Dr. Peter Hotez brings a unique perspective to his work. As a world-renowned vaccine scientist, he has spent his career studying “neglected tropical diseases” like malaria, West Nile Virus, and Zika in the planet’s most inaccessible and impoverished places. He and a colleague coined the term. Over the past three decades, he has developed lifesaving treatments for some of the deadliest illnesses — and witnessed the tragic consequences when vaccines are not available.
He’s also a trained pediatrician and the father of an autistic daughter. In his latest book, “Vaccines Did Not Cause Rachel’s Autism,” Dr. Hotez offers his most personal account yet of the power of vaccines and the danger of an alarming trend he has seen in his home state of Texas: The growing number of unvaccinated children. In fact, he was among the first American physicians to predict the ongoing measles outbreaks that have swept across New York, Texas, and Washington this year.
This week Dr. Hotez addressed nearly 200 grassroots advocates at the UN Foundation’s Shot@Life Summit, an annual gathering of health care providers, nurses, parents, students, and citizens who understand why vaccines are vital for providing all people — especially children — the opportunity for a healthy future. That’s why the United Nations and all 193 member states have made protecting children from preventable diseases a key pillar of Sustainable Development Goal 3: Good Health and Well-Being.
I spoke with Dr. Hotez about why measles is a particularly dangerous illness, the role that poverty plays in the spread of disease, and how policymakers, advocates, and the scientific community can work together to prevent future outbreaks.
MJ Altman: Your daughter was not only a willing participant in this book, but an enthusiastic one. Why do you think she was so eager to share her experience with readers?
Peter Hotez: Part of it is because she has followed my life and my career, and although she doesn’t understand the nuances of it, she knows the humanitarian drive. So she’s learned from me and from our family the power of vaccines, and I think she felt she could make a contribution in her own way.
MA: One of the things you shared in your book is how limited the options are for adults like Rachel who live with autism. What role do you think the anti-vaccine movement has played in shaping what kinds of conversations happen around autism?
PH: Well, that’s just it and I talk about this in the book. The anti-vaccine movement is damaging in so many ways: In terms of lowering vaccine coverage to the point where now we have measles epidemics, lowering vaccine coverage so that we have unnecessary deaths from childhood influenza, lowering vaccination rates to the point where teenage girls are not being vaccinated for cervical cancer.
But there are other consequences, and one of them is that when we talk about autism at the policy level, it quickly veers toward these phony discussions about vaccines. So we never get to what autism families really need, both the individuals with autism and their families. So it has a lot of collateral damage as well.
One of the unexpected good things that’s happened out of the book is there’s this group of individuals on the autism spectrum who self-identify as “The Autistics,” who have come to rally around the book and to say, “We’re not something to be weeded out of the gene pool. We’re not an epidemic. We’re people. This is who we are.” I was very touched by it. And when I wrote the book, I never thought something like that would happen.
MA: It reminds me of a reaction I’ve seen online, that among the many things that is so hurtful about the anti-vaccine movement is this idea that parents would rather their children risk death from disease than be autistic.
PH: Especially because it’s not either or. Whether or not your children will wind up on the autism spectrum has nothing to do with vaccines. But one thing you can guarantee is that if they’re not vaccinated, they’ll be at risk of serious and potentially deadly infections from disease.
MA: It’s been nearly 10 years since The Lancet retracted the now debunked study linking autism and vaccines. Why do you think this misconception has persisted for so long?
PH: It’s grown so much bigger than that study. And now the anti-vaccine lobby has become its own media empire. There are, by some accounts, almost 500 anti-vaccine websites that are amplified by Facebook and other forms of social media. They’re now writing fake books, fake documentaries. They’ve become politicized. They mounted political action committees.
Right now the anti-vaccine lobby controls the Internet. And part of that is because we have not had a commensurate response on the pro-vaccine side. So that’s one reason why I wanted to write the book.
MA: In previous interviews, you’ve mentioned the irony of the anti-vaccine movement and how it could only exist because of the success of modern vaccines. Can you explain what you mean?
PH: When polio reached through American cities in the 1940s and ’50s, and then the polio vaccine became available, parents flocked to it because they saw firsthand the devastation in their communities from polio, as well as measles and others. So the late 1950s throughout the 1960s and ’70s were the Golden Age when communities and parents embraced vaccines. And we did such a good job getting rid of these diseases that a lot of the urgency that parents felt about vaccinating their child disappeared.
For instance, measles was the single-leading killer of children globally after smallpox was eradicated — 2.6 million children died in the 1980s. Now we’ve brought it down through UN agencies to around 100,000 cases worldwide. The anti-vaccine lobby sends out false messages saying measles is good for you, that it strengthens the immune system. In fact, in my office, I have a kids’ book called “Melanie’s Marvelous Measles.” So we need to get back command and control of communications.
MA: Why is measles in particular so dangerous?
PH: All of the diseases we vaccinate against are important: whooping cough, diphtheria, tetanus, and polio. Measles is interesting because it’s so highly contagious. It’s one of the most contagious viruses we know. When a single individual gets measles, on average, 12 to 15 other individuals will also get it — typically infants under 12 months who are not yet old enough to get vaccinated.
What that means is that to prevent measles, we have to have very high vaccine coverage in a community — up as high as 95%. Then when vaccine coverage starts to slip, measles is often the first breakthrough infection that we see. That’s why we’re seeing measles play out now in the Pacific Northwest and here in Texas. So it’s become what I call a biomarker for vaccine coverage. If you don’t see measles, it means you’re doing something right.
But if you do see measles, that means you’ve let things flip and that’s what’s happened now in Europe, in several states in the U.S., and in the Philippines due to the country’s own unique anti-vaccine movement. It’s also happening in places like Venezuela, Colombia, and Brazil for very different reasons. There, it’s not so much because of the anti-vaccine movement, but because of the collapse of health systems and the economy.
MA: Can you talk about this concept of herd immunity and why choosing to vaccinate yourself or your child is not just a matter of individual choice, but collective responsibility?
PH: The anti-vaccine movement uses these throwaway terms like “medical freedom” or “parental choice.” Here’s the real truth: The truth is that if you’re a child, you have a fundamental right to be protected against serious or even deadly infectious diseases. That’s a human right of childhood. Just like if you’re a child, you have a right to be put into a car seat or a safety belt. That right cannot be taken away just because some adult found a phony piece of information on a fake Internet site. That’s what we’re up against.
MA: Just last week, U.S. House Rep. Adam Schiff sent a letter to the CEOs of Facebook and Google urging them to address the rampant spread of misinformation on vaccines on their platforms. What role do you think these social media companies should play in this issue?
PH: I think what’s happened is the Internet has become the weapon of choice for the anti-vaccine lobby — both the misinformation websites, but also three of the major outlets now used to communicate: Facebook, Google, and even Amazon have become major outlets for the anti-vaccine lobby to promote their misinformation.
I think Google has taken some steps. It’s not as bad as it used to be. When you used to Google the word “vaccine,” you would only get vaccine misinformation. I think Google has taken some steps to ameliorate that. But the other search engines certainly haven’t yet. If you put the word “vaccine” into a Yahoo search engine, you get a disaster.
MA: You’ve pointed out that media coverage of outbreaks tends to focus more on well-known diseases like Ebola. What are some of the diseases that you think should receive more attention and why have you chosen to focus much of your vaccine research on lesser-known diseases in remote areas.
PH: They’re lesser-known and now we’ve labeled them “neglected tropical diseases,” but in fact they represent the most common afflictions of people living in poverty. They’re extraordinary numbers, literally hundreds of billions of people are infected by hookworm or schistosomiasis or chagas disease.
The problem is that because they only affect the poorest of the poor, there’s not an obvious commercial market available for them. So what we’re trying to do is pioneer the concept that we can develop them in the non-profit sector. And I’ve been doing this now since the 2000s, when I started a non-profit product development partnership. So we’re going into our 3rd decade.
Vaccine development is a slow process. These vaccines — we call them “anti-poverty vaccines” — will have an impact not only improving health, but also on reducing poverty because these are poverty-promoting conditions. The problem for these diseases is that there are not only scientific hurdles, but they’re also major business model challenges. There’s no real business model for developing vaccines for these types of diseases. So it’s both exciting and a bit scary.
MA: What role does poverty play in disease outbreaks?
PH: These neglected tropical diseases both occur in the setting of poverty and actually reinforce poverty because of their chronic and debilitating effects. The point is that poverty is the overriding determinant of these diseases. So wherever you find poverty, you’ll find these neglected tropical diseases. So the term is a bit of a misnomer, because they’re really diseases first and foremost of extreme poverty.
An example I would point to are the pockets of extreme poverty that we find even in places like the U.S. The traditional norms of global health — of looking at developed versus less developed countries — is giving way to a new paradigm where all economies are rising, but they’re leaving behind a bottom segment of society. So in many places, it’s the “poorest of the rich” as we call them that account for most of the world’s poverty-related neglected diseases. I wrote a book on this called “Blue Marble Health” to give a different term than global health.
MA: This segues perfectly into my next question. In your book, Blue Marble Health, you argue that humanity’s most neglected infections actually thrive in the world’s largest economies. Can you give an example of what you mean?
PH: Sure, and it turns out that Texas and the southern part of the U.S. has the largest number of poverty-related diseases. So our faculty, for instance, has found evidence of hookworm transmission in poor parts of Alabama. We have found chagas disease transmission in Texas.
By some estimates, we think there could be 12 million Americans living with a poverty-related neglected diseases. They’re not even rare diseases; they’re incredibly common, but they’re primarily affecting the poor and primarily affecting people of color mostly living in poverty. It’s also a social justice issue.
MA: You’ve been asked to brief members of Congress this week about the measles outbreaks happening around the country. What role does public policy play in preventing disease outbreaks and supporting effective vaccine outreach?
PH: In the U.S. there are things to be done at both the policy level and the advocacy level. At the policy level, we have these 18 states that allow these non-medical exemptions, and we were able to find that those states have the largest number of kids not getting their vaccines. Those are also the states where we’d predicted we’d see measles and sure enough, right on cue, this year we’ve had outbreaks in Washington, Oregon, and Texas.
I think what has to happen is what happened in California. California was also one of those states [with non-medical exemptions] and they had a terrible measles epidemic in 2014 and 2015 that had a huge health impact and also cost the state millions of dollars. And the California legislature said, we’re not going to do this anymore, and they closed those non-medical exemptions down. I think the same has got to happen in all of those other 18 states that currently allow them. And that is going to require doing policy at the individual state level.
But at the same time, there’s still this big vacuum in advocacy. We’re not hearing from our federal agencies like we should. So we need to step up our level of vaccine advocacy and explaining things like I explain in the book: That vaccines do not cause autism; that these diseases like measles are not benign illnesses. And I think people want to hear from our public health leaders.
MA: You’ve talked about this concept of “scientific tikkun” — the obligation of scientists to engage with the public and share their research outside of their own community. Why do you think there’s been this vacuum?
PH: I think when this anti-vaccine movement began in the late 90s with The Lancet paper, it was considered a fringe movement or even a cult, and I think there was a strategic decision — I wasn’t in the room, but I’m guessing this is what happened — that we’re not going to call attention to this. We don’t want to give it oxygen. If anything, it could empower the movement more than we intend to.
I think that made sense in the early days of the anti-vaccine movement. But now that it’s grown into this media empire, there has to be a counterbalance.
MA: What do you think of grassroots movements like the Shot@Life campaign and the many advocates you’re going to be addressing this week in Washington, D.C.?
PH: They’re all heroes. I mean that very sincerely. This is why we’ve been able to make these tremendous gains. It’s one thing to develop a vaccine, and it’s another thing to get it disseminated to literally billions of people across the world. You need both.
And the only way both are going to happen is if we have our advocates. From my perspective, there’s nothing more important than the UN Foundation’s Shot@Life campaign. My hope is my book will empower vaccinators and give them the talking points they need. Because right now they’re under siege. They’re under siege by families that are only hearing phony misinformation and in some ways, they’re victims as well.
But I think it’s really important to give pediatricians, nurse practitioners, nurses, health care providers, and vaccinators across the world the key talking points to stand up against this very nefarious movement.