Peter Hotez

00:07And we're live. How are you, sir? How are you? Good to see you again. I'm thrilled to be here. Thanks for doing this, man. Thanks for having me. I No, 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, um you explained to me that some ungodly percentage of people that live in tropical climates are infected by parasites. That's right. Well, my day job is developing vaccines for tropical diseases. We develop the vaccines no one else will make because of the for the world's poorest people. So, we call them tropical diseases, but they really are diseases of poverty. The vaccine issue, the the advocacy issue around vaccines and autism is kind of a new thing that I

00:55got drawn into just because I'm a uh parent of an adult daughter with autism and I make vaccines, so it was a natural that I'd get drawn into it. Yeah, so when I said that you were going to come on, then I got inundated by people that are, you know, the the vaccine thing is such a polarizing issue. Yeah, it's awful. And so many people seem to think they absolutely know what causes what, especially when it comes to something like autism, which is uh it's a huge issue in this country. It's a huge issue around the world. And it didn't used to seem to be. The question is, was that because it was undiagnosed? Was that because it just there's it's more prevalent today? What do you think? What is your take on this? Well, I don't think we really know. Um one thing's for sure, we're diagnosing people with autism who we diagnosed with as something else in the past, you know, whether it was

01:51you know, really horrible diagnoses. We'd use pejorative terms like mental retardation. What's the matter, Jamie? 2:04, sorry. And my bad. Just telling you the clock was off. Oh, okay. Sorry. Sorry. Should we start again? No, no, no, it's okay. He was just saying He was just telling me that the our clock is screwed up because of the daylight savings time. Sorry. Totally unrelated to what you were saying. country's clock is screwed up because of daylight savings. Right. Um so so we don't know. We don't Well, you know, what one thing's clear, the the number of diagnoses is going up, but part of that is because what we used to call pejorative things like mental retardation now get thrown into the autism category. The other thing that it absolutely How so? Well, you know, now we call it as part of the autism spectrum. Um we also because autism often has a lot of associated intellectual

02:42disabilities, not always, but sometimes. Uh the other is that um Can I pause the for a second? Is that based on uh aptitude tests? Like how do you How do they decide? How do they decide what's autism? Yes. They They have a list of diagnostic uh categories. But it's not based It's not like you could test someone if they test positive for a disease. That's right. That's right. Well, uh although it you know, one of the interesting side pieces to this is, you know, the there's a group of in people out there who self-identify themselves as the autistics. And they get very resentful or hurt when they're called a disease or disorder. They And because they say, "Well, we're not an epidemic. We're We're a person." And they That is part of this whole neurodiversity movement, which is quite interesting. Neurodiversity movement. Right. They say they're neurodiverse that they, you know, maybe think

03:33differently from others and they respond differently than others, but they're not {quote} abnormal. And And I think they have a good argument. Hmm. Um I heard a crazy argument once with someone that was So So the So the point is that it's, you know, the the impairment, like Rachel, my daughter, it's not so much her autism that uh uh thwarts her, you know, ability to have partners or to uh have a meaningful career. It's the fact that she has profound in in her case, profound intellectual disability that goes along with it. Um I forget what I was going to say. The So when when they say that people have a There's a spectrum, right? And some people who are autistic have in incredible abilities. They have They have incredible mathematical abilities, musical abilities, language abilities. And then some people do not. Some people have legitimate issues. Yeah, with Rachel's case, my daughter,

04:29it's um 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. Uh fortunately, Goodwill Industries came to her rescue and our rescue, and now she works there 2 hours a day sorting clothes. And And that's been really meaningful for her to get a paycheck. Oh, that's great. Even if it's minimum wage, yeah. Right. Just to do something and feel Right. Feel part and feel part of the mix. That's huge. That's huge for everyone, right? Absolutely. Absolutely. Um but so there's no uh there's it's not like you could test positive for syphilis or you can test positive for the flu. Right. Although now, you know, as I say, you know, so that's why I don't like using those those terms because it it it puts people on the autism spectrum as though they have a disease or disorder, which I don't like to do. But it But it

05:16is a disorder, no? well, you know, now we know there are 99 genes that are linked to autism. But why is it a bad thing to say that you have a disorder if it's just a disorder? You know, people have disorders. It's a fact. Well, you know, a lot of the individuals in that that self-identify themselves as the autistics don't like to think of themselves as a disorder. They like to think of themselves as different different, but not necessarily as a disorder. Right, but that doesn't help us when we're trying to discuss it, does it? Yeah, it gets very it's it's hard It gets hard to talk about and you have to be they're they're trying to stop you from talking about it in a certain fashion, which is actually accurate, right? When they have an issue. There is an issue. To say there's no issue is kind of ridiculous. It's I mean, there's a reason why so many people are so concerned about

06:01autism and vaccines and just autism in general, whether it's an environmental pollution factor or they like to do is they like to make the distinction between autism, that neurodiversity thing, and actually having intellectual disabilities that go along with it. Okay. And maybe it's a bit of semantics also, but they feel strongly about it. Right. Now, if we don't know what causes autism We do. We do. Well, we're getting there very closely. So, we've now there is a very important paper produced by uh written by group at the Broad Institute, Harvard MIT, which is one of the premier genetics, genomics organizations in the country. And they've now identified 99 genes. It's a It's a huge team of scientists, not only at the Broad, including peace scientists at Baylor College of Medicine. 99 genes involved in autism uh all involved in early fetal development, uh early brain development

06:57uh 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 we have learned so much in the last couple of years about autism, how it begins early fetal development well before a kid's 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 or early brain development. Is it possible that some people have this tendency towards autism and it's exacerbated by vaccines? think so. Um I think what what happens is the sequence of events happens uh during pregnancy, but the full clinical expression of autism often doesn't happen till 18 or 19 months of age. Like Rachel, for instance, wasn't actually diagnosed till 19 months of age. And

07:50there's some fab- fabulous studies now showing that that clinical expression of autism actually coincides with a big increase in the ex- in the volume of the brain. You can actually show on serial magnet- magnetic resonance imaging, serial MRI, how the brain starts to the brain volume starts to increase. And that's very uh will often remember, "Oh, my kid got vaccinated around 18 months of age or or 15 months of age." And want to link the two. But now you can go back to 6 months of age. And this is studies done at the University of North Carolina, Chapel Hill, showing So, that you can do an MRI at 6 months of age and they can predict now with they say with 90% accuracy which of the kids will go on to develop autism. And then you could take it What are they saying? What? What are they saying? Um they can see I have You have to go We can go into detail in the paper, but they can see

08:44certain things on signatures on MRI that tell them that this kid is going to go on to develop autism. Okay, so in fact, there is a way to test positive for autism then with this serial MRI. That's what they think, right? And 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 in a gene controlling neuronal connections, which makes a lot of sense if you think about what autism is. Yeah, of course. So So there is a way to to show whether children will be more likely to develop autism and there's there is a way to to look at their brain through fMRI at a very early age. And And also do the And also do genetic sequence. So, it's not simply a matter of how they perform on cognitive tests.

09:36That's right. That's right. We're getting much better at getting our arms around the diagnosis. Why do you think there's so many people that have these anecdotal stories of their child getting vaccinated, especially large doses of vaccines when they hit them with like 10 in a row, and then all of a sudden or measles measles, mumps, and rubella is the one that gets repeated over and over again. That's the the 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, rubella 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 and things like that and then autism will then begin sometime between the first

10:18and second year of life. So, it's logical to want to connect the two, but now we know it's not even plausible because we know that if you go back to that MRI at 6 months of age or go back prenatally, we can even determine which kids are going to go on to develop autism. So, even though this vaccine And then complementing it, complementing it are massive epidemiologic studies done on over 1 million kids. That in fact a new paper was just released this week showing that um kids who get the MMR get the MMR vaccine are no more likely to get autism than kids who don't who don't get the MMR vaccine. And the converse is also true. Kids on the autism spectrum are no more of likely to have gotten the MMR vaccine than kids not on the autism spectrum. Okay, so So, so it's a combination of that those big studies of over 1 million kids together with knowing what autism is

11:12that completely rules out the possibility. Right, so these genes, excuse me, the and the issue with these genes and then the ability to scan the brain with a serial MRI and that so you can tell which children have the propensity. Is it possible that children have all these issues and then do not get autism or do 100% of those children with those issues get autism? That's a good question. Uh I don't know. I'm a vaccine scientist. So, I'm you know, the the well well, I'm a biologist but I'm a vaccine scientist who who's really tried to do a deep dive in autism doing research on the book. versus human development Right. Right. Okay, so So, what you're saying though is that if a child does not have these mutations and does not have these issues that are present during a serial MRI that they will not go on to develop autism. Is that true? as we can tell. as we can tell.

12:06Yeah. So, children without those issues who get vaccinated have have no problems which most children have no problems. Right? Yeah, I mean the you know, we've learned a lot about the the risk of vaccines and the numbers are extraordinary. I mean the risk of a severe adverse event happening after getting a vaccine is roughly on the order of one in a million between between one in a million and one in 10 million. Um so, and I found an internet report once that like likelihood of getting struck by lightning is one in 700,000. So, it's you know, the likelihood of having a severe event after a vaccine is your bet odds are better of getting struck by lightning than And when you say severe event, what do you mean by severe event though? Uh well, the there's actually a table that's put out by the national vaccine compensation act that includes shoulder injury. Uh that's one encephalitis and so

13:08Yeah, that's actually on the put getting injecting it in the wrong place. Oh, so it goes into the joint or something like that? Yeah. Is that common? No. No. So, there there have been issues where children have adverse effects and reactions to vaccines. What do you attribute those to? But one you know, one in a million. I think you know, in some cases biological variability I think in some cases inadvertently if it's a live virus vaccine like the measles, mumps, rubella vaccine and you have an underlying immune deficiency that wasn't picked up before then that virus can replicate better but very rare things like that. Right. So, as far as you know, children who are healthy who get a vaccine it's it's not biologically possible for them to develop these traits, these mutations in the genes and these issues that you see present best we can tell right now that seems to be the case, right?

14:05As best you can tell right now is a it's a great thing to say. I I But for people that are like hmm on the outside like what does that mean? I'm not a doctor. I'm not smart enough to understand what Dr. Hotez is saying here. What is he saying? Best as we can tell. How much can we tell? So, here's what we can tell. We know um studies on over 1 million children that there's no link between vaccines and autism. That's number one. And and so, let me parse let me let me parse this out in two bits. So, there's there's the studies on over 1 million children showing that vaccines do not cause autism. That's part one. The second part and then I'll do and then I'll do a deeper dive at each of them. The second part shows not only is there massive evidence that there's no link between vaccines and autism, there's no plausibility because we know so much about autism how it begins in

14:55pregnancy. So, let's go back to the first part. The first part is studies on over 1 million children. One of the things that the anti-vaccine lobby does is they play this game of what I what it's not really a game but what what they what they do is play this kind of uh thing of vaccine whack-a-mole because at first they alleged it was the MMR vaccine and that came out 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 again round again saying now it's the alum or aluminum in

15:43vaccines. So, and then each time the scientific community responds with massive epidemiologic studies showing there's absolutely none of those things that are true. And do you think that it's just when you look at say if there's one in a million that has an issue with this and there's And it's not autism by the way. So, what whatever those issues are that they hear these stories and these stories do accumulate because there's 300 plus million people in this country and over 10, 20 years of one in a million you develop a significant history of cases where children did have issues with vaccines. So, these people hear about these stories and people are terrified. Obviously, you're I have children. You become very overprotective over 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? Why does a baby get

16:3810 shots in a day? That seems crazy. Well, they don't get 10 shots in a day. Most of the most of the vaccines are now combined. So, for instance, in one vaccine we can vaccinate against diphtheria, pertussis, tetanus, um polio, uh Haemophilus influenzae type B which is a terrible cause of of meningitis. And and some cases now even hepatitis. So, one shot is protecting of all these things. Well, that's combined and there's all sorts of studies showing that it's safe to combine them and and it's fantastic. Now you can vaccinate with one shot against six diseases. And these are life-threatening diseases. Right. So, the only concern is the child's immune system when they're bombarded with this one So, a lot of times it causes them to be tired or they get sick or they don't feel very well. is the immune system is not bombarded. I think that's another kind of a misnomer

17:28that or a misunderstanding that's put out by the anti-vaccine lobby. Remember, the child's gut, the intestines, and the respiratory tree is is this or organs of antigen presentation. A baby on average is exposed to hundreds of new antigens every day. So, the idea that you're going to quote overwhelm the immune system with a vaccine against six diseases just doesn't make any sense either. Again, this is all phony baloney stuff put out by the anti-vaccine lobby. Let's let's be clear. The anti-vaccine lobby owns the internet right now. They've What does that mean? What that means is they've got 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,

18:27other forms of social media. So, third, you know, look at the Amazon site. I mean it's it's incredible. So, my book this book the good news is it's I think it 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, the 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 uh um fall with plying them with false information about what vacs vaccines do. So, and and the problem is we don't have a robust system of pro-vaccine advocacy to counter it. So, we don't really hear as much as we need to from the federal government, from the CDC, from the Surgeon General. So, unfortunately in this country the

19:28defense of vaccines falls to a handful of academics like myself. And you know, I'm an academic. I wrote a book. What what chance do I stand against this major uh media empire that they've Why do you think that exists? Why do you think there is this major media empire that's against vaccines? That's a great question. What's the motive what's the motivation number one and number two where's the money coming from? Right. Right, there's real money behind this. There's millions of dollars behind this to put out phony documentaries and phony books. What's a good phony documentary to point to? Well, I'm a little reluctant to do it say it because they're so litigious and and uh and you know, I I don't have the means to defend a lawsuit and things like that. So, but but they're out there. these um documentaries I usually don't name specific names or I understand. These documentaries, what

20:18do you think their motivation is? Did you Do you think they they earnestly believe that vaccines do cause harm or vaccines do cause I I I don't I excuse me uh autism. I don't know. I mean, is there some kind of other agenda that they have? I mean, we do know in some cases that um the some elements of the anti-vaccine lobby are promoting phony autism therapies. Right? They're doing terrible things like this thing called MMS which are bleach enemas. What? Yeah, bleach giving bleach enemas to kids. You can't To children. Bleach. Why bleach? Because they're cleansing the immune system. They're cleansing them of toxins. No, it's really awful stuff. Um and they're doing chelation therapy which is very dangerous. that? That's where they they claim, you know, kids are overdosed with toxic metals. So, they give a chemical that actually can chelate the metal, but it

21:09can chelate your calcium and then put you into a fatal arrhythmia as well. They're also Who's doing this chelation therapy? Like what you can Google it. Um it's uh or you whatever But are they Are these doctors? Like Some some cases they're uh doctors unfortunately or other health professionals. And what is I mean, I'm sure you've studied this. What is the evidence Wait, it gets worse. There's no evidence. And then and then they're doing hyperbaric therapy uh which is really bad. So, in some minute. Hyperbaric therapy is bad? Well, for it doesn't do anything for autism. That's for sure. Okay. But it's it's good for recovering from injuries and Yeah, under certain selected but who knows what who knows what it's doing to a young kid, right? I mean, so So, you shouldn't be doing that. Um the then the other then that's one. So, how much of this is being driven by

21:55um financial motivation pedaling these phony autism therapies? I can't say. My sense is that's not the big piece of this. Yeah. Um there's also some reports now Russian bots and trolls that are amplifying this and sowing political instability in this country. Right. But again, you add that all up the phony autism therapies, the Russian bots and trolls. To 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 cemented in their mind and they're not willing to look at it objectively and look at the

22:46full spectrum of possibilities and look at the science behind what you guys are saying because in their head they've been saying vaccines cause autism. They've been saying it for so long that once someone gets that and they're connected to that, it's very difficult for them to shift gears. People have a really hard time not being married to an idea. Yeah, no, I agree that. And um you know, when I talk and I spend a lot of time going on the country giving uh 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 and more and more than a few parents. My impression is most of the parents are who are who are called to be so-called vaccine hesitant as as the word of the day are not really deeply dug in. I mean, you can you can

23:35have 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 uh that it that it begins in pregnancy and they'll vaccinate their kids. There is another percentage and I don't know what the percentage is, whether 10 15% that are deeply dug in and are wholly invested in this conspiracy theory that the that the government is in cahoots with the pharmaceutical companies and blahdy blahdy blah. Yes. And then if you try to talk them out of it uh they just think you're part of the conspiracy. So, it's it's sort of a no no-win approach there. But but most parents you can have a good conversation with. Most parents. Yeah. Um it's not necessarily even most parents, right? I mean, what what you're dealing with is these people that maybe they're into a

24:25bunch of different alternate therapies, a bunch of different kinds of cleansing and you know, there's a lot of that nonsense that you find online where I mean, look, there's legitimate But I But I guess But I guess my point Sorry. That's okay. Please, go ahead. No, but I guess my point is um parents don't get the chance because they're so inundated with phony anti-vaccine information. If they do a Google search. Yeah, or whatever, you know, whatever search they do. So, what do you think should be done? Should there be a pro-vaccine documentary that makes sense? I I think Thanks for that question. I think there's three things that need to be done. I think first of all, some of this anti-vaccine media empire needs to be dismantled. Dismantled? Dismantled. And And that But who's to say whether they're wrong or right? Like shouldn't I mean, it seems like there

25:12should be some sort of a debate, right? Like if there's someone who's saying that there's some evidence of vaccines cause debate, you're saying there's no evidence of vaccines cause debate uh no, excuse me, that vaccines cause autism and you're saying there's no evidence that vaccines cause autism, there should be a debate where there's some sort of like some sort of a monitored conversation where you can have you versus someone else and break this down. Yeah, but that that has That's a two-edged sword, too, because, you know, then it gives some false legitimacy to the anti-vaccine side. It's like debating the smoking cause cancer. Yeah, but doesn't Isn't there already a problem? I mean, it seems like if there's this many if you do a Google search and you're just overwhelmed with anti-vac It seems like the the fight has already been lost if that's the case. That's right.

26:02So, giving them legitimacy Let's say it's not necessarily giving them a legitimacy. It's giving them you you giving you rather a forum to dismiss their legitimacy. Yeah, I mean, I think, you know, part of what has to be done is I mean, it's And And this gets into all sorts of First Amendment issues and I'm not a lawyer. Uh but, you know, the the idea that Amazon now is putting out all of these phony books and and phony documentaries. Well, they're just a distributor, right? I mean, they don't have to go over every book that they sell with a fine-tooth comb. maybe they should. I mean, not fine-tooth comb, but maybe there should be some screening. Maybe Amazon, maybe Facebook should all be hiring chief scientific officers to you know, putting some stops on the dissemination of of information because it's harming children. I mean, I mean, this is The reason I get passionate about it

26:50um the reason I actually wrote the book is is kind of interesting. I It actually happened before all of these big measles outbreaks that we've been having. Yeah. Um I noticed that in Texas there was where I my laboratory is at Texas Children's Hospital and Baylor College of Medicine. We noticed that there was a steep increase in the number of kids whose parents were opting them out of getting vaccinated to the point where in Texas we have over six over 60,000 kids not getting their vaccines in the state of Texas. And those are the ones we know about. We don't know anything about the 325,000 home-schooled 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 was drove me to write the book. So, the point is now Texas is very vulnerable

27:40to measles outbreaks. And I say measles more than the others cuz that's the most highly contagious disease. What are the What's the danger of a child getting measles? And is there any benefit to a child getting measles in terms of their immune system? No, there's no benefit and that's one of the phony books they put out. It's called Melanie's Marvelous Measles. I mean, it's it's awful. So, um uh What do they say in that book? They say build your immune system. It does not. It does not. It's Remember, um after So, let's go back a little bit. Smallpox was eradicated in the late 1970s through vaccination. Once smallpox was eradicated eradicated, measles was arguably the single leading killer of children globally. 2.6 million children died every year of measles because it causes measles pneumonia, measles encephalitis. Talk about permanent neurologic injury. That's a bad actor, measles.

28:30And 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 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 me the anti-vaccine media empire is it started out as a fringe group, but now it's really affecting public health allowing a deadly disease like measles to come back. Do you think if there's some sort of definitive evidence that shows to the general public like you could you could show it to them like this is what causes autism. We've narrowed it down to these genes and it it has nothing to do with

29:23vaccines. If you give these vaccines to people without these genes, there is no way they're going to get autism. They get autism specifically because of these variations in their genes. You just you you just summarized the book. Right. But I mean, the we We need more than a book, right? Right. It does disturb me when I hear about all these kids getting measles. And not just measles, but means in some places polio has made a resurgence. Yeah. Well, well, polio, you know, we're down to about three three countries that still have transmission of wild-type polio. It's Nigeria, Pakistan, Afghanistan. So, hopefully we're getting our arms around polio, but measles has now come back roaring back with a vengeance. haven't people contracted polio outside of those areas? I mean, those are the areas where it's common. Every now and then some cases pop up. We had some in Now, wherever and this could

30:10get onto a whole 'nother topic. Wherever there's collapse in health systems infrastructure, such as during from war or political instability, these diseases can come back. They can come back and the people that are vulnerable, the children that are not immunized. That's right. And when you're immunized, you're not vulnerable. That's right. Yeah. This is it's a really confusing thing for people because on the outside they people always want to think that big pharma Look, I've I've said some terrible things about big pharma and the reason being is painkillers. Cuz painkillers and antidepressants and there's SSRIs which are overprescribed and the painkiller one kills me because I've known people directly that have been addicted to these god damn things and the doctors are passing them out like candy. So, people look at big pharma as being, "Oh, these are the monsters that push this."

30:58They're also the people that give you things that save people's lives. Yeah. There's there's a lot going on there. Yeah, I'm no I'm no big defender of of the big pharmaceutical companies. I mean, one of the things that the anti-vax the insults that anti-vaxers hurl at me is they say I'm a shill for industry. They say I'm secretly taking money from Merck and GlaxoSmithKline. It's all crap. I don't take a penny from them and I and I and it's it's not even real. How do you get paid? Just by the from the university? paid by the university and and some of that some of my salary is offset by non grants from nonprofit foundations. Um then like like the National Institutes of Health, right? And then they say I'm secretly making millions of dollars for our vaccines for hookworm and schistosomiasis and Chagas. you doing with all that money? I cuz my wife says, "If only that were the case."

31:48Right? 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 in phase one phase two clinical trials cuz we don't have the big pharma money to take this 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, is 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? Cuz there's there's quite a few health

32:36related documentaries that I know are horse because I've talked to actual real scientists and clinical researchers that say like all these things you're saying are wrong and this is why they're wrong and this you could show this that they're wrong. And then when someone says, "Hey, I saw this documentary. It says that all you should eat is toast." You could say, "Listen, man, you got to go here and watch this and it'll show you why that's nonsense." Right. Is there anything like that right now or is there any discussion? Not right now. There are some discussions, but we're a long way off from that. And the problem is the anti-vaccine documentaries are being distributed widely distributed, widely sold and And those people that are talking about it, here's the the other problem. Whenever I talk to someone about it was I've been doing this a lot lately where

33:19I'll talk to someone about something they're passionate about. I go, "What books have you read on it?" And it's like, "Well, I saw this documentary." It's very And and there are books. In fact, there's 19 19 19 ahead of mine, right? Right, but books that are written by actual researchers, people that have spent decades in labs understanding what's going on. You don't really you know, you don't get a lot of that from the people that are anti anything. Right. Well, that's that's why I wrote the new book. It's a very confusing thing for parents cuz you're scared, you know, you have this little tiny baby that you love more than anything in this world and then the doctor say, "Hey, we've got this round of vaccines coming." and you're just terrified that you're going to do something to your child that's going to turn your child into someone who's compromised. Yeah, and and the point is

34:08problem is these diseases are back now and so it the urgency to vaccinate is now more than ever. I mean, remember right now look what's going on in Vancouver, Washington right now where the measles outbreak is underway. The ones who who are at greatest risk are infants under the age of 12 months, not yet old enough to get their vaccine. So, that if you're a parent right now living in Vancouver, Washington, you're terrified. You're terrified about taking your baby out to Walmart or the public library. vaccine. Cuz they're not old enough to get their vaccine. Right. So, now the disease is coming back because the older kids are catching it cuz they didn't get the vaccine. the anti-vaccine lobby uses terms like personal liberties and medical freedom. Well, where are the personal liberties of this parent now who's terrified to take her in When you say anti-vaccine lobby, now I know that

34:55Robert Kennedy Jr. is he's a he's a big one and he seems like a very intelligent guy. How could he not be aware of the science behind this and what is he getting wrong? What what he's getting wrong is just about everything. You know, he's formed an organization called Children's Health Defense and and it started he had a press conference about it. I think it was September, October of last year. It is probably one of the best organized anti-vaccine groups out there. Now, he's doing other things other than vaccines. He's doing a lot of things about environmental health and things like that. I don't know any part of that business. I've only followed what they what he does with vaccines, but it's all it's all nonsense. Why is he doing this about vaccines? know. What's his I mean, you have to ask him what what's his motivation. be a guy that you would want to have a

35:42debate with or have a discussion with? But again, I mean, I'm I'm uncomfortable with the idea of a debate because it's like it's like debating I don't know. It's like debating a Holocaust denier or whether the Holocaust exists. I mean, not that this rises to the same level, but saying, but if you're again, I want to bring this up. If you're you're complaining there's 19 books ahead of yours that are anti-vaccine books, you've already lost the battle. Like it's time to regroup and maybe regrouping would be confronting someone with actual scientific information. I mean, you are a real doctor. Mhm. You're a guy who actually studies this and you're a man who understands the science. You're a legitimate academic. You could you could actually put a dent in this with a real conversation. Yeah, potentially. Potentially. Yeah, I mean, what would he be able to say? Like what is his take on it?

36:29Well, remember he's he's an attorney and he's he's very clever, right? And you know, he knows how to presumably knows how to do arguments in court and what am I? I'm a scientist. Right, but do you think that he wants to deceive people or do you think that maybe he's just incorrect in his accumulation of data? Yeah, I can't say what his motivation is, but his his his information is is highly misleading. Mhm. Now, what else is you you say the lobby? Is this an organized thing? Good question. I mean, we again, we need somebody who really wants to do a deep dive in this and kind of dissect out the pieces to understand. Um but it's it's impressive what you've got out there in terms of the hundreds of websites and the amplification on social media and everything else. Is it are there just one or two or three groups behind it or is it a random collection of organizations? That that needs to be

37:28looked at. That does need to be Now, what what do you think is causing autism? And in your personal estimation, do you think that it is a that there's a rise in the factors that are causing autism or do you think that it's a rise in the understanding of these variables that contribute to it that you could diagnose people with and that before they were previously undiagnosed? So, I I think most of it is that that we're just diagnosing it more. We're including individuals in the autism category that we didn't before. And by the way, the numbers are about to go up even more because we're getting better at diagnosing girls and women with autism, which is also quite interesting. We used to say it was 10 to 1 boys to girls and now we know there are a lot more girls and women on the autism spectrum. It's just that they're usually more verbal and they can camouflage it

38:17Mhm. better, but they have very high rates of comorbidities like obsessive-compulsive disorder, attention deficit hyperactivity disorder. A lot of the teenage girls with eating disorders now they're finding could actually be on the autism spectrum. So, the numbers are about to go up again. I mean, that's just an example. I mean, is I guess what you're really trying to get at is it is it beyond that? Is there is there a bonafide increase beyond the number of diagnosis? And that one I'm still not sure about. Yeah, I read an article about early onset gender dysphoria being connected to young girls with autism and that there's a disproportionate number of girls with gender dysphoria who turn out to be also autistic. Right, I've heard that as well. That's actually So, it's really fascinating to think about. Now, unfortunate and fascinating at the same time, right? there's

39:07there's a nice paper by a very good environmental scientist named Phil Landrigan who used to be at Mount Sinai. Now, I think he's at Boston College now. 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. Do you know what those chemicals are? So, I have to remember all I I talk about them in the book. One of them is Depakote, valproic acid, which is a psychiatric medicine used as a mood stabilizer or an antidepressant. So, prolonged use of Depakote during pregnancy has been linked to something that resembles autism. Is this a common medication? common medication, um 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 you know, people like Bobby Kennedy and

40:03everything else, if you really want if you really think there's some environmental link to autism, we've got a list of at least six chemicals during early exposure in pregnancy that are probably causing mutations and things like that that are already leading to autism. Why aren't we Why isn't anybody looking into that? Mhm. It's just crazy. I mean, so all the focus on vaccines goes into vaccines and it kind of sucks all the oxygen out of the room. So, that, you know, really understanding the search for autism gets delayed or in some cases doesn't get pursued at all. Or the other thing that happens in many state legislatures and things like that, the focus is so much about vaccines that we don't talk about what autism parents really need. I mean, what do I need for Rachel? We need, you know, employment counseling and help. We need mental health counseling. What do we do after

40:49we're gone? Rachel right now is living with us. I'm I turned 60. My wife is, you know, 58. What happens to us 10, 15, 20 years from now? There's no road map. Right. So, so all of that gets shunted aside because of these phony baloney anti-vaccine argument. That's why I get angry. That's when I start to realize these guys, in addition to affecting public health, are actually hurting autism families as well. Well, that makes sense. I mean, I 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, um maybe we should really concentrate on that and and publish something about this. Is this something that Is there an article that people can go to that says something about this? There is. I talk about it in the book. I I can If I open up the book, I can

41:42provide it for you. Um is there anything that people can read online about this without going to your book? Um probably. You know, one of the problems that we face in this country is that we put a lot of scientific articles behind paywalls, which is a real source of frustration for me. And that's why do that? Well, one of the reason One of the things that I've done now is um I'm one of the I founded a an open access journal called the Public Library of Science Neglected Tropical Diseases, so that anybody with a computer, you know, an internet connection and a printer can download the articles free of charge. And we need more of that. That's great. But right now, if someone wants to find out these chemicals, they have to buy your book or buy some sort of access to scientific papers. not sure with that particular paper whether it's behind a paywall or not. I'll have to look. Yeah, I mean,

42:33besides measles, what other diseases are more prevalent now because of people not vaccinating their kids? that There's three diseases that I worry about the most, actually four. Well, whooping cough is another one. So, that that's one. But the other one I worry about is the flu vaccine. Kids aren't getting their flu vaccine. Last year in the 2018 flu epidemic, 150 unvaccinated kids died of influenza despite the recommendation of vaccinating the kids for flu. enlighten me on this because what I've been told is that sometimes they get the flu vaccine wrong. So, you can get vaccinated, but it doesn't doesn't protect you for the strain of flu that everybody's getting. Well, so that's again something that was heavily an idea that was heavily pushed by the anti-vaccine lobby. Here's the story. You're right, last partially right. Last year, the there was not a

43:24perfect match between the between the the virus in the vaccine, the killed virus in 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 would likely prevent you from being hospitalized. So, it would have an effect even if you did get the flu. cuz there was enough cross protection so that it would it would mitigate the symptoms. That's confusing to people because if they have the flu, they say, "Oh, well, then it didn't work." That's right, but it did because it prevented you from getting sick and dying. And and again, that was that was a message that never really got out in 2018. Okay, but let's talk about someone like me who's a healthy person. I've had the flu before, um but I don't usually get a flu shot. That's crazy. You should, especially now you're especially now as you're getting

44:09older. Why is that? Um because flu is one of the leading is probably the single leading infectious disease killer of of of adults in the United States. But every time I've had it, it's really been like just a couple of days out. I rest. I get a lot of fluids. my friend. So, it is? Is it luck or is it health or what? know, well, sure, taking care of I mean, let's So, if you look at the 80,000 adults who died in the influenza epidemic of 2018 in the United States, you're right, a lot of them had underlying um things like diabetes or or non-communicable, you know, cardiovascular disease or underlying respiratory disease. Maybe they were smokers. But that they're still But there's still thou there's still thousands of individuals who were perfectly healthy who died of influenza that we know. So, when you don't get your flu vaccine, you're taking a terrible chance. And and why not? Well,

45:03I mean, what what are you risking by getting the flu vaccine? I'm busy, bro. You know what? You know You know where I in You know where I get my vaccinations? Walgreens? Uh even better. I We have a big grocery store chain in Texas, a big supermarket called HEB. Do you get it up the nose? I get No, I I get it I get the injection right at the pharmacy. The far All of my vaccines I've gotten for the last few years have been given by the pharmacist. Interesting. So, Couldn't couldn't be easier. Are you Have you ever gotten the flu since you've been getting the vaccine every year? Uh Well, you know, I've gotten I've gotten sick with a like a cold like a like a sore throat and feeling crummy. Was that a mild case of flu? I can't really tell. Okay. Um but you've never gotten sick right after you got a vaccine. Some people do, right? No. Some people do get a vaccine and

45:52then they have an adverse reaction to it. you know, after you're getting your vaccine, you can get get some soreness and you can feel maybe a a slight fever for a few hours or a day, but usually it's you're fine. What is that? What is that? Yeah, what is that fever? Why Why are you getting a fever from Because the the vaccine is stimulating the immune system and stimulating the inflammatory system. So, even though you feel like you're getting sick because of the vaccine, it's actually good for your immune system. That That's right. And you're not really sick. I mean, it's nothing like as nearly as bad as getting the flu. The other vaccine uh now that you're getting up there, you have to start considering is the shingles vaccine, Shingrix. Mhm. And that's a that's a great vaccine. It hurts though for a couple of days. Do you take care of your immune system

46:40in other ways? Do you take probiotics? Are you cautious about your diet? Um I'm not as cautious about my diet as I should be. I'm a junk food-aholic, actually. seems like a terrible thing for your health. It is a terrible thing for my health and something my wife is working on at the moment. seems ridiculous for someone who works with health. Yeah. Yeah. What's going on with you, man? Sometimes, man, I just don't get it right. How often? What? How often? How often do I steal a bag of chips or something like that? garbage? Uh I don't know. No, no, hopefully not every day, but you know, maybe a couple of times a week, you know. Oh. That's what with Rachel my my daughter with autism, that's like our thing is to go to the It's called the burger joint or to Shake Shack to get a to get a cheeseburger. We'll stick sneak some fries, so. Mhm. So, you we call it. Like that mouth pleasure so

47:36much, you're willing to sacrifice a little bit of health. Yeah, I you know, I you know, I I can I have to concede that's the case. Well, there's I mean, I don't have to tell you, but there's a large body of data that connects poor diet to a host of diseases. Mhm. That seems like a crazy decision for a guy in your line of work. There you go. Sometimes the uh Sometimes the it's not all brain. It's it it's something else. But I mean, if you ate healthy food, I mean, the thing is your body starts craving healthy food. You start Yeah, no no question. No question about it. Do you take vitamins? I don't take vitamins. Really? Yeah, I don't know. Wow. they do. I don't think they're needed. Cuz most in the In the American In the American up. Hold up. Hold up. You don't think they're needed while you're eating junk food? Well, hopefully I'm not only eating junk food, right?

48:26Okay, but you know there's a large body of clinical research on the efficacy of vitamins, especially vitamins D, vitamin have taken vitamin D for periods on the recommendation of my internist, yeah. And what do I essential fatty acids, which are great for your brain, fish oil, all these different things that are fantastic for your information. going to I'm not going to argue with you. You got You got You got it You got it hand You got You got it over me, yeah. Listen, but it would you would have a much better argument, don't you think? You're making my wife's day here. If you're taking care of yourself 100% instead of just concentrating your vaccines. I'm sure you do, but vaccines aren't going to prevent cancer. No, that's true. Right. And there's a lot of diseases or diabetes or cardiovascular disease or And a lot of these diseases are connected directly to diet.

49:15Right. Yeah. Yeah. Come on, man. And other lifestyle changes. Yeah. Good eating, good exercise, sedentary life. I try to go on the treadmill for 30 minutes every morning. I do it. Actually, I'm pretty good about that. 30 minutes every morning. I'm on you just go for an actual walk? It's more interesting. that, too. So, I do I do No, but I do my 30 minutes on the treadmill in the morning and then I and my I take a long walk with my wife in the evening. But it you know, the the thing that knocks the crap out of you is the travel. Yes. I find that very frustrating because you don't exercise right, and then you eat you don't eat well well, and you don't control the diet as well, so that's Um well, I have a solution to that, and eat well and exercise. Those are those are solutions to that. Just do it. You know, I treat it like I'm brushing my teeth. I brush my teeth every day. I exercise

49:58every day, too. So, when I travel, I don't have an option. When I land, I go to the gym. This is how it goes. I land, I get my hotel room, I put my shorts on, Yeah, I do that, too. I do that, too, when I travel. It's the only way. Yeah. Yeah. You have to do it. If you say this is just what gets done. Right. This is how you do it. Yeah, I try to be really compulsive about that, so. Yeah, I have it written out. I know what I'm going to do. Especially if if the It's great if the hotel has a good gym. The hotel, you know, if they have weights and a bunch of different run outside if if we don't have it. You run? Yeah. Do you? Not very well, but But you do? Okay. Yeah. We're going to get you healthy, buddy. Yeah. Can't be pushing only chemicals in injectable forms to facilitate health. Fair enough. Yeah. They're not chemicals, they're vaccines. sorry. What's in them? What? Some I

50:48mean, it's some sort of chemical, no? No, they're antigens, right? They're they're What's the fluid? macromolecules. What's the liquid stuff? Uh typically it would be saline or, you know, salt water and Now, um what is missing from today's vaccine protocol if anything? In terms of diseases we should be vaccinating for, but we're not? Yeah, there certainly are. Um you know, one of them is a big big problem among young infants, especially premature infants, called RSV, respiratory syncytial virus infection. Where does that come from? It it's um you know, it's a respiratory virus that peaks around the same time that flu does, so it's a very severe respiratory illness. So, this is again one of those vaccines that's not a big money maker, so the Bill and Melinda Gates Foundation is trying to provide grants for supporting that one. That that's a good one. And then there

51:44are all the diseases that affect poor people both in developing countries and even among the poor in the United States. So, we're trying to make them this book. That's that's the next one called Blue Marble Health. The next one. So, this is not released yet? No, this is out. This actually This actually preceded the this one. Now, this book is all about poor people and infectious diseases and that the rise of these infectious diseases even in the United States. That's right. So, you know, when we think about So, I I you know, led this big campaign to raise awareness of something called neglected tropical diseases or NTDs. These are the most common afflictions of people living in poverty. I call them the most important disease you've never heard of. They're diseases like schistosomiasis and Chagas disease and leishmaniasis. And I've been devoting my life to seeing

52:37if we could develop vaccines for those diseases in the nonprofit sector, you know, because the big pharmaceutical companies just don't see just aren't going to take these on. Mhm. So, we're trying to do it in the nonprofit sector, but the this book, the Blue Marble Health book came out of some number crunching that I did using data from the World Health Organization or something called the Institute for Health Metrics and Evaluation, which is based in Seattle, Washington, that found something very surprising, and that is most of the world's poverty-related diseases are not necessarily in the poorest, most devastated countries of Africa, meaning like Democratic Republic of Congo or Central African Republic. They're there, but on a numbers basis, most of these poverty-related diseases are actually in the G20 economies. The 20 wealthiest economies, together with Nigeria, which is not a

53:32G20 country, but has an economy bigger than the bottom three or four. So, that was pretty amazing amazing for me to find that out because you know, at first I I didn't believe the numbers because I said, "Well, how can it be if they're poverty-related diseases, why are they in the 20 wealthiest economies?" And then I realized that it's among the poor living in wealthy countries. So, the poorest of the rich today now account for most of the world's poverty-related diseases. And what what's the cause of this? So, why why the link with poverty? 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 sandflies can get inside the house, or

54:24if you look um in in poor neighborhoods like in and around Houston, you see a lot of environmental degradation around the neighborhood. You see discarded tires that breed Aedes aegypti mosquitoes or standing water. But, I don't I don't think What what What did the tires do? Discarded tires? yeah, so one of the best habitats for the mosquito that transmits dengue and Zika and chikungunya and yellow fever are discarded tires. That's what they love. So, this you know, if you go into poor neighborhoods, you'll see a lot of tire dumping, for instance. And and that's those are habitats for that that Aedes aegypti mosquito, including here in Southern California it when the water gets in the tire and it's stagnant water? exactly it, yeah. Uh 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

55:19a year and a half, 2 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 mosquitoes Mosquito heaven. Mosquito heaven, yeah. So strange. got So, yeah, absolutely. You go into poor neighborhoods, abandoned swimming pools, things like that. That's that's where we're getting a number of these diseases. have very many mosquitoes in Southern California. I mean, it's really kind of amazing in that regard. Well, well, it depends. So, you know, in some counties where they do aggressive spraying and things like that, you won't. But, in many counties, you probably probably in some of the poorer counties, poorer districts, you still do. Well, I mean, in terms of the way it is on the East Coast. Like I grew up in Boston, and in the summertime, you just have mosquitoes everywhere. You just can't get away from them. And then I've been

56:05to Alaska, which is the craziest place I've ever been to in my life in terms of mosquitoes. Have you been? I haven't been to Alaska, but I yeah. You get out of your car, and they attack you like a horde of birds. That's because you they only get 1 month of the season to do it, yeah. Yeah. So, they're super aggressive, and they're they're also very large. big problem is along the Gulf Coast of the US. We have that Aedes aegypti mosquito, and that's why I got so worried about Zika virus hitting the Gulf Coast of the US. Yeah. Um mosquitoes in other countries obviously contain malaria. I mean, we've been very fortunate that that's never made it over to here. Well, no, we we used to have malaria used to be widespread in the United States. Um both the one that was was a real killer disease called falciparum malaria on the Gulf Coast, and even up into Illinois

56:52and the Ohio River Valley, we had a lot of malaria caused by vivax in the 1800s. In fact, there's a whole there's a book written by Dickens when he visited the United States called Martin Chuzzlewit, and when he describes all these sickly people in Illinois and Cairo, Illinois on the confluence of the Mississippi and the Ohio River, he's clearly describing malaria. Wow. I did not know. Yeah. So, what stopped it? We So, there's actually a very nice book written by a medical historian at Duke University named Margaret Humphreys called Malaria, Race, and Poverty, and she has a hypothesis, but I think she's onto something, that it the decreased the malaria dropped in association with aggressive economic development. Mhm. Uh so that the the FDR's New Deal included something called the Agricultural Adjustment Act that got people off of off of with agrarian pursuits and put them into factories.

57:51Quality of housing went up, and that's probably what caused a lot of the reduction in these tropical diseases. Remember, they're really diseases of poverty. Mhm. I I spent a lot of time working in China, and I'm seeing that play out right now in China. You know, China has had this very very aggressive program of economic development, mostly in the eastern part of the country. But, in the southwest part of the country, going to 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,

58:38just like for the neglected tropical diseases we study. But, you know, unfortunately, for many countries, economic development is still decades away, so that's why that's the rationale for developing these vaccines. Is it because economic development moves people into more urban environments where there's less tropical diseases period? part of it, although now we're seeing some tropical diseases thrive in urbanized environments like, you know, yellow fever and Zika and dengue as well. So, it's not only urbanization. You have has to be urbanization with good planning that's not done unchecked that outstrips the infrastructure in terms of water and sanitation. So, this brings me to the thing that I wanted to talk to you about in the first place cuz 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

59:24haunting me ever since, that the vast majority of people that live in tropical climates have parasites. Mhm. Vast majority. Yeah, that's right. That That's right. There's things like Toxoplasma gondii and So, let's look at the Let's look at the hit parade, right? The top one is one called ascariasis, intestinal roundworm. Uh the estimates are on 800 million people have Ascaris roundworms in their bellies. Wow. So, 800 million. more than one in 10 people on the planet, mostly people who live in extreme poverty. Um 400 million have hookworm infection. 400 million have whipworms. So, all of these are wormy diseases. 200 million people with scabies, which is an ectoparasite on on the skin that causes terrible itching and and secondary bacterial infections. Schistosomiasis is another one. The point is every almost every single person who is in extreme poverty

60:22has one of these what I call neglected tropical diseases. And one of the interesting features about them is they're very debilitating. They not So, they not only occur in the setting of poverty, but I think they reinforce poverty cuz they make people too sick to go to work. Yes. They make uh They actually shape We can show they shave IQ points off of kids when they have them. Well, this is the hookworm connection to the idea of the slack-jawed dumb Southerner, Right. In the United States of America. Right. And now, one of the things that we have found, so Rahelio Mejia on my faculty uh working with an environmental activist named Catherine Coleman Flowers in Alabama found that hookworm is still present in Alabama. Mhm. So, among the Among the four so they they understand what we're talking about because for the longest time there was this stereotype about

61:10people that lived in the South that they were dull-minded. Right. And that this could be directly connected to hookworm infection, which had run rampant Right. There was even the term given called They called it the germ of laziness that that hookworm infection because it causes severe anemia. So, if you're walking around with terrible anemia, of course you're going to you're too You're not feeling up to working a full day and all that sort of stuff. So, Right. hookworm was widely present in present in the southeastern United States at the turn of the 20th century. And then as malaria went down with economic development, so so did hookworm infection as well. But, we still have pockets in this country. And this wasn't understood at the time, right? They didn't know that these people were infected with hookworm? N- For for for forever and no, up until very recently.

61:57So, the cause of hookworm wasn't discovered till 1900. What is that cause? It's called Necator americanus. The American killer is and that's the name of the worm. And this is from walking barefoot? Or that goes in through the hands or, you know, enters all parts of the body. So, But, it's very common to get it from walking barefoot. That's right. Which was more common in the South. Right. Right. Warm weather. And so, that's one of the diseases we've made a vaccine for that's now in clinical trials. Mhm. Yeah, when I found that one out, I was like, "Oh my god, well, that's it. That totally makes sense." Because for the longest time was there there was that stereotype. And then when you find out that it's directly connected to a massive infection of this disease this worm So, these are the diseases that are holding back people who live in poverty. Yes.

62:40And originally, I thought only in places like the poorest countries in sub-Saharan Africa or Southeast Asia, but now I realize it's these pockets of poverty across the entire planet that people are affected by these diseases. And these diseases can be vaccinated. That's where We're trying to prove that we can make a vaccine against And there is a hookworm vaccine, right? Right now in clinical trials, yeah. Just in clinical trials. That's right. That's right. Now, wasn't there a Lyme disease vaccine, but the problem was it was actually causing people to get Lyme disease? So, that's a to talk about controversial topics. Yes. So, that um so, there was a Lyme disease vaccine that was developed uh actually from a colleague of mine uh at Yale University. And then it was and they licensed it. I think it was GlaxoSmithKline. And they developed it as They called it

63:23Lymerix. It was the Lyme disease vaccine. And actually, most of the studies suggest that actually worked pretty well. Uh 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 it ultimately uh it hurt the bottom line of the company and they they withdrew it from the market. of mine's dad got the vaccine and then got Lyme disease. They think he got Lyme disease from the vaccine. Probably not. Probably is a weird word for someone with Lyme disease. being nice. They got it from a vaccine. No, he didn't get Lyme disease from the Impossible? Impossible cuz Lyme disease is caused by the Lyme bacteria, the spirochete called Borrelia burgdorferi. Mhm. And the vaccine is not a live vaccine. It's a

64:12recombinant protein-based vaccine. So, it's not possible. So, there's nothing in that vaccine that it could could have caused this adverse reaction that they directly attribute to that vaccine? Probably not. So, again, you're saying probably Well, I don't know the patient. I don't know I haven't examined the injury. So, I hate to They swear. I mean, that's the narrative at that household. Well, again, you know, it's reinforced by a lot of negative information out there on the internet. Yeah, well, it's also reinforced by the fact they pulled the vaccine. Yeah. Well, they pulled the vaccine not because it wasn't working, but because of market perception and and all that sort of And that was a time before the number of cases of Lyme disease had really taken off. So, strange to me because they didn't pull the measles, mumps, and rubella vaccine because of perception. Why would they

64:55pull the Lyme disease vaccine because of perception? the reason was is because um the the cost-benefit equation works a little differently. With measles, measles is a killer disease. Mhm. Lyme disease was not a killer disease. But, god damn it, it's wrecking people now. In some cases. It seems to be uh connected to uh a host of other elements, too, correct? Like Lyme disease it exacerbates a bunch of different maybe possibly even existing health issues. Well, you have to be careful. You know, the the and this gets into another controversial rabbit hole. I'm not sure we want to get into or not today, but um you know, 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 um the scientific evidence does not support something called chronic Lyme disease. Yet, there are lots of um

65:50people suffering with chronic debilitating illness who claim that it's caused by Lyme disease. Yes. So, this is something that um is out now. Why is there a debate? Like, what is the What are Why are they saying that it there is no such thing as chronic Lyme disease? What's their evidence? Um the evidence is that there's no evidence that they can detect spirochetes in the body in many cases. People who have had Lyme disease don't have persistent evidence of having uh antibodies any longer to to the Lyme spirochete. So, um it's a whole different area. Right, but they do have this chronic inflammation and pain in their joints Yes. and their body starts breaking down. They have something, but it doesn't seem to the Infectious Disease Society of America, uh which is one of the leading infectious disease bodies in our country. And I'm not an expert on Lyme disease, so I'm not too comfortable

66:44going there with you. are saying that there's no evidence that uh that that's is actually associated with active infection with Lyme disease. And what are they How are they describing it and what How are they So, in other words, what's So, what's causing all of these symp- Unknown. Unknown. Unknown. Mhm. But, isn't it bizarre that these same people got Lyme disease first and then had all these host of issues afterwards? Well, the I guess part of the problem is in some cases they had Lyme disease first, in some cases they really didn't have Lyme disease. Unfortunately, there are a number of unscrupulous health care providers and even physicians out there that are making the misdiagnosis either they're 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.

67:32Mhm. I'm sure you're aware of the lone star tick, Right. and the allergy to red meat. Yeah, right. That's really fascinating, isn't it? Yeah. Yeah. Yeah, and that's another one that's on the rise, correct? Yeah. Well, actually all tick-borne diseases are on the rise now. Yeah. Um possibly because of climate change, which is another factor in our country that's doing that. So, we're seeing uh you know, if you look now at what are the big drivers of uh infectious diseases right now in the in not only in in the US, but globally, there really some interesting forces. And a lot of them are social determinants. So, a big one is poverty. That's that's a huge one. The other big one is political instability and war because it interrupts public health control measures. So, for instance, Venezuela, which was leading public health control in Latin America for decades, you know,

68:21with the collapse of the economy in in the in the Chavez era and now into the Maduro area Maduro area, we've got a terrible situation where uh we've had measles return in a big way. So, huge numbers of cases of measles. Uh we've had all the neglected tropical diseases come back uh as well as malaria, Chagas disease, leishmaniasis. So, it's really interesting how that is destabilizing the whole region because now Venezuela has one of the largest diasporas of people as big as the diaspora coming out of Syria and Iraq. So, now the diseases are moving into adjacent areas of Brazil and Colombia and Ecuador. And so, it's really and and that's another big driver is political instability. The third one uh we think is climate change may be very important. So, you know, why did we see this big uh surge of chikungunya virus infection in the Western Hemisphere or Zika? We don't

69:16really 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 uh after it's been gone for 70 years. Malaria has returned to Italy. We're seeing schistosomiasis, a neglected tropical disease, on the island of Corsica. We've got dengue, chikungunya, West Nile virus across Italy, Spain, Portugal. So, we're trying to understand why that is and there's some thought that climate change may be a big driver of that. Now, what other infectious diseases or parasites, rather, do they have vaccines for? Do they have a vaccine for toxo? There's no vaccine for toxoplasmosis. There's a prototype malaria vaccine Prototype? Yeah. Well, it's it's an There's a There's a malaria vaccine. It's called Mosquirix. That's the trade name. That was developed, uh, supported by with a lot of funding from the Bill and Melinda Gates

70:15Foundation and, uh, working in partnership with GlaxoSmithKline. And that malaria vaccine now has been approved for use in children by the European Medicines Agency and it's being introduced now in three countries in Africa, Malawi, Ghana, and I forgot the third one. I think it was Tanzania. Is there an adverse reaction that people have to that stuff cuz I know the traditional malaria medication I I had friends that took it and had horrible nightmares. Oh, yeah. Malarone is terrible. Yeah. Gives you very lucid dreams and yeah. Yeah, no. So far, no. I mean And so, there When you say children, how old are the children that they're vaccinating with this? Well, the problem that you get into with malaria is that before 6 months of age, you have maternal antibodies on board. Your mother You're born with antibodies from your mother and they'll start to wane by

71:056 months of age. So, the ones who get hospitalized with measles what's called cerebral malaria, which is a devastating condition, or severe malaria anemia, which is also a killer, are those children between 6 months of age and 5 years of age. So, those are the ones that we want to protect. Now And it's one of the leading killers of children globally, right? Right. And And we don't have the vaccine. Sickle cell is connected to it, correct? Right? Sickle cell is it has something to do with, uh, people developing an immunity to malaria? Yeah, that's a I'm surprised you knew that. That's a out from Tiffany Haddish. Who's Tiffany Haddish? How dare you? She's a very funny comedian. Okay. Uh, I'm sure she is. Uh, but she's Well, she's right. It's not really It's It's not really immunity, but it's a natural protection. So, individuals who have the sickle cell trait

71:59uh, seem to be partially resistant to malaria. Mhm. And that's the thinking why the gene for sickle cell has been preserved in Africa for so long is because it does confer some protection against malaria. So, it's a reason for keeping the gene in the gene pool. Yeah, we were actually discussing it because a friend that I grew up with died from it. Um, so it seems to only exist in African Americans or Africans. Is that correct? Predom- No, there's some other places as well, but predominantly in African and among African Americans. Or people whose ancestors came from these tropical climates where they possibly Yeah. Yeah, so it's It's really quite an amazing story. So, um, there's no no no, um, vaccine for toxoplasmosis. Is there anything on the horizon? Is there anything being worked on because that's a big one, right? It's a real big problem among people

72:52with HIV AIDS, for instance. That's a because it reactivates your toxoplasmosis and we even see it in I even see it in kids sometimes, but the thinking is it how so? Well, what happens is, um, it's 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, uh, 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 you you die with it and don't even know you have it, but in some cases, it gets reactivated. Right now, um, there doesn't seem to be a lot of incentive for developing a toxoplasmosis vaccine, although I'd be very interested

73:47to to work on something like that. Why would there be no incentive? It's such a large-scale disease. It's hundreds of millions people worldwide, right? That's right. And part of the problem is we have almost no information on the actual number of people who have it Mhm. and, um, how extensive it is. So, we call that disease burden. We don't have good disease burden estimates of toxoplasmosis. I'm scared to get tested. I've had a bunch of cats. I've had feral cats. Yeah, you prob- And I'm crazy. Well, there's a good chance you're you're are infected, but as long as your immune system's intact, then you're okay. Now, there is a a related disease that from cats called toxocariasis and that's a parasitic worm infection we're finding in the United States among the poor. And that's a worm So, what happens is if you go into poor neighborhoods, you know, you see a lot

74:34of feral cats and dogs in poor neighborhoods. Almost 100% of them have this worm in their intestines and they're seeding the environment with eggs in their feces and the feces are spread all over the poor neighborhoods. Kids come into contact with them and the worm has the ability to migrate through the brain and cause cerebral toxocariasis. Um, and I think it's an important cause of developmental delays. It's one of those neglected diseases I among in the US I talk about in the book. And there's no vaccine for that, either? There's no vaccine for it and we have very little awareness about it. Wow. Yeah, I've never even heard of it until just now. Right. So, this is And it's not rare. I mean, in some cases, you know, up to 10% of certain populations like African African Americans living in poverty are infected with it. And it's primarily pets or does it is it rodents as well?

75:21Probably mostly stray dogs. It's not even pets. It's mostly stray dogs and cats. And And I get very And this is an example of a neglected tropical disease. Here's Here's a disease of up to 10% of African Americans living in poverty in the United States and almost nobody is studying it. Wow. Right? can affect the way your mind functions. Right. It's And it And it's been linked now to developmental delays. So, you know, everybody wants to know why, you know, kids living in poverty have developmental delays and people just assume it's because they live in deprived environments and that's where everything. But I think toxocariasis is an important underlying reason for it. Um, 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 and the truth is Ebola is never going to come to the United States. Why not?

76:11going to be cuz it's too difficult to transmit. Um, 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. That's I mean, I don't understand why people don't talk about that one. That That one seems insane. Right. Yeah, absolutely. It's a no-brainer, right? I mean, and so, but, you know, it's very hard to get people to care about diseases of poverty. I mean, and this is one of the striking things about when I wrote the book was, you know, I've had a lot of success getting people to care about neglected tropical diseases in Africa and worked with, you know, the US Agency for

76:54International Development to support a package of medicines that's now being administered over a billion people annually. And that, you know, is one of my proudest accomplishments is is helping to raise awareness about neglected tropical disease 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 US the lights go out. Why is that? I don't know. I can't I What am I can't figure out what I'm doing wrong. I've had so much success getting peop- people to care about NTDs, neglected tropical diseases in in poor developing countries but, you know, there's been no response to this this book. I mean, it is, uh um And And the estimates that I come up in the book are we have 12 million Americans living in poverty with a neglected tropical disease. Toxocariasis is one of them. Another one

77:46is Chagas disease and and the list goes on. It's been very hard to get people to care about the poor in this country. That's very strange to me and I've always said that about the way we treat other countries when we want to send them aid and rebuild these countries, but we don't do anything about these terrible communities that have been terrible in this country for decade upon decade. Right. And so, I try to make the point the world has changed. You know, this this old norm of global health, developed versus developing. It still exists, but it's going away. We're What we're seeing is a general rise uh in all all economies. I mean, 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

78:34these poverty-related diseases. And you know, I I know, um, 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. Well, she's probably pretty busy, too. Yeah, she's doing a lot of other stuff. If you had a magic wand and, uh, someone said you could do whatever you want to fix this, what would you do? So, um, I I did meet with a couple of people on the Hill and and they asked me that question. What's the magic wand? And, um, there's a couple of things. One, we need to actually look for these diseases because the problem is they're the the diseases they cause are very subtle like developmental delays. So, that if you're, a know, a kid who lives in poverty with developmental delays, the pediatrician doesn't even

79:25think to do a test for toxocariasis. So that So we need to raise awareness. We need to go into poor communities across the country and actually take a blood test and actually measure for the presence of that disease or that parasite. Once you find that disease, what would you do then? Well, it depends on the disease. In some cases, we have treatments for it. Like the treatment for toxocariasis is a 5-day course of a simple pill of albendazole. And it cures it? And it cures it. So yeah, so that we have you know, we have interventions. So one, you know, 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 test themselves because they're very complicated tests.

80:17Sometimes, you know, they they're done at the Centers for Disease Control and Prevention. Um our lab or our National School of Tropical Medicine does a few of them, but it's not like, you know, when you go for a you go for blood work in your doctor and you get a little lab slip from Quest Diagnostics with the, you know, the blood chemistries, the blood counts. There's no box there for toxocariasis and Chagas disease. So we need more improved tests, point-of-care diagnostic tests. Not just improved tests, but just letting you know something like that. Yeah, and so they don't have to send it off to the CDC or to, you know, our National School of Tropical Medicine. Is there a treatment for toxo? There is a treatment for toxoplasmosis. What is it? Um it's a pyrimethamine sulfa drug. But it requires a long treatment course. How long? Uh I'd have to look up the number of

81:05days. I haven't treated a patient with toxoplasmosis in a while, but And it it kills it effectively? It can, yeah. Really? Yeah. Oh, I thought it was something you you kept for life. Well, if you don't get treated. Right. Yeah. Okay. So more And then if you're immunocompromised and it comes back, then that that's a problem as well. Mhm. So most people that have it really don't even know they have it. That's right. Yeah. And actually and most people who have neglected tropical diseases don't know they have it Yeah. So that in Texas for instance, we have transmission of a parasitic disease called Chagas disease. It's a cause of heart disease. Um we you know, our members of our faculty were actually able to track down individuals who had donated blood uh and the Gulf Coast Regional Blood Authority actually found uh somebody people positive for Chagas disease. They were told to go see their

81:57primary health care provider. Uh and then unfortunately, the primary health care provider is not educated about these diseases and they just assume must be a false positive. So, you know, our faculty had tracked them down and were able to get them into treatment. And what is the treatment for Chagas disease? It's a It's a an anti-parasitic agent called benznidazole. And that kills it? That can kill if you catch it early enough, but sometimes you don't catch it early enough. it becomes systemic, then you have Then that's why we're trying to develop a therapeutic vaccine for this disease. Oh. But again, it's a therapeutic vaccine for a poverty-related disease, so it's it's very tough. God, man. So the point is these diseases are widespread among the poor and we just don't pay attention to them. Yeah. That's great. It's And so I think, you know, again, I'd love to hear your

82:42thoughts. I mean, what is it that um we just turn our backs on the poor in this country? It's uh It's disturbing. It's very disturbing. dismissive attitude. And and and they disproportionately affect people of color as well, right? Because um you know, because it's so linked to poverty. Well, also right, slavery. Yeah, I mean I mean the history of slavery in this country, then the the history of systemic racism in places where they just literally would not sell homes to people who are African American. All these things are connected to the the the contribution of maintaining these impoverished communities and there's been almost no effort whatsoever other than the people living in the community trying to do better and raise everybody up. Right. There's been no effort whatsoever by the federal government to step in and try to rehabilitate like a a large-scale

83:31approach to rehabilitating places like the ghettos of Houston or Baltimore or You know, Detroit. I thought I knew what poverty living I was before I moved to Texas in 2011, I was chair of microbiology at George Washington University and I thought I I thought I knew what poverty looked like. I moved down to the Gulf Coast and it's a different animal. I mean, the the depth and breadth of poverty in the Gulf Coast in the southern part of the United States is just extraordinary and it's been very hard to get people to um want to really take it on and really address these these poverty-related diseases. Do you think What do you think the cause of it is? I mean, if you've you've studied this for quite a while. What the cause of the neglect? Yes. Yeah, I don't know. I don't know. Well, you know, is it something about American exceptionalism or something that we just don't want to admit we have

84:23poor people? Uh I don't know. You know, I wasn't the first to come up, you know, to raise this issue about poverty. When I was in high school or junior high school, I was forced to read a book and at the time I didn't care about it. It was called The Other America. It was written by uh uh fantastic um social activist named Michael Harrington, um who was a I think someone told me he's a very devout Catholic actually. And so and he wrote this book called The Other America. It talks about the hidden poverty off the road. And the actual number of people who live in extreme poverty hasn't changed since that book was written in the early '60s. That book was help was what helped Lyndon first Kennedy then Lyndon Johnson launch the war on poverty in 1964. I dusted off that book and it still it still works today and that's how I start out talking about my book Blue Marble

85:12Health about that book The Other America by Michael Harrington. Yeah, that that is a very strange thing our acceptance of these communities and I mean, I've always said that if you want to make America a better place, the best thing to do is not invade other countries or intervene. The best thing to do is try to rebuild these impoverished communities. Yeah, well, Gandhi Gandhi a way out. Gandhi once said a civilization is judged by the treatment of its minorities and we're not you know, by that criteria, we're not doing so well. You know, the we our country was visited by the United Nations Special Rapporteur on Poverty in 2017 and his numbers came up with we have 19.4 million Americans who live in what's called extreme poverty. That is at half the US poverty line and roughly around 5 million Americans living on less than $2 a day, the same benchmark it used for global poverty

86:11everywhere. Yeah. And and guess what? Those probably all have neglected tropical diseases. 5 million people like just like those living in extreme poverty in Africa and everywhere else. people living on $14 a week. $2 a day, yeah. That's insane. Yeah. The University of Michigan Center on Poverty is 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. Jesus Christ. Yeah. And again, this is not a topic that is very popular. I mean, when when you see presidential debates, this is this is not something that comes up. No, nobody talks about it. And again, even for disease, I mean, who What are the diseases we hear about? Ebola and diseases like that and sometimes in my frustration, I say, you know, we're these are imaginary diseases and yet here we've got widespread

87:05diseases of the poor in the US and the lights go out. You remember when that woman came back from Africa and she was a nurse and she had been some in some connection contacted with Ebola. She didn't have it and they wanted to quarantine her. Oh yeah, and they they stuck her out in some cabin on the airport or something. It was terrible, yeah. What did you think about that? I just thought it was so cruel and uh Is it just a an ignorance of how it's transmitted? right. How is it transmitted? Well, actually Ebola, you know, it turns out it's the opposite of measles. Measles is one of the most contagious diseases known. It has a reproductive number of 12 to 18. What that means, if a single individual gets measles, 12 to 18 others get it because the virus hangs around in the environment and it's so easily transmissible. Hangs around like a if you touch this table or a table.

87:57right or even in the even in the atmosphere. So um and that's why you get these really large measles outbreaks like you're seeing in Washington State. Um and and usually those are infants under the age of 12 months not yet old enough to be vaccinated. They're the ones who wind up hospitalized and and sick. The um Ebola is just the opposite. Ebola has 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 cuz 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 um the reason it's being so hard right now to contain in Democratic Republic of Congo is not because it's so highly contagious. It's just that the place is is decimated by the collapse in infrastructure associated with civil

88:45war. So even though we have now an Ebola vaccine, it's hard to vaccinate everybody. And how is it transmitted? Uh Ebola by contact with fluids of somebody with with Ebola. So it has to get into your tissue somehow or another. Right. Right. Oh. What else should we worry about? You're freaking me out. Well, uh what the the point is a lot of these diseases are solvable if if we just put our mind to it. So one of the things I even aware of it? I mean, it seems like of the things I say in the book is if 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 to 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 2/3 of the world's poverty related neglected

89:36diseases right off the bat. Wow. So, a lot of it is political will or ignorance or lack of awareness and political will. Well, it's 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 Chagas, I didn't know about a lot of these other diseases you're describing. Yeah, I know. I mean, so we we need to raise awareness about these That's why I'm so thrilled to 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 to different name from global health to to separate separate it from the two. Um so, you know, coming on here is so powerful in terms of amplifying that message. So, again, back to the magic wand, what what could be done? I mean, is it a funding issue or is it a first before

90:28that an education issue? Well, I think the there's multiple issues. So, I mean, if again, the the drivers we've been talking today about promoting these diseases really tough to do anything about extreme poverty, um 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, uh 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 uh access to getting the the the pharmaceutical companies involved as well. It also seems like it it would this would cost an insane amount of

91:24money to just go through all these poor communities, test everyone, and start distributing these these drugs, and what would pay for all that stuff? Well, you know, some people have asked me, well, what would the Affordable Care Act take care of this? And I said, well, we're two steps away from the Affordable We're two two two standard deviate not two standard deviate two degrees of separation away from the Affordable Care Act cuz we're not even having recognizing these diseases. Yeah, you got to know about it first. I mean, most I I would What percentage of the population even knows about all these Right. all these parasite created diseases? Or know that vaccines don't cause autism. Yeah, well, that one is a that that's the biggest one, right? I mean That's a tough one. And again, I don't understand it. I mean, I'm just saying it. I'm saying vaccines don't cause

92:13autism cuz you're saying it. Right. You know, and I think this is the part of the boat is a lot of part of the problem we're in this boat with a bunch of people who are scientifically illiterate like myself. We're discussing these issues who don't really know what they're talking like I I saw someone talking about tetanus cuz some boy um had uh tetanus and he was in the hospital for a long time and his his bill was hospital bill is like a million dollars. Okay, yeah. Yeah. Well, cuz it's an ICU admission, right? Right. And they were saying, hey, you know, why didn't this kid get a tetanus shot? And it goes back to the same thing, right? That people don't want these vaccines. Yeah. And that could have prevented it. And again, I don't blame the parents. I think the parents in some ways are victims themselves. They're victims of this very aggressive misinformation campaign that's out there.

93:00Tetanus is a big one though, isn't it? Yeah, tetanus and we have a vaccine for it. That's part of the what's called the DPT. That's one of the first vaccines you get as an infant. There's no excuse for having a tetanus case in the United States. Right. And this kid was unvaccinated, right? Right. Yeah. That's my understanding. Yeah. I mean, is there a cure for tetanus outside of vaccines? Well, I mean, there are supportive measures that you can do, um but you know, they require um hospitalization, ventilation, putting on a respirator. Mhm. It's it's a bad and you could still die. So, it's a it's an awful awful disease. I've seen tetanus working in Central America and elsewhere. You see a case of tetanus, you never forget it. What what is tetanus technically? Well, the other name is lockjaw where your muscles go into spasm and um and uh you and including the muscles

93:47involved in breathing, so you can't even breathe as a result of it. It it freezes the muscles. What is What is doing it? What's doing it? Is it a parasite? It's actually a caused by a bacteria. The bacteria releases a toxin called tetanus toxin. Ugh, that sounds like a horrible way to go. It's a terrible I mean, these are awful diseases and I think one of the things that the anti-vaccine group or lobby as I call it does is they try to be very dismissive of these diseases. They try to deliberately downplay the effects. I mean, you'll see the stuff on the web, measles build your immune system. I I've seen that. You said it yourself. So, you you said you saw that somewhere. I didn't read it. I just saw it and I said that doesn't make any sense. Let me ask. It's it's crap, right? And um Well, what are they saying? What is What is the They're saying it's just a rash, it

94:36builds your immune system, it makes you stronger, it's it's it's something out of from a different planet. I don't know where they're coming But we do I think the reason for that becoming popular is because you we do kind of helicopter parent our kids a little bit too much. They should come in contact with a bunch of different things cuz it does build their immune system, correct? Well, that's an interesting hypothesis called the hygiene hypothesis that says um you know, if your kids are living in too sterile environment, then um this can also result in autoimmune diseases and things like that, but it allergies allergies and uh I have mixed feelings about the hypothesis. To me, it's not not airtight by any means. Airtight, but it's there's there's some sort of a correlation particularly between peanut allergies and keeping peanuts away from children. And that there was a study shown that

95:26Jonathan Haidt's work uh in one of his books talked about how there was a study done in communities where they didn't protect kids from um peanut allergies and there's much smaller percentage of people developing peanut allergies versus kids that they did. Yeah. Yeah. Well, this is also one of the things that the anti-vaccine lobby is doing now. They're they're you know, when I write a book like this, vaccines don't cause autism. Now, what you're seeing, remember I told you about that whack-a-mole business where they went from MMR to thimerosal to spacing vaccines too close together to aluminum. Now, there's some groups that are moving away from autism altogether and now they're saying, well, vaccines cause autoimmune disease or vaccines cause other neurologic deficits. But it's all it's all flimflam. It's all flimflam. What is But there are there are vaccine courts

96:15though, right? And vaccine courts courts, yeah. And they have handed out payments to people who were injured by vaccines. Right. What is What is that? So, um 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 2015. Um 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 could be that they have a table of that they could attribute to vaccines. So, there were 2,000 payouts and of those 2,000, 80% they didn't really think were attributed to vaccines, but they paid it out anyway cuz 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

97:16one in 10 million. Or even 2,000 by 2.5 billion, it's still one in a million cases. That's one in a million, yeah. And these cases uh what was happening to these people other than the shoulder injury that you were talking about? a there's a list and I talk about it in the book. There's actually a table you can download on the web of for each vaccine a list of potential injuries that they allow. And these potential injuries is it as we were talking about earlier, is this just biological variability that some people just react differently to different things? I think in some cases we don't know. In other cases, you know, with the live virus vaccines, if you have a severe genetic immune deficiency and maybe it wasn't picked up, then there then there's that risk. But you know, what's what's a one in a million? What's a one in a 10 million risk? As I said, we have to keep that in perspective

98:05because 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. And the real danger is these actual infectious diseases spreading and the damage they could do, damage they like tetanus back, yeah. Yeah, measles is is a is an awful disease, causes measles encephalitis, measles pneumonia. I find that a lot of people that are um that are steadfast in their uh resistance to vaccines, they they also believe in a lot of other questionable things. Mhm. It seems like these things get lumped into these groups of things that they don't trust the government about. Right. Right. Yeah, I think that's part I think that's probably true. Yeah. Uh that's what it talks about our sketchy government.

98:58was which was Well, you know, it was interesting. So, you know, I said, you know, we need to hear from the Centers for Disease Control more in the Surgeon General. Now, they're starting to speak out. But you know, the people who counter that say, well, part of the problem is people don't trust their government. I say, well, that's true of some, but I think most people, if you know, if you we had a, you know, more visible public health force out there, people would listen to it. Well, I think that what you're talking about in terms of these poor neighborhoods and these parasites getting into people's system and affecting cognitive development. And what it What was the other one besides Chagas? Was it Toxocariasis was the one that affects cognitive development. And the fact that there's actual cures for these things, too. I mean, that I estimated in a paper there are 2.8

99:42million African Americans living in poverty with toxocariasis. Wow. This is not a rare disease, Joe. This is This is a common disease. But it's so unknown. But it's occurring among the poor and it's a chronic and debilitating infection. It's not dramatic. It's not not Ebola. It's not killing people. Is this mostly in warmer climates as well? It's probably it's more in common in the south than in in the north. Is it because they have long longer time to to to stay alive? Is that are the eggs are in the environment and the worm develops within the egg. Is there any other diseases that are going on that we don't know about? Um yeah. unaware about? Yeah, sure. Um there's other There's a brain parasitic infection called cysticercosis. Where's that one from? That one is from eggs, often from individuals who have a tapeworm. Uh so that's we're we're seeing cases of that.

100:33Um there's uh 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. Mhm. Um that's got very high rates of not only encephalitis, but also uh one of our faculty members, Kristy 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. West Nile virus does come up though. At least that's discussed in the news and people are aware of it. Right. Right. Right. But there's no vaccine. There's no vaccine, but there could be. What is it? There could be. What's What's What's holding it back? What's holding it back is lack of market forces. Lack of financial incentive for the pharmaceutical companies to take it on. Um so if there's an extremely large

101:22investment to develop something along those lines. Is that what it is? I mean, and vaccines are from an investor's perspective a tough sell because you know, there's a possibility, you know, first of all, you need many years of clinical trials. It can sometimes take two decades from the original conception of a vaccine to actually going through clinical trials. So the hookworm vaccine I've been working on, uh we've been doing it uh since the 1990s. So we're talking decades-long time horizons. When you talk to an investor about something with decades-long time horizons, you figure it out, right? The light The lights go out. I mean, the uh very very quickly. That's where it gets gross, right? Because this is all we're relying on these private businesses Right. money to cure a public health issue. That's right. That's right. That seems kind of crazy. Well, so in response to that, what

102:14happened 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, and including the Gates Foundation, and they put around They put developed this concept or which an organization called CEPI, the Coalition for Epidemic Preparedness Innovation, to incentivize uh biotechs and pharmaceutical companies to embark on uh diseases for which of pandemic potential like Ebola, like Lassa fever, like MERS coronavirus infection. And that was great, but the problem is 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 they they need to have some sort of financial incentive to

103:14attack these diseases. That seems like a crazy way to deal with health crisis. That's right. That's right. And so what I've recommended is I said the 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, um these are the 20 largest economies, to put together public sector funds uh for that purpose. Public sector funds for investing in developing vaccines and treatments? For poverty-related diseases, these chronic debilitating diseases. And in fact, you know, we can show that the using working with health economists, we actually work with a terrific health economist, his name is Bruce Lee of all of all names. He's a professor at Johns Hopkins. Seems like he would change his name. Yeah, right. Uh he loves it. Um and he's able He's been able to show

104:07um 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 you still doesn't help you with the fact that you still need some, but the return is on public health. Yeah. need somebody to come along and provide that investment. Yeah, that's true. so what's happened is our our technical ability to develop vaccines has outstripped our our our financial instruments that we have to do it. So I get a stream of young people uh 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 in 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

104:54disappointed when I tell them get an MBA or get a law degree because where we need the innovation now is in the in in the finance sector. Mhm. There's a There must be a business model out there that would work, that would figure out how how to do this. I just don't have the background to do it. It seems like once the momentum is in the corner of this being handled by the private sector, and that the private sector has to develop these vaccines and these treatments, and they have to do it with some sort of 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. That's right. That's right. So that's crazy. It's crazy, but that's the reality. And so um what the exciting thing about what I do is, you know, developing these vaccines for poverty-related diseases, there's no road map. Right now that we're in clinical trials,

105:45I don't know what the road map is to get to licensure and getting these vaccines out to the public. The terrifying thing, the thing that keeps me up at night, is there's no road map. Right. So, you know, it's both good and bad. There is How much does it cost to get a vaccine, I mean, in general, from developmental period to actual application? Well, the pharmaceutical companies have traditionally said billions, but I don't think that's the case. I think one of the reasons um you be they're doing that is because they're also recovering their R&D costs. You know, they're putting money into R&D that they that they that they charge in order to you know, either make a profit or at least break even. So for instance, the cervical cancer vaccine, the HPV vaccine, that, you know, when I last looked was $420 for the three doses. It doesn't take cost $420 to make that vaccine. It It's just that

106:45they're recovering their R&D costs, which is 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 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. Uh we'll just, you know, that was used for R&D, and we would just cost for the cost of goods. So at least we can get it down to just a couple of dollars a dose, a few dollars a dose. Now, for anybody that's listening to this conversation and they have additional questions, where's the best place you should guide them? It would it be your books? Probably the books cuz I wrote the books for lay audiences. Lay audiences sort of. I mean, somebody with a college university education, but I mean,

107:36they're not you know, it's they're they're published by Johns Hopkins University Press. So it And they are kind of they're uneven in terms of how weighty they get into the science, but certainly the vaccines not cause Rachel's autism. I wrote it with the idea of parents, vaccine-hesitant parents, and also the pediatricians. Cuz 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 in loaded loaded for bear into the pediatrician's office with all these factoids, and the pediatrician's like, well, gee, I never heard that before. And and then the pediatrician is made to feel stupid like he's not keeping up with the science. He is or she is, but it's just they're not keeping up with the misinformation. So I provide talking points in the epilogue of the book. And Blue Marble Health is the best

108:25resource for people to understand these About diseases of of the poor in wealthy countries. Then I have a third book that I wrote a few years ago called Forgotten People, Forgotten Diseases that describes the neglected tropical diseases. Well, I really hope that what comes out of this is someone gets motivated to create some sort of a documentary really on both subjects. I mean, I think that we would greatly benefit from some clarity for people that do have concern about autism that's in a digestible form. For good or for bad, people like to watch documentaries. Right. I I hope you don't get too beat up over this because I know the anti-vaccine groups are very passionate and Well, I I I don't have a position. I mean, I know why they would beat me up. Well, they That's Well, they beat me up a lot. I can say sure they'd go after you and they already call me a shill. They call me a

109:13shill for a lot of things though. Being leaving the round earth. Jamie has a t-shirt that he sells at youngjamie.com. It's round earth shill. Right. Literally. I've been called a round earth shill. So, people believe the earth is flat. There's a lot of those. I don't know if you know. I didn't know that. There's a lot. So, you get beat up no matter what if you're talking. But, so but I really think it would get be it would do a good service if somebody did put together a documentary because I don't think most people are I think most people are just relying on this fear like that vaccines do cause autism. Um there's also this connection between people that are older, correct? When when they're older and they have children, there seems to be a lot more likely There seems to be and that may be related to as you get older, your sperm or your egg have some genetic

109:59instability and more likely to produce mutations. Yes. That's probably the mechanism. That would go hand in hand Yes. with the genetic basis of autism. Um and then the Blue Marble Health book, I mean, what what you've been saying today about these diseases and how many of them exist and how many of them are almost unknown, untreated, Right. undiagnosed and just how many people are unaware. Um I really hope that someone does something about that too. But, in the meantime, people can buy your books. Are they available in audio as well? Um definitely The Vaccines Did Not Cause Rachel's Autism is audio books and I'm not sure about Blue Marble Health. Okay. But, you can get it on Amazon. Well, thanks for being here. Appreciate it. It's good to see you again. Well, thank you for raising awareness of all this stuff. I really appreciate it, Joe. My pleasure. And I appreciate you coming

110:45down here and explaining a lot of this stuff for us. It's been a great time. I really enjoyed the opportunity. Um if people want to get a hold of you on Twitter, what is your Twitter handle? Just @PeterHotez. Okay. Thanks, sir. Appreciate it. definitely have done. Yeah, I'm sure