Vaccines, MAHA, & 
RFK Jr.

Paul: I think RFK Jr. just makes stuff up. Autism has just had round after round. First, he said that the measles, mumps, and rubella vaccine caused autism. 24 studies across three continents and seven countries, involving hundreds of thousands of people, have shown that the MMR vaccine doesn't cause autism. Then it became thimerosal, all of which has been shown not to be true.

Paul: I think it's fair to question vaccines. You should be skeptical of anything you put in your body. He's not skeptical. He's cynical. He doesn't believe it.

Brent: Welcome to the Life Lab by Death Clock. I am your host, Brent Franson. The mission of Death Clock is to help 100 million people live ten years longer. Today, we speak with Doctor Paul Offit about vaccines. Doctor Offit is the director of the Vaccine Education Center at CHOP. He's the Maurice R. Hilleman Professor of Vaccinology and professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

Brent: He's a former member of the CDC Advisory Committee on Immunization Practices and the FDA Vaccines and Related Biological Products Advisory Committee. We've been wanting to do an episode on vaccines for quite some time. Obviously, there are a lot of questions related to vaccines being brought up by the MAHA movement and RFK Jr., so we've really been wanting to separate fact from fiction.

Brent: Where are the vaccine criticisms right, where are they misinformation, and where are they totally off base? Doctor Offit is about as experienced as you can get in terms of vaccines. He doesn't seem to be conflicted in terms of being compensated by vaccine companies; he's just following the science. But he's very critical of Robert F. Kennedy Jr. and the MAHA movement, particularly regarding vaccines.

Brent: So I tried to take the approach of the skeptic, asking him the questions that would often come up from people in MAHA or that might be asked by RFK Jr. himself. I thought it was a really great discussion. He's a wonderful guest. You can listen to the facts and arguments and make up your own mind.

Brent: Doctor Paul Offit, welcome to the show.

Paul: Thank you. It's my pleasure.

Brent: Today we're going to be talking about vaccines. I've been really looking forward to this conversation because we've been trying to get the right person on to talk about it, and you are the definition of the right person. Vaccines have obviously been in the news a lot lately; it's the topic du jour.

Brent: I have four young kids, including a four-month-old, so I've been thinking about this a lot personally. Before we dive in, will you give us a sense of your background and your day job?

Paul: Sure. I went to medical school at the University of Maryland School of Medicine, did pediatric training at Children's Hospital of Pittsburgh, and then came to Children's Hospital of Philadelphia, where I began a fellowship in pediatric infectious diseases. After completing it, I went to Stanford University for a few years of research, returned to Children's Hospital of Philadelphia, and spent 26 years with the team there working on rotavirus. Rotavirus causes fever, vomiting, and diarrhea, primarily in children under two years old.

Paul: It killed about 2,000 children a day in the developing world and caused about 70,000 hospitalizations from severe dehydration in this country every year. We created a vaccine that was licensed by the Food and Drug Administration, recommended for all children in this country by the CDC, and recommended for all children globally by the World Health Organization. That vaccine, developed at Children's Hospital of Philadelphia, is estimated to save about 165,000 lives a year.

Brent: Yes, we know it well. It can be a hard vaccine to get, actually. Can you speak quickly to that? Why is that the case? In our personal experience, there seems to be high demand at certain times of the year and it's hard to produce.

Paul: It shouldn't be. There are two vaccines: RotaTeq and Rotarix. They shouldn't be hard to get; the vaccine is given by mouth. It does require cold storage, but in this country, that shouldn't be a problem.

Brent: Okay. As we get into a contentious topic, can you speak about conflicts of interest? Are you paid by pharmaceutical companies that make vaccines? Do they pay for your research?

Paul: I have no conflicts of interest. I was funded for 26 years by the National Institutes of Health. Although our vaccine was licensed by my hospital to Merck, who manufactured it, we weren't going to make hundreds of millions of doses in our laboratory. Only pharmaceutical companies have the research and development expertise to manufacture these vaccines.

Paul: Merck made the vaccine, but I was never paid by Merck, nor were my collaborators. I was paid by the National Institutes of Health.

Brent: So no speaking engagements, and they're not paying for your research? Pfizer, Moderna—you're not receiving money from them in any way?

Paul: No. I was on the Advisory Committee on Immunization Practices to the CDC between 1998 and 2003. You can have no association with a pharmaceutical company if that's true. I was also on the FDA vaccine advisory committee from 2017 to 2025, where you similarly cannot have any pharmaceutical associations. Once, to put this in perspective, I spoke at Pfizer during their science day as their keynote speaker.

Paul: They had lunch, and I couldn't eat it. I said, "I will pay you for this lunch; you cannot pay for my lunch." When I walked up to the podium, a woman handed me a bottle of water. I said, "If you paid for this water yourself, I'm fine, but if your company paid for it, I can't take it."

Paul: It's that touchy, as you know from asking the question.

Brent: Wonderful. Before we get into it, you were on that FDA committee until 2025. There was a change of administration in 2025, and there's been some friction between you and RFK Jr. Can you speak briefly about that change to give us some context?

Paul: I served two terms, from 2017 to 2021, and completed that term. They asked me to serve another four years, which carried us through the pandemic until 2025, wrapping up in January of 2025.

Paul: A senior official at the FDA asked me to serve another four years. I agreed to two more years and was put on the agenda. But then you have to complete a special government employee form, which is basic administrative info, and it just never made it through HHS.

Paul: I think Robert F. Kennedy Jr. didn't want me on that committee for whatever reason. We've drifted apart over the years, whether due to something I said or just differing views. In any case, he didn't want me there, so my term ended, and that's fine.

Brent: You served on this FDA committee during Trump's first term, so whatever happened here is likely specific to RFK Jr. or the second term, rather than a simple political divide.

Paul: No, I think it's Robert F. Kennedy Jr. specifically. He called me about 20 years ago with questions about vaccines, and we had a pleasant conversation for about an hour. Later, in a Rolling Stone article that was eventually retracted due to factual errors, he claimed the only reason I defend vaccines is because I co-invented a rotavirus vaccine, which he falsely alleged contained a mercury preservative.

Paul: There was a series of misstatements in that Rolling Stone article that caused them to retract it. I have certainly spoken out against him ever since he became an anti-vaccine activist and put children in harm's way. I oppose what he does because I believe it hurts children in this country.

Paul: I oppose him every chance I get, and I write a weekly Substack that often addresses his claims.

Brent: What is the steel man of his perspective? Listening to him on Rogan recently, he seems genuinely concerned that we're not conducting the trials we should be.

Brent: He is obviously concerned about the rise in autism and other issues. Giving him the benefit of the doubt, where might he have a point if we look at the other side of the argument?

Brent: We miscommunicated somewhat during COVID regarding natural immunity, and we jumped the gun slightly on a vaccine that was later pulled back. Where is there merit in RFK-style skepticism?

Paul: It's not skepticism; it's cynicism. He believes there is a vast international conspiracy funded by the pharmaceutical industry that controls the government, medical journals, and doctors. That isn't true. He also believes vaccines have reduced infectious diseases only at the cost of causing chronic diseases, for which he has no evidence.

Paul: He maintains this immutable, science-resistant belief. I see no area to give him credit. If you read his book, *The Real Anthony Fauci*—which I don't recommend—on pages 285 to 288, you will learn that Robert F. Kennedy Jr. doesn't believe in germ theory.

Paul: He doesn't believe that specific germs cause specific diseases. How are we supposed to find middle ground with that position?

Brent: Fair enough. More broadly, would you agree there is merit to concerns regarding younger men and myocarditis early in COVID? We weren't as transparent as we could have been about natural immunity, and with the flu shot, we often get the strain wrong.

Brent: If you're middle-aged and healthy, maybe you don't strongly need it and it won't help you that much. There is some truth in acknowledging we haven't gotten everything perfectly right. I largely agree with your position, but playing devil's advocate, there are many skeptics.

Brent: There were things mishandled during COVID, right? And there is some truth regarding flu shots or other areas where legitimate daylight exists outside of RFK Jr. specifically.

Paul: When the COVID vaccines first came out, the FDA Vaccine Advisory Committee reviewed them in December 2020 based on two clinical trials: a 40,000-person trial for Pfizer and a 30,000-person trial for Moderna. That was roughly 35,000 adults who had received the vaccine.

Paul: We were asked whether to recommend authorization for these two mRNA vaccines. This was a novel virus, SARS-CoV-2, with unusual clinical and biological characteristics, and a novel platform, as we'd never had a messenger RNA vaccine before. We reviewed roughly 800 pages of data before making recommendations, which were posted on the FDA website the following day.

Paul: Anyone could read them. You knew another shoe would drop because it always does when moving from a trial of 35,000 people to administering a vaccine to hundreds of millions. You know a rare, potentially serious adverse event will emerge.

Paul: It was a matter of how rare and how serious. As it turned out, myocarditis (inflammation of the heart muscle) was a consequence, primarily in young males between 16 and 29 years old. It occurred in up to 1 in 6,600 people, but was transient, self-resolving, and short-lived, with no evidence of permanent harm.

Paul: Initially, we admitted those patients to the hospital because we hadn't seen it before, but later managed them as outpatients. That was a real finding. Could communication have been better? We did communicate it, though some argued we didn't.

Paul: There are a couple of places we could have done better. One is that COVID was recommended as an annual vaccine for everyone over six months old. Early on, I felt we should target high-risk groups, matching the core goal of the vaccine.

Paul: The primary goal was to keep people out of the hospital, ICU, and morgue. Those getting hospitalized and dying were primarily high-risk groups: people over 75, the immunocompromised, pregnant women, and those with chronic heart or lung disease.

Paul: We should have targeted those groups, as most other countries did. Not doing so bothered people. Firing people from their jobs also created understandable pushback. Natural infection provided protection, and when previously infected individuals objected to mandates, that should have counted initially.

Paul: That rubbed people the wrong way. During those first couple of years, those decisions triggered a backlash, particularly regarding mRNA vaccines.

Paul: They became the focal point for feelings of government overreach.

Brent: It's easy to judge in retrospect. Sitting on a committee with limited information from a 35,000-person trial, you have to make a decision for hundreds of millions of people knowing rare events will occur. You do the best you can in real time.

Brent: Six years later, we can analyze decisions, but that's different from making real-time choices. What is your perspective on general questions or skepticism surrounding vaccines broadly?

Brent: Critics say we aren't conducting clinical trials on children, so we don't know if there are links to chronic disease or autism. How much clinical trial data exists for vaccines recommended early in life (0 to 10 years old), and how robust is it regarding randomized controlled trials (RCTs)? If RCTs aren't used in certain cases, what is the rationale?

Paul: For every new vaccine, there is a prospective, placebo-controlled, randomized trial typically involving tens of thousands of people. Phase 1 involves dozens of people to check for common, serious problems and ensure immunogenicity. Phase 2 expands to hundreds of people to continue monitoring safety.

Paul: Phase 3 tests tens of thousands of people to rule out relatively uncommon serious problems. Phase 4 is post-marketing surveillance when the vaccine is distributed to millions. Systems like the Vaccine Safety Datalink monitor safety because rollout is gradual.

Paul: Linked electronic medical records allow us to detect rare signals, which is how myocarditis was identified for mRNA vaccines and how blood clotting was linked to the Johnson & Johnson adenovirus vector vaccine—occurring at roughly 1 per 250,000 people.

Paul: You won't catch events that rare in pre-licensure studies. Once identified and characterized—including rare cerebral venous sinus thrombosis—the risks were found to outweigh benefits, leading to the J&J vaccine being withdrawn by May 2023.

Paul: It was authorized in February 2021 and taken off the market two years later. Safety is continuously monitored. The notion that vaccines cause unstudied long-term problems isn't supported by evidence. Serious adverse events—like Guillain-Barré syndrome with early swine flu vaccines, narcolepsy with a European flu vaccine, or vaccine-derived paralysis with oral polio vaccine (1 in 2.4 million doses)—are identified and acted upon.

Paul: By 2000, as head of the polio working group for ACIP, we successfully transitioned away from the oral polio vaccine in the U.S. because wild polio was eliminated, meaning the vaccine's rare risk outweighed its benefit.

Paul: We are constantly evaluating safety. RFK Jr. fabricates claims regarding autism. First, he claimed the MMR vaccine caused autism; 24 studies across three continents and seven countries, involving hundreds of thousands of people, disproved that.

Paul: Then he shifted to thimerosal, a mercury-containing preservative, and later to aluminum adjuvants—all of which have been thoroughly disproven. It is fair to question vaccines and remain skeptical about what goes into your body, but he isn't skeptical; he's cynical. Despite 24 clear studies, he maintains that the MMR vaccine causes autism.

Paul: He holds a fixed, immutable belief that vaccines cause autism, regardless of evidence.

Brent: Regarding the randomized controlled trial critique, your response is that we perform them initial pre-licensure, and post-rollout monitoring tracks additional rare outcomes like myocarditis. Is there any truth to claims that older, longstanding vaccines lacked RCTs?

Brent: For instance, did the MMR vaccine have an RCT? Are there ethical constraints preventing traditional placebo trials for established vaccines, or have all recommended vaccines undergone rigorous RCT testing?

Paul: There's virtually no truth to that claim. When the first measles vaccine came out in 1963, it underwent a prospective, placebo-controlled trial. The mumps vaccine in 1967 and rubella in 1969 did the same. Once those individual vaccines were proven effective, running a placebo-only trial for the combined MMR vaccine would have been unethical.

Paul: Anti-vaccine activists often fixate on the definition of placebo, arguing it must always be saline. In practice, a placebo contains the vaccine components minus the active antigen. Similarly, when an updated 13-valent pneumococcal vaccine replaced the 7-valent version, giving children a inert placebo instead of the effective 7-valent vaccine would be unethical.

Paul: You cannot withhold proven protection from children. Vaccines work. Growing up in the 1950s, I had measles, mumps, German measles, and chickenpox. I survived, but many children did not.

Paul: I had measles, I had mumps, I had German measles, I had chickenpox, I survived all those infections. But not everybody did.

Brent: We experienced an example of ethical limitations recently. Our four-month-old son has hypothyroidism and requires synthetic T4. Without it, he would die at a very young age.

Brent: You wouldn't run a placebo-controlled trial withholding levothyroxine from infants without a thyroid because half the control group would die. It's unethical. That's a clear example of something known to work where a traditional placebo trial isn't permissible.

Brent: Where does the truth lie regarding autism trends? Few would dispute there has been a rise in reported autism cases. If it isn't linked to vaccines, what is driving the increase?

Brent: All right. Well, what is the increase in autism?

Paul: Experts at organizations like the Autism Science Foundation point out that broader diagnostic criteria and improved awareness account for much of the increase. There is also a documented association with advanced maternal and paternal age.

Paul: Parents are having children later in life compared to previous generations, which contributes to the rate. Primary experts attribute the rise mostly to better recognition and expanded diagnostic standards.

Paul: I recall a classmate in elementary school in the 1950s who was clearly on the spectrum, but the term was rarely used in general practice then, despite entering medical literature in the 1940s.

Paul: He had profound autism, even if it wasn't formally recognized at the time.

Brent: What about parental accounts of regression? You see compelling personal stories online where parents describe a toddler changing dramatically right after receiving a vaccine. Is that purely coincidental, or what explains those experiences?

Brent: And then we took our toddler in to get a vaccine, and then the next day they're catatonic or they're non-verbal autistic. There's a night and day change pre vaccine and post vaccine. Those are what I tug at the heartstrings. Is that just coincidence. What's your sense of of what's happening there?

Paul: Signs are often present before vaccination. During omnibus proceedings in the Vaccine Injury Compensation Program evaluating MMR and autism, researchers reviewed home movies taken of children prior to receiving the MMR vaccine at 12 to 15 months.

Paul: Developmental experts identified early behavioral markers of autism in those earlier videos before the vaccine was administered. While parents may link the onset to the appointment, subtle signs were frequently present earlier.

Brent: Several standard childhood vaccines coincide with the age when developmental milestones and speech delays become noticeable. That timing can lead to confirmation bias, mistaking temporal correlation for causation.

Brent: When when really there is there's correlation. There's not causation.

Paul: People naturally look for explanations to make sense of distressing events. In the second year of life, speech and communication expectations increase significantly, making developmental delays far more noticeable to parents at that age.

Paul: And so so if there's a delay, that's when you would appreciate it, okay.

Brent: What about claims regarding aluminum adjuvants—that aluminum in vaccines is neurotoxic, accumulates in the brain, and leads to conditions like autism or Alzheimer's?

Paul: Aluminum is the third most abundant element on Earth, present in water and soil. From vaccines in the first few years of life, an infant receives about 4 milligrams of aluminum total into the bloodstream, compared to roughly 400 milligrams absorbed from environmental sources and diet over the same period.

Paul: Whether from vaccines or dietary absorption, elemental aluminum is processed and excreted identically by the body. A comprehensive Danish study led by Anders Hviid published in the *Annals of Internal Medicine* evaluated children over 23 years receiving varying levels of aluminum in vaccines (0 to 4.5 mg).

Paul: The study analyzed 50 different conditions to test for dose-response correlations with aluminum exposure and found no association. It was a rigorous population-level study.

Paul: Despite these published findings, RFK Jr. lobbied the journal to retract the study because it contradicted his claims.

Paul: I mean any good any decent study that's done that doesn't agree with his bias. He just wants to find a way to to eliminate.

Brent: What about arguments pointing to Amish communities, claiming low vaccination rates correlate with an absence of autism or chronic disease?

Paul: That reflects lower engagement with outside clinical diagnostics rather than an absence of the condition. Clinicians providing care within Lancaster County's Amish community observe autism rates consistent with general populations when evaluated.

Paul: Similar claims were made regarding Somali-American communities in Minnesota. When standardized diagnostic criteria are applied cross-culturally, underlying prevalence remains consistent.

Brent: Let's discuss specific vaccines, such as Hepatitis B for newborns. Transmission occurs via IV drug use, sexual contact, or maternal transfer. For low-risk mothers, parents ask why a newborn needs a Hep B shot at birth if immunity wanes over time. What is the justification for universal birth doses?

Brent: My wife is a very conservative Catholic woman. She's not a really risky person. And so why are we giving our two day old or whatever it is, a hep B vaccine, and I've heard it only lasts ten years. What's the justification for everybody getting hep B at birth?

Paul: When the universal birth dose was introduced in 1991, thousands of children under ten contracted Hepatitis B annually. Half were infected during delivery by mothers with unrecognized infections, while others contracted it through household transmission.

Paul: Roughly 50% of chronically infected individuals are unaware they carry the virus. Hepatitis B can survive on surfaces for up to seven days and transmit via household contact through items like washcloths or nail clippers.

Paul: Thousands of young children acquired Hepatitis B through non-sexual, non-IV household exposure. Introducing the birth dose in 1991 effectively eliminated pediatric cases in that age bracket. The three-dose series provides at least 30 years of protection.

Paul: They got it from relatively casual contact with someone with hepatitis B. When we introduced that vaccine. Then in 1991, we basically eliminated the disease in the less than ten year old. And it's a safe vaccine. It's a three dose vaccine that, at least, you know, was introduced in the early 90s, revised at least 30 years worth of protection against hepatitis B, which is a long incubation period disease.

Paul: Because Hepatitis B has an incubation period of several months, long-term protection relies on immune memory rather than circulating antibodies. Memory B cells rapidly activate upon exposure.

Paul: The birth dose established robust early protection. Recent policy shifts permitting delays until two months if first-trimester maternal screening is negative introduce unnecessary gaps.

Paul: When delays are encouraged, some parents assume safety risks exist with the birth dose and defer vaccination further, leaving infants vulnerable.

Paul: Infants infected with Hepatitis B during their first year have a 90% chance of developing chronic infection leading to cirrhosis or liver cancer. Undermining universal birth dosing puts infants at risk.

Paul: Public health guidance must rely on established clinical evidence to protect pediatric health effectively.

Brent: Is there an argument for personalized care for Hep B, screening mothers individually and deciding case-by-case? Some European countries use targeted approaches. What is the counterargument to individual screening over universal birth dosing?

Brent: What's your push back on the personalized care is the best approach. Case by case basis is the best approach argument.

Paul: First, maternal screening rates aren't 100%; roughly 15% of mothers are missed, making the birth dose a critical safety net. Second, mothers negative in the first trimester can acquire infection later in pregnancy. Third, screening tests carry a ~5% false-negative rate.

Paul: Universal birth dosing eliminates those failure points safely. The vaccine profile at birth is as safe as at two months, removing infant risk for a disease with severe chronic outcomes.

Paul: Infections contracted before age five carry a 25% risk of chronic liver disease. The birth dose contains a single recombinant surface antigen protein with an established safety profile.

Brent: Regarding tetanus: it isn't contagious, and U.S. deaths are extremely low annually. Yet boosters are recommended every ten years. What is the rationale for routine tetanus boosters?

Paul: Tetanus cases are rare precisely because the vaccine is effective. Before widespread vaccination, thousands died from tetanus annually. While *Clostridium tetani* isn't contagious person-to-person, spores remain endemic in environmental soil.

Paul: Any contaminated puncture wound poses a severe risk. Periodic boosters maintain protective antitoxin levels against a dangerous environmental pathogen.

Paul: Individual choices on public health recommendations directly impact disease exposure risks. Public health guidance aims to inform choices accurately against online misinformation.

Paul: Framing public health purely through individual decision-making without clear guidance leads to reliance on unverified internet sources and higher disease rates.

Paul: Designating routine vaccines (like rotavirus, flu, or COVID) as purely optional shared decision-making undermines public health protection against circulating viruses that cause severe pediatric hospitalizations.

Paul: Citing policies in small nations like Denmark overlooks key population differences. Denmark, with ~6 million people, experiences rotavirus hospitalization rates proportional to pre-vaccine U.S. levels per capita.

Paul: Preventing severe pediatric dehydration through vaccination remains superior to managing predictable hospitalizations.

Paul: If you multiply it out 1200 cases times 55 is about 66,000 cases. So that's roughly the same number of hospitalization we had here. Why would you ever allow children to be hospitalized with severe dehydration? Why is that a good thing? Why shouldn't Denmark be emulating us? Is what I want to know.

Brent: What is the response to claims that measles outbreaks stem from vaccine failure or shedding rather than lower vaccination coverage?

Paul: The Moraten measles strain introduced in 1968 is highly effective: one dose provides 93-95% protection, and two doses confer robust long-term immunity. Two-dose coverage allowed the U.S. to eliminate endemic measles in 2000.

Paul: Measles is extremely contagious via airborne aerosols that remain suspended for up to two hours. Outbreaks occur when community vaccination coverage drops below the required ~95% herd immunity threshold, not from vaccine shedding or failure.

Paul: Maintaining high uptake is critical to prevent dangerous resurgences of this airborne virus.

Paul: And now in some areas it's well less than that. That's why it's coming back. It's nothing to do with a failure of the vaccine. It's a phenomenally effective vaccine.

Brent: Vaccine success has largely removed diseases like Hepatitis B, tetanus, and measles from daily public visibility. Many people don't realize how severe tetanus or measles infections are because they've never encountered a case.

Brent: Tetanus mortality in unvaccinated individuals remains high, causing immense physical suffering prior to death.

Brent: These diseases are brutal without immunization. Mild experiences with viral illnesses like COVID can distort perceptions of pathogens like tetanus.

Brent: I'm not vaccinated. I got Covid like, I don't know, I was on the couch for a few days and it wasn't so bad. No, that is not what it's like if you get tetanus and, you have not had the the vaccination.

Paul: Eliminating measles eliminated public memory of its severity. Prior to the 1963 vaccine, the U.S. saw 3-4 million cases, 48,000 hospitalizations, and 1,000 cases of encephalitis annually, alongside fatal conditions like SSPE.

Paul: SSPE (subacute sclerosing panencephalitis) is a progressive, fatal brain disorder occurring years after measles infection. Preventing these severe outcomes is why immunization remains vital.

Paul: I've only seen five cases, but it's untreatable. I mean, it's children are fine. They get over their measles infection. Then five years later, seven years later, longer, they have a deterioration of handwriting skills. They have a deterioration in personality. And they descend into this vegetative state from which there is no escape and they invariably die. And this is a preventable disease.

Paul: Without historical memory of disease burden, public appreciation for vaccine protection wanes until preventable outbreaks recur.

Brent: It's a paradox of success: effective vaccines make dangerous diseases invisible, leading people to take disease-free communities for granted.

Paul: Choosing not to vaccinate against contagious pathogens like measles impacts vulnerable community members who cannot be immunized, such as pediatric cancer patients undergoing chemotherapy.

Paul: Public health relies on collective responsibility to safeguard those who are medically vulnerable.

Paul: So act like it.

Brent: What is your perspective on COVID boosters? Initially, as a healthy person in my mid-40s, I got the primary series and first booster, then paused. Later, learning about Long COVID and post-viral complications led me back to getting boosted. Who should receive annual boosters?

Brent: COVID's not that bad. I don't want to put things into my body that are not required. I'm not going to have the Covid booster. And then we did a few episodes here on chronic fatigue syndrome and long Covid, and I became convinced of the Covid boosters, not for the acute phase itself. Yeah, I don't think that that's that bad for me.

Brent: Well, I don't I it's not that, symptomatic. It's tolerable. I guess, in terms of just the experience of it. But I sure do not want these chronic issues that can come up after, after bad infections. And so I'm now back on the Covid booster train. But what's your view on who should be getting the Covid booster?

Brent: Who shouldn't and and why?

Paul: High-risk groups (elderly, immunocompromised, pregnant women, and chronic condition patients) benefit from annual boosters. Healthy, younger adults can reasonably choose whether to receive annual boosters based on personal risk assessment.

Paul: Studies show clear reductions in Long COVID risk from initial primary doses and early boosters. Broadly mandating boosters across all age groups low-risk healthy adults wasn't necessary once high-risk targeted protection was established.

Brent: How should parents evaluate COVID vaccines for young children under ten?

Paul: Children who have not been vaccinated or infected should receive primary immunization. CDC data showed 1,000 to 2,000 pediatric COVID hospitalizations annually, with 20% requiring ICU care and half occurring in previously healthy children.

Paul: Vaccination offers controlled primary protection without the risks associated with unmitigated primary infection.

Paul: I mean, they should we should stop calling it, you know, natural immunity and call it what it is, which is survivor immunity.

Brent: What about the HPV vaccine? Skeptics raise concerns about side effects like infertility, arguing risks outweigh benefits for healthy teenagers. What is the evidence regarding HPV vaccination?

Brent: What's your sense of of the argument I don't know for or against HPV vaccine.

Paul: Human papillomavirus is a known driver of cervical, anal, genital, and head/neck cancers. The HPV vaccine has reduced HPV-associated cervical cancer incidence in the U.S. by over 60%.

Paul: The vaccine uses a single viral L1 protein to induce immunity. Nearly two decades of safety data confirm its effectiveness and safety profile for both girls and boys.

Paul: About one-third of HPV-related cancers occur in males. Because oncogenesis occurs decades after initial exposure, the long gap can reduce immediate urgency among parents.

Paul: The thing is, is, though the cancer doesn't occur until about 20 years plus after your infection. So, you know, I think that pediatricians sometimes are less compelled by that vaccine because they don't really see the consequences of the infection.

Brent: What about concerns over the expanding immunization schedule? The number of doses across childhood has increased over recent decades. Is there validity to concerns that adding doses contributes to health issues?

Brent: Parents see multiple combination shots across childhood visits. Has the schedule expanded safely?

Paul: When a vaccine safely prevents pediatric mortality and morbidity without interfering with concomitant vaccines, adding it to the schedule protects children against 18 target diseases.

Paul: Parents see up to 26 injections during early childhood visits, which can feel overwhelming. That hesitancy often stems from a lack of familiarity with the severe diseases being prevented.

Paul: Parent advocacy organizations formed by families affected by flu, meningitis, or pneumococcal disease emphasize that preventable loss is devastating. Vaccination keeps children in the safest position possible.

Paul: No. So we always have this sort of myth of invulnerability that's never going to happen to us. But if you talk to these parent advocacy groups like Families Fighting Flu, meningitis, Angeles, those parents all tell the same story, which is I can't believe this happened to me until it happens to you. And then they become advocates for educating about the disease, educating about the vaccine, God bless them.

Paul: Online wellness and alternative supplement industries generate significant revenue promoting unverified claims against established public health measures.

Paul: And if there's there's this great monograph called The Disinformation Dozen that's put out by the centers for Countering Digital Hate. And they go through the 12 people or groups that are they put most misinformation on the internet. They're really well funded, funded by the alternative medicine industry, funded by the Wellness industry. I'm telling you, the misinformation business is a much more lucrative business than the information business.

Paul: Nonetheless, the information business is always being countered by, as you did at the beginning of this interview. Yeah, but you know, aren't aren't you in the pocket about Big pharma? Forget big pharma, it's big wellness and big alt med that's really driving all this.

Brent: To clarify total shot counts: under the standard recommended schedule up to age 18, how many total doses are administered across all target diseases?

Paul: Preventing 18 target diseases involves roughly 50 to 56 individual doses integrated across combination vaccines from birth through age 18.

Brent: Looking at communication strategy: you speak openly and critically regarding RFK Jr.'s claims. Many public health challenges exist—high chronic disease rates, obesity, and diabetes.

Brent: Some argue public health institutions needed reform and that criticism encourages discussion. How do you evaluate direct pushback versus constructive engagement?

Brent: And so it's not like we were great at public health before. And, you know, so we need somebody to come in and shake it up. And they're not going to get everything perfectly right. What is the you know, what's the right balance here? And how do you think about your approach of being very aggressive in the way that you, you know, that you criticize him and having that, I don't know, contribute to this, seesaw effect that's happening.

Paul: Obesity, hypertension, and metabolic illness are major domestic challenges requiring focused policy attention, alongside structural health disparities.

Paul: Addressing ultra-processed foods, excess sugar, and sedentary lifestyles is important. However, conflating metabolic health goals with opposition to proven vaccines undermines public health.

Paul: Attacking established vaccines leads to preventable resurgences of measles, pertussis, flu, and tetanus, endangering pediatric safety needlessly.

Paul: Promoting raw milk consumption or unproven medical therapies replaces sound evidence-based policy with risk.

Paul: Improving diet, exercise, and sleep habits is vital, but linking those goals to anti-vaccine rhetoric damages evidence-based healthcare.

Paul: What is the advantage of unpasteurized milk other than exposing you to Listeria, Campylobacter, salmonella? And then what is the advantage of, of, saturated fats as compared to unsaturated fats, which setting back the American Heart Association 30 years. It's it's so, so he because he's anti-science. He hurts that movement. And also I think when you see somebody like Casey means who was, you know, wrote the book Good Energy and is kind of another wellness influencer, I think the wellness community and or med Community Alternative Medicine committee are moving into the center of public health.

Paul: That's not good either. You're seeing RFK Jr, for example, getting the FDA to back off bogus the promotion of bogus autism therapies like key lation, which is, you know, binding heavy metals or hyperbaric oxygen or stem cell therapy. So you're seeing that sort of woo move into the into the public health. Maybe that's not good either. I do think we can eat better and exercise more and sleep better.

Paul: I agree with all that. But I think this this movement's getting sidetracked also by linking it to the MAGA, agenda. You know, you are cutting back on, on, regulation of environmental pollutants. I don't think there's been a single grant funded by the National Cancer Institute for cancer this year. I mean, for all their talk about chronic diseases, they're cutting back on the funding of studying chronic diseases.

Paul: I don't see how any of this helps.

Brent: Health policy should remain anchored in transparent rigorous science rather than partisan politics.

Brent: It just just lastly, do you have a theory of mind? Because I don't think we hear that RFK or Casey means that it's about money, that they are just, they're filling up their pockets with money. And so they're knowingly lying. I mean, RFK, he does seem very genuine in his belief in terms of what he talks about.

Brent: He comes across that way. Do you have a theory of mind as to, you know, why he is, propagating information in the way that he is?

Paul: He certainly benefits from the wellness industry, which is a $6.3 trillion industry dwarfs, the big pharma industry, actually. But, you know, big pharma is always going to be seen as illness, as evil, whereas wellness always sounds like a good thing. Do he and his allies benefit from the wellness? Absolutely. Cassie means I think she's. I think her her, nomination will ultimately be defeated in part because she clearly sells products, in that wellness category.

Paul: Just look at her newsletter, read her book.

Brent: But but is that is that fair of RFK? Because he was like, I was cleaning up the rivers and, you know, he cleaned up the East River. He was an environmental activist. He was a Democrat for a long time. He's a Kennedy. He kind of comes from money. Is that is that fair? Like, my sense of it is that it's something it's something else.

Brent: Either he he genuinely believes it and he's misguided, or maybe it's what you're saying. It's a very libertarian approach to personal health that's everybody should be able to make their own decisions. And maybe that's the kind of world he wants to be in. Is it a fair criticism of him that it would be, hey, it's just about the money.

Paul: Well, he certainly makes money suing people. I mean, he made $2.5 million in the two years before he became secretary of Health and Human Services. Are suing pharmaceutical companies for claims that, frankly, were not based on science. I mean, so that's who he is. Do I think he believes what he's doing? Yes, I actually do. I think he believes that vaccines have merely replaced infectious diseases with chronic disease.

Paul: I do. That's why he doesn't comment on chronic diseases. Why never gets up and says, in the midst of our biggest measles epidemic, and in 33 years where three people died last year, including two healthy children for the first time in 20 years, he never gets up and says, vaccinate your children, vaccinate your children. He doesn't say that.

Paul: So he but he believes it. I think he's a believer. He's a zealot, which in many ways makes him more dangerous. But he is a science denier. If you show him data, if people respond to his concerns about, say, aluminum, salts and vaccines by doing an excellent study that looks at the last 23 years of children who got one dose or another of aluminum, he just doesn't believe it.

Paul: So who is that? I mean, is that really the guy you want as secretary of Health and Human Services is the guy who you want is health secretary of Health and Human Services, the guy who goes on Theo Vaughn's show and says, I'm not scared of germs because I snorted cocaine off toilet seats. He's the secretary of Health and Human Services.

Paul: I mean, am I asking too much?

Brent: Communicating medical facts clearly to the public remains crucial. Modern chronic disease rates stem primarily from diet, inactivity, and lifestyle factors.

Brent: And we primarily talk about preventative health and, and chronic disease. And just one comment there. It's very obvious the source of our chronic disease. It's our terrible diets and it's our sedentary lifestyle. It's our sitting around staring our screens a great thing on our sleep. It's not like there's some big question as to where these chronic diseases are coming from.

Brent: But even, you know, it's been so effective that even for me, I had thought this happy argument, you know, is seems pretty strong. Why are we giving this little baby the hep B vaccine and then spend some more time looking at it and talking to you? And ultimately we did it. But it is a successful campaign. Which is which is very concerning, because in these conversations, you realize that the science around these vaccines is just really strong and it just is what it is.

Brent: Evaluating vaccine evidence directly reinforces the underlying strength of the science. Thank you for your decades of research work and dedication to public health education.

Brent: And, you know, running around hiking and, you know, we're we're really setting an example of physical activity and health and eating well, because it's not 100% of what they're saying is wrong. But let's hopefully we can balance that with, you know, getting it right everywhere instead of getting it right in one place and then counteracting all of that work by getting it so catastrophically wrong in another.

Paul: No, I think that's really good. I mean, in many ways, I root for the Make America Healthy Again movement because we do eat too much of the way of ultra processed foods. We don't sleep enough, we don't, and we eat too much sugar, especially in the Snap programs, you know, the supplemental nutritional programs for children. And that's all really important.

Paul: And it's just getting buried in this nonsense of RFK drew. He's the wrong guy. And I just don't think I don't. I'm surprised when people don't get it and where my passion comes from, by the way, is I don't like watching children come into our hospital and suffer and die from something that's completely preventable. And he has a lot to do with that.

Paul: He has for 20 years been a lot of misinformation and disinformation about vaccines that's hurt children. And that's I think, your point of, you know, why do I need a a hepatitis B birth dose is perfectly reasonable. You should be wondering. You should be skeptical of anything you put into your body, your child's body. You should and put people feet to the fire to have them explain why it is that you really do need this.

Paul: I agree with you. I think you should be skeptical, but it's crossing that line from skepticism to cynicism that, you know, I just don't trust the American Academy because I don't trust these doctors because they, you know, and but, I mean, I'm the co-inventor of a vaccine. I mean, was I ultimately in any way financially compensated for that?

Paul: I was it wasn't by the company, but it was by my hospital. So I was compensated for that 26 year effort. I'm sorry that bothers some people, but I think a lot of people get compensated for what they do. I was the first.

Brent: Yeah, you saved 160,000 lives a year. I if you invent something that does that, I think we should compensate that. And frankly, yeah, I don't think you received anywhere near as much compensation as a, you know, some entrepreneur who sold their random tech company, yesterday. And they're affecting way fewer lives. After all, this is a kind of free market, capitalist society.

Brent: And so thank you for your work again. Thank you for your time today. And yeah, I hope we can just we can find the middle ground on all this.

Paul: That'd be great. Thank you.