There's an unexpected benefit when you get the flu shot past flu vaccines have protected against four COVID strains, but this year's will only protect against three.
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He also talked about an increased number of kids taking melatonin to sleep and ending up in the ER. Dr. Pothof explains what you can do to keep your family safe.
Plus, Dr. Pothof explains what you need to know about lead exposure and a recent cinnamon recall by the FDA.
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Measles seems poised to make a comeback in America. Two adults and two children staying at a migrant shelter in Chicago have gotten sick with the disease. A sick kid in Sacramento, California, may have exposed hundreds of people to the virus at the hospital. Three other people were diagnosed in Michigan, along with seven from the same elementary school in Florida. As of Thursday, 17 states have reported cases to the CDC since the start of the year. (For comparison, that total was 19, plus the District of Columbia, for all of 2023, and just 6 for 2022.) Weve got this pile of firewood, Matthew Ferrari, the director of the Center for Infectious Disease Dynamics at Penn State, told me, and the more outbreaks that keep happening, the more matches were throwing at it.
Whos holding the matchbook? Theres an easy answer to whos at fault. One of the nations political parties, and not the other, turned against vaccines to some extent during the pandemic, leading to voter disparities in death rates. One party, and not the other, has a presumptive presidential candidate who threatens to punish any school that infringes on parental rights by requiring immunizations. And one party, but not the other, appointed a vaccine-skeptical surgeon general in Florida who recently sidestepped standard public-health advice in the middle of an outbreak. The message from Republicans, as The Washington Posts Alexandra Petri joked in a recent column, can sound like this: We want measles in the schools and books out of them!
But the politics of vaccination, however grotesque it may be in 2024, obscures whats really going on. Its true that vaccine attitudes have become more polarized. Conservative parents in particular may be opting out of school vaccine requirements in higher numbers than they were before. In the blood-red state of Idaho, for example, more than 12 percent of kindergartners received exemptions from the rules for the 202223 school year, a staggering rate of refusal that is up by half from where it was just a few years ago. Politicized recalcitrance is unfortunate, to say the least, and it can be deadly. Even so, Americas political divides are simply not the cause of any recent measles outbreak. The virus has returned amid a swirl of global health inequities. Any foothold that it finds in the U.S. will be where hyperlocal social norms, not culture-war debates, are causing gaps in vaccine access and acceptance. The more this fact is overlooked, the more were all at risk.
Consider where the latest measles cases have been sprouting up: By and large, the recent outbreaks have been a blue-state phenomenon. (Idaho has so far been untouched; the same is true for Utah, with the nations third-highest school-vaccine-exemption rate.) Zoom into the county level, and youll find that the pattern is repeated: Measles isnt picking on Republican communities; if anything, it seems to be avoiding them. The recent outbreak in Florida unfolded not in a conservative area such as Sarasota, where vaccination coverage has been lagging, but rather in Biden-friendly Broward County, at a school where 97 percent of the students have received at least one MMR shot. Similarly, the recent cases in Michigan turned up not in any of the states MAGA-voting, vaccine-forgoing areas but among the diverse and relatively left-wing populations in and around Ann Arbor and Detroit.
Stepping back to look at the country as a whole, one cant even find a strong connectionor, really, any consistent link at allbetween U.S. measles outbreaks, year to year, and U.S. childrens vaccination rates. Sure, the past three years for which we have student-immunization data might seem to show a pattern: Starting in the fall of 2020, the average rate of MMR coverage for incoming kindergarteners did drop, if only by a little bit, from 93.9 to 93.1 percent; at the same time, the annual number of reported measles cases went up almost tenfold, from 13 to 121. But stretch that window back one more year, and the relationship appears to be reversed. In 2019, America was doing great in terms of measles vaccinationacross the country, 95.2 percent of kindergartners were getting immunized, according to the CDCand yet, in spite of this fantastic progress, measles cases were exploding. More than 1,200 Americans got sick with the disease that year, as measles took its greatest toll in a generation.
Its not that our high measles-vaccination coverage didnt matter then or that our slightly lower coverage doesnt matter now. Vaccination rates should be higher; this is always true. In the face of such a contagious disease, 95 percent would be good; 99 percent much better. When fewer people are protected, more people can get sick. In Matthew Ferraris terms, a dropping immunization rate means the piles of firewood are getting bigger. If and when the flames do ignite, they could end up reaching farther, and burning longer, than they would have just a year or two ago. In the midst of any outbreak large enough, where thousands are affected, children will die.
Read: The good news about vaccine hesitancy
Despite Americas fevered national conversation about vaccines, however, rates of uptake simply havent changed that much. Even with the recent divot in our national vaccine rates, the country remains in broad agreement on the value of immunity: 93 percent of Americas kindergartners are getting measles shots, a rate that has barely budged for decades. The sheer resilience of this norm should not be downplayed or ignored or, even worse, reimagined as a state of grace from which weve fallen. Our protection remains strong. In Florida, the surgeon generals lackadaisical response to the crisis at the Broward County elementary school did not produce a single extra case of the disease, in spite of grim predictions to the contrary, almost certainly thanks to how many kids are already vaccinated.
At the same time, however, measles has been thriving overseas. Its reemergence in America is not a function of the nations political divides, but of the diseases global prevalence. Europe had almost 60,000 cases last year, up from about 900 in 2022. The World Health Organization reports that the number of reported cases around the world surged to 306,000, after having dropped to a record low of 123,000 in 2021. As the pandemic has made apparent, our world is connected via pathogens: Large outbreaks in other countries, where vaccination coverage may be low, have a tendency to seed tiny outbreaks in the U.S., where coverage has been pretty high, but narrow and persistent cracks in our defenses still remain. (In 2022, more than half of the world's unvaccinated infants were concentrated in just 10 countries; some of these are measles hotspots at this moment.) This also helps explain why so many Americans got measles in 2019. That was a catastrophic year for measles around the world, with 873,000 reported cases in total, the most since 1994. We had pretty good protection then, but the virus was everywhereand so, the virus was here.
Read: Floridas experiment with measles
In high-income countries such as the U.S., Ferrari told me, clustering of risk tends to be the source of measles outbreaks more than minor changes in vaccine coverage overall. Even in 2019, when more than 95 percent of American kindergarteners were getting immunized, we still had pockets of exposure where protection happened to be weakest. By far the biggest outbreak from that year occurred among Hasidic Jewish populations in New York State. Measles was imported via Israel from the hot spot of Ukraine, and took off within a group whose vaccination rates were much, much lower than their neighbors. In the end, more than 1,100 people were infected during that outbreak, which began in October 2018 and lasted for nearly a year. A national vaccination rate has one kind of meaning, but all outbreaks are local outbreaks, Noel Brewer, a professor at the University of North Carolina at Chapel Hill and a member of the federal Advisory Committee on Immunization Practices, told me. They happen on a specific street in a specific group of houses, where a group of people live and interact with each other. And those rates of vaccination in that specific place can drop well below the rate of coverage that will forestall an outbreak.
Weve seen this time and time again over the past decade. When bigger outbreaks do occur in the U.S., they tend to happen in tight-knit communities, where immunization norms are radically out of sync with those of the rest of American society, politics aside. In 2014, when an outbreak of nearly 400 cases took hold in Ohio, almost entirely within the Amish community, the local vaccination rate was estimated to be about 14 percent. (The statewide number for young children at that time was more than 95 percent.) In 2011 and 2017, measles broke out among the large Somali American community in Minnesota, where anti-vaccine messaging has been intense, and where immunization rates for 2-year-olds dropped from 92 percent 20 years ago to 35 percent in 2021. An outbreak from the end of 2022, affecting 85 people in and around Columbus, Ohio, may well be linked to the nations second-biggest community of Somalis.
Care must be taken in how these outbreaks are discussed. In Minnesota, for example, state health officials have avoided calling out the Somali community, for fear of stigmatizing. But another sort of trouble may arise when Americans overlook exactly whos at risk, and exactly why. Experts broadly agree that the most effective way to deal with local outbreaks is with local interventions. Brewer pointed out that during the 2019 outbreak in New York, for example, nurses who belonged to local Jewish congregations took on the role of vaccine advocates. In Minnesota, the Department of Health has brought on more Somali staff, who coordinate with local Somali radio and TV stations to share its message. Yet these efforts can be obscured by news coverage of the crisis that points to a growing anti-science movement and parents giving up on vaccination all across the land. When measles spread among New Yorks orthodox Jews, The New York Times reported on an anti-vaccine fervor on the left that is increasingly worrying health authorities. When the virus hit Columbus, NBC News noted that it was happening as resistance to school vaccination requirements is spreading across the country.
Two different public-health responses can be undertaken in concert, the experts told me: You treat the problem at its source, and you also take the chance to highlight broader trends. A spate of measles cases in one community becomes an opportunity for pushing vaccination everywhere. Thats always an important thing for us to do, Ferrari said. Even so, the impulse to nationalize the problem will have its own, infelicitous effects. First, its meaningfully misleading. By catastrophizing subtle shifts in vaccination rates, we frighten many parents for no reason. By insisting that every tiny outbreak is a product of our national politics, we distract attention from the smaller measures that can and should be takenwell ahead of any upsurge of diseaseto address hyperlocal vaccination crises. And by exaggerating the scale of our divisionsby asserting that weve seen a dangerous shift on a massive scale, or an anti-vaccine takeover of the Republican Partywe may end up worsening the very problem that worries us the most.
We are a highly vaccinated nation, our politics notwithstanding. Telling people otherwise only fosters more division; it feeds the feeling that taking or refusing measles shots is an important mode of self-expression. It further polarizes health behavior, which can only widen the cracks in our defenses. We have become quite militant and moralistic about vaccination, Brewer told me, and we probably would do well to be less absolute. Measles outbreaks overseas are growing; measles outbreaks here will follow. Their specific causes ought not be ignored.
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Neil Young is placing his music back on Spotify a little over two years after pulling it due to misinformation about vaccines on The Joe Rogan Experience. The streaming platform used to be the exclusive home of Rogan, but they recently inked a $250 million deal with the podcaster that will make the show available on other platforms.
My decision comes as other music services, Apple, Amazon, Qobuz, Tidal, all high res, have started serving the same disinformation podcast I had opposed at Spotify, Young wrote to fans on The Neil Young Archives. Because I cannot leave all those services like I did Spotify, because my music would have no streaming outlet to music lovers at all, I have returned.
This doesnt mean Young is happy with Spotify. His letter repeatedly hammers them for continuing to use low resolution audio files. [I have] sincere hopes that Spotify sound quality will improve and people will be able to hear and feel all the music as we made it, he wrote. Hopefully Spotify will return to Hi Res as the answer and serve all the music to everyone. Spotify, you can do it! Really be #1 in all ways. You have the music and the listeners!!! Start with a limited hi res tier and build from there!
Young originally pulled his music from Spotify in January 2022. I am doing this because Spotify is spreading fake information about vaccines, he wrote, potentially causing death to those who believe the disinformation being spread by them.
In response, Rogan said that he was a longtime fan of Neil Young, and had no desire to hurt anybody despite repeatedly questioning the safety and effectiveness of Covid vaccines to his massive audience. Im not trying to promote misinformation, he said at the time. Im not trying to be controversial. Ive never tried to do anything with this podcast other than to just talk to people I do not know if theyre right. I dont know because Im not a doctor; Im not a scientist. Im just a person who sits down and talks to people and has conversations with them.
At press time, Youngs music had not reappeared back on Spotify.
But elsewhere, efforts to enhance vaccine manufacturing capability pale in comparison, especially in the UK.
When you look, scratch beneath the surface, it is nothing, Clive Dix, the former head of the Covid vaccine taskforce, told the Telegraph. In the whole environment for manufacturing, the UK is a bit of a hostile place for it to occur. So people have moved away.
Like Mr Poonawalla, Dr Dix said a lack of political interest is a major barrier to the UK upping its manufacturing capabilities.
Experts have pointed to the Vaccine Manufacturing and Innovation Centre to highlight this issue.
It was launched during the pandemic as a not-for-profit company that would combine research and manufacturing under one roof. But in 2022, the 200m government-funded centre was sold to a private pharmaceutical company.
Dr Dix added that more incentives are needed to bring vaccine research and manufacturing to the UK, like the tax breaks recently introduced in Ireland. Otherwise, Britain will be left wholly reliant on other countries in the case of a new pandemic.
Weve actually lost a lot of our manufacturing [to other countries], partly because big companies look up the cost base for doing it, he says. A lot has gone to India and China Weve just let it slip through our fingers because of the cost base that we have.
Across the Channel, Europe which found itself in hot competition with the UK and US for supplies during the coronavirus pandemic appears to be much more proactive. In June 2023, the European Union signed contracts with four vaccine producers to reserve manufacturing capacity in the case of future outbreaks.
At the cost of 160 million per year, the deals with the US pharmaceutical giant Pfizer, Spanish vaccine makers HIPRA and CZ vaccines, and Dutch company Bilthoven Biologicals covers enough capacity for 325 million doses annually. It includes a range of vaccine types, including mRNA, viral vector and protein-based shots.
Dr Dix believes it is not too late to bring the ailing political will back and replicate Europes efforts.
I think you could easily resurrect it with the right leadership and make it happen, he says.
Back in Pune, Mr Poonawalla stressed that investing in a diverse portfolio of manufacturers in different geographical regions will be critical if leaders worldwide want to avoid the supply-chain issues that plagued Covid-19 jabs.
If you dont have a ready-made facility available, were just going to be exactly in the same situation where we were dependent on four or five manufacturers in the world, he says.
Every country is going to scramble for it, youre going to have all these bans and restrictions, raw material restrictions, regulatory restrictions that delayed and confused and created havoc during the pandemic.
The SII was not immune to havoc. As India was engulfed by Covid-19 which has killed at least 770,000 people in the vast country the government banned vaccine exports.
At the time, SII had exported just 60 million of its doses, which were predominantly intended for low income countries unable to secure shots from elsewhere. AstraZeneca, which SSI struck a deal with to produce a billion doses of its shot, served a legal notice over delivery delays.
The delivery of vaccinations worldwide was splintered, with wealthy nations first in line to protect their people and poorer nations left behind.
Next time around, Mr Poonawalla said SII will be committed to guaranteeing the same thing doesnt happen, and that costs will be kept low to ensure the most vulnerable get the shot.
At SII, we firmly believe that no one should be left behind in the fight against global health emergencies, he said.
Our commitment to equity, coupled with our ongoing efforts to enhance manufacturing capabilities, forge strategic partnerships, and align with international initiatives, positions us to a timely and fair distribution of life-saving vaccines to those in need, both in India and around the world, during the next pandemic.
SIIs has also faced opposition from the US drug lobby for its calls to reform intellectual property protections, while regulations have made it hard for the company to break through in wealthy markets.
More broadly, Indias pharmaceutical industry is facing major scrutiny. It has been plagued by scandals, including a deadly cough syrup that killed hundreds of children, though SII has stressed that it was not involved.
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The world's biggest vaccine maker will start rolling out a cheap new malaria inoculation in Africa from May, bolstering the fight against one of the most deadly infectious diseases globally.
The mosquito-borne malady kills more than 600,000 people a year, 95 percent of them in Africa, according to the World Health Organization (WHO).
It is more fatal among the young, and the annual toll of malaria deaths includes nearly half a million African children aged under five.
The Serum Institute of India (SII) this year plans to ship 25 million doses of the new vaccine, developed along with Oxford University researchers and known as R21.
"In terms of importance and saving lives... it's going to be a hugely impactful vaccine, SII chief executive Adar Poonawalla told AFP.
"We've offered these vaccines to the African continent at $4 or less in the first year itself. And then as we scale up, maybe we can bring that down a little bit further."
The R21 vaccine, a three-dose course and booster shot for children aged 5-36 months, is the second malaria shot approved by the WHO.
But researchers say it will be cheaper than the other vaccine produced by British pharma giant GlaxoSmithKline.
The WHO said its rollout was expected to greatly expand supply to meet high demand from African countries.
The SII has been the largest vaccine manufacturer globally for several years but saw its profile rise substantially after manufacturing millions of cheap COVID vaccine shots for export at the height of the pandemic.
With demand for coronavirus prevention waning, it has repurposed some pandemic-era facilities to combat other diseases at its sprawling factory complex in Pune, a few hours' drive from business capital Mumbai.
Small glass vials are pumped with R21 doses and whizzed off on a conveyor belt for quality checks and packaging ahead of their looming export.
Poonawalla says the institute's goal is to roll out R21 in a few countries before the main malaria season starts in about six to seven months.
"Ideally we should have vaccinated the people most vulnerable at risk. That's the target," he said, adding that production would eventually reach 100 million R21 doses per year.
SII research and development director Umesh Shaligram said the vaccines would be shipped towards the end of April with deployment to start by May and June.
The vaccines will mostly be bought and distributed through the United Nations Children's Fund (UNICEF) and Gavi, a global vaccine alliance.
Chad, Central African Republic, DR Congo, Mozambique and South Sudan will be the first five countries to receive R21 doses, a UNICEF spokesperson told AFP.
"Uganda and Nigeria are planning to introduce it later in the year," the spokesperson added.
The court found that 20th Television may have engaged in religious discrimination against the actor, who was denied an exemption from the vaccine.
Rockmond Dunbar in 911.
20th Television must face a religious discrimination trial for firing Rockmond Dunbar, an original castmember on 911, after he refused to take the COVID-19 vaccine, marking the second ruling to clear the way for trial a lawsuit against a studio over terminations triggered by vaccine mandates amid the pandemic.
U.S. District Judge Dolly Gee found on Friday that 20th may have discriminated against Dunbar for declining to provide him a religious exemption to the vaccine as a follower of the Church of Universal Wisdom. The trial will assess whether he had a sincerely held religious belief within the meaning of civil rights laws that conflicted with the vaccine mandate and if reasonable accommodations could have been offered, allowing him to continue acting on the series without endangering others or causing undue hardship to the studio.
If 20th is found to have engaged in religious discrimination in the trial, the decision could threaten how studios approach exemptions to vaccine mandates if they are reimplemented in the future. Dunbar claimed that his request for an exemption was denied after Disney determined that he was not a true believer in the Church of Universal Wisdom. An exemption request from General Hospitals Ingo Rademacher, who was fired from the series after refusing the vaccine, was similarly rejected after Disney, which owns ABC, questioned the sincerity of his belief in a book called The Revelation of Ramala. It appears that Disney vetted exemption applications on a case-by-case basis, investigating whether the religions constituted true religious institutions and whether applicants actually followed the beliefs.
Fridays ruling comes on the heels of a Los Angeles judge concluding in February that ABC may have engaged in religious discrimination against two former General Hospital crewmembers, who sued the network after they were fired for refusing the vaccine. In that case, the court will similarly evaluate whether James and Timothy Wahl had religious beliefs that ABC should have accommodated by affording them exemptions and offering them certain workarounds to mandatory vaccination policies.
In 2022, Dunbar sued 20th and Disney, which owns the TV production arm of 20th Century Studios and has been dismissed from the case, after he was fired for refusing to comply with vaccine mandates. The return-to-work protocols, which were agreed upon by Hollywoods guilds and studios, stated that vaccines could be required for those working in Zone A of a production typically a projects main actors, as well as key crewmembers who work closely with them in the highest-risk areas of the set.
In response to an alleged violation of Title VII of the Civil Rights Act, which bars discrimination on the basis of race, religion and sex, among other things, 20th contested the sincerity of Dunbars beliefs. It stressed that he had repeatedly taken actions contradicting tenets of the Church of Universal Wisdom by undergoing certain medical procedures less than a year before refusing the vaccine.
Dunbar answered by claiming that he communed with God, who allegedly made exceptions and permitted [him] to act differently, he attested to the court. According to the actor, he was also told that the COVID-19 vaccine was made from evil and that it will compromise [his] spirit and that it was not for [him].
The court expressed skepticism at the assertions, explaining that communing with God is not a blanket privilege that undermines our system of ordered liberty. She also noted that Dunbars original request for an exemption only mentioned unspecified medical issues, not any sort of religious objection.
In a similar lawsuit against the San Diego Unified School District that went up to a federal appeals court, it was found that a request for an exemption could be denied on the grounds that the employees belief is not sincerely held or that such an exemption would pose an undue hardship by burdening the employer through the increased risk of spreading COVID-19 to others.
Still, Gee stressed that the Supreme Court has observed that the determination of what is a religious belief is more often than not a difficult and delicate task.
And so it is here, the judge wrote. Defendants identify evidence that seems to undermine the sincerity of Dunbars religious beliefs, but Dunbar has also presented evidence that suggests under a lower than preponderance burden that his beliefs are strongly held and genuine nonetheless.
Under Title VII, employers must provide a reasonable accommodation as long as it does not cause undue hardship, which federal courts have found to include the increased risk of COVID-19 exposure and transmission. In the trial, jurors will determine whether 20th could have provided Dunbar a workaround to getting the vaccine without endangering others.
On this issue, the court emphasized that the return-to-work agreement barred unvaccinated actors from being on set with minors under the age of 12 and others for whom the vaccine was not yet available. In September 2021, the 911 cast included three minors, one of whom played Dunbars child on the series.
The remainder of Dunbars claims for race discrimination, retaliation and breach of contract, among others, were dismissed.
There is no credible dispute that Defendants offered a legitimate, non-discriminatory reason for finding Dunbar in breach of the Agreement and terminating him his non-compliance with the mandatory vaccine policy is a legitimate, non-discriminatory reason, the order stated about the race discrimination claim.
Dunbar, who had over $1.3 million in his contract left to be paid out, will also not be able to pursue punitive damages in the absence of evidence that anyone acted with malice or recklessness in denying him a religious exemption.
20th and Disney did not immediately respond to requests for comment.
Last month, a Los Angeles judge ruled against ABC on summary judgment and allowed a religious discrimination claim under the Fair Employment and Housing Act to go to trial against the network. The court suggested that accommodations could have been provided to General Hospital crewmembers, who sought and were denied religious exemptions, by allowing them to follow safety protocols that were in effect from July 2020 to the fall of 2021, before vaccine mandates were instituted. During this time, the production did not have an outbreak of the virus, lawyers for the crewmembers claimed.
The ruling was issued on the heels of ABC defeating a similar lawsuit from Ingo Rademacher over his dismissal from General Hospital for refusing to get the COVID-19 vaccine. Unlike with crewmembers who were not in close, unmasked contact with others, the court found in that case that it was impossible for unvaccinated actors to safely work on set during the pandemic due to the nature of their work.
Jeremy Faust is editor-in-chief of , an emergency medicine physician at Brigham and Women's Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine. Follow
Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.
In part 1 of this exclusive video interview, MedPage Today editor-in-chief Jeremy Faust, MD, and Paul Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia, discuss the science of vaccines, the future of COVID, and the politics of the anti-vax movement.
The following is a transcript of their remarks:
Faust: Hello, Jeremy Faust, editor-in-chief of MedPage Today.
We are joined today by Dr. Paul Offit. Dr. Offit is a professor of pediatrics at CHOP, Children's Hospital of Philadelphia. He's the co-inventor of the rotavirus vaccine and he serves on the Vaccine and Related Biological Products Advisory Committee for the FDA. His new book is entitled, Tell Me When It's Over: An Insider's Guide to Deciphering COVID Myths and Navigating Our Post Pandemic World.
Dr. Paul Offit, thank you for joining us.
Offit: Thank you.
Faust: Let's start with the conversation about vaccines and science, and then we'll go over to some public health issues that you talk about in the book.
The first thing I'd like you to help people understand is actually a biological thing that you talked about in the book, which is that there's a difference regarding whether a virus can be eradicated depending on its incubation period. Can you just explain that for people who either didn't go to med school or who went to med school a while ago?
Offit: Sure. So if you take a virus that has a long incubation period, like measles for example, if you're vaccinated or naturally infected, you'll develop antibodies in your bloodstream which will protect you against mild disease for 3 to 6 months until those antibodies start to come down. But you'll also develop memory cells, memory B cells, memory T helper cells, memory cytotoxic T cells, which are generally long-lived and sometimes lifelong.
For a long incubation period disease where it takes 10 days, 14 days to first develop symptoms, you actually don't need antibodies in the circulation, you just need memory cells that can then, in the case of B cells, make antibodies. That, usually, is plenty of time when you have a long incubation period to activate those cells, to get them to differentiate in the case of B cells make antibodies to prevent even mild disease.
So for that kind of disease, you can actually eliminate it from the face of the Earth. Smallpox is a long incubation period disease and so we've eliminated it. Polio, we're getting close to eliminating it -- another long incubation period disease. And measles, we eliminated measles from the United States in 2000. It's come back in large part because of falling immunization rates, but that's that.
For short incubation period diseases like SARS-CoV-2 or influenza or respiratory syncytial virus or rotavirus, there what you can do is when you immunize, you can induce antibodies, which will then protect you against mild disease for a while. You'll also induce these memory cells, which will protect you against severe disease because it takes a while to develop severe disease. But, you're not going to be protected against mild disease for long.
I was fortunate enough to be part of a team at Children's Hospital of Philadelphia that created the rotavirus vaccine. Rotaviruses don't really evolve away from protection induced by vaccination or natural infection. All viruses mutate, but they don't really evolve away from recognition by antibodies induced by vaccination or natural infection.
So what we've done with that disease is essentially we've eliminated hospitalizations in this country, but the virus still circulates. That virus doesn't create variants. It still circulates in the community, and it still causes mild disease, you probably have 95% immunization rates.
Even if 100% of people in the world were vaccinated against COVID and the virus didn't mutate or didn't evolve, you still would see that virus circulating because it's a short incubation period disease. You're going to get mild disease again and again and again. We never made that clear early in this pandemic.
Faust: In terms of this virus, I struggle with whether or not I should or we should be thinking about it as a garden variety coronavirus that just happens to be new and happens to be worse prior to immunity. Is that how you think about it? And if so, what's going on with the seasonality? Because clearly every year now we see a peak in the winter months, but unlike some of these other viruses -- as you say in the book -- it doesn't just go away in the summer.
Offit: Right. So there are four strains of circulating so-called human coronaviruses, and for the most part they're winter diseases. We'll see them in our hospital accounting for maybe 10% to 15% of children who are hospitalized with respiratory symptoms.
One of those viruses entered the human population in the late 1700s, another of those viruses entered the human population in the late 1800s. So I think it's fair to assume that this virus, SARS-CoV-2, will be with us for decades, if not longer.
Will it, as you argue, will it sort of settle into a seasonal pattern as these others did and become primarily a winter respiratory virus -- join the pantheon of winter respiratory viruses, like not only the human coronaviruses, but influenza, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, etc? We'll see.
It hasn't clearly defined itself as a seasonality yet, but if you had to make a guess -- and you should never make a guess about this virus because you're always wrong -- I would say that it probably would settle into being a winter virus.
Faust: Alright. Let's talk a little bit about vaccine politics. The anti-vaccine movement has been with us for a long time, but it seems to me that in the past decade or two, it made a shift from primarily being a feature of the fringe left to actually going to the other side. For example, in terms of religious exemptions to other vaccines, only two states, I believe you said, had said no religious exemption, and it was Mississippi and West Virginia.
So in fact, I used to think of vaccine hesitancy and anti-vaxxing as from my original neck of the woods, the Bay Area, these crunchy liberals who believe in natural stuff. Now, it's sort of gone the other way. What happened there?
Offit: I think there's never been a politics to the anti-vaccine movement. I think on the left it was, as you note, this sort of all-natural "don't inject me with anything with a chemical name." And that outbreak of measles in Southern California in 2014-2015 that spread to 25 states, that was a phenomenon of the left, if you will. There has always been this sort of libertarian "government off my back; don't tell me what to do." But you're right -- it has swung wildly to the right.
The anti-vaccine movement has never been better funded. There was recently an article in the Washington Post talking about how much money has poured into the coffers of groups like RFK [Robert F. Kennedy] Jr.'s Children's Health Defense or Del Bigtree's Informed Consent Action Network. They are better funded than they've ever been. They're certainly far better funded than the people who are trying to communicate facts about vaccine safety and efficacy.
It's a tough time, and you're seeing a real pushback against the kind of weapons that are needed in public health, whether it's isolation or quarantine or vaccines or masking. In some ways, I think we may be less prepared for the next pandemic than we were for this one.
Faust: You also write about Dr. Ala Stanford, who is a really perfect embodiment of another thing that happened in the pandemic, which is that the Black population initially [had] a little bit of hesitancy around the vaccine, but due to efforts like Dr. Stanford's, actually the opposite happened: you have a huge interest in the Black community. There's a trust there that I think might be a win.
So do you think that that's what's happened here? That because this virus hit Black communities and other communities of color so hard, the vaccine was seen as something to be lauded and accepted, rather than a continuation of like prior suspicion about medical research and all of the earned baggage there?
Offit: I think she was one of the bright and shining lights that occurred during this pandemic. I have known Ala for a little while and just feel honored to know her. She's a hero to me.
So here's a woman, an African American surgeon at Temple University, who really took it upon herself to form something called the Black Doctors COVID Consortium with her own money. She then went into North Philadelphia, primarily a Black and brown community, and sat in people's living rooms and just tried to explain to them why it was important for them to get a vaccine. And if they said no, she would come back. And if she said they said no again, she would still come back. She got 50,000 people in that community to be vaccinated.
There should be a thousand Ala Stanfords, because I think if we're going to really combat this misinformation and disinformation, I think it has to occur at that level. I don't think it can really be at the federal level or the state level. I think it has to be at the local level, so you go into an ultra orthodox Jewish community in Brooklyn and explain why it's important to be vaccinated or a Somali American population in Hennepin County, Minnesota and explain why it's important to be vaccinated. But you have to find out who the people are that they trust, because I think there's been an enormous loss of trust during this pandemic.
The study, titled 'Immunogenicity of SARS-CoV-2 vaccines BBV152 (COVAXIN) and ChAdOx1 nCoV-19 (COVISHIELD) in seronegative and seropositive individuals in India: a multicentre, non-randomized observational study', compared the immune responses in users for Covishield v Covaxin, it added.
The study involved collaboration between 11 institutes, including at least six from Pune. These six included the Indian Institute of Science Education and Research Pune (IISER), the National Chemical Laboratory (NCL), the National Centre for Cell Science (NCCS), and the Pune Knowledge Cluster.
Covishield was AstraZeneca's COVID-19 vaccine produced and branded locally by the Adar Poonawalla-led Serum Institute of India (SII) in Pune, while Covaxin was developed and produced by the Hyderabad-based Bharat Biotech.
1. Covishield's Robust Immune Responses: The comprehensive study, conducted from June 2021 to January 2022 and encompassing 691 participants aged 18 to 45 from Bangalore and Pune, found that Covishield, which employs a virus vector for spike protein delivery, consistently showed more robust immune responses than Covaxin, an inactivated virus vaccine.
2. Differential Immune Responses: The majority of participants exhibited a near-complete immune response to Covishield, while the response to Covaxin varied, particularly among those vaccinated before the emergence of the Omicron variant.
3. Antibody Levels and T Cells: Covishield induced higher antibody levels in both seronegative (individuals without prior exposure) and seropositive (individuals with prior exposure) subjects, suggesting a more potent and enduring immune response. Additionally, Covishield triggered a higher number of T cells compared to Covaxin, indicating a stronger overall immune response.
4. Protection Against Variants: Covishield consistently demonstrated higher antibody levels against various virus strains, suggesting its potential superior protection against variants such as Omicron.
Follow-up studies on vaccine immunology and the analysis of immune protection factors were lacking and theres a scarcity of comparative studies on these two vaccines. This is one of the very few studies that not only investigates the immune responses of participants after vaccination but also considers their immune history prior to vaccination," said Dr Mangaiarkarasi Asokan, former programme head, of VISION, and lead author of the study.
"While there was a whole lot of talk going on about which vaccine performed better against the COVID-19 virus, for us in India, only two vaccines were available and the majority of citizens were vaccinated in a phase-wise manner," said Vineeta Bal, emeritus professor, Biology, IISER Pune on the overall significance of this research.
She added that before this study, there was no comparison data available about the performance and effectiveness of these vaccines. "Some people only had data on Covaxin while others had data on Covishield. For the first time, this study has given us the comparative data for both vaccines," she added.
Bal also added that they pioneered technology to conduct this study, which will "now be helpful for immunology assessment in future".
Professor LS Shashidhara, centre director, NCBS, called it a "first-of-its-kind population-level immunological study on vaccines" and noted that it is significant as the virus is "still spreading and evolving".
"Such studies need serum samples from diverse subjects representing genetic, geoclimatic and nutritional diversity and innovative study design and rigorous statistical methods. No one single organisation can undertake such a study. We are grateful to all our partners and indebted to Hindustan Unilever for its generous funding. Results of this study so far and additional research that we are pursuing will have major inputs for future vaccine strategies as a public health programme," he added.
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Published: 08 Mar 2024, 07:24 AM IST
Local health officials say a steady rise in exemptions from required childhood vaccinations, coupled with misinformation on their safety, is contributing to a concerning trend of fewer kids getting fully vaccinated.
While state data shows that nearly all local school-aged children have received the vaccines required to attend school or licensed child care centers, the small number with exemptions based on religious and personal conviction objections has been growing steadily for years.
Health officials from the local to the federal level have made it clear for decades that childhood vaccinations are safe and effective, but some parents remain wary as exemption numbers continue to climb. And health officials say the COVID-19 pandemic only made misinformation about vaccinations more prevalent, further pushing hesitant parents away.
Still, the federal Centers for Disease Control and Prevention notes that vaccines are tested and evaluated rigorously before they are approved for use to ensure they are as safe as possible. Vaccines are the best way to protect against serious diseases, the CDC states.
Allie White, executive director of the Dubuque County Public Health Department, said the upward trend of vaccine exemptions is concerning, though most kids still are getting their shots.
From a public health perspective, this increase that were seeing is definitely a cause for concern, she said. Were worried about the number of unvaccinated individuals and that it continues to trend upwards.
Exemption numbers increasingWhile the number of Iowa students with vaccine exemptions based on religious objections remains small, it has crept upward in recent years.
For the 2023-2024 school year, 3% of students in Iowa have religious exemptions from receiving at least one required vaccination, up from 2.6% in the 2022-2023 school year and 1.3% in the 2015-2016 school year, according to the Iowa Department of Health and Human Services.
In Dubuque County, 3.1% of students have religious exemptions in the current school year, compared to 3.6% in Clayton County, 2.1% in Delaware County and 2.8% in Jackson County.
That is an increase from the previous year, when the exemption rate was 2.7% in Dubuque County, 3.4% in Clayton County and 1.5% in Delaware County, though Jackson County saw no change in its rate. In the 2021-2022 school year, 2.3% of students had religious exemptions in Dubuque County, while the rate was 3.5% in Clayton County, 1.4% in Delaware County and 3% in Jackson County.
Hannah Porcic, lead nurse for Dubuque Community Schools, said the district hasnt seen an increase that would rise to a concerning level. District data shows that the percentage of students with religious exemptions increased from 2.03% in the 2018-2019 school year to 3.12% in the current school year.
A lot of times, its just helping educate them on the law requirements and guiding them to resources, Porcic said. I think parents just make the best choice that they feel is best for their family, and sometimes thats a medical or religious exemption.
Porcic said district nurses work with families to answer questions about vaccinations, help them understand their options and learn what is required by state law. Whether families need access to insurance, providers or exemption forms, nurses provide them with the information they need.
Laura Ryan, Western Dubuque Community School District lead nurse, wrote in an email to the Telegraph Herald that the district hasnt seen a noticeable increase in vaccine exemptions during the past few years. However, she said the district may see more of the effects of vaccine hesitancy as babies born during the COVID-19 pandemic start to enter school.
Deangela Brooks, of Dubuque, has four children and another on the way. She said she didnt really consider whether or not to vaccinate her children and that she did what was recommended by health care professionals during her pregnancies.
My (OB/GYN) recommended it, just for the safety of the baby when they were born, she said.
Religious conviction?Parents in Iowa and Illinois can pursue vaccine exemptions on either religious or medical grounds.
In both states, the medical exemption form requires a health care providers signature attesting that the relevant vaccines would harm the health of the child.
In Illinois, the religious exemption form requires a health care providers signature and requires parents to disclose which vaccines they want their child to be exempt from and the religious grounds for the request. Iowas religious exemption form only requires a notary and parent signatures agreeing that the immunization conflicts with a genuine and sincere religious belief and that the belief is in fact religious, and not based merely on philosophical, scientific, moral, personal or medical opposition to immunizations.
In addition to medical and religious exemption options, parents in Wisconsin also can receive a waiver from vaccine requirements based on personal conviction.
White, who worked as a school nurse before taking on her current role, said in her experience, most families who pursue a religious exemption actually just have a personal preference. She also said some parents might pursue an exemption because it is difficult for them to get transportation to vaccine appointments.
Unfortunately, sometimes its easier for a parent or caregiver to get an exemption form signed and notarized than it is to actually get them to receive the vaccine, she said. Sometimes I do believe that to be a barrier, as well.
Mary Rose Corrigan, city of Dubuque public health director, said that decades ago, parents had to cite a religion and the specific doctrine in that religion informing their beliefs against vaccinations, though that no longer is the case.
A person doesnt really have to be following a specific religion in order to have a religious exemption, she said. Its more of a philosophical viewpoint in some cases.
Other schools exemptionsVaccine exemption rates vary in southwest Wisconsin and northwest Illinois, with Wisconsin schools seeing higher rates generally.
According to the Wisconsin Department of Health Services, the percentage of students with religious waivers has remained similar over time, but the percentage of students with a personal conviction waiver increased from 1.2% in the 1997-1998 school year to 5% in the 2022-2023 school year.
For the 2022-2023 school year, 3% of students in Southwestern Wisconsin School District had a personal conviction waiver. Cuba City School District also had a 3% waiver rate, Platteville School District had 8%, Potosi School District had 6%, Lancaster Community School District had 5%, Darlington Community School District had 4% and Benton School District had 4%.
Jeff Kindrai, director of the Grant County Health Department, said the county did see a drop in the number of children ages 2 and younger who are up to date of their required vaccinations during the pandemic, though the numbers have gone back up to 57% in 2023. However, he said it isnt uncommon for surrounding counties to have immunization numbers much higher than that.
Since the pandemic, we have not gone in the direction weve wanted to see, he said.
Kindrai said that trend is concerning because some vaccine-preventable diseases are extremely contagious, making the area more susceptible to an outbreak if vaccination levels are lower.
Most vaccine hesitancy is based on misinformation, he said, so the department works to get accurate information and opportunities to people who need them.
In Illinois, the Galena and East Dubuque school districts reported fewer than 10 students with religious exemptions at each of their schools in the 2022-2023 school year, according to the Illinois State Board of Education.
Galena school district nurse Emily Rigopoulos said the vaccine compliance rate is high for Galena and that there are typically 5 to 10 students in the entire district with religious exemptions, out of a district population that last fall was more than 800. She said that number has stayed consistent since she began working there in 2020.
However, she said she has seen an increase in parents reaching out and asking for more information on vaccinations since the COVID-19 pandemic.
I think its just more they want to be informed of what their child actually needs and whats required of them, she said. They do end up getting vaccinated, and I havent really had a lot of pushback, thankfully.
Lori Stangl, director of clinical services for the Jo Daviess County Health Department, said her department hasnt seen much hesitation when it comes to routine childhood vaccinations, but the county continues to see low COVID-19 vaccination rates.
I think most people, we give them all of the vaccine information statements prior to them receiving it, and its well received, she said. Theres not a lot of people having too many questions or doubts with vaccines any more than was prior to (COVID-19.)
Pandemics rolePublic health officials said a rise in misinformation about the safety of vaccines that spread on the heels of the COVID-19 pandemic only has hindered attempts to get hesitant parents on board with getting kids their shots.
The CDC notes that beliefs that the COVID-19 vaccine gives the recipient the virus, affects fertility or contains unsafe ingredients are all incorrect myths. Indeed, the CDC notes that COVID-19 vaccines were rolled out under the most intense safety monitoring in U.S. history and that agencies continue to monitor the shots safety.
Still, some parents remain hesitant about the COVID-19 vaccine in particular, though it is not a required school vaccine in Iowa, Illinois or Wisconsin.
Lora Small, of Dubuque, said her kids have all their vaccines required for school, but none have the COVID-19 vaccine.
(The childhood vaccines) have been out for years, and the COVID-19 vaccine came out just not even a few months after COVID-19. No, I dont trust it, she said.
Laura Knabel, a registered nurse at UnityPoint Health-Visiting Nurse Association, tied the increase in vaccine exemptions in part to the pandemic.
What is interesting to me is, were seeing more kids who have all of their vaccines up until (the COVID-19 pandemic) and then fell off, she said.
She said VNA spends a lot of time with patients trying to debunk myths and conspiracies about vaccines and instead provide them with the facts about generally mild side effects and the diseases shots prevent.
You should always be educated about what is happening to your kids, but you need to be educated by professionals, she said.
The CDC notes on its website that vaccines go through a long process of laboratory testing and clinical trials to evaluate their safety before they can be approved for use. And even after that, health experts continue to monitor vaccines safety.
Millions of children safely are vaccinated each year, according to the CDC, and any side effects are almost always mild.
The disease-prevention benefits of getting vaccines are much greater than the possible side effects for almost all children, the CDC states.
Knabel also said many children with religious exemptions only lack one or two vaccines, but Iowas data doesnt capture how many are fully unvaccinated and how many are just missing one shot.
Return to routineCorrigan said the pandemic threw families off of their vaccine routines, so there has been emphasis on getting kids back on track in the past year. However, she said the pandemic also contributed to the spread of misinformation about vaccines.
Our influenza vaccination rates are lower than they have been, and its spilling over into some of the childhood diseases also, she said. But hopefully, as the pandemic recovery continues, we can boost our general immunization rates back up, but thatll take a few years for that to settle out.
White said her department works daily to communicate accurate and transparent information about vaccines, but they also lean on local providers who are often a familys most trusted source for health information.
Were definitely working to reduce misinformation to make sure theres accurate information out there, and to make sure that our providers have the tools they need to be able to share accurate information in a trusted manner with the families that they serve, White said.
She likewise noted that in addition to an uptick in misinformation about vaccines, the pandemic also disrupted childrens vaccination routines.
At times, that meant putting off routine doctors appointments and delaying vaccinations for some children. Once were out of that routine, its sometimes difficult to fall back into it, she said. I do think that that partially has contributed, as well.
Corrigan said widespread immunizations have led the U.S. to see a dramatic reduction in childhood communicable diseases such as measles, diphtheria and polio. However, that also means some parents arent familiar with the danger of those illnesses.
People are not aware of the severity and seriousness of these childhood diseases, she said. We continue to try to educate parents on those factors, on the importance of immunizations for children and their not only childhood health, but lifelong health.
Preventable diseases cropping upLocal officials cited a recent spike in measles cases 41 across the country as of late February as a result of waning vaccination rates.
Corrigan noted that recent measles outbreaks in surrounding states such as Minnesota and Missouri are affecting nonimmunized populations most.
Its always a concern, especially when we have incidents around the country of outbreaks of vaccine-preventable diseases, as is the case now, she said.
Jeff Sander-Welzien, infection preventionist for MercyOne Eastern Iowa Region, said in an email to the TH that the rise in religious exemptions is cause for concern, as seen by the surge in measles cases.
He said when fewer people are vaccinated, a resurgence of preventable diseases is expected.
Sander-Welzien said the best tool to fight misinformation is education. He frequently informs patients that a vaccination doesnt guarantee someone wont get an infection. Instead, it prevents individuals from being hospitalized or suffering complications from a disease.
He said childhood vaccines are safe, have gone through extensive testing and are an important part of protecting kids from sometimes life-threatening illnesses.
We are seeing the resurgence of vaccine-preventable diseases that can have devastating consequences for our most vulnerable children especially babies, he said in the email.
Corrigan also said it is disheartening to see the Iowa Legislature pursue bills she said erode the requirements for immunizations. The Iowa Senate recently approved a bill that would require school communications on vaccine requirements to also include information on exemptions and how to get them.
There are other bills that would change or lessen immunization requirements, which basically continues to erode public health authority to ensure that our communities are safe for everybody, she said.
Right information, resourcesOfficials said they spend time helping families get the resources they need to receive vaccines and providing as much information as possible once they get in the door.
For children who arent vaccinated because their families havent had access to a physician, Rigopoulos typically reaches out to the Jo Daviess County Public Health Department, and an employee there contacts the family.
Usually, the health department will set up a time to bring the child in and they can get immunized there at the health department, she said. The health department also can step in and help schedule for future vaccines.
Rigopoulos also collects updated information on resources that offer health assistance to families in need.
Corrigan said entities such as the VNA or Crescent Community Health Center provide multiple layers of vaccination opportunities for families, whether they have insurance or not.
We do a lot of work to review data to see whos not up to date on their immunizations through our statewide immunization database ... so we can contact and assist people who need to be brought up to date on their immunizations, she said.
Katie Felderman, a medical assistant at Crescent Community Health Center in Dubuque, said staff not only vaccinate kids at the center but also offer shots at local schools and at events. Crescent focuses on reaching uninsured and underinsured individuals, but it also serves those with private insurance.
Felderman said Crescent hasnt seen a major increase in families being hesitant to get their children vaccinated.
Alex Murphy, director of communications for the Iowa Department of Health and Human Services, said in an email to the TH that the department does year-long campaigns focused on the importance of vaccinations, working closely with local public health officials.
Ultimately, Iowa HHS encourages Iowans to ask their trusted health care provider about which immunizations are right for them and their children, he said in the email.
Mara Walker, of Dubuque, said she originally was a bit hesitant to vaccinate her kids after hearing misinformation such as that vaccines inject the virus into the recipient. After researching and finding that to be false, though, she decided to vaccinate them.
I think children should get vaccinated because it prevents a lot of things, she said. If (parents) do their research and really look into vaccinations, they will see the benefits of it. A lot of people just go by word of mouth and not do their own research.
Leana S. Wens March 6 op-ed, Florida finds the wrong medicine to fight measles, is absolutely correct in describing measles as highly contagious. In my experience, that disease and the others prevented by the measles, mumps and rubella (MMR) vaccine is also cruel.
In 1972, I was hired as a teachers aide at the Maryland School for the Deaf. The school was in great need of assistants due to the rubella bulge of new students into the elementary school grades.
Those children might have been infected when their mothers were exposed to rubella while pregnant. The consequences to a developing baby are serious and can be life-altering. Deafness is a possibility, as are impaired vision, heart murmurs and other attacks on the developing child.
I worked in a very full classroom of new students who were living at just 5 or 6 old in a residential school. Because my students were deaf, most arrived with a natural delay in language development. We could teach them English and American Sign Language and provide special attention. On the weekends the children boarded the bus and went home. The school also had a grant to support staff traveling to parts of the state to teach parents and other adults how to communicate with their children. It was a band-aid for many young families.
It is fortunate that children with similar disabilities are now more likely to attend schools in their communities and that they and their families can receive support closer to home. But rather than rejecting the MMR vaccine and risking the preventable deafness or blindness I witnessed, I hope everyone will embrace this protection for themselves, their families and even strangers.
Nancy Connors, Chevy Chase
