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

Episode Date: April 26, 2021

Peter Hotez is an internationally recognized physician-scientist in neglected tropical diseases and vaccine development. In this episode, they first follow up on the podcast episode (#158) with Brian Deer (the investigative journalist who exposed the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism) with a broader discussion about the origin and evolution of the anti-vaccine movement. They explore some of the specific claims being made around vaccine additives, the timing of when vaccines are given, and claims about issues with the HPV vaccine specifically. Next, Dr. Hotez shares his own journey as a parent of an autistic child and speaks of the challenges of diagnosing autism, what could account for the seeming increase in the prevalence, and whether there is any support for the notion that environmental triggers play a role. They close out with a discussion on the state of affairs with respect to COVID-19 vaccination, comparing the various vaccines as well as the challenges that emerging variants of the virus may present. This episode was originally recorded on April 2, 2021.   We discuss: The stubborn persistence of anti-vaccine sentiment (3:00); A closer look at claims about thimerosal and vaccine spacing causing autism (12:00); The Hib vaccine: An example of the profound difference a vaccine can make (23:30); The controversy surrounding the human papillomavirus (HPV) vaccine (30:45); The growing anti-science sentiment, COVID vaccine hesitance, and the basis of the anti-vaxx movement (39:00); The origins of autism, and Hotez’s personal story as a parent of an autistic child (1:02:45); The challenge of diagnosing autism, increasing prevalence, and a potential parallel to Alzheimer’s disease (1:14:15); Comparing the various COVID-19 vaccines and the impact of emerging variants of the virus (1:30:00); Global vaccination challenges and “vaccine diplomacy” (1:40:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/PeterHotez3  Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Atia. This podcast, my website, and my weekly newsletter, I'll focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop, and we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in-depth content if you want to take your knowledge of this space to the next level. At the end of this episode, I'll explain what those benefits are, or if you want to learn

more now, head over to peteratia MD dot com forward slash subscribe. Now without further delay, here's today's episode. My guess this week is Dr. Peter Hotez. This may be a familiar name to a lot of you because this will be Peter's third time as a guest on this podcast. I wanted to have him back for two almost unrelated reasons. The first is I wanted to do a follow-up to the discussion last week with Brian Deer, because in that discussion we focused very heavily on one particular claim around vaccine and autism, namely the NMR vaccine, but I wanted to have a kind of broader discussion around the

evolution of that theme, and we get into that in great detail. We explore the controversy around thymarisol and other additives along with the timing of vaccines and specific vaccines like the HPV vaccine and the concerns surrounding infertility and miscarriages. We then talk about his own personal journey as an autism parent, his daughter Rachel, who's 28 years old now, has autism and how that, if it all changed his thinking. now has autism and how that, if it all changed his thinking, and we talk a little bit about the diagnosis of autism and how complicated that is, and also what could account for the seeming increase in the prevalence and even the incidence of autism. We talk about the genetics of autism, and we talk about the likely timeline of development and how this may or may not support the notion that there are environmental triggers at play with respect to autism, be it

vaccines or otherwise. Finally, we talk about the state of affairs with respect to COVID vaccination, doing a little bit of a deep dive into some of the nerdy details around what we know four months out with respect to the existing vaccines in the United States and abroad, including some concerns over the AstraZeneca vaccine. And what it can tell us about the emerging strains that are of some concern, particularly in South Africa and Brazil. So there's a lot packed into this. And if you have the ability to watch it on video Please do so on our YouTube channel at one point Peter shares some very interesting graphics Explaining the mutations of the coronavirus that I found very helpful and I think you will as well So without further delay, please enjoy my conversation with Dr. Peter hotels

Hey, Peter, it's so great to have you back on the drive. There's so much I want to talk about every time you and I sit down, whether it's on the podcast or just on the phone, I get the sense we could go on for hours. I want to really talk about a bunch of things today, but I want to start our discussion with a broader topic than just coronavirus or SARS-CoV-2, COVID, things like that, which I know is a topic you are still front lines on. And I don't think a day goes by that you're not being sought after for your opinion on things. And we will certainly get to many of those things later today.

But again, I want to start with a topic that was near and dear to your heart long before the coronavirus emerged in this fashion, which is the topic of vaccines and vaccine safety. Now, recently I had Brian Deere on the podcast. And I think for many people, it was an illuminating discussion because Brian himself is not particularly a vaccine advocate. He's very clear about that. He's just an advocate for good science.

I think his work uncovering the web of lies and deceit surrounding the work of Andrew Wakefield is really unparalleled, especially when one considers the depths to which it was scrutinized both scientifically and even in the court of law. The first thing I really want to understand, Peter, is why is it that after the complete debunking of everything that Andrew Wakefield did said, published, etc. Why is this still an issue? Why is it that in a post Andrew Wakefield world, most polls would suggest somewhere on the neighborhood correct me if I'm wrong, 20% of Americans still believe there's a relationship

between vaccines and autism. What's happened, and it's actually a very profound question, and I agree Brian's work was extremely important, and then the scientific community came in in a big way, debunking all of the assertions, and one of the things about the anti-vaccine lobby that it spawned or that it ignited, at least in the modern sense, is that from then on,

they kept on moving the goalposts. So it began in its modern form in 1998 with the Wakefield paper asserting that measles bumps reveal a vaccine causes autism by the live virus vaccine replicating in the colon. The scientific community responds in a very vigorous, robust way, publishing multiple papers, large cohort studies showing that kids who were autistic, and I got involved in it because I have a daughter with autism, and kids who are autistic are no more likely to have gotten the MMR vaccine than kids who are not, and similarly kids who get the MMR vaccines are no more likely to become autistic than kids who don't. And really sound epidemiologic studies, but then they switch. They flip. They said, okay,

well, it's not really MMR vaccine. They had Robert F. Kennedy and a group of people saying it's the thymarousal preservative in vaccine. And then it switched again to spacing vaccines too close together, then it switched again to alemin vaccines. And now what you're starting to see is even shifting away a bit from autism, saying that vaccines cause something called chronic illness or looking at the HPV vaccine for cervical cancer and other cancers, and then seeing a cause of infertility or miscarriages. And each time the scientific community responds. And what they do is to maintain momentum, to reenergize, they keep on shifting. And the concern for me now is they're not even looking at this from a pseudoscience

point of view. What they're now focusing on is the politicization of it. We'll talk more about it, but it's starting around 2014, 2015, they managed to glom onto the Republican Tea Party and to make it a politicized movement around these concepts of health freedom and medical freedom. And that's what we're dealing with today now. And you know, that's why you've got all the craziness on Fox news the last four or five nights with Tucker Carlson going on this rant against vaccines and Laura Ingram going on this rant against me and Tony Fauci and this is a problem in that they have this adaptability they create these versions 1.0 2.0 3.0 of the anti-vaccine movement, but the autism piece never entirely left. That's still its legacy fake assertion that still haunts us today.

Given how deep Brian went into the discussion, specifically of MMR and autism, that relationship, I don't think anything else needs to be said on that topic. And obviously for anybody who's listening to this, that still has questions around that, I would highly recommend that they go back and watch that video. Listen to that podcast, read the book and truthfully, and I don't say this to be, I don't know how to say this delicately, but I think if after assimilating all of that work, you still believe that there's a relationship between that vaccine and autism, there's probably nothing that can be said that can dissuade you from that. And I would just leave it at that, agree to disagree. But let's focus on some of the other things that you've brought up.

Do you have a preference for where you'd like to begin? Would you like to start with thymarisol? Yeah, I mean, you can, but it always comes down to the same few things. I mean, what happens in the case of Brian Deere in the MMRMR in addition to the scientific community, refuting it on the basis of large cohort studies and prospective studies, what he was able to do was show nefarious intent, which was extremely helpful because knowing that what's happened since then is the anti-vaccine movement has grown so much larger than Wakefield. Now you've got dedicated anti-vaccine groups, national anti-vaccine groups, children's health defense, and ICANN, and those kinds of things. But then you also have local political action committees, PACs that are linked to far-right wing extremism.

So it's become this very complicated ecosystem or web. And now it's even gone beyond the United States. So yeah, I mean, we could go into why thimerisol is not linked to autism. And then we could go into why spacing vaccines is not related to autism or what autism is. Now it begins an early fetal brain development. But it won't stop the momentum of the anti-vaccine movement

because they light a fire, they cause damage, and then they move on. And that's their modus operandi. I don't disagree with that, Peter. I guess the way I think about the role I'd like us to play in this discussion is I don't think we're here to stop the anti-vaccine movement. What I'd like to do is help parents who frankly are inundated with information and can't distinguish between signal and noise, at least come to a place where we can have an honest discussion about it, because I really

do want to have that discussion. And I think the order in which you actually just went through them is a very elegant way to talk about this. Let's spend a few minutes on thimerisol. Let's spend a few minutes on some of these other claims. And then let's actually talk about autism because there is no denying the fact that the incidents and prevalence of autism are increasing. We should talk about what some of the plausible reasons for that are and why the scientific community has been able to rule out these claims that are being put forth. I have great empathy for the parent who's listening to this, who is confused.

And that doesn't necessarily mean just the parents of children with autism, but that's the parent who's trying to decide, what am I supposed to do here? Am I supposed to get my kid vaccinated? And am I supposed to get them vaccinated at this pace? And does my kid really need three HB vaccines in the span of six months? I think just having an open honest discussion about that is by no means going to dissuade

the 20% of people who are clearly in the camp that says vaccines are evil. But I do believe that there's a very confused group of people in the middle. And I hope we can talk about that. So is it safe to say that post-wake field? Because I'm trying to go back and remember the timeline. It was around 2007-2008 that every claim of wake trying to go back and remember the timeline. It was around 2007, 2008 that every claim of Wakefield had been pretty much debunked. And to your point, it wasn't just debunked scientifically. And it had been made clear that he had lied and he had manipulated

data as had a leery. And this was one big house of cards. The Lancet paper was retracted, I think, in 2010. Although I think there was an expression of concern put out by the Lancet a few years before the maybe 2004 I can't remember exactly. So, and the basis for the retraction, they didn't really spell it out that much. They basically said the results are no longer valid. I don't think the retraction letter issued by the Lancet

went into all of the investigation that the medical council had done and for Wakefield to be struck off the register. I don't think the retraction mentioned anything about the Brian Deer paper. Yeah, I think it was Deer's reporting. And frankly, the most damning evidence was the lawsuits. It was the complete inability of wake field to maintain any legal argument against the people who were accusing him of fraud. So let's put that aside and let's move forward. Let's start by telling people what thymarisol is and what is it doing in a vaccine. Well, first of all, thymarisol is really not in childhood vaccines anymore. So what happens is if you have a multidose vial of vaccines whereby you've got a vial

of vaccine that could be given to six or seven or 20 people, each time you're introducing a needle into that vial through a rubber stopper, potentially you're introducing bacteria. And the worry is that if you do that enough, that there could be some bacterial growth or overgrowth into the vile, so you need to put some preservative in. That's nontoxic that will kill the bacteria. And when Thymarousel was discovered, it was considered quite an advance in terms of allowing you to vaccinate large populations. And the bottom line was it was taken out, the manufacturers took it out of the vials just because of all the bad publicity swarming around it. There was never evidence to show that it was a problem. But I think the thinking was, we don't really need it,

we can give single dose vials instead. Let's just take it off the table and in fact, that was done there. Still, some of the flu vaccine still have thymarisol in the US, not all of them. You can still get a single dose vile for flu vaccine and take that as well. But there was never ever any shown association

between thymarisol and any untoward effect, certainly in terms of autism. Thymarisol was one of the big pushes from Bobby Kennedy Jr. correct. Wasn't this really his initial cause and his initial fight? I think so. I think he got into it because he's an environmental law attorney, looks at toxic waste.

And I think when he saw the mercury word, he probably got a link to minimata disease, which is remember back in Japan several decades ago, there was a lot of mercury exposure and fish and young kids who were exposed to what's called methyl mercury. I think it was during pregnancy and the kids that were born were born with intellectual deficits,

and there was a syndrome associated with it was called minimata disease. And so I think probably people in his camp put two and two together and they said, well, probably autism must be some form of minimata disease, even though it's not the same, maybe there's enough there that it could be due to thymyrusol.

But again, the large cohort studies showed absolutely no linkage with autism, and ultimately we know why, because we know autism is associated with prenatal events. That's how he got involved, and there were books about it, there were a couple of books making these assertions. And then once again, it started gaining a lot of momentum very much like the way Wakefield did a decade before. And I think the first publication, which I write about on my book, vaccines did not cause Rachel's autism. And while you're looking for that Peter, I'll just clarify for listeners because you mentioned

it quickly, the difference between methyl mercury, organic mercury, inorganic mercury, because you made the point that thymarasol is an organic mercury. There's sort of a difference between organic and inorganic mercury. And most of the toxicity that we see when people are over consuming fish that are high on the food chain, such as large tuna, swordfish, shark is organic mercury. It is methyl mercury, not inorganic mercury. Right, so minimata disease, which was named after a city in Japan, it resulted from a chemical plants

industrial release of methyl mercury, which is different from thimerisol, which is a totally different compound. It's ethyl mercury, and it was in wastewater, and it accumulated in a bay where fish and shellfish lived and were consumed as seafood and large scale methyl mercury ingestions and pregnant mothers caused a congenital syndrome, causing neurologic disease in the form of gait and mowedage disturbances, in some cases even coma and death. So there was a paper that was published at that time in a journal called Medical Hypothesis that first proposed that maybe autism could be related to thymarisol

because even though it's not in methylmercury, maybe it's ethylmercury doing this. And that was in 2001 that the paper got published three years after the Wakefield assertion. And so this was a pretty common preservative, but then it was subsequently taken out. And what was interesting is even after it was taken out, the rates of autism never went down. That's pretty clear. And there were again large cohort studies showing absolutely no link with thymarisol. All of that said, Peter, I certainly wouldn't want to suggest that the paper in 2001 and even the work that followed was anything but reasonable. I mean, that's the purpose of medicine, right? I mean, you see something like autism, you look for plausible

associations and you see a neurologic disease that is associated with mercury, it's entirely reasonable to formulate a hypothesis that says this other thing that looks kind of like it could be it. And the paper was published in a journal called medical hypotheses. Exactly. I mean, it's completely reasonable. It's the stuff that follows that's challenging. It's after the scientific community goes to great lengths and great attempts to seek the truth and publishes, you know, paper after paper after paper and mainstream scientific

journals that the anti-vaccine groups refuse to acknowledge its cling to their debunk hypothesis, and their only response is, well, the scientists must be paid off by the pharma companies or the journal. It must be paid off by the pharma companies or the editors may must be paid off by the pharma companies. And so they resort to conspiracies rather than rather than, I get it let's move on let's try to figure out what really causes autism and they've never shown that intellectual curiosity about what really does cause autism and they continually

discount the massive amount of scientific work that's gone into really uncovering what autism is. Before we get into the deeper why, because that's a big part of what I want to understand, and there's two deep why's here, run around autism and one around latent distrust and the path that there's a fork in the road where one person can be very influenced by data. They can think probabilistically, they can think in terms of uncertainty, they can accept and reason their way through these things.

And then there's another person who's going to cling to a belief in the presence of emerging data that refute that hypothesis. And they'll continue to come up with an excuse. And I really want to try hard not to pass a moral judgment in either case, but there's clearly an anti-science sentiment that is growing, that is fostering this. Before we get to that, let's go to the next point, which is,

Thaemara Solid believe was electively removed in about very early in the 2000s. I think it was actually removed two years before the medical hypothesis paper. I think it was removed in 1999 actually, or at least that process was started. It had already been underway. What was the next position of the goal post after Thymarisol? So then it was this concept of greening our vaccines or making them more, I don't know why they used the word green I guess making them more eco friendly and that the third major hypothesis was that kids were becoming autistic because of antigen overload that somehow they were getting too many vaccines at once this was overwhelming the immune system and somehow that led to autism, which again never made a lot of sense to me how

they say it's leading to inflammation. And I always would point out that we've seen what the brains of kids on the autism spectrum look like. I've seen my own daughters, you know, CT and MRI scans in her work up of autism. And we know what inflammation looks like. You can see inflammation work above autism. And we know what inflammation looks like. You can see inflammation, our evidence of inflammation or at least blood on a CT or MRI. And we know what herpes in cephalitis looks like. And autism doesn't do that. It's not an inflammatory state of the brain. And so that one never made any sense either. There were several other people who came into this people like the pediatrician, Dr. Bob Sear started writing books about how we have to space vaccines further apart and had written

a number of books about that as well. But again, well, first, it never had plausibility and that's the lot there today. And if you go on Amazon.com and look at books on vaccinations, I think those books are still top sellers. Now, in the case of Pomerosol, at least there was a plausible explanation that was put forth as a hypothesis. When the hypothesis for spacing was put forth, was there some epidemiologic data that suggested this? I'm not aware of it. And the problem was, you know, we didn't have clinical trial data to support the spacing of the vaccines.

The current vaccine regimen, the schedule, is based on years and years of studies confirming immunogenicity and protection. It's also based on years and years of studies showing that there's no immunological interference. In other words, if you give pair of two vaccines together, that one doesn't interfere with the other, it's a very carefully orchestrated dance. And then these guys come in with these wacko schedules without any scientific basis. And then it forces the scientific community to try to re-evaluate whether you're still getting the same immunogenicity or not, and also the immunological interference.

So it's not just a matter of saying, well, what difference does it make as kids are getting the same vaccines? It's unclear whether they're going to be just as effective or safe as that very carefully orchestrated dance that was developed jointly by the FDA and CDC. That's a very interesting point, Peter. And frankly, not one I'd ever considered. I get asked not infrequently by patients about vaccinating their children on the schedule. And these are not people who think vaccines are causing autism, but they do have some concern,

presumably just based on things that they've read, heard, etc. that say, hey, does my kid really need to have all of these shots in the first nine months of life? And their belief, which is not unreasonable, isn't this just a way to ensure kids get their vaccines? Because during the first year of life, the parent is so much more likely to come in for well baby checks, and they're gonna have much more frequent contact with their pediatrician, and that that's the reason that this schedule

is being imposed on us, as opposed to any really biologically necessary. Again, I use the example of hep B, which most kids are really not at risk of hep B. Let me give you a different H disease as an example. So, homophilus influenza type B. It's a bacterial cause of meningitis. Back in the Pleistocene era,

when I was a house officer, I was a pediatric house officer at Mass General. In 87, 88, I would be admitting a kid with homophilus influenza type B meningitis to my service every couple of weeks. And Mass General was one of the oldest pediatric residencies. They called it the Children's Service. And back then the house officer did everything. You had to do the Lumber puncture. You had to look at the cerebral spinal fluid. Under the

microscope, you had to do the gram stain and eventually sent it a lab, but to confirm it. But you would basically make the diagnosis right then and there. And when you did it, your heart sank because you knew that there was a high likelihood that kid was going to have permanent neurologic injury or might not even survive. And it took a big emotional toll on me and my fellow house staff to have these young healthy infants now get home offless influenza type B meningitis. And at that time, we didn't have a vaccine that worked in infants. There was the capsule of the homophilus influenza type B,

the polyribophosphate capsule, but it was shown that it wasn't a immunogenic in infants. So it was still licenses of vaccine for older kids to catch the few older kids that could still make an immune response but it didn't work in infants. Why is that, by the way? Turns out, I need to happenize it onto protein. And that's what John Robinson-Rachael Schneerson did at the National Institute of Child Health and Development and IH.

They figured that out and developed a conjugate vaccine that now worked in infants, which now you could start vaccinating at that time. You didn't have anything that worked in young infants. So all you could do at that time is to take a prophylactic antibiotic called refampicin, which had the unpleasant effect of turning your urine orange, reddish orange. And at that time, I had our first sunborn Matthew, and we were living right across the street from mass general.

And I was terrified that I was going to bring him offless influenza type B home. So I was terrified that I was going to bring him off with this influenza type B home. So I took refampicin all the time. And I peed orange for two years, practically, to the point where one of the first the only fights I've ever had with Anne was my wife was permanently staining the toilet bowl orange

because I was taking that antimicrobial. And then this miracle occurred. The miracle was John Robinson know, John Robinson, Michele Schneerson, also David Smith and Porter Anderson and Rochester figured out that if they attach that polyrobophosphate capsule to protein and optimize it, now you get T cell responses and infants and it works.

That vaccine was licensed in 1989 as I was finishing my house offer training. For infants, for young infants, and now it's part of that early vaccination schedule. By the time I finished my, then I went to Yale for my pediatric infectious disease fellowship, I had a lab there and then I was a junior attending at Yale Children's Hospital. By the time I started rounding as an attending two years later, the disease was gone. Basically, I taught the house staff about it purely for historical interest, just like the old guys that Mass General taught me about diphtheria and tetanus.

That's how dramatic it was because we added it to the infant schedule. I think that's a good example of these infant vaccines. To get a vaccine through, to be licensed by the FDA, to file that biologics license application for those very expensive. Second, it's a lots of review. It has to go through the biologic license process of the FDA.

It's got to go through the Verpack Committee, the FDA for review. It then goes to the Centers for Disease Control and the ICIP, the Advisory Committee and Immunization Practices. There's a lot of smart people that are looking at all of this to say, do we really need this? What's the cost effectiveness? What's the benefit to society?

What's the benefit to child health? These are not decisions that are made lightly or these are things which are carefully thought out. So you don't think that there's some consideration given to this is a window in which the probability of vaccination is greater just due to exposure. Again, I bring up HEPB just because you and I didn't get our HEPB vaccines until we were adults. And of course, I don't know when you got yours, but for me, I think I got it in medical school. It was just in time given our exposure to hep B is enormous once you're in medical system, because it's transmitted just like HIV. And depending on where you trained, you might be in a population. I think our first got mine when I was we were keeping a lab in Shanghai and China

for parasitic diseases. And I think going off the China frequently there's a lot of hepatitis B, I think that may have been when I got mine. But you're right, back then we weren't giving it to infants. So I guess my question is, and again, I'm just saying this to try to take the side of the parent, right? I'm trying to put myself in the shoes of the parent who says, this is too much. And again, to be clear, this is not the parent who says vaccines are evil, my kid will never get vaccinated. This is the parent who's saying, is this a little too much too soon?

Does a child really need a happy vaccine as an infant? What is the probability that a child will be exposed to hepatitis B? The only example I can think of is a child whose parent is in the health care system or is an IV drug user, whose who is themselves a high risk for hep B and who is not vaccinated, but outside of that, you could certainly make the case that a person does not need a hep B vaccine until they're when adolescent or at least a youngster in school, correct? until they're when adolescent or at least a youngster in school, correct? Right, but let's take a step back. Let's look at that example of the homophils

influenza type B. No doubt, no question in your mind that that's what we needed to do. Absolutely. Right, okay. Especially given where the risk is highest to that patient. I mean, that's an amazing example of that, right? Right, and that's why I bring us

so the vast majority of vaccines are not given for trivial reason. Or no vaccine is given for trivial reason. And the need is more apparent for some than the others. The exact reason why hepatitis B was selected for young infants, I wasn't at the table when that decision was made. It may be that there was enough at risk populations that it's very hard to cherry pick individuals when there's so many people who absolutely needed that it just becomes easier to vaccinate the whole population rather than say, okay, well, you're in a specific

at risk ethnic group or you're in a specific at risk occupational hazard. On the other hand, when you look at what that vaccine is, it's about as low risk of vaccine as you can imagine. It's a recombinant, we make vaccines like this all the time. It's a recombinant protein vaccine produced in yeast. It's been around almost four decades. It's been given the hundreds of millions of children and really fabulous safety record. So what are you losing, I guess, is the other way to put it?

Let's talk a little bit about HPV. This is, some people hailed this vaccine as a miracle, given the relationship between the human papilloma virus, at least three strains of the human papilloma virus and cervical cancer. This is not an insignificant cancer for women. Sadly, many of us know women who have either died as a result of this disease or have lost their reproductive capacity as a result of this disease. Furthermore, many men might even know the anxiety that a pap smear has caused their

partner if it has shown one of the high risk strains, you know, 16, 18, a number of these things. So I think for many of us, when the HP vaccine came along, it was a really big deal. I mean, this was fantastic news. Can you talk through some of the controversy surrounding it, both from a scientific standpoint, but also from a moral, ethical, religious, political standpoint? Because I think, to me, HPV might be one of the best examples

of the intersection of all of those forces. So HPV induced cancers, like cervical cancer, laryngeal cancers, are predominantly sexually transmitted cancers. So if you look at infectious causes of cancer, roughly, about 16% of all cancers are caused by infectious disease agents like hepatitis B, like HPV. And the numbers go up all the time because we get better and better discovering infectious agents that cause cancer.

So in Africa, about a third of the cancers are of infectious origin. And this was developed by the National Cancer Institute, including someone who's very dear to me, Doug Lowry. They were able to show that vaccinating against this virus can prevent infection of the virus, and therefore will likely prevent cancer. And now new studies have shown indeed, it's born out that indeed, it does prevent cervical cancer. And now new studies have shown indeed it's born out that indeed it does prevent

cervical cancer. And on that basis, the Australian government has now launched a program where they think they can eliminate cervical cancer from the continent of Australia by 2030. So that's really exciting to actually eliminate a cancer through the vaccination process. The issue has come up, you have to vaccinate. Originally, it was mainly focused on cervical cancers rather than the cancers that would develop in males. The recommendation was you want to have those girls vaccinated before their sexual debut, before they start having intercourse as they get to be teenagers or young adults. And so you want to get them when they're nine or 10 year old little girls in time to make

certain that everybody gets vaccinated. And I think that did not go over well with a lot of people because they not realized there are nice little nine 10 year old girl is one day going to be a woman who is sexually active and I think that was hard for some people. But in fact, it has a remarkable ability of saving lives and preventing cervical cancer and that's why Australia has been implementing that in the US in contrast. What's happened, well, we have a couple of problems, first of all, we're a big country. The access to the vaccine is not everything we'd like in rural areas. It's not everything we'd like, especially among underrepresented minorities. And there's an access issue.

But the other big thing is this has been targeted now by the anti vaccine lobby. They have tried to come up with fake assertion after fake assertion. That's not supported by the scientific data. So they claimed it was causing autoimmunity. They claimed it's causing missed. They'd linked a lot of it to female reproductive health issues. They said it was causing infertility. It was causing miscarriage. And again, one by one, the scientific community had to do those big cohort studies to refute all of those links. I guess this is as good a time as any Peter to ask the first of several meta questions. Wait, you didn't give me feedback.

So was that convincing or were you still unimpressed? I mean, what do you think the issue is? I think that's a great point. And I say that as a father of a 12 year old girl, which I was just sort of joking with my mom this morning. You know how your iPhone that'll give you like a flashback picture or video from some time in the past? This morning it sent me a video of my daughter when she was, well she would have been seven, the next guy would have been one.

So seven year old and one year old and the beach playing. And it's like the cutest thing on the face of the earth. And I probably watched the video like seven times. And then I sent it to my mom and I said, I don't remember when she was this little. You know, my mom made some comment like, yeah, enjoy it now, cause five, six years she's gonna be in college and blah, blah,

and so I get that. There is nothing to me that is both simultaneously amazing and sad as the natural loss of a game of tug-of-war that goes on between a parent and a child. My friend Rick Elias described it, you're playing tug-of-war and you have to lose by the time the kid's about 18. So I can see that. I get I'm trying to put myself in the shoes of the person who thinks this doesn't make sense And I think there's an argument that they would make that would say well I don't want my child. I don't want my daughter. Let's just again I think this is an important issue that we should explain why both male and female

It's relevant to both but if we're just taking it through the lens that I think it first came through which is My daughter is 12. I do not want her to be sexually active until she is, and I come up with some arbitrary age like 18. Therefore, I am not going to have her vaccinated until she's 18. Another point of view is, in an ideal world, I would prefer she's not sexually active until she's mature enough to handle that. I don't know when that is, but it sure as hell isn't 12. I don't want her to have this vaccine at 12, but the downside of not vaccinating her in time is she could be cursed with a lifetime of asymmetry. There's an asymmetric bet here. I can understand why some parents might struggle with that, even though I tend to think

in terms of risk and probabilities, maybe more than the average person. I totally agree with everything you've said. I think the problem now is that you've got these anti-vaccine groups specifically targeting HPV, including I think now you've got children's, I forget which it is whether it's Kennedy or this organization is, I don't remember, but again, this is what's going on right now. And I'm not aware of any evidence to support all of these things like infertility or miscarriages or autoimmune.

And what's really interesting also is the anti-vaccine groups have now copy-pasted those assertions onto the COVID-19 vaccine. So they could be pretty lazy. So they're just basically saying the same thing, because I guess it works for them in that parake way. But as a result of that, and I said, it's not the only thing because we have access and rural and underrepresented minority groups, but we're going the wrong way with HPV vaccine. We're not even close to

thinking about creating a cervical cancer elimination strategy. Dr. Justin Trudeau You mentioned laryngeal cancer as well. I don't think enough people understand the threat of that. Frankly, all upper airway cancer, right? I mean, you're talking about cancers of the soft palate. You're talking about lots of head and neck cancers are on the rise. I can't remember exactly the stat. I want to say like the second or third largest growing cancer in young men is head and neck cancer on account of sexually transmitted disease. Yeah. And if you talk to the head and neck surgeons, we're right next to MD Anderson Cancer Center within this Texas Medical Center. It's devastating, the very aggressive surgeries

that you have to do, it's really heartbreaking. By the way, we never finished the one thing about the autism, which was you made the statement autism on the rise. I think it's important to clarify that. I think we're clearly getting better at diagnosing autism. I'm not convinced that the incidence of autism is truly increasing. There's a lot of one I come back to on autism. We're not abandoning that.

But thank you for clarifying that. Coming back to this point I wanted to make, which is meta question number one. Why do, call it 20% of the population and an entire cottage industry of lobbies, lobbying groups, packs, et cetera, come out so hard against this one class of drug, whereas we don't see it for antibiotics. Where are the 20% of people who think penicillin is evil and the companies that make so-fran or, you know, so-fran, but, you know, similarly, like, where are the companies that are coming out against insulin, exogenous insulin, that all these diabetics are using?

Look, I'm going to be a skeptic for a moment. I don't think there's a greater mismatch between drug companies doing wrong and profiting, overcharging patients for a medication than insulin. I think the economics of insulin are an embarrassment to how pharma works. Where's the rage? Like where are the 20% of Americans that aren't losing their mind over what Nova Nordisk is doing? So what is it about vaccines in particular that brings out so much iron, so much skepticism, and so much anti-science rhetoric? Well, I don't know that I have all the answers, but I think part of it is the fact that you're

giving vaccines to, not in all cases, but in most cases, you're giving vaccines to well individuals to prevent them from getting sick. So you're giving something that's not always intuitively obvious that they need as opposed to insulin, as opposed to penicillin, somebody is sick and somebody needs a treatment. So this is being so that you understand, but for a vaccine, you're preventing somebody from getting sick. And I think that simple feature is a big component of it. I think the other is the fact that so many vaccines

are mandatory for school entries. So there is that loss of choice that you feel it's being imposed on you. So those two things become pretty easy to exploit, unless you've got really strong vaccine advocacy activities in your community, it's pretty easy for an anti-vaccine group to cherry pick those two things. And then when you have conditions like autism and people want to understand how did this happen, particularly the regressive form where kids seem to be developing

normally in abnormal milestones, and then regress, this is easy pickings for an anti-vaccine group to come along. So it was an example. For instance, back in the 1900s, in the UK, they started anti-compulsory vaccination leaks, and this extended to the US. So I think it's the combination of the fact that they're preventative, not therapeutic, and the mandate component. I think those two are a toxic mix that get some people upset about vaccines, particularly in this environment, which now dominates the internet. I mean, in the past, when you had an anti-compulsory vaccination league, you could go to your physician. The physician would explain why that's all nonsense,

and why you should get vaccinated. Now we've got something called the internet. Now we've got something called social media that dominates our lives, and you've got Amazon now. It's a single, largest promoter of anti-vaccine COVID conspiracy books. So most of the information you're getting now on a daily basis as a single largest promoter of anti-vaccine COVID conspiracy books. So most of the information you're getting now on a daily basis is actually anti-vaccine, anti-science information.

But again, I'm still trying to understand why the disdain for science is so prevalent. So hear me out on another thought experiment. If the president says, I want to, I'm using this because it's the current example, right? If the president says, I have a legislative agenda that's going to propose a multi-trillion dollar infrastructure bill, you may not think that's the best idea, right? You're going to oppose that through legislative action. You're going to oppose that through lobbying. Maybe that's not a great example. I guess what I'm trying to get at is,

if you're opposed to vaccines, I can at least understand the argument around medical freedom, because you could at least stand up and say, look, I'm opposed to being told I have to take a drug to prevent an illness I don't have. And then you could at least argue the merits of the individual versus society. Like to me, that's a more palatable argument. But the complete anti-science part, maybe because I'm a scientist, is just harder for me to empathize with. Like it's harder for me to put myself in those footsteps because I can't think that way. But I want to, because I think it's important to be able to think that way and not be dismissive of it, if that makes sense.

Here's what I think happened, which is I think part because of my activities and I'm not alone, others were involved in this. There was a lot of effort to debunk the links between vaccines and autism and each PV vaccine and all the craziness that they asserted to cause. And I think it was taking some steam out of the anti-vaccine movement. But you still had enough parents in places like Orange County that were scared about vaccines, the causing autism, that it allowed a measles epidemic to erupt. And it was a pretty bad epidemic in Orange County.

And to 2014, 2015, it was linked, I think, the origins may have been Disneyland, where the epidemic came from. What happened was the California legislature responded appropriately, I think, and said, you know what, we're allowing these vaccine exemptions, but it's getting out of hand. And now it's causing a measles epidemic. And measles is a bad actor, right? It's got a significant mortality and permanent disability, deafness and other things. And they shut down the vaccine exemption. And I think that helped re-energize the anti-vaccine movement

because I think they were losing some steam around autism. And they saw this as an opportunity to rebuild, to reinvent themselves. And they reinvented as an opportunity to rebuild, to reinvent themselves. And they reinvented themselves as a political movement around health freedom, medical freedom. And they're really amplified in Texas, where I am. And it took off with they created political action committees like Texans for vaccine choice. And the packs started getting other pack money. And they, the packs were giving packs, other packs packs money and so there was a lot of money flowing and

It was very powerful and they were able to convince the Republican Tea Party in Texas Which is a very powerful group to adopt this issue as a platform issue and that's when it really started to accelerate and you started to see packs formed not only in Texas, but also in Oklahoma, other Western states as well. So it was more of a Western state phenomenon than anywhere else. And so your political allegiance, your identity actually became tied to not vaccinating your kid or to be skeptical of vaccines. And then it all really blew up last year because those same anti-vaccine groups then started going up against masks and social distancing, again, under this health freedom, medical freedom banner. And now it became a full-on anti-science movement. And you really saw this happen starting and around in last summer when the epidemic moved into the southern states and people showed their political allegiance to the Republican party by defying masks and social distancing.

And then it went up in the upper Midwest as well. And then you had that story, that awful story of the ICU nurse and tears being interviewed talking about one of her ICU patients who's dying words where COVID-19 is a hoax. That's when you started to see this kind of mainstreaming of what was a fringe group around health freedom, medical freedom in 2015, and now become a major platform of the Republican party going up against science. And then you saw the targeting of scientists. That's when they began really going after Dr. Fauci. They began going after Bill Gates. They've been started going after me quite a bit.

And now this thing is steamrolling. I mean, you had Tucker Carlson last week going on this whole rant about vaccines and questioning vaccines in Laura Ingram at Fox News went after me a couple of nights ago and specifically saying what, you have to forgive me if I don't follow this stuff too closely. Yeah, well, it's pretty unpalatable stuff. I mean, they would say that we misled the public, that we got it wrong, that we didn't understand the epidemic, and then they would parade out all the great barrington stuff about no lockdowns, even though none of us ever said lockdowns, they create

these straw men that say we're trying to lock everybody down and we're hurting our economy. And along with that, they're saying, what's going out with these vaccines? And so tying, and again, this is a throwback to 2015, when was first linked to political extremism on far right. So what was started out as an anti-vaccine movement is now movement against any kind of public health intervention and demonizing scientists and basically calling us the boogie man and that. And it's continuing. Now you've got this was exported last summer to Europe. You had these anti-mask anti-vaccine protests, which for the first time used that same American language in Berlin, in Paris, in Trafalgar Square, in London, you had the New York Times reporting how it's linked

to QAnon and other far-right wing extremist groups. And so this really concerns me. And then, of course, to make it all a more complicated is the fact that now you've got the US and British intelligence talking about Putin's government has been lobbying this whole program of what's being called weaponized health communication on our internet in order to destabilize the country and destabilize other democracies. And what was kind of a fringe group arising out of the Tea Party in Texas is now, I don't know what you want to call it, whether it's a descience empire or

a Confederacy that has lots of moving parts to it, but I'm concerned about the fact that it continues to build. Do you think this is just a very vocal part of the Republican Party, or do you think this actually represents an entire political party? I mean, it seems hard to me that this could represent an entire political party given the heterogeneity of beliefs that would exist across that from fiscal conservative, social conservatives. I mean, all of these things. Yeah. And the fact that the Republican party historically has not been anti-science, right? I mean, National Academy of Sciences was started in the Lincoln administration, Eisenhower, Launch NASA, George W. Bush Launch, PEPFAR. So this seems new to me. And I don't

know how much it's pervasive in the Republican Party. Certainly it's become now a major component of Fox News in the evening. And as recently as last year, I was going on Fox News almost every day on a pretty regular basis. And I didn't see it until the disinformation campaign came out of the Trump White House. And when they said COVID, what this around a year ago, last year, when they said COVID was a hoax or the flu and, you know, attributed the COVID deaths to other causes or yet, Kayleigh Mack, and he say the hospitalizations were all elective, catch up in elective surgeries and

discrediting masks and then later on in the summer, they brought out Scott Atlas. So there was no question about it, this very deliberate disinformation campaign coming out of the Trump White House. And I was one of the first to call it out, not because I'm so brilliant, but because I've been going up against these anti-vaccine guys for years and have become, by default, an

expert in anti-science disinformation campaigns and could recognize it. I see it accelerating. I can't say whether it's across the whole Republican party, but it's a lot more pervasive now among Republicans than it's ever been. And then what's the evidence? Well, the evidence is now the PBS news hour teamed up with NPR and Marist, and they've now found that if you look at the single most vaccine hesitant group in the United States, this was just last week, it's what's called white Republicans, I think was 41%. A significant percentage of white

Republicans are saying they're not going to get vaccinated. And that's not the first poll. I mean, we did one with a group of Texas A&M. I'm not a social scientist, but we teamed up with a group of social scientists in Texas A&M, led by Tim Callahan, the School of Public Health, found the same thing. I think we call them Trump voters. And Kaiser Family Foundation also found the same thing twice. So this is the number one vaccine. Now I've seen another poll that suggested, and it didn't slice the data by race and party. It sliced it by race and party separately.

And it found the greatest predictor was indeed Republican Party Association, but the second was African-American. What's the best explanation for that? What's more now, it's coming down. So what's happened that you were absolutely right. So about two, three months ago, African-American groups and white Republicans were sort of neck and neck and who was the most vaccine hesitant.

It stayed up among Republicans, but it's been coming down among in the African-American groups. And one of the things I've been going on, lots of podcasts and radio shows that reach black and brown audiences. And I was on one last night with Baptist Church in Richmond, Virginia. And I asked the pastor, I said, are you seeing less of it? Now he goes, definitely it's coming down. And I said, what do you think is happening? Well, Doc, I think part of it is people like you, you know, reaching out to black and brown communities. But the other is a lot of the clergy of a creator, and sort of an informal network now. And we're really hitting hard on the need to get vaccinated. So I think that may be part of it. But initially it was quite high.

And I think what the reasons why I don't entirely understand what's often said is it's around structural and historic racism and that horrible legacy of Tuskegee. I think the other thing that I've seen though is the liberating targeting of African American groups by the anti vaccine lobby. And and now I just saw on the internet, there's a new quote documentary clicked on the trailer. And it's got saw on the internet, there's a new quote, documentary clicked on the trailer and it's got people getting the Pfizer biotech vaccine that it switches right away to Tuskegee experimentation. So by it's kind of making that links, I think it could do a lot of damage.

So, but it seems to be somewhat resolving, but it's still really high among those group of Republicans. And you saw it when COVID-19 accelerated in the summer and in the southern states and in the upper Midwest and the fall. And so what's going on? And I'm worried that now you've got, again, people tying their allegiance to the Republican Party or their identity to being against scientists and science. And this is not good for the country. There are a few things I want to say and one thing to add, the thing that we haven't

mentioned yet that I think is worth mentioning is the enormous measles outbreak in Minnesota that occurred in the Somali community. I think that story doesn't get enough attention because I guess it's now been enough years. But I've always found that to be an unbelievably sad story. In some ways, more sad than the orange county outbreak because this was really a deliberate targeting of a community of immigrants, not fast-ciled with the language, and the measles outbreak was terrible there. And I guess that's the thing I've always struggled with if you just put your common sense

hat on. Every time a community gets targeted to stop taking, in this case, the MMR vaccine, a measles outbreak shows up. Yeah. And measles is sort of the, Paul often always calls it the canary and the coal mine. And it's, and I think he's right, it's because it's got such a high reproductive number of 12 to 18. As soon as the vaccination coverage goes down, measles finds it.

That was the first time I think that you saw the anti-vaccine groups targeting specific ethnic groups. So, Lena Sun at the Washington Post back in 2017 reported that Wakefield, who had kind of disappeared for a while, was at town hall meetings. I don't know if he organized them or if the small immigrant community organized them, but there he was piling on and brought down vaccine coverage from over 90% to Washington Post reported to 40%. Guess what's going to happen? That was, and I think it was 21 kids that landed in the hospital. And then it happened again in 2018, 2019. They began targeting orthodox Jewish groups in New York and New Jersey. And what they did was just so offensive.

They started parading around in these phony yellow Jewish stars, like the Holocaust, with the word Vax written in it. Vax was written like Hebrew letters and started comparing vaccines to the Holocaust. And that caused this massive measles epidemic across both in Muncie, New York, by the Tampa, Z bridge, and then in Brooklyn. And I think there are 18 people in the ICU because of that 50 hospitalizations. So this has become the new motor software. And then in 2019, you saw these series of Harlem vaccine forums that they organized, even

held one in the Riverside Church, which is on the Upper West Side in the York, near Columbia University. It's one of the iconic churches in the history of the civil rights movement of the Reverend Sloan coffin and somehow got access there and held there rally there. So all of that has caused a lot of damage. Now this new documentary, quote, documentary that's coming out. So I'm very concerned. So you've got, as I say, these multiple facets, you've got the health freedom component expanding now across the Republican Party, now into Western Europe. You've got the Russians fueling this with their systematic, weaponized health communication. And now you've got the specific targeting

of racial and ethnic groups and causing a lot of damage. And the problem is it takes time to explain. I can't give you a 30 second unicef commercial about this. How long have we been talking a full hour now? You kind of get it now, but it takes time to unfold and explain. And the problem is it makes people

very uncomfortable. When I was going on CNN and MSNBC and last year at this time, I didn't want to call out the White House for their disinformation campaign. I mean, what we're told is scientists is, Hey, Peter, just stick to the science, you know, you're not a political guy, you're not an expert in White House, Washington politics. What are you doing? You can't do that. But being an expert in anti-science disinformation campaigns

by being targeted by these guys, I mean, Robert F. Kennedy Jr. calls me the, on his Instagram, called me the OG villain, the original gangster villain. So that's what you're talking to today. I had to look up what OG meant. I unfortunately became a bit of an expert in anti-science disinformation campaigns. I could smell one a mile away. And I saw this and I said, I know what this is. You know, you saw Peter Navarro out there with all the Chinese conspiracies. And I said,

we're being gaslighted here. And I said to Anne, my wife, I said, I don't know what to do. This is taking me to a very dark place. You know, I'm supposed to only talk about the science. And she saw a set I was getting. She said, Peter, you know, if you don't say anything and you find out all this massive loss of life from COVID and didn't do all you can to stop it, you're going to hate yourself. And that's all I needed to hear. And then I really went after it. It took me to a very dark place.

And part at that time, you weren't getting a lot of backing. I didn't get a lot of backing from the academic and professional societies because it's not what they do. And so I really felt out there alone. Later on, I think when it became safe, whether people came to my support, but in the beginning, it was a very lonely thing to do. I mean, I'm glad I did it, but it took emotionally, it really knocked the crap out of me. It was very tough to do that because the truth is, I'm not that ideologically driven politically. I mean, I was in Washington for 10 years, and as Chair of Microbiology at GW, and one

thing I learned in Washington, if you want to get anything done, you reach across the aisle. So, we got a lot of neglected tropical disease legislation passed. And now I would think nothing of going to Sam Brownback, who is now he's the governor of Kansas, back then he was a very conservative senator from Kansas. He would hold a prayer breakfast meeting, and I'd go to that, and I would speak,

and then I'd go across the way and talk to Senator Leahy's people, who's this very liberal senator from Vermont. And back then, nobody thought twice about those kinds of things, but it's not happening anymore. So, to be able to have to tear into what was going out at the Trump White House, and it was often perceived as I was just being somebody in the Democratic camp, which wasn't the case, but I understand why it was perceived that way.

And now what's interesting is whenever I have something with the Biden administration, I think is not quite right, then I get beat up a lot from my colleagues on the left. And there's a lot more of those who say, you know, what are you doing after well we've been through? How can you criticize the Biden-Wine-up? I'm really criticizing. I think they're doing a good job, but there are things that need to be changed as well. So it's very tough. If your focus is only on saving lives and doing whatever you can to save lives, that's very tough because it means if you're sincere about that, you go on

Newsmax and you go on Fox News, which I've been doing. And you go on radio podcasts and that reach black and brown audiences. That's what I've been doing. So hopefully the end of it all I'll be okay, but it's not easy doing this. Peter, is there a historical precedent for such a distrust of science? I mean, that given that the scientific method has only been around for Call it 400 years that doesn't give us a great opportunity to look for such things, but Even in the last century or two have we ever seen such massive distrust for the establishment of science? I haven't seen this distrust systematically. Certainly there's been a lot of pushback or anger around certain things scientists have said.

Like, for instance, during colonial times, when cotton mather tried to vaccinate the Massachusetts colony against smallpox, people were very aggressive with him and they actually threw a fire bomb into his window around that particular issue. That's gone up and down in American history, but I've just not seen this systematic distrust of science and scientists and the targeting of scientists and the mainstreaming of anti-science. That's kind of worrisome.

And of course, a lot of this is because now we have this new era of the internet and social media and Amazon and all those kinds of things doing a lot of damage. So you kind of want to pivot a little bit to something very personal for you. How old is Rachel now? Not she's 28. 28. So let's go back in time, 28 years. Tell me what you remember about her birth and the first few years of her life. So by the time Rachel was born, I had already had two other kids. And I remember Anne saying, always feeling that something was off. She wasn't as hugging or clingy as the other kids were,

but didn't really come to medical attention till around 19 months of age. That's when the pediatrician clearly saw developmental delays and referred us to special services. And ultimately, I was at Yale. I was an assistant professor then running a lab. And that was hard for me because I was going off to China and keeping a lab in China. And now having a child with a medical issue was really tough. Ultimately, I had to give up going to China and reconfigure our program, but at Yale, that's also the home of the Yale Child Study Center, which is one of the big thought-leaders places for autism and she was referred eventually to the Yale Child Study Center

where the world's experts on autism, people like Fred Volkmar and Donald Cohen and Linda Mays and there was a child psychiatry fellow in Wendy Levine who really looked into this very carefully. And she was clear that she was on the autism spectrum. And it's a little tougher to diagnose for girls than boys because girls tend to be more verbal. Was she verbal at 19 months?

Was she appropriately verbal? Well, she wasn't always appropriate, but she was always verbal. I mean, she would repeat. There's a lot of echolaleia. She would repeat things, but she had reason to this day. She's got reasonably normal language skills. It's just her performance IQ is really, really low. And that's one of the big issues with Rachel. It's the intellectual disabilities in her case that go with autism. And in fact, that's a very interesting side story about Rachel is the whole ecosystem of

girls and women on the autism spectrum because older literature says it was 10 to 1 boys to girls. And that's because boys are so flored in their presentation and symptoms. Girls can camouflage it better. They can mask it better. They can mask it better. They are often verbal, but they have very high rates of comorbidities, like obsessive-compulsive disorder,

or ADHD, attention deficit, hyperactivity disorder, or even a lot of the teenage girls with bulimia and eating disorders. Now, many of them may be on the autism spectrum. So we're getting better at it. So it used to be 10 to 1. Now I think it's moving closer to 3 to 1 boys to girls in some say I'm even approached parity or something close to parity like 1.5, but it's way underdiagnosed. And Alice and singer has the autism science foundation has been supporting efforts to really call

great because she has a daughter on the autism spectrum to look at this in more detail because it is so underdiagnosed. But in Rachel's case, it finally came to diagnosis in 19 months of age. And I got very interested in that because when you look back then at the CDC definition of autism, I don't think it's on the website anymore, but I guess a couple of years ago was still there. It said, most kids on the autism spectrum were diagnosed between 18 or 24 months of age. And I got very interested in that because there was a research group at University of North Carolina Chapel Hill run by this guy named PIVIVN who was able to show that

that clinical expression of autism coincided with a big increase in brain volume expansion. So you could actually follow this on serial MRI. And that's important because a lot of parents will remember when their kid was diagnosed with autism, especially the regressive form, because that's so driven, that's just all slowing of milestones, but actually loss of milestones. They'll remember that their kid get vaccinated, maybe with measles or something else around that time and want to link the two. But now this group at UNC Chapel Hill can go back much earlier back to infancy and show that there's already those changes happening in the brain.

And now, of course, we can show prenatally. So Eric Cortezni's group at UCSD and multiple groups. Now the Broad Institute Harvard MIT has identified about a hundred genes linked to autism spectrum to sort of all involved in early fetal brain development. Many of them involved in neuronal communication, so a lot of neuronal cytoskeleton genes. For instance, so we did hold up some sequencing on Rachel and Anne and I at Baylor Genetics and identified a neuronal cytoskeleton gene, a non-red cell, spectra, a neuronal spectra, which makes a lot more sense in terms of understanding neuronal communications andkeleton gene, a non-red cell, spectrant, a neuronal spectrant, which makes a lot more sense

in terms of understanding neuronal communications and sort of things. So I think what happens is you see the activation of genes in early fetal brain development and that sets into motion of progression, but that full clinical expression of it doesn't happen till around 18, 19 months of age often. That's not unusual for neuropsychiatric conditions.

Right? I mean, Blitz gets a frenia, for instance. Oftentimes, kids with schizophrenia are not diagnosed to adolescents or even young adults. So this is how the brain works. I think I'm not a neuroscientist, but that's my take on this. I mean, just on a personal level, how did you cope with this realization and did it ever cause you to question anything that you were doing?

Like were you able to sort of distance it or think about it through kind of a scientific lens even though it was something very personal? It went from being, this is the scientific literature and it's entirety to to this is my daughter. Back in the 90s, we know a lot less about autism than we know now, and all the things that I told you about, a lot of it has only come to light in the last few years. And then the Wakefield paper came out, and I remember that because I think Rachel was

about five years old at the time, and it was all over the papers. And of course Anne was asking me about it. And to me it over the papers. And of course, Anne was asking me about it. And to me, it never made sense. It said, how can it be? I mean, they called it pervasive developmental disorder back then for a reason, because it was indeed pervasive. And you could see that a lot of these kids were macrosophalic.

They have enlarged heads. So this was clearly a neuroanatomical condition. I mean, you knew that there were shifts in Prokhengy fibers and there were structural alterations in the brain of kids with autism. How can it be that a vaccine you give at one year of age would cause that? It just never made any sense to me.

There was never, and so for me, there was never the plausibility. but the full weight of scientific evidence wasn't there. I mean, that was my opinion more than turns out more or less to be true. And so that's why I was one of the early adopters of saying there's no way in hell. It's going to be MMR vaccine. And it just doesn't make any sense. This goes sound like a strange question, but was there a part of you that almost wished it was so that you might be able to say this would be amazing if we knew this? Because again, at the time Wakefield proposed this, he wasn't even saying that all vaccination was bad. He was simply saying

they should be separate vaccines. Don't put measles,'s rebella in one shot, give them separately. This was his first thesis. So even wearing your hat as an infectious disease physician, if you could have believed that the answer was MMR combined, causes autism, and while it won't save my daughter to know that I could spare every other parent, because clearly you exude the ethos of wanting to help everyone. All we have to do is separate these vaccines and we could solve it. I mean, was there a part of you that just wanted this to be true? Not necessarily.

I mean, if it made sense to me and if there was a logical explanation, and yeah, if we knew there was a simple intervention, sure, but it was just so outrageous at the time. That wasn't even on my radar screen at that time to think in that way. I just knew that it had to be genetic or maybe an epigenetic basis. And by the way, that's a real treat trying to explain epigenetics to lay audiences. I start talking about microRNAs and histone deacetylation, and I'm still working on. So the epigenetic component is another one that's important. But again, all of that had to be prenatal. And I remember having some conversations with some of the anti-vaccine people and then saying had to be prenatal. And I said, and we, yes, we do

give some prenatal vaccines like flu vaccine. The immediate response was, aha. And I said, no, I mean, you know, again, I don't see how an immunization during pregnancy could be linked to that. And now the scientific data supports shows there's no link. Autism is still such a complicated thing in terms of people even understanding what it means. So the definition has morphed a little bit. So today we talk about AST being a spectrum. And it's gotten a very complicated because there's this whole concept

of neurodiversity. So there are many in the autism community who bristle, if you even try to describe it as a pathologic condition, they say, no, this is just an example of neurodiversity. People are different. And I understand that what I try to emphasize with Rachel, it's not the autism per se that's incapacitating. It's in her case, you know, she's got clear,

profound intellectual disability. She can barely read. She can't do simple math. You know, when she goes to the store to buy something, she will hand them a fistful of single dollar bills and say, here, because she doesn't know how to count the money. She, no matter how hard we've tried to train her to do that, she doesn't understand the value of things. And so she depends on the goodness of the merchants in our local mantras, neighborhood have been great, you know, and they kind of know Rachel. So it's in her case, it's finding intellectual disabilities that make it tough and make us worry because the other piece to this is

now she's an adult with autism and intellectual disabilities and the special services and all that kind of stuff really falls off the radar screen because we have no plan for her right now. We don't know we've tried to have her in a residential facility which which I think didn't okay job, but her behavior was too uncooperative, and finally they had to kind of kick her out. And so now she's with us. And what worries me is, I don't know what's gonna happen after

and I are no longer here. There's no roadmap for what you do with an adult with intellectual disabilities. And that really worries me, especially in Texas, it's just not strong with services of those kind. And maybe it's better up in the Northeast. And we've heard New York and Massachusetts, but trying to work that as a huge, huge, heavy burden on us.

How is the diagnosis made today? So if a parent today or a pediatrician today suspects that something is not normal, whether it be language delay, changes in behavior, emotional regulation, eye contact, all the things that would flag someone, what is the actual process by which a diagnosis is made? Is this something that shows up in the DSM? What is the criteria for diagnosis? It's still in the DSM.

The DSM is still not as strong as it could be, especially for girls, especially for little girls, but presumably the child gets referred to something called birth to three, which is an early intervention program. And at some point they get medical attention, typically to a behavioral pediatrician, maybe a child psychiatrist, only about six of them left in the planet. There's a huge need for more child psychiatrists. I tell all my medical students to go into child psychiatry with the hope that one of them

goes into it. That's a real crisis as well. Then the diagnosis is made along the way of limited social interactions in some cases, lack of, although again with girls in a minute's different so there are a list of criteria that you can look at what's on the differential diagnosis like is it a diagnosis of exclusion where they're just basically saying here are a bunch of things that could present with this pattern we're going to rule them all out and that which remains is a st or them all out and that which remains is AST or because when you think about so many of the things like it's not like Down syndrome where there's such a clear phenotype and genotype, it's unmistakable. This is much more nuanced. And out years and future years will make whole XM sequencing so much more available that I think any time you have a child like that, you'll get a whole like some sequencing and we'll actually be able to target it to a specific gene.

In some cases, that may be useful because there could be pharmacological intervention in case, there's something that is impairing abilities and can be targeted. Can you explain why that's important? Why whole exome sequencing is relevant versus just quote unquote a genetic sequence? Well, because with whole exome sequencing, you're getting the full sequence of every expressed gene. What that does for you is identify rare mutations that you wouldn't pick up just by looking at chromosomes.

And so it's a very powerful technology. At this point, it only picks up around 40%. So if you're avatism and you do whole exome sequencing, my understanding is you only see a mutation, maybe 30, 40% of the time, because there's other things going on, including the non-express genes. So exome sequencing just looks at the express genes,

but if you do the whole genome, potentially you could pick up additional ones as well. So we're still in the early stages of that. And what's very interesting, and that was some children's hospitals are looking at the possibility of doing whole XM sequencing and every child they admit for whatever cause because we're learning so much about the genetics and epigenetics, not only of autism, but so many other conditions. Right now, you're left with what I consider to be somewhat rudimentary list of criteria from the DSM.

And I'll never forget, Peter, I once had a lecture from a child psychiatrist when I was in medical school at Cornell, and I remember him saying, we're going to look upon the DSM is such a anachronistic or auto-touched document for child psychiatry. It just doesn't cut. It's just really falls down for child psychiatric disorders. And that was in the 1980s. Maybe it's moved on since then. I'd be curious to hear from a child psychiatrist today today what they think about the DSM, but I'll never forget that comment. And when you look at the DSM criteria,

they're just not really robust for so many childhood conditions. And again, this whole concept of neurodiversity is not reflected in the DSM like it needs to be. It'll get refined. And I think that combining with whole XM sequencing and that combining with whole like some sequencing and that, combining with all the developments in neuropsychiatric medications, I think things will look very different 10 years from now and then 10 years again from then.

Do you have a sense ballpark how many children that are born today? What will be the incidence of autism in the cohort of kids born in 2021? Well, I think one is the number that's thrown out there now. What is it? 162? I can't remember the latest. It's surprising. Yeah, I mean, it seems remarkably high. Could come close to doubling because we're way undercounting all the girls and women with autism. So it wouldn't surprise me that it would go down to something like one in 30 or what do we think that was in 1980 for example? Yeah, I don't even know, but very rare because the criteria changed before there was a very strict criteria about nonverbal boys with certain repetitive behaviors. And then we've enlarged so much. And then it's going to get very murky, because now with this whole picture of neurodiversity,

what point is it a condition that warrants criteria under DSM? And what is it just being neurodiverse? And I don't know that there's going to be a cutoff, right? It's always going to be that gray zone. So I talked to my oldest daughter, a lot, who's in the system, professor, UCLA, she has a PhD in developmental psychology and works at the Center for Disabilities. And this is a real struggle and a difficult to get your

arms around. But I think we still need a lot of brilliance around these points. At what point is it something that you diagnose in the DSM and at what point is it not? And I don't have the answers to that right now. When you consider something like Alzheimer's disease and you look at the change in prevalence

over the last 50 years, there are many factors involved. People are living longer. We have many more tools to make the diagnosis. and then there are also factors that many of us myself included believe are actually increasing the incidence. So the prevalence is higher because people live longer, because we diagnose more, but because the true incidence is increasing.

Why do you think that is? Because I think many of the risk factors for Alzheimer's disease are increasing dramatically, so vascular disease, metabolic disease being being taken by them by far. As we see insulin resistance increase, as we see a dyslipidemia increase and all of the things that accompany it, I think we're actually creating more neuropathology. We're actually working with a group at Baylor, we make vaccines. There's a group at Baylor College of Medicine run by David Corey, who also has a collaboration with Europeans, have shown some evidence of fungal involvement,

even Candida, because there are some of the plaques that you see in the beta amyloid is got fungal sequences as well. And so what is the role of Aspergerlis and other and yeast forming fungi in this is getting very interesting as well. And so what is the role of Asperger-Gillis and other and yeast-forming fungi in this is getting very interesting as well. I think that Alzheimer's disease is probably, for lack of a better word, the final common path. There are many roads to it. Right, right. And I do think that there's absolutely a sort of toxic version of it as well that may actually include infectious agents or environmental toxins and things like that. With fungal that disease, you could do something about that. You could vaccinate, for instance, get fungal disease.

Could a fungal vaccine become a help with reducing neurodegenerative disease? So that's one of the things that we're starting to look at. Using that as a model for thought, how do you now think about autism? Is it that we're clearly more attuned to this, so we're making the diagnosis more. But do you also think there's an increase in the incidence? In other words, is there an environmental trigger that is either triggering this with or without

manipulating the genomes? Now, we're going to have to talk about what epigenetics means. So people understand you can have an environmental trigger that comes along triggers a condition for which there's a genetic susceptibility that does not alter the genome or one that does so and alters the genome. What do you think is actually happening and what are some of the plausible explanations? Before I answer that, let me just say just because this is uncomplicated enough to make it even more complicated, there's a group at

Gai Singar in Pennsylvania that's been looking at a number of psychiatric conditions and they've identified groups of families that have the same genetic mutation. Yet one individual has been diagnosed with autism and other schizophrenia and another some other condition. I forget it was addictive behavior or something along those lines. So you're right. Genetics is dominant but I think there are epigenetic factors that could have some influencing role and most likely it's it's going on in pregnancy. So when you talk about epigenetics it's going on in pregnancy. So when you talk about epigenetics, that doesn't discount entirely environmental factors. But if it is, its environmental factors happening in pregnancy.

Explain why it has to be an environmental factor in pregnancy versus an environmental factor post-utero. Because I think, again, I'm not a neuroscientist, but I think the structural changes in the brain are already well underway by the time the baby is born, so that there are processes that are set when you look at all the work coming out of Curchesne's lab and other labs, it's clearly showing that this is going on early on in fetal brain development, maybe as late as the second trimester, but happening in utero. And that's where all the action is occurring.

If there are as environmental influences, it's most likely something happening in pregnancy. So if you're a parent or a soon to be parent and you're listening to this, you're terrified. It's terrifying enough to think that during the first six months of your pregnancy, the first and second trimester, so many things can go wrong. I mean, obviously, during the first trimester, you're mostly just thinking about not miscarrying. And then once you sort of get through, call it week 8, 9, 10, and you're thinking, okay, well, we're almost halfway to the point

of knowing, being confident we're not going to miscarry, then you start to think about big structural stuff. Is the heart okay? Does this thing have four chambers? Is the brain of normal size? To think that there's some environmental trigger that could take a genetically susceptible fetus and render them autistic, I can't imagine how that doesn't produce an incredible amount of speculation and consternation. But I think you have to be careful with your language. So it's not just genetically susceptible. The genes are there and they're... Are these deterministic? They're causing autism. There might be some environmental influences that could affect expression through epigenetics, but it's not so simple as to

say genetics is susceptibility. I don't think that's quite that straightforward. How deterministic do we think these genes are then? I know you're what you're looking for. You're looking for an 80, 20, 90, 10, 70, 30. I don't think we know that, I mean, it's polygenic, presumably. What do we think here? Well, in Rachel's case, it seemed to be as so far as what we know, it's a single gene,

and I think that's true, but they're not all the same gene. So the point is the Broad Institute at Harvard MIT paper, which I think was in the cell, identified about 100 genes. But the common denominator was they seemed to be all involved in early fetal brain development, all except for one in the cortex of the brain, most involved in early excitatory and inhibitory neurons, and a lot of them in the neuronal

cytoskeleton. So there's a lot there there. I mean, it's clearly the genes are dominant, whether or not there's some epigeneticetic influences that can affect whether it's full on expression of autism or whether there's schizophrenic components to it. I think that may be likely as well, but it's not as simple as saying just genetic susceptibility and it's overwhelming the environmental factor. I think it's the other way around. I think it's overwhelmingly the genetics is the dominant factor. And yes, deterministic. And maybe there are some epigenetic influences.

So if that's the case, then there would be really two reasonable explanations for the increase in the incidence of autism. I mean, do you believe that there has been an increase in the incidence of autism over the last 40 or 50 years? A true increase in incidence, not diagnosis. I have not seen any evidence for that, but I can see it's tough to prove. So one of the things I ask are teachers, you know, are you seeing more autism? And most teachers will say, yeah, I'm seeing a lot more autism, but I think a lot of that is due to more awareness. I think a lot of things that we now call autism, we didn't call

autism back then. I mean, we used the R word a lot, right? They're mentally retarded or they're this or that. And now we realize they're on the autism spectrumers. Also, this component and some teachers have told me you've said, well, if you want to get special services for your kid, you have to label it as autism. Otherwise, they're not eligible for special services. And you know, how much of that is going out as hard for me to know either. And again, as I point out, as we get better with diagnosing girls and women with autism, those numbers are going to go through the roof yet again. How heritable do you believe the transmission of this is? Is this something where

it's sort of like eye color where a child can be born with green eyes to a parent of blue and brown eyes? How do the genes transmit? What's the best guess? Yeah, again, not an expert. I mean, in some cases, I think, just spontaneous mutations. I think others, you know, I remember when Rachel was diagnosed with autism and said, clearly, it's your side of the family. And I said, what do you mean? What about your uncle's so-and-so? And so there was those kinds of discussions, hard to know. I mean, I think clearly you see autism in parents of kids

with autism. And it may not be fully diagnosed, but you definitely see that a lot of times. And I think that's quite common. Anne has a theory that autism is more common among people of intellectual accomplishment. And maybe there's some truth to that, but I think it's just bias on the basis of people that

end. I'm been at a university in my whole life and in is always running into academics. So I can understand why she thinks that, but I don't think that's been well established. That's really interesting, Peter. I actually, I guess I took it as a given that there was a true increase in the incidence of autism, though not as significant as what the perception is, because the perception is also being driven by, as you say, just a tremendous increase in awareness, diagnostic criteria becoming broader, more things being included. So for example, what used to be called aspergers is now technically a part of ASD. Right.

But I guess the question is, how would you ever sort it out? I guess what you could look, if you had specific genetic markers that you could look at, that would be something you can hang on to and say is the increase in certain genetic markers going up, but that's not trivial to look at either. But I've always felt that there's been no true increase, but there may be some evidence for it. So let's pivot to a little bit of the current around COVID.

As we stand here today, Peter, we're well on the path to most Americans who want to be vaccinated are getting pretty close to being vaccinated. By the way, what's the latest on the vaccination of children? Where is the CDC on that? What do we know about the vaccine? How many of the current vaccines, as we stand here today, really, there are three that are

used in the US, correct? I think the AstraZeneca one is not used in the United States. They haven't applied for emergency use authorization. I'm worried about that vaccine for reasons that we can talk about. But then there's the Nova Vax vaccine. So there could be as many as five by the spring. In terms of kids, Pfizer just released data showing high levels of efficacy and adolescents 12 to 15, but there were small numbers. There was around 1200 in the vaccine,

group 1200 in the control group. And there were 18 cases of COVID in the control group, none in the vaccinated group, and on that basis, and their press release is at 100% efficacy. I'm sure that won't hold up. I mean, it'll probably go down. One of the interesting things about the kids though, those adolescents, the virus neutralizing antibody titers are really high, like 1200.

So higher than older adults. So that may be a factor as well. And we're now starting to get our arms around correlates of protection at really high levels of virus neutralizing antibody seem roughly to correlate with efficacy. Is that consistent with your belief, Peter, that this would be more B cell mediated than T cell mediated? Well, I think T cells have a role. I mean, I think virus neutralizing antibody

may not be everything, but if you don't have high levels of virus neutralizing antibody, you're not gonna get protection. And the problem with comparing those virus neutralizing antibodies is when you look at the actual papers, they compare it with convalescent serum titers and they're all over the map. So now there's a paper

up on Medarchive that does something very simple, which is rather than just give the absolute value for the geometric mean titers, whether it's against pseudovirus or whether it's against plaque reduction neutralization titers, what they do is they do a ratio of the virus neutralizing antibody titers against the vaccine versus the virus neutralizing antibody titers on the convalescent, the kind of normalize it. And there's this very nice curve that's been generated that shows you need to get it that the level of virus neutralizing antibodies

has to be at least as high as the convalescent and preferably about 1.5 or two to get really high levels of protection. And I think that's probably what we're looking at. So it's not quite a true core litter of protection, but I think we're moving in that direction. And the adolescents get really high levels of virus neutralizing the antibody.

And did that Pfizer study give two shots or one? I think it was two. So now that we're out of the gate and millions of people have been vaccinated, do you have any preference or concern over any of the vaccines? You obviously mentioned AstraZeneca, which I want to hear about, but let's start with the US vaccines.

Any reason to believe that one is better than the other. In fact, I'll share with you something that I found very interesting, which was the J and J vaccine, which is a single vaccine, and that vaccine, well, the headline is lower efficacy if you actually look at the absolute risk reduction as opposed to the relative risk reduction is at least as efficacious as Pfizer and Moderna. I found that to be very interesting, and I'm surprised how that was sort of omitted from all the press. And I also think it's hard to compare because it's a single dose,

it's being given a single dose versus the two doses. And it wouldn't surprise me if that J&J vaccine ultimately becomes a two dose vaccine down the line because you may want to give a booster for one of the variants as well. And in two doses, the virus neutralizing antibody titers is really, really high. And it'll be as good in terms of protection as Pfizer and Moderna. Certainly, I think to me, the single dose, J and J looks better than the single dose Pfizer and Moderna, not by much. The bottom lines are all good, they're all good vaccines. And I also think, don't be surprised if later on we're going

to need a boost for all of them. There'll be a third dose of the Moderna Pfizer vaccine or a second dose of the J and J. And what that will do, it'll elevate virus neutral as nianabadi titers higher, it'll create more durability of protection, I think, and that boost will be reconfigured for the South African and the Brazilian variant, which are not here in a big way in the US, but maybe come a bigger problem down the line. Right now it's the UK variant, the B-117 variant that's accelerating, all of the operational warp speed vaccines work really well against the UK variant. And I'm very optimistic.

That's because that variant has not mutated through its spike protein. Well, it has. So the UK variant has a single amino acid substitution in an aromatic amino acid, creating an aromatic amino acid. And that seems to reduce the level of virus neutralizing antibody. I don't know if I have a mechanism to show you pictures. I really think this is, it's a little bit of molecular biology, but not much. I just showed this at a pediatric grant

rounds at Columbia this morning. I really love this. And to me, it helps people understand, you know, as I often like to say, it's not a 32nd unicef commercial, but... It's funny. I haven't 32nd unicef commercial, but it's funny. I haven't seen any unicef commercials recently. Huh. Okay. So now this B117 variance going up.

So this is a paper and it's up in bioarchive or pre-print server looking at the B117 variant. And in the spike protein, what there is, there's an amino acid substitution in the 501 position, what went from the sparigene to a tyrosine. And a tyrosine is an aromatic amino acid, it has a ring to it. And they're able to show, model it with the receptor, the NG-tensic converting enzyme, that now there's another tyrosine. It's got a nice strong bond there. Yeah, there's a ring ring interaction.

So it's these pie electrons that circulate in aromatic rings that are interacting with each other. In addition, there's a hydrogen bond. And the reason I love this so much is all we're talking about with this big acceleration of cases going up in Michigan and affecting younger people and higher mortality and morbidity, it's a bit of a simplification, but then again, it's not. It's all coming down to pi pi interactions between two aromatic rings in two tyrosines.

Let's just make sure people understand this because not everybody understands biochemistry, right? Each amino acid is coded for, there's a code, right? So you have three nucleotides that code for an amino acid is coded for, there's a code, right? So you have three nucleotides that code for an amino acid. So it sounds like one of those gets changed and it changed the amino acid. And I can't remember, did you say it started at three anine? So this is the wild type of the original lineage

is now switching over to a tyrosine. It went from three anine to tyrosine and then all of a sudden that changes, literally changes the shape, but also creates kind of an electrochemical attraction that wasn't there before. And so all of a sudden, the spike protein has a greater attraction to the ACE2 receptor.

Right, which presumably translates in the better virus entry, maybe more virus replication, and that's why you're getting more severe disease, and younger people are getting sicker as well. The good news is the virus neutralizing antibodies to the original spike protein seems to still work well against this B117 variant. So we're going to take this picture now and zoom out a bit. So now this is the spike protein, which is a trimer. Actually, let me show you a real picture of it. So you can see what it looks like.

This is the trimeric spike protein. So these are these little purple flowers on top. Each one is a trimeric spike protein. And now we're going to show it again here. And they've got each one has its own receptor binding domain. And now what's going to happen is only one of the receptor binding domains flips up and binds to the receptor to the ACE2 receptor. And here's that one amino acid substitution again that I blew up on previous slide. So if you had the wild type on here, Peter, it would show it would look the same,

but it would look the same. You would just have a lower affinity there. Yep. And he wouldn't see this. It wouldn't be marked as having this mutation. But the point is the antibodies to all of the original lineages from the vaccines seem to work just as well because still neutralize this interaction.

The problem comes in now with the other variants that are coming up from South Africa and Brazil, the P1 variant from Brazil and the B1351, that's got a second amino acid substitution over here, which is creating a lysine. And that I think is creating extra levels of electrostatic interaction. So the binding potentially is even tighter. And this now is interfering with the ability of antibodies to neutralize. So the virus neutralizing antibody tighter goes down

and that translates to decreased inefficacy. So when you look at the published numbers, these are some of the numbers here of the level of efficacy against the original, I'll call that original slash UK, which is probably roughly about the same versus ZA, the South African variant. And that's why you see it going down. Wow. So this is interesting. Let's digest this for a second. So Pfizer and Moderna take an enormous reduction against that variant. Well, no, no, let's be careful. So the Novavax and J&J, that's actual efficacy, published efficacy data. In the case of Pfizer and Moderna, what you're

looking at here is declines in levels of virus neutralizing antibody and vitro. Thanks for clarifying that. That's very important. And because the level of virus neutralizing antibody and vitro. Thanks for clarifying that. That's very important. And because the level of virus neutralizing antibody so high to begin with, there's enough residual that is you're still getting good protection. And I, but we don't yet have the clinical data to see.

Well, now Pfizer's issued a press release yesterday saying they think in a very small set, it seems to work really well against the South African variant, which makes sense given the high levels of virus neutralizing antibody to begin with. Tell me why you think the AstraZeneca takes the biggest hit here then. Yeah, so the AstraZeneca started out, in some cases not as high levels of virus neutralizing antibody. And a study was done in South Africa showing only 10% basically ineffective against the South African variant.

But talking to the Oxford people, one of the things they say is it's a little unfair because they only tested it against moderate and mild disease. And they feel that if you were to test against severe illness, it would still be very effective. And they counter that if you were to test to get severe illness, it would still be very effective. And they counter that the J&J results were mostly looking at severe illness. And if they like J&J had looked at severe illness, they would have come up with similar numbers. But, you know, I guess we have to wait and see what happens with that.

The bigger issue with the AstraZeneca vaccine is just public perception around the cerebral thrombosis that is being reported out of Europe, I think that's causing a lot of damage. And it goes back and forth. The German government through their Paul Ehrlich institute pointed out that you had six, I think, with six cases of sinus venous thrombosis, which is a rare condition in the vaccinated group and they suspended it and then several other European countries did. That had big ramifications, especially for Africa. You know,

francophone Africa listens to what's going on in France and etc. And I was going on a number of Zoom conferences with groups in Africa and they were very concerned about the AstraZeneca, because that was supposed to be a workhorse vaccine for low and middle income countries. The European medicine agencies came along, said, no, no, it looks okay. It's, we think this is not related to the vaccine. But then in Science Magazine, two excellent science journal,

the Scratch and Vogel and Kai Kuperschmitt looked at this and they wrote about 31 cases of cerebral venous thrombosis and more clearly showing it could be linked to the vaccine is a very rare event. But still that can really alter public perception, especially in light of all of the very aggressive anti-vaccine activities that are happening. So I don't know what the US is going to do at this point. I hope they do authorize it for emergency release, even if they never use it in the US. And the reason is if the US declines or if that derails, I think you could have a chilling effect on Latin America and Africa,

because we don't have a lot of vaccines out there. That's that's why we came along with our recombinant protein vaccine, because they're not a lot of options. The big issue is, you know, if you look at what's going to be made for low and middle-income countries, they're not a lot of choices out there. I mean, the two mRNA vaccines, it's still a new technology. We're not going to be able to scale that up in a big way for Africa and Latin America. Yes, I mean, it's great. Pfizer donated 230,000 doses to Rwanda. It was fantastic. But look at the numbers. There's 1.1 billion people in sub-Saharan Africa, 650 million people

in Latin America. We're going to need four billion doses of vaccines. We're not going to come from it's not going to come from the mRNA vaccines. Is the refrigeration also a problem? Yeah, the fact that that owner is freezer requirement and then the J and J is having some issues and scaling up production Part of the problem was when the science policy makers were looking at this They went so heavy on the innovation and they wound up producing a lot of really cool vaccines that are highly effective But in terms of durability for scale up to make 4 billion doses, I don't think that was high enough on their radar screen and didn't realize that when you use a brand new technology, it's really hard to move to 4 billion doses. And that's why I'm hoping

our vaccine comes along, which is in part a couple of donors came to me after one of the podcasts I did with you and that was game changing for us because it allowed us to adapt our coronavirus program for vaccines we're making for SARS and MERS to this recombinant protein vaccine for COVID-19. What's the vehicle? It's recombinant protein in yeast, just like the hepatitis B vaccine. you could produce a ton of it. They have capacity for producing 100 million doses a month. And it's looking really good in clinical trials and in non-human primate trials. I can't talk about it yet, but it should be out soon. And hopefully that will come in and make a big difference because I'm really scared

that we have nothing for Africa and Latin America. I mean, what's amazing is how I had to struggle for funding. I mean, not it was spending, you know, a good part of last year just trying to keep the program going because it was so hard to get funds for what was so obviously needed, which is a low cost, unfussy, durable vaccine for low and middle income countries. And because of your podcast groups like Tito's vodka

came through with some funding and you know, they're based in Austin and anonymous donor and a couple of others. So now the Clayberg Foundation is helping us in a big way. There are Texas Foundation and the JPB Foundation and a few others. So that was game changing. So Peter, based on everything you're saying, it sounds like the biggest concern right now would have to be Brazil followed by Africa. Unless I missed it, did you explain the mutation in Brazil and the efficacy that any of the current vaccines would have against it, notwithstanding the scale up limitations? Yeah, a couple of things. So the P1 variant in Brazil has those same two amino acid changes in the South African.

I think of them as brother, sister issues. Dealing with South Africa will hopefully take care of Brazil as well. One other thing I wanted to mention is the global policy makers did a good job of creating this co-vax sharing facility. It's really quite brilliant in this design. I think that's not the issue because they were really worried about equity. The equity issue, I think, was more of the fact that we didn't ensure there was enough vaccine available for the co-vax sharing facility.

And that's really the problem right now. And hopefully we can come in and address it and take care of this because if we don't figure out a way to vaccinate the rest of the world, if we only vaccinate North America in Europe, it's going to be a catastrophe. This virus is going to continue to circulate and cause tremendous humanitarian destruction, but also who knows what other variants could evolve as well as a consequence of allowing that to go unfettered. What drives the evolutionary pressure here of these mutations? It's just standard Darwinian behavior where mutations occur and they're escaping because

these mutations, how does the mutagenicity of this virus compared to influenza? It seems far less than influenza. A lot of us were surprised by the variance. We thought that we hadn't really seen this as much in coronaviruses. What some people speculate is it happened because of an immunocompromised individual who had a lot more virus replication in their system and that combining even possibly with receiving plasma convalescent therapy that put some kind of selective pressure on it. And that's kind of an hypothesis that's out there, but that's not strong. I don't think we really

know that for certain at this point. The good news is the way I see it is a lot of the viruses are converging to the same mutations. So my hope, and it's only a hope, and there's by no mean consensus in the scientific community, is that if we make a booster to this South African slash P1 Brazilian, we might be done at that point, that there won't be this continual evolution for totally something different. But I don't think we know that for certain. So the good news also is it looks like our vaccine seems to give pretty good levels of virus neutralizing

antibody to the South African variant as well. So we're making the booster for it for the South African just in case, but we may not need it. We'll see. We don't know how often we would need the booster. It could be every six months, every 12 months, every 18 months. It's too soon to tell, obviously, until we have longitudinal data looking at the neutralizing antibodies. I mean, my dream situation is we give this one boost beyond the original vaccine series later this year and next year, and then we're done that it won't have to be every year. But like anything else, we'll just have to monitor and follow it.

But people say it's going to be like flu, where you have to vaccinate every year. And at this point, I don't think so, but I can't say for certain. Because in the case of the flu, that's driven more by the muted genicity than the lack of B-cell response, isn't it? Well, in the case of the flu, you're getting these wholesale antigenic shifts. So really like a totally different virus. And there's this carefully orchestrated dance that we have in place to monitor flu virus strains, you know, maybe coming out of Asia. And then quickly transmitting the message to the pharmaceutical manufacturers who make

a whole different vaccine every year. It's really quite extraordinary. I don't think we're going to need to do that for coronavirus vaccines. At least that's my hope, but we'll see how this unfolds. Well, one thing's for certain, if you look at what's available for African Latin America right now, it's not good. And so I've been talking to a colleague, Patrick Shengshin, who's in Los Angeles, and he's really interested to see can we build out vaccine development capacity in Africa or maybe Latin America? Because right now there's no vaccines made on the African continent,

nearly enough in Latin America, not much in the Middle East. We've learned that if you only rely on the multinational companies, even with that great co-vax sharing facility, they're not gonna make new vaccines for the world, at least in rapid timeframe. It's amazing they do what they do. I mean, Gavi, the Gavi Alliance for Vaccine in the World's Children, depends heavily on the multinational companies.

They do a great job, but we need parallel mechanisms in place, like new vaccine development, production facilities in locally in Africa and Latin America. And that's something that we've been working on in this concept of vaccine diplomacy and building that out. Well, Peter, I know that we have a real hard stop in time because you've got another obligation, but really happy that we were able to spend a couple hours together. We covered a lot of ground and we actually got through half

of what I wanted to talk about. So I consider that a win. It was an only half. Okay, well, I'm always happy to come back. I love being on your podcast one because I learned so much from you. And the thing I really appreciate is you ask questions that I just never would have thought of on my own. And you know, after you ask it, I say, why don't I know that I should have, I mean,

that's so obvious that I should know that because it's the right question to ask. So you have this amazing talent for asking the right questions and I appreciate that. Well, thanks very much again for everything, Peter, and I'm sure we will be talking again soon. Okay, thanks so much. Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership program that allows us to bring you more in-depth, exclusive content without relying on paid ads. It's our goal to ensure members get back much more than the price of the subscription. Now, that end, membership benefits include a bunch of things.

One, totally kick-ass comprehensive podcast show notes that detail every topic paper person thing we discuss in each episode. The word on the street is nobody's show notes rival these. Monthly AMA episodes are asking me anything episodes hearing these episodes completely. Access to our private podcast feed that allows you to hear everything without having to listen to spills like this. The qualities which are a super short podcast that we release every Tuesday through Friday, highlighting the best questions, topics and tactics discussed on previous episodes of the drive. This is a great way to catch up on previous episodes without having to go back and

necessarily listen to everyone. Steep discounts on products that I believe in, but for which I'm not getting paid to endorse. And a whole bunch of other benefits that we continue to trickle in as time goes on. If you want to learn more and access these member only benefits, you can head over to peteratiamd.com forward slash subscribe. You can find me on Twitter, Instagram, Facebook, all with the ID Peter Atia MD. You can also leave us a review on Apple podcasts or whatever podcast player you listen on. This podcast is for general informational purposes only.

It does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Users should not disregard or delay an obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously for all of my disclosures in the companies I invest in or advise, please visit peteratiamd.com forward slash about

where I keep an up-to-date and active list of such companies. Thank you. you