WEBVTT - Ep 173 Childhood Vaccine Schedule 2: Who’s making the call? 0:00:00.160 --> 0:00:03.120 I am one of the increasingly rare old timers who 0:00:03.200 --> 0:00:06.760 lived during the pre vaccination era. I am the second 0:00:06.840 --> 0:00:10.360 to the last of thirteen siblings, five of whom died 0:00:10.480 --> 0:00:15.520 of vaccine preventable diseases in infancy, born to poor immigrant parents. 0:00:15.840 --> 0:00:18.520 I remember well my mother's account of the causes of 0:00:18.560 --> 0:00:23.280 their deaths, three from pertussis and two from measles. Even 0:00:23.320 --> 0:00:26.160 after many years had passed, she spoke of the death 0:00:26.160 --> 0:00:29.960 of her angels with a great deal of emotion. Imagine 0:00:30.000 --> 0:00:35.879 losing not one, two, three, or four, but five babies. 0:00:36.720 --> 0:00:40.479 It was common in the pre vaccine era. Like our family, 0:00:40.640 --> 0:00:45.159 many families lost several children to these diseases. We forget 0:00:45.760 --> 0:00:49.200 time blurs are memories of these common tragedies of yesteryear. 0:00:50.080 --> 0:00:53.080 I remember well, during the winter and spring of each year, 0:00:53.479 --> 0:00:57.120 hearing the whoop of pertussis in movie theaters, school assemblies, 0:00:57.160 --> 0:01:01.680 and assorted gatherings. Today have ever heard this, and those 0:01:01.680 --> 0:01:06.080 who have forget. I remember the summer outbreaks of polio, 0:01:06.400 --> 0:01:09.160 the crippled children who could no longer walk, or walked 0:01:09.200 --> 0:01:12.399 with limb distorted limps. As a third and fourth year 0:01:12.400 --> 0:01:16.720 medical student, I remember answering the appeals of hospital administrators 0:01:16.760 --> 0:01:19.440 who could not find the nursing staff for special duty 0:01:19.520 --> 0:01:22.679 tending to the needs of polio patients in iron lungs. 0:01:23.400 --> 0:01:24.039 We forget. 0:01:24.959 --> 0:01:29.120 I remember the awful cases of measles my own children experienced. 0:01:29.840 --> 0:01:32.560 I remember the children with smallpox during the years my 0:01:32.560 --> 0:01:36.320 family lived in Pakistan. I remember those who lost their 0:01:36.360 --> 0:01:40.200 sight from lesions in their eyes. I remember those who died. 0:01:40.880 --> 0:02:34.720 We forget. It's just such an incredibly powerful letter. 0:02:34.800 --> 0:02:37.920 Yes, this is, I mean, this is the second time 0:02:37.960 --> 0:02:41.440 that we have included this first hand account. The first 0:02:41.440 --> 0:02:44.040 time was in our one of our vaccines episodes back 0:02:44.080 --> 0:02:46.160 in eighteen. 0:02:46.680 --> 0:02:48.440 Yeah, and it is. 0:02:48.639 --> 0:02:52.200 It has stuck with me so much, shame same because 0:02:52.240 --> 0:02:56.640 it is such a powerful personal story of what we 0:02:56.760 --> 0:02:59.000 have gained and what we stand to loose. 0:02:59.160 --> 0:03:00.280 Right actly. 0:03:01.000 --> 0:03:04.760 This was a letter from EJ. Gene Gangorosa to the 0:03:04.800 --> 0:03:06.400 Immunization Action Coalition. 0:03:07.160 --> 0:03:07.280 Uh. 0:03:07.600 --> 0:03:10.399 They were a professor emeritus from Emory University and wrote 0:03:10.440 --> 0:03:12.280 that letter all the way back in the year two thousand. 0:03:13.000 --> 0:03:15.680 Yeah, and it's still so relevant today. 0:03:15.720 --> 0:03:20.320 It is and such just an important piece of sort 0:03:20.360 --> 0:03:23.640 of that like living memory that that we do we 0:03:23.720 --> 0:03:24.720 forget yep. 0:03:24.919 --> 0:03:27.200 Yeah, and we have to we have to remember. 0:03:27.360 --> 0:03:29.280 Yeah, Hi, I'm. 0:03:29.120 --> 0:03:31.920 Aaron Welsh and I'm Erin Allman Updyke. 0:03:31.760 --> 0:03:33.960 And this is this podcast will kill you. 0:03:34.120 --> 0:03:38.480 It sure is, and we're the second part as our best. 0:03:39.040 --> 0:03:42.760 Yes. Yeah, So last week we took you through just 0:03:42.800 --> 0:03:45.600 a refresher course on vaccines, how they worked, and then 0:03:45.600 --> 0:03:48.320 we did a very quick tour through each of the diseases, 0:03:48.400 --> 0:03:52.040 the many diseases that these vaccines protect us from. 0:03:52.080 --> 0:03:52.800 We call it quick. 0:03:52.880 --> 0:03:54.760 We called it quick. Yep. 0:03:55.200 --> 0:03:57.920 We closed out that episode with a big picture of 0:03:57.960 --> 0:04:01.720 view of why vaccination is so very important, not just 0:04:01.880 --> 0:04:04.680 at the individual level, not just for yourself, for your kids, 0:04:05.080 --> 0:04:09.440 but also to protect our communities. Vaccines are truly one 0:04:09.480 --> 0:04:14.120 of science's greatest achievements, and as our firsthand just demonstrated, 0:04:14.560 --> 0:04:17.360 there are increasingly fewer of us who know what it's 0:04:17.440 --> 0:04:20.159 like to live in a world without vaccines. And the 0:04:20.240 --> 0:04:23.120 amazing thing is that we don't have to. 0:04:23.240 --> 0:04:27.719 Write we have these incredible vaccines, and even better, we 0:04:27.839 --> 0:04:32.719 have highly knowledgeable, well trained scientists who consider all the 0:04:32.839 --> 0:04:36.440 aspects of the data that we have to tell us 0:04:36.560 --> 0:04:38.800 which vaccines we should take and win. 0:04:39.760 --> 0:04:43.480 That's right, everyone, Today we're talking about the ACIP. 0:04:44.240 --> 0:04:49.480 Yes, Advisory Committee on Immanization Practices here in the US YEP. 0:04:49.680 --> 0:04:52.599 In this episode today, we're going to talk so much 0:04:52.600 --> 0:04:53.640 more about the ACIP. 0:04:53.760 --> 0:04:54.840 We're going to talk about. 0:04:54.600 --> 0:04:58.040 How we came to have our childhood vaccine schedule that 0:04:58.040 --> 0:05:00.800 we do have today, what goes in to making it, 0:05:01.160 --> 0:05:04.520 and where things stand with vaccine preventable illness around the 0:05:04.520 --> 0:05:09.000 world today, Because despite the existence of safe and effective vaccines, 0:05:09.080 --> 0:05:13.400 we are still seeing outbreaks of diseases like measles, like 0:05:13.440 --> 0:05:17.839 whooping cough, like rebella, diseases that can seriously injure or 0:05:17.920 --> 0:05:19.479 even kill those who get it. 0:05:19.640 --> 0:05:22.800 Yeah, a lot of these outbreaks are happening in regions 0:05:22.839 --> 0:05:25.479 of the world that lack access to vaccines or lack 0:05:25.560 --> 0:05:28.680 the infrastructure to deliver vaccines to everybody who needs them. 0:05:29.200 --> 0:05:32.200 And undoubtedly we'll be seeing more and more of these 0:05:32.240 --> 0:05:35.880 outbreaks and preventable death and suffering due to the attacks 0:05:35.920 --> 0:05:40.279 and dismantling of USAID, which is a huge problem. But 0:05:40.640 --> 0:05:43.479 some of these outbreaks, especially in high income countries like 0:05:43.520 --> 0:05:46.880 the US, are directly attributable to the rise in vaccine 0:05:46.960 --> 0:05:49.640 hesitancy and declining vaccination coverage. 0:05:50.600 --> 0:05:55.200 Vaccine hesitancy is one of the biggest threats to global health, 0:05:55.560 --> 0:05:57.719 and it's not something that's just going to go away 0:05:57.880 --> 0:06:01.080 on its own. It needs to be directly addressed in 0:06:01.200 --> 0:06:06.520 every possible way, at every possible level. And in this regard, 0:06:07.080 --> 0:06:09.760 all of us can truly make a difference. And so 0:06:10.320 --> 0:06:12.800 we really can. And that's what we want to round 0:06:12.800 --> 0:06:15.800 out this episode with. It's just going through some evidence 0:06:15.800 --> 0:06:20.320 based methods. We love evidence still, evidence based things for 0:06:20.640 --> 0:06:24.000 having conversations with those who might be wary of vaccines. 0:06:24.920 --> 0:06:27.560 We've got a lot to go through. So should we 0:06:27.600 --> 0:06:29.520 start with quanquarantine time? 0:06:29.600 --> 0:06:30.120 We should? 0:06:32.120 --> 0:06:34.960 What are we drinking this week? We're still drinking Boosted. 0:06:35.200 --> 0:06:39.159 We are still drinking getting in those booster shots. 0:06:39.240 --> 0:06:45.560 Yeah it is. It's delicious. It's got gin and raspberries 0:06:45.680 --> 0:06:49.440 and lemonade. And we'll post the full recipe for Boosted 0:06:49.480 --> 0:06:52.080 the Quarantine as well as our alcohol free plas sy 0:06:52.120 --> 0:06:55.160 Barrita on our website This Podcast will Kill You dot Com, 0:06:55.200 --> 0:06:57.200 as well as on all of our social media channels, 0:06:57.200 --> 0:06:58.360 so make sure you're following us. 0:06:58.400 --> 0:07:02.480 Make sure you are and on our website This Podcast 0:07:02.520 --> 0:07:04.280 will Kill You dot Com, you can find just so 0:07:04.279 --> 0:07:06.520 many incredible things that you'd love to find we've got 0:07:06.600 --> 0:07:09.240 merch We've got transcripts from all of our episodes. We've 0:07:09.240 --> 0:07:11.560 got a link to a Goodreads account and a bookshop 0:07:11.600 --> 0:07:14.600 dot org affiliate account. We've got our music from Bloodmobile. 0:07:15.120 --> 0:07:20.600 We've got sources for evidence from all of our episodes, 0:07:20.600 --> 0:07:21.440 including this one. 0:07:22.000 --> 0:07:22.760 So many sources. 0:07:22.880 --> 0:07:24.840 We've got to contact us form. We've got a first 0:07:24.840 --> 0:07:26.920 hand account form if you'd like to submit your first 0:07:26.920 --> 0:07:32.160 hand account. Just so much there there, There's a lot, 0:07:32.240 --> 0:07:36.880 there really is, And if you haven't already, we would 0:07:36.920 --> 0:07:42.160 love to encourage you to rate, review, and subscribe so 0:07:42.200 --> 0:07:44.280 that you don't miss any of our things. And because 0:07:44.320 --> 0:07:47.080 it does really help us when other people can find 0:07:47.080 --> 0:07:47.480 our work. 0:07:47.680 --> 0:07:49.080 We like taking this podcast. 0:07:49.360 --> 0:07:53.480 It does. We appreciate it. Uh, are we ready? 0:07:53.520 --> 0:07:53.920 I think so? 0:07:54.400 --> 0:07:56.560 Should I take a quick break? And then Aaron walk 0:07:56.640 --> 0:07:59.160 us through the history of the ACP. 0:07:59.320 --> 0:08:00.400 I'm really excited I did. 0:08:00.400 --> 0:08:01.800 To learn about this. Oh. 0:08:02.040 --> 0:08:05.920 I really had a really fun time digging into the details. 0:08:05.920 --> 0:08:07.400 So yeah, let's just take a quick break so we 0:08:07.400 --> 0:08:24.640 can get right to it. Okay, what goes into creating 0:08:24.840 --> 0:08:27.640 a vaccine schedule? Like why do we have the one 0:08:27.640 --> 0:08:30.400 that we do here in the US, and who decides that. 0:08:30.400 --> 0:08:31.960 Such a good question, right. 0:08:33.320 --> 0:08:36.840 Vaccine schedules are different in different countries, and they take 0:08:36.880 --> 0:08:40.000 into account things like how prevalent a certain diseases and 0:08:40.040 --> 0:08:42.160 how much of a threat it poses, and so that 0:08:42.240 --> 0:08:46.079 explains why some of high risk countries use the BCG 0:08:46.360 --> 0:08:49.880 vaccine for tuberculosis, for instance, and others might not use 0:08:49.920 --> 0:08:54.120 that vaccine or include it in routine immunizations. In the US, 0:08:54.480 --> 0:08:58.400 the federal body that makes decisions about which vaccines to recommend, 0:08:58.600 --> 0:09:01.840 at what ages, and how many doses is the Advisory 0:09:01.840 --> 0:09:06.680 Committee on Ammunisation Practices the ACIP. This committee is made 0:09:06.720 --> 0:09:10.800 of up to nineteen voting members who vote on vaccine recommendations, 0:09:10.960 --> 0:09:15.000 and they include independent medical and public health experts who 0:09:15.080 --> 0:09:17.680 do not work at the CDC, as well as one 0:09:17.800 --> 0:09:23.440 consumer representative. This is a volunteer position and members serve 0:09:23.520 --> 0:09:27.920 staggered four year terms. Prospective members have to apply and 0:09:27.960 --> 0:09:30.880 then they have to undergo the screening process that includes 0:09:30.920 --> 0:09:33.760 things like disclosing conflicts of interest and this is like 0:09:33.960 --> 0:09:39.400 routinely done and maintained that's fairly important. Ultimately, they are 0:09:39.480 --> 0:09:43.640 selected by the Secretary of Health and Human Services, who 0:09:43.800 --> 0:09:48.280 at the time of recording is RFK junior, who, as 0:09:48.640 --> 0:09:51.640 probably most people are aware, has a long and vocal 0:09:51.760 --> 0:09:57.400 history promoting anti vaccine propaganda, including during a measle's outbreak 0:09:57.480 --> 0:10:00.280 in Samoa that led to the deaths of ai eighty 0:10:00.280 --> 0:10:02.760 three children, mostly under the age of five. 0:10:03.000 --> 0:10:06.640 Yep, and they he ultimately is going to be choosing 0:10:07.160 --> 0:10:09.560 who sits on ACIP. 0:10:10.120 --> 0:10:13.240 Yeah, and so I will say that, like there are 0:10:14.320 --> 0:10:18.000 there are a certain number of people right now whose 0:10:18.160 --> 0:10:20.320 terms will be up, and so it might not be 0:10:20.400 --> 0:10:23.240 I mean unless ACIP gets completely dismantled. 0:10:23.200 --> 0:10:27.080 Whole right, can of worms arn questions. 0:10:26.760 --> 0:10:29.920 As to like how much damage can someone do who 0:10:29.960 --> 0:10:31.440 has mal intent? 0:10:31.559 --> 0:10:33.680 I would hope that there are stop gaps in place. 0:10:33.679 --> 0:10:35.119 But tell me more, Aaron. 0:10:35.120 --> 0:10:36.120 Yes, yes, Okay. 0:10:36.200 --> 0:10:40.280 So the ACIP Charter, which allows for its continued functioning, 0:10:40.360 --> 0:10:43.319 has to be renewed and approved every two years by 0:10:43.360 --> 0:10:44.960 the Department of Health and Human Services. 0:10:45.000 --> 0:10:46.000 Okay, Okay. 0:10:46.559 --> 0:10:50.559 Currently there are fifteen members active members on this committee, 0:10:50.840 --> 0:10:52.520 with four whose terms are up. 0:10:52.400 --> 0:10:53.280 In twenty twenty five. 0:10:53.400 --> 0:10:56.839 Okay, okay, So in theory, in twenty twenty five he 0:10:56.880 --> 0:10:57.920 could replace four people. 0:10:57.960 --> 0:10:58.280 Okay. 0:10:59.200 --> 0:11:02.079 There are other non voting members of this committee who 0:11:02.080 --> 0:11:05.280 represent other federal institutions such as the Centers for Medicare 0:11:05.320 --> 0:11:08.800 and Medicaid Services and the Indian Health Service, as well 0:11:08.800 --> 0:11:12.079 as organizations like the American Academy of Pediatrics and the 0:11:12.160 --> 0:11:15.480 National Foundation for Infectious Diseases and many others. 0:11:15.600 --> 0:11:15.880 Yeah. 0:11:16.000 --> 0:11:20.480 Yeah, ACIP meets three times a year, three times a year. 0:11:20.320 --> 0:11:24.359 Three times a year. Yeah, more than I anticipated. 0:11:24.679 --> 0:11:27.760 I know. It is. It's it's a lot. 0:11:27.800 --> 0:11:32.719 They're constantly viewing data and voting on recommendations. Like this 0:11:32.800 --> 0:11:35.400 is a con because things happen. Things have moved very 0:11:35.480 --> 0:11:36.400 quickly in medicine. 0:11:36.480 --> 0:11:36.760 Yeah. 0:11:36.920 --> 0:11:39.280 Well, and it's so low at the same time, exactly. 0:11:39.440 --> 0:11:40.920 Yeah, but like to keep up to date. 0:11:40.960 --> 0:11:43.160 This is not just like oh, let's you know, dust 0:11:43.200 --> 0:11:46.439 off the piles of data. It's like constant regilance. 0:11:46.559 --> 0:11:47.320 Okay, awesome. 0:11:47.600 --> 0:11:48.360 Yeah. 0:11:48.600 --> 0:11:51.600 So there was a meeting scheduled for February twenty six 0:11:51.720 --> 0:11:54.719 to twenty eighth of this year, and it was postponed. 0:11:54.840 --> 0:11:57.400 Ok And there has been, as of the time of recording, 0:11:57.440 --> 0:12:03.880 no updated meeting date. And maybe maybe it will get rescheduled, 0:12:03.880 --> 0:12:07.679 maybe it won't, but you should know that if it 0:12:08.000 --> 0:12:11.160 does get rescheduled, and if any one of the subsequent 0:12:11.280 --> 0:12:14.000 meetings do take place that I want everyone to know 0:12:14.040 --> 0:12:17.120 that there are opportunities, at least at this point in time, 0:12:17.679 --> 0:12:19.880 to submit public comments, Okay, and. 0:12:19.800 --> 0:12:21.680 Like, well we can do we can. 0:12:21.920 --> 0:12:24.920 Yes, We'll link to the page that has more info 0:12:24.960 --> 0:12:27.000 on this. But in the past, the public was able 0:12:27.040 --> 0:12:29.480 to submit a written comment and request to make an 0:12:29.640 --> 0:12:31.880 oral public comment during the meeting. So there are written 0:12:31.880 --> 0:12:34.160 comments that you can make, and you could also request 0:12:34.160 --> 0:12:36.800 to make an oral comment during the meeting itself. 0:12:36.840 --> 0:12:38.439 Awesome, right, So. 0:12:38.480 --> 0:12:41.040 This is an opportunity for all of us to demonstrate 0:12:41.400 --> 0:12:44.720 how much vaccines mean to us, right writing, our health, 0:12:45.400 --> 0:12:46.720 our safety, our freedom. 0:12:46.840 --> 0:12:49.480 We love them, Thank you love them, Please take them 0:12:49.480 --> 0:12:50.440 most yeap. 0:12:51.559 --> 0:12:55.520 If the February meeting does not get rescheduled, there will 0:12:55.559 --> 0:12:59.360 be another one, maybe, I guess June twenty sixth, June 0:12:59.400 --> 0:13:03.960 twenty fifth, twenty six Okay, okay, So what is what 0:13:04.080 --> 0:13:07.280 is the ACIP looking for precisely during these meetings? 0:13:07.320 --> 0:13:08.079 Right? What do they do? 0:13:08.400 --> 0:13:08.600 Right? 0:13:08.880 --> 0:13:13.040 So, broadly speaking, they consider quote, disease epidemiology and burden 0:13:13.080 --> 0:13:19.200 of disease, vaccine efficacy and effectiveness, vaccine safety, economic analyzes, 0:13:19.400 --> 0:13:23.000 and implementation issues. Okay, so a whole lot of different 0:13:23.040 --> 0:13:24.000 things like all. 0:13:23.920 --> 0:13:26.200 Of the different thing picture that you could think of 0:13:26.360 --> 0:13:29.000 when it comes to vaccines, the disease itself, how good 0:13:29.000 --> 0:13:31.880 the vaccines works, the economics of it all makes sense. 0:13:32.240 --> 0:13:35.520 Yeah, yeah, And so this is what they are looking at. 0:13:35.600 --> 0:13:37.880 These are the types of questions that they're looking at. Now, 0:13:37.880 --> 0:13:40.840 what are they voting on? Right, So they are voting 0:13:40.840 --> 0:13:43.880 on They vote on final recommendations. Right at the end 0:13:43.880 --> 0:13:48.360 of this are recommendations and they include quote, the number 0:13:48.440 --> 0:13:52.600 of doses of each vaccine, timing between each dose, the 0:13:52.760 --> 0:13:56.120 age when infants and children should receive the vaccine, and 0:13:56.440 --> 0:13:58.440 precautions and contraindications. 0:13:58.440 --> 0:13:59.280 So who should not. 0:13:59.240 --> 0:14:01.840 Receive the vact scene Okay, that's what they vote on. 0:14:02.360 --> 0:14:06.199 And these are just recommendations, recommendations. It is then the 0:14:06.240 --> 0:14:08.760 CDC who has to decide whether or not they adopt 0:14:08.760 --> 0:14:12.160 the recommendations from ACIP right, right. And then there's also 0:14:12.280 --> 0:14:15.600 like the American Academy of Pediatrics also decides what to incorporate. 0:14:15.640 --> 0:14:17.160 It's like there are a lot of the thing is 0:14:17.559 --> 0:14:17.920 this is. 0:14:17.880 --> 0:14:21.640 A constant conversation, right that is going on, and there 0:14:21.720 --> 0:14:24.960 is one shared goal, which is to how. 0:14:24.800 --> 0:14:28.040 To best ensure the health of the public. 0:14:28.320 --> 0:14:32.320 The public that's that is the goal public health. How 0:14:32.320 --> 0:14:32.920 about that. 0:14:32.760 --> 0:14:33.320 That's the goal. 0:14:34.920 --> 0:14:37.240 So the acip is not a new committee. 0:14:37.280 --> 0:14:40.560 It was first organized in nineteen sixty four, and at 0:14:40.560 --> 0:14:43.480 the time of its first meeting, the only organization that 0:14:43.560 --> 0:14:47.120 was making recommendations on vaccines in the US was the 0:14:47.160 --> 0:14:51.520 American Academy of Pediatrics Committee on Infectious Diseases, and their 0:14:51.560 --> 0:14:54.640 recommendations were included in a publication called the Red Book, 0:14:54.800 --> 0:14:58.000 which you I know, you know the Red Book. Many 0:14:58.000 --> 0:14:59.520 people out there may have heard of it and still 0:14:59.560 --> 0:15:03.000 exists to It's a really important resource for physicians as 0:15:03.080 --> 0:15:07.200 well as the icip Like these, these recommendations that are 0:15:07.200 --> 0:15:10.359 included in the Red Book are also considered by the ACIPKA. 0:15:11.240 --> 0:15:13.400 At the time of the first Red Book, which was 0:15:13.480 --> 0:15:18.200 nineteen thirty eight, the included recommendations were fairly limited. Part 0:15:18.240 --> 0:15:20.520 of the reason for this was because there were far 0:15:20.640 --> 0:15:23.600 fewer vaccines available than there are today. So the only 0:15:23.640 --> 0:15:26.840 ones that they officially recommended in terms of the timing 0:15:26.960 --> 0:15:31.200 for when a child should receive them were smallpox. Of course, 0:15:31.240 --> 0:15:36.280 before it was eradicated. Diphtheria tetanus pertussis also known as 0:15:36.280 --> 0:15:41.800 whooping cough, typhoid fever vericella and tuberculosis. Okay, so I 0:15:41.800 --> 0:15:44.360 mean compare that to what we went through yesterday. We 0:15:44.760 --> 0:15:48.520 have lot and so so many more. I just don't 0:15:48.560 --> 0:15:51.640 We don't include typhoid fever regularly, or smallpox obviously, or 0:15:51.680 --> 0:15:52.520 smallpox of course. 0:15:52.600 --> 0:15:52.880 Yeah. 0:15:52.960 --> 0:15:55.840 It's so interesting too, though, that they had versella back then, 0:15:56.280 --> 0:15:58.600 because then we didn't have it for so long. 0:15:58.920 --> 0:16:00.080 It's just so interesting. 0:16:00.320 --> 0:16:02.920 I have so many questions, I know, and we may 0:16:02.960 --> 0:16:04.960 have even touched on that in our veracell. 0:16:04.720 --> 0:16:08.480 We probably did, you know, I don't remember things same. 0:16:09.960 --> 0:16:12.560 But then the introduction of the polio vaccine in nineteen 0:16:12.640 --> 0:16:16.080 fifty three the prompted passage of the Polio Vaccination Act 0:16:16.120 --> 0:16:18.960 a couple of years later, and then this provided funds 0:16:18.960 --> 0:16:22.240 to what was then the Communicable Diseases Center later became 0:16:22.280 --> 0:16:25.680 known as the CDC, and this helped states buy and 0:16:25.720 --> 0:16:29.960 distribute polio vaccines. But there was still no formal process 0:16:30.080 --> 0:16:33.720 for the federal government to make recommendations for vaccines and 0:16:33.840 --> 0:16:37.640 the timing of vaccinations at a national level. Vaccines were 0:16:37.680 --> 0:16:40.280 recommended for licensing at the federal level, like by the 0:16:40.320 --> 0:16:42.920 Surgeon General. They would say, okay, yes, this, we recommend 0:16:42.960 --> 0:16:47.040 this for licensing prove but mostly the government was focused 0:16:47.040 --> 0:16:50.280 on vaccines only as far as the military was concerned, 0:16:50.360 --> 0:16:54.520 got it tracking efficacy and outbreaks and so on. So 0:16:54.600 --> 0:16:56.720 it was like that is where the data collection was, 0:16:56.840 --> 0:16:58.400 That's where the decision making was. 0:16:58.480 --> 0:16:59.920 That was the main intro. 0:17:00.440 --> 0:17:03.600 That makes sense, It makes your protecting assets in that case. 0:17:05.480 --> 0:17:09.240 Sorry, and I think especially the timing close to World 0:17:09.240 --> 0:17:12.119 War two and then Korea. Yeah, so there was like 0:17:12.160 --> 0:17:15.679 a lot of that. Yeah, there was context for that. 0:17:17.280 --> 0:17:20.560 But then the polio vaccine was came out in nineteen 0:17:20.640 --> 0:17:23.400 fifty two, nineteen fifty three, and then the Musles vaccine 0:17:23.400 --> 0:17:25.960 ten years later in nineteen sixty three. It was clear 0:17:26.040 --> 0:17:29.240 that there was a need for a national immunization policy, 0:17:30.200 --> 0:17:33.639 especially with two more vaccines MOMPS and rubella on the 0:17:33.680 --> 0:17:36.119 horizon for the rest of the nineteen sixties, Like they 0:17:36.160 --> 0:17:39.640 were like clearly, you know, there was most something. It was, yeah, 0:17:39.680 --> 0:17:42.359 these things were going to happen. Yeah, And so things 0:17:42.400 --> 0:17:46.000 really got started with the Vaccination Assistance Act in nineteen 0:17:46.040 --> 0:17:49.800 sixty two, and this provided support for mass vaccination campaigns, 0:17:49.960 --> 0:17:53.679 especially targeting school aged children, which is where most of 0:17:53.720 --> 0:17:57.639 the spread and harm from these diseases was concentrated, and 0:17:57.840 --> 0:18:00.480 ultimately it led to the formation of the ACI in 0:18:00.560 --> 0:18:03.840 nineteen sixty four. So like, instead of having one meeting 0:18:03.840 --> 0:18:06.280 for measles and one meeting for polio and one meeting 0:18:06.320 --> 0:18:06.920 for this, it. 0:18:06.880 --> 0:18:08.800 Was like, why don't we just do them all at once? 0:18:08.880 --> 0:18:09.760 Do this all at once? 0:18:09.960 --> 0:18:10.400 Yeah? 0:18:10.560 --> 0:18:12.600 Efficiency? How about that? 0:18:14.880 --> 0:18:15.240 I can't. 0:18:15.240 --> 0:18:15.640 I'm sorry. 0:18:15.640 --> 0:18:18.080 I was going to make like a government efficiency joke, 0:18:18.119 --> 0:18:21.280 but I because it's too real, too close. 0:18:21.400 --> 0:18:23.159 Yeah, yeah, I know. 0:18:24.160 --> 0:18:28.320 At the first meeting, the committee considered measles, influenza, rubella, 0:18:28.480 --> 0:18:31.880 and smallpox vaccines for recommendation. I think there was still 0:18:31.920 --> 0:18:35.040 at this point a separate committee for polio. Okay, But 0:18:35.160 --> 0:18:38.680 since the beginning, the ACIP has worked closely with professional 0:18:38.800 --> 0:18:42.520 organizations like the American Academy of Pediatrics, the American Academy 0:18:42.520 --> 0:18:47.119 of Family Physicians, the American College of Ctatricians and Gynecologists, 0:18:47.160 --> 0:18:52.440 and others. Together, the ACIP and all of these organizations, 0:18:52.440 --> 0:18:56.680 both federal and professional, carefully evaluate all of the available 0:18:56.760 --> 0:18:59.760 data to make recommendations on how to best protect the 0:18:59.760 --> 0:19:01.080 health of Americans. 0:19:01.240 --> 0:19:01.440 Yeah. 0:19:01.880 --> 0:19:03.200 Again, that is the goal. 0:19:03.280 --> 0:19:03.960 That is the goal. 0:19:04.240 --> 0:19:04.800 That is the goal. 0:19:05.240 --> 0:19:07.679 So what does this look like in practice and I 0:19:07.760 --> 0:19:10.159 want to share a real life example of how one 0:19:10.200 --> 0:19:13.200 of these recommendations is made and what information is considered 0:19:13.240 --> 0:19:15.840 when weighing whether or not to change a recommendation. 0:19:15.920 --> 0:19:17.800 Okay, so let's talk about measles. 0:19:17.960 --> 0:19:21.400 It is timely. Yeah, unfortunately timely topic. 0:19:22.440 --> 0:19:25.199 So since the introduction of the first measles vaccine in 0:19:25.320 --> 0:19:29.960 nineteen sixty three, researchers have developed new versions of the vaccine, 0:19:30.040 --> 0:19:33.680 each of which has been and continues to be evaluated 0:19:34.040 --> 0:19:38.480 for safety, efficacy, ease of administration, and so on. So 0:19:38.560 --> 0:19:42.320 like live versus killed with or without certain adjuvants in 0:19:42.359 --> 0:19:45.200 a combo shot or solo, the timing for the best 0:19:45.240 --> 0:19:48.600 immune stimulation, like all those sorts of things are considered 0:19:48.680 --> 0:19:53.680 for each of these vaccines regularly, continuously, and on occasion, 0:19:53.680 --> 0:19:57.680 the ACIP has changed their recommendation for which measles vaccine 0:19:57.720 --> 0:20:00.320 to include, such as in nineteen sixty eight when they 0:20:00.480 --> 0:20:04.000 changed the recommendation from the less attenuated vaccine, which was 0:20:04.040 --> 0:20:07.359 the Edmonston B strain, to one that was based on 0:20:07.440 --> 0:20:11.800 a more attenuated strain, the Moratin vaccine. The Moratin vaccine, 0:20:12.119 --> 0:20:16.920 the more attenuated strain, was as effective as the previous vaccine, 0:20:16.920 --> 0:20:18.680 but it produced fewer side effects, right. 0:20:18.600 --> 0:20:21.199 So it was like an even weaker version of a 0:20:21.280 --> 0:20:24.480 measles virus compared to an older vaccine, but it protected 0:20:24.480 --> 0:20:27.160 you just as well, had fewer side effects, so that. 0:20:29.280 --> 0:20:33.040 They also revisited what age to give the vaccine. So 0:20:33.119 --> 0:20:36.280 initially their recommendation was nine months of age, and then 0:20:36.280 --> 0:20:39.560 that changed to twelve months and then fifteen months. And 0:20:39.600 --> 0:20:43.119 the reason for these changes was not about safety, but 0:20:43.160 --> 0:20:47.119 more about efficacy because researchers had found that babies that 0:20:47.119 --> 0:20:50.359 were vaccinated earlier tended to lose immunity a bit more 0:20:50.640 --> 0:20:53.040 than if they were vaccinated later. It's probably due to 0:20:53.080 --> 0:20:55.399 maternal antibodies circulating. 0:20:54.840 --> 0:20:57.520 Yeah, or just like you know, babies in their weird 0:20:57.520 --> 0:20:58.840 immune systems. 0:20:58.760 --> 0:20:59.480 Right exactly. 0:20:59.840 --> 0:21:02.720 These are things that they that they will look at monitoring. 0:21:02.720 --> 0:21:04.520 They were looking out for, yeah. 0:21:04.320 --> 0:21:07.080 Because of basic scientific research that was going on in 0:21:07.080 --> 0:21:10.080 clinical research that's going on where people are actually like 0:21:10.440 --> 0:21:13.840 testing people who get these vaccines for their antibody response, 0:21:13.880 --> 0:21:17.040 for example, and then collecting and gathering off that data. 0:21:16.920 --> 0:21:21.199 And connecting that to epidemiological research that was monitoring outbreaks 0:21:21.240 --> 0:21:24.560 and in what ages and what birth cohorts and all 0:21:24.600 --> 0:21:26.800 of these different Yeah, all of these different things. 0:21:26.640 --> 0:21:28.119 All of this amazing research. 0:21:28.640 --> 0:21:35.920 Yep, yes, yeah, okay, okay, But starting in nineteen sixty three, 0:21:36.320 --> 0:21:40.320 the ACIP had recommended only one dose of the measles vaccine, 0:21:40.560 --> 0:21:43.360 or later a few years later, when mumps and rubella 0:21:43.440 --> 0:21:47.680 came along MMRKA, they had recommended one dose, just one dose. 0:21:48.440 --> 0:21:51.000 And this is of course different from the two shot 0:21:51.080 --> 0:21:54.359 series that we get today that we discussed last week. 0:21:54.840 --> 0:22:00.679