00:00I'm joined by Dr. Amish Adalja. He's an infectious disease expert and senior scholar at Johns Hopkins University Center for
00:05Health Security.
00:06Dr. Adalja, great to have you with us once again.
00:07And let me just start by asking about how we got to this place.
00:11And I guess a natural follow-on to that is what would the U.S. need to do to kind
00:14of get beyond this or get back to the way things were?
00:17How far is the cat out of the bag?
00:20When you think about outbreaks, sometimes it's hard to understand how things got started, how you got to the status
00:25quo.
00:25With measles, it's really a no-brainer.
00:28We got there because vaccination rates fell below the herd immunity threshold.
00:33And we're talking about what is the most contagious infectious disease that we humans face, one that requires a high
00:40level of immunity in the population and one in which it's circulating in many parts of the world.
00:45So all it took was for us to lower our armor, to lower our force field, and then measles came
00:51back.
00:51It never went away.
00:53And the solution is equally simple.
00:54It's just to get more vaccine into the arms of people who are unvaccinated, and then this problem will disappear.
01:01David and I have a selfish question.
01:03When we were putting this in the lineup yesterday, we've had MMRs as kids.
01:07Are we protected?
01:09People who had the usual vaccine course as children, does that take you through adulthood?
01:13Or at some point, if you're in one of these places with high infection rates, do you need some sort
01:17of booster?
01:18For the vast, vast majority of people, the standard two-dose childhood vaccination schedule will protect them for life.
01:25That doesn't mean that the vaccine is 100%, but it's pushing above 95%.
01:30So there's no generalized recommendation for boosters that are needed for the population.
01:35It's really about people who have had zero doses of measles.
01:38That's what's driving this.
01:40You know, in your line of work, a lot of what you deal with is kind of communication about the
01:44need for vaccination going forward.
01:46And I'm curious, at this moment, when it seems like there are government officials who are not promoting them or
01:51not advocating for them, maybe it's incumbent more on public health practitioners like yourself to push for that.
01:57What is the messaging campaign like?
01:59In other words, how do you assess the way in which public health professionals are making the case for vaccines
02:04at a time when they seem more necessary than ever?
02:06And what kind of campaigns have been effective?
02:07Have you seen any that have worked?
02:10So I think it depends upon why someone is not vaccinated.
02:13There may be people who haven't gotten around to getting their children vaccinated.
02:16There may be people who have questions about vaccines.
02:19So you kind of have to take a different tack depending upon where someone is.
02:22And often it's very different to do it kind of as a one-size-fits-all message on television by
02:27a talking head versus a provider sitting in front of a patient or a patient's family and asking, what questions
02:33do you have about measles?
02:34And I think that's the better way to do it.
02:36We know that people will move towards vaccination if they can get answers to the questions that they have in
02:43a nonjudgmental way.
02:45That's a very different type of rhetoric when you're dealing with the likes of RFK Jr., who is spreading disinformation,
02:50where you just have to basically call him out for spreading lies.
02:54So it's very kind of nuanced and very personalized.
02:58And that's what works.
02:59We know that parents trust family doctors.
03:02They trust their primary care providers.
03:04That's where the actual movement occurs, not so much when someone's on, you know, blasting from a megaphone about the
03:12vaccine.
03:13I think we talked about this last time you were on here, but it seems pretty much a fait accompli
03:17now that the U.S. is going to lose its measles elimination status.
03:20There was this hearing the U.S. requested that it be pushed back until the fall.
03:25So now that decision won't come down until fall.
03:27But at this point, can you see any way that that doesn't happen given the case rates in the U
03:31.S.?
03:32No, I think that the United States has effectively lost its elimination status.
03:36And even if by some technicality it maintains its elimination status, the deeper question is, does the United States have
03:42resiliency against measles?
03:44The answer is no, irrespective of what the elimination status decision is.
03:48And there will be politics around the elimination decision.
03:51So I think it's just, for all intents and purposes, the U.S. does not have the ability to control
03:55measles any longer.
03:57On the issue of control, I'm curious how that dovetails with kind of economic considerations.
04:01So when you look at where these outbreaks are, I saw there's one in Teton County in Wyoming, for instance.
04:06When you start to see an outbreak like this, so much work has to be done to track down who's
04:10been exposed to it, get the word out.
04:12Obviously, mount a vaccination campaign as well.
04:15Could you talk a bit about the economic consequences of having a resurgence in a disease like measles in the
04:20way in which we're seeing here in the U.S.?
04:22So anytime there's an infectious disease, it will lead to disruption.
04:25People can't go about their activities of daily life, which means if it's a child with measles, that child can't
04:30go to school, that child's parents might have to stay home, that child's parents might have to hire someone to
04:36babysit.
04:37And then you have a health department that then has to go and investigate who is the person in touch
04:42with.
04:42Do they need to contact people?
04:43Do they need to do any kind of countermeasures to stop the measles from spreading in a given community?
04:48All of that costs money.
04:50And it's money that doesn't need to be spent because these measles cases are happening voluntarily by people's choices.
04:56This is not some force of nature.
04:57This is people's choice to not vaccinate their children.
05:01And then it has economic consequences that don't need to be incurred.
05:06And I think that's another important point to make with infectious diseases is that they keep humans from flourishing because
05:12they're stuck in bed sick and they're not out there producing.
05:15They're out there innovating and you're taking money that could be used for some other concern.
05:21And now it's being put back to something.
05:23It's put into something that we shouldn't have to be putting money into when we've had a solution to this
05:28since the 1960s.
05:29Doc, before we let you go, we want to ask you about the other thing a lot of Americans are
05:32worried about, and that's a cyclospora going around with this, you know, possibly this tainted lettuce.
05:37It seems like, did the administration, did the government react fast enough, and is this a larger concern about food
05:46safety and oversight in the U.S.?
05:48I do think it was more of a reactive reaction from the government.
05:53I think state governments did very well, namely Michigan, which got hit very, very hard.
05:56But you have to remember that the CDC basically got decimated in this administration in terms of cuts to its
06:02budget, whole divisions that were eliminated, including the division that would have been responsible for cyclospora.
06:08So there's less people doing this.
06:10So when you're thinking about a foodborne outbreak, it's time and the speed to identify what the vehicle is that's
06:17spreading something.
06:18If you've got less people around to crunch the data, to do the interviews with people who are case patients,
06:25it's going to take longer.
06:26And the state departments have done well, but they are also underfunded, chronically underfunded, understaffed.
06:32So it is something that decreases the overall resiliency to foodborne illnesses when you don't have a robust system in
06:38place or when that system is being actively dismantled.
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