non: You're listening to the ATS Breathe Easy, the latest podcast brought to you by the American Thoracic Society.
[00:00:18] Patti: Hello and welcome. You're listening to and watching the ATF BDZ, I'm your host, Patti Trepaffi, former CNN Headline News Anchor.
Joining us today to discuss vaccines and children are Dr. Paul Offit and Dr. Tina Hartford. First, these headlines.
Welcome back. Dr. Offit is the director of the Vaccine Education Center and a physician in the Division of Infectious Diseases at Children's [00:01:00] Hospital of Philadelphia. He's an internationally recognized expert in virology and immunology and is a member of the FDA Vaccine Advisory Committee. And Dr.
Hartert is director of the Center for Asthma Research. and professor of pediatrics and medicine at Vanderbilt University Medical Center. She is also the co chair of the American Thoracic Society's Vaccine and Immunization Initiative Task Force. Welcome to you both. Thank you. During the COVID 19 pandemic, there were vaccine requirements and schools have required vaccines for children for decades.
And there was a lot of pushback during the pandemic, and this sentiment is common in many communities. What could happen if requirements for vaccines were further relaxed?
[00:01:50] Paul: Well, that's already happening. Um, the um, there's been a flood of litigation in many states pushing back against vaccine mandates, including school vaccine mandates.
And with [00:02:00] that, you're starting to see an increase in vaccine preventable diseases. We, in 2023, had roughly 5, 900 cases of pertussis. We're in 2024, we had more than 32, 000 cases. That's more than pre pandemic left levels with measles. We had about three outbreaks and 50 cases in 2023 2024. We had 16 outbreaks and almost 300 cases of measles.
So we're going in the wrong direction. And I think what happened during the covid pandemic is we leaned into this libertarian left hook by requiring vaccines. So you couldn't go to your favorite Bar or restaurant or sporting event or place of worship. I think people, uh, got angry and, um, I think you're seeing that now in all this legislation against, uh, vaccine mandates.
[00:02:43] Patti: Must be very concerning. Dr Hartard, as a pulmonologist, you know that your patients are at higher risk for severe acute disease, long term consequences and even death from respiratory infections with the vaccine rates [00:03:00] declining and flu COVID RSV and pneumonia on the rise right now. What concerns you the most?
[00:03:07] Tina: What alarms me the most is the risk of erasing the progress that we've made in eradicating morbidity and mortality from what are we know vaccine preventable diseases. Vaccines admittedly are one of the most important health innovations in human history, and they've Played a major role in increasing our life expectancy, decreasing child mortality.
And it's fair to say that nearly all of our patients in our pulmonary clinics and sleep clinics of specialty clinics are patients who are at the highest risk of hospitalization and death from respiratory infection events, events that we know are proven to be 12 year old patient with asthma, or 60 year old lung transplant patient.
And if our vaccination rates continue to decline, as dr off it mentioned, we risk and we're already seeing an increase in infectious [00:04:00] diseases and preventable deaths. erasing this progress isn't gonna happen overnight, but it will happen. And then second, you asked about long term consequences of vaccine preventable infections.
And this is real. I think we often largely focus on acute effects of vaccine preventable infections, critically important. But we now know that these infections have many long term consequences. And most everyone by now has heard about long cove it We know that Children with severe R. S. V. Infection as infants have or lung function on higher risk of many adverse respiratory outcomes, including premature adult death from respiratory disease.
So there's this added value potentially of vaccines that extend past prevention of just severe acute infections. For example, we know measles vaccine reduces all cause childhood infectious mortality. And lastly, vaccines don't just protect the person vaccinated. We know vaccinating kids protects kids, but it can also protect their grandparents.
[00:04:58] Patti: Yeah. Dr. Hartford, um, there are [00:05:00] some people who are concerned about side effects and risks. What do you tell them?
[00:05:04] Tina: Yeah, I think it's really important that we globally acknowledge their concerns. I always ask about concerns because you know, if we don't, if we don't ask, it's always the last thing that comes up as they're walking out the door.
I try to never dismiss or gloss over their concerns. And I think especially with Parents or people show up with their loved ones acknowledging that the things that they hear are sometimes scary. But I think we also don't always do a good job discussing benefit risk balance. Vaccines aren't approved unless the benefit risk ratio tips very far in favor of benefit.
This is a preventive intervention. And so the bar for approval is much higher than for approving treatment. So important to acknowledge their care. concerns and talk about them be transparent. Um, [00:06:00] but we rarely put into context what the risk is of not being vaccinated. And we know this information. We know the risk of an infant being hospitalized for R.
S. V. In the United States. And we know that there are effects not only of acute infection, but long term adverse respiratory outcomes. Um, there are protective effects on our community and our classrooms are teachers. Um, and I think it's really helpful to have a simple ways to explain this. and put it in context, being able to talk about the risk of not being vaccinated, that an unvaccinated child who comes into contact, for instance, with an infected person with measles has over a 90 percent chance of getting measles.
We know in a outbreak of measles in the Netherlands about 25 years ago, then out unvaccinated persons, 224 times more likely to be infected. This is the risk that we can share. not just [00:07:00] acknowledging their concerns, but also putting in context what the benefit risk is of not being vaccinated.
[00:07:07] Patti: Okay, Dr Offit, I'll come back to you and let me ask you also, uh, there are unique cultural backgrounds of patients, so not to alienate them.
What tips do you use with your patients and their parents to help them feel comfortable getting vaccines?
[00:07:23] Tina: I think it's a great point. Understanding what's important to them is tremendously important. And I think that's different for everyone. Empathetic listening. I do ask outright about people's concerns, not just about vaccines, but in general.
And I think it's also important to acknowledge when they ask or they have concerns that they're advocating for their child or or the parent. their loved person. I also think it's very helpful to link vaccination with their goals. If that's [00:08:00] keeping their 12 year old asthmatic out of the hospital or their loved one with C.
O. P. D. Um, out of the hospital. And I think at the end of the day, what matters to people is different. But I think we have this common bond of protecting their loved ones. Um, and a parent also isn't asking about vaccine side effects to get under our skin. They're asking because they're concerned about their child, uh, or themselves.
[00:08:25] Patti: Thank you. And dr off it. Patients need to be empowered to make decisions about vaccination and other medical decisions. What do you find motivates their parents to get their child vaccinated? Do you use a presumptive approach where you assert that the child will get a vaccine at the end of the visit?
[00:08:46] Paul: I think Dr.
Hart has said it well. The choice not to get a vaccine is not a risk free choice. It's a choice to take a different and more serious risk. And I think what you try and get people to understand is that what that risk looks like. I mean, if you look, for example, at parent advocacy [00:09:00] groups like Family Sliding Flu or Meningitis Angels or National Meningitis Association, these are parents who had either chosen not to get a vaccine or the child was too young to have gotten a vaccine, who then the child has a child that suffers severe and become advocates for that, you know, for that vaccine to educate about the disease, but they all tell the same story.
I can't believe this happened to me until it happens to you. And I think that's in some ways that one of the challenges of vaccines is when you give a vaccine, nothing happens and it's hard to make that compelling. But I think you have to get people to realize what the choice is when you choose not to get a vaccine.
[00:09:36] Patti: Science has made great progress in eradication, near eradication of many illnesses. But with vaccine rates dropping, are you concerned about an increase in significant outbreaks, which puts not only your patients but their families, communities and frankly, the country possibly at risk.
[00:09:53] Paul: Yes, and it's the most contagious of the vaccine preventable diseases that will come back first.
And that's measles. I mean, there's [00:10:00] something called a contagious index, meaning how many people would I infect during a typical day? Assuming I'm infected and everybody I come in contact with isn't has never had experience with that virus or bacteria. And first, things like stars could be to the cause of Cove it or or respiratory syncytial virus or influenza.
The the contagiousness index is between two and four for measles. It's 18. You don't have to have direct contact with somebody who has measles to get sick. You just have to be in their airspace within two hours of them being there. I live through the 1991 Philadelphia measles epidemic, and this was 30 years into the availability of a vaccine.
And we had 1400 cases and nine deaths over a three month period measles. That's that's the disease. I fear the most
[00:10:42] Patti: Yes. What do young pulmonologists need to know about the illnesses that they've never seen in patients but could return if herd immunity is not retained? Dr. Hartford.
[00:10:56] Tina: Yeah, I think first is recognizing that vaccination is [00:11:00] within their scope of practice.
I think we make that assumption, but we actually know from surveys that many specialists don't feel like vaccination is within their scope of practice. I think the second is it's so important to have a voice. Social media has given a megaphone to people with opinions about vaccines, often not supported by data.
And for the pulmonologist, you are likely to be your patients most trusted source of information about vaccines. And I think we all have to make clear recommendations about vaccines for our patients. Uh, I think it's important to acknowledge advocacy, uh, for the families. Families ask about these things.
Patients ask because of something they've heard. If we don't say something, the only people they're listening to are, are people either in the community or social media. or their family members who may not necessarily have informed opinions. And the last point [00:12:00] I just make to you asked about young polinologist is just to say that even among our patients who are skeptical of our health institutions or science, they still have confidence in the longstanding relationships.
that they have with us, their clinicians. And we should actually feel obligated and to deserve that trust and advocate for them. And this very much includes raising our collective voices and recommending vaccines and the data to support them to protect our patients health and believing that individually when we do this, we do make a difference.
[00:12:36] Patti: Thank you, Dr Offit and Hartert, and it was very timely discussion. For more on vaccines, check out the ATS Vaccine Resource Center for vetted and trusted information from clinicians as well as patients. We'll drop the link in your show notes. Also, there will even be more programs about vaccines at the ATS 2025 International Conference [00:13:00] in San Francisco.
So from May 16th to the 21st. Visit conference.thoracic.org to register today for you next time.
[00:13:15] non: Thank you for joining us today. To learn more, visit our website@thoracic.org. Find more ats, breathe Easy podcasts on transistor, YouTube, apple podcasts and Spotify. Don't forget to like, comment, and subscribe, so you never miss a show.