#159 – Peter Hotez, M.D., Ph.D.: Evolution of the anti-vaccine movement, the causes of autism, and COVID-19 vaccine state of affairs

Peter Hotez is an internationally recognized physician-scientist in neglected tropical diseases and vaccine development. In this episode, they first follow up on the podcast episode (#158) with Brian Deer (the investigative journalist who exposed the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism) with a broader discussion about the origin and evolution of the anti-vaccine movement. They explore some of the specific claims being made around vaccine additives, the timing of when vaccines are given, and claims about issues with the HPV vaccine specifically. Next, Dr. Hotez shares his own journey as a parent of an autistic child and speaks of the challenges of diagnosing autism, what could account for the seeming increase in the prevalence, and whether there is any support for the notion that environmental triggers play a role. They close out with a discussion on the state of affairs with respect to COVID-19 vaccination, comparing the various vaccines as well as the challenges that emerging variants of the virus may present. This episode was originally recorded on April 2, 2021.

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We discuss:

• The stubborn persistence of anti-vaccine sentiment (3:00);
• A closer look at claims about thimerosal and vaccine spacing causing autism (12:00);
• The Hib vaccine: An example of the profound difference a vaccine can make (23:30);
• The controversy surrounding the human papillomavirus (HPV) vaccine (30:45);
• The growing anti-science sentiment, COVID vaccine hesitance, and the basis of the anti-vaxx movement (39:00);
• The origins of autism, and Hotez’s personal story as a parent of an autistic child (1:02:45);
• The challenge of diagnosing autism, increasing prevalence, and a potential parallel to Alzheimer’s disease (1:14:15);
• Comparing the various COVID-19 vaccines and the impact of emerging variants of the virus (1:30:00);
• Global vaccination challenges and “vaccine diplomacy” (1:40:45); and
• More.

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The stubborn persistence of anti-vaccine sentiment [3:00]

• Brian Deer, who is not particularly a vaccine advocate but an advocate for good science, was recently on The Drive
• There is so much deceit in the work of Andrew Wakefield, who claimed that the MMR vaccine caused autism
• Peter wants to discuss: Why, after Wakefield was debunked, is this still an issue?
• A 2015 poll showed that more than 20% of millennial-age Americans still think vaccines cause autism

The anti-vaccine lobby keeps moving the goalposts (4:30)

• Began in 1998 with now the now-retracted Wakefield paper asserting that the MMR vaccine causes autism by the live virus replicating in the colon
  • robustly refuted by scientists
  • large cohort studies showed not linked, sound epidemiological data debunked the claim
• Then switched claims
• Each time the scientific community responds, they keep shifting arguments to maintain momentum and re-energize the movement

The focus has now shifted from pseudoscience to politics (4:30) 

• Beginning around 2014-15, latched onto the Tea Party Movement to make it a politicized movement around concepts of health and medical freedom
• Hotez decries the “craziness on Fox News”
• “They create these versions 1.0, 2.0, 3.0 of the anti-vaccine movement, but the autism piece never entirely left. That’s still its legacy fake assertion that still haunts us today”
• Peter urges listeners to listen/watch the podcast with Brian Deer and to read Brian’s book for detailed information about the lack of association between the MMR vaccine and autism

“I don’t know how to say this delicately, but I think if after assimilating all of that work, you still believe that there’s a relationship between that vaccine and autism, there’s probably nothing that can be said that can dissuade you from that.” —Peter Attia

• It was helpful that Deer was able to show not just the Wakefield’s scientific fallacy but also his nefarious intent
• The movement has grown much larger than Wakefield
• Now also spreading beyond the US
• Discussing the science “won’t stop the momentum of the anti-vaccine movement because they light a fire, they cause damage and then they move on and that’s their modus operandi”
• Peter says this podcast episode is not going to stop the anti-vaccine movement but that his goal is to “help parents, who frankly are inundated with information and can’t distinguish between signal and noise”
  • Peter says it’s worth discussing thimerosal and increasing autism rates and other claims to help parents who are confused
  • He doubts he can dissuade the 20% of people who think vaccines are evil, but he wants to reach those in the middle who are undecided
• By 2007-08, Wakefield’s claims had not only been debunked scientifically but also it was clear that he and John O’Leary had lied and manipulated data
  • The Lancet retracted Wakefield’s paper in 2010
  • Said results were no longer valid
  • referred to the medical council panel but did not mention Brian Deer’s work
  • The journal had published an institutional defense of the work in 2004
• Peter says the lawsuits were the most damning because Wakefield couldn’t produce evidence to maintain any legal argument

 

A closer look at claims about thimerosal and vaccine spacing causing autism [12:00]

Thimerosal

• Thimerosal is no longer in most childhood vaccines
• If have a multidose vial of vaccine, risk of introducing bacteria every time you’re introducing a needle into the vial through a rubber stopper
  • Need a preservative that’s nontoxic to humans but will kill the bacteria
  • Was an advance that allowed vaccination of large populations
• It was taken out of vaccines because of all the bad publicity swarming around it
  • There was no scientific evidence that it is harmful, but the thinking was that it was unnecessary because single dose vials could be used instead, so take it out to increase vaccination rates
  • Thimerosal is still in some flu vaccines in US, although they can also be given as a single dose
• No association between thimerosal and any adverse health effect was ever established
  • Bobby Kennedy made thimerosal his cause
  • He is an environmental lawyer who probably thought of Minamata Disease when he saw that thimerosal contained mercury
    • Decades ago, Japanese people were exposed to high levels of methylmercury in fish
    • Developed neurological symptoms that came to be called Minamata Disease
  • Thimerosal does not cause autism, which is associated with prenatal events
  • But Kennedy got involved and a couple of books made that claim
• Gained momentum as Wakefield’s claim had
• Hotez addressed these claims in his book Vaccines Did Not Cause Rachel’s Autism
• Peter clarifies the difference between thimerosal and methylmercury
  • Thimerosal is ethyl mercury, an organic mercury
  • Methylmercury, which causes the toxicity we get from eating fish, is also an organic mercury
  • Minamata disease resulted from the industrial release of methyl mercury, a different compound from thimerosal / ethyl mercury 
  • Methyl mercury accumulated in fish and caused a congenital neurologic disease with gait and motor disturbances and other problems including coma and death
• In 2001, a journal called Medical Hypotheses published a paper suggesting that thimerosal could be linked to autism
  • Thimerosal was a common preservative but was eventually removed from vaccines
  • But after it was taken out, the rates of autism did not decrease
• Large cohort studies did not show any link between autism and thimerosal      
• Peter points out that the 2001 paper was not unreasonable at the time; it was formulating a hypothesis by looking at plausible associations 
• The problem comes later “after the scientific community goes to great lengths and great attempts to seek the truth and publishes paper after paper after paper in mainstream scientific journals” when anti-vaccine groups don’t acknowledge that work and “cling to their debunked hypothesis”
  • Say that scientists or journals must be paid off by pharmaceutical companies
  • Resort to conspiracy theories instead of showing intellectual curiosity about what actually causes autism
• “continually discount the massive amount of scientific work that’s gone into really uncovering what autism is”
• Peter says there are people who are “very influenced by data, they can think probabilistically, they can think in terms of uncertainty, they can accept and reason their way through these things” and others who “cling to a belief in the presence of emerging data that refute that hypothesis and they’ll continue to come up with an excuse”
• Anti-science sentiment is growing
• The process of removing thimerosal from vaccines began around 1999

Vaccine Spacing (19:45)

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