Speaker 1: I am one of the increasingly rare old timers who
Speaker 1: lived during the pre vaccination era. I am the second
Speaker 1: to the last of thirteen siblings, five of whom died
Speaker 1: of vaccine preventable diseases in infancy, born to poor immigrant parents.
Speaker 1: I remember well my mother's account of the causes of
Speaker 1: their deaths, three from protessis and two from measles. Even
Speaker 1: after many years had passed, she spoke of the death
Speaker 1: of her angels with a great deal of emotion. Imagine
Speaker 1: losing not one, two, three, or four, but five babies.
Speaker 1: It was common in the pre vaccine era. Like our family,
Speaker 1: many families lost several children to these diseases. We forget.
Speaker 1: Time blurs our memories of these common tragedies of yesteryear.
Speaker 1: I remember well, during the winter and spring of each year,
Speaker 1: hearing the whoop of protessis and movie theaters, school assemblies,
Speaker 1: and assorted gatherings. Today few have ever heard this, and
Speaker 1: those who have forget. I remember the summer outbreaks of polio,
Speaker 1: the crippled children who could no longer walk or walk
Speaker 1: with limb distorted limps. As a third and fourth year
Speaker 1: medical student, I remember answering the appeals of hospital administrators
Speaker 1: who could not find the nursing staff for special duty
Speaker 1: tending to the needs of polio patients in iron lungs.
Speaker 2: We forget.
Speaker 1: I remember the awful cases of measles my own children experienced.
Speaker 1: I remember the children with smallpox during the years my
Speaker 1: family lived in Pakistan. I remember those who lost their
Speaker 1: sight from lesions in their eyes. I remember those who died.
Speaker 2: We forget.
Speaker 3: So that was.
Speaker 1: A letter to the Immunization Action Coalition by E. J.
Speaker 1: Jean Gangarosa, who was a professor emeritus from Emory University.
Speaker 1: He wrote that letter in two thousand. Yeah, it's it
Speaker 1: is amazing. He's very right. We do forget. And those
Speaker 1: of us who have never heard it don't know, right, Yeah,
Speaker 1: we don't know what it's like. My name is Aaron.
Speaker 4: Welsh and I'm Aaron Oman Updyke.
Speaker 1: And this is this podcast will Kill.
Speaker 2: You Vaccines Today.
Speaker 1: Yes, this is the first episode of a two part
Speaker 1: series on vaccines and all about the history of vaccines,
Speaker 1: the biology of vaccines, how they work. And we are
Speaker 1: also so thrilled for this episode because we got to
Speaker 1: talk to two real life vaccine experts, doctor Gail Rogers
Speaker 1: and doctor Pedmini Shrikantaya, who are both senior program officers
Speaker 1: at the Bill and Melinda Gates Foundation. We chatted with
Speaker 1: doctor Shrikantaia and doctor Rogers about how vaccines are developed,
Speaker 1: some of the different vaccine preventable diseases that are targeted
Speaker 1: around the world, and the challenges faced in some global
Speaker 1: vaccination initiatives. We had such a great time talking with them,
Speaker 1: seriously aspirational.
Speaker 4: Yeah, they've like lived lives that we want to live someday.
Speaker 1: It was so cool and we know that you're going
Speaker 1: to love them too. So day tuned. Okay, so what
Speaker 1: are we drinking today? It's it's vaccine time.
Speaker 4: Quarantiny time, quarantiny time. We're drinking wait for it.
Speaker 1: Enders fame, finally, finally, Yes. So this quarantini is named
Speaker 1: for John Enders, who is the recipient of a Nobel
Speaker 1: Prize for his work on how on cultivating the poliovirus,
Speaker 1: which really paved the way to create polio vaccine. He
Speaker 1: also created the measles vaccine. I'm talking too much about
Speaker 1: the history. Tell me what's in the drink.
Speaker 4: It's konnac orange liqueur and lemon juice.
Speaker 2: Is basically a sidecar.
Speaker 4: Yeah, so fancy little fancy, little fun drink, and we'll
Speaker 4: have the full recipe for that quarantini as well as
Speaker 4: our non alcoholic plusy burrita on all of our social
Speaker 4: media channels as well as our website. This part okays
Speaker 4: We'll kill You dot com.
Speaker 1: Yeah, check it out, check check it out. We also
Speaker 1: really quick need to make a fun little announcement. We
Speaker 1: are working on an episode where we answer questions you
Speaker 1: send us about us, or about disease ecology or epidemiology,
Speaker 1: or podcasting or cocktail techniques or honestly whatever you can think.
Speaker 4: Of anything you want to know, So send us your
Speaker 4: questions by email to this podcast will Kill You at
Speaker 4: gmail dot com.
Speaker 1: And if you decide to send us a question that
Speaker 1: you want us to answer for this episode, please put
Speaker 1: ask the errands or something to that effect in the
Speaker 1: subject line and let us know whether you're okay with
Speaker 1: us saying your name on the episode.
Speaker 4: We can't wait to hear from you, all right, should
Speaker 4: we just jump right into it?
Speaker 1: I think we should.
Speaker 2: Okay, We'll take a quick shark break.
Speaker 4: So, vaccines are often called one of the greatest public
Speaker 4: health inventions of all time, and I agree they totally are.
Speaker 4: But it's partially because they work at two different levels.
Speaker 4: Vaccines work both on an individual level, so when you
Speaker 4: get vaccinated, you are protected against whatever infection you just
Speaker 4: got vaccinated against, which is great. Who doesn't want to
Speaker 4: be protected? But they also work at the population level,
Speaker 4: so when you get vaccinated, you're actually protecting all of
Speaker 4: those around you as well. Can pat yourself on the
Speaker 4: back for doing a public service every time you get vaccinated.
Speaker 4: So to understand exactly how vaccines can be so awesome
Speaker 4: and work on these two totally different levels, I'm going
Speaker 4: to get into some serious detail about the biology and
Speaker 4: epidemiology of how they work. And I'm going to do
Speaker 4: it so that you can a understand how awesome our
Speaker 4: immune systems are. B understand how cool it is that
Speaker 4: vaccines exist, and see be the one who explains this
Speaker 4: to Aunt Martha at Thanksgiving this year.
Speaker 1: Oh yeah, okay, excellent.
Speaker 2: All right.
Speaker 4: So, to first understand how vaccines can protect you, specifically,
Speaker 4: dear listeners, we first have to understand how our immune
Speaker 4: system works and how our bodies fight off infection. So
Speaker 4: immuneologists don't hate me. I'm going to break this down
Speaker 4: in the simplest possible way. More complicated, but these are
Speaker 4: the basics. There are two major parts to our immune system.
Speaker 4: There's a non specific which is called the innate immune response,
Speaker 4: and then there's a specific response, which is called the
Speaker 4: adaptive response. Okay, the innate immune response, it's very fast
Speaker 4: on the uptake. When you get exposed to viruses or bacteria,
Speaker 4: it can find them and start to get to work
Speaker 4: really quickly, but it's not that powerful. It doesn't last
Speaker 4: that long and it can't destroy everything. So we have
Speaker 4: a second immune response, the adaptive immune response.
Speaker 2: This is something that allows us to target very specific.
Speaker 4: Individual pathogens, but it takes some time. It's a little
Speaker 4: bit slow to get started. So what that means is
Speaker 4: that before your adaptive immune response kicks in, you usually
Speaker 4: get sick, you feel crappy, and then your adaptive immune
Speaker 4: system needs time to kick in and actually fight off
Speaker 4: that infection. But the good thing about this adaptive immune
Speaker 4: response is that it has a memory like an elephant.
Speaker 2: It never it never forgets.
Speaker 4: So anything that the adaptive immune response has responded to once,
Speaker 4: the second time it's exposed to that same virus or bacteria,
Speaker 4: it can respond much more rapidly and much more effectively.
Speaker 2: Right, Okay, So here's how it works. In four acts.
Speaker 2: We're gonna have a play.
Speaker 1: Oh my god, mine's the four parts too.
Speaker 2: Oh my god, we didn't even plan that.
Speaker 1: Oh we didn't.
Speaker 2: Okay, thrilling, Oh my goodness.
Speaker 4: Okay, so we're uh biology play first four X.
Speaker 2: Here we go.
Speaker 4: So we have three main characters. Do you have three
Speaker 4: main characters too?
Speaker 1: I have a host of characters.
Speaker 4: Okay, well, we're just simplifying it to three. We're gonna
Speaker 4: have three main characters in our immune system play the macrophages,
Speaker 4: the T cells, and the B cells.
Speaker 1: Okay.
Speaker 4: All of these three characters are types of white blood cells,
Speaker 4: and in your body you have a lot more than
Speaker 4: just these three, but these are our three main characters,
Speaker 4: and all of the rest of your white blood cells are.
Speaker 2: Going to be the ensemble. Okay, all right.
Speaker 1: Act one.
Speaker 4: You breathe, Okay, in your breath, you inhale an antigen.
Speaker 4: This might be a virus, a bacteria, a toxin, your
Speaker 4: neighbor's boogers, aerosolized poop, whatever.
Speaker 1: It's nice.
Speaker 2: Yeah, well that's life.
Speaker 4: It's a foreign substance that doesn't belong in your body,
Speaker 4: and in your body just waiting at the ready are thousands,
Speaker 4: nay millions of these white blood cells ready to jump
Speaker 4: into action. First incomes the macrophages. The macrophagers are going
Speaker 4: to see this antigen, this virus or bacteria, and they're
Speaker 4: going to eat it. They're gonna gobble it up, and
Speaker 4: they're gonna take that and take a part of it,
Speaker 4: and they're going to bring it over to their friends
Speaker 4: who enter stage left. The tea cells and the T
Speaker 4: cells walk in and they're like, hey, macro how's it going.
Speaker 4: What you got What do you have for us today?
Speaker 4: And the macrophage is like, so, I don't know exactly
Speaker 4: what this is, but I found it over there and
Speaker 4: I know it doesn't belong here.
Speaker 2: I recognize it. I'm not sure what to do with it.
Speaker 4: And the T cells are like, don't worry, we got you,
Speaker 4: act too.
Speaker 2: We got you.
Speaker 4: So the T cells they recognize that antigen. There's a
Speaker 4: whole group of these T cells and they're like, we
Speaker 4: can do two different things. Some of these tea cells
Speaker 4: they're a little wacky, they're a little wild. Okay, they're
Speaker 4: called the cytotoxic tea cells. They probably have like a
Speaker 4: mohawk and a motorcycle, sweet. They recognize that antigen, they're like,
Speaker 4: I know, I know how to take care of this,
Speaker 4: don't worry. So they're gonna exit and they're gonna go
Speaker 4: start replicating like wildfire, and they're gonna go out and
Speaker 4: just find anything that has that same antigen, any virus
Speaker 4: that looks the same, any bacteria that looks the same
Speaker 4: as that antigen, and they're gonna go out and kill it.
Speaker 4: They're just gonna start murdering things throughout your body.
Speaker 1: Okay, okay, shoot first, ask questions later.
Speaker 2: Exactly.
Speaker 4: So those are the cidotoxic mohawk tea cells. The other
Speaker 4: T cells they've got like bangs in a short bob.
Speaker 4: They're the helper T cells. They're a lot calmer. They're
Speaker 4: gonna take this antigen and swing their way over to
Speaker 4: their friends who hang out at the lymph node bar,
Speaker 4: the B cells. And as they walk into the lymph nodebar,
Speaker 4: they call out amongst the thousands of B cells just
Speaker 4: hanging out and they're like, hey, hi, everybody, does anyone
Speaker 4: recognize this anigen? Mcriface just dropped it off. Do you
Speaker 4: guys know what to do with it? This is kind
Speaker 4: of your thing? And in through the swinging what do
Speaker 4: you call those old timey western doors, swinging doors, swingy
Speaker 4: Western doors. You hear the clink saloon doors, saloon doors.
Speaker 2: There you go.
Speaker 4: You hear the clink clink of spurs and in walks
Speaker 4: wearing a ten gallon hat a B cell and he says,
Speaker 4: I sure do, I sure do recognize that antigen. And
Speaker 4: then they get to work actually immunity. So ten gallon
Speaker 4: hat B cell, he knows what to do. He starts
Speaker 4: replicating and replicating, making more and more copies of himself,
Speaker 4: and inside he's making antibodies. These antibodies are super specific.
Speaker 4: They're going to target just that one antigen that the
Speaker 4: T cell brought over. And these B cells are making
Speaker 4: millions of these antibodies, and what they do is they
Speaker 4: throw them out into your bloodstream. They travel throughout your
Speaker 4: whole body, and they find and attached to that anigen
Speaker 4: anywhere that they find it, whether it's in your cells
Speaker 4: that have been infected, whether it's on the bacteria or
Speaker 4: on the outside of a virus. Anything that has this
Speaker 4: specific anigen is going to get an antibody attached to it.
Speaker 4: It's kind of like a flag that you put on buildings.
Speaker 4: When you say this one's going to get demolished, and
Speaker 4: this one's going to get demolished, that's what an antibody is.
Speaker 4: So these antibodies go out and mark all of these
Speaker 4: cells so that the ensemble, the rest of the cast,
Speaker 4: the rest of your white blood cells can recognize it.
Speaker 4: They can come in and clean up the mess. They
Speaker 4: take soldiers exactly, So they come in and destroy that infection.
Speaker 1: Okay, So can I just review absolutely? Okay. So the
Speaker 1: macrifhage picks something up weird and then they bring it
Speaker 1: over and they're like, okay, everyone, T cells, B cells,
Speaker 1: what is this?
Speaker 2: Mm hmmm.
Speaker 1: So the T cells, the killer ones, they go and
Speaker 1: they just kill anything that remotely resembles that antigen.
Speaker 4: Anything that specifically resembles that antigen.
Speaker 1: Okay, specifically resembles that antigen. What does that mean? Specifically resembles?
Speaker 4: It means anything that is that exact same anagen. So
Speaker 4: it's not going to go out and just kill anything
Speaker 4: that looks similar to it. It'll just okay, that exact antigen.
Speaker 1: Okay. And then the helper T cells they go and
Speaker 1: find the B cells and say, hey, this is what
Speaker 1: we're looking for. Can you go and tag everything exactly?
Speaker 1: So then that makes the killer T cells.
Speaker 2: Easier, absolutely yeah.
Speaker 4: And it also brings in the rest of the white
Speaker 4: blood cells so that it's not just the T cells
Speaker 4: out there killing things. Okay, Act four Memory. So once
Speaker 4: your body has done all this work and cleared the infection,
Speaker 4: it's not done. Old ten gallon hat B cell and
Speaker 4: a few of those wild cytotoxic mohawk T cells they're
Speaker 4: going to develop into memory cells. These cells hang out
Speaker 4: and persist. They no longer run around making antibodies or
Speaker 4: killing cells. They're going to go backstage and wait until
Speaker 4: it's their time again. Maybe they'll play cards, they'll bide
Speaker 4: their time, and if that same antigen ever shows their
Speaker 4: face again, these B cells and T cells, the memory
Speaker 4: cells will be able to jump right back into action.
Speaker 4: They won't have to go through the whole rigamarole of
Speaker 4: acts one, two, and three. They'll just be able to
Speaker 4: use the antibodies they've already have in the mem resells
Speaker 4: to make more copies and identify and target that anagen
Speaker 4: and quash the infection before it ever takes hold. So
Speaker 4: this is the principle that vaccines exploit. They expose you
Speaker 4: to an anigen, which is a virus or a bacteria
Speaker 4: or part of a virus or bacteria, and that triggers
Speaker 4: your immune system to develop this memory response, so that
Speaker 4: if you're ever exposed to that virus or bacteria in
Speaker 4: real life, you've already got a response ready to go.
Speaker 4: You don't have to take the time to build that
Speaker 4: immune response.
Speaker 1: And so the difference between that first exposure and then
Speaker 1: seeing that same pathogen again is a state of disease
Speaker 1: and then a state of rapid immune response and no
Speaker 1: disease exactly, and then a vaccine just bypasses that whole disease.
Speaker 1: You don't have to actually endure the disease symptoms exactly.
Speaker 4: So if you imagine that you're immune cells in a
Speaker 4: lot of cases, if they're dealing with a live virus,
Speaker 4: a full on, fully loaded measles virus, it's not like
Speaker 4: they're just dealing with something passive. That virus has come
Speaker 4: in guns ablazing, it's replicating, it's going full force, while
Speaker 4: your immune cells might be kind of like tripping over
Speaker 4: their lines and getting things wrong and trying.
Speaker 2: To figure out what to do about it.
Speaker 4: Right, So, an immunization is kind of like a dress
Speaker 4: rehearsal for the play.
Speaker 2: It's real.
Speaker 4: There's people in the audience still, and you're going to
Speaker 4: develop the exact same response at the end of it.
Speaker 4: But you don't have a live virus trying to kill
Speaker 4: you while you develop this immune response the very first time.
Speaker 1: Mm hmmmm cool yeah, cool, it's fantastic. I mean, vaccines
Speaker 1: are the best.
Speaker 2: Are the best.
Speaker 4: So that's how vaccination can protect you as an individual.
Speaker 4: How does it protect an entire population. This is something
Speaker 4: we've touched on before, but it's called herd immunity, and
Speaker 4: it goes something like this. Every infectious agent bacteria, virus, fungi, whatever,
Speaker 4: in order to survive, it has to spread from person
Speaker 4: to person.
Speaker 2: That's how they reproduce.
Speaker 4: And in order to do so, in order to spread
Speaker 4: from person to person, there have to be susceptible people
Speaker 4: in the population for that virus or bacteria to get into.
Speaker 4: So if a population has a high level of vaccination,
Speaker 4: let's say like ninety seven percent of one hundred people
Speaker 4: are vaccinated, that means that those ninety seven people have
Speaker 4: developed this immune response already. They're already protected. So if
Speaker 4: you happen to drop an infected person in the middle
Speaker 4: of that population. The chances that that infected person would
Speaker 4: run into somebody who's still susceptible to that disease are really,
Speaker 4: really low. So you'd have that one infected person who
Speaker 4: will get sick and then hopefully they'll recover, or else
Speaker 4: they'll die from their infection, and then that's it. Nobody
Speaker 4: else gets sick because that sick person didn't run into
Speaker 4: anyone who was susceptible to that disease. But if you
Speaker 4: imagine that maybe only fifty percent of people are vaccinated,
Speaker 4: then only fifty percent of people are immune and the
Speaker 4: other fifty are susceptible, and you dropped an infected individual
Speaker 4: in the middle of that population, there's a pretty good
Speaker 4: chance that that infected person will run into somebody who
Speaker 4: happens to be susceptible, and maybe they cough or they
Speaker 4: shake their hand or lick their face, and now you
Speaker 4: have two infected people. And then that second infected person,
Speaker 4: they have a pretty good shot, like forty nine more
Speaker 4: people that they might run into another susceptible individual and
Speaker 4: lick their face, and now you have three infected individuals, right,
Speaker 4: and so on and so on. So this is the
Speaker 4: principle behind herd immunity. If the entire herd, the entire population,
Speaker 4: or enough of it is immune to infection, either because
Speaker 4: they've already been exposed and recovered from the disease or
Speaker 4: they were vaccinated and they developed immunity, then the infection
Speaker 4: can't spread.
Speaker 2: Right.
Speaker 1: So the more people that are immunized against something or
Speaker 1: immune to something by whatever, means the less chance that
Speaker 1: a pathogen has of establishing in a population or being
Speaker 1: transmitted exactly.
Speaker 4: So by getting vaccinated, you are protecting yourself from getting
Speaker 4: that infection, but you're also protecting that tiny baby on
Speaker 4: the train who's too young to get vaccinated, your grandma
Speaker 4: who's frail and immunocompromised, whoever. You're protecting literally everyone around
Speaker 4: you when you get vaccinated. So that's how vaccines work.
Speaker 4: They're pretty dang cool. Yeah, I love them, big fan,
Speaker 4: me too, major if you can't tell already. So, there
Speaker 4: are a lot of different types of vaccines, and we're
Speaker 4: going to talk a little bit about the differences between them.
Speaker 4: Not a full on immunology lecture, but just a quick rundown.
Speaker 4: But I do want to say at the very top
Speaker 4: of this that all vaccines that are used are extremely safe.
Speaker 4: They're extensively tested and very highly regulated, and all the
Speaker 4: different types of vaccines that we have are very effective.
Speaker 4: And part of the reason that we have different types
Speaker 4: of vaccines is because different viruses and bacteria behave differently
Speaker 4: and so we have to come up with different types
Speaker 4: of vaccines.
Speaker 2: To target those specific pathogens.
Speaker 4: So some vaccines, for example, the MMR vaccine that's measles,
Speaker 4: mumps and rubella, which you talked about before, and also verisicella,
Speaker 4: which is chicken pox. These are made from what we
Speaker 4: call live attenuated viruses, so that means the vaccine itself
Speaker 4: has a live virus in it, but that virus has
Speaker 4: been modified.
Speaker 2: So that it's super super weak.
Speaker 4: It's not a strong, virulent virus that actually makes you
Speaker 4: get sick. It's a weak, little infantile virus. Through this
Speaker 4: type of vaccine elicits a really good immune response because
Speaker 4: it's just like getting a real infection in that you
Speaker 4: have virus replicating in your body, but because it's such
Speaker 4: a weak virus, you don't get sick from it. However,
Speaker 4: it does mean that some people who are immunal compromised,
Speaker 4: who have very weak immune systems might not be able
Speaker 4: to get these live virus vaccines because their immune system
Speaker 4: might not be strong enough to fight off even.
Speaker 2: A very weak virus.
Speaker 4: Gotcha, Okay, we also have whole killed vasvaccines. So these
Speaker 4: are vaccines that are a whole entire virus, so all
Speaker 4: of the different parts of the virus, but we kill
Speaker 4: the virus before we make the vaccine out of it.
Speaker 4: So that's the inactivated poliovirus, the one that is an
Speaker 4: injection or the influenza vaccine.
Speaker 1: And so are there also killed bacteria vaccine?
Speaker 4: Are Yeah, So there's a killed bacteria vaccine for typhoid
Speaker 4: and there's also a live vaccine for typhoid.
Speaker 2: Hey, there's both.
Speaker 5: Cool.
Speaker 4: So these whole killed vaccines, you still develop a really
Speaker 4: strong immune response, but you might need to get more
Speaker 4: boosters with this type of vaccine because it might not
Speaker 4: be quite as strong of a response as you get
Speaker 4: from a live vaccine. But people who are immuno compromised
Speaker 4: can still get these killed virus vaccines because there's no
Speaker 4: live virus in these vaccines that's replicating.
Speaker 1: So going back to the flu vaccine, yes, this means.
Speaker 2: This means.
Speaker 4: That you cannot get the flu from the fl vaccine.
Speaker 1: Correct, absolutely not ever so more, can you pass on
Speaker 1: the flu to someone if you have gotten the flu shot?
Speaker 2: Exactly, it's not possible.
Speaker 4: It's a killed dead virus. Okay. Sometimes you might get
Speaker 4: a slight fever or muscle aches, especially in the arm
Speaker 4: that you got the shot in or the butt cheek
Speaker 4: where you got your vaccine. Do you know why aarin
Speaker 4: that you might get a fever and feel achy?
Speaker 1: Is it some sort of innate immune response.
Speaker 2: Oh, you're so good.
Speaker 4: That's your actual immune system actually doing its job. So
Speaker 4: you might feel a little bit cruddy after you get
Speaker 4: a vaccine, but it's a lot less cruddy than you
Speaker 4: would feel if you got that actual.
Speaker 1: Infection, right, And also you wouldn't die, you will like
Speaker 1: you could, like you might if you've got the actual
Speaker 1: infection right.
Speaker 2: Exactly.
Speaker 4: Yeah, no, Again, adverse events are extremely, extremely rare for vaccines.
Speaker 2: They're very safe.
Speaker 4: The other thing about live virus vaccines, and the reason
Speaker 4: why some vaccines that we used to use as live
Speaker 4: virus vaccines we no longer use live virus vaccines, is
Speaker 4: that there is a small chance that people can actually
Speaker 4: get sick essentially from the vaccine.
Speaker 2: Itself.
Speaker 4: Because it is a live virus, there is a chance
Speaker 4: that either the virus can change a little bit or mutate,
Speaker 4: or your immune system, even if you have a good
Speaker 4: immune system and you're not even compromised, might not just
Speaker 4: be strong enough to fight off that vaccine strain. So,
Speaker 4: for example, with the oral polio vaccine, which is a
Speaker 4: live version of the polio vaccine that isn't really used
Speaker 4: much around the world. It's only used in places where
Speaker 4: there's mostly where there is still a chance of polio infection,
Speaker 4: like wild type polio still circulates in about one in
Speaker 4: two point five million doses. Someone would end up getting
Speaker 4: polio from the polio vaccine. So it is theoretically possible
Speaker 4: that with a live virus vaccine that you could end
Speaker 4: up getting sick or end up for example, if you
Speaker 4: get the vericella vaccine and then end up getting a rash,
Speaker 4: you could potentially then pass vericella to somebody who's immunal
Speaker 4: compromised from that vaccine strain. Again, it's very very very rare.
Speaker 4: These would be considered adverse events, and those are all
Speaker 4: reported to a system called the Vaccine Adverse Events Reporting System.
Speaker 1: And those would be detectable as vaccine strains, so the
Speaker 1: infection would be milder than if it were a wild type.
Speaker 4: Exactly right, Yeah, okay, okay. There's a few other kinds
Speaker 4: of vaccines. There are toxoid vaccines, which are very fun.
Speaker 4: Toxoid vaccines are an inactivated version of a bacterial toxin.
Speaker 4: So do you remember one that we covered already.
Speaker 1: Uh, diptheria, diphtheria.
Speaker 2: Also tetanus. Okay.
Speaker 1: I think that toxoid vaccines are my favorite, and I
Speaker 1: don't know why you know they.
Speaker 2: Actually they're my second favorite. I'll tell you my favorite
Speaker 2: in just a second.
Speaker 1: Oh, I can't wait.
Speaker 4: So, because some bacteria don't actually make you sick themselves,
Speaker 4: but they produce a toxin that makes you sick, then
Speaker 4: we can just take that toxin and give you a
Speaker 4: vaccination with that inactivated toxin, which is called a toxoid,
Speaker 4: and that way you're protected against any strains of that
Speaker 4: bacteria that contain the toxin.
Speaker 2: Very question answer.
Speaker 1: Cholera produces a toxin. Is the colera vaccine toxoid or
Speaker 1: is it?
Speaker 2: That's a good question. I'm pretty sure that it is.
Speaker 2: I was just looking at the color of vaccine. I
Speaker 2: think I wrote it down.
Speaker 1: No, I have it right here. Hold on. Okay, So
Speaker 1: the one that was produced in eighteen ninety six was
Speaker 1: killed whole and then the second one that was in
Speaker 1: nineteen ninety one is also kill killed whole cell, whole
Speaker 1: cell vaccine, and then the one in two thousand and
Speaker 1: nine was also killed whole cell.
Speaker 4: Okay, killed wholes So cholera is a killed whole cell vaccine.
Speaker 4: Maybe that's why it's not a super excellent vaccine. Yeah,
Speaker 4: it's not the most effective anyways. There are also what
Speaker 4: are called component vaccines. This is, as an example, the
Speaker 4: hepatitis B vaccine. So a component vaccine, instead of having
Speaker 4: an entire killed virus, it has just a small part,
Speaker 4: just the part that you would need to be able
Speaker 4: to quash that infection. In the case of hepatitis B,
Speaker 4: we have a single antigen, the surface antigen. So that's
Speaker 4: like what's on the surface of the hepatitis B virus,
Speaker 4: aka what your body needs to be able to see
Speaker 4: to prevent that virus from ever getting in to your cells.
Speaker 4: So we have some vaccines like that that are just
Speaker 4: made of a single component of a virus.
Speaker 1: Okay, and do they are there also component bacterial vaccines, Yeah.
Speaker 4: There are, for sure, But what's more common for bacteria
Speaker 4: vaccines are my favorite vaccine, the conjugate vaccine. So this
Speaker 4: is what is really commonly used against bacteria. The reason is, okay,
Speaker 4: this is where we get back into some immunology.
Speaker 1: Oh good.
Speaker 4: It turns out bacteria are very good at evading our
Speaker 4: immune system.
Speaker 2: They're very clever.
Speaker 4: They've been with us for millions of years, so they
Speaker 4: know how to get around our immune responses.
Speaker 2: So a lot of.
Speaker 4: Bacteria on their surface have sugars polysaccharides. These polysaccharides specifically
Speaker 4: evolved in order to evade our immune response. Because, as
Speaker 4: it turns out, that whole amazing immune response that I
Speaker 4: told you about with the B cell ten galon and
Speaker 4: the helper T cells, those only work if the anigen
Speaker 4: is a protein.
Speaker 2: Mmmmmm.
Speaker 4: So what we figured out to outsmart these bacteria who
Speaker 4: have polysaccharides not proteins on their surface, is that we
Speaker 4: can take these polysaccharide sugars and we can conjugate them,
Speaker 4: which means attach them to a protein antigen. For example,
Speaker 4: the tetanus toxoid, which we know is safe because we
Speaker 4: use it in vaccines conjugate a bacterial polysaccharide to that
Speaker 4: protein and use that as a vaccine, and then our
Speaker 4: body will make antibodies to fight off that bacterial sugar.
Speaker 1: Oh my brain is tingling, isn't it? That feels? So
Speaker 1: that's so fascinating.
Speaker 2: They're my favorite, so very cool.
Speaker 4: That's how we got vaccines for hemophalous influenzae, nicicerium, and ingititis.
Speaker 2: Et cetera.
Speaker 4: So those are I think definitely the newest vaccines are
Speaker 4: conjugate vaccines. Well, even newer are the DNA vaccines, which
Speaker 4: I'm not going to talk about today. But how fun right,
Speaker 4: that's amazing, very cool question.
Speaker 5: M hm.
Speaker 1: How exactly are vaccines developed?
Speaker 2: Great question. I'm not going to answer it.
Speaker 4: Okay, but that's because we were fortunate enough to chat
Speaker 4: with doctor Gail Rogers, who is a senior program officer
Speaker 4: at the Bill and Melinda Gates Foundation, which is the
Speaker 4: world's largest private charity foundation that focuses on improving health
Speaker 4: and reducing poverty around the world. And doctor Rogers has
Speaker 4: worked on several vaccine initiatives at the development and deployment stages, and.
Speaker 2: She shared with us her expertise.
Speaker 4: On vaccine development, so I'm gonna let her answer.
Speaker 1: Take it away.
Speaker 2: Gail.
Speaker 4: So, doctor Rogers, thank you so much for chatting with
Speaker 4: us today.
Speaker 3: Oh, you're very welcome. I'm excited to do it.
Speaker 4: We're really excited to talk with you about vaccine development
Speaker 4: in the future of vaccine. So let's jump in great.
Speaker 4: Can you introduce yourself and tell us a bit about
Speaker 4: your background and your role now at the Gates Foundation.
Speaker 3: Sure.
Speaker 5: I'm a pediatric infectious disease physician and I worked in
Speaker 5: academic in a hospital and children's hospital for many years
Speaker 5: and then went into industry working on vaccines.
Speaker 3: Specifically in the area of pneumonia.
Speaker 5: And from there I moved on to work where I
Speaker 5: currently work at the Gates Foundation to also in.
Speaker 3: The Pneumonia group to really both develop and.
Speaker 5: Make countries that are low resource countries have them have
Speaker 5: better access to vaccines, in particular to vaccines for pneumonia.
Speaker 1: Fantastic. So on this episode, we're trying to give listeners
Speaker 1: information about the process of vaccine development. So when we
Speaker 1: hear that a new vaccine has just been licensed, like
Speaker 1: the recent malaria or dengay vaccines, that vaccine has gone
Speaker 1: through rigorous development and clinical trials before it gets to
Speaker 1: the licensing stage. Could you explain the general process of
Speaker 1: vaccine development from when a vaccine is just someone's idea
Speaker 1: to when it's actually being distributed around the world.
Speaker 5: Sure, so it's it's a pretty lengthy process and and
Speaker 5: that that's something that and as and I think the
Speaker 5: right word is rigorous, as you as you mentioned.
Speaker 3: So it starts out in somebody's idea.
Speaker 5: Of doing this, and usually there is a pre clinical stage,
Speaker 5: which is when it is looked at in the laboratory. Uh,
Speaker 5: it might be looked at against different strains of what
Speaker 5: you're trying to protect against, and then tested in some
Speaker 5: forms in animals, usually to start off with before it
Speaker 5: goes into what's called first in human studies, and first
Speaker 5: in human studies are in adults. Even though the vaccine
Speaker 5: may not ultimately be used in adults. It always to
Speaker 5: start off in the first phase in adults and then
Speaker 5: moves once and and that really is for safety reasons.
Speaker 3: And then it it.
Speaker 5: Goes into the second phase of testing to see if
Speaker 5: it would work against the target as well as being
Speaker 5: safe in other populations.
Speaker 3: And that's where you start.
Speaker 5: And those are rather small studies where you start looking
Speaker 5: at it in the populations that you want to target,
Speaker 5: being that for in my case it's it's babies, it's pediatric,
Speaker 5: So it would start off in adults and then move
Speaker 5: maybe to toddlers, and then move to infants where it
Speaker 5: is tested for safety and whether it is useful or
Speaker 5: whether it works. And then there is what is the
Speaker 5: big studies, which are called the phase three studies, in
Speaker 5: which it's tested.
Speaker 3: In many more children.
Speaker 5: In different schedules, sometimes in different countries UH and really
Speaker 5: rigorously tested under under many circumstances to make sure that
Speaker 5: they're safe and that and then this is the one
Speaker 5: that they that you want to make sure that it
Speaker 5: works against the germ that you're treating, that you want
Speaker 5: I'm sorry that you're preventing. So after that all the
Speaker 5: evidence is looked at. All this data is looked at
Speaker 5: by really committees in the countries that are made of
Speaker 5: committees of experts, of vaccine developers, of physicians, of safety experts,
Speaker 5: et cetera.
Speaker 3: Where all the data is looked.
Speaker 5: At and based on those data, then licensure is given
Speaker 5: and from there from when a license is given, then
Speaker 5: it can go and be used by doctors as well
Speaker 5: as by countries themselves excellent.
Speaker 4: So, as we talk about on the episode, the past
Speaker 4: one hundred years have been incredibly productive for vaccine development,
Speaker 4: especially the past forty years, even the past ten years.
Speaker 4: Yet there are still so many other pathogens for which
Speaker 4: there is no vaccine. So what makes a pathogen a
Speaker 4: good target or a more challenging target for vaccine development?
Speaker 5: Yeah, I guess it's it's really it really is is
Speaker 5: really interesting.
Speaker 3: Part of it is what you look to prevent. So
Speaker 3: a lot of the times one looks to prevent the.
Speaker 5: Worst of the worst, the deadliest, So certainly there is
Speaker 5: a focus on very serious, very serious pathogens being being targeted.
Speaker 3: And then what makes.
Speaker 5: One more successful than others, I think is the wide
Speaker 5: variety of the pathogens and how often they can change,
Speaker 5: which is is pretty daunting.
Speaker 3: For example, I know you talked to to Padmini and.
Speaker 6: She runs influenza, but influenza changes so frequently that the
Speaker 6: target forgetting one vaccine to cope against all all types
Speaker 6: is really challenging.
Speaker 3: In I can tell you specific case.
Speaker 5: Of the numacaccus, which you know causes is the most
Speaker 5: common cause of pneumonia and common cause of death in children,
Speaker 5: less than five and for which there is a vaccine,
Speaker 5: and there had been a vaccine.
Speaker 3: Many years ago. This is you know, that was geared
Speaker 3: to adults. And it was.
Speaker 5: Only in when in the nineties when the technology was
Speaker 5: became available to know how to how to actually compose
Speaker 5: the vaccine to make children's immune system react to it,
Speaker 5: that that a vaccine became available for children.
Speaker 3: So the challenges are in.
Speaker 5: The pathogen itself, it's in how our immune system, you know,
Speaker 5: reacts to it and what type of protection can be
Speaker 5: elicited at different ages. And then for numacaccus, for example,
Speaker 5: there's over ninety zerotypes they're called that cause pneumonia, and
Speaker 5: it's hard to envision trying to do this for all ninety.
Speaker 5: So it started out with doing it for several for
Speaker 5: seven initially and when that worked and those were the
Speaker 5: seven that were picked as being the most commonly cause
Speaker 5: of disease, and.
Speaker 3: Then it got expanded. So currently we have ten.
Speaker 5: Zerotypes and thirteen two different vaccines that target those zerotypes
Speaker 5: and more on the way as technology advances.
Speaker 1: Well, speaking of technology, so there is as you mentioned,
Speaker 1: a lot of very interesting future avenues for vaccine development.
Speaker 1: So what do you see as some of the most
Speaker 1: exciting future prospects for vaccine technology. Where do you think
Speaker 1: we're going with vaccines.
Speaker 7: I think we are, you know, we're aiming to do
Speaker 7: to you know, challenge and really try to control the worst.
Speaker 3: Of the pathogens as as they become more prominent.
Speaker 5: So I think that for one, technology is helping us
Speaker 5: to to try to get to a universal influenza vaccine.
Speaker 5: So old pathoges that we know of, but what I'm
Speaker 5: kind of really interested in, and you know, not directly
Speaker 5: involved with the development, but really see as new diseases
Speaker 5: come up that are truly worldwide threats, such as bola,
Speaker 5: such as zeka, that it's pretty now clear that advances
Speaker 5: can be made pretty quickly in these fields with with
Speaker 5: the new with new technologies that will lead us to
Speaker 5: having vaccines, for example, for vola, in a time span
Speaker 5: that was really unreachable or inconceivable before. So I guess
Speaker 5: I'm kind of hopeful for a response time.
Speaker 3: In the future.
Speaker 8: I'm hoping, uh for antimicrobial resistance a vaccine for that
Speaker 8: that would be multipathogen I mean, this is really a.
Speaker 5: Dream as as organisms they're pretty smart and they can
Speaker 5: outdo antibiotics quite quickly. I think that you know, going
Speaker 5: the potentially going the vaccine route is going to be important.
Speaker 1: That's really exciting that the idea of a vaccine for
Speaker 1: multiple pathogens that are anti microbial resistant. I I just
Speaker 1: in my mind just went.
Speaker 9: Well, that's a dream, but you got a dream big
Speaker 9: and yeah, and you know, just seeing for example, there
Speaker 9: there are other things as well that I think I
Speaker 9: can point towards that are really interesting on a different realm,
Speaker 9: which is trying to get what we what we strive
Speaker 9: for gates, which is trying to get vaccines that are.
Speaker 5: Available or are in development to be aimed toward pathogens
Speaker 5: for countries that have lower limited resources, so developing countries
Speaker 5: for example. And before we had vaccines that were really good,
Speaker 5: but we have no way that low resource countries could
Speaker 5: afford them. And now they're innovative financing mechanisms and you know,
Speaker 5: involving cheered pricing, et cetera. So at the same time
Speaker 5: that they're licensed in the US, in Europe and used
Speaker 5: in middle income countries.
Speaker 3: They can be used in low income countries as well
Speaker 3: as well.
Speaker 5: And that's I mean, that's particularly exciting to have that
Speaker 5: kind of equity being built throughout the world for prevention.
Speaker 2: Yeah, that's amazing.
Speaker 4: So for some of our listeners who want to dive
Speaker 4: even deeper into the future of vaccine development, can you
Speaker 4: help direct our listeners on where they can go to
Speaker 4: find more information about some of the vaccines that are
Speaker 4: being developed by the Gates Foundation and elsewhere.
Speaker 5: Yeah, sure so, I think that always A really good
Speaker 5: resource is the CDC dot gov website. They have a
Speaker 5: really of what's available as well as, uh, what's what's
Speaker 5: up and coming. There's also the Clinical Trials dot gov
Speaker 5: that that tells you all the trials that are that
Speaker 5: that are being done with with vaccines as well as
Speaker 5: with with other drugs. So certainly so those are those
Speaker 5: are really good resources for for you to look for
Speaker 5: that what's what's up and coming?
Speaker 1: Fantastic, Thank you so much well, doctor Rogers. I think
Speaker 1: those are all the questions that we have for you today.
Speaker 1: Thank you so so much for taking the time out
Speaker 1: of your busy schedule to chat with us today. We
Speaker 1: really appreciate it and we had a great time.
Speaker 7: No problem.
Speaker 3: This is great. Thank you so much.
Speaker 1: That was so awesome. We learned so much.
Speaker 2: Oh my gosh, so much.
Speaker 1: How cool was it to talk with her?
Speaker 4: Amazing?
Speaker 2: Okay, so that's vaccines.
Speaker 4: That's all I have for the biology is like a
Speaker 4: whole immunology course.
Speaker 1: Yeah, I feel armed with knowledge.
Speaker 2: Great well armed me with the.
Speaker 1: Okay, we'll get ready to learn. There's a lot of
Speaker 1: history here.
Speaker 2: Let's take a quick break. Huh.
Speaker 1: All right, let's do it. For this episode, I'm going
Speaker 1: to give an overview of the history of vaccine development
Speaker 1: and the observed effects and disease prevalence after vaccines were
Speaker 1: widely adopted. I'm not going to go heavily into the
Speaker 1: various anti vaccine movements yet. I'm saving that for next episode.
Speaker 1: So hold on, hold tight, Hold on to your bets,
Speaker 1: Hold on to your bets. And I'm also not going
Speaker 1: to go into the details of every single vaccine that
Speaker 1: has been created, because if I were to do that,
Speaker 1: we would be here forever. But I am going to
Speaker 1: touch on the highlights of vaccine developments and what I
Speaker 1: see as the biggest stages of vaccine history. So Act one,
Speaker 1: I love it blossom. Yep. As we know, the word
Speaker 1: vaccine itself tells us its roots. Edward Jenner developed and
Speaker 1: tested the first vaccine against smallpox in seventeen ninety six
Speaker 1: in England from a cowpox or vaca means cow. Even
Speaker 1: though cowpox is no longer used in the smallpox vaccine
Speaker 1: or any vaccines, the name stuck and is used for
Speaker 1: all diseases. Okay, so that much we know. Technically speaking, though,
Speaker 1: the smallpox vaccine really is the first vaccine. But that's
Speaker 1: not exactly where the history of vaccines begins. Some of
Speaker 1: this is a bit of a refresher from past episodes.
Speaker 1: By the way, So the history of vaccines starts over
Speaker 1: a thousand years ago in China, where writings tell of
Speaker 1: a tradition called inoculation used to prevent smallpox infections. This
Speaker 1: practice may even go back to as early as two
Speaker 1: hundred BCE. Wow. Yeah, it's amazing, totally amazing. Basically, you
Speaker 1: were supposed to grind up scabs from people who had
Speaker 1: recovered from a mild form of the disease and then
Speaker 1: blow them into the noses of healthy children, gross gross.
Speaker 1: This would usually result in some mild symptoms, but it
Speaker 1: would also ensure that the child would not come down
Speaker 1: with severe smallpox later in life. Side note, the earliest
Speaker 1: immunization might be even older than variolation against smallpox. So
Speaker 1: apparently people used to try to prevent severe or disfiguring
Speaker 1: leshmaniasists by scraping an active lesion of someone with the
Speaker 1: disease and putting it on a child's arm or button.
Speaker 4: Really yeah, I know.
Speaker 1: And so there isn't a licensed leshmanias's vaccine today, but
Speaker 1: people at the Texas Children's Hospital Center for Vaccine Development
Speaker 1: are working on it. Okay, back to back to variolation,
Speaker 1: slash and oculation. Because the Silk Road allowed for exchange
Speaker 1: not just of goods but also ideas. Turkey picked up
Speaker 1: this practice as well, so this concept was starting to
Speaker 1: pick up steam in Eastern Europe around the same time
Speaker 1: that people were starting to travel to the New World,
Speaker 1: bringing with them smallpox among other killer microbes like measles
Speaker 1: and influenza that would wipe out the majority of the
Speaker 1: native populations yep. In Turkey, the practice was refined a
Speaker 1: bit so instead of snorting ground up scabs just like
Speaker 1: do a lot of ground up yeah, so gross, So
Speaker 1: people actually injected the infectious material just under the skin.
Speaker 1: So this is varilation. And so even though smallpox was
Speaker 1: a deadly killer that could devastate communities. People outside of
Speaker 1: Turkey and China were super hesitant to take up the
Speaker 1: practice because they viewed it as dirty, despite numerous reports
Speaker 1: of its efficacy. This is also the same people who
Speaker 1: would just dump poop right in the streets.
Speaker 2: But cool, that's fine.
Speaker 1: Cool. A few people went against this thinking, and I
Speaker 1: mentioned some of them on the smallpox episode, such as
Speaker 1: Lady Mary Montague and Cotton Mather. And it's not surprising
Speaker 1: that varilation was slow to catch on, really because stories
Speaker 1: of its effectiveness were largely just stories. At that point,
Speaker 1: clinical trials weren't yet a thing. But these iconoclastic thinkers
Speaker 1: definitely helped pave the way for the acceptance of variolation
Speaker 1: and eventually vaccination.
Speaker 2: Okay, smallpoc.
Speaker 1: Vaccination, as we all know, was developed by Edward Jenner
Speaker 1: in seventeen ninety six, and the story we all know
Speaker 1: and love. Jenner, who already knew about varulation, had his
Speaker 1: revelation when he realized that milkmaids never got smallpox because
Speaker 1: they were protected against it after being exposed to cowpox,
Speaker 1: loer infections bloh blah.
Speaker 2: Episode three.
Speaker 1: Yep, he tested this out, and I do want to
Speaker 1: include this part. He tested this out on a child
Speaker 1: named James Phipps, well Jimmy jim, inoculating him first with
Speaker 1: cowpox on May fourteenth, seventeen ninety six.
Speaker 4: That's the day this episode's being released. Yes, oh my god,
Speaker 4: did we do it on purpose? One hundred percent?
Speaker 2: No, No, definitely not.
Speaker 1: This is my favorite serendipity. I love it. Two hundred
Speaker 1: and twenty three years ago. Today, on the day that
Speaker 1: hopefully a lot of you are hearing this, yeah, is
Speaker 1: the day of the first vaccine.
Speaker 4: Oh my gracious, oh, I feel so excited.
Speaker 2: In my heart.
Speaker 1: Good good, Okay. So, anyway, we got Phipps with this
Speaker 1: cowpox injection thing, he's protected from smallpox. The Royal Society
Speaker 1: of London is like, okay, this looks great. I love it. Okay.
Speaker 1: So I don't remember if I mentioned this in the
Speaker 1: episode of Smallpox, but apparently the cow that was the
Speaker 1: source of the cowpox used in this vaccination was named Blossom,
Speaker 1: hence hence the title vaccine so her hide. Blossom's hide
Speaker 1: is displayed at Saint George's Hospital in London. So if
Speaker 1: there are any London listeners that are out there, please
Speaker 1: send us a pic. Okay, was Jenner actually the first
Speaker 1: to come up with this idea of cowpox preventing smallpox.
Speaker 1: Probably not, we know of at least one of the
Speaker 1: person who, twenty years before Jenner's vaccine emits a smallpox
Speaker 1: out break decided to infect his family with cowpox, and
Speaker 1: no one became infected, but word got around and the
Speaker 1: community was like very angry and anxious. They were like,
Speaker 1: this family is gonna grow horns and utters and they're
Speaker 1: gonna mutate, So you all need to get out of here.
Speaker 1: So the family moved to avoid the constant physical and
Speaker 1: verbal harassment from their wonderful neighbors. Wow, And they lived
Speaker 1: out along in smallpox free life alone, forever alone. So
Speaker 1: it seems not so much that Jenner was the first
Speaker 1: to make the logical leap about cowpox protecting against smallpox,
Speaker 1: but rather the first to conduct trials on multiple people
Speaker 1: and bring his results to the attention of a large
Speaker 1: and legit medical society, and the first. This first vaccine
Speaker 1: would light the way for the development of so many more.
Speaker 1: Act two Chance favors the prepared mind, even though vaccination
Speaker 1: got him such a dork, I love it, even though
Speaker 1: vaccination clearly saved lives by preventing severe cases of smallpox
Speaker 1: and decreasing epidemics. People didn't really know exactly how it worked.
Speaker 1: For about sixty or seventy years after Jenner first vaccinated
Speaker 1: FIPS germ theory, which is the idea that microorganisms can
Speaker 1: cause disease and can be transmitted from person to person,
Speaker 1: it hadn't really been developed, much less widely accepted. Luckily
Speaker 1: for the world, Louis Pasture had had it up to
Speaker 1: here with sour wine and spoiled beer, haven't we all.
Speaker 1: I'm kidding though about that. Probably, I don't know for
Speaker 1: sure if that's if that's what motivated him. In the
Speaker 1: eighteen fifties and eighteen sixties, Pasture, who's one of our
Speaker 1: favorite microbiologists, was investigating fermentation in alcohol, specifically wine and beer,
Speaker 1: and found that yeast, a microorganism, was responsible for the
Speaker 1: production of alcohol, and that when exposed to certain other microorganisms,
Speaker 1: the wine or beer could spoil. He made the logical
Speaker 1: jump from microbes spoiling wine to microbes causing disease in
Speaker 1: humans and animals, and switched his research focus from alcohol
Speaker 1: production to the field that we now call microbiology. Where
Speaker 1: do vaccines come into this okay. In the summer of
Speaker 1: eighteen eighty, so, almost one hundred years after Jenner's vaccine,
Speaker 1: Louis Pasture was going on vacation. He packed his bags,
Speaker 1: double checked the stove was turned off, and told his
Speaker 1: assistant to finish up a chicken cholera study they had
Speaker 1: been working on. So, chicken or avian cholera is caused
Speaker 1: by Pasturella maltacida or something like that for those of
Speaker 1: you who might be curious. Apparently it's extremely high mortality
Speaker 1: rate in the chickens and yeah, and in wild and
Speaker 1: domestic fowl.
Speaker 2: Woh, poor baby.
Speaker 1: Yeah. So Pasture just set off for holiday, leaving his
Speaker 1: search in good hands, or so he thought. It turns
Speaker 1: out the assistant was busy getting ready for his own
Speaker 1: vacation and completely forgot about the experiment. Luckily, he returned
Speaker 1: before Boss Pasture did, and when he got back he
Speaker 1: saw the test tube with avian collar broth still sitting
Speaker 1: on the bench, and the chickens were running around blissfully
Speaker 1: unaware that they.
Speaker 2: Had narrowly escaped a horrible death.
Speaker 1: The assistant was like, wow, better late than never, and
Speaker 1: injected the chickens with the stale broth. Nothing happened to
Speaker 1: the chickens.
Speaker 4: Oh my gosh, right, I didn't know this little story.
Speaker 1: This is so cool, isn't it fun? Yeah, so he
Speaker 1: tried again with a fresh batch of Avian cholera. Again nothing.
Speaker 1: At this point, the assistant Chamberlain is like, oh god,
Speaker 1: he's in full panic mode. He's like, I am good.
Speaker 1: He's like, I'm about to get fired, but I have
Speaker 1: to tell the boss. So he fills in Pasture on
Speaker 1: the results, and Pasture is like, oh my gosh, are
Speaker 1: you kidding me? This is the most exciting thing. What
Speaker 1: do you mean do this same exact experiment, leave the
Speaker 1: broth out for a long time, and then just do
Speaker 1: the whole thing all over again. I love this.
Speaker 4: I feel like I would love to work for pest.
Speaker 4: You're like, I gotta tell my boss I really screwed up,
Speaker 4: and they're like, this.
Speaker 2: Is the best news.
Speaker 1: Yeah, it's like that genius. So then that's what Chamberlain does,
Speaker 1: and again the chickens remain healthy and cholera free.
Speaker 2: Oh my gosh.
Speaker 1: Both Pasture and his assistant realized that their stale cholera
Speaker 1: was acting to protect the chickens from disease. In a
Speaker 1: similar way as to how the smallpox vaccine worked, but
Speaker 1: even cooler. Unlike that smallpox vaccine, this avian colera vaccine
Speaker 1: was made from the same species of bacteria themselves, so
Speaker 1: you didn't have to find a milder strain or species
Speaker 1: crede a vaccine like the cowpox virus. In this pox virus,
Speaker 1: you just had to weaken the existing one. So this
Speaker 1: opened this door in Pasture's mind, hence the phrase commonly
Speaker 1: attributed to him, Chance favors the prepared mind. But he
Speaker 1: began to test various ways, such as chemicals, to weaken
Speaker 1: or attenuate different bacterial species to make more vaccines. This
Speaker 1: itself was a contentious issue because many scientists believed that
Speaker 1: bacteria were static. They were either virulent or not, and
Speaker 1: they didn't change over their lifetime. According to them, adding
Speaker 1: chemicals to weaken the bacteria was not possible, but Pasture's
Speaker 1: Avian collar of vaccine was not a fluke. In the
Speaker 1: summer of eighteen eighty one, Pastures successfully produced an anthrax
Speaker 1: vaccine by attenuating the bacteria using phenol. He demonstrated the
Speaker 1: effectiveness of his vaccine on various farm animals, and it
Speaker 1: was pretty widely accepted, especially by farmers because anthrax was
Speaker 1: a huge killer of cow and sheeps and goats and
Speaker 1: so on. Pasture decided to keep the name vaccine as
Speaker 1: a nod to Genner, and the story of vaccines was
Speaker 1: about to enter its heyday, Act three, Low Hanging Fruit Pastures.
Speaker 1: Development of the avian cholera and anthrax vaccines using chemical
Speaker 1: inactivation marks a pretty big turning point in the history
Speaker 1: of vaccines. There was now a template or a road
Speaker 1: map that scientists could follow to try to develop vaccines
Speaker 1: against other diseases. First identify the causative agent, then weaken
Speaker 1: it using chemicals or through multiple passages, try it out
Speaker 1: on animals, and then try it out on humans if
Speaker 1: things look good. In eighteen eighty five, Pasture developed the
Speaker 1: rabies vaccine, which I talked about in the Rabies episode,
Speaker 1: and then Almroth Wright, Richard Feiffer, and Wilhelm Cole developed
Speaker 1: the first typhoid vaccine in eighteen ninety six. That same year,
Speaker 1: Waldemar Mordecai half kind developed a collar of vaccine Yeah
Speaker 1: what a name, which he promptly tested on himself and
Speaker 1: then narrowly escaped with his life apparently. Yeah, but he decided.
Speaker 2: Super effective vaccine there.
Speaker 1: Wow, he thought good enough, so he tested it out
Speaker 1: on a bunch of friends and fortunately it worked, and
Speaker 1: then he went big time with trials in India. So,
Speaker 1: while he was in India testing out his collar of vaccine,
Speaker 1: half Kind witnessed the third plague pandemic and the death
Speaker 1: and chaos that it brought. He was tasked with developing
Speaker 1: a plague vaccine, which he did in eighteen ninety seven,
Speaker 1: and which he, in typical fashion, tested on himself first.
Speaker 1: He experienced a mild fever but survived and figured it
Speaker 1: was good enough to test on other people such as prisoners. Actually,
Speaker 1: fortunately the vaccine did work without serious side effects, and
Speaker 1: his quick work probably saved thousands of lives. However, his
Speaker 1: fame accolades were short lived. In nineteen o two, after
Speaker 1: being given the plague vaccine, a bunch of people developed
Speaker 1: tetanus symptoms and nineteen died. Ooh yeah, So the deaths
Speaker 1: were traced to a bottle of plague vaccine manufactured by
Speaker 1: half Kind, and he was fired and exiled and remained
Speaker 1: unemployed for at least four years. And this whole time
Speaker 1: he was begging to read the entire report of the inquest, like,
Speaker 1: what exactly happened? How could this have gone wrong? I
Speaker 1: don't understand? So he finally got his wish, and as
Speaker 1: he read it, he learned that the specific bottle had
Speaker 1: been handled by a lab tech who dropped his forceps
Speaker 1: in the dirt and didn't bother to clean them or
Speaker 1: get a replacement. Tetanus loves soil. It loves to live
Speaker 1: in soil.
Speaker 2: Yeah, oh that's so awful.
Speaker 1: Right, yeah, sterile technique important, very so. Eventually half Kind
Speaker 1: was publicly exonered, but the damage to his reputation was
Speaker 1: already done and would never fully recover. Half Kind's contaminated
Speaker 1: plague vaccine is a perfect illustration of the lack of
Speaker 1: oversight on vaccine development during this time. While all of
Speaker 1: these vaccines and antitoxins were being produced in the late
Speaker 1: eighteen hundreds, there wasn't really any government regulation, so a
Speaker 1: classic example of technology outpacing the law. And as you
Speaker 1: might expect, things took a tragic turn, or rather they
Speaker 1: took several tragic turns. Around nineteen oh one, the year
Speaker 1: before Half the Half Kind incident, some smallpox vaccines and
Speaker 1: dip theory antitoxin were contaminated with tetanus and twenty four
Speaker 1: people died. Following these tragedies, people were like, we demand
Speaker 1: that the government look over the manufacturing of vaccines, and
Speaker 1: they got their wish. So right after this, in nineteen
Speaker 1: oh two, Teddy Roosevelt signed into law the Biologics Control Act,
Speaker 1: which would require that health commissioners oversaw vaccine production. Just
Speaker 1: some much needed legislation, Vaccine development didn't slow down with
Speaker 1: these new regulations. If anything, it spurred researchers to create safer,
Speaker 1: more potent, more stable vaccines, and there were still plenty
Speaker 1: of devastating diseases for which there was no effective treatment
Speaker 1: or protection. In the nineteen twenties, researchers started to experiment
Speaker 1: with adjuvants, which comes from the Latin for to help,
Speaker 1: adding them to increase the efficacy of a vaccine by
Speaker 1: eliciting a stronger immune response that lasted longer and provided
Speaker 1: better protection. The French scientist Gaston Ramon discovered that the
Speaker 1: chemical formuline, which had been used just to preserve antitoxin,
Speaker 1: also actually inactivated the toxins. So this allowed him to
Speaker 1: develop the diph theory of vaccine. In nineteen twenty three,
Speaker 1: as well as a tetanus vaccine a few years later.
Speaker 4: Gosh, it seems like they need it since all their
Speaker 4: vaccines keep getting infected with tetanus.
Speaker 1: Right. His contributions to vaccine development have resulted in over
Speaker 1: sixty million lives saved estimated.
Speaker 2: Geez.
Speaker 1: Next was Protessis. Protessis aka Whoopincoff was an infamous child
Speaker 1: killer alongside measles. Still is and it will definitely have
Speaker 1: an episode.
Speaker 2: All of its own eventually. Yeah.
Speaker 1: And because it was so feared and killed so many
Speaker 1: children so horribly, it was high on the list for
Speaker 1: vaccine development. But it was a tough nut to crack.
Speaker 1: First of all, it had been a real struggle getting
Speaker 1: the bacteria isolated, and even once it was isolated, it
Speaker 1: was nearly impossible to culture. But eventually a broth was
Speaker 1: developed which allowed Pearl Kendrick, Grace Elderling, and Loney Clinton
Speaker 1: Gordon to develop, test, and implement a Protess's vaccine in
Speaker 1: nineteen forty that would be used up until the nineteen nineties.
Speaker 2: Wow, which just pretty dope.
Speaker 1: Yeah, Goo, ladies. During the nineteen thirties, vaccines against influenza, tuberculosis,
Speaker 1: the BCG vaccine and yellow fever were developed, with Max
Speaker 1: Tyler earning the only Nobel Prize to be given just
Speaker 1: for the discovery of a new vaccine, the yellow fever vaccine. Okay,
Speaker 1: it wasn't always sunshine and rainbows in the vaccine world.
Speaker 1: There were some dark turns, including the unethical experimentation on
Speaker 1: human volunteers that was rampant throughout this entire period quote
Speaker 1: unquote volunteers, right, yeah, sorry, I forgotten with the air quotes.
Speaker 1: The contamination of a batch of yellow fever vaccine that
Speaker 1: led to fifty thousand military personnel getting infected with hepatitis
Speaker 1: B during World War Two.
Speaker 2: Holy cred.
Speaker 1: Yeah, yeah, this is when they didn't know that hepatitis
Speaker 1: B can survive in plasma. And also the Cutter polio
Speaker 1: vaccine incident, in which a batch of polio vaccines were
Speaker 1: contaminated with the live virus, resulting in the paralysis of
Speaker 1: fifty six people, mostly children. I talk about this a
Speaker 1: bit in the polio episode, but for each of these
Speaker 1: either new laws or regulations were put into place to
Speaker 1: prevent additional suffering. Most of the vaccines that I've mentioned
Speaker 1: so far could almost be looked at as kind of
Speaker 1: the low hanging fruit of the microbiology world. Of course,
Speaker 1: it was a huge leap of technology in scientific thought
Speaker 1: to develop the concept of vaccines in the first place.
Speaker 1: But once it was there, scientists applied it to the
Speaker 1: most common diseases, and in particular those whose causative agent
Speaker 1: had been identified. Those that were culturable responded well to
Speaker 1: attenuation and had low mutation rates or strain diversity. Because
Speaker 1: these were diseases that were fairly straightforward to develop vaccines for,
Speaker 1: it was almost just a race to see who could
Speaker 1: publish their vaccine first. In many ways, it's pretty cool.
Speaker 1: By the nineteen fifties. Even though there was a smallpox vaccine,
Speaker 1: a rabies vaccine, a diph theory of vaccine, yellow fever vaccine,
Speaker 1: and several others, many terrible diseases, including measles, mumps, rubella, hepatitis, meningitis, hemophlus,
Speaker 1: influenza type B, and polio still killed or permanently disabled
Speaker 1: many many people, children in particular, act for cultured Why
Speaker 1: did vaccine development for diseases like measles, rubella, and polio
Speaker 1: lag behind that of diptheria, plague, and cholera. An important
Speaker 1: part of that answer is the fact that measles, rubella,
Speaker 1: and polio are caused by viruses that can only replicate
Speaker 1: in cells, while diptheria, plague, and cholera are caused by
Speaker 1: bacteria that can replicate on their own, which makes them
Speaker 1: much easier to grow in a lab setting because all
Speaker 1: you need is a correct nutrient broth. If you wanted
Speaker 1: to make a lot of bacteria to produce your vaccine
Speaker 1: or study the bacterium, you would just make a lot
Speaker 1: of broth. On the other hand, viruses need cells in
Speaker 1: order to reproduce, so if you wanted a lot of viruses,
Speaker 1: you had to have a lot of cells where they
Speaker 1: could grow. And that's trickier than it sounds. Where do
Speaker 1: you get the cells? Well, One solution was to maintain
Speaker 1: large numbers of lab animals to infect with the virus.
Speaker 1: Not great. Another was cell culture. Cell culture, which we
Speaker 1: haven't talked that much about so far. It involves isolating
Speaker 1: cells from living tissue and growing them under controlled settings
Speaker 1: in a lab. These cells can come from animals or
Speaker 1: humans or plants, but we're not going to talk about those, sorry, Matt.
Speaker 1: And they often can continue to replicate indefinitely. All you
Speaker 1: have to do is just take a little subset of
Speaker 1: the cells, place them in a new sterile container with
Speaker 1: the appropriate nutrients, and keep them at a temperature they like.
Speaker 1: Cell culture is an amazing technology that was really only
Speaker 1: getting it start in the mid nineteen hundreds, but huge
Speaker 1: developments were occurring as researchers kept finding new applications for
Speaker 1: the cells. One of these applications was growing large quantities
Speaker 1: of viruses to study and to try to develop vaccines for.
Speaker 1: Before cell culture, vaccines for viruses were made either directly
Speaker 1: in animal tissue such as chicken embryos in the case
Speaker 1: of yellow fever, or animal nervous tissue, such as in
Speaker 1: the case of rabies, but those were not perfect solutions
Speaker 1: by any means. Regulating the growth of viruses was more
Speaker 1: difficult in both cases, and maintaining large numbers of lab
Speaker 1: animals was expensive and logistically challenging. Cell culture went a
Speaker 1: long way towards solving these problems, and the history of
Speaker 1: cell culture is fascinating, particularly with the ethical discussions. But
Speaker 1: I just can't go into it here, but we are
Speaker 1: going to cover it someday, So keep an ear out
Speaker 1: for a Henrietta Lax episode.
Speaker 2: Oh definitely, okay, So.
Speaker 1: Cell lines began to be used to culture viruses, which
Speaker 1: greatly advanced the field. One of the most important developments
Speaker 1: involves our buddy.
Speaker 2: John Enders was.
Speaker 1: Under same of Ender Shame, who was one of the
Speaker 1: creators of the measles vaccine. Also, I just love his
Speaker 1: origin story. Okay, while finishing his master's thesis on Middle
Speaker 1: English at Harvard. Yeah, so he he got he got
Speaker 1: a master's in Middle English and he was all set
Speaker 1: to do a PhD on Middle English English. But he
Speaker 1: found himself. Yeah, he found himself rooming with an Australian bacteriologist.
Speaker 1: They became close buds. He was charming and Enders would
Speaker 1: tag along with him to the lab and he was like, Wow,
Speaker 1: what is this. This is super cool?
Speaker 2: What are you doing?
Speaker 1: I love this? And so he decided to get this
Speaker 1: doctorate in microbiology instead of Middle English.
Speaker 4: It's everyone who studies Middle English who listens to this podcast, right,
Speaker 4: and then like.
Speaker 2: Now I'm doing every biology and we're like yeah, yes.
Speaker 4: By the way, those emails literally like break our hearts
Speaker 4: with happiness.
Speaker 2: They're the most thrilling.
Speaker 1: Oh yeah, absolutely. Okay. So in the nineteen forties, Enders
Speaker 1: began to doubt the conventional wisdom that poliovirus only grew
Speaker 1: a nervous tissue, and he decided to try to grow
Speaker 1: the virus on other types of human fetal tissue, which
Speaker 1: was successful. This was a huge turning point in polio
Speaker 1: research that would lead to the creation of the vaccine
Speaker 1: that saved countless lives and prevented so many cases of paralysis.
Speaker 1: This development also earned Enders and his two research partners,
Speaker 1: Weller and Robins, the Nobel Prize in Physiology or Medicine
Speaker 1: in nineteen fifty four. Using a similar technique, but monkey
Speaker 1: kidney cells rather than human feudal cells, Jonas Salk developed
Speaker 1: the polio vaccine in nineteen fifty two. Monkey kidney cells
Speaker 1: had been used for a while to grow and study viruses,
Speaker 1: but something concerning came to light in the nineteen fifties.
Speaker 1: Many of these cells, which were still being used by
Speaker 1: people like Albert Sabin and Hilary Koprowski to develop live
Speaker 1: polio vaccines, were found to be contaminated by a virus
Speaker 1: called SV forty SV meaning Simian virus forty just being
Speaker 1: random the forty one or something, Yeah, I think so.
Speaker 1: So whether these viruses caused any kind of disease in
Speaker 1: humans wasn't known, but this was really worrisome because many
Speaker 1: animal cell lines had been found to be contaminated with
Speaker 1: cancer causing viruses. The live polio vaccines developed by Koprowski
Speaker 1: and Sabin, which had been widely tested but not yet licensed,
Speaker 1: were found to be contaminated with the virus, and socks
Speaker 1: killed polio vaccine, which had been administered to millions of
Speaker 1: people around the world, was also found to contain viral
Speaker 1: particles of SV forty.
Speaker 5: Wow.
Speaker 1: So in those people who had already received the live vaccine,
Speaker 1: researchers found no antibodies for SV forty, which indicated that
Speaker 1: it didn't cause any major infection. But that's still a
Speaker 1: lot of unknowns YEA, And so after this initial study
Speaker 1: that notified researchers of the presence of SB forty, a
Speaker 1: researcher named Bernice Eddie had been on the hunt for
Speaker 1: any hidden dangers of the viruses tucked away in these vaccines,
Speaker 1: and she found some disturbing things. When injected into lab
Speaker 1: animals such as hamsters, the animals developed tumors and died
Speaker 1: within a few months. No, not great. She published her work,
Speaker 1: which contributed to the general controversy and concern that was
Speaker 1: being raised about the existing Salk and Saban polio vaccines,
Speaker 1: and she was promptly demoted by her boss, who told
Speaker 1: her that she wouldn't be allowed to speak at any
Speaker 1: more meetings without him reviewing and approving everything. She was
Speaker 1: going to say, rude, ugh gross. By that time that
Speaker 1: regulars were put into place to prevent the contamination of
Speaker 1: the polio vaccine by SV forty. By the time people
Speaker 1: were like, Okay, this is actually a big deal. Over
Speaker 1: ninety eight million Americans had received the Salk vaccine, which
Speaker 1: had at least inactive and very possibly active SV forty
Speaker 1: particles in it. Okay, So another researcher who tried to
Speaker 1: sound the alarm bell about SV forty was Maurice Hillman,
Speaker 1: who would go on to become the most prolific vaccine
Speaker 1: developer ever ever, surpassing even John Enders. His name should
Speaker 1: be a household name, but he was just super modest.
Speaker 1: He and his team developed vaccines for over forty diseases,
Speaker 1: over forty vaccines. What his work is estimated to save
Speaker 1: eight million lives every year. Isn't that amazing?
Speaker 2: That is amazing?
Speaker 1: Yeah, I really wanted to shout him out okay, So anyway,
Speaker 1: vaccines made from SV forty infected cells could not be
Speaker 1: considered safe, which meant massive and expensive testing as well
Speaker 1: as throwing away the vaccines already produced. There needed to
Speaker 1: be a longer term, more stable solution. Enter a man
Speaker 1: named Leonard Hayflick. Hayflick worked on cell culture at the
Speaker 1: Weistar Institute in Philadelphia, Pennsylvania, under Hillary Kapowski. He had
Speaker 1: developed a strain of cells from human feudal lung tissue
Speaker 1: that he believed held great promise for the field of
Speaker 1: virology and for the development of vaccines overall. This cell strain,
Speaker 1: which he called WI thirty eight, came from a fetus
Speaker 1: that had been aborted by a woman in Sweden in
Speaker 1: nineteen sixty two, where abortion had been legal since nineteen
Speaker 1: thirty eight. I also want to point out here that
Speaker 1: tissue from aboard of fetuses had been used in scientific
Speaker 1: research for a while at that point, quite a long while,
Speaker 1: and is still widely used today with many more legal
Speaker 1: regulations in place regarding consent. Just FYI. Hayflick wanted to
Speaker 1: cultivate these lung cells because he believed they would be
Speaker 1: cleaner and safer for vaccine production. Compared to monkey kidney cells,
Speaker 1: the WI thirty eight cells did not turn cancerous as
Speaker 1: did many other cell types used in culture, and they
Speaker 1: were shown to be free of any viruses. So most importantly, though,
Speaker 1: Hayflick was able to grow human viruses in these cells,
Speaker 1: and that had powerful implications for vaccine development, because if
Speaker 1: you can culture, you can study, and you can most
Speaker 1: likely attenuate. So these cells were shown to be stable, diploid,
Speaker 1: non cancer causing, and could be maintained in a lab
Speaker 1: for months. It was a huge deal, but the medical
Speaker 1: community wasn't quite ready to embrace WI thirty eight cells.
Speaker 1: Many who had spent years developing vaccines using monkey kidney cells,
Speaker 1: like Albert Saban, weren't ready to trash their research program
Speaker 1: and start anew despite the promise the WI thirty eight
Speaker 1: cells had others express caution.
Speaker 2: These cells were new.
Speaker 1: Time would perhaps tell whether they were safe, but not
Speaker 1: enough time had passed yet, so WI thirty eight cells,
Speaker 1: particularly in the US, took a backseat in vaccine development
Speaker 1: compared to monkey kidney cells. Not everyone, though, was willing
Speaker 1: to give up on them. Stanley Plotkin, a vaccine developer,
Speaker 1: worked at the y Star Institute along with Hayflick and Koprawski.
Speaker 4: These are some great names, by the way.
Speaker 1: I know right. He had witnessed the rise and concern
Speaker 1: about viruses contaminating monkey kidney cells and became convinced that
Speaker 1: Hayflick's WI thirty eight cells were the way to go.
Speaker 1: A couple of years after Hayflick had published on these cells,
Speaker 1: a devastating rubella epidemic in the US resulted in twelve
Speaker 1: point five million infections what one in fifteen Americans Holy guawk.
Speaker 1: Twenty one hundred people developed encephalitis, six two hundred and
Speaker 1: fifty pregnancies ended in miscarriage or still birth. Five thousand
Speaker 1: women chose to get abortions because they had been infected
Speaker 1: during pregnancy.
Speaker 2: Congenital rubella is terrible yep.
Speaker 1: Twenty one hundred infants died soon after birth, and twenty
Speaker 1: thousand babies were born and survived with congenital rubella syndrome
Speaker 1: h twenty thousand.
Speaker 4: Oh my my heterus.
Speaker 1: These numbers are actually probably an underestimate because physicians weren't
Speaker 1: required to report rubella cases until a year.
Speaker 2: After this epidemic.
Speaker 1: So this epidemic was horrible and the urgency for an
Speaker 1: effective vaccine was keenly felt. Plotkin, who had been working
Speaker 1: on a rubella vaccine using w I thirty eight cells,
Speaker 1: decided to test his out to be blunt. It wasn't great,
Speaker 1: didn't work. Many toddlers in the experiment straight up developed reubella,
Speaker 1: while others developed no protection whatsoever.
Speaker 2: Oh dear yeah.
Speaker 1: But Plotkin didn't give up on his vaccine. Instead, he
Speaker 1: tried different ways to weaken the virus, growing it over
Speaker 1: and over again or growing the virus at different temperatures.
Speaker 1: Eventually he hit the sweet spot. Multiple passages and a
Speaker 1: low incubation temperature of eighty six degrees fahrenheit or thirty
Speaker 1: degrees celsius weakened the injected rubella enough to not cause
Speaker 1: any disease or side effects, but left it strong enough
Speaker 1: to produce antibody's and lasting immunity.
Speaker 4: Wow.
Speaker 1: Despite Plotkin's WA thirty eight derived rubella vaccine having super
Speaker 1: solid experimental results, it was not getting any traction. Instead,
Speaker 1: it was getting overshadowed by a different rubella vaccine developed
Speaker 1: in monkey cells. When Plotkins WA thirty eight based vaccine
Speaker 1: was dropped from production in nineteen seventy, it wasn't noticed
Speaker 1: by too many people beyond those involved in its development.
Speaker 1: But there was another person who did take notice because
Speaker 1: she had serious concerns about the efficacy of the animal
Speaker 1: cell based vaccines that had been selected over the w
Speaker 1: I thirty eight one. Her name was Dorothy Horstman and
Speaker 1: she was a pediatrician and vaccinologist at Yale Medical School.
Speaker 1: She found that eighty percent of those who received the
Speaker 1: commercially available rubella vaccine became reinfected within a few months.
Speaker 1: Really bad, not eighty percent, that's a lot yea. And
Speaker 1: even more concerning, they didn't necessarily develop overt signs of
Speaker 1: the disease, but were silently infected, meaning they could shed
Speaker 1: the virus to pregnant women who were unvaccinated. So she
Speaker 1: turned to Plotkins vaccine, testing it along with the commercially
Speaker 1: available ones at daycares, and she found that Plotkin's vaccine,
Speaker 1: in contrast to the two commercially available ones, produced an
Speaker 1: immune response and the types of antibodies that mimicked natural infection,
Speaker 1: making the immune memory last much longer. So there was
Speaker 1: a clear winner in this race. Following Horsemen's research, Plotkins
Speaker 1: WA thirty eight Rebella vaccine was finally licensed in nineteen
Speaker 1: seventy eight, and the only other competitor, a vaccine made
Speaker 1: from animal cells, was withdrawn the following year. Wow WI
Speaker 1: thirty eight cells have gone on to make vaccines that
Speaker 1: have been given to over three hundred million people, and
Speaker 1: similar methods were used to make an additional six billion vaccines.
Speaker 3: WHOA.
Speaker 1: These vaccines have saved millions of people from horrific deaths
Speaker 1: or excruciating infections or debilitating disabilities from infections like rebella, rabies,
Speaker 1: chicken pox, measles, polio, hepatitis A, shingles, and adinovirus. They've
Speaker 1: been so integral to the development of vaccines, to laying
Speaker 1: the groundwork for our understanding of how celles function and
Speaker 1: for examining the safety and application of potential pharmaceuticals that
Speaker 1: they are displayed in little glass tubes at the National
Speaker 1: Museum of American History Wood. Yeah.
Speaker 4: Oh, I was just there, and I didn't know those
Speaker 4: were there. I would have sought them out, just went
Speaker 4: straight to Julia Child's kitchen.
Speaker 1: No, of course, those high counters got eleve them. These cells,
Speaker 1: which have their origin in a single aborted fetus, have
Speaker 1: prevented millions and millions of miscarriages, infant deaths, and pain
Speaker 1: and suffering around the world. There's so much more to
Speaker 1: the story of w I thirty eight cells if you
Speaker 1: can believe it, and if you want to learn more,
Speaker 1: I recommend the.
Speaker 2: Book The Vaccine Race.
Speaker 1: The widespread success of various vaccination programs led to record
Speaker 1: lows and diseases that previously killed or disabled millions each year.
Speaker 1: Arguably the biggest accomplishment in vaccine history besides the invention
Speaker 1: of vaccines themselves, happened when the world was officially declared
Speaker 1: smallpox free in nineteen eighty, with the last known wild
Speaker 1: case occurring in nineteen seventy seven in Somalia. The effort
Speaker 1: to eradicate smallpox left a larger legacy than just elimiting
Speaker 1: the disease, though, so by assembling this global team to
Speaker 1: target this disease, it had built a vaccine infrastructure that
Speaker 1: could be used to deliver vaccines all over the world.
Speaker 1: So the WHO used this already existing infrastructure to deploy
Speaker 1: additional vaccines, which I'm sure we'll hear more about, and
Speaker 1: they set up in the WHO also set up the
Speaker 1: Expanded Program on Immunizations EPI to do this. Throughout the seventies, eighties, nineties,
Speaker 1: and two thousands and beyond, more vaccines were developed, including
Speaker 1: ones for a chicken pox, strep, pneumonia, niceria, meningititis, hepatitis B, hemophlis,
Speaker 1: infalenza type B e Q fever, hepatitis A, rotavirus, typhoid,
Speaker 1: human papaloma virus. I mean, just it's amazing, tickboarn andencephalitis.
Speaker 1: Gotta throw that in there. Yeah, I wanted to illustrate
Speaker 1: just how many lives vaccines have saved and improved since
Speaker 1: being developed. So this is what I'll call vaccines by
Speaker 1: the numbers, and this just compares us numbers because that's
Speaker 1: all I could find in a table format. So if
Speaker 1: anyone has global comparisons between the pre vaccination era and
Speaker 1: the post vaccination era, please send them our way. Diphtheria
Speaker 1: before vaccines annually twenty one thousand cases, eighteen hundred deaths.
Speaker 1: It's twenty first century annually zero cases, zero deaths. Measles
Speaker 1: in the US before vaccines annually five hundred and thirty
Speaker 1: thousand cases Jesus four hundred and forty deaths twenty first
Speaker 1: century TBD. I'll just say for now tentatively over one
Speaker 1: hundred cases annually. Yeah, average protessis annually before vaccines two
Speaker 1: hundred thousand cases, four thousand deaths twenty first century. On average,
Speaker 1: fifteen thousand, six hundred cases annually, twenty seven deaths. A
Speaker 1: lot higher than I thought. Actually, it's a lot.
Speaker 4: Of waiting immunity with the protessas vaccine.
Speaker 1: Yeah. Paralytic polio before vaccines annually sixteen thousand, three hundred cases,
Speaker 1: nineteen hundred deaths twenty first century zero zero.
Speaker 2: Wow.
Speaker 1: Rubella. In nineteen sixty nine, which is the last year
Speaker 1: before rubella vaccine was licensed, there were over fifty five thousand,
Speaker 1: five hundred cases reported to the CDC, and ten years
Speaker 1: later that number was eleven thy eight hundred. Between those years,
Speaker 1: the number of congenital rebella cases in the US declined
Speaker 1: by thirty six percent, but at the turn of the
Speaker 1: twenty first century, there were one hundred and seventy six
Speaker 1: reported cases of rebella and nine cases of congenital rebella.
Speaker 5: Wow.
Speaker 2: That amazing, That is absolutely incredible.
Speaker 1: In two thousand and five, the CDC announced that endemic
Speaker 1: rebella had been eliminated from the US, and ten years
Speaker 1: later In April twenty fifteen, PAHO, the Pan American Health Organization,
Speaker 1: announced that endemic rebella had been eliminated from the Western hemisphere.
Speaker 1: It just got chills me too. It's hot in this room. Smallpox,
Speaker 1: there are so many of these. Smallpox in the first
Speaker 1: half of the twentieth century, twenty nine thousand cases and
Speaker 1: three hundred and thirty seven deaths annually. Zero obviously in
Speaker 1: the twenty first century. Yeah, it's gone. It's gone. Gonka
Speaker 1: tetanus in the first half of the twenty first century,
Speaker 1: five hundred and eighty cases and four hundred and seventy
Speaker 1: two deaths annually. Twenty first century, forty one cases four deaths.
Speaker 1: Before the vaccine homophlus influenza type BE caused meningitis, bloodstream infections,
Speaker 1: and pneumonia and twenty thousand children every year, killing one
Speaker 1: thousand of them and causing permanent brain damage and many more.
Speaker 1: When fear drove down vaccination rates, outbreaks happened in two
Speaker 1: thousand and eight. In two thousand and nine in Minnesota, Pennsylvania,
Speaker 1: New York, Oklahoma, and Maine, with at least four children
Speaker 1: dying because those parents chose.
Speaker 2: Not to vaccinate them.
Speaker 1: Okay, chicken pox. The incidents of chicken pox and shingles,
Speaker 1: as well as US hospitalizations and deaths because people do
Speaker 1: die from chicken pox and shingles.
Speaker 2: Yes they do.
Speaker 1: It declined by ninety percent after it became part of
Speaker 1: the routine skin schedule. Wow. And when a booster was added,
Speaker 1: the incidents fell another eighty one percent.
Speaker 10: Wow.
Speaker 1: No one younger than twenty years old has died of
Speaker 1: chicken pox in the US since twenty ten.
Speaker 2: Wow.
Speaker 1: Yeah, ok okay, two more numbers. It is estimated that
Speaker 1: the work done by John Enders and his teams and
Speaker 1: Here's Fame has saved over one hundred and twenty million
Speaker 1: lives as of twenty seventeen. And I said it before,
Speaker 1: but I want to say it again. Maurice Hillman's work
Speaker 1: is estimated to save eight million lives each year. So
Speaker 1: he has saved more lives than any other scientist. So
Speaker 1: let's hear it for Maurice. I kind of want that
Speaker 1: to be the title of our episode.
Speaker 2: Let's hear it from Maurice.
Speaker 4: I like it.
Speaker 1: Yeah, Okay, I really like it. The need for vaccines
Speaker 1: has never diminished, and the recent resurgence in vaccine preventable
Speaker 1: illnesses only highlight their importance. Aarin, I'm hoping you'll tell
Speaker 1: me some good news about vaccines today.
Speaker 4: All right, after one more shortbreak. All right, so let's
Speaker 4: talk about some of the vaccines. What the vaccine recommendations
Speaker 4: are around the world. Okay, great, So the World Health
Speaker 4: Organization has a list of recommended routine vaccinations. So I'll
Speaker 4: kind of just go through this. You've already mentioned a
Speaker 4: lot of these because, as it turns out, these recommended
Speaker 4: vaccinations are, in general, the ones that have had the
Speaker 4: biggest impact around the world in terms of decreasing the
Speaker 4: number of disease outbreaks that we see.
Speaker 2: So the World Health.
Speaker 4: Organization recommends as a blanket statement for all countries with
Speaker 4: vaccination programs that they include BCG, which is the tuberculosis vaccine,
Speaker 4: which I think is interesting because that's the one that
Speaker 4: the US does not vaccinate for, but that one the
Speaker 4: World Health Organization recommends as a general recommendation.
Speaker 1: Does the US vaccinate against that?
Speaker 4: So the BCG vaccine is a vaccine for tuberculosis that's
Speaker 4: good at preventing disseminated so like full body tuberculosis in infants.
Speaker 4: For some reason, that's not entirely clear. It's not great
Speaker 4: at protecting adults, so it doesn't protect adults.
Speaker 2: From getting t B.
Speaker 4: Huh, yeah, it's it's not good in adults. It's just
Speaker 4: good in kids. And it's really just good against disseminated infection.
Speaker 4: And so infants in a lot of countries get BCG
Speaker 4: like at birth, but in the US we don't have
Speaker 4: high enough rates of tuberculosis to justify giving the BCG vaccine.
Speaker 4: Essentially interesting, Yeah, and then some countries only give it
Speaker 4: to certain certain subsets of their population if they have
Speaker 4: if those children happen to be at high.
Speaker 2: Risk or something like that.
Speaker 4: Okay, so all right, We've also got hepatitis B, which
Speaker 4: is another vaccine giving to infants at birth, Polio DTP,
Speaker 4: which is diphtheria tetanus, and protessis hib homophluous influenza type B,
Speaker 4: the horrible one that causes meningitis, the new Macacco VAC
Speaker 4: which there's actually a couple different new Macaco vaccines, but
Speaker 4: this protects against meningitis as well as pneumonia. Okay, in
Speaker 4: children and adults. There's different ones for children and adults. Rotavirus, measles, rubella,
Speaker 4: and HPV so these are the ones that WHO says
Speaker 4: every country should vaccinate for sure for these at a minimum.
Speaker 4: There's a few more that we vaccinate for in the
Speaker 4: US that the World Health Organization has on their list
Speaker 4: as recommending for countries that have strong vaccination programs where
Speaker 4: they can generally achieve at least eighty percent vaccination coverage.
Speaker 4: And so those are mumps, vericella which is chicken pox,
Speaker 4: and seasonal influenza. Great, so that's the US vaccine list.
Speaker 4: We actually also vaccinate against niceria meningitis in the US,
Speaker 4: which is truly horrible illness that causes meningitis, and that
Speaker 4: one is recommended by the WHO for some countries, So
Speaker 4: the US is one of the countries that has that
Speaker 4: on their recommendations list. And then there's a whole number
Speaker 4: of other vaccines that are recommended in certain geographic areas
Speaker 4: or for certain populations. So, for example, some countries like
Speaker 4: China have Japanese encephalitis as a recommended vaccine for all children.
Speaker 4: Hepatitis A is recommended.
Speaker 2: A lot for travelers.
Speaker 4: It's probably going to be put on the routine vaccination
Speaker 4: list here in the US pretty soon. And then there's
Speaker 4: things like typhoid, cholera, yellow fever, tick born encephalitis.
Speaker 1: Okay, I'm getting that this week. Yeah, that's thrilling.
Speaker 4: So yeah, So basically, recommendations differ around the world because
Speaker 4: every country is going to decide what is the most
Speaker 4: important diseases that they want to vaccinate their people against,
Speaker 4: and different geographic regions are going to have different risk profiles,
Speaker 4: so they're going to vaccinate against different diseases.
Speaker 2: Some One thing that's really.
Speaker 4: Important to keep in mind about all of these recommendations
Speaker 4: is that vaccines are always recommended to be given to
Speaker 4: the youngest age group that's at risk for developing that disease.
Speaker 4: So that's a very important part. Is that we always
Speaker 4: want to vaccinate before someone has a risk of being
Speaker 4: exposed to that pathogen, right and in populations whose members
Speaker 4: we know are going to respond to that immunization. So
Speaker 4: some vaccines we don't give to infants, for example, because
Speaker 4: they might have maternal antibodies still circulating that would neutralize
Speaker 4: that vaccination. So we have to wait to give some
Speaker 4: vaccines to infants until they're a little bit older.
Speaker 2: But in general, we.
Speaker 4: Give vaccines to people before they're ever exposed because a
Speaker 4: vaccine doesn't do you any good if you've already been
Speaker 4: exposed to the pathogen.
Speaker 1: Yeah, makes sense. What about rabies?
Speaker 4: Oh so rabies is a Yeah, rabies is an interesting one.
Speaker 4: We give that after because in that case it actually
Speaker 4: does help protect you after because when the rabies virus
Speaker 4: is in, once it makes it into your central nervous system,
Speaker 4: your body can't produce antibodies against it. So by giving
Speaker 4: you a vaccine that circulates for longer in your bloodstream,
Speaker 4: you have time to actually create those antibodies against it.
Speaker 2: Right.
Speaker 4: So, in the case of rabies, it does work to
Speaker 4: immunize after, okay, But for most other pathogens it doesn't.
Speaker 2: Okay. So how does coverage actually differ across the globe
Speaker 2: when we look at all these different vaccines.
Speaker 4: Yeah, honestly, it differs so much that it's hard to
Speaker 4: even get a handle on it.
Speaker 5: Right.
Speaker 4: The World Health Organization has numbers ranging from fifty percent
Speaker 4: of all children have gotten the polio vaccine who should
Speaker 4: have gotten the polio vaccine, like in twenty eighteen, eighty
Speaker 4: five percent of children have gotten MMR and DTP and
Speaker 4: things like that. But the thing is that those numbers
Speaker 4: don't really tell US much because geographic variation is so
Speaker 4: high that in some countries you're going to have over
Speaker 4: ninety nine percent coverage and in some countries you're gonna
Speaker 4: have extremely low coverage. And so even for example, in
Speaker 4: the United States, So the way that the US mandates
Speaker 4: vaccinations is that children have to be vaccinated by the
Speaker 4: time they enter public school.
Speaker 2: So by the time you're in kindergarten, if you're going
Speaker 2: to a.
Speaker 4: Public school, you have to be vaccinated. But every state
Speaker 4: handles differently how they enforce that mandatory vaccination. So some
Speaker 4: states make it easier to get exemptions, whether for medical
Speaker 4: or religious or personal reasons. You can request exemptions, and
Speaker 4: some states make it really really difficult, where you basically
Speaker 4: can only get an exemption from back scenes if you
Speaker 4: have a very legitimate medical reason like a serious allergy
Speaker 4: or immunal compromise or something like that.
Speaker 1: Right, I think there are just like two states that
Speaker 1: don't allow religious or philosophical exemptions.
Speaker 4: I can guess what one of them is, although I
Speaker 4: didn't look up which states they were. But so in
Speaker 4: twenty seventeen twenty eighteen, in forty nine states that reported
Speaker 4: their vaccine coverage rates for kindergarteners. While you look at
Speaker 4: the US, overall vaccination rates were very high for things
Speaker 4: like DTP and MMR and verriicella, anything from about usually
Speaker 4: about ninety five percent. If you look at the whole
Speaker 4: United States, in Washington.
Speaker 8: D C.
Speaker 4: Which had the lowest coverage, it was only eighty one
Speaker 4: percent oof and in mississippy ninety nine percent coverage of kindergarteners.
Speaker 1: Okay, interesting, Does Mississippi have a philosophical exemption?
Speaker 2: No, they do not.
Speaker 4: You cannot get exemptions for religious, philosophical, or conscientious reasons
Speaker 4: in Mississippi only medical page.
Speaker 2: Yeah, I didn't know that. Fascinating.
Speaker 1: That's so high five Mississippi.
Speaker 4: Right way to go. So you can see that even
Speaker 4: within the US, which is a very small part of
Speaker 4: the world, we have huge variation in vaccine coverage. And
Speaker 4: what happens when you have variation in vaccine coverage is
Speaker 4: that you can have pockets of the population that have
Speaker 4: very low vaccination rates, and this does lead to outbreaks.
Speaker 4: We can see this in the data. And what we
Speaker 4: also see in the data, and I do think this
Speaker 4: is really interesting, is that a lot of the outbreaks
Speaker 4: do tend to happen in populations that choose not to vaccinate.
Speaker 2: Right.
Speaker 4: So, for example, a recent review found that seventy percent
Speaker 4: of measles cases that happened in vaccine eligible individuals, meaning
Speaker 4: not including the babies that were too young to be vaccinated,
Speaker 4: seventy percent of those cases were among children with non
Speaker 4: medical exemptions. So that's personal or religious exemptions to vaccination
Speaker 4: in Pretessa's outbreaks. And what's interesting about Protessis outbreaks is that,
Speaker 4: unlike Meso's outbreaks, we do see Pretessis happening in previously
Speaker 4: vaccinated people because immunity can wane as.
Speaker 2: You get older.
Speaker 4: With the Protessis vaccine, that's why you need They recommend
Speaker 4: boosters for the protesters vaccine. But even among Pertessis outbreaks,
Speaker 4: between twenty five and forty five percent in some outbreaks
Speaker 4: of cases were among unvaccinated or under vaccinated individuals, and
Speaker 4: very often a large percentage of those unvaccinated individuals are
Speaker 4: what they call intentionally unvaccinated.
Speaker 1: Yeah, so for the seventy percent of measles cases that
Speaker 1: happen among vaccine eligible kids, I presume kids, what is
Speaker 1: the other thirty percent?
Speaker 4: So it was it was seventy percent of cases were
Speaker 4: children with non medical exemptions, So then the other ones
Speaker 4: might have been kids that had either medical exemptions or
Speaker 4: another reason that they weren't vaccinated okay, other than being
Speaker 4: too young.
Speaker 1: Okay, So that thirty percent is they may not have
Speaker 1: been able to or they didn't for some other reason,
Speaker 1: but that it wasn't.
Speaker 4: It wasn't a non medical exemption issue. Yeah, yeah, okay,
Speaker 4: they could have also been under vaccinated. So studies have
Speaker 4: also found that the kids who tend to be completely unvaccinated,
Speaker 4: and especially intentionally unvaccinated, so families who are choosing to
Speaker 4: not vaccinate their kids, those kids tend to be from
Speaker 4: families of higher socioeconomic and higher education status.
Speaker 10: Yeah.
Speaker 2: Whereas kids who.
Speaker 4: Are undervaccinated, meaning they have some of their vaccinations but
Speaker 4: not all of them, and those kids are still at
Speaker 4: risk for getting disease, those kids tend to be from
Speaker 4: families of lower education and lower socioeconomic status, which suggests
Speaker 4: that they might be facing barriers to getting vaccinated. So
Speaker 4: that's a pretty huge deal.
Speaker 1: Right it should be. I mean, vaccination should be easy
Speaker 1: and affordable slash completely free. Speaking of my opinion.
Speaker 4: I would agree with you entirely. So let's talk about
Speaker 4: what the costs of vaccinations are.
Speaker 1: Fantastic, what a transition.
Speaker 4: So in the US, if you have health insurance, vaccines
Speaker 4: are covered. All of the recommended vaccines are required to
Speaker 4: be covered by your health insurance provider. So you might
Speaker 4: have copays or other out of pocket fees. You might
Speaker 4: have to pay facilities fees at you're a hospital. No
Speaker 4: shade show, so much shade. But the vaccines themselves are
Speaker 4: covered by health insurance in the US. However, this is
Speaker 4: only true for recommended vaccines. So if you, for example,
Speaker 4: are outside of the age range of what is recommended
Speaker 4: for the HPV vaccine, your insurance is not required to
Speaker 4: cover that, which means it will cost you two hundred
Speaker 4: dollars out of pocket per vaccine.
Speaker 1: By the way, and so this also applies to travel
Speaker 1: like travel vaccines, it does aid and so on.
Speaker 4: Yeah, so those are pretty expensive. What was the yellow
Speaker 4: fever one? Like one hundred and fifty bucks or something.
Speaker 1: At least I think it might have been a little more.
Speaker 4: Yeah, if a child, So if we're talking about childhood vaccines,
Speaker 4: which is most of what we've talked about so far
Speaker 4: in this episode, if a child does not have insurance
Speaker 4: in the US, they qualify for the Vaccines for Children's Program,
Speaker 4: which is a federally funded program that covers the cost
Speaker 4: of all the recomd and in vaccines for children, it
Speaker 4: is not always super easy to access. I think in
Speaker 4: general you have to go to a federally qualified health
Speaker 4: center to get those vaccines. So for example, in Champagne,
Speaker 4: kids can go to some school based health clinics or
Speaker 4: the Champagne Public Health Department. But in theory there are
Speaker 4: programs in place to make sure that kids, even if
Speaker 4: they don't have insurance, have access to vaccines. Doesn't mean
Speaker 4: that they're always getting vaccinated. Around the world, every different
Speaker 4: country does things a little bit differently. So some countries
Speaker 4: have entirely free vaccines. Some countries, like Australia, actually pay
Speaker 4: people to vaccinate.
Speaker 1: That's I love that me too.
Speaker 4: I think it's so great because some countries also find
Speaker 4: you if you don't or if you're not up to date.
Speaker 4: So it's like oooh or different stroke.
Speaker 1: Well, positive reinforcement, negative reinforcement, right, both are effective, kind
Speaker 1: of one might be more than right.
Speaker 4: And then there's also something called the Global Alliance for
Speaker 4: Vaccines and Immunization GOVEY or Gavy.
Speaker 2: I don't know, let's say.
Speaker 4: Govey, because it's a fancier Govy.
Speaker 2: Govey.
Speaker 4: Govey was established, Gavi Gavy.
Speaker 1: I like that. Let's go with that.
Speaker 2: Gavy.
Speaker 4: They're gonna hate us was established in two thousand and
Speaker 4: their goal is improving vaccine coverage around the world. So
Speaker 4: they provide funding for a number of different vaccines for
Speaker 4: countries and to establish vaccine programs to keep them up
Speaker 4: and running and things like that. The Bill and Melinda
Speaker 4: Gates Foundation helped Gavy. Gavey helped them get started, and
Speaker 4: in the first sixteen years of the program, more than
Speaker 4: six hundred and forty million children had access to vaccines
Speaker 4: because of GOV and it's estimated that more than nine
Speaker 4: million lives were saved.
Speaker 2: Awesome, pretty great.
Speaker 4: And then the the World Health Organization in UNICEF also
Speaker 4: have programs in place to help subsidize the cost of
Speaker 4: vaccines in a lot of countries. Fantastic And to bring
Speaker 4: you even more information about the future of vaccines and
Speaker 4: vaccines initiatives and what's really going on around the world today,
Speaker 4: we talked with doctor Padmini Streakantaya, who's another senior program
Speaker 4: officer at the Bill and Melinda Gates Foundation.
Speaker 1: Doctor Shrikantaya, thank you so very much for taking the
Speaker 1: time to chat with us today about vaccines. Could you
Speaker 1: introduce yourself and tell us a bit about what you
Speaker 1: do as a senior program officer at the Gates Foundation
Speaker 1: and maybe a bit of your background.
Speaker 10: Sure, So, as you know, my name is Pudmini Shrikantaya.
Speaker 10: I am an infectious disease position by training and also
Speaker 10: an epidemiologist. So I trained in internal medicine, but knew
Speaker 10: I was interested in public health, and about almost twenty
Speaker 10: years ago trained at the CDC in a program called
Speaker 10: the Epidemic Intelligence Service, which is a training program in
Speaker 10: applied public health and epidemiology, and since then have been
Speaker 10: focused on infectious diseases in public health. And I came
Speaker 10: to the Gates Foundation about a year and a half
Speaker 10: ago and here I work in the Global Health Division
Speaker 10: in the Pneumonia Team, which is headed by doctor Keith Kligman,
Speaker 10: and I lead three initiatives or initiatives on three different
Speaker 10: pathogens or syndromes. One is on antimicrobial resistance or antibiotic resistance.
Speaker 10: The second is on a virus called respiratory sensicial virus,
Speaker 10: which is a leading cause of pneumonia in young children
Speaker 10: and especially in infants under six months of age. And
Speaker 10: the third is on influenza, which, as you know, is
Speaker 10: a major killer globally and here in the United States
Speaker 10: as well.
Speaker 1: Very cool.
Speaker 4: Yeah, So, I think when a lot of us hear
Speaker 4: about vaccines, we usually think about the vaccines that we
Speaker 4: got as children, like the MMR vaccine or the DETAP vaccine,
Speaker 4: or even sometimes the seasonal influenza vaccine. But there are
Speaker 4: so many other vaccines out there that are incredibly important
Speaker 4: and save millions of lives and also help to reduce
Speaker 4: poverty worldwide. So can you tell us about some of
Speaker 4: the global vaccine initiatives that are high priorities at the
Speaker 4: Gates Foundation?
Speaker 10: Sure?
Speaker 5: So.
Speaker 10: Within the Pneumonia team, actually, I can tell you that
Speaker 10: we are focused on vaccines as our major lever for
Speaker 10: preventing the infectious pathogens that cause pneumonia and lower respiratory
Speaker 10: tract infections, which remain among the leading causes of mortality
Speaker 10: among young children under the age of five. So, within
Speaker 10: the Pneumonia team, our focus is on the new macaucus,
Speaker 10: which is a bacteria that causes pneumonia and invasive disease
Speaker 10: and for which there is a very effective vaccine which
Speaker 10: has been in use in the US for a number
Speaker 10: of years and has shown remarkable reductions in invasive infections
Speaker 10: due to newmacaccus as well as what's called herd immunity.
Speaker 10: In the area that I'm focused on, we are very
Speaker 10: interested in the and keenly working towards the development of
Speaker 10: a vaccine for RSV or respiratory syncesicial virus as they mentioned,
Speaker 10: very important and one of the leading causes of pneumonia
Speaker 10: and an important cause of pneumonia related mortality in infants
Speaker 10: under the age of six months. So this population is
Speaker 10: particularly because the mortality is seen in very young infancy
Speaker 10: in the first three months of age. This population is
Speaker 10: it presents an important or presents a challenge for how
Speaker 10: we approach vaccination.
Speaker 2: And in this case.
Speaker 10: For RSV, what we're pursuing with our partners is maternal vaccination.
Speaker 10: So in this scenario, a pregnant woman is vaccinated in
Speaker 10: her third trimester of pregnancy, mounts an immune response to
Speaker 10: the vaccine, and those antibodies are passed through the placenta
Speaker 10: to the fetus, and so the baby at birth now
Speaker 10: has levels of antibodies that are protective against the against RSV,
Speaker 10: or the idea that they would have protected levels of
Speaker 10: antibody against RSV and UH, and then those young infants
Speaker 10: would be protected against pneumonia for their first few to
Speaker 10: several months of life. So r SV is one example,
Speaker 10: and the field is full of a number of other
Speaker 10: developers who are working on vaccines to protect both young
Speaker 10: infants as well as elderly populations who are also at
Speaker 10: greater risk of severe disease and poor outcomes. The other
Speaker 10: that I'm focused on, or that we are focused on
Speaker 10: in the Foundation is influenza. And as you mentioned right now,
Speaker 10: much of the effort for influenza is on seasonal influenza vaccination.
Speaker 10: The goal and the focus of our influence of vaccine
Speaker 10: development efforts is really on universal influenza vaccine. So this
Speaker 10: idea is that a vaccine that is effective against the
Speaker 10: strains of influenza that are circulating and then as well
Speaker 10: as the strains of influenza that may emerge. Particularly, the
Speaker 10: concern is for a pandemic influenza or influenza that is
Speaker 10: dramatically different than the than what the circulating strains are.
Speaker 10: So this is a tall order, and this is our
Speaker 10: efforts through our partners are in pre clinical stages primarily
Speaker 10: at this point, but I think this is the what
Speaker 10: we're really aiming for with with influenza. And maybe the
Speaker 10: last thing I'll talk about is is the work that
Speaker 10: I'm doing with our partners again on animicropial resistance. Most
Speaker 10: of the efforts and most of the focus globally when
Speaker 10: people are talking about animicropial resistance has really been on
Speaker 10: specific bacterial and fast growing bacterial pathogens. But specific to
Speaker 10: the efforts that I want to mention today are trying
Speaker 10: to understand the bard of disease due to resistant pathogens
Speaker 10: and bacteria in particular, and in our efforts, our focus
Speaker 10: is really on neonatal or newborn subsis and pathogens or
Speaker 10: bacteria that are causing sepsists and mortality in these populations
Speaker 10: then become our potential target for vaccination. And maybe that's
Speaker 10: a good point to just mention in terms of how
Speaker 10: we select what are targets for vaccination, it's really driven
Speaker 10: by trying to understand where the disease burden lies and
Speaker 10: where the where mortality and disease mortality lies, and where
Speaker 10: there is that significant burden of disease burden and disease
Speaker 10: mortality will be our focus for trying to figure out
Speaker 10: what is the best method of preventing this illness and
Speaker 10: how could vaccines potentially be an important and successful leaver.
Speaker 10: So maybe i'll stop there and turn it over back
Speaker 10: to you.
Speaker 1: Thank you so much. That was incredibly thorough and you Yeah,
Speaker 1: you really did raise a lot of interesting and very
Speaker 1: important points, particularly in terms of vaccine development and targets
Speaker 1: and sort of you know, jumped our questions a bit. No,
Speaker 1: that's great, anticipated our needs.
Speaker 2: Yeah.
Speaker 1: So one of the things about a lot of these
Speaker 1: these global vaccine initiative initiatives, in the places where they
Speaker 1: are targeted, resources might be limited or there might not
Speaker 1: be a strong public health infrastructure set up yet. So
Speaker 1: what are some of the challenges that you face on
Speaker 1: the ground and actually getting vaccines to the people who
Speaker 1: need them, and how are you at the Gates Foundation
Speaker 1: working to overcome those challenges.
Speaker 10: Yeah. So within the Foundation there is a large group
Speaker 10: and team that actually works on vaccine delivery that has
Speaker 10: really focused on a lot of these issues that you raise.
Speaker 10: And I think that one of the things is many
Speaker 10: of the countries where we're focused in South Asia and
Speaker 10: Sub Saharan Africa, where health systems aren't that strong. Most
Speaker 10: of these countries do have routine immunization programs, and we
Speaker 10: certainly advocate for countries to invest further in their routine
Speaker 10: immunization programs, which lays the foundation not only for a
Speaker 10: stronger health system, but also helps to protect the most
Speaker 10: vulnerable populations and therefore have a more resilient population as
Speaker 10: these young children grow up. So in terms of thinking
Speaker 10: about these challenges, one for example that I can mention
Speaker 10: is when we are interested in maternal vaccines and maternal immunization,
Speaker 10: where we have to think about not just the challenges
Speaker 10: in a routine immunization program where children will be brought
Speaker 10: at certain time points you mentioned for example, you know,
Speaker 10: at birth, at six weeks, at six months or nine months,
Speaker 10: and thereafter at routine immunization time points. Here in a
Speaker 10: maternal vaccine situation, we actually need to target the mother,
Speaker 10: the pregnant mother in the anti natal care system. And
Speaker 10: so our challenge has been together with many experts and
Speaker 10: colleagues in the field, is to figure out how when
Speaker 10: we do have an effective a maternal vaccine, like for
Speaker 10: RSV or or group B strap or other pathogens that
Speaker 10: we feel are important pathogens to target with maternal vaccination.
Speaker 10: We'll need to figure out and we're working hard to
Speaker 10: try to figure out how do we access and how
Speaker 10: do we work with the obstetric and anti natal care
Speaker 10: populations to leverage those platforms and help to strengthen those
Speaker 10: platforms to provide immunization to the mother that will ultimately
Speaker 10: protect the infant. While we see these challenges, we also
Speaker 10: see that many of these interventions, and particularly vaccination interventions,
Speaker 10: can be used in and of themselves to help strengthen
Speaker 10: what might not be the strongest healthcare systems to begin with.
Speaker 4: That's excellent and kind of really leads into the next
Speaker 4: question we were going to ask you, which is that
Speaker 4: we talk in this episode about how the benefits of vaccines,
Speaker 4: you know, include that you are protected and like you
Speaker 4: mentioned herd immunity, your neighbor is protected from infectious disease,
Speaker 4: but vaccines are indirectly tied to a lot of other
Speaker 4: improvements in health and poverty reduction. So can you talk
Speaker 4: a little bit more about how this works, how vaccines
Speaker 4: have had this very multifaceted impact on health and the economy.
Speaker 10: Yeah, so you know, I think that vaccines. I think
Speaker 10: what is one of the things important to remember is
Speaker 10: vaccines are one of the most cost effective health tools
Speaker 10: that have ever been invented. Every dollar spent on childhood
Speaker 10: immunization returns up to forty four dollars in economic and
Speaker 10: social benefits. And while we prevent a specific illness through
Speaker 10: a vaccine or a specific pathogen, many of these illnesses.
Speaker 10: RSV is a great example. When an infant contracts RSV,
Speaker 10: not only are they at risk for the poor outcomes
Speaker 10: of the RSV infection, not only does that lead to
Speaker 10: the infection and episode of that acute illness, but they
Speaker 10: are also then potentially at greater risk for subsequent infections.
Speaker 10: So you can see how for a family where each
Speaker 10: health shock is a potential for a drop in economic gains,
Speaker 10: not only are they concerned about the health and well
Speaker 10: being of that one child, but that illness impacts their
Speaker 10: ability to earn as a family, their ability to provide
Speaker 10: for themselves and for other members in the family. That
Speaker 10: if there is a subsequent superinfection or a subsequent new
Speaker 10: macoccal infection, for example, then there is a whole next
Speaker 10: shock that actually happens, and through vaccination, if you're preventing
Speaker 10: that first instance, you are actually helping to prevent that
Speaker 10: cascade of events as well.
Speaker 1: Yeah, so can you tell us maybe point our listeners
Speaker 1: in a direction to where they can find more information
Speaker 1: on the work that you and that the Gates Foundation
Speaker 1: is doing.
Speaker 10: Sure, so, I think the best place to go is
Speaker 10: just to our Gates Foundation website, which is www dot
Speaker 10: Gatesfoundation dot go RG and they'll be able to navigate
Speaker 10: through the plethora of different global health efforts that the
Speaker 10: Foundation is engaged on. I've just touched on just a
Speaker 10: few that I'm specifically involved with in the pneumonia team,
Speaker 10: but within global health, there are teams that are focused
Speaker 10: on TV on HIV, on enteric and diarrheal diseases, other
Speaker 10: pathogens within pneumonia, malaria, as well as neglected tropical diseases,
Speaker 10: just to name a few. So I hope your listeners
Speaker 10: have a chance to learn more about all of these
Speaker 10: different efforts.
Speaker 1: Great, we do too.
Speaker 4: Thank you so much. I think those are all of
Speaker 4: the big questions that we had for you today. Thank
Speaker 4: you so much for taking time out of your busy
Speaker 4: schedule to talk with us. We really appreciate it, and
Speaker 4: I feel like we covered so much ground in a
Speaker 4: short time.
Speaker 1: Yeah, thank you, my pleasure.
Speaker 10: Thanks a lot.
Speaker 1: That was so amazing. It was so cool to talk
Speaker 1: with both doctor Straikantaiya and doctor Rogers and to get
Speaker 1: more insight into how vaccines actually are developed and also
Speaker 1: like what vaccines are t targeted and what's going on
Speaker 1: around the world. That was amazing.
Speaker 4: We're so lucky that we get to do stuff like this, Aaron, No,
Speaker 4: it's been thrilling. Thank you so much to Amber's Eddies
Speaker 4: for setting all that up.
Speaker 1: Yes, Amber, here are our champion. You know how earlier
Speaker 1: I kept listing all the different numbers about vaccines and
Speaker 1: live saved, and we've had.
Speaker 4: So many incredible numbers in this episode, so many numbers.
Speaker 1: Okay, I'm gonna add just one more. Sorry about that,
Speaker 1: but so it's a number related to the Gates Foundation
Speaker 1: that I came across recently that estimates that since nineteen
Speaker 1: ninety and estimated one hundred and twenty two million lives,
Speaker 1: mostly children, have been saved by the work that the
Speaker 1: Bill and Melinda Gates Foundation has done.
Speaker 4: Wow, that's incredibly that amazing, that's incredible. So overall, vaccines
Speaker 4: are safe, they're effective, and we know that there's a
Speaker 4: lot of misinformation out there right now about vaccines. So
Speaker 4: next week, hmm, next week week. You don't have to
Speaker 4: wait two weeks.
Speaker 1: Guys, this is a surprise. We're doing this a week early.
Speaker 4: Because we don't want you to have to wait a
Speaker 4: single more day. So next week we will be addressing
Speaker 4: the history of vaccine hesitancy, which, as it turns out,
Speaker 4: isn't so modern. No, and then we're also going to
Speaker 4: address a lot of the specific concerns that you have
Speaker 4: that you've written to us about and that many people
Speaker 4: have about vaccines, so that you can feel good about them,
Speaker 4: and you can explain to your aunt Martha why she
Speaker 4: should feel good about vaccines too.
Speaker 1: It's going to be fantastic.
Speaker 4: Oh, it's going to be great, and we have such
Speaker 4: great guests lined up. We can't wait to tell you
Speaker 4: about it.
Speaker 1: Yes, Oh my gosh, you guys. All right, So should
Speaker 1: we do sources?
Speaker 2: Yes? Absolutely?
Speaker 1: Okay. I have a few books that I've read. Vaccines
Speaker 1: did Not Cause Rachel's Autism by doctor Peter Hotez.
Speaker 2: So good, so good, really good.
Speaker 1: Between Hope and Fear by Michael Kinch, Deadly Choices by
Speaker 1: doctor Paul Offitt, and the Vaccine Race by Meredith Wadman.
Speaker 1: And I have some papers as well that I'll post.
Speaker 1: And I also wanted to give a shout out to
Speaker 1: some multimedia. So there's a Nova episode. I believe it's
Speaker 1: called Calling the Shots. Yeah, and that's that's about vaccines today.
Speaker 1: It touches a little bit on the history, but it
Speaker 1: has some great information and some great interviews with different people.
Speaker 2: Excellent.
Speaker 4: I have more sources for this at next week's episode
Speaker 4: than I've ever had in my life. So we're gonna
Speaker 4: post all of our sources as we always do on
Speaker 4: our website, This podcast will Kill You dot com. Under
Speaker 4: the episodes tab, you can find every single source we've
Speaker 4: ever used for every episode.
Speaker 1: Yeah. So, so thank you to Bloodmobile for providing the
Speaker 1: music for this episode and all of our episodes.
Speaker 4: And you can find Bloodmobile's music now on band camp.
Speaker 2: Band Camp.
Speaker 1: We'll post a link on our website, but I think
Speaker 1: it's the real Bloodmobile or something like that. Okay, cool, Yeah,
Speaker 1: and also thank you to you all for listening.
Speaker 2: Thank you so mudy.
Speaker 4: This is a really fun episode and we hope that
Speaker 4: you loved it and learned a lot, and we can't
Speaker 4: wait for next week's episode. It's gonna be so fun.
Speaker 2: Okay, wash your hands, you filthy animal.
Speaker 6: U