So Many Vaccines, So Much Misinformation

FMC Fast Chat takes you inside the news so you can be in the know in 30 minutes. Hosted by Fair Media Council CEO and Executive Director Jaci Clement, Fast Chat features notables in news, media, and business.

Today's episode is So Many Vaccines and So Much Misinformation, and I am so pleased that our guest today is Dr. Ruth Karen, who is Director of the Johns Hopkins Vaccine Initiative, as well as a pediatrician. So we're thrilled to have you with us, Dr. Karen. And for the next 30 minutes, I'm going to try very hard to ask you every question I can think of, which is a lot.

Well, thank you so much, Jaci. It's really a pleasure to be here with you, and I look forward to it.

Well, I guess let's just kind of broad stroke it to start out, because what happened is, A pandemic rolled in, the world shut down, and then along came a vaccine. And you would think that would've been the answer and everyone would've jumped on board and said, okay, let's get our vaccines and let's get the world back up and running. But it didn't quite happen that way. So from my perspective, I blame part of that on the mainstream media of not really reporting what was going on very well.

Mm-hmm.

Putting out some misinformation, maybe not understanding the information that health providers were giving them, because what we see a lot of, you know, is a general assignment reporter who today covered banking and tomorrow is covering health, and they don't know, you know, the ins and outs of the subject. So from your perspective, how do you think things rolled out once the vaccine was announced?

Well, What do you think? First, I would just say that to those of us who had colleagues working on these vaccines, and so many of us were involved in one way or another in 2020, either in vaccine development and the vaccine evaluation and providing information about these vaccines, it was astonishing. I think the general public may not have understood how remarkable it was that we had a pandemic declared in March and we had vaccines that had emergency use authorization, EUAs, in December. I mean, that was breathtaking. I think part of the problem really was exactly as you say, Jacqui, that not all of the reporters were well-versed in science, although I do think On the one hand, it's wonderful for me as an academic scientist, pediatrician, to be able to talk to reporters who have good backgrounds. And there are reporters who have remarkable backgrounds and are incredibly sophisticated. But I do think it's our job to be able to communicate across a range of experience and proficiency and to make sure that people can understand. So I think really what happened is it was faster perhaps than people ever imagined this would happen.

Yeah.

These were new kinds of vaccines, mRNA vaccines. We'd never had mRNA, you know, they— we had mRNA vaccines tested, but we'd never had an mRNA vaccine licensed before. So this was a new platform and people were unfamiliar with that. And I also think that in terms of COVID itself, our information was evolving. And I think people tended to think about things in absolute terms. And I do think that there was great effort to communicate what we knew when we knew it. There was a lot made, for example, of the fact that in March we weren't telling everyone to wear masks. And later on, we told everyone to wear masks. Well, that's— it's not that we were trying to pull the wool over anyone's eyes or provide misinformation.

Yeah.

In March, we really didn't know how important masks could be. And later on, we figured that out. So I think it's a combination of, as you say, reporters who may not have been as experienced, But I also fault us in all of our communication efforts. The other thing I would just say, and this is something I feel strongly about, and it goes back to the issue of understanding science and the scientific process, is I think we have to do a better job of science education all the way through, starting with our youngest kids. So.

Yeah, fair enough. Now, there There is the general, I'll say misconception that, and I still hear it today, which is, I got my COVID vaccine, therefore I shouldn't have been able to get COVID, but I did. So I think part of the problem, if I understand this correctly, is if you break it down to a very basic level, there's 2 different kinds of vaccines. The kind of vaccine that is absolute and you cannot contract anything if you get that vaccine, And then you have the other kind, which is you may contract it, but you will have symptoms that are less severe. So is it fair to say that there's basically 2 camps of vaccines and the idea that if you get vaccinated, you're 100% out of the woods is—

Yeah, I would say that there are more vaccines than you might think that are in that second camp that just prevent severe disease. And I will, you know, I think part of it was we were a little bit victims of our own success early on. We, you know, at the very, very, very beginning, the scientists, the regulators at the FDA, everyone was saying, what is the purpose of these vaccines? The purpose is to prevent severe disease and death. That is the purpose.

Yeah.

We had vaccines that not only that absolutely did that, but not only did that, with the original variants that we had, they actually prevented any COVID disease pretty well. That has become less true. The vaccines, you may still have mild or even moderate disease if you're vaccinated and then you get COVID, but these vaccines continue to do very well at preventing severe disease and death. So I think we have to These are magic bullets, but they're not— they don't give you complete protection. And I think we have to accept that. And I, you know, opinions vary. I think it is myself, I think it is unlikely that we will ever have a vaccine that completely protects against any kind of infection. You know, a runny nose, a cough, a sore throat. But we may have better and better vaccines in terms of protecting against all but the very mildest disease.

And are you talking specifically for COVID or in general?

I'm talking specifically for COVID. Specifically for COVID. We do have vaccines that, you know, I'll give you an example, measles vaccines, Prevent measles. Prevent—

Period.

Yes, period.

They do. Okay.

Yeah.

All right. And so one of the things we're seeing now is polio back into the water, the New York City water system, and to some extent, Nassau County. I'm here on Long Island. We've gotten reports that polio is back. Now, I thought that had been eradicated. So to see polio popping back up, one, I don't understand that. But 2, now the polio vaccine is one of those, if you get the polio vaccine, you don't get anything related to polio, correct?

Right. You, well, you don't, you don't, you, you won't get polio, that is for sure. You know, one of the things, you're right, we haven't, polio is not like smallpox. We hadn't totally eradicated it from the world. We hadn't had cases. in the United States for decades. And then there was a case in a person who was unvaccinated in New York State. In addition, so for polio, the ratio is about 100 to 1. So for every case of polio that you see, we think there could be as many as 100 people that are infected But asymptomatic or might have a little bit of diarrhea, but certainly don't have polio as we know polio. You know the real problem in New York State has been that we do have pockets of you know we have we have areas where only 30% of children have gotten their polio vaccines, and so those kids are at risk. Those kids are absolutely at risk, and we. need to do a better job of communicating those risks. I don't know that we would've predicted polio here back in the US, but I think all of us are very sensitive, particularly we who work in the vaccine world, about measles because measles is one of those germs that if you're not— if 90— it has to be something like 98% of your population has to be immune to prevent a measles outbreak. And we— so if you fall down, if you fall down on your vaccination rates, you can easily have measles outbreaks. And as you know, we've had the Disneyland outbreak, for example. But we need to do better at instilling vaccine confidence is, I guess, the way I would put it.

Yeah. And I think that's a great segue for the conversation because so many people are afraid of the vaccine. Now, I don't know what's going on, if there's a new emphasis on direct marketing or something, but it just seems like all of a sudden all this information is coming at me that I need my COVID booster, I need a flu shot. Did I get my polio vaccine when I was a child? Go ask your mother if that happened or not. Shingles, monkeypox. It just seems like suddenly there's a new push on vaccines for everyone to be vaccinated. And it makes you wonder, well, if I do get all these vaccines, will there be some sort of interaction between them? I don't know if it's safe to get all of these. And, you know, how do I know I'm not going to grow a second head at some point if I do get all these vaccines?

Sure. Well, you know, there— it's funny that you should say a second head because there were cartoons, you know, smallpox was really the very first vaccine that we had and it was developed by, you know, Edward Jenner in the 1700s. And there were cartoons of what might happen, and it was actually poking fun, it turns out, at some of the anti-vaccine people. But what would happen if you were vaccinated? And it was made at the time, it was a virus derived from cowpox. And so there were pictures of people growing cow heads and those sorts of things. So the So that kind of fear has been around for a while. You may be right about that there's more direct marketing. I will say that a lot of these vaccines are not new. So for example, the shingles vaccine, the first one was licensed back in 2006. That was Zostavax. And the later one, Shingrix, was licensed in about 2017. So these aren't new, though I think people, perhaps because of direct marketing, people are hearing about them them a bit more. We know that— so I think when you ask about, can I get all these vaccines, I think you're asking a couple of questions. One question is, how many vaccines can I get at one time? And the other question is, just in general, is it all right for my body, for my immune system, to get lots of vaccines? I think Probably those 2 questions. And so I— so there are certain combinations of vaccines that we've studied that we know are okay. For example, we really do know it does really seem that it's okay to get the COVID vaccine and flu vaccine simultaneously. And we're taught, you know, you— I'm sure you've heard the campaigns. It makes a lot of sense for people to get these at the same time. In terms of the bigger question about Oh gosh, what am I doing to my immune system? One of the things that I think it's important for people to recognize, and this is talking about people who are not immunocompromised, who don't have particular or don't have autoimmune diseases, don't have particular diseases of the immune system. But for people who don't have those, we are bombarded with microbes, right, with bacteria and viruses every single day of our lives, right? What we get in a vaccine is a drop in the bucket compared to all of the things our immune system is exposed to. And our immune system is— it's made for this. It's made exactly to recognize something is foreign and to make an immune response against it to protect us. And the whole idea of a vaccine ideally is that you get all the advantages of being exposed to the infection without the disadvantages of actually becoming ill from an infection.

Okay, well, is there such a thing though? Can you be too vaccinated? What, what about just the body's natural response to fighting something off?

Well, I think so. So I don't think you can be too vaccinated. And let me bring it back, for example, to COVID, because I think this is a great example. So I think the silver lining to the fact that COVID doesn't— these COVID vaccines don't absolutely prevent infection, they make it a milder infection. is that you get something called hybrid immunity. So you get, it's like a one-two punch in the best possible way. So you get your vaccine-induced immunity, and then if you have a mild infection when you've already been vaccinated, the vaccine keeps it from becoming more severe.

Okay.

But you get the kind of immunity that you get from natural infection. And there are some data to tell us that this kind of dual immunity, this hybrid immunity, is actually the best kind of immunity. It doesn't mean we should all— we who are vaccinated should all run out and try to get COVID. It doesn't mean that. But it means that because I think honestly it is inevitable. I think those of us who've not had COVID, sooner or later I think we will get infected. But when we do, particularly if we have vaccine on board, that infection will be mild and we'll have that dual immunity.

How much though, is it realistic to expect people to keep running out the door to get another vaccine? I think that was one of the conversations early on with the pandemic was we can't, well, one, as a country afford to continuously offer free vaccines to everyone, but 2, also for people to expect to become sort of a routine with now yearly or semiannual or multiple times during the year getting a vaccine. How does that play out in reality?

Yeah, so I agree with you. One, I know there's a lot of vaccine fatigue. I hear it. And by the way, there's vaccine fatigue across professionals, non-professionals. I mean, everybody, everyone.

There's pandemic fatigue.

Oh, that's good to hear, actually. Well, I won't say vaccine fatigue. There's COVID vaccine fatigue a little bit, you know, both pandemic fatigue and COVID vaccine fatigue. I'm sympathetic. I truly am sympathetic. I think what we will likely need to plan for is though is annual vaccination. As I said, fortunately it can be given at the same time as flu vaccine. So you go in, you get your flu shot at the CVS, or other pharmacy, you get your COVID vaccine. I agree with you that it's not realistic to imagine that people are gonna get boosters more than once a year. I do think that for the average relatively healthy person, that's about as much as we can ask. I would though say that we, you know, there are, perpetually these new variants. We've— there was just something in the paper this morning about some of the new variants that are arising in Asia and in Europe. And I think our current best protection against those is our booster vaccine. And, you know, only about less than 10% of Americans, of adult Americans, have gotten their boosters.

That's crazy when you think about it.

Yeah.

Now though, I get a little confused with the boosters also. Is it a booster per variant? Or if I just got a booster and a new variant comes out, is my current booster at all effective against the new variant?

That's a more complicated question than it sounds like. It's a really good question. So the answer is that yes, your vaccine has some effect against the variants. And we know that vaccinated people who are vaccinated with a vaccine containing that very first strain of SARS-CoV-2 virus, that very first one still had some protection against Omicron variants. But we know that the current vaccine, which is bivalent, which contains that original strain and Omicron strain, seems to give you better antibody protection against the new variants than just the old one all by itself.

Okay. All right. So if I'm looking at vaccines, I'm trying to shorthand this for, especially for people that, you know, General public doesn't like to read a lot, or, you know, the attention span has diminished a lot in recent history, for which we can also blame the media partially for that. So if I'm looking, though, I want to take care of my health, I want to make sure I'm taking care of the health for people around me as well, because I don't want to be that guy who infects other people, right?

Mm-hmm.

Is the key to it looking at the effectiveness of a booster or a shot? Because I know early on, I got the Moderna shot early on and that had something like, I don't know, a 90% effective rate. When I see that 90%, should I be thinking I have only a 10% chance of catching anything? How does that work?

It's a very good question and part of it is protection against what? As people are doing these studies, You know, it's protection against illness. It may not be completely protection against infection. And in particular, one of the things we are learning and we do know is, and we hope we'll have better vaccines for this in the future, is that these vaccines after a few weeks probably aren't gonna do a lot to prevent transmission.

Oh, okay.

So if your neighbor wants to be protected against COVID, they should not rely on your immunity. They should go out and get their very own COVID vaccine. Some of our, by the way, some of our vaccines do a little, that's called herd immunity. Some of our vaccines do a little bit better at protecting other people in the community, but our COVID vaccines so far don't. We think that maybe there could be vaccines say given by nose drop or nasal spray that might do a little bit better at protecting against that transmission.

Now, the other thing that always comes up in conversation is for people that have small children. There's always the concern of, is the child too young to receive vaccines like this, or even for pregnant women? Can you shed some light on how do we know if these are safe for Both young children and for pregnant women.

Right. So, um, so I'm going to start— even though I'm a pediatrician, I'm actually going to start with pregnant women, and I'll come back to children in a minute because I've done a fair amount of work on vaccines in pregnancy as well as vaccines for children. So one of the really important things, Jacqui, when we're thinking about this is the comparison should not be vaccination to nothing and no illness. The really good, the appropriate, in my view, the appropriate comparison is vaccination to what happens to somebody who gets COVID who's not vaccinated.

Okay.

And in pregnancy, one of the things we know is that pregnant women are more if you compare them to non-pregnant individuals of the same age, they are more likely to have bad lung disease, to end up in the hospital, to end up in intensive care, to have premature labor and premature birth.

Right.

So there's more risk to a pregnant individual of COVID than to somebody who's her same age who is not pregnant. In addition, we know 2 other things. One is that we've actually had an opportunity to assess the safety of these vaccines in pregnancy, and we've shown that the vaccines are well tolerated and that the rate of, you know, Unfortunately, things happen in pregnancy. People unfortunately do have miscarriages and do have preterm births, but the rate of those in vaccinated individuals is no higher than the rate in unvaccinated individuals. So we don't think that there's vaccine-associated risk with getting the COVID vaccine. The other thing that we know, and there was a very important study done by a colleague of mine and her colleagues is that babies born— because antibody goes from mother to baby across the placenta—

Mm-hmm.

Babies born to pregnant women who got vaccinated were less likely to get hospitalized with COVID in the first 6 months than babies born to unvaccinated women. So there's benefit to the mother and there's benefit to the baby.

Wow.

So that's the story on pregnant people.

Okay.

Thinking about children, it is true, thank goodness, that in general COVID has been less severe in children than it's been in adults. But COVID infects everyone. As we know. Absolutely everybody. And there have been 1,500 child deaths from COVID in this country.

Mm-hmm.

500 deaths of children under age 5 from COVID So this is— children die of this disease and children are hospitalized with this disease. So it's not— this is not a nothing. And I think it's important for people to be aware of that, to understand that.

Okay.

I think one question I really want to ask you kind of relates to the now. So we did the past pretty well, I think. You know, we're hearing messages, a lot of messaging saying, you know, the worst is over or COVID has passed. But I don't think that's true given the fact that you know, we see more boosters coming out and more variants coming out. But invariably, the conversation generally turns to, you know, if you have questions, turn to your doctor and talk to your doctor, which is good advice, except is it really fair for us to expect our, you know, our family medicine doctor to be up and understanding these vaccines and these technologies that probably came along after my doctor graduated medical school? You know, I don't know if I can really rely strictly on my doctor is my question.

Right.

Well, one thing I will say is that I think there has been a lot of outreach to doctors. And I think doctors, it's a lifelong learning process. And I think most busy primary care physicians are remarkably, in my view, able to keep up. But I would just say that there are other resources for people. And I know that you're very, very much focused on good information and not misinformation because there certainly is also a lot of misinformation out there. And I would really point people to the CDC website. And we can, you know, maybe afterwards I can send you some links and we could post those.

Please.

The CDC has wonderful information, accurate, timely FAQs on, you know, everything from I've been exposed, I am vaccinated, I'm not vaccinated, how long do I need to isolate, how long do I need to wear a mask, all of those kinds of questions that people have to answering questions, FAQs specifically about the vaccines and the kinds of vaccines and recommendations for vaccination. And it's kept very much up to date. So I think it's a wonderful resource for providers and for, for the public.

When we talk about the need for more vaccines, but some people like me who are afraid of needles, going for a vaccine usually requires, you know, a whole day of thinking about it and getting my nerve up before I go. Is there any hope for someone like me?

Well, Yes. So I don't think we're gonna get rid of needles completely. So sorry, Jaci. It's not gonna go away overnight. But I think there are a few things. One is that people are thinking about nose drop or nasal spray vaccines. And you may be familiar with a vaccine called Flumist, which we give to some children, and that's by nasal spray. And the idea that aside from the fact that for people who don't like needles, it's not a needle, is that it gives you an immune response up in your nose and your throat as well as throughout your body. And that, that might actually help ward off some of that initial infection. So that's one thing. And then the other thing is that there are these things coming out called microarray patches or MAPs is the acronym. And they are little, It almost feels like just little, almost like Velcro. Think of it kind of like Velcro on a dot that would have vaccine on it and you apply it to your skin.

Okay.

So it's almost like micro, micro needles, but you wouldn't perceive them really as a needle. That's not, that's gonna be vaccine by vaccine. Not all vaccines, it's sort of, not completely plug and play. It's not that you could put any vaccine on a microarray patch, but in the future, some vaccines we might be able to get that way. And that would be helpful in a lot of ways because it could even potentially be something you could put on yourself. You're not going to give yourself an injection, but you might be able to apply a patch to your skin or to your child's skin. It's important for us to understand what a wonderful tool vaccines are. I think it's important for people to ask questions. We, we should study safety. We have. We continue to do that. And that vaccines, as I think everybody's heard, you know, they're part of the solution.

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Thank you.