Latest / Health Ethics Podcast / Vaccines now: Politicians, science, and a new public health reality

Transcript

Vaccines now: Politicians, science, and a new public health reality · Health Ethics Podcast

• 0:09
  Speaker 1: Welcome to Health Ethics, a series of conversations with leading
• 0:13
  Speaker 1: experts about ethical considerations associated with health and healthcare, both
• 0:17
  Speaker 1: locally and globally. I am Brian Pilkington, Professor of Bioethics
• 0:21
  Speaker 1: in the Department of Medical Sciences at the Hackensack Meridan
• 0:24
  Speaker 1: School of Medicine. This series, like its predecessor, which focused
• 0:29
  Speaker 1: on the COVID nineteen pandemic, relies on the idea that
• 0:32
  Speaker 1: challenging ethical issues are best addressed by folks from diverse
• 0:36
  Speaker 1: backgrounds practically reasoning together, and complements the Health Ethics series
• 0:41
  Speaker 1: with its panel of leading experts from medicine, nursing, politics, economics,
• 0:46
  Speaker 1: philosophy and the law. Thank you and enjoy the episode.
• 0:59
  Speaker 2: Welcome Everyone, Health Ethics Podcast. I'm Brian Pilkingden, Professor at
• 1:02
  Speaker 2: the Hackensack Meritian School of Medicine in the Department of
• 1:05
  Speaker 2: Medical Sciences, and it is my great pleasure today to
• 1:07
  Speaker 2: be speaking with doctor Aviva Shine and doctor Patrick Bardell.
• 1:12
  Speaker 2: Doctor Shine received her MD from Albert Einstein College of
• 1:16
  Speaker 2: Medicine in nineteen ninety seven and did her pediatric residency
• 1:19
  Speaker 2: at Mount Sinai Hospital in New York City. Place close
• 1:22
  Speaker 2: to my heart. Both of my kids were born there,
• 1:24
  Speaker 2: and she practiced primary care pediatrics and has done for
• 1:27
  Speaker 2: over twenty five years. She has worked teaching with residents
• 1:30
  Speaker 2: at My Mom and My Mom and The's Hospital, Brooklyn,
• 1:33
  Speaker 2: and spent fifteen years in private practice in New Jersey.
• 1:37
  Speaker 2: She currently works at the a federally qualified health center,
• 1:40
  Speaker 2: as well as teaching at our School of Medicine. And
• 1:43
  Speaker 2: I'm so excited have doctor Shine here. And she's joined,
• 1:46
  Speaker 2: as I mentioned by doctor Patrick Bardell, who is an
• 1:48
  Speaker 2: expert in the field of molecular microbiology and pethogenesis. And
• 1:53
  Speaker 2: Patrick previously was faculty at the Georgia Institute of Technology
• 1:56
  Speaker 2: at Michigan State University College of Human Medicine now is
• 2:00
  Speaker 2: the course director for the Immunity, Infection and Cancer course.
• 2:03
  Speaker 2: Both of these experts are perfectly placed to discuss our
• 2:06
  Speaker 2: topic today, which is ethics, vaccinations and the failure of agreement.
• 2:11
  Speaker 2: So we've got a pediatrician, we've got a microbiologist, and
• 2:13
  Speaker 2: we are on our way. So welcome to you both.
• 2:16
  Speaker 2: Thank you for being Thanks sure inviting us.
• 2:18
  Speaker 3: Yeah, thanks for inviting us, Brian, and I wanted to
• 2:19
  Speaker 3: mention that doctor Shine teaches our session in I two
• 2:23
  Speaker 3: C on vaccines.
• 2:24
  Speaker 2: To perfectly place people to jump right into this conversation
• 2:28
  Speaker 2: in a landscape that has been malleable in ways that
• 2:31
  Speaker 2: as a non clinician nonside is I'm surprised about. But yeah,
• 2:36
  Speaker 2: let's see if we can sort this stuff out over
• 2:38
  Speaker 2: the next twenty twenty five minutes or so. So, could
• 2:42
  Speaker 2: you describe overall changes that you have seen, both in
• 2:45
  Speaker 2: terms of public facing information about science and in the
• 2:48
  Speaker 2: practice of caring for children during the new administration, changes
• 2:54
  Speaker 2: to HHS, changes to CDC. So in the past couple
• 2:57
  Speaker 2: of years, what are the notable changes that you both
• 2:59
  Speaker 2: have seen? And we'll start with of evil, we'll start
• 3:02
  Speaker 2: with you.
• 3:02
  Speaker 4: Sure, So, I mean the changes are so bad it's
• 3:06
  Speaker 4: almost hard to catalog them all. I think the biggest
• 3:10
  Speaker 4: one was just that the new AHHS secretary fired all
• 3:15
  Speaker 4: seventeen members of ASIP, the Advisory Committee on Immunization Practices
• 3:22
  Speaker 4: that has you know, been who have been there for
• 3:26
  Speaker 4: years and decades making vaccine policy based on scientific research,
• 3:30
  Speaker 4: based on studies, based on transparency, and so they were
• 3:36
  Speaker 4: all dismissed and new people were brought in, many of
• 3:41
  Speaker 4: whom are vaccine skeptics, some of whom have significant conflicts
• 3:46
  Speaker 4: of interest where you know, they've been paid witnesses and
• 3:50
  Speaker 4: cases against vaccine manufacturers, quite a few of whom have
• 3:54
  Speaker 4: absolutely no training in infectious disease or knowology. And so
• 3:58
  Speaker 4: you have this new committee making recommendations on vaccine policy,
• 4:03
  Speaker 4: and they've just totally upended the vaccine the recommended vaccine schedule,
• 4:09
  Speaker 4: so that we've gone from eighteen previously recommended childhood vaccines
• 4:13
  Speaker 4: to eleven now. And you know, we can go into
• 4:16
  Speaker 4: more detail about what's been changed specifically and how that's
• 4:22
  Speaker 4: been written, but you know that's just part. You know,
• 4:25
  Speaker 4: there's obviously been significant cuts in funding. There have been
• 4:29
  Speaker 4: The CDC director was fired for refusing to rubber stamp
• 4:34
  Speaker 4: vaccine policies without reviewing scientific data. You know, there's been
• 4:39
  Speaker 4: so much that's happened. There's been five hundred million dollars
• 4:42
  Speaker 4: in funding for mRNA vaccine research has been terminated. So
• 4:46
  Speaker 4: there's a lot. But that's kind of my overall summary.
• 4:50
  Speaker 2: Superpluent, and I want to get into sort of the
• 4:51
  Speaker 2: day to day practice of caring for children and training
• 4:55
  Speaker 2: folks right who care for children. As I mentioned, I
• 4:57
  Speaker 2: have a vested interest, especially now in the last few
• 4:59
  Speaker 2: years with little ones at home, and I'm curious next
• 5:02
  Speaker 2: time I bring the younger one in if you know that, yeah,
• 5:05
  Speaker 2: if the pediatrician offers fewer vaccines than I anticipated. But
• 5:09
  Speaker 2: let me jump to Patrick before we do that, Patrick
• 5:12
  Speaker 2: falling up on a Viewa's points. Has anything changed scientifically?
• 5:16
  Speaker 3: From my perspective, the changes have been mostly on the
• 5:20
  Speaker 3: sort of communication level in that so there's a couple
• 5:24
  Speaker 3: of like so for the CDC, the Office of Communications
• 5:27
  Speaker 3: was temporarily shut down, right, That happened early in twenty
• 5:31
  Speaker 3: twenty five, and there have been sort of less direct
• 5:35
  Speaker 3: communications from the Office of Communication this year than previously,
• 5:39
  Speaker 3: so you're not necessarily seeing as much public facing information
• 5:42
  Speaker 3: being put out there. I think the data sources for
• 5:45
  Speaker 3: the CDC are still rather good because it's a relatively
• 5:48
  Speaker 3: decentralized system where states report up to the CDC. And
• 5:52
  Speaker 3: we're talking about something like health and human services, I do.
• 5:55
  Speaker 3: That's where I get more concerned. The Health and Human
• 5:57
  Speaker 3: services communications that I've seen had a sort of philosophical
• 6:02
  Speaker 3: bent to their communications that is not necessarily just giving
• 6:05
  Speaker 3: you the direct science, but giving you the science that
• 6:08
  Speaker 3: they want to show you to argue for a pre
• 6:11
  Speaker 3: determined position. So it's it's like you've got some ideology
• 6:16
  Speaker 3: in the factual information along with sort of people'll talk
• 6:21
  Speaker 3: about this later, just a lot of cherry picking of
• 6:25
  Speaker 3: data to support the conclusions that you already want to
• 6:28
  Speaker 3: get to.
• 6:28
  Speaker 2: Good points and helpful points on how the changes in
• 6:32
  Speaker 2: communication and where folks might be able to go to
• 6:34
  Speaker 2: get useful information aviva. How does this impact just DELI
• 6:39
  Speaker 2: practice with children. So we've got changes relative to the
• 6:43
  Speaker 2: the vaccine, we've got fewer vaccines in general now being recommended.
• 6:49
  Speaker 2: We can go into sort of the back and forth
• 6:51
  Speaker 2: on the mRNA funding. So as a parent, who shows
• 6:55
  Speaker 2: up or when.
• 6:56
  Speaker 4: You see yeah yeah, what is it technically speaking? Yeah yeah,
• 7:00
  Speaker 4: I mean I think there's a few different levels. So
• 7:03
  Speaker 4: initially I think there was some concern about whether the
• 7:07
  Speaker 4: vaccines were still going to be accessible, whether insurance was
• 7:10
  Speaker 4: still going to cover them, which so far it seems
• 7:13
  Speaker 4: like for most of them. And there may be some
• 7:15
  Speaker 4: question about a second HPV vaccine because that recommendation changed
• 7:20
  Speaker 4: whether that will still be covered by insurance, But for
• 7:23
  Speaker 4: the most part, insurance and VFC vaccines for children, which
• 7:27
  Speaker 4: is the program that actually covers over fifty percent of
• 7:31
  Speaker 4: children in this country get their vaccines through VFC, and
• 7:35
  Speaker 4: it's still paying for the vaccines. What I think it
• 7:38
  Speaker 4: does is just inject more uncertainty and confusion into an
• 7:45
  Speaker 4: area that was already creating a lot of stress for parents.
• 7:49
  Speaker 4: And So if parents were already wondering about our vaccine safe,
• 7:54
  Speaker 4: is the current schedule safe? Who do I trust? Now?
• 7:58
  Speaker 4: They're getting such mixed messages. Basically, most doctors, and this
• 8:04
  Speaker 4: is I've seen this in surveys, don't are not going
• 8:08
  Speaker 4: to follow the new CDC recommendations. So professional organizations are
• 8:14
  Speaker 4: putting out their own recommendations, you know, the American Academy
• 8:17
  Speaker 4: of Pediatrics being the main one, but also like a COG,
• 8:21
  Speaker 4: the kind of you know, Obstetrics andecology organization, the Academy
• 8:26
  Speaker 4: of Family Physicians, the IDEA Association. They're all putting out
• 8:30
  Speaker 4: guidelines based on evidence, which are basically the same guidelines
• 8:36
  Speaker 4: that ASIP had had in place for years, and that's
• 8:39
  Speaker 4: what we're using. And so, but how confusing must that
• 8:43
  Speaker 4: be for a parent to try to sort through all
• 8:47
  Speaker 4: that and figure out who to trust and where to
• 8:50
  Speaker 4: get your information? And parents just come in wanting to
• 8:55
  Speaker 4: make the best decision for their children, wanting to do
• 9:00
  Speaker 4: whatever is in their children's best interests and keep their
• 9:03
  Speaker 4: children healthy. And I just think this rather than you
• 9:07
  Speaker 4: know what, the stated objective is to restore faith in
• 9:11
  Speaker 4: public health and to keep you know, make things more transparent,
• 9:15
  Speaker 4: and this has done exactly the opposite.
• 9:19
  Speaker 2: A great point, And for folks who regularly listen to
• 9:22
  Speaker 2: the podcast, the theme of trust has come up a
• 9:24
  Speaker 2: good deal. And people probably remember Tom Naska talking a
• 9:27
  Speaker 2: bit about the importance of trust in medicine and in
• 9:31
  Speaker 2: medical education. So yeah, what what should parents do? I mean,
• 9:35
  Speaker 2: even bioethicists have weighed in on base studies being unasked,
• 9:39
  Speaker 2: like big name bioethesis actually Mark Camplin who was on
• 9:42
  Speaker 2: this podcast a couple of months ago talking about some
• 9:45
  Speaker 2: of these issues. So what should parents do? Is it
• 9:48
  Speaker 2: the case that most of these other organizations outside of
• 9:53
  Speaker 2: you know, federally federal government controlled organizations, if they're recommending
• 9:58
  Speaker 2: what ASIP used to recommend. Is that easy enough for
• 10:01
  Speaker 2: pediatricians to say, look, everyone's going in for this stuff,
• 10:05
  Speaker 2: And well over here you have these other recommendations coming
• 10:09
  Speaker 2: out of AHHS can you guide parents in that way?
• 10:13
  Speaker 2: Is it folks who were already hesitant or skeptical who
• 10:18
  Speaker 2: now are being reaffirmed. Are there folks in the middle
• 10:21
  Speaker 2: that you've seen, sort of parents who aren't really sure
• 10:23
  Speaker 2: and who are now backing away? I mean, just anecdotally,
• 10:25
  Speaker 2: what are your experiences.
• 10:26
  Speaker 4: In it runs the whole gambit. I mean, the people
• 10:28
  Speaker 4: who were already skeptical, this just reinforces their skepticism. But
• 10:33
  Speaker 4: then there are people who weren't skeptical, and now all
• 10:36
  Speaker 4: of a sudden they're like, well, I don't know, I'm
• 10:38
  Speaker 4: hearing this stuff that you know, why is our schedule
• 10:42
  Speaker 4: different from Denmarks? You know, isn't Denmark a great country?
• 10:46
  Speaker 4: And maybe we should be emulating them. Maybe there's something
• 10:49
  Speaker 4: wrong with our schedule. And it's complicated. You know, the
• 10:52
  Speaker 4: vaccine science is complicated. There are a lot of different vaccines,
• 10:56
  Speaker 4: There's hundreds of studies out there. You could spend an
• 11:00
  Speaker 4: enormous amount of time reviewing this information. It's hard enough
• 11:05
  Speaker 4: to understand if you have a scientific background, and it's
• 11:07
  Speaker 4: just an enormous amount of information to review. So I
• 11:11
  Speaker 4: don't blame parents for being confused and bewildered.
• 11:15
  Speaker 3: Yeah, I tend to agree about the sort of confusion there,
• 11:18
  Speaker 3: especially because you know, when you're talking about the changes
• 11:23
  Speaker 3: to the Childhood Vacciny Vaccine Nation schedule, right, you're moving
• 11:27
  Speaker 3: things into shared clinical decision making territory, and shared clinical
• 11:31
  Speaker 3: decision making tends to occur when the evidence.
• 11:36
  Speaker 5: Is not strong for one choice or another.
• 11:41
  Speaker 3: And the evidence didn't change, so it sort of begs
• 11:48
  Speaker 3: the question, like, so why did.
• 11:49
  Speaker 5: We move it? That's sort of where I'm on at all.
• 11:52
  Speaker 4: And I even think like that term shared clinical decision
• 11:55
  Speaker 4: making is so confusing, you know, doesn't it sound good
• 11:59
  Speaker 4: like we should all be participating in decision making about
• 12:03
  Speaker 4: our children's health decisions. But that's not exactly what shared
• 12:08
  Speaker 4: clinical decision making means, right, Like what Patrick says is
• 12:11
  Speaker 4: it has a scientific meaning, like we don't have enough
• 12:14
  Speaker 4: evidence to recommend one thing over another, so let's discuss
• 12:19
  Speaker 4: the risks and benefits. But that's just not the case
• 12:22
  Speaker 4: in terms of the vaccine schedule. There's an enormous amount
• 12:25
  Speaker 4: of evidence, but yet shared clinical decision making, if I
• 12:28
  Speaker 4: were a lay person, sounds really like something that we
• 12:32
  Speaker 4: should all be doing.
• 12:33
  Speaker 2: Bioethicists like to talk about shared decision making a lot,
• 12:37
  Speaker 2: and different folks mean slightly different things by it. But
• 12:39
  Speaker 2: one easy way to divide it up as well. You know,
• 12:41
  Speaker 2: I show up to my pediatricians on my kids pediatricians office,
• 12:44
  Speaker 2: and the pediatritions is the expert in the medical science
• 12:47
  Speaker 2: and the practice, and I or my kids are an
• 12:49
  Speaker 2: expert in their own values. So I have particular values
• 12:52
  Speaker 2: it right, and we do the science. We do that
• 12:53
  Speaker 2: and we figure out a way out to move forward,
• 12:55
  Speaker 2: and maybe that works for small alterations in a schedule,
• 13:00
  Speaker 2: a little bit of a delay here or there, but
• 13:02
  Speaker 2: some of the radical changes eighteen to eleven and in
• 13:04
  Speaker 2: a context right, the Denmark comment is well taken, and
• 13:10
  Speaker 2: this goes I think also to Patrick's point. I mean,
• 13:12
  Speaker 2: we can get to this too, about expertise and cherry
• 13:14
  Speaker 2: picking data to make a claim, oh there's another schedule
• 13:18
  Speaker 2: here without attending to any of these social structural features
• 13:23
  Speaker 2: seems problematic, and so why don't we jump there? And
• 13:27
  Speaker 2: because you know, Pepper and anything else as we go through.
• 13:30
  Speaker 2: But if we're thinking about expertise, right, if we're thinking
• 13:33
  Speaker 2: about what we really want, if parents really want their
• 13:35
  Speaker 2: kids to be healthy, which every parent wants their kids
• 13:38
  Speaker 2: to be healthy and safe and all of that. You
• 13:40
  Speaker 2: want the best person, I think to make the call.
• 13:44
  Speaker 2: And so what as practicing ped nutrition as a practicing scientist.
• 13:49
  Speaker 2: So what do you think is needed at the highest
• 13:51
  Speaker 2: levels of government in terms of facility with scientific knowledge
• 13:55
  Speaker 2: and medical practice. I mean, I teach bioethics. I spend
• 13:58
  Speaker 2: my days in these sphere. There's lots of stuff I
• 14:01
  Speaker 2: don't know. And so I call Patrick if it's going
• 14:04
  Speaker 2: to you know, or I call a leader. I call
• 14:06
  Speaker 2: someone who can say, hey, right, I know this is
• 14:08
  Speaker 2: how this works at a basic level. I'm not going
• 14:10
  Speaker 2: to give you the deal, but this is how it works.
• 14:12
  Speaker 2: So I understand the relevant scientific features for the ethical issue.
• 14:17
  Speaker 2: If people are determining policies and radical changes, right, getting
• 14:21
  Speaker 2: rid of a whole oversight group, replacing with other people
• 14:25
  Speaker 2: put to the side, conflicts of interest, what do you
• 14:28
  Speaker 2: both think? What kind of facility with scientific uh information
• 14:33
  Speaker 2: and processes do folks in these high places need?
• 14:36
  Speaker 5: What does it like? What does it take to be
• 14:38
  Speaker 5: at these high levels?
• 14:39
  Speaker 3: And it's hard because some of the people who are
• 14:41
  Speaker 3: signing off on these changes that I don't agree with
• 14:43
  Speaker 3: have what you would consider scientific expertise, right, so you
• 14:47
  Speaker 3: know they have PhDs, they have mds.
• 14:51
  Speaker 5: So what does that mean? Right? Like that, And so
• 14:53
  Speaker 5: that's why I don't actually think you can get rid
• 14:55
  Speaker 5: of the conflict of interest. I think the conflict of
• 14:57
  Speaker 5: interest is actually.
• 14:58
  Speaker 3: Most of it, because you know, there are lots of
• 15:01
  Speaker 3: people out there who can interpret data, who can give
• 15:05
  Speaker 3: you a recommendation that is like cut and dry. Right, So,
• 15:08
  Speaker 3: like you know, you've talked about the here's the expert,
• 15:11
  Speaker 3: here's the values. You know, as a scientist, my role
• 15:15
  Speaker 3: is to say, okay, based on what we have seen,
• 15:19
  Speaker 3: if you do X, then you will get why if
• 15:23
  Speaker 3: you change the vaccine schedule, less people will get vaccinated,
• 15:27
  Speaker 3: more people will get these diseases which will result in
• 15:31
  Speaker 3: uptics and morbidity, mortality, things like that.
• 15:33
  Speaker 5: I can't tell.
• 15:34
  Speaker 3: You that you should or you shouldn't do it, right,
• 15:36
  Speaker 3: that's up to you, right, Like how do you value
• 15:39
  Speaker 3: the freedom to say no to a vaccine versus upticks
• 15:43
  Speaker 3: in these sort.
• 15:44
  Speaker 2: Of parameters, the question about well, to who's the who right,
• 15:47
  Speaker 2: the question of whether a parent makes it to us right?
• 15:49
  Speaker 2: And this gets us in the contents what you want
• 15:51
  Speaker 2: to talk about too, because I'm interested in this topic
• 15:53
  Speaker 2: it's our folks listen to the podcast. But if I
• 15:57
  Speaker 2: make a conscientious decision and I weigh costed benefits because
• 16:01
  Speaker 2: I'm concerned about something with respect to my kid, that's
• 16:03
  Speaker 2: one thing a JHS CBC. I mean, aren't determinations supposed
• 16:08
  Speaker 2: to be made in terms of public health or I
• 16:11
  Speaker 2: mean balancing public health? So I think we might be
• 16:14
  Speaker 2: thinking about different kinds of people. And if it really,
• 16:18
  Speaker 2: I mean, isn't the case that it seems like the
• 16:20
  Speaker 2: cherry picking data problem is a general problem and so
• 16:24
  Speaker 2: everybody has a PhD, everybody or lots of folks. That's fine.
• 16:27
  Speaker 2: I don't know if that makes someone sufficiently facile with
• 16:30
  Speaker 2: scientific information in order to set a schedule, because if
• 16:34
  Speaker 2: that's a that makes it like, well, you know, Patrick
• 16:36
  Speaker 2: goes in for this, and I don't know, the other
• 16:39
  Speaker 2: microbiologist goes in for that, and you just kind of pick.
• 16:43
  Speaker 3: Right, And I think that's what that's what is end
• 16:46
  Speaker 3: of happening, right, Like the the the vaccine schedule didn't
• 16:49
  Speaker 3: just like it wasn't just handed down by mister vaccine scientists.
• 16:54
  Speaker 3: It was developed over years and years over It was
• 16:58
  Speaker 3: developed over years with a lot of different information and.
• 17:03
  Speaker 2: I'm sure that facts are valuating and all that, right,
• 17:06
  Speaker 2: So there are certain kinds of maybe non scientific features
• 17:10
  Speaker 2: that go into this, right. So we're attending to public
• 17:13
  Speaker 2: school schedules, right, and these sorts of things that you know,
• 17:15
  Speaker 2: when kids might get together and all that. But I'm
• 17:17
  Speaker 2: thinking the move take the case of moving from eighteen
• 17:20
  Speaker 2: to eleven. It seems like if it really is just
• 17:24
  Speaker 2: a matter of how you slice up the scientific landscape,
• 17:27
  Speaker 2: and someone reasonably could slice it up towards eleven and
• 17:30
  Speaker 2: reasonably could slice it up towards eighteen, that seems to
• 17:33
  Speaker 2: be a different view than what lots of folks have had.
• 17:35
  Speaker 2: If I understand your view correctly, that well, just dropping
• 17:38
  Speaker 2: it to eleven that's not a good thing. And here
• 17:41
  Speaker 2: are the reasons why the science doesn't support that. So
• 17:44
  Speaker 2: can you speak to that, and then I want to
• 17:45
  Speaker 2: jump to it.
• 17:46
  Speaker 4: Yeah, I mean, I think scientists can disagree about things, right,
• 17:49
  Speaker 4: And again, when you talk about areas of shared clinical
• 17:52
  Speaker 4: decision making, that may be where there's a situation where
• 17:55
  Speaker 4: you could make an argument in either direction. There are
• 17:57
  Speaker 4: a lot of complex things in scientific treatment and medical
• 18:02
  Speaker 4: treatment where you weigh risks benefits and people may genuinely
• 18:08
  Speaker 4: choose a different treatment because of their values. I think
• 18:12
  Speaker 4: vaccines are different in terms of the way they impact
• 18:16
  Speaker 4: not just the individual who's getting the vaccine, but society
• 18:19
  Speaker 4: at large. So there's that I do think that, you know,
• 18:22
  Speaker 4: if you look at the current decision makers, there's clearly
• 18:25
  Speaker 4: an agenda behind you know. So is it that they're
• 18:29
  Speaker 4: just looking at the facts and calling balls and strikes,
• 18:33
  Speaker 4: or is there an agenda behind it? Is there a
• 18:36
  Speaker 4: consensus and where does the consensus lie? And I think,
• 18:39
  Speaker 4: you know which we do have the time to. Let's say,
• 18:42
  Speaker 4: look at individual, each individual vaccine change or recommendation that's
• 18:48
  Speaker 4: been changed. Let's take hepatitis B right and say, well, yeah,
• 18:54
  Speaker 4: there are countries that don't do a birth dose of
• 18:56
  Speaker 4: hepatitis B, and hepatitie speed is vertically transmitted, so you know,
• 19:02
  Speaker 4: we're worried about moms transmitting it to babies, which is
• 19:05
  Speaker 4: a very high risk if a mother has hepatitis BEE.
• 19:08
  Speaker 4: But if we're screening moms, and why should a mom
• 19:11
  Speaker 4: who has screened negative for hepatitis B, why should her
• 19:15
  Speaker 4: baby be given a vaccine? That baby, you know, theoretically
• 19:18
  Speaker 4: isn't at risk because we know this mom is negative.
• 19:21
  Speaker 4: And that's a very simplified view of making hepatitis B
• 19:27
  Speaker 4: vaccine policy. If you just look at that, maybe you
• 19:31
  Speaker 4: could make an argument for it, for changing that birth dose.
• 19:35
  Speaker 4: But if you look at the bigger picture, even for
• 19:38
  Speaker 4: just a minute or two, and you say, well, what
• 19:41
  Speaker 4: happened in the nineteen eighties when we started vaccinating you know,
• 19:46
  Speaker 4: when hepatitis B vaccine became available and we started vaccinating
• 19:50
  Speaker 4: only babies that were considered high risk meaning moms were
• 19:54
  Speaker 4: positive or their vaccine status or their happy status was unknown,
• 20:00
  Speaker 4: did we see a decline in hepatitis BE in children?
• 20:03
  Speaker 4: We didn't. So, you know, there's already your first piece
• 20:06
  Speaker 4: of evidence that maybe that policy is not that effective
• 20:09
  Speaker 4: in America. And how much hepatitis B is there in America?
• 20:15
  Speaker 4: You know, how many infections are out there? Well, it
• 20:17
  Speaker 4: turns out there's actually millions of people infected with hepatitis B.
• 20:22
  Speaker 4: And how many of them are aware of that? Well,
• 20:23
  Speaker 4: maybe fifty percent of them don't even know that they
• 20:26
  Speaker 4: have hepatitis BE. And how contagious is hepatitis BE? Extremely
• 20:30
  Speaker 4: contagious lives on surfaces for up to a week, can
• 20:33
  Speaker 4: be transmitted in you know, microscopic amounts of blood. So
• 20:37
  Speaker 4: then then you kind of think, well, maybe doing away
• 20:41
  Speaker 4: with a birth dose is not such a good idea,
• 20:44
  Speaker 4: And you can kind of line up all those reasons
• 20:47
  Speaker 4: and then look at the vast differences in healthcare in Denmark,
• 20:53
  Speaker 4: in family leave in Denmark. You know, if you can
• 20:55
  Speaker 4: take a year, which is what Danish maternity paternity leave is,
• 21:00
  Speaker 4: and you don't have to send your baby to daycare
• 21:04
  Speaker 4: or get a babysitter whose heppy status you might not know,
• 21:07
  Speaker 4: you know, like those risks are totally different. You just
• 21:11
  Speaker 4: can't compare. And so when you start to actually look
• 21:16
  Speaker 4: at the bigger picture and really drill down into the data,
• 21:21
  Speaker 4: it becomes pretty clear that a birth dose of hepatiza,
• 21:25
  Speaker 4: a universal birth dose recommendation for hepty makes a lot
• 21:29
  Speaker 4: of sense from a public health perspective. And so, you know,
• 21:33
  Speaker 4: you could it's just very time consuming. You can go
• 21:35
  Speaker 4: through every single one of these vaccine mandate changes and
• 21:41
  Speaker 4: point to that kind of evidence. But that's just one example.
• 21:46
  Speaker 5: That was a great example. Yeah, yeah, it's a great example. Right.
• 21:50
  Speaker 5: So we know that hepatiz can be can be transmitted.
• 21:53
  Speaker 3: Horizontally, and there are many different many cases of that
• 21:58
  Speaker 3: that happen each year. Right, and before the universal mandate
• 22:01
  Speaker 3: or recommendation in nineteen ninety one.
• 22:05
  Speaker 4: I think, yeah, it's ninety one, there.
• 22:08
  Speaker 3: Were thousands of infants that were infected, most likely horizontally,
• 22:14
  Speaker 3: right from someone who's not their.
• 22:15
  Speaker 4: Mind, that's right, that's right.
• 22:17
  Speaker 5: Infants are at higher risk.
• 22:19
  Speaker 3: Infants who get hepatitis B don't clear it, so they
• 22:24
  Speaker 3: develop a chronic hepatitis B infection, which leads to higher
• 22:28
  Speaker 3: rates of liver cancer, cirrhosis.
• 22:30
  Speaker 5: And early death.
• 22:31
  Speaker 3: Right. So yeah, and it's a great point. Right, You're
• 22:35
  Speaker 3: not considering the entire thing. That's what I mean by
• 22:38
  Speaker 3: cherry picking. Like science, scientific studies, when you say a study,
• 22:44
  Speaker 3: when you're telling the results of your study, you have
• 22:46
  Speaker 3: to be really careful about, you know, to do science well,
• 22:49
  Speaker 3: you have to really care about these are the limitations
• 22:51
  Speaker 3: of my study.
• 22:53
  Speaker 5: They do not necessarily embrace everything.
• 22:56
  Speaker 3: Right, you know, thinking about vaccines again, you know the
• 23:01
  Speaker 3: the controversy over the over adjuvants or or thymerosol as
• 23:07
  Speaker 3: a preservative. You know, if you have data that says
• 23:11
  Speaker 3: that an adjuvant causes cell death, that is one thing,
• 23:15
  Speaker 3: and that can be a true study, but that study
• 23:18
  Speaker 3: maybe in in vitro cells. Right, what does that mean?
• 23:23
  Speaker 3: As we scale up to an animal right, we scaleup
• 23:27
  Speaker 3: to a human right because people are not other animals,
• 23:30
  Speaker 3: They're not my.
• 23:33
  Speaker 5: Right, and are like, what does that dosage look like
• 23:36
  Speaker 5: in a in a person? And these are like, these
• 23:38
  Speaker 5: are much more complicated questions.
• 23:41
  Speaker 2: This is really helpful. And this is what I think
• 23:42
  Speaker 2: is most beneficial about conversations like this. Uh, whether it's
• 23:47
  Speaker 2: Terry Pigham, data or evil you just laid out before,
• 23:51
  Speaker 2: is this is how I think that folks at the
• 23:54
  Speaker 2: highest levels of government making policy should be doing things right.
• 23:58
  Speaker 2: And it's I, as an individual might make certain kinds
• 24:02
  Speaker 2: of choices right. We can do liberty, we can run
• 24:04
  Speaker 2: the conscience art arguments all day. I may, as a parent,
• 24:07
  Speaker 2: might make choices for my children. That gets a little
• 24:10
  Speaker 2: bit more complicated. But when we're talking about a lot
• 24:12
  Speaker 2: of folks, right, the people in the CDC aren't worried
• 24:15
  Speaker 2: about my kid, They're about all the kids. And so
• 24:20
  Speaker 2: students who've listened to this a lot, well, like you know,
• 24:22
  Speaker 2: I'll get I'll get some flat because this sort of
• 24:25
  Speaker 2: gets close to consequentialism. I'm not a consequentialist. Of course,
• 24:27
  Speaker 2: no one on a podcast is, because you shouldn't be consequentialus.
• 24:30
  Speaker 2: But this just seems to be how we ought to reason.
• 24:33
  Speaker 2: You go through the scientific data, you look at the
• 24:36
  Speaker 2: relevant social factors, and you make determinations based on all
• 24:40
  Speaker 2: of the evidence, and pointing out what happened with both
• 24:43
  Speaker 2: vertical and horizontal transmission would happened earlier when smaller dose
• 24:48
  Speaker 2: or smaller population size was receiving in the vaccine. This
• 24:54
  Speaker 2: just seems fairly sensible from someone who doesn't work in
• 24:58
  Speaker 2: science and not in public health either. So it's that
• 25:02
  Speaker 2: kind of thinking that I think I would look for
• 25:03
  Speaker 2: an expert. And also I think that's what and we've
• 25:08
  Speaker 2: talked about this before, but that's what the social contract
• 25:12
  Speaker 2: requires of others. So maybe physicians are parties to social contracts.
• 25:16
  Speaker 2: Folks have debateded this, they've debated this on this podcast,
• 25:19
  Speaker 2: and thinking about trust and the social contract. What is
• 25:21
  Speaker 2: owed to the American people by the leaders of the
• 25:26
  Speaker 2: folks who determined this policy, right, I'll just be a
• 25:28
  Speaker 2: little sloppy who determine these policies, who have influence sort
• 25:33
  Speaker 2: of high and large podiums and a loud microphones. It
• 25:36
  Speaker 2: seems like something's owed. What is it? So huge question? Well, right,
• 25:41
  Speaker 2: we've got only a couple minutes left in our time.
• 25:45
  Speaker 2: What do you think in light of this social contract,
• 25:48
  Speaker 2: if you buy into it, what do you think is
• 25:50
  Speaker 2: owed to the American people, both by physicians, by microbiologists,
• 25:54
  Speaker 2: but also by the folks at the highest levels.
• 25:56
  Speaker 4: We have to be transparent about, you know, what our
• 26:00
  Speaker 4: biases may be, and certainly with vaccines, about what the
• 26:05
  Speaker 4: risks are that there's uncertainty in science that you know,
• 26:11
  Speaker 4: so much of this is continually monitored, right, Like we
• 26:16
  Speaker 4: have all these surveillance systems like THEIRS and the Vaccine
• 26:21
  Speaker 4: Data Link and stuff like that. We need to acknowledge
• 26:25
  Speaker 4: when there's a mistake has been made or and that happens, right,
• 26:30
  Speaker 4: vaccines have been pulled from the market. There's plenty of
• 26:34
  Speaker 4: examples of that. You know, the original rotavirus vaccine which
• 26:39
  Speaker 4: was linked to into susception, which wasn't clear in the
• 26:43
  Speaker 4: initial data because it was such a rare occurrence. You
• 26:47
  Speaker 4: didn't have enough participants in the original studies. But once
• 26:50
  Speaker 4: you had more kids getting that vaccine, you saw that.
• 26:54
  Speaker 4: Or the J and J covid vaccine which was linked
• 26:58
  Speaker 4: to blood clots. So you know, to me, science is
• 27:02
  Speaker 4: self correcting and we just need to continue to do
• 27:05
  Speaker 4: that and be honest.
• 27:09
  Speaker 3: Yeah, I think going off of that being honest about
• 27:13
  Speaker 3: sort of what is your goal? You know, you can
• 27:15
  Speaker 3: say that the goal of Health in Human Services or
• 27:18
  Speaker 3: the CDC is to produce the absolute.
• 27:21
  Speaker 5: Lowest mortality rate for X, y z. Right, that's a
• 27:24
  Speaker 5: reasonable thing to say.
• 27:25
  Speaker 3: And this is the data that says how we could
• 27:29
  Speaker 3: do that, right, and so this you know, so being
• 27:32
  Speaker 3: clear about I am presenting this, but I have these
• 27:34
  Speaker 3: sort of priors that may influence the things that I choose.
• 27:38
  Speaker 3: I think is good for scientists because it actually helps people.
• 27:43
  Speaker 3: It helps with the trust in scientists, right, Like, people
• 27:45
  Speaker 3: don't enjoy when scientists are like, well you have to
• 27:47
  Speaker 3: do this because this is this is what it says
• 27:51
  Speaker 3: without saying what values they're using to get there, right, Like,
• 27:56
  Speaker 3: you know, if you want to lower morbidity mortality, these
• 27:58
  Speaker 3: are the the the interventions that do it. Whether you
• 28:02
  Speaker 3: value lowering morbidity or mortality, that's up to you, like like,
• 28:05
  Speaker 3: but I do.
• 28:06
  Speaker 2: So. Yeah, that's both excellent points and really helpful for
• 28:12
  Speaker 2: both trust and science, like understand the process, and this
• 28:15
  Speaker 2: leads us run out of time. This leads us to
• 28:18
  Speaker 2: like primary and secondary education issues related to there's a
• 28:22
  Speaker 2: ton we can talk about. But I think transparency and
• 28:25
  Speaker 2: trust are two keys, and this is what we get
• 28:28
  Speaker 2: from science and being slocked as we get from science.
• 28:32
  Speaker 2: But someone has to make a determination. And you think
• 28:35
  Speaker 2: Patrick that, yeah, we should care about morbidity and mortality,
• 28:39
  Speaker 2: but then when we go to individuals, right, I do,
• 28:41
  Speaker 2: but I care more about my I love everybody, but
• 28:44
  Speaker 2: I care more about my own kids than I care
• 28:46
  Speaker 2: about others, and not everyone sits around thinking about social contracts.
• 28:50
  Speaker 3: Right.
• 28:50
  Speaker 2: So I want my kids to be vaccinated, both because
• 28:53
  Speaker 2: I want them to be protected from certain kinds of things,
• 28:56
  Speaker 2: but also because they have friends and I'm friends with
• 28:59
  Speaker 2: their parents. Care about other people, but I care most
• 29:01
  Speaker 2: about them, And so I think you don't want me
• 29:06
  Speaker 2: making policy about pediatrics because I'm going to do whatever
• 29:10
  Speaker 2: benefits my kids. And I think a lot of people
• 29:12
  Speaker 2: are in that place, and hence the large oversight bodies.
• 29:17
  Speaker 3: I agree with you, and I think that the failure
• 29:20
  Speaker 3: of communication of a lot of this is that the
• 29:24
  Speaker 3: safety and things like that of the vaccine so like,
• 29:26
  Speaker 3: why would I not get a vaccine?
• 29:27
  Speaker 5: Right, Well, there are.
• 29:28
  Speaker 3: Some risks and sort of the issue that comes in
• 29:32
  Speaker 3: that is that doing the vaccine. The vaccine is good
• 29:36
  Speaker 3: for your child as an individual and for society. Right,
• 29:41
  Speaker 3: the safety is well studied, right, and the risk here
• 29:46
  Speaker 3: child is very very low. We have to tell you, right,
• 29:49
  Speaker 3: and we should tell you that it is not zero.
• 29:52
  Speaker 3: There is no medical procedure where the risk is zero.
• 29:56
  Speaker 3: But you know, I think that the sort of the
• 30:01
  Speaker 3: failures that I see are like this, like this emphasis
• 30:04
  Speaker 3: on like oh no, that's a problem, you know, you know,
• 30:07
  Speaker 3: it's you now have a one in a billion chance
• 30:10
  Speaker 3: of like health outcome? Is that a serious health outcome
• 30:12
  Speaker 3: that you have at risk of? I don't know, right,
• 30:14
  Speaker 3: Like it's gonna depend like it's all variable.
• 30:18
  Speaker 4: I think it comes back to your agenda. Like if
• 30:20
  Speaker 4: your agenda is vaccines are are dangerous and we should
• 30:24
  Speaker 4: minimize them, and you know, we should emphasize other things
• 30:28
  Speaker 4: in terms of immune health, then you kind of over
• 30:32
  Speaker 4: emphasize the risk and it is hard for people to
• 30:36
  Speaker 4: put risk into perspective.
• 30:38
  Speaker 5: That's like a whole other podcast.
• 30:40
  Speaker 4: It's a whole other thing.
• 30:41
  Speaker 5: That's a whole other podcast series.
• 30:44
  Speaker 2: Yeah, yeah, I mean human beings notoriously reason poorly in
• 30:48
  Speaker 2: situations of uncertainty, right, so there's a yeah. So I've
• 30:53
  Speaker 2: kept you both longer than I promise, So thank you
• 30:56
  Speaker 2: with so much. This was a really helpful conversation and
• 30:58
  Speaker 2: just sort of putting together. There is a number of
• 31:01
  Speaker 2: disparate threads connected to vaccination and recent concerns, and we've
• 31:06
  Speaker 2: touched on communication, we've touched on pediatric practice, we've touched
• 31:09
  Speaker 2: on microbiology, different governmental features, conscience, public requirements, and you
• 31:14
  Speaker 2: guys have been great. And again for everyone listening, I've
• 31:16
  Speaker 2: been speaking with doctor A. Viv Shine and doctor Patrick
• 31:20
  Speaker 2: Bardell and for yeah, but thank you both so much.
• 31:26
  Speaker 4: Thank you.
• 31:27
  Speaker 1: Great Topic series is a production of the Health Ethics Lab,
• 31:31
  Speaker 1: and I am grateful to colleagues in the Department of
• 31:33
  Speaker 1: Medical Sciences, the IHS Library, and the Hackensack Ready in
• 31:36
  Speaker 1: the School of Medicine for making this collaboration possible. To
• 31:40
  Speaker 1: learn more about our work or to engage with the
• 31:42
  Speaker 1: series content, reach out to me Brian Pilkington at Brian
• 31:46
  Speaker 1: dot Pilkington at hmh M dot org.