Dr. Peter Hotez debunks vaccine-autism myths, citing over one million children studied with no MMR link and 99 autism-associated genes tied to prenatal factors. He warns of measles deaths rising from 2.6M to 100K annually pre-vaccine, now resurging due to hesitancy, while neglected tropical diseases (NTDs) like hookworm and Toxicoriasis—affecting up to 10% of impoverished African Americans—thrive in urbanized areas with failing infrastructure. Despite progress on malaria vaccines, toxoplasmosis and Chagas remain underfunded due to misplaced priorities, proving anti-vaccine misinformation distracts from real public health crises. [Automatically generated summary]
I should tell people before we get started, I did not know when I asked you to come back on that you were heavily involved in this whole vaccine debate.
What I wanted to have you on to talk about is tropical diseases, because I remember when we did that sci-fi show, you explained to me that some ungodly percentage of people that live in tropical climates are infected by parasites.
Well, my day job is developing vaccines for tropical diseases.
We develop the vaccines no one else will make because they're for the world's poorest people.
So we call them tropical diseases, but they really are diseases of poverty.
The vaccine issue, the advocacy issue around vaccines and autism is kind of a new thing that I got drawn into just because I'm a parent of an adult daughter with autism and I make vaccines, so it was a natural that I'd get drawn into it.
One thing's for sure, we're diagnosing people with autism who we diagnosed as something else in the past, you know, whether it was, you know, really horrible diagnosis.
We'd use pejorative terms like mental retardation.
They say they're neurodiverse, that they, you know, maybe think differently from others and they respond differently than others, but they're not, quote, abnormal.
So the point is that it's, you know, the impairment, like Rachel, my daughter, it's not so much her autism that thwarts her, you know, ability to have partners or to have a meaningful career.
It's the fact that she has profound, in her case, profound intellectual disability that goes along with it.
Yeah, with Rachel's case, my daughter, she has a pretty good verbal IQ, 80-90, but she has a very low performance IQ in 40. She can't do simple math.
She can't count money.
Fortunately, Goodwill Industries came to her rescue and our rescue, and now she works there two hours a day sorting clothes, and that's been really meaningful for her to get a paycheck.
Although now, as I say, that's why I don't like using those terms because it puts people on the autism spectrum as though they have a disease or a disorder, which I don't like to do.
But if it is a disorder, no?
Well, now we know there are 99 genes that are linked to autism.
Well, also, they're trying to stop you from talking about it in a certain fashion, which is actually accurate, right?
They have an issue.
There is an issue.
To say there's no issue is kind of ridiculous.
I mean, there's a reason why so many people are so concerned about autism and vaccines and just autism in general, whether it's environmental pollution factors or whatever.
written by a group at the Broad Institute at Harvard at MIT, which is one of the premier genetics genomics organizations in the country, And they've now identified 99 genes.
It's a huge team of scientists, not only at the Broad, including scientists at Baylor College of Medicine.
99 genes involved in autism, all involved in early fetal development, early brain development in the first and second trimester of pregnancy.
So now we're starting to really get our arms around what autism is.
And that's one of the things I talk about in the book.
I mean, We have learned so much in the last couple of years about autism, how it begins early fetal development well before kids ever see vaccines.
And that's one of the reasons I say vaccines did not cause Rachel's autism.
Vaccines don't cause autism because autism is already underway in early brain development.
I think what happens is the Sequence of events happens during pregnancy, but the full clinical expression of autism often doesn't happen until 18 or 19 months of age.
Like Rachel, for instance, wasn't actually diagnosed until 19 months of age.
And there's some fabulous studies now showing that that clinical expression of autism actually coincides with a big increase in the volume of the brain.
You can actually show on serial Magnetic Resonance Imaging, serial MRI, how the brain volume starts to increase.
And that's very important because parents will often remember, oh my kid got vaccinated around 18 months of age or 15 months of age.
I want to link the two.
But now you can go back to six months of age.
And this is studies done at the University of North Carolina Chapel Hill showing so that you could do an MRI at six months of age.
And they can predict now, they say with 90% accuracy, Which of the kids will go on to develop autism?
We can go into detail in the paper, but they can see certain things on signatures on MRI that tell them that this kid is going to go on to Okay, so in fact there is a way to test positive for autism then with this serial MRI. That's what they think, right.
And now we have the 99 genes, so we can even take it back further by doing what's called whole exome sequencing.
Sequencing all the DNA, all the expressed DNA. Of an individual.
And in Rachel's case, we did that and we actually found a mutation in a gene controlling neuronal connections, which makes a lot of sense if you think about what autism is.
So there is a way to show whether children will be more likely to develop autism and there is a way to look at their brain through fMRI at a very early age.
Why do you think there's so many people that have these anecdotal stories of their child getting vaccinated, especially large doses of vaccines when they hit them with like 10 in a row, and then all of a sudden, or measles, mumps, and rebellious, the one that gets repeated over and over again.
That's the one that made my child have autism.
I've heard that so many times.
And I've heard it from friends, from friends that have children that have autism.
They had a child, their child got the measles, mumps, rebellious shot, and then immediately there was a very distinct change in the child's behavior.
Well, no question when you get the measles, mumps, rubella vaccine, many times kids cry and things like that.
And then autism will then begin sometime between the first and second year of life.
So it's logical to want to connect the two.
But now we know it's not even plausible because we know If you go back to that MRI at six months of age or go back prenatally, we can even determine which kids are going to go on to develop autism.
And then complementing it, our massive epidemiologic studies done on over one million kids.
In fact, a new paper was just released this week showing that kids who get the MMR vaccine are no more likely to get autism than kids who don't get the MMR vaccine.
And the converse is also true.
Kids on the autism spectrum are no more likely to have gotten the MMR vaccine than kids not on the autism spectrum.
So it's a combination of those big studies of over one million kids together with knowing what autism is that completely rules out the possibility.
Right, so these genes, and the issue with these genes, and then the ability to scan the brain with the serial MRI, so you can tell which children have the propensity.
Is it possible that children have all these issues and then do not get autism, or do 100% of those children with those issues get autism?
Okay, so what you're saying though is that if a child does not have these mutations and does not have these issues that are present during a serial MRI, that they will not go on to develop autism.
Yeah, I mean, you know, we've learned a lot about the risk of vaccines and the numbers are extraordinary.
I mean, the risk of a severe adverse event happening After getting a vaccine is roughly on the order of 1 in a million between between 1 in a million and 1 in 10 million.
So and I found an internet report once that the likelihood of getting struck by lightning is 1 in 700,000.
So it's, you know, the likelihood of having a severe event after a vaccine is your odds are better of getting struck by lightning than And when you say severe event, what do you mean by severe event, though?
Well, there's actually a table that's put out by the National Vaccine Compensation Act that includes shoulder injury, that's one, encephalitis.
I think in some cases, inadvertently, if it's a live virus vaccine, like the measles, mumps, rubella vaccine, and you have an underlying immune deficiency that wasn't picked up before, then that virus can replicate better.
So, as far as you know, children who are healthy who get a vaccine, it's not biologically possible for them to develop these traits, these mutations in the genes, and these issues that you see present?
We know, studies number one million children, that there's no link between vaccines and autism.
That's number one.
So let me parse this out in two bits.
So there's the studies on over one million children showing that vaccines do not cause autism.
That's part one.
And then I'll do a deeper dive on each of them.
The second part shows not only is there massive evidence that there's no link between vaccines and autism, there's no plausibility because we know so much about autism and how it begins in pregnancy.
So let's go back to the first part.
The first part is studies on over one million children.
One of the things that the anti-vaccine lobby does It's not really a game, but what they do is play this kind of thing of vaccine whack-a-mole because at first they alleged it was the MMR vaccine.
And that came out of the study that was published in The Lancet in 1998. Then another group came along and said, no, no, no, we didn't mean the MMR vaccine.
We meant the thimerosal preservative that used to be in vaccine.
And the scientific community not only debunked the MMR link, they debunked the thimerosal link.
Then the anti-vaccine lobby came along and said, no, no, we didn't mean that.
We're spacing vaccines too close together.
Then they changed it around again, saying now it's the alum or aluminum in vaccines.
And then each time the scientific community responds with massive epidemiologic studies showing just absolutely none of those things are true.
And do you think that it's just, when you look at, say if there's one in a million that has an issue with this, and it's not autism, by the way.
So whatever those issues are, that they hear these stories and these stories do accumulate because there's 300 plus million people in this country and over 10, 20 years of one in a million, you develop a significant history of cases where children did have issues with vaccines.
So these people hear about these stories, and people are terrified.
Obviously, I have children.
You become very overprotective of your children.
You worry a lot.
And then you also don't know, like, why do they get so many shots all in a row like that?
We can vaccinate against diphtheria, pertussis, tetanus, polio, haemophilus influenzae type B, which is a terrible cause of meningitis, and in some cases not even hepatitis.
So one shot is protected.
Well, it's combined and there's all sorts of studies showing that it's safe to combine them and it's fantastic.
Now you can vaccinate with one shot against six diseases.
What that means is they've put out now, by some estimates, 500 anti-vaccine websites so that every time you put the word vaccine into a search engine, whether it's Yahoo or Google, you're going to get anti-vaccine misinformation.
That's number one.
Second, we know now it's amplified on social media like Facebook, other forms of social media.
So third, look at the Amazon site.
I mean, it's incredible.
So my book, this book, the good news is it's – I think right now it's the highest-rated pro-vaccine book on Amazon.
The bad news is overall it's ranked about 20 because there's 19 other phony baloney anti-vaccine books ahead of it.
So Amazon is the biggest purveyor now of anti-vaccine books.
Wait, it gets even worse.
Then you also have now – they've become politicized.
They have political action committees in multiple states.
Lobbying state legislators about plying them with false information about what vaccines do.
And the problem is we don't have a robust system of pro-vaccine advocacy to counter it.
So we don't really hear as much as we need to from the federal government, from the CDC, from the Surgeon General.
So unfortunately in this country the defense of vaccines It falls to a handful of academics like myself.
I'm an academic.
I wrote a book.
What chance do I stand against this major media empire?
Yeah, but who knows what it's doing to a young kid, right?
So you shouldn't be doing that.
Then that's one.
So how much of this is being driven by By financial motivation peddling these phony autism therapies, I can't say.
My sense is that's not the big piece of this.
There's also some reports now of Russian bots and trolls that are amplifying this and sowing political instability in the country.
But again, you add that all up, the phony autism therapies, the Russian bots and trolls, in my mind, That really doesn't get our arms around the big driver of this thing.
So I think we really need some good investigative journalists to look into this.
Well, do you think that there's some sort of a concerted effort, or do you think that it's just a bunch of people that really believe that vaccines do cause autism, they don't truly understand the science, they haven't talked to someone like you, and maybe they have this idea that's cemented in their mind and they're not willing to...
Look at it objectively and look at the full spectrum of possibilities and look at the science behind what you guys are saying.
Because in their head they've been saying vaccines cause autism.
They've been saying it for so long that once someone gets that and they're connected to that, it's very difficult for them to shift gears.
People have a really hard time not being married to an idea.
You know, when I talk and I spend a lot of time going around the country giving what are called grand rounds lectures to hospitals and medical schools, pediatric grand rounds, so I've had the chance to talk to a lot of pediatricians and nurses and nurse practitioners and more than a few parents.
My impression is most of the parents Who are called to be so-called vaccine hesitant, is the word of the day, are not really deeply dug in.
I mean, you can have a conversation with them and explain to them, like we're talking now in a very, you know, non-technical way, you know, the evidence showing vaccines don't cause autism and the lack of plausibility given...
That it begins in pregnancy and they'll vaccinate their kids.
There is another percentage, and I don't know what the percentage is, but there's 10, 15 percent that are deeply dug in and are wholly invested in this conspiracy theory that the government is in cahoots with the pharmaceutical companies and blah, blah, blah.
And then if you try to talk them out of it, they just think you're part of the conspiracy.
So it's sort of a no-win approach there.
But most parents you can have a good conversation with.
I mean, what you're dealing with is these people that maybe they're into a bunch of different alternate therapies, a bunch of different kinds of cleansing.
There's a lot of that nonsense that you find online where, I mean, look, there's legitimate...
It seems like there should be some sort of a debate, right?
Like if there's someone who's saying that there's some evidence that vaccines cause debate, you're saying there's no evidence that vaccines cause autism, and you're saying there's no evidence that vaccines cause autism, there should be a debate where there's some sort of a monitored conversation Where you can have you versus someone else and break this down.
Yeah, I mean, I think, you know, part of what has to be done is, I mean, and this gets into all sorts of First Amendment issues, and I'm not a lawyer, but, you know, the idea that Amazon now is putting out all of these phony books and phony documentaries.
I mean, not a fine-toothed cone, but maybe there should be some screening.
Maybe Amazon, maybe Facebook should all be hiring chief scientific officers to...
You know, putting some stops on the dissemination of information because it's harming children.
I mean, the reason I get passionate about it, the reason I actually wrote the book is kind of interesting.
It actually happened before all of these big measles outbreaks that we've been having.
I noticed that in Texas, my laboratories at Texas Children's Hospital and Baylor College of Medicine, we noticed that there was a steep increase in the number of kids whose parents were opting them out of getting vaccinated to the point where in Texas we have almost 60,000 kids not getting their vaccines we noticed that there was a steep increase in the number of kids whose parents And those are the ones we know about.
We don't know anything about the 325,000 homeschooled kids.
So we probably have over 100,000 kids not getting vaccinated all because of this misinformation campaign.
And I was really troubled by the fact that there was no response to it.
And that drove me to write the book.
So the point is now Texas is very vulnerable to measles outbreaks.
And I say measles more than the others because that's the most highly contagious disease.
Smallpox was eradicated in the late 1970s through vaccination.
Once smallpox was eradicated, eradicated measles was arguably the single-eating killer of children globally.
2.6 million children died every year of measles because it causes measles pneumonia, measles encephalitis.
Talk about permanent neurologic injury.
That's a bad actor, measles.
And then deafness and all.
And then through global vaccination campaigns, we brought it down By the year 2000, to about half a million kids dying.
And then the Gates Foundation put up $750 million to create the Gavi Alliance, the Global Alliance for Vaccines and Immunization.
We've brought it down now to 100,000.
But now measles is coming back.
Europe's a disaster right now.
We've got 80,000 measles cases in 2018 in Europe, and now it's coming back to the US. And so my worry is this anti-vaccine media empire started out as a fringe group, but now it's really affecting public health, allowing a deadly disease like measles to come back.
Do you think if there's some sort of definitive evidence that shows to the general public, like you could show it to them, like this is what causes autism, we've narrowed it down to these genes, and it has nothing to do with vaccines.
If you give these vaccines to people without these genes, there is no way they're going to get autism.
They get autism specifically because of these variations in their genes.
We had some, you know, wherever, and this can get onto a whole other topic, wherever there's collapse, In health systems, infrastructure, such as from war, political instability, these diseases can come back.
It's a really confusing thing for people because on the outside, people always want to think that big pharma...
I've said some terrible things about big pharma, and the reason being is painkillers.
Because painkillers and antidepressants, and there's SSRIs, which are overprescribed, and the painkiller one kills me because I know people directly that have been addicted to these goddamn things, and the doctors are passing them out like candy.
Yeah.
People look at big pharma as being, oh, these are the monsters that push this.
They're also the people that give you things that save people's lives.
Because my wife says, if only that were the case, right?
These are diseases of the poorest of the poor.
I'll never make a penny on these diseases.
In fact, you know, one of the frustrations I have with the big pharmaceutical companies Is we've gotten, made a lot of progress with our vaccines.
We've gone all the way from discovery through early phase process development and manufacturing and IND filing with the FDA, Investigational New Drug Applications, but we're getting kind of stuck at phase one, phase two clinical trials because we don't have the big pharma money to take us all the way to licensure.
So I've had a lot of meetings with the big pharmaceutical companies to see if they can partner with us, and so far that hasn't happened.
So has there ever been any discussion or any interest in creating some sort of a compelling documentary that's pro-vaccination that can counter all these things?
Because there's quite a few health-related documentaries that I know are horseshit.
Because I've talked to actual real scientists and clinical researchers that say, like, all these things they're saying are wrong, and this is why they're wrong, and you could show this if they're wrong.
And then when someone says, hey, I saw this documentary, it says that all you should eat is toast, you could say, listen, man, you've got to go here and watch this, and it'll show you why that's nonsense.
Is there anything like that right now, or is there any discussion?
And those people that are talking about it, here's the other problem.
Whenever I talk to someone about, I've been doing this a lot lately, where I talk to someone about something they're passionate about, I go, what books have you read on it?
Books that are written by actual researchers, people that have spent decades in labs understanding what's going on, you don't really, you know, you don't get a lot of that from the people that are anti-anything.
It's a very confusing thing for parents, because you're scared.
You know, you have this little tiny baby that you love more than anything in this world, and then the doctors say, hey, we've got this round of vaccines coming, and you're just terrified that you're going to do something to your child that's going to turn your child into a Someone who's compromised.
But again, I mean, I'm uncomfortable with the idea of a debate because it's like debating, I don't know, it's like debating a Holocaust denier, whether the Holocaust exists.
I understand what you're saying, but if you're, again, I want to bring this up, if you're complaining there's 19 books ahead of yours that are anti-vaccine books, you've already lost the battle.
It's time to regroup.
And maybe regrouping would be confronting someone with actual scientific information.
I mean, you are a real doctor.
You're a guy who actually studies this.
And you're a man who understands the science.
You're a legitimate academic.
You could actually put a dent in this with a real conversation.
And in your personal estimation, do you think that there's a rise in the factors that are causing autism or do you think that it's a rise in the understanding of these variables that contribute to it that you could diagnose people with and that before they were previously undiagnosed?
There's a nice paper by a very good environmental scientist named Phil Landrigan, He used to be at Mount Sinai now.
I think he's at Boston College now.
And he publishes about five or six chemicals in the environment, which if you're exposed to for long periods of time during early pregnancy, Your child will be born with some features that resemble autism.
It's a common medication, but now that we know this information, we don't use it anymore.
And so one of the things that I've been saying to people like Bobby Kennedy and everything else, if you really think there's some environmental link to autism, We've got a list of at least six chemicals during early exposure and pregnancy that are probably causing mutations and things like that that are leading to autism.
Why isn't anybody looking into that?
It's just crazy.
I mean, so all the focus goes into vaccines and it kind of sucks all the oxygen out of the room so that, you know, really understanding the search for autism gets delayed or in some cases doesn't get pursued at all.
Or the other thing that happens in many state legislatures and things like that, the focus is so much about vaccines that we don't talk about what autism parents really need.
I mean, what do I need for Rachel?
We need employment counseling and help.
We need mental health counseling.
What do we do after we're gone?
Rachel right now is living with us.
I turned 60. My wife is 58. What happens to us 10, 15, 20 years from now?
There's no roadmap.
Right.
So all of that gets shunted aside because of these phony baloney anti-vaccine arguments.
And that's why I get angry.
That's when I start to realize these guys, in addition to affecting public health, are actually hurting autism families as well.
And I can completely understand why this would upset you, especially as a scientist.
Now, when you're talking about these various chemicals that you think do contribute to or possibly cause autism, maybe we should really concentrate on that and publish something about this.
Is there an article that people can go to that says something about this?
You know, one of the problems that we face in this country is that we put a lot of scientific articles behind paywalls, which is a real source of frustration for me.
Well, one of the things that I've done now is I'm one of the I founded an open access journal called the Public Library of Science Neglected Tropical Diseases so that anybody with a computer, you know, an internet connection and a printer can download the articles free of charge.
So that's again, something that was heavily pushed by the anti-vaccine lobby.
Here's the story.
You're right, partially right.
Last year, there was not a perfect match between the virus and the vaccine, the killed virus and the vaccine, and the wild-type flu strain that was out there.
But it was good enough to prevent you from dying, and it was good enough to likely prevent you from being hospitalized.
Well, sometimes, you know, after getting your vaccine, you can get some soreness and you can feel maybe a slight fever for a few hours or a day, but usually you're fine.
So, you know, when we think about, so I, you know, led this big campaign to raise awareness of something called neglected tropical diseases or NTDs.
These are the most common afflictions of people living in poverty.
I call them the most important disease you've never heard of.
There are diseases like schistosomiasis and Chagas disease and Leishmaniasis.
And I've been devoting my life to seeing if we could develop vaccines for those diseases in the nonprofit sector, because the big pharmaceutical companies just aren't going to take these on.
So we're trying to do it in the nonprofit sector.
But this book, the Blue Marble Health book, came out of some number crunching that I did using data from the World Health Organization or something called the Institute for Health Metrics and Evaluation, which is based in Seattle, Washington.
I found something very surprising, and that is most of the world's poverty-related diseases are not necessarily in the poorest, most devastated countries of Africa, meaning like Democratic Republic of Congo or Central African Republic.
They're there, but on a numbers basis, Most of these poverty-related diseases are actually in the G20 economies, the 20 wealthiest economies, together with Nigeria, which is not a G20 country but has an economy bigger than the bottom three or four.
So that was pretty amazing for me to find that out because At first, I didn't believe the numbers because I said, well, how could it be if they're poverty-related diseases?
Why are they in the 20 wealthiest economies?
Then I realized that it's among the poor living in wealthy countries.
So the poorest of the rich today now account for most of the world's poverty-related diseases.
So that's a great – so one of the things I do in the book is I ask that, well, what is it about poverty that's making you susceptible?
I don't think we really know.
I mean clearly in some cases if you live in poor dilapidated housing without window screens, Things like mosquitoes and kissing bugs and sand flies can get inside the house.
Or if you look in poor neighborhoods like in and around Houston, you see a lot of environmental degradation around the neighborhood.
You see discarded tires that breed 80s gypti mosquito or standing water.
You know, I moved into a house once in Encino, down the street from here, in fact, and no one had lived in the house for about a year and a half, two years, and the pool had not been taken care of, and I went out into the pool and it was green and there were schools of mosquito larvae.
The big problem is along the Gulf Coast of the U.S. We have that Aedes aegypti mosquito and that's why I got so worried about Zika virus hitting the Gulf Coast of the U.S. Yeah.
Malaria used to be widespread in the United States.
Both the one that was a real killer disease called falciparum malaria on the Gulf Coast and even up into Illinois in the Ohio River Valley we had a lot of malaria caused by VIVAX in the 1800s.
In fact, there's a book Written by Dickens when he visited the United States called Martin Chuzzlewit when he describes all these sickly people in Illinois and Cairo, Illinois and the confluence of the Mississippi and the Ohio River.
So there's actually a very nice book written by a medical historian at Duke University named Margaret Humphries called Malaria, Race and Poverty.
And she has a hypothesis, but I think she's onto something, that malaria dropped in association with aggressive economic development.
So that the FDR's New Deal included something called the Agricultural Adjustment Act that got people off with agrarian pursuits and put them into factories.
Quality housing went up and that's probably what caused a lot of the reduction in these tropical diseases.
Remember, they're really diseases of poverty.
In fact, I spent a lot of time working in China and I'm seeing that play out right now in China.
It's a very aggressive program of economic development, mostly in the eastern part of the country.
But in the southwest part of the country, you go into Yunnan, Sichuan provinces, you go back in time 75 years and you still see those diseases.
So do you think that the best cure or the best way to stop malaria would be just to increase the economy of these areas in Africa where they're experiencing it?
Clearly, economic development is a very potent driver.
Now, what it is about economic development, we still don't have our arms around that yet, but economic development is very important, just like for the neglected tropical diseases we studied.
But, you know, unfortunately for many countries, economic development is still decades away, so that's the rationale for developing these vaccines.
I think that's part of it, although now we're seeing some tropical diseases thrive in urbanized environments like yellow fever and Zika and dengue as well.
So it's not only urbanization.
It has to be urbanization with good planning.
That's not done unchecked.
That outstrips the infrastructure in terms of water and sanitation.
So this brings me to the thing that I wanted to talk to you about in the first place, because this is what you brought up to me when we were doing this sci-fi show, and you said something to me that has been haunting me ever since, that the vast majority of people that live in tropical climates have parasites.
And now one of the things that we have found, so Rogelio Mejia on my faculty, working with an environmental activist named Katherine Coleman Flowers, In Alabama found that hookworm is still present in Alabama.
Explain that to people so they understand what we're talking about because for the longest time there was this stereotype about people that live in the South that they were dull-minded and that this could be directly connected to hookworm infection which had run rampant.
So these are the diseases that are holding back people who live in poverty.
Originally, I thought only in places like The poorest countries in sub-Saharan Africa or Southeast Asia, but now I realize it's these pockets of poverty across the entire planet that people are affected by these diseases.
So there was a Lyme disease vaccine that was developed actually from a colleague of mine at Yale University.
And they licensed it, I think it was to GlaxoSmithKline.
And they developed it as – they called it LymeRx.
It was the Lyme disease vaccine.
And actually most of the studies suggest that it actually worked pretty well.
The problem was there were a number of people who felt that the vaccine made them worse or they said they had chronic Lyme disease, that it wasn't effective.
So it was really a market perception problem more than anything else and ultimately it hurt the bottom line of the company and they withdrew it from the market.
Well, they pulled the vaccine not because it wasn't working but because of market perception and all that sort of – and that was a time before the number of cases of Lyme disease have really taken off.
And this gets into another controversial rabbit hole.
I'm not sure we want to get into or not today.
But the Infectious Disease Society of America, for instance, has come out with a strong statement saying that there's really no such thing as chronic Lyme disease.
And the scientific evidence does not support something called chronic Lyme disease, yet there are lots of people suffering with chronic debilitating illness who claim that it's caused by Lyme disease.
The Infectious Disease Society of America, which is one of the lead infectious disease bodies in our country, and I'm not an expert on Lyme disease, so I'm not too comfortable going there with you, are saying that there's no evidence that that's actually associated with active infection with Lyme disease.
Well, I guess part of the problem is in some cases they had Lyme disease first, in some cases they really didn't have Lyme disease.
Unfortunately, there are a number of unscrupulous healthcare providers and even physicians out there that are making a misdiagnosis of Lyme disease or in some cases they're actually taking everyone who comes through the door and diagnosing them with Lyme disease.
Well, actually, all tick-borne diseases are on the rise now, possibly because of climate change, which is another factor in our country that's doing that.
So we're seeing, you know, if you look now at what are the big drivers of infectious diseases right now, not only in the U.S., but globally.
There are really some interesting forces, and a lot of them are social determinants.
So a big one is poverty.
That's a huge one.
The other big one is political instability in war because it interrupts public health control measures.
So, for instance, Venezuela, which was leading public health control in Latin America for decades, You know, with the collapse of the economy in the Chavez era now into the Madura area, we've got a terrible situation where we've had measles return in a big way, so huge numbers of cases of measles.
We've had all the neglected tropical diseases come back, as well as malaria, Chagas disease, Leishmaniasis.
So it's really interesting how that is destabilizing the whole region because now Venezuela As one of the largest diasporas of people, as big as the diaspora coming out of Syria and Iraq.
So now the diseases are moving into adjacent areas of Brazil and Colombia and Ecuador.
And so it's really – and that's another big driver is political instability.
The third one we think is climate change may be very important.
So why did we see this big surge of chikungunya virus infection in the Western Hemisphere or Zika?
We don't really understand the forces of that.
And what's going on in southern Europe right now is quite concerning.
We've had malaria return to Greece after it's been gone for 70 years.
Malaria has returned to Italy.
We're seeing schistosomiasis, a neglected tropical disease, on the island of Corsica.
We've got dengue, chikungunya, West Nile virus across Italy, Spain, Portugal.
So we're trying to understand why that is, and there's some thought that climate change may be a big driver of that.
There's a malaria vaccine, it's called Mosquerix, that's the trade name that was developed, supported with a lot of funding from the Bill and Melinda Gates Foundation and working in partnership with GlaxoSmithKline.
And that malaria vaccine now has been approved for use in children by the European Medicine Agency.
And it's being introduced now in three countries in Africa, Malawi, Ghana, and I forgot the third one.
Well, the problem that you get into with malaria is that before six months of age, you have maternal antibodies.
Remember, you're born with antibodies from your mother and they'll start to wane by six months of age.
So the ones who get hospitalized with what's called cerebral malaria, which is a devastating condition, or severe malaria anemia, which is also a killer, are those children between six months of age and five years of age.
So those are the ones that we want to protect.
And it's one of the leading killers of children globally, right?
It's not really immunity, but it's a natural protection.
So individuals who have the sickle cell trait seem to be partially resistant to malaria.
And that's the thinking why the gene for sickle cell has been preserved in Africa Yeah, we were actually discussing it because a friend that I grew up with died from it.
Well, what happens is in some countries up to 30% of people are actually infected with toxoplasma.
And the parasite has the ability to undergo a dormancy state in the body until your immune system gets compromised either because of AIDS or because if you get some kind of medicine that suppresses your immune system and then it can reactivate it and cause what's called cerebral toxoplasmosis, which is quite serious.
So most people handle their toxoplasmosis very well.
You know, you die with it and don't even know you have it, but in some cases it gets reactivated.
Right now, there doesn't seem to be a lot of incentive for developing a toxoplasmosis vaccine, although I'd be very interested to work on something like that.
Well, there's a good chance you are infected, but as long as your immune system is intact, then you're okay.
Now there is a related disease from cats called Toxicoriasis and that's a parasitic worm infection we're finding in the United States among the poor.
So what happens is if you go into poor neighborhoods, you see a lot of feral cats and dogs in poor neighborhoods, almost 100% of them have this worm in their intestines and they're seeding the environment with eggs in their feces and the feces are spread.
All over the poor neighborhoods, kids come into contact with them, and the worm has the ability to migrate through the brain across cerebral toxicoriasis.
And I think it's an important cause of developmental delays.
It's one of those neglected diseases in the U.S. I talk about in the book.
So, you know, everybody wants to know why, you know, kids living in poverty have developmental delays and people just assume it's because they live in deprived environments and that sort of thing.
But I think Toxicoriasis is an important underlying reason for it.
And this is an example of a neglected disease.
You know, we, I mean, everybody's heard of Ebola, right?
And everyone's worried about Ebola and the truth is Ebola is never going to come to the United States.
Why is that?
Because it's too difficult to transmit.
Unless you have a complete collapse in the health system, we're never going to have Ebola epidemics in the United States.
But here's a disease of 10% of African Americans living in poverty, and no one's heard of it, and there's no incentive to study it.
So that's why I'm trying to raise awareness about these poverty-related diseases in the United States.
But it's very hard to get people to care about diseases of poverty.
And this is one of the striking things about when I wrote the book, was I've had a lot of success getting people to care about neglected tropical diseases in Africa and worked with the U.S. Agency for International Development, To support a package of medicines that's now being administered to over a billion people annually.
And that, you know, is one of my proudest accomplishments is helping to raise awareness about neglected tropical diseases like we've been talking about, hookworm and schistosomiasis in Africa, Asia, Latin America.
But the minute I talk about poverty-related diseases in the U.S., The lights go out.
I don't know.
I can't figure out what I'm doing wrong.
I've had so much success getting people to care about NTDs, neglected tropical diseases, in poor developing countries.
But there's been no response to this book.
And the estimates that I come up in the book are we have 12 million Americans live in poverty with a neglected tropical disease.
Toxicoriasis is one of them.
Another one is Chagas disease.
And the list goes on.
It's been very hard to get people to care about the poor in this country.
And I've always said that about the way we treat other countries.
We want to send them aid and rebuild these countries, but we don't do anything about these terrible communities that have been terrible in this country for decade upon decade.
And so I try to make the point the world has changed.
This old norm of global health, developed versus developing, it still exists, but it's What we're seeing is a general rise in all economies.
Some African countries have 8% or 9% economic growth, but it's all leaving behind a bottom segment of society.
And so I don't care where you show me poverty, whether it's in Texas or Alabama or Nigeria or Bangladesh, I will show you these poverty-related diseases.
And, you know, I know – what's her name?
AOC, the congresswoman from New York, has talked a little bit about hookworm in Alabama.
So last time I was in Washington, I dropped off a copy of the book in her office, but no response yet.
So I did meet with a couple of people on the hill and they asked me that question, what's the magic wand?
And there's a couple of things.
One, we need to actually look for these diseases because the problem is the diseases that cause are very subtle, like developmental delays.
So that if you're a kid who lives in poverty with developmental delays, the pediatrician doesn't even think to do a test for toxicoriasis.
So we need to raise awareness.
We need to go into poor communities across the country and actually take a blood test and actually measure for the presence of that disease or that parasite.
So one, doing what I call active surveillance, looking for these diseases.
The other one...
is really trying to understand how these diseases are transmitted.
What is it about poor neighborhoods that is facilitating transmission?
I think the third problem is the diagnostic tests themselves because they're very complicated tests.
Sometimes they're done at the Centers for Disease Control and Prevention, our lab, our National School of Tropical Medicine does a few of them.
But it's not like when you go for blood work in your doctor and you get a little lab slip from Quest Diagnostics with the blood chemistries, the blood counts.
There's no box there for toxicoriasis and chagas.
So we need more improved tests, point of care diagnostic tests.
And actually, most people who have neglected tropical diseases don't know they have it.
In Texas, for instance, we have transmission of a parasitic disease called Chagas disease.
It's a cause of heart disease.
Members of our faculty were actually able to track down individuals who had donated blood And the Gulf Coast Regional Blood Authority actually found people positive for Chagas disease.
They were told to go see their primary health care provider.
And unfortunately, the primary health care provider is not educated about these diseases, and they just assume it must be a false positive.
So, you know, our faculty had tracked them down and were able to get them into treatment.
There's been no effort whatsoever by the federal government to step in and try to rehabilitate, like a large-scale approach to rehabilitating places like the ghettos of Houston or Baltimore or Detroit.
Yeah, well, Gandhi once said, a civilization is judged by the treatment of its minorities.
And by that criteria, we're not doing so well.
You know, our country was visited by the United Nations Special Rapporteur on Poverty in 2017. And his numbers came up with, we have 19.4 million Americans who live in what's called extreme poverty.
That is at half the U.S. poverty line.
And roughly around 5 million Americans living on less than $2 a day.
The same benchmark you'd use for global poverty.
5 million?
Yeah.
And guess what?
Those probably all have neglected tropical diseases.
The University of Michigan Center on Poverty has also shown that we have, I forget the number, 2.7 million families living on less than $2 a day, which is probably about the same as the 5 million number.
And sometimes in my frustration, I say, you know, these are imaginary diseases, and yet here we've got widespread diseases of the poor in the U.S., and the lights go out.
Well, actually, Ebola, you know, it turns out is the opposite of measles.
Measles is one of the most contagious diseases known.
It has a reproductive number of 12 to 18. What that means, if a single individual gets measles, 12 to 18 others get it because the virus hangs around in the environment and it's so easily transmissible.
And that's why you get these really large measles outbreaks like you're seeing in Washington State.
And usually those are infants under the age of 12 months, not yet old enough to get vaccinated.
They're the ones that wind up hospitalized and sick.
Well, Ebola is just the opposite.
Ebola is a reproductive number of two or three.
So unless you're taking care of a dead or dying Ebola patient or someone who's recently died because it's only towards the end stage of the disease that you really get large numbers of virus particles in the body, you're not going to get Ebola.
So the reason it's being so hard right now to contain the Democratic Republic of Congo Yeah, right, right.
Well, one of the things I say in the book is because these diseases are so widespread among the poor in the G20 countries, if we could get The elected or the leaders of those G20 countries together at a G20 summit and say, we're really going to do something about the neglected diseases in our own borders, and I'll include the United States, we could get rid of two-thirds of the world's poverty-related neglected diseases right off the bat.
So a lot of it is political will, ignorance or lack of awareness and political will.
Well, it seems like in this country, ignorance is a big part of it because this is something I've thought about many times, but I didn't know about chaga.
I didn't know about a lot of these other diseases you're describing.
Yeah, no, I mean, so we need to raise awareness about these.
That's why I'm so thrilled to come here because I've just amplified the number of people who've heard of this concept of blue marble health, which is a name that I've given a different name from global health to separate it from the two.
So, you know, coming on here is so powerful in terms of amplifying that message.
So, I mean, again, the drivers we've been talking today about promoting these diseases, really tough to do anything about extreme poverty, war and conflict, climate change.
Climate change, clearly there are some things we can do.
Aggressive, unchecked urbanization.
But the other things that you can do is build better tools.
By that I mean better diagnostics, better drugs, better vaccines.
And unfortunately for these poverty-related diseases, there's no market incentive for it.
So it falls to academics, to professors, to people trying to do this in the nonprofit sector.
And we're doing the best we can.
But it's not nearly as good as having access to getting the pharmaceutical companies involved as well.
It also seems like this would cost an insane amount of money to just go through all these poor communities, test everyone and start distributing these drugs and what would pay for all that stuff.
Part of the problem, we're in this boat with a bunch of people who are scientifically illiterate, like myself, who are discussing these issues who don't really know what they're talking about.
I saw someone talking about tetanus Because some boy had tetanus and he was in the hospital for a long time and his hospital bill was like a million dollars.
Well, the other name is lockjaw, where your muscles go into spasm, including the muscles involved in breathing, so you can't even breathe as a result of it.
You're tight, but there's some sort of a correlation, particularly between peanut allergies and keeping peanuts away from children.
And there was a study, Jonathan Haidt's work, in one of his books, talked about how there was a study done in communities where they didn't protect kids from peanut allergies and the much smaller percentage of people developing peanut allergies versus kids that they did.
Well, this is also one of the things that the anti-vaccine lobby is doing now, that they're When I write a book like this, Vaccines Don't Cause Autism, now what you're seeing, remember I told you about that whack-a-mole business where they went from MMR to thimerosal to spacing vaccines too close together to aluminum.
Now there's some groups that are moving away from autism altogether, and now they're saying, well, vaccines cause autoimmune disease or vaccines cause other neurologic deficits.
So, you know, it was, for instance, if you look over a 10-year period, I think it is between, I haven't looked at the numbers in a while, I think it's between 2008 and 2014 and 2015. Over that period of time,
there were 2.5 billion doses of vaccine given, 2.5 billion, of which the vaccine courts identified around 200 that were a list of serious injuries that they have a table of that they could attribute to vaccines.
So there were 2,000 payouts, and of those 2,080%, they didn't really think were attributed to vaccines, but they paid it out anyway because that's how the courts work, and then 200 where they could really say, yeah, it looks like this could be related to vaccines.
So you divide 200 by 2.5 billion, that's 1 in 10 million.
And these potential injuries, is it, as we were talking about earlier, is this just biological variability that some people just react differently to different things?
In other cases, you know, with the live virus vaccines, If you have a severe genetic immune deficiency and maybe it wasn't picked up, then there's that risk.
But, you know, what's a one in a million?
What's a one in a ten million risk?
As I said, we have to keep that in perspective because the odds of getting hit by lightning is one in a 700,000, if you believe that number.
Or, you know, what's the risk every time you – Take your child out in a car and drive around the neighborhood.
I'm sure the risk is far higher than one in a million.
Well, I think that what you're talking about in terms of these poor neighborhoods and these parasites getting into people's system and affecting cognitive development.
That one is from eggs, often from individuals who have a tapeworm.
So we're seeing cases of that.
There's some of the viruses transmitted by mosquitoes.
One of the ones we don't talk about a lot, which is a very serious infection, Is West Nile virus infection.
That's got very high rates of not only encephalitis, but also one of our faculty members, Christy Murray, is showing very high rates of depression and other neurologic debilitation for, and that's another one.
We could probably use a vaccine for, but there isn't the market incentive to do it.
Well, so in response to that, what happened was after the Ebola fiasco in 2014, where we didn't have an Ebola vaccine in Guinea, Liberia, and Sierra Leone, A group of individuals came together at Davos, the World Economic Forum, including the Gates Foundation.
They developed this concept of an organization called CEPI, the Coalition for Epidemic Preparedness Innovation, to incentivize biotechs and pharmaceutical companies to embark on diseases of pandemic potential.
Like Ebola, like Lassa fever, like Mayor's coronavirus infection.
And that was great, but the problem was they didn't address these poverty-related diseases.
So those of us who are working on poverty-related diseases are still kind of on the outside looking in.
It just seems like Having everything managed by private companies that need to have some sort of financial incentive to attack these diseases, that seems like a crazy way to deal with health crisis.
And so what I've recommended, as I said, that organization, CEPI, is great for what it's doing, but we need another mechanism.
What I've proposed is that since these diseases are so common among the poor in the G20 countries, These are the 20 largest economies to put together public sector funds for that purpose.
For poverty-related diseases, these chronic debilitating diseases.
In fact, we can show that working with health economists, we actually work with a terrific health economist whose name is Bruce Lee of all names.
He's a professor at Johns Hopkins.
He's been able to show that our vaccines are not only cost-effective, they're cost savings, meaning that they're economically dominant, that they'll actually save money.
The problem is it doesn't help you with the fact that you still need some, but the return is on public health.
You still need somebody to come along and provide that investment.
So what's happened is our technical ability to develop vaccines has outstripped our financial instruments that we have to do it.
So I get a stream of young people In my office, wanting to go into global health, I mean, the commitment for this next generation, I know they get a lot of bad press, but my impression is this next generation, their commitment to public service is at an all-time high.
And they say, you know, Dr. Hotez, I'm all in.
I'm going to go into global health.
And they're a little bit disappointed when I tell them, get an MBA. Or get a law degree because where we need the innovation now is in the finance sector.
There must be a business model out there that would work, that would figure out how to do this.
It seems like once the momentum is in the corner of this being handled by the private sector, And that the private sector has to develop these vaccines and these treatments, and they have to do it with some sort of a financial incentive.
If they don't have a bucket of gold at the end of the rainbow, they're not going to take a ride.
Well, the pharmaceutical companies have traditionally said billions, but I don't think that's the case.
I think one of the reasons they're doing that is because they're also recovering their R&D costs.
They're putting money into R&D that they charge in order to either make a profit or at least stay even.
The cervical cancer vaccine, the HPV vaccine, that when I last looked was $420 for the three doses.
It doesn't cost $420 to make that vaccine.
It's just that they're recovering their R&D costs, which is fair enough.
So one of the things that we're proposing to do for our neglected disease vaccines is we'll delink the R&D costs.
In other words, if we've gotten Grants, whether it's from the Gates Foundation in the past or the NIH or the European Union or the Dutch government or the Carlos Slim Foundation, we're not going to pass those costs on.
We'll just, you know, that was used for R&D and we would just cause for the cost of goods.
So at least we can get it down to just a couple of dollars a dose, a few dollars a dose.
Probably the books, because I wrote the books for lay audiences.
Lay audiences, sort of.
I mean, somebody with a university education.
I mean, they're not, you know, they're published by Johns Hopkins University Press, and they are kind of, they're uneven in terms of how weighty they get into the science, but certainly the vaccines do not cause racials autism.
I wrote it with the idea of parents, vaccine-hesitant parents, and also the pediatricians.
Because the other problem with pediatricians is, you know, they're there in their office and parents are reading this stuff on the internet.
And they come and loaded for bear into the pediatrician's office with all these factoids.
And the pediatrician's like, well, gee, I never heard that before.
And then the pediatrician is made to feel stupid, like he's not keeping up with the science.
He is or she is.
But it's just they're not keeping up with the misinformation.
So I provide talking points in the epilogue of the book.
So you get beat up no matter what if you're talking.
But I really think it would do a good service if somebody did put together a documentary because I think most people are just relying on this fear that vaccines do cause autism.
There's also this connection between people that are older, correct?
When they're older and they have children, there seems to be more likely...
I mean, what you've been saying today about these diseases and how many of them exist and how many of them are almost unknown, untreated, undiagnosed, and just how many people are unaware.
I really hope that someone does something about that too.