Alabama. So among the poor. Explain that to people so they understand what we're talking about because for the longest time there was this stereotype about people that lived in the south that they were dull-minded right and that this could be directly connected to hookworm infection which had run rampant right there was even the term given called they called the germ of laziness, that hookworm infection, because it causes severe anemia.

So if you're walking around with terrible anemia, of course, you're not feeling up to working a full day and all that sort of stuff. So hookworm was widely present in the southeastern United States at the turn of the 20th century. And then as malaria went down with economic development, so did hookworm infection as well. But we still have pockets in this country. And this wasn't understood at the time, right? They didn't know that these people were infected with hookworm? Forever, no, up until very recently. So the cause of hookworm wasn't discovered till 1900. What is that cause?

It's called Nicator Americanus, the American killer, and that's the name of the worm. And this is from walking barefoot? Or that goes in through the hands or enters all parts of the body. But it's very common to get it from walking barefoot. That's right. Which was more common in the South. Right, right. And so that's one of the diseases we've made a vaccine for that's now in clinical trials.

Yeah, when I found that one out, I was like, oh, my God, well, that's it. That totally makes sense because for the longest time there was that stereotype. And then when you find out that it's directly connected to a massive infection of this disease, this worm. So these are the diseases that are holding back people who live in poverty. Originally, I thought only in places like the poorest countries in sub-Saharan Africa or Southeast Asia. But now I realize it's these pockets of poverty across the entire planet that people are affected by these diseases. And these diseases can be vaccinated. We're trying to prove that we can make a vaccine against it.

And there is a hookworm vaccine, right? Right now in clinical trials. Just in clinical trials? That's right. Now, wasn't there a Lyme disease vaccine, but the problem was it was actually causing people to get Lyme disease? So that's a – talk about controversial topics. So there was a Lyme disease vaccine that was developed actually from a colleague of mine at Yale University. And they licensed it.

I think it was to GlaxoSmithKline. And they developed it. They called it LymeRex. It was the Lyme disease vaccine. And actually, most of the studies suggest that actually worked pretty well. The problem was there were a number of people who felt that the vaccine made them worse or they said they had chronic Lyme disease, that it wasn't effective. So it was really a market perception problem more than anything else.

And ultimately, it hurt the bottom line of the company and they they withdrew it from a good friend of mine's dad got the vaccine and then got lyme disease they think he got lyme disease from the vaccine probably not probably is a weird word well someone with lyme disease that's being nice no no he didn't get lyme disease no way impossible impossible because lyme disease is caused by the Lyme bacteria, the spirochete called Borrelia burgdorferi. And the vaccine is not a live vaccine. It's a recombinant protein-based vaccine, so it's not possible. So there's nothing in that vaccine that could have caused this adverse reaction that they directly attribute to that vaccine?

Probably not. Again, you're saying probably not. Well, I don't know the patient. I haven't examined the individual, so I hate to. They swear. I mean, that's the narrative of that household. Well, again, you know, it's reinforced by a lot of negative information out there on the Internet.

Yeah, but it's also reinforced by the fact they pulled the vaccine. Yeah. Well, they pulled the vaccine not because it wasn't working but because of market perception and all that sort of – and that was a time before the number of cases of Lyme disease had really taken off. That seems strange to me because they didn't pull the measles, mumps, and rubella vaccine because of perception. Why would they pull the Lyme disease vaccine because of perception? I think the reason was because the cost-benefit equation works a little differently.

With measles, measles is a killer disease. Lyme disease was not a killer disease. But God damn, it's wrecking people now. In some cases. It seems to be connected to a host of other ailments too, correct? Like Lyme disease exacerbates a bunch of different, maybe possibly even existing health issues. Well, you have to be careful.

And this gets into another controversial rabbit hole I'm not sure we want to get into or not today. But the Infectious Disease Society of America, for instance, has come out with a strong statement saying that there's really no such thing as chronic Lyme disease. And the scientific evidence does not support something called chronic Lyme disease, yet there are lots of people suffering with chronic debilitating illness who claim that it's caused by Lyme disease. So this is something that is out there right now. Why is there a debate? Why are they saying that there is no such thing as chronic lyme disease what's their evidence um the evidence is that there's no

evidence that they can detect spirochetes in the body in many cases uh uh people who have had lyme disease don't have persistent evidence of having antibodies any longer to to the lyme spirochete so um it's a whole different area. Right, but they do have this chronic inflammation and pain in their joints and their body starts breaking down. They have something, but it doesn't seem to be. The Infectious Disease Society of America, which is one of the lead infectious disease bodies in our country,

and I'm not an expert on Lyme disease, so i'm not too comfortable going there with you are saying that there's no evidence that uh that that's actually associated with active infection with lyme disease what are they how are they describing it and what how are they so in other words so what's causing all of these unknown unknown unknown hmm but isn't it bizarre that these same people got lyme disease first and then had all these host of issues afterwards? Well, I guess part of the problem is in some cases they had Lyme disease first. In some cases they really didn't have Lyme disease. Unfortunately, there are a number of unscrupulous health care providers and even physicians out there that are making misdiagnosis. that are making a misdiagnosis of Lyme disease,

or in some cases they're actually taking everyone who comes through the door and diagnosing them with Lyme disease. I'm sure you're aware of the Lone Star tick and the allergy to red meat. Yeah, right. That's really fascinating, isn't it? Yeah, and that's another one that's on the rise, correct? Yeah. Well, actually, all tick-borne diseases are on the rise now, possibly because of climate change, which is another factor in our country that's doing that. So we're seeing, you know, if you look now at what are the big drivers of infectious diseases right now, not only in the U.S., but globally, there are really some interesting forces. And a lot of them are social determinants. So a big one is poverty.

That's a huge one. The other big one is political instability and war because it interrupts public health control measures. So for instance, Venezuela, which was leading public health control in Latin America for decades with the collapse of the economy in the Chavez era and now into the Maduro area, we've got a terrible situation where we've had measles return in a big way. So huge numbers of cases of measles. We've had all the neglected tropical diseases come back, as well as malaria, Chagas disease, Leishmaniasis. So it's really interesting how that is destabilizing

the whole region because now Venezuela has one of the largest diasporas of people, as big as the diaspora coming out of Syria and Iraq. So now the diseases are moving into adjacent areas of Brazil and Colombia and Ecuador. And so it's really, and that's another big driver is political instability. really, and that's another big driver is political instability. The third one we think is climate change may be very important. So, you know, why did we see this big surge of chikungunya virus infection in the Western Hemisphere or Zika? We don't really understand the forces of that. And what's going on in Southern Europe right now is quite concerning. We've had malaria return to Greece after it's been gone for 70 years. Malaria has returned to Italy. We're seeing schistosomiasis, a neglected tropical

disease, on the island of Corsica. We've got dengue, chikungunya, West Nile virus across Italy, Spain, Portugal. So we're trying to understand why that is, and there's some thought that climate change may be a big driver of that. Now, what other infectious diseases or parasites, rather, do they have vaccines for? Do they have a vaccine for toxo? There's no vaccine for toxoplasmosis. There's a prototype malaria vaccine. Prototype? prototype malaria vaccine.

Prototype? Yeah. Well, there's a malaria vaccine. It's called Moscarix. That's the trade name that was developed, supported with a lot of funding from the Bill and Melinda Gates Foundation and working in partnership with GlaxoSmithKline. And that malaria vaccine now has been approved for use in children by the European Medicine Agency. And it's being introduced now in three countries in Africa, Malawi, Ghana, and I forgot the third one. I think it was Tanzania.

Is there an adverse reaction that people have to that stuff? Because I know the traditional malaria medication, I had friends that took it and had horrible nightmares. Oh, yeah. Malarium is terrible. Yeah. It gives you very lurid dreams. Yeah. Yeah.

No. So far, no. And so when you say children, how old are the children that they're vaccinating with this? Well, the problem that you get into with malaria is that before six months of age, you have maternal antibodies unborn. You're born with antibodies from your mother, and they'll start to wane by six months of age. So the ones who get hospitalized with measles, what's called cerebral malaria, which is a devastating condition, or severe malaria anemia, which is also a killer, are those children between six months of age and five years of age. So those are the ones that we want to protect.

And it's one of the leading killers of children globally, right? Right. And we don't have a vaccine. Sickle cell is connected to it, correct? Sickle cell, it has something to do with people developing an immunity to malaria? Yeah, I'm surprised you knew that. I found out from Tiffany Haddish. Who's Tiffany Haddish? How dare you? She's a very funny comedian. Okay. I'm surprised you knew that. I found out from Tiffany Haddish. Who's Tiffany Haddish? How dare you?

She's a very funny comedian. Okay. I'm sure she is. But she's right. It's not really immunity, but it's a natural protection. So individuals who have the sickle cell trait seem to be partially resistant to malaria. And that's the thinking why the gene for sickle cell has been preserved in Africa for so long is because it does confer some protection against malaria. So it's a reason for keeping the gene in the gene pool.

Yeah, we were actually discussing it because a friend that I grew up with died from it. So it seems to only exist in African Americans or Africans. Is that correct? No, there's some other places as well, but predominantly in African and among African Americans. Or people whose ancestors came from these tropical climates. Yeah. So it's really quite an amazing story. So there's no vaccine for toxoplasmosis. Is there anything on the horizon? Is there anything we've worked on?

Because that's a big one, right? It's a real big problem among people with HIV AIDS, for instance, because it reactivates your toxoplasmosis. And we even see it in kids sometimes. But the thinking is— Reactivates it? How so? Well, what happens is, in some countries, up to 30% of people are actually infected with toxoplasma. And the parasite has the ability to undergo a dormancy state in the body until your immune system gets compromised, either because

of AIDS or because if you get some kind of medicine that suppresses your immune system, and then it can reactivate it and cause what's called cerebral toxoplasmosis, which is quite serious. So most people handle their toxoplasmosis very well. You know, you die with it and don't even know you have it, but in some cases it gets reactivated. Right now, there doesn't seem to be a lot of incentive for developing a toxoplasmosis vaccine, although I'd be very interested to work on something like that. Why would there be no incentive? It's such a large-scale disease. It's hundreds of millions of people worldwide, right? That's right. And part of the problem is we have almost no information on the actual number of people who have it and how extensive it is. So we call that disease burden.

We don't have good disease burden estimates of toxoplasmosis. I'm scared to get tested. I've had a bunch of cats. I've had feral cats. Yeah, you've been. And I'm crazy. Well, there's a good chance you are infected, but as long as your immune system's intact, then you're okay.

Now, there is a related disease from cats called toxochoriasis, and that's a parasitic worm infection we're finding in the United States among the poor. And so what happens is if you go into poor neighborhoods, you see a lot of feral cats and dogs in poor neighborhoods, almost 100% of them have this worm in their intestines, and they're seeding the environment with eggs in their feces, and the feces are spread. All over the poor neighborhoods, kids come into contact with them and the worm has the ability to migrate through the brain and cause cerebral toxicoriasis and i think it's an important cause of developmental delays it's one of those neglected diseases among in the u.s i talk

about in the book and there's no vaccine for that there's no vaccine for and we need very little awareness about it wow yeah i've never even heard of it until just now. Right. So this is... And it's not rare. I mean, in some cases, you know, up to 10% of certain populations like African Americans living in poverty are infected with it. And it's primarily pets or is it rodents as well? Probably mostly stray dogs. It's not even pets. It's mostly stray dogs and cats. And this is an example of a neglected tropical disease. Here's a disease of up to 10% of African Americans living in poverty in the United States. And almost nobody is studying it.

Wow. And it can affect the way your mind functions. Right. And it's been linked now to developmental delays. So, you know, everybody wants to know why, you know, kids living in poverty have developmental delays and people just assume it's because they live in deprived environments and that sort of thing. But I think toxicoriasis is an important underlying reason for it.

And this is an example of a neglected disease. You know, we, I mean, everybody's heard of Ebola, right? And everyone's worried about Ebola. And the truth is Ebola is never going to come to the United States. Why is that? It's never going to be, because it's too difficult to transmit. Unless you have a complete collapse in the health system, we're never going to have Ebola epidemics in the United States. But here's a disease of 10% of African Americans living in poverty, and no one's heard of it, and there's no incentive to study it.

So that's why I'm trying to raise awareness about these poverty-related diseases. That's crazy. I don't understand why people don't talk about that one. That one seems insane. Right. Yeah, absolutely. It's a no-brainer, right? Yeah.

But it's very hard to get people to care about diseases of poverty. people to care about diseases of poverty. I mean, and this is one of the striking things about when I wrote the book was, you know, I've had a lot of success getting people to care about neglected tropical diseases in Africa and worked with the U.S. Agency for International Development to support a package of medicines that's now being administered to over a billion people annually. And that, you know, is one of my proudest accomplishments is helping to raise awareness about neglected tropical diseases like we've been talking about, Hookworm and Schistosomiasis in Africa, Asia, Latin America. But the minute I talk about poverty-related diseases in the U.S.,

the lights go out. Why is that? I don't know. I can't figure out what I'm doing wrong. I've had so much success getting people to care about NTDs, neglected tropical diseases, in poor developing countries. But there's been no response to this book. I mean it is – and the estimates that I come up in the book are we have 12 million Americans live in poverty with a neglected tropical disease. Toxicoriasis is one of them.

Another one is Chagas disease, and the list goes on. It's been very hard to get people to care about the poor in this country. That's very strange to me. And I've always said that about the way we treat other countries. We want to send them aid and rebuild these countries, but we don't do anything about these terrible communities that have been terrible in this country for decade upon decade. Right, and so I try to make the point the world has changed. This old norm of global health developed versus developing, it still exists, but it's going away. What we're seeing is a general rise in all economies.

I mean some African countries have 8% or 9% economic growth, but it's all leaving behind the bottom segment of society. And so I don't care where you show me poverty, whether it's in Texas or Alabama or Nigeria or Bangladesh, I will show you these poverty-related diseases. And, you know, I know – what's her name? AOC, the congresswoman from New York, has talked a little bit about Hookworm in Alabama. So last time I was in Washington, I dropped off a copy of the book in her office, but no response yet. She's probably pretty busy too. Yeah, she's doing a lot of other stuff. If you had a magic wand and someone said you could do whatever you want to fix this, what would you do?

So I did meet with a couple of people on the Hill, and they asked me that question, what's the magic wand? And there's a couple of things. One, we need to actually look for these diseases, because the problem is the diseases they cause are very subtle, like developmental delays. So that if you're a kid who lives in poverty with developmental delays, the pediatrician doesn't even think to do a test for toxic choriasis. So we need to raise awareness. We need to go into poor communities across the country and actually take a blood test and actually measure for the presence of that disease or that parasite. Once you find that disease, what would you do then?

Well, it depends on the disease. In some cases, we have treatments for them. Like the treatment for toxicoriasis is a five-day course of a simple pill of albendazole. And it cures it? And it cures it. Really? Yeah. So we have interventions.

So one, doing what I call active surveillance, looking for these diseases. The other one is really trying to understand how these diseases are transmitted. What is it about poor neighborhoods that is facilitating transmission? I think the third problem is the diagnostic tests themselves, because they're very complicated tests. Sometimes, you know, they're done at the Centers for Disease Control and Prevention. Our lab, our National School of Tropical Medicine does a few of them. But it's not like, you know, when you go for blood work and you're a doctor and you get a little lab slip from Quest Diagnostics with the, you know, the blood chemistries, the blood counts, there's no

box there for toxicoriasis and Chagas disease. So we need more improved tests, point-of-care diagnostic tests. Not just improved tests, but just letting people know something. Make it more accessible, yeah. And so they don't have to send it off to the CDC or to our National School of Tropical Medicine. Is there a treatment for toxo? There is a treatment for toxoplasmosis. What is it?

It's a paramethamine sulfa drug. But it requires a long treatment course. How long? I'd have to look up the number of days i haven't treated a patient with toxoplasmosis in a while but and it kills it effectively it can yeah really yeah oh i thought it was something you kept for life well if you don't get treated right okay so and then if you're immune compromised and it comes back then that that's a problem as well so most people that have it really don't even know they have it.

That's right. And actually, most people who have neglected tropical diseases don't know they have it either. So in Texas, for instance, we have transmission of a parasitic disease called Chagas disease. It's a cause of heart disease. Members of our faculty were actually able to track down individuals who had donated blood. And the Gulf Coast Regional Blood Authority actually found people positive for Chagas disease. They were told to go see their primary health care provider.

And unfortunately, the primary health care provider is not educated about these diseases. And they just assume it must be a false positive. So our faculty had tracked them down and were able to get them into treatment. And what is the treatment for Chagas disease? It's an antiparasitic agent called benzinidazole. And that kills it? That can kill it if you catch it early enough, but sometimes you don't catch it early enough. So if it becomes systemic, then you have –

Then that's why we're trying to develop a therapeutic vaccine for this disease. But again, it's a therapeutic vaccine for a poverty-related disease, so it's very tough. Oh, man. So the point is these diseases are widespread among the poor, and we just don't pay attention to them. Yeah. That's great. And so I think, again, I'd love to hear your thoughts. I mean, what is it that we just turn our backs on the poor in this country?

It's disturbing. It's very disturbing. There's a dismissive attitude. And they disproportionately affect people of color as well, right? Because, you know, because it's so linked to poverty. Well, also, right, slavery. Yeah. I mean, the history of slavery in this country,

the history of systemic racism in places where they just literally would not sell homes to people who are African American. All these things are connected to the contribution of maintaining these impoverished communities. And there's been almost no effort whatsoever, other than the people living in the community trying to do better and raise everybody up. other than the people living in the community trying to do better and raise everybody up, there's been no effort whatsoever by the federal government to step in and try to rehabilitate, like a large-scale approach to rehabilitating places like the ghettos of Houston or Baltimore or Detroit. You know, I thought I knew what poverty, living in, I was, before I moved to Texas in 2011, I was chair of microbiology at George Washington University. And I thought I knew what poverty looked like.

I moved down to the Gulf Coast. It's a different animal. I mean, the depth and breadth of poverty in the Gulf Coast and the southern part of the United States is just extraordinary. And it's been very hard to get people to want to really take it on and really address these poverty-related diseases. Do you think – what do you think the cause of it is? I mean, you've studied this for quite a while. What? The cause of the neglect? Yes. Yeah. I don't know. I don't know. Is it something about American exceptionalism or

something that we just don't want to admit. We have poor people. I don't know. You know, I wasn't the first to come up, you know, to raise this issue about poverty. When I was in high school or junior high school, I was forced to read a book, and at the time I didn't care about it. It was called The Other America. It was written by a fantastic social activist named Michael Harrington, who was a – I think someone told me he's a very devout Catholic, actually. And so, and he wrote this book called The Other America, talks about the

hidden poverty off the road. And the actual number of people who live in extreme poverty hasn't changed since that book was written in the early 60s. That book was what helped first Kennedy, then Lyndon Johnson, launch the War on Poverty in 1964. I dusted off that book, and it still works today. And that's how I start out talking about my book, Blue Marble Health, about that book, The Other America by Michael Harrington. Yeah, that is a very strange thing,

our acceptance of these communities. And I mean, I've always said that if you want to make america a better place the best thing to do is not invade other countries or intervene the best thing to do is try to rebuild these impoverished communities yeah well gandhi gandhi people way out gandhi once said a civilization is judged by the treatment of its minorities. And we're not – by that criteria, we're not doing so well. You know, the – we – our country was visited by the United Nations Special Rapporteur on Poverty in 2017. And his numbers came up with – we have 19.4 million Americans who live in what's called extreme poverty. That is at half the U.S. poverty line.

And roughly around 5 million Americans living on less than $2 a day, the same benchmark you'd use for global poverty everywhere. 5 million. Yeah. And guess what? Those probably all have neglected tropical diseases. 5 million people. Just like those living in extreme poverty in Africa.

5 million people living on $14 a week. $2 a day, yeah yeah that's insane yeah the university of michigan center on poverty is also shown that we have uh i forget the number 2.7 million families living on less than two dollars a day which is probably about the same as the five million number jesus christ yeah and again this is not a topic that is very popular. I mean, when you see presidential debates, this is not something that comes up. No, nobody talks about it. And, again, even for disease.

I mean, what are the diseases we hear about? Ebola and diseases like that. And sometimes in my frustration I say, you know, these are imaginary diseases. And yet here we've got widespread diseases of the poor in the U.S., and the lights go out. You remember when that woman came back from Africa, and she was a nurse, and she had been in some connection contacted with Ebola. She didn't have it, and they wanted to quarantine her. Oh, yeah, and they stuck around in some cabin on the airport

or something like that. Something crazy like that. It was terrible, yeah. What did you think about that? I just thought it was so cruel. Is it just an ignorance of how it's transmitted? Yeah, that's right. How is it transmitted?

Well, actually, Ebola, you know, it turns out is the opposite of measles. Measles is one of the most contagious diseases known. It has a reproductive number of 12 to 18. What that means, if a single individual gets measles, 12 to 18 others get it because the virus hangs around in the environment and it's so easily transmissible. Hangs around like if you touch this table. That's right. That's right, or even in the atmosphere.

And that's why you get these really large measles outbreaks like you're seeing in Washington State. And usually those are infants under the age of 12 months, not yet old enough to get vaccinated. Those are the ones that wind up hospitalized and sick. Ebola is just the opposite. Ebola is a reproductive number of two or three. So unless you're taking care of a dead or dying Ebola patient or someone who's recently died, because it's only towards the end stage of the disease that you really get large numbers of virus particles in the body, you're not going to get Ebola. So the reason it's being so hard right now to contain in Democratic Republic of Congo is not because it's so highly contagious. It's just

that the place is decimated by the collapse in infrastructure associated with civil war so even though we have now an ebola vaccine it's hard to vaccinate everybody and how is it transmitted uh ebola by contact with fluids of somebody with with ebola so it has to get into your tissue somehow right right yeah oh what else should we worry about? You're freaking me out. Well, the point is a lot of these diseases are solvable if we just put our mind to it. Or if people are even aware of it. countries. If we could get the elected or the leaders of those G20 countries together at a G20 summit and say, we're really going to do something about the neglected diseases in our own borders, and I'll include the United States, we could get rid of two-thirds of the world's poverty-related neglected diseases right off the bat. So a lot of it is political will, ignorance or lack of

awareness and political will. Well, it seems like in this country, ignorance is a big part of it is political will or ignorance or lack of awareness and political will well it seems like in this country ignorance is a big part of it because uh this is something i've thought about many times but i didn't know about chaga i didn't know about a lot of these other diseases you're describing yeah no i mean so we we need to raise awareness about these that's why i'm so thrilled i'm so thrilled to come here because i've just amplified the number of people who've heard of this concept of blue marble health, which is a name that I've given, a different name from global health to separate it from the two. So coming on here is so powerful in terms of amplifying that message. So again, back to the magic wand, what could be done? I mean, is it a funding issue or is it at first before that an education issue?

Well, I think there's multiple issues. So, I mean, again, the drivers we've been talking today about promoting these diseases, really tough to do anything about extreme poverty, war and conflict, climate change. Climate change, clearly there are some things we can do. Aggressive unchecked urbanization. But the other things that you can do is build better tools. By that I mean better diagnostics, better drugs, better vaccines. And unfortunately for these poverty-related diseases, there's no market incentive for it.

So it falls to academics, to professors, to people trying to do this in the nonprofit sector. And we're doing the best we can, but it's not nearly as good as having access to getting the pharmaceutical companies involved as well. It also seems like this would cost an insane amount of money to just go through all these poor communities, test everyone, and start distributing these drugs. And what would pay for all that stuff? Well, some people have asked me, well, would the Affordable Care Act take care of this? And I said, well, we're two steps away from the Affordable Care Act. We're two degrees of separation away from the Affordable Care Act because we're not even recognizing these diseases. Yeah, you've got to know about it first. I mean, what percentage of the population even knows about all these parasite-created diseases?

Or know that vaccines don't cause autism. Yeah, well, that's the biggest one yeah i mean that's a tough one and again i don't understand it i mean i'm just saying it i'm saying vaccines don't cause autism because you're saying it right you know and i think this is the part of the boat is a lot of people part of the problem we're in this boat with a bunch of people who are scientifically illiterate like myself who are discussing these issues who don't really know what they're talking about. I saw someone talk about tetanus because some boy had tetanus, and he was in the hospital for a long time, and his hospital bill was like a million dollars.

Oh, God, yeah. Yeah. Well, because it's an ICU admission, right? Right. And they were saying, hey, why didn't this kid get a tetanus shot? And it goes back to the same thing, right? That people don't want these vaccines. Yeah.

That could have prevented. And again, I don't blame the parents. I think the parents in some ways are victims themselves, are victims of this very aggressive misinformation campaign that's out there. Tetanus is a big one, though, isn't it? Yeah, tetanus, and we have a vaccine for it. That's part of what's called the DPT. That's one of the's called the DPT. That's one of the first vaccines you get as an infant. There's no excuse for having a tetanus case in the United States.

Right, and this kid was unvaccinated, right? Right, that's my understanding. Yeah, I mean, is there a cure for tetanus outside of vaccines? Well, I mean, there are supportive measures that you can do. But, you know, they require hospitalization, ventilation, putting on a respirator. And you could still die. So it's an awful, awful disease. I've seen tetanus working in Central America and elsewhere.

You see a case of tetanus, you never forget it. What is tetanus technically? Well, the other name is lockjaw, where your muscles go into spasm, including the muscles involved in breathing. So you can't even breathe as a result of it. It freezes the muscles. What is doing it? What's doing it? Is it a parasite?

It's actually caused by a bacteria. The bacteria releases a toxin called tetanus toxin. That sounds like a horrible way to go. It's terrible. I i mean these are awful diseases and i think one of the things that the anti-vaccine group or lobby as i call it does is they try to be very dismissive of these diseases they try to deliberately downplay the effects i mean you'll see this stuff on the web measles build your immune system i have seen you said it yourself i didn't read it yourself so you saw that

somewhere i didn't read it yeah i just saw it yeah that doesn't make any sense let me ask it's crap right now and um what are they saying what is what is the they're saying it's just a rash it builds your immune system it makes you stronger it's it's it's something out of from a different planet i don't know where they're coming but from. I think the reason for that becoming popular is because we do kind of helicopter parent our kids a little bit too much. They should come in contact with a bunch of different things because it does build their immune system, correct? Well, that's an interesting hypothesis called the hygiene hypothesis. Right. It says, you know, if your kids are living in too sterile environment, then this can also result in autoimmune diseases and things like that.

Allergies. Allergies. And I have mixed feelings about that hypothesis. To me, it's not airtight by any means. Not airtight. But there is some sort of a correlation, particularly between peanut allergies and keeping peanuts away from children. particularly between peanut allergies and keeping peanuts away from children. And that there was a study shown, there was Jonathan Haidt's work in one of his books,

talked about how there was a study done in communities where they didn't protect kids from peanut allergies and the much smaller percentage of people developing peanut allergies versus kids that they did. Well, this is also one of the things that the anti-vaccine lobby is doing now. And when I write a book like this, vaccines don't cause autism. Now what you're seeing, remember I told you about that whack-a-mole business where they went from MMR to thimerosal to spacing vaccines too close together to aluminum. Now there's some groups that are moving away from autism altogether. And now they're saying, well, vaccines cause autoimmune disease or vaccines cause other neurologic deficits. But it's all flim flam.

It's all flim flam. There are vaccine courts, though, right? There are vaccine courts, yeah. And they have handed out payments to people who were injured by vaccines. Right. What is that? People who were injured by vaccines. Right. What is that?

So, you know, it was, for instance, if you look over a 10-year period, I think it is between, I haven't looked at the numbers in a while, I think it's between 2008 and given, 2.5 billion, of which the vaccine courts identified around 200 that were a list of serious injuries that they have a table of that they could attribute to vaccines. So there were 2,000 payouts, and of those 2,080%, they didn't really think were attributed to vaccines but they paid it out anyway because that's how the courts work and then 200 where they could really say yeah it looks like this could be related to vaccine so you divide 200 by 2.5 billion that's 1 in 10 million or even 2,000 by 2.5 billion that's one in a million that's one in a million and these cases uh what was happening to these people other than the shoulder injury that you were talking about?

Yeah, there's a list, and I talk about it in the book. There's actually a table you can download on the web for each vaccine, a list of potential injuries that they allow. And these potential injuries, is it, as we were talking about earlier, is this just biological variability that some people just react differently to different things? I think in some cases we don't know. In other cases, you know, with the live virus vaccines, if you have a severe genetic immune deficiency and maybe it wasn't picked up, then there's that risk. But, you know, what's a one in a million, what's a one in a 10 million risk? As I said, we have to keep that in perspective because the odds of getting hit by lightning is one in 700,000, if you believe that number. Or, you know, what's the risk every time you take your child out in a car and drive around the neighborhood? I'm sure the risk is far higher than one in a million.

And the real danger is these actual infectious diseases spreading and the damage they could do, damage things like tetanus. They're coming back, yeah. Yeah. Yeah, measles is an awful disease. It causes measles, encephalitis, measles, pneumonia. I find that a lot of people that are steadfast in their resistance to vaccines, they also believe in a lot of other questionable things. vaccines, they also believe in a lot of other questionable things. It seems like these things get lumped into these groups of things that they don't trust the government about.

Right, right. Yeah, I think that's probably true. Yeah. That's what sucks about having a sketchy government. Which was, well, you know, it was interesting. So, you know, I said, you know, we need to hear from the Centers for Disease Control and more and the Surgeon General. Now they're starting to speak out. But, you know, people countered that and said, well, part of the problem is people don't trust their government.

And I said, well, that's true of some. But I think most people, if, you know, if we had a, you know, more visible public health force out there, people would listen to it. health force out there people would listen to it well i think that what you're talking about in terms of these poor neighborhoods and these parasites getting into people's system and affecting cognitive development and what was the other one besides chaga was the toxic choriasis was the one that affects cognitive development and the fact that there's actual cures for these things too i mean that i estimated in a paper there are 2.8 million african americans living in poverty with toxic arises.

Wow. This is not a rare disease, Joe. This is a common disease. But it's so unknown. But it's occurring among the poor, and it's a chronic and debilitating infection. It's not dramatic. It's not Ebola. It's not killing people.

Is this mostly in warmer climates as well? It's more common in the south than in the north. Is it because they have longer time to stay alive? Yeah because the eggs are in the environment and the worm develops within the egg. Is there any other diseases that are going on that we don't know about? Yeah sure there's other there's a brain parasitic infection called cysticercosis. What's that one from? That one is from eggs, often from individuals who have a tapeworm. So we're seeing cases of that. There's some of the viruses transmitted by mosquitoes.

One of the ones we don't talk about a lot, which is a very serious infection, is West Nile virus infection. lot, which is a very serious infection, is West Nile virus infection. That's got very high rates of not only encephalitis, but also one of our faculty members, Christy Murray, is showing very high rates of depression and other neurologic debilitation for it. And that's another one we could probably use a vaccine for, but there isn't the market incentive to do it. West Nile virus does come up, though. At least that's discussed in the news and people are aware of it. Right, right. As soon as you said it. Right.

But there's no vaccine. There's no vaccine, but there could be. What is it? There could be. Sure. What's holding it back? What's holding it back is lack of market forces, lack of financial incentive for the pharmaceutical companies to take it on.

So there's an extremely large investment to develop something along those lines? That's right. Yeah, I mean, vaccines are, from an investor's perspective, a tough sell because, you know, there's a possibility. First of all, you need many years of clinical trials. It can sometimes take two decades from the original conception of a vaccine to actually going through a clinical trial. So the hookworm vaccine I've been working on, we've been doing it since the 1990s. So we're talking decades-long time horizons. When you talk to an investor about something with decades-long time horizons, you figure

it out, right? The lights go out, I mean, very quickly. That's where it gets gross, right? Because this is all, we're relying on these private businesses to invest money to cure a public health issue. That's right. That seems kind of crazy. Guinea, Liberia, and Sierra Le to embark on diseases of pandemic potential, like Ebola, like Lassa fever, like MERS coronavirus infection. And that was great, but the problem was they didn't address these poverty-related diseases.

So those of us who are working on poverty-related diseases are still kind of on the outside looking in. on poverty-related diseases are still kind of on the outside looking in. It just seems like having everything managed by private companies that need to have some sort of financial incentive to attack these diseases, that seems like a crazy way to deal with health crises. That's right. That's right. And so what I've recommended is, I said, that organization, CEPI, is great for what it's doing, but we need another mechanism. What I've proposed is that since these diseases are

so common among the poor in the G20 countries, these are the 20 largest economies to put together public sector funds for that purpose. Public sector funds for investing in developing vaccines and treatments? For poverty-related diseases, these chronic debilitating diseases. And in fact, you know, we can show that using, working with health economists, we actually work with a terrific health economist, his name is Bruce Lee of all names. He's a professor at Johns Hopkins. Seems like he would change your name. Yeah, right. He loves it.

And he's been able to show that our vaccines are not only cost effective, they're cost savings, meaning that they're economically dominant, that they'll actually save money. The problem is it still doesn't help you with the fact that you still need some, but the return is on public health. You still need somebody to come along and provide that investment. health, you still need somebody to come along and provide that investment. So what's happened is our technical ability to develop vaccines has outstripped our financial instruments that we have to do it. So I get a stream of young people in my office wanting to go into global health. I mean, the commitment for this next generation, I know they get a lot of bad press, but my impression is this next generation, their commitment to public service is at an all time high. And they say, you know, Dr. Hotez, I'm all in, I'm going to go into global health. And they're a little bit disappointed when I tell them get an MBA or get a law degree, because where we need the innovation now is in the finance sector. There must be a business model out there that would

work, that would figure out how to do this. I just don't have the background to do it. It seems like once the momentum is in the corner of this being handled by the private sector, and that the private sector has to develop these vaccines and these treatments, and they have to do it with some sort of financial incentive. If they don't have a bucket of gold at the end of the rainbow, they're not going to take a ride. That's right. Fuck, that's crazy.

But that's the reality. And so the exciting thing about what I do is developing these vaccines for poverty-related diseases. There's no roadmap. Right now that we're in clinical trials, I don't know what the roadmap is to get to licensure and getting these vaccines out to the public. The terrifying thing, the thing that keeps me up at night, is there's no roadmap. Right.

So it's both good and bad. It's both good, yeah. How much does it cost to get a vaccine, I mean, in general, from developmental period to actual application well the pharmaceutical companies have traditionally said billions but i don't think that's the case i think one of the reasons um they're doing that is because they're also recovering their r&d costs. You know, they're putting money into R&D that they charge in order to, you know, either make a profit or at least stay even. So, for instance, the cervical cancer vaccine, the HPV vaccine, that, you know, when I last looked was $420 for the three doses.

It doesn't cost $420 to make that vaccine. It's just that they're recovering their R&D costs, which is fair enough. So one of the things that we're proposing to do for our neglected pass those costs on. That was used for R&D and we would just cause for the cost of goods. So at least we can get it down to just a couple of dollars a dose, a few dollars a dose. Now, for anybody that's listening to this conversation and they have additional questions, where's the best place that you should guide them? Would it be your books? Probably the books because I wrote the books for lay audiences.

Lay audiences sort of. I mean somebody with a university education. I mean they're not – they're published by Johns Hopkins University Press. And they are kind of – they're uneven in terms of how weighty they get into the science, but certainly the vaccines did not cause Rachel's autism. I wrote it with the idea of parents, vaccine-hesitant parents, and also the pediatricians. Because the other problem with pediatricians is, you know, they're there in their office and parents are reading this stuff on the internet. And they in loaded loaded for bear

into the pediatrician's office with all these factoids and the pediatrician's like well gee i never heard that before and and then the pediatrician is made to feel stupid like he's not keeping up with the science he is or she is but it's just they're not keeping up with the misinformation so i provide talking points in the epilogue of the book. And Blue Marble Health is the best resource for people to understand these. About diseases of the poor in wealthy countries. Then I have a third book that I wrote a few years ago called Forgotten People, Forgotten Diseases that describes the neglected tropical diseases. Well, I really hope that what comes out of this is someone gets motivated to create some

sort of a documentary really on both subjects. I mean, I think that we would greatly benefit from some clarity for people that do have concern about autism that's in a digestible form. For good or for bad, people like to watch documentaries. Right, and I hope you don't get too beat up over this because I know the anti-vaccine groups are very passionate. Well, I mean, I don't have a position. I mean, I don't know why they would beat me up.

Well, they beat me up a lot. Well, I'm sure they'd go after you, and they already call me a shill. They call me a shill for a lot of things, though, leaving the round earth. Jamie has a T-shirt that he sells at youngjamie.com. It's round earth shill. Right. Literally.

I've been called a round earth shill. The earth is flat. There's a lot of those. I don't know if you know. I didn't know that. There's a lot. damey.com it's round earth shill right literally i've been called a round earth shill and i said the earth is flat right there's a lot of those i don't know if you know i didn't know that there's a lot so you get beat up no matter what if you're talking but um so uh but i really think it would be it would do a good service if somebody did put together a documentary because i don't think most people are aware i think most people are just relying on this fear that vaccines do cause autism. There's also this connection between people that are older, correct? When they're older and they have children, there seems to be a more likely…

There seems to be, and that may be related to as you get older, your sperm or your egg have some genetic instability and more likely to produce mutations. Yes. That's probably the mechanism. That would go hand in hand with the genetic basis of autism. And then the Blue Marble Health book, I mean, what you've been saying today about these diseases and how many of them exist and how many of them are almost unknown, untreated, undiagnosed, and just how many people are unaware.

I really hope that someone does something about that, too. But meantime people can buy your books are they available in audio as well um definitely the vaccines do not cause rachel's autism it's audio books and i'm not sure about blue marble health okay but you can get it on amazon well thanks for being here i appreciate it it's good to see you again well thank you for raising awareness of all this stuff i really appreciate it my pleasure and i appreciate you uh coming down here and explaining a lot of this stuff for us. It's been a great time. I really enjoyed the opportunity. If people want to get a hold of you on Twitter, what is your Twitter handle?

Just at Peter Hotez. Okay. Thanks, sir. Appreciate it. Thank you.