Speaker 1: Hello to listeners old and new.
Speaker 2: We are trying something new this week and next we
Speaker 2: are going to be re releasing two of our favorite
Speaker 2: past episodes, Vaccines Part one and two.
Speaker 1: These are two episodes that we are really, really proud of.
Speaker 1: We've referenced them both countless times since we release them,
Speaker 1: and our audience has grown a lot since our second season,
Speaker 1: so there's probably a fair amount of you that haven't
Speaker 1: ever heard these And as we've.
Speaker 2: Seen in the past two years, as this pandemic has
Speaker 2: reached on, the importance of vaccines is still so apparent.
Speaker 1: And misinformation and disinformation abounds.
Speaker 2: We'll be back in two weeks with fresh new content
Speaker 2: for your ears, but for now, we hope you enjoy
Speaker 2: for the second time Vaccines.
Speaker 1: I am one of the increasingly rare old timers who
Speaker 1: lived during the pre vaccine nation era. I am the
Speaker 1: second to the last of thirteen siblings, five of whom
Speaker 1: died of vaccine preventable diseases in infancy, born to poor
Speaker 1: immigrant parents. I remember well my mother's account of the
Speaker 1: causes of their deaths, three from protessis and two from measles.
Speaker 1: Even after many years had passed, she spoke of the
Speaker 1: death of her angels with a great deal of emotion.
Speaker 1: Imagine 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 the 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 1: We forget. I remember the awful cases of measles my
Speaker 1: own children experienced. I remember the children with smallpox during
Speaker 1: the years my family lived in Pakistan. I remember those
Speaker 1: who lost their sight from lesions in their eyes. I
Speaker 1: remember those who died. We forget. So that was a
Speaker 1: letter to the Immunization Action Coalition by E. J. Jean Gangarosa,
Speaker 1: who was a professor emeritus from Emory University. He wrote
Speaker 1: that letter in two thousand. Yeah, it's it is amazing.
Speaker 1: He's very right. We do forget and those of us
Speaker 1: who have never heard it don't know, right, Yeah, we
Speaker 1: don't know what it's like. My name is Aaron Welsh
Speaker 1: and I'm Aaron Oman Updyke and this is this podcast
Speaker 1: will Kill You Vaccines Today. Yes, this is the first
Speaker 1: episode of a two part series on vaccines and all
Speaker 1: about the history of vaccines, the biology of vaccines, how
Speaker 1: they work. And we are also so thrilled for this
Speaker 1: episode because we got to talk to two real life
Speaker 1: vaccine experts, who doctor Gail Rogers and doctor Pedmini Shrikantaya,
Speaker 1: who are both senior program officers at the Bill and
Speaker 1: Melinda Gates Foundation. We chatted with doctor Shrikantaia and doctor
Speaker 1: Rogers about how vaccines are developed, some of the different
Speaker 1: vaccine preventable diseases that are targeted around the world, and
Speaker 1: the challenges faced in some global vaccination initiatives. We had
Speaker 1: such a great time talking with them, seriously aspirational.
Speaker 2: 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 stay tuned. Okay, so what
Speaker 1: are we drinking today? It's it's vaccine time, quarantiny time.
Speaker 1: It's quarantiny time. We're drinking wait for it, Enders fame, finally, finally, Yes.
Speaker 1: So this quarantini is named for John Enders, who is
Speaker 1: the recipient of a Nobel Prize for his work on
Speaker 1: how on cultivating the poliovirus, which really paved the way
Speaker 1: to create polio vaccine. He also created the measles vaccine.
Speaker 1: I'm talking too much about the history. Tell me what's
Speaker 1: in the drink.
Speaker 2: It's kgnac, orange liqueur and lemon juice.
Speaker 1: Is basically a sidecar.
Speaker 2: Yeah, so fancy, little, fancy, little fun drink. And we'll
Speaker 2: have the full recipe for that quarantini as well as
Speaker 2: our non alcoholic plusy burrita on all of our social
Speaker 2: media channels as well as our website. This podcast will
Speaker 2: kill you dot com.
Speaker 1: Yeah, check it out to 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
Speaker 1: think of.
Speaker 2: Anything you want to know, So send us your questions
Speaker 2: by email to this podcast will kill You at gmail
Speaker 2: 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. We can't wait
Speaker 1: to hear from you, all right, should we just jump
Speaker 1: right into it? I think we should. Okay, we'll take
Speaker 1: a quick shark break.
Speaker 2: So vaccines are often called one of the greatest public
Speaker 2: health inventions of all time, and I agree they totally are.
Speaker 2: But it's partially because they work at two different levels.
Speaker 2: Vaccines work both on an individual level, so when you
Speaker 2: get vaccinated, you are protected against whatever infection you just
Speaker 2: got vaccinated against, which is great.
Speaker 1: Who doesn't want to be protected?
Speaker 2: But they also work at the population level, so when
Speaker 2: you get vaccinated, you're actually protecting all of those around
Speaker 2: you as well. So you can pat yourself on the
Speaker 2: back for doing a public service every time you get vaccinated.
Speaker 2: So to understand exactly how vaccines can be so awesome
Speaker 2: and work on these two totally different levels, I'm going
Speaker 2: to get into some serious detail about the biology and
Speaker 2: epidemiology of how they work. And I'm going to do
Speaker 2: it so that you can a understand how awesome our
Speaker 2: immune systems are. B understand how cool it is that
Speaker 2: vaccines exist, and see be the one who explains this
Speaker 2: to Aunt Martha at Thanksgiving this year.
Speaker 1: Oh yeah, okay, excellent. All right.
Speaker 2: So to first understand how vaccines can protect you specifically,
Speaker 2: dear listeners, we first have to understand how our immune
Speaker 2: system works and how our bodies fight off infection. So
Speaker 2: immuneologists don't hate me. I'm going to break this down
Speaker 2: in the simplest possible way. More complicated, but these are
Speaker 2: the basics. There are two major parts to our immune system.
Speaker 2: There's a non specific which is called the innate immune response,
Speaker 2: and then there's a specific response, which is called the
Speaker 2: adaptive response. Okay, the innate immune response, it's very fast
Speaker 2: on the uptake. When you get exposed to viruses or bacteria,
Speaker 2: it can find them and start to get to work
Speaker 2: really quickly, but it's not that powerful. It doesn't last
Speaker 2: that long and it can't destroy everything. So we have
Speaker 2: a second immune response, the adaptive immune response. This is
Speaker 2: something that allows us to target very specific individual pathogens,
Speaker 2: but it takes some time. It's a little bit slow
Speaker 2: to get started. So what that means is that before
Speaker 2: your adaptive immune response kicks in, you usually get sick,
Speaker 2: you feel crappy, and then your adaptive immune system needs
Speaker 2: time to kick in and actually fight off that infection.
Speaker 2: But the good thing about this adaptive immune response is
Speaker 2: that it has a memory like an elephant.
Speaker 1: It never it never forgets.
Speaker 2: So anything that the adaptive immune response has responded to once,
Speaker 2: the second time it's exposed to that same virus or bacteria,
Speaker 2: it can respond much more rapidly and much more effectively.
Speaker 1: Right, Okay, so here's how it works.
Speaker 2: In four acts. We're gonna have a play.
Speaker 1: Oh my god, mine's at the four parts too. Oh
Speaker 1: my god, we didn't even plan that. Oh we didn't.
Speaker 1: That's thrilling. Oh my goodness.
Speaker 2: Okay, so we're uh biology play first four X.
Speaker 1: Here we go.
Speaker 2: So we have three main characters. Do you have three
Speaker 2: main characters too?
Speaker 1: I have a host of characters.
Speaker 2: Okay, Well, we're just simplifying it to three. We're gonna
Speaker 2: have three main characters in our immune system play the macrophages,
Speaker 2: the T cells, and the B cells.
Speaker 1: Okay, all of these three.
Speaker 2: Characters are types of white blood cells, and in your
Speaker 2: body you have a lot more than just these three,
Speaker 2: but these are our three main characters, and all of
Speaker 2: the rest of your white blood cells are going to
Speaker 2: be the ensemble.
Speaker 1: Okay, all right, Act one.
Speaker 2: You breathe, Okay, in your breath, you inhale an antigen.
Speaker 2: This might be a virus, a bacteria, a toxin, your
Speaker 2: neighbor's boogers, aerosolized poop, whatever.
Speaker 1: It's nice. Yeah, well that's life.
Speaker 2: It's a foreign substance that doesn't belong in your body,
Speaker 2: and in your body, just waiting at the ready are thousands,
Speaker 2: nay millions of these white blood cells ready to jump
Speaker 2: into action. First incomes the macrophages. The macrophages are going
Speaker 2: to see this antigen, this virus or bacteria, and they're
Speaker 2: going to eat it. They're going to gobble it up,
Speaker 2: and they're going to take that and take a part
Speaker 2: of it, and they're going to bring it over to
Speaker 2: their friends who enter stage left.
Speaker 1: The tea cells, and the tea cells walk in and
Speaker 1: they're like, hey, macro, how's it going. What you got?
Speaker 1: What do you have for us today?
Speaker 2: And the mcrofage is like, so, I don't know exactly
Speaker 2: what this is, but I found it over there and
Speaker 2: I know it doesn't belong here. I recognize it. I'm
Speaker 2: not sure what to do with it. And the T
Speaker 2: cells are like, don't worry, we got you, act too,
Speaker 2: we got you. So the T cells they recognize that
Speaker 2: an egen. There's a whole group of these tea cells
Speaker 2: and they're like, we can do two different things. Some
Speaker 2: of these tea cells they're a little wacky, they're a
Speaker 2: little wild. Okay, they're called this cytotoxic tea cells. They
Speaker 2: probably have like a mohawk and a motor cycle.
Speaker 1: Sweet. They recognize that antigen.
Speaker 2: They're like, I know, I know how to take care
Speaker 2: of this.
Speaker 1: Don't worry.
Speaker 2: So they're gonna exit and they're gonna go start replicating
Speaker 2: like wildfire, and they're gonna go out and just find
Speaker 2: anything that has that same antigen, any virus that looks
Speaker 2: the same, any bacteria that looks the same as that antigen,
Speaker 2: and they're gonna go out and kill it. They're just
Speaker 2: gonna start murdering things throughout your body.
Speaker 1: Okay, okay, shoot first, ask questions later. Exactly.
Speaker 2: So those are decided tooxic mohawk tea cells. The other
Speaker 2: T cells they've got like bangs in a short bob.
Speaker 2: They're the helper T cells. They're a lot calmer. They're
Speaker 2: gonna take this antigen and swing their way over to
Speaker 2: their friends who hang out at the lymph node bar,
Speaker 2: the B cells. And as they walk into the lymph
Speaker 2: node bar, they call out amongst the thousands of B
Speaker 2: cells just hanging out, and they're like, hey, hi, everybody,
Speaker 2: does anyone recognize this anigen?
Speaker 1: Mcriphace just dropped it off. Do you guys know what
Speaker 1: to do with it? This is kind of your thing.
Speaker 2: And in through the swinging what do you call those
Speaker 2: old timey western doors, swinging doors, swingy western doors. You
Speaker 2: hear the clink saloon doors, saloon doors.
Speaker 1: There you go.
Speaker 2: You hear the clink clink of spurs and in walks
Speaker 2: wearing a ten gallon hat, a B cell he says,
Speaker 2: I sure do, I sure do recognize that anigen. And
Speaker 2: then they get to work actually immunity. So ten gallon
Speaker 2: hat B cell. He knows what to do. He starts
Speaker 2: replicating and replicating, making more and more copies of himself,
Speaker 2: and inside he's making annibodies. These antibodies are super specific.
Speaker 2: They're going to target just that one antigen that the
Speaker 2: T cell brought over. And these B cells are making
Speaker 2: millions of these antibodies, and what they do is they
Speaker 2: throw them out into your bloodstream. They travel throughout your
Speaker 2: whole body, and they find and attached to that anigen
Speaker 2: anywhere that they find it, whether it's in your cells
Speaker 2: that have been infected, whether it's on the bacteria or
Speaker 2: on the outside of a virus. Anything that has this
Speaker 2: specific anigen is going to get an antibody attached to it.
Speaker 2: It's kind of like a flag that you put on
Speaker 2: buildings when you say this one's going to get demolished,
Speaker 2: and this one's going to get demolished. That's what an
Speaker 2: antibody is. So these antibodies go out and mark all
Speaker 2: of these cells so that the ensemble, the rest of
Speaker 2: the cast, the rest of your white blood cells can
Speaker 2: recognize it, and now they can come in and clean
Speaker 2: up the mess. They take soldiers exactly, so they come
Speaker 2: and destroy that infection, Okay, So can I just review absolutely?
Speaker 1: Okay. So the macrifhage picks something up weird and then
Speaker 1: they bring it over and they're like, okay, everyone, T cells,
Speaker 1: B cells, what is this? Mm hmmm. So the T cells,
Speaker 1: the killer ones, they go and they just kill anything
Speaker 1: that remotely resembles that antigen.
Speaker 2: Anything that specifically resembles that antigen.
Speaker 1: Okay, specifically resembles that antigen. What does that mean specifically resembles.
Speaker 2: It means anything that is that exact same antigen. So
Speaker 2: it's not going to go out and just kill anything
Speaker 2: that looks similar to it.
Speaker 1: It'll just okay that exact antigen, okay. And then the
Speaker 1: helper T cells they go and find the B cells
Speaker 1: and say, hey, this is what we're looking for. Can
Speaker 1: you go and tag everything exact? So then that makes
Speaker 1: the killer T cells job easier absolutely yeah, RCT.
Speaker 2: And it also brings in the rest of the white
Speaker 2: blood cells so that it's not just the T cells
Speaker 2: out there killing things.
Speaker 1: Okay. Act four memory.
Speaker 2: So once your body has done all this work and
Speaker 2: cleared the infection, it's not done. Old ten gallon hat
Speaker 2: B cell and a few of those wild cytotoxic mohawk
Speaker 2: T cells. They're going to develop into memory cells. These
Speaker 2: cells hang out and persist. They no longer run around
Speaker 2: making antibodies or killing cells. They're going to go backstage
Speaker 2: and wait until it's their time again. Maybe they'll play cards,
Speaker 2: they'll bide their time, and if that same antigen ever
Speaker 2: shows their face again, these B cells and T cells,
Speaker 2: the memory cells will be able to jump right back
Speaker 2: into action. They won't have to go through the whole
Speaker 2: rigamarole of acts one, two, and three. They'll just be
Speaker 2: able to use the antibodies they've already have in the
Speaker 2: memory cells to make more copies and identify and target
Speaker 2: that anergy and quash the infection before it ever takes hold.
Speaker 2: So this is the principle that vaccines exploit. They expose
Speaker 2: you to an anigen, which is a virus or a
Speaker 2: bacteria or part of a virus or bacteria, and that
Speaker 2: triggers your immune system to develop this memory response, so
Speaker 2: that if you're ever exposed to that virus or bacteria
Speaker 2: in real life, you've already got a response ready to go.
Speaker 2: You don't have to take the time to build that
Speaker 2: 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 2: So if you imagine that your immune cells, in a
Speaker 2: lot of cases, if they're dealing with a live virus,
Speaker 2: a full law on, fully loaded measles virus, it's not
Speaker 2: like they're just dealing with something passive. That virus has
Speaker 2: come in guns ablazing, it's replicating, it's going full force,
Speaker 2: while your immune cells might be kind of like tripping
Speaker 2: over their lines and getting things wrong and trying.
Speaker 1: To figure out what to do about it.
Speaker 2: Right, So, an immunization is kind of like a dress
Speaker 2: rehearsal for the play. It's real, there's people in the
Speaker 2: audience still, and you're going to develop the exact same
Speaker 2: response at the end of it, but you don't have
Speaker 2: a live virus trying to kill you while you develop
Speaker 2: this immune response the very first time.
Speaker 1: Mm hmmm, cool, yeah, cool, it's fantastic. I mean, vaccines
Speaker 1: are the best, You're the best, So.
Speaker 2: That's how vaccination can protect you as an individual. How
Speaker 2: does it protect an entire population. This is something we've
Speaker 2: touched on before, but it's called immunity, and it goes
Speaker 2: something like this. Every infectious agent bacteria, virus, fungi, whatever,
Speaker 2: in order to survive, it has to spread from person
Speaker 2: to person. That's how they reproduce. And in order to
Speaker 2: do so, in order to spread from person to person,
Speaker 2: there have to be susceptible people in the population for
Speaker 2: that virus or bacteria to get into. So if a
Speaker 2: population has a high level of vaccination, let's say like
Speaker 2: ninety seven percent of one hundred people are vaccinated, that
Speaker 2: means that those ninety seven people have developed this immune
Speaker 2: response already. They're already protected. So if you happen to
Speaker 2: drop an infected person in the middle of that population,
Speaker 2: the chances that that infected person would run into somebody
Speaker 2: who's still susceptible to that disease are really, really low.
Speaker 2: So you'd have that one infected person who will get
Speaker 2: sick and then hopefully they'll recover or else they'll die
Speaker 2: from their infection, and then that's it. Nobody else gets
Speaker 2: sick because that sick person didn't run into anyone who
Speaker 2: was susceptible to that disease. But if you imagine that
Speaker 2: maybe only fifty percent of people are vaccinated, then only
Speaker 2: fifty percent of people are immune and the other.
Speaker 1: Fifty are susceptible.
Speaker 2: And you dropped an infected individual in the middle of
Speaker 2: that population, there's a pretty good chance that that infected
Speaker 2: person will run into somebody who happens to be susceptible,
Speaker 2: and maybe they cough, or they shake their hand or
Speaker 2: lick their face, and now you have two infected people.
Speaker 2: And then that second infected person, they have a pretty
Speaker 2: good shot, like forty nine more people that they might
Speaker 2: run into another susceptible individual and lick their face, and
Speaker 2: now you have three infected individuals, right, and so on
Speaker 2: and so on. So this is the principle behind herd immunity.
Speaker 2: If the entire herd, the entire population, or enough of
Speaker 2: it is immune to infection, either because they've already been
Speaker 2: exposed and recovered from the disease or they were vaccinated
Speaker 2: and they developed immunity, then the infection can't spread.
Speaker 1: Right. So the more people that are immunized against something
Speaker 1: or immune to something by whatever means, the less chance
Speaker 1: that a pathogen has of establishing in a population or
Speaker 1: being transmitted exactly.
Speaker 2: So by getting vaccinated, you are protecting yourself from getting
Speaker 2: that infection, but you're also protecting that tiny baby on
Speaker 2: the train who's too young to get vaccinated, your grandma
Speaker 2: who's frail and immunocompromised, whoever. You're protecting literally everyone around
Speaker 2: you when you get vaccinated. So that's how vaccines work.
Speaker 2: They're pretty dang cool. Yeah, I love them, big fan,
Speaker 2: me too, major if you can't tell already. So, there
Speaker 2: are a lot of different types of vaccines, and we're
Speaker 2: going to talk a little bit about the differences between them.
Speaker 2: Not a full on immunology lecture, but just a quick rundown.
Speaker 1: But I do want to.
Speaker 2: Say at the very top of this that all vaccines
Speaker 2: that are used are extremely safe. They're extensively tested and
Speaker 2: very highly regulated, and all the different types of vaccines
Speaker 2: that we have are very effective. And part of the
Speaker 2: reason that we have different types of vaccines is because
Speaker 2: different viruses and bacteria behave differently, and so we have
Speaker 2: to come up with different types of vaccines to target
Speaker 2: those specific pathogens. So some vaccines, for example, the MMR
Speaker 2: vaccine that's measles, mumps, and rubella, which you've talked about before,
Speaker 2: and also varistella, which is chicken pox. These are made
Speaker 2: from what we call live I've attenuated viruses, so that
Speaker 2: means the vaccine itself has a live virus in it,
Speaker 2: but that virus has been modified so that it's super
Speaker 2: super weak. It's not a strong, virulent virus that actually
Speaker 2: makes you get sick. It's a weak, little, infantile virus.
Speaker 2: So this type of vaccine elicits a really good immune
Speaker 2: response because it's just like getting a real infection in
Speaker 2: that you have virus replicating in your body, but because
Speaker 2: it's such a weak virus, you don't get sick from it. However,
Speaker 2: it does mean that some people who are immuno compromised,
Speaker 2: who have very weak immune systems, might not be able
Speaker 2: to get these live virus vaccines because their immune system
Speaker 2: might not be strong enough to fight off even a
Speaker 2: very weak virus.
Speaker 1: Gotcha, Okay.
Speaker 2: We also have whole killed vaccines, So these are vaccines
Speaker 2: that are a whole entire virus, so all of the
Speaker 2: different parts of the virus, but we kill the virus
Speaker 2: before we make the vaccine out of it, so that's
Speaker 2: the inactivated poliovirus, the one that is an injection or
Speaker 2: the influenza vaccine.
Speaker 1: And so are there also killed bacteria vaccine? Are Yeah?
Speaker 2: So there's a killed bacteria vaccine for typhoid, and there's
Speaker 2: also a live vaccine for typhoid.
Speaker 1: Hey, there's both.
Speaker 2: Cool. So these whole killed vaccines, you still develop a
Speaker 2: really strong immune response, but you might need to get
Speaker 2: more boosters with this type of vaccine because it might
Speaker 2: not be quite as strong of a response as you
Speaker 2: get from a live vaccine. But people who are immuno
Speaker 2: compromised can still get these killed virus vaccines because there's
Speaker 2: no live virus in these vaccines that's replicating.
Speaker 1: So going back to the flu vaccine, Yes, this means
Speaker 1: this winds.
Speaker 2: That you cannot get the flu from the flu vaccine.
Speaker 1: Correct, absolutely not. Ever so, nor can you pass on
Speaker 1: the flu to someone if you have gotten the flu shot. Exactly,
Speaker 1: It's not possible.
Speaker 2: It's a killed, dead virus.
Speaker 1: Okay.
Speaker 2: Sometimes you might get a slight fever or muscle aches,
Speaker 2: especially in the arm that you got the shot in
Speaker 2: or the butt cheek where you got your vaccine. Do
Speaker 2: you know why aarin that you might get a fever
Speaker 2: and feel achy.
Speaker 1: Is it some sort of innate immune response. Oh, you're
Speaker 1: so good.
Speaker 2: That's your actual immune system actually doing its job. So
Speaker 2: you might feel a little bit cruddy after you get
Speaker 2: a vaccine, but it's a lot less cruddy than you
Speaker 2: would feel if you got that actual infection right.
Speaker 1: And also you wouldn't die. You will like you could,
Speaker 1: like you might if you've got the actual infection right. Exactly.
Speaker 2: Yeah, no again, adverse events are extremely extremely rare for vaccines.
Speaker 1: They're very safe.
Speaker 2: The other thing about live virus vaccines, and the reason
Speaker 2: why some vaccines that we used to use as live
Speaker 2: virus vaccines we no longer use live virus vaccines, is
Speaker 2: that there is a small chance that people can actually
Speaker 2: get sick essentially from the vaccine itself. Because it is
Speaker 2: a live virus. There is a chance that either the
Speaker 2: virus can change a little bit or mutate, or your
Speaker 2: immune system, even if you have a good immune system
Speaker 2: and you're not even a compromised, might not just be
Speaker 2: strong enough to fight off that vaccine strain. So, for example,
Speaker 2: with the oral polio vaccine, which is a live version
Speaker 2: of the polio vaccine that isn't really used much around
Speaker 2: the world. It's only used in places where there's mostly
Speaker 2: where there is still a chance of polio infection, like
Speaker 2: wild type polio still circulates in about one in two
Speaker 2: point five million doses. Someone would end up getting polio
Speaker 2: from the polio vaccine. So it is theoretically possible that
Speaker 2: with a live virus vaccine that you could end up
Speaker 2: getting sick or end up For example, if you get
Speaker 2: the vericella vaccine and then end up getting a rash,
Speaker 2: you could potentially then pass vericella to somebody who's immunal
Speaker 2: compromised from that vaccine strain. Again, it's very very very rare.
Speaker 2: These would be considered adverse events, and those are all
Speaker 2: 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
Speaker 1: type exactly right, Yeah, okay, okay.
Speaker 2: There's a few other kinds of vaccines. There are toxoid vaccines,
Speaker 2: which are very fun. Toxoid vaccines are an inactivated version
Speaker 2: of a bacterial toxin. So do you remember one that
Speaker 2: we covered already, uh, diptheria dip theoria also tetanus.
Speaker 1: Okay, toxoid vaccines are my favorite, and I don't know why, you.
Speaker 2: Know, actually they're my second favorite. I'll tell you my
Speaker 2: favorite in.
Speaker 1: Just a second. Oh, I can't wait.
Speaker 2: So, because some bacteria don't actually make you sick themselves,
Speaker 2: but they produce a toxin that makes you sick, then
Speaker 2: we can just take that toxin and give you a
Speaker 2: vaccination with that inactivated toxin, which is called a toxoid,
Speaker 2: and that way you're protected against any strains of that
Speaker 2: bacteria that contain the toxin.
Speaker 1: Very question answer. Cholera produces a toxin. Is the colera
Speaker 1: vaccine toxoid or is it? That's a good question. I'm
Speaker 1: pretty sure that it is. I was just looking at
Speaker 1: the color of vaccine. I think I wrote it down. No,
Speaker 1: I have it right here. Hold on. Okay, So the
Speaker 1: one that was produced in eighteen ninety six was killed
Speaker 1: whole and then the second one that was in nineteen
Speaker 1: ninety one is also killed whole cell vaccine, and then
Speaker 1: the one in two thousand and nine was also killed
Speaker 1: whole cell.
Speaker 2: Okay, killed wholes So cholera is a killed whole cell vaccine.
Speaker 2: Maybe that's why it's not a super excellent vaccine. Yeah,
Speaker 2: it's not the most effective anyways. There are also what
Speaker 2: are called component vaccines. This is, as an example, the
Speaker 2: hepatitis B vaccine. So a component vaccine, instead of having
Speaker 2: an entire killed virus, it has just a small part,
Speaker 2: just the part that you would need to be able
Speaker 2: to quash that infection. In the case of hepatitis B,
Speaker 2: we have a single antigen, the surface antigen. So that's
Speaker 2: like what's on the surface of the hepatitis B virus,
Speaker 2: aka what your body needs to be able to see
Speaker 2: to prevent that virus from ever getting in to your cells.
Speaker 2: So we have some vaccines like that that are just
Speaker 2: made of a single component of a virus.
Speaker 1: Okay, and do they are there also component bacterial vaccines, Yeah,
Speaker 1: there are for sure.
Speaker 2: But what's more common for bacteria vaccines are my favorite vaccine,
Speaker 2: the conjugate vaccine. So this is what is really commonly
Speaker 2: used against bacteria. The reason is, okay, this is where
Speaker 2: we get back into some immunology.
Speaker 1: Oh good, It.
Speaker 2: Turns out bacteria are very good at evading our immune system.
Speaker 1: They're very clever.
Speaker 2: They've been with us for millions of years, so they
Speaker 2: know how to get around our immune responses.
Speaker 1: So a lot of.
Speaker 2: Bacteria on their surface have sugars polysaccharides. These polysaccharides specifically
Speaker 2: evolved in order to evade our immune response, because, as
Speaker 2: it turns out, that whole amazing immune response that I
Speaker 2: told you about with the b cell ten gallon and
Speaker 2: the helper T cells, those only if the anigen is
Speaker 2: a protein.
Speaker 1: Mmmmm.
Speaker 2: So what we figured out to outsmart these bacteria who
Speaker 2: have polysaccharides not proteins on their surface, is that we
Speaker 2: can take these polysaccharide sugars and we can conjugate them,
Speaker 2: which means attach them to a protein antigen. For example,
Speaker 2: the tetanus toxoid, which we know is safe because we
Speaker 2: use it in vaccines. Conjugate a bacterial polysaccharide to that
Speaker 2: protein and use that as a vaccine, and then our
Speaker 2: 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. No, they're my favorite, so very cool.
Speaker 2: That's how we got vaccines for hemophalous influenzae, nicia, and ingititis.
Speaker 1: Et cetera.
Speaker 2: So those are I think definitely. The newest vaccines are
Speaker 2: conjugate vaccines. Well even newer are DNA vaccines, which I'm
Speaker 2: not going to talk about today.
Speaker 1: But how fun right, that's amazing, very cool question. H
Speaker 1: How exactly are vaccines developed? Great question.
Speaker 2: I'm not going to answer it, okay, but that's because
Speaker 2: we were fortunate enough to chat with doctor Gail Rogers,
Speaker 2: who is a senior program officer at the Bill and
Speaker 2: Melinda Gates Foundation, which is the world's largest private charity
Speaker 2: foundation that focuses on improving health and reducing poverty around
Speaker 2: the world. And doctor Rogers has worked on several vaccine
Speaker 2: initiatives at the development and deployment stages, and she shared
Speaker 2: with us her expertise.
Speaker 1: On vaccine development. So I'm gonna let her answer take
Speaker 1: it away, Gail.
Speaker 2: So, doctor Rogers, thank you so much for chatting with
Speaker 2: us today.
Speaker 1: Oh, you're very welcome.
Speaker 3: I'm excited to do it.
Speaker 2: We're really excited to talk with you about vaccine development
Speaker 2: in the future of vaccine. So let's jump in.
Speaker 4: Great.
Speaker 2: Can you introduce yourself and tell us a bit about
Speaker 2: your background and your role now at the Gates Foundation.
Speaker 3: Sure, I'm a pediatric infectious disease physician, and I worked
Speaker 3: in academic in a hospital and children's hospital for many
Speaker 3: years and then went into industry working on vaccines, specifically
Speaker 3: in the area of pneumonia. And from there I.
Speaker 4: Moved on to work where I currently work at the
Speaker 4: Gates Foundation to also.
Speaker 3: In the pneumonia group to really both develop and.
Speaker 4: Make countries that are low resource countries have them have
Speaker 4: 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 4: Sure. So it's a pretty lengthy process, and that's something
Speaker 4: that as and I think the right word is rigorous
Speaker 4: as you As you.
Speaker 3: Mentioned, so it starts out in somebody's idea.
Speaker 4: Of doing this, and usually there is a pre clinical
Speaker 4: stage which is when it is looked at in the laboratory. UH.
Speaker 4: It might be looked at against different strains of what
Speaker 4: you're trying to protect against, and then tested in some
Speaker 4: forms in animals, usually to start off with before it
Speaker 4: goes into what's called first in human studies, and first
Speaker 4: in human studies are in adults. Even though the vaccine
Speaker 4: may not ultimately be used in adults, it always to
Speaker 4: start off in the first phase in adults and then
Speaker 4: moves once and that really is for safety reasons, and
Speaker 4: then it goes into the second phase of testing to
Speaker 4: see if it would work against the target as well
Speaker 4: as being safe in other populations. And that's where you start.
Speaker 4: And those are rather small studies where you start looking
Speaker 4: at it in the populations that you want to target,
Speaker 4: being that for in my case it's it's babies, it's pediatric.
Speaker 4: So it would start off in adults and then move
Speaker 4: maybe to toddlers and then move to infants where it
Speaker 4: is tested for safety and whether it is useful or
Speaker 4: whether it works UH. And then there is what is
Speaker 4: the big studies, which are called the phase three studies,
Speaker 4: in which it's tested in many more children in different schedules,
Speaker 4: sometimes in different countries, uh, and really rigorously tested under
Speaker 4: under many circumstances to make sure that they're safe and
Speaker 4: that and then this is the one that they that
Speaker 4: you want to make sure that it works against the
Speaker 4: germ that you're treating, and that you that you want
Speaker 4: I'm sorry that you prevent. So after that, all the
Speaker 4: evidence is looked at. All this data is looked at
Speaker 4: by really committees in the countries that are made of
Speaker 4: committees of experts, of vaccine developers, of physicians, of safety experts,
Speaker 4: et cetera. Where all the data is looked at and
Speaker 4: based on those data, then licensure is given and from
Speaker 4: there from when a license is given, then it can
Speaker 4: go and be used by doctors as well as by
Speaker 4: countries themselves.
Speaker 2: Excellent. So, as we talk about on the episode, the
Speaker 2: past one hundred years have been incredibly productive for vaccine development,
Speaker 2: especially the past forty years, even the past ten years.
Speaker 2: Yet there are still so many other pathogens for which
Speaker 2: there is no vaccine. So what makes a pastigen a
Speaker 2: good target or a more challenging target for vaccine development?
Speaker 4: Yeah, I guess it's it's really it really is. Is
Speaker 4: is really interesting. Part of it is what you look
Speaker 4: to prevent. So a lot of the times one looks
Speaker 4: to prevent the worst of the worst, the deadliest. So
Speaker 4: certainly there is a focus on very serious, very serious
Speaker 4: pathogens being being targeted.
Speaker 3: And then what makes.
Speaker 4: One more successful than others, I think is the wide
Speaker 4: variety of the pathogens and how often they can change,
Speaker 4: which is is pretty daunting. For example, I know you
Speaker 4: talked to to Padmini and she runs influenza, but influenza
Speaker 4: changes so frequently that the target for getting one vaccine
Speaker 4: uh to cope against all all types is really challenging.
Speaker 3: In I can tell you specific case of.
Speaker 4: The pneumococcus which you know causes is the most common
Speaker 4: cause of pneumonia and common cause of death in children
Speaker 4: less than five, and for which there is a vaccine,
Speaker 4: and there had been a vaccine many years ago. This
Speaker 4: is you know, that was geared to adults. And it
Speaker 4: was only in when in the nineties when the technology
Speaker 4: was became available to know how to how to actually
Speaker 4: compose a vaccine to make children's immune system react to
Speaker 4: it that that a vaccine became available for children. So
Speaker 4: the challenges are in the pathogen itself, it's in how
Speaker 4: our immune system you know reacts to it and what
Speaker 4: type of protection can be elicited at different ages. And
Speaker 4: then for numacaucus, for example, there's over ninety zero types
Speaker 4: they're called that cause pneumonia.
Speaker 5: And.
Speaker 4: It's hard to envision trying to do this for all ninety.
Speaker 4: So it started out with doing it for several for
Speaker 4: seven initially and when that worked and those were the
Speaker 4: seven that were picked as being the most commonly cause
Speaker 4: of disease, and.
Speaker 1: Then it got expanded.
Speaker 4: So currently we have ten zerotypes and thirteen two different
Speaker 4: vaccines that target those zero types and more on the
Speaker 4: 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 4: Oh? I think we are, you know, we're aiming to
Speaker 4: do to you know, challenge and really try to control
Speaker 4: the worst of the pathogens as as they become more
Speaker 4: more prominent. So I think that for one, technology is
Speaker 4: helping us to to try to get to a universal
Speaker 4: influenza vaccine. So old pathoges that we know of, But
Speaker 4: what I'm kind of really interested in and you know,
Speaker 4: not directly involved with the development, but really see as
Speaker 4: new diseases come up that are truly worldwide threats, such
Speaker 4: as bola, such as zeka, that it's pretty now clear
Speaker 4: that advances can be made pretty quickly in these fields
Speaker 4: with with the new with new technologies that will lead
Speaker 4: us to having vaccines, for example, for vola, in a
Speaker 4: time span that was really unreachable or inconceivable before. So
Speaker 4: I guess I'm kind of hopeful for a response time.
Speaker 3: In the future.
Speaker 4: I'm hoping for antimicrobial resistance a vaccine for that that
Speaker 4: would be multi pathogen. I mean, this is really a
Speaker 4: dreams as organisms they're pretty smart and they can outdo
Speaker 4: antibiotics quite quickly. I think that you know, going the
Speaker 4: 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: my mind, well that's.
Speaker 6: A dream, but you got a dream big and uh yeah,
Speaker 6: and you know, just seeing for example, there there are
Speaker 6: other things as well that I think I can point
Speaker 6: towards that are really interesting on a different realm.
Speaker 4: Which is trying to get what we what we strive
Speaker 4: for Gates, which is trying to get vaccines that are
Speaker 4: available or are in development to be aimed toward pathogens
Speaker 4: for countries that have lower limited resources, so developing countries
Speaker 4: for example. And before we had vaccines that were really good,
Speaker 4: but we have no way that low resource countries could
Speaker 4: afford them. And now they're innovative financing mechanisms and uh,
Speaker 4: you know, involving teered pricing, et cetera. So at the
Speaker 4: same time that they're licensed in the US, in Europe
Speaker 4: and used in middle income countries, they can be used
Speaker 4: in low income countries as well as well. And that's
Speaker 4: I mean, that's particularly exciting to have that kind of
Speaker 4: equity being built throughout the world for prevention.
Speaker 1: Yeah, that's amazing.
Speaker 2: So for some of our listeners who want to dive
Speaker 2: even deeper into the future of vaccine development, can you
Speaker 2: help direct our listeners on where they can go to
Speaker 2: find more information about some of the vaccines that are
Speaker 2: being developed by the Gates Foundation and elsewhere.
Speaker 4: Yeah, sure, so I think that always A really good
Speaker 4: resource is the CDC dot gov website. They have a
Speaker 4: really of what's available as well. As what's up and coming.
Speaker 4: There's also the Clinical Trials dot gov that that tells
Speaker 4: you all the trials that are that that are being
Speaker 4: done with with vaccines as well as with with other drugs.
Speaker 4: So certainly so those are those are really good resources
Speaker 4: for for you to look for that what's what's up
Speaker 4: 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 4: No problem. This is great.
Speaker 3: Thank you so much.
Speaker 1: That was so awesome. We learned so much. Oh my gosh,
Speaker 1: so much. How cool was it to talk with her?
Speaker 2: Amazing?
Speaker 1: Okay, so that's vaccines, Yeah, that's.
Speaker 2: All I have for the biology is like a whole
Speaker 2: immunology course.
Speaker 1: Yeah. I feel armed with knowledge. Great, well, armed me
Speaker 1: with Okay, we'll get ready to learn. I can't. There's
Speaker 1: a lot of history here. 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.
Speaker 5: Yep.
Speaker 1: As we know, the word vaccine itself tells us its roots.
Speaker 1: Edward Jenner developed and tested the first vaccine against smallpox
Speaker 1: in seventeen ninety six in England from a cowpox or
Speaker 1: vaca means cow. Even though cowpox is no longer used
Speaker 1: in the smallpox vaccine or any vaccines, the name stuck
Speaker 1: and is used for all diseases. Okay, so that much
Speaker 1: we know. Technically speaking, though, the smallpox vaccine really is
Speaker 1: the first vaccine. But that's not exactly where the history
Speaker 1: of vaccines begins. Some of this is a bit of
Speaker 1: a refresher from past episodes. By the way, So the
Speaker 1: history of vaccines starts over a thousand years ago in China,
Speaker 1: where writings tell of a tradition called inoculation used to
Speaker 1: prevent smallpox infections. This practice may even go back to
Speaker 1: as early as two hundred BCE. Wow, yeah, it's amazing, amazing. Basically,
Speaker 1: you were supposed to grind up scabs from people who
Speaker 1: had recovered from a mild form of the disease and
Speaker 1: then 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: leshmaniasis infections by scraping an active lesion of someone with
Speaker 1: the disease and putting it on a child old's arm
Speaker 1: or butt. Really yeah, I know. And so there isn't
Speaker 1: a licensed Leshnie's vaccine today, but people at the Texas
Speaker 1: Children's Hospital Center for Vaccine Development are working on it. Okay,
Speaker 1: back to back to variolation. Slash and oculation because the
Speaker 1: Silk Road allowed for exchange not just of goods but
Speaker 1: also ideas. Turkey picked up this practice as well, so
Speaker 1: this concept was starting to pick up steam in Eastern
Speaker 1: Europe around the same time that people were starting to
Speaker 1: travel to the New World, bringing with them smallpox among
Speaker 1: other killer microbes like measles and influenza that would wipe
Speaker 1: out the majority of the native populations.
Speaker 6: Yep.
Speaker 1: In Turkey, the practice was refined a bit so instead
Speaker 1: of snorting ground up scabs just like doing so gross,
Speaker 1: so 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. But cool,
Speaker 1: that's fine. Cool. A few people went against this thinking,
Speaker 1: and I mentioned some of them on the Smallpox episode,
Speaker 1: such as Lady Mary Montague and Cotton Mather. And it's
Speaker 1: not surprising that varilation was slow to catch on, really
Speaker 1: because stories of its effectiveness were largely just stories at
Speaker 1: that point, clinical trials weren't yet a thing, but these
Speaker 1: iconoclastic thinkers definitely helped pave the way for the acceptance
Speaker 1: of variolation and eventually vaccination. Okay, smallpox vaccination, as we
Speaker 1: all know, was developed by Edward Jenner in seventeen ninety six,
Speaker 1: and the story we all know and love. Jenner, who
Speaker 1: already knew about varulation, had his revelation when he realized
Speaker 1: that milkmaids never got smallpox because they were protected against
Speaker 1: it after being exposed to cowpox loler infections. Blah blah,
Speaker 1: Episode three. Yeah, he tested this out, and I do
Speaker 1: want to include this part. He tested this out on
Speaker 1: a child named James Phipps, little Jimmy Jim, inoculating him
Speaker 1: first with cowpox on May fourteenth, seventeen ninety six.
Speaker 2: That's the day this episode's being released. Yes, oh my god,
Speaker 2: did we do it on purpose? One hundred percent?
Speaker 1: No? No, definitely not. This is my favorite, just serendipity.
Speaker 1: I love it. Two hundred and twenty three years ago today,
Speaker 1: on the day that hopefully a lot of you are
Speaker 1: hearing this, yeah, is the day of the first vaccine
Speaker 1: Oh my gracious, oh, I feel so excited 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 of vaccine, so her hide. Blossom's
Speaker 1: hide is displayed at Saint George's Hospital in London. So
Speaker 1: if there are any London listeners that are out there,
Speaker 1: please send us a pic. Okay. Was Jenner actually the
Speaker 1: first 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 emitst a smallpox outbreak,
Speaker 1: decided to infect his family with cowpox and no one
Speaker 1: became infected. But word got around and the community was
Speaker 1: like very angry and anxious. They were like, this family
Speaker 1: is gonna grow horns and utters and they're gonna mutate,
Speaker 1: so you all need to get out of here, So
Speaker 1: the family moved to avoid the constant physical and verbal
Speaker 1: harassment from their wonderful neighbors. Wow, and they lived out
Speaker 1: along in smallpox free life alone, forever alone. So it
Speaker 1: seems not so much that Jenner was the first to
Speaker 1: make the logical leap about cowpox protecting against smallpox, but
Speaker 1: rather the first to conduct trials on multiple people and
Speaker 1: bring his results to the attention of a large and
Speaker 1: legiti medical society, and the first. This first vaccine would
Speaker 1: 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 them 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 He made the logical jump
Speaker 1: from microbes spoiling wine to microbes causing disease in humans
Speaker 1: and animals, and switched his research focus from alcohol production
Speaker 1: to the field that we now call microbiology. Where do
Speaker 1: vaccines come into this? Okay, In this summer of eighteen eighty, so,
Speaker 1: almost one hundred years after Jenner's vaccine, Louis Pasture was
Speaker 1: going on vacation. He packed his bags, double checked the
Speaker 1: stove was turned off, and told his assistant to finish
Speaker 1: up a chicken cholera study they had been working on. So,
Speaker 1: chicken or avian cholera is caused by Pasturella maltacida or
Speaker 1: something like that, for those of you who might be curious.
Speaker 1: Apparently it's extremely high mortality rate. In the chickens and yeah,
Speaker 1: and in wild and domestic fowl. Oh poor baby. Yeah.
Speaker 1: So Pasture just set off for holiday, leaving his research
Speaker 1: in good hands, or so he thought. It turns out
Speaker 1: the assistant was busy getting ready for his own vacation
Speaker 1: and completely forgot about the experiment. Luckily, he returned before
Speaker 1: Boss Pasture did, and when he got back he saw
Speaker 1: the test tube with avian collar broth still sitting on
Speaker 1: the bench, and the chickens were running around blissfully unaware
Speaker 1: that they had narrowly escaped a horrible death. The assistant
Speaker 1: was like, wow, better late than never, and injected the
Speaker 1: chickens with the stale broth. Nothing happened to the chickens.
Speaker 2: 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 this is the most exciting thing. What do you mean,
Speaker 1: do this same exact experiment, leave the broth out for
Speaker 1: a long time, and then just do the whole thing
Speaker 1: all over again.
Speaker 2: I love this. I feel like I would love to
Speaker 2: work for Pester. You're like, I gotta tell my boss
Speaker 2: I really screwed up, and they're.
Speaker 1: Like, this is the best news. Yeah, it's like that genius.
Speaker 1: So then that's what Chamberlain does, and again the chickens
Speaker 1: remain healthy and cholera free. Oh my gosh. Both Pasture
Speaker 1: and his assistant realized that their stale cholera was acting
Speaker 1: to protect the chickens from disease in a similar way
Speaker 1: as to how the smallpox vaccine worked, but even cooler.
Speaker 1: Unlike that smallpox vaccine, this avian colera vaccine was made
Speaker 1: from the same species of bacteria themselves, so you didn't
Speaker 1: have to find a milder strain or species create a
Speaker 1: vaccine like the cowpox virus and the smallpox virus. You
Speaker 1: just had to weaken the existing one. So this opened
Speaker 1: this door and pass Ure'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, Pasture 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 cows and sheeps and goats and
Speaker 1: so on. Pasture decided to keep the name vaccine as
Speaker 1: a nod to jet, 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 road map
Speaker 1: that scientists could follow to try to develop vaccines against
Speaker 1: other diseases. First identify the causative agent, then weaken it
Speaker 1: using chemicals or through multiple passages. Try it out on animals,
Speaker 1: and then try it out on humans if things look good.
Speaker 1: In eighteen eighty five, Pasture developed the raby vaccine, which
Speaker 1: I talked about in the Rabies episode, and then Almroth Wright,
Speaker 1: Richard Pfeiffer, and Wilhelm Cole developed the first typhoid vaccine
Speaker 1: in eighteen ninety six. That same year, Waldemar Mordecai Halfkind
Speaker 1: developed a collar of vaccine Yeah what a name, which
Speaker 1: he promptly tested on himself and then narrowly escaped with
Speaker 1: his life apparently yeah, but he decided for effective vaccine there, Wow,
Speaker 1: he thought good enough, So he tested it out on
Speaker 1: a bunch of friends and fortunately it worked, and then
Speaker 1: he went big time with trials in India. So while
Speaker 1: he was in India testing out his collar a 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 and accolades were short lived. In nineteen o two,
Speaker 1: after being given the plague vaccine, a bunch of people
Speaker 1: developed tetanus symptoms and nineteen died. Ooh yeah, so the
Speaker 1: deaths were traced to a bottle of plague vaccine manufactured
Speaker 1: by half Kind, and he was fired and exiled and
Speaker 1: remained unemployed for at least four years. And this whole
Speaker 1: time he was begging to read the entire report of
Speaker 1: the inquest, like what exactly happened? How could this have
Speaker 1: gone wrong? I don't understand? So he finally got his wish,
Speaker 1: and as he read it, he learned that the specific
Speaker 1: bottle had been handled by a lab tech who dropped
Speaker 1: his forceps in the dirt and didn't bother to clean
Speaker 1: them or get a replacement. Tetanus loves soil, It loves
Speaker 1: to live in soil. Yeah. Oh that's so awful, right, yeah,
Speaker 1: sterile technique important, very so Eventually half Kind was publicly exonerated,
Speaker 1: but the damage to his reputation was already done and
Speaker 1: would never fully recover. Kaind's contaminated plague vaccine is a
Speaker 1: perfect illustration of the lack of oversight on vaccine development
Speaker 1: during this time. While all of these vaccines and antitoxins
Speaker 1: were being produced in the late eighteen hundreds, there wasn't
Speaker 1: really any government regulation, so a classic example of technology
Speaker 1: outpacing the law. And as you might expect, things took
Speaker 1: a tragic turn, or rather they took several tragic turns.
Speaker 1: Around nineteen oh one, the year before Half the Half
Speaker 1: Kind incident, some smallpox vaccines and dip theory antiitoxin were
Speaker 1: contaminated with tetanus and twenty four people died. Following these tragedies,
Speaker 1: people were like, we demand that the government look over
Speaker 1: the manufacturing of vaccines, and they got their wish. So
Speaker 1: right after this, in nineteen oh two, Teddy Roosevelt signed
Speaker 1: into law the Biologics Control Act, which would require that
Speaker 1: health commissioners oversaw vaccine production. Just some much needed legislation,
Speaker 1: Vaccine development didn't slow down with these new regulations. If anything,
Speaker 1: it spurred researchers to create safer, more potent, more stable vaccines,
Speaker 1: and there were still plenty of devastating diseases for which
Speaker 1: there was no effective treatment or protection. In the nineteen twenties,
Speaker 1: researchers started to experiment with adjuvants, which comes from the
Speaker 1: Latin four, to help adding them to increase the efficacy
Speaker 1: of a vaccine by eliciting a stronger immune response that
Speaker 1: lasted longer and provided better protection. The French scientist Gaston
Speaker 1: Ramon discovered that the chemical formuline, which had been used
Speaker 1: just to preserve antiitoxin, also actually inactivated the toxins. So
Speaker 1: this allowed him to develop the diph theory of vaccine
Speaker 1: in nineteen twenty three, as well as a tetanus vaccine
Speaker 1: a few years later.
Speaker 2: Gosh, it seems like they need it since all their
Speaker 2: vaccines keep getting infected with tetanus. Right.
Speaker 1: His contributions to vaccine development have resulted in over sixty
Speaker 1: million lives saved estimated. Jeez. Next was Protessis. Protessis aka
Speaker 1: Whoopincoff was an infamous child killer alongside measles still is
Speaker 1: and it will definitely have an episode all of its
Speaker 1: own eventually. Yeah, and because it was so feared and
Speaker 1: killed so many children, so horribly. It was high on
Speaker 1: the list for vaccine development, but it was a tough
Speaker 1: nut to crack. First of all, it had been a
Speaker 1: real struggle getting the bacteria isolated, and even once it
Speaker 1: was isolated, it was nearly impossible to culture. But eventually
Speaker 1: a broth was developed which allowed Pearl Kendrick, Grace Elderling
Speaker 1: and Loney Clinton Gordon to develop, test and implement a
Speaker 1: protest's vaccine in nineteen forty that would be used up
Speaker 1: until the nineteen nineties. Wow, which just pretty dope. Yeah,
Speaker 1: good 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. Holy cred. Yeah, yeah, this
Speaker 1: is when they didn't know that hepatitis B can survive
Speaker 1: in plasma. And also the Cutter polio vaccine incident, in
Speaker 1: which a batch of polio vaccines were contaminated with the
Speaker 1: live virus, resulting in the paralysis of fifty six people,
Speaker 1: mostly children. So talk about this a bit in the
Speaker 1: polio episode. But for each of these either new laws
Speaker 1: or regulations were put into place to prevent additional suffering.
Speaker 1: Most of the vaccines that I've mentioned so far could
Speaker 1: almost be looked at as kind of the low hanging
Speaker 1: fruit of the microbiology world. Of course, it was a
Speaker 1: huge leap of technology and scientific thought to develop the
Speaker 1: concept of vaccines in the first place. But once it
Speaker 1: was there, scientists applied it to the most common diseases,
Speaker 1: and in particular those whose causative agent had been identified,
Speaker 1: those that were culturable responded well to attenuation and had
Speaker 1: low mutation rates or strain diversity. Because these were diseases
Speaker 1: that were fairly straightforward to develop vaccines for, it was
Speaker 1: almost just a race to see who could publish their
Speaker 1: vaccine first. In many ways, it's pretty cool. By the
Speaker 1: nineteen fifties, even though there was a smallpox vaccine, a
Speaker 1: 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 tell An
Speaker 1: important 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 ditheria, 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's 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. Oh definitely. Okay, So, cell
Speaker 1: lines began to be used to culture viruses, which greatly
Speaker 1: advanced the field. One of the most important developments involves
Speaker 1: our buddy John Enders was under same of Ender Shame,
Speaker 1: who was one of the creators of the measles vaccine. Also,
Speaker 1: I just love his origin story. Okay, while finishing his
Speaker 1: master's thesis on Middle English what at Harvard? Yeah, so
Speaker 1: he he got he got a master's in Middle English,
Speaker 1: and he was all set to do a PhD on
Speaker 1: Middle English English, but he found himself. Yeah, he found
Speaker 1: himself rooming with an Australian bacteriologist. They became close buds.
Speaker 1: He was so charming and Enders would tag along with
Speaker 1: him to the lab and he was like, wow, what
Speaker 1: is this. This is super cool? 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 2: It's everyone who studies Middle English who listens to this podcast, right,
Speaker 2: and then like.
Speaker 1: Now I'm doing every biology and we're.
Speaker 2: Like yes, by the way, those emails literally like break
Speaker 2: our hearts with happiness.
Speaker 1: They're the most thrilling. Oh yeah, absolutely, Okay. So in
Speaker 1: the nineteen forties, Enders began to doubt the conventional wisdom
Speaker 1: that poliovirus only grew a nervous tissue, and he decided
Speaker 1: to try to grow the virus on other types of
Speaker 1: human fetal tissue, which was successful. This was a huge
Speaker 1: turning point in polio research that would lead to the
Speaker 1: creation of the vaccine that saved countless lives and prevented
Speaker 1: so many cases of paralysis. This development also earned Enders
Speaker 1: and his two research partners, Weller and Robins, the Nobel
Speaker 1: Prize in Physiology or Medicine in nineteen fifty four. Using
Speaker 1: a similar technique, but monkey kidney cells rather than human
Speaker 1: fedal cells. Jonas Salk developed the polio vaccine in nineteen
Speaker 1: fifty two. Monkey kidney cells had been used for a
Speaker 1: while to grow and study viruses, but something concerning came
Speaker 1: to light in the nineteen fifties. Many of these cells,
Speaker 1: which were still being used by people like Albert Sabin
Speaker 1: and Hilary Koprowski to develop live polio vaccines, were found
Speaker 1: to be contaminated by a virus called SV forty SV
Speaker 1: meaning Simian virus forty just being random or something, Yeah,
Speaker 1: I think so. So whether these viruses caused any kind
Speaker 1: of disease in humans wasn't known, but this was really
Speaker 1: worrisome because the many animal cell lines had been found
Speaker 1: to be contaminated with cancer causing viruses. The live polio
Speaker 1: vaccines developed by Kaprowski and Sabin, which had been widely
Speaker 1: tested but not yet licensed, were found to be contaminated
Speaker 1: with the virus, and socks killed polio vaccine, which had
Speaker 1: been administered to millions of people around the world, was
Speaker 1: also found to contain viral particles of SV forty 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 didn't
Speaker 1: cause any major infection. But that's still a lot of unknowns.
Speaker 1: And so after this initial study that notified researchers of
Speaker 1: the presence of SV forty, a researcher named Bernice Eddie
Speaker 1: had been on the hunt for any hidden dangers of
Speaker 1: the viruses tucked away in these vaccines, and she found
Speaker 1: some disturbing things. When injected into lab animals such as hamsters,
Speaker 1: the animals developed tumors and died within a few months. No,
Speaker 1: not great. She published her work, which contributed to the
Speaker 1: general controversy and concern that was being raised about the
Speaker 1: existing Salk and Saban polio vaccines, and she was promptly
Speaker 1: demoted by her boss, who told her that she wouldn't
Speaker 1: be allowed to speak at any more meetings without him
Speaker 1: reviewing and approving everything she was going to say, rude,
Speaker 1: ugh gross. By that time that regulations were put into
Speaker 1: place to prevent the contamination of the polio vaccine by
Speaker 1: SV forty. By the time people real like, okay, this
Speaker 1: is actually a big deal, over ninety eight million Americans
Speaker 1: had received the Salk vaccine which had at least inactive
Speaker 1: and very possibly active SV forty particles in it. Okay,
Speaker 1: So another researcher who tried to sound the alarm bell
Speaker 1: about SV forty was Maurice Hillman, who would go on
Speaker 1: to become the most prolific vaccine developer ever ever, surpassing
Speaker 1: even John Enders. His name should be a household name,
Speaker 1: but he was just super modest. He and his team
Speaker 1: developed vaccines for over forty diseases. Over forty vaccines. What
Speaker 1: his work is estimated to save eight million lives every year.
Speaker 1: Isn't that amazing? That is amazing? Yeah? I really wanted
Speaker 1: to shout him out. Okay, So, anyway, vaccines made from
Speaker 1: SV forty infected cells could not be considered safe, which
Speaker 1: meant massive and expensive testing as well as throwing away
Speaker 1: the vaccines already produced. It needed to be a longer term,
Speaker 1: more stable solution enter a man named Leonard Hayflick. Hayflick
Speaker 1: worked on cell culture at the Weistar Institute in Philadelphia, Pennsylvania,
Speaker 1: under Hillary Kapowski. He had developed a strain of cells
Speaker 1: from human feudal lung tissue that he believed held great
Speaker 1: promise for the field of virology and for the development
Speaker 1: of vaccines overall. This cell strain, which he called WI
Speaker 1: thirty eight, came from a fetus that had been aborted
Speaker 1: by a woman in Sweden in nineteen sixty two, where
Speaker 1: abortion had been legal since nineteen thirty eight. I also
Speaker 1: want to point out here that tissue from a board
Speaker 1: of fetuses had been used in scientific research for a
Speaker 1: while at that point, quite a long while, and is
Speaker 1: still widely used today with many more legal regulations in
Speaker 1: place regarding consent. Just FYI. Hayflick wanted to cultivate these
Speaker 1: lung cells because he believed they would be cleaner and
Speaker 1: safer for vaccine production Compared to monkey kidney cells. The
Speaker 1: WI thirty eight cells did not turn cancerous as did
Speaker 1: many other cell types used in culture, and they were
Speaker 1: 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 could 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 a new Despite the promise the WI thirty
Speaker 1: eight cells had. Others express caution 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 Koprawskise.
Speaker 2: Some great names by the way I know right.
Speaker 1: He had witnessed the rise and concern about viruses contaminating
Speaker 1: monkey kidney cells and became convinced that Hayflick's Wi thirty
Speaker 1: eight cells were the way to go. A couple of
Speaker 1: years after Hayflick had published on these cells, a devastating
Speaker 1: rubella epidemic in the US resulted in twelve point five
Speaker 1: million infections what one in fifteen Americans Holy guawk twenty
Speaker 1: one hundred people developed encephalitis. Six two hundred and fifty
Speaker 1: pregnancies ended in miscarriage or still birth. Five thousand women
Speaker 1: chose to get abortions because they had been infected during pregnancy.
Speaker 1: Congenital Rubella is terrible, yep. Twenty one hundred infants died
Speaker 1: soon after birth, and twenty thousand babies were born and
Speaker 1: survived with congenital rubella syndrome H twenty thousand.
Speaker 2: 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 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 WI thirty eight cells, decided
Speaker 1: to test his out to be blunt. It wasn't great,
Speaker 1: didn't work. Many toddlers in the experiment straight up developed rebella,
Speaker 1: while others developed no protection whatsoever. Oh dear, yeah, But
Speaker 1: Plotkin didn't give up on his vaccine. Instead, he tried
Speaker 1: different ways to weaken the virus, growing it over and
Speaker 1: over again, or growing the virus at different temperatures. Eventually,
Speaker 1: he hit the sweet spot. Multiple passages, and a low
Speaker 1: incubation temperature of eighty six degrees fahrenheit or thirty degrees
Speaker 1: celsius weakened the injected rubella enough to not cause any
Speaker 1: disease or side effects, but left it strong enough to
Speaker 1: produce antibodi's and lasting immunity.
Speaker 2: Wow.
Speaker 1: Despite Plotkin's WI 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 WI 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. That's a lot. And even more concerning, they
Speaker 1: didn't necessarily develop overt signs of the disease, but were
Speaker 1: silently infected, meaning they could shed the virus to pregnant
Speaker 1: women who were unvaccinated. So she turned to Plotkin's vaccine,
Speaker 1: testing it along with the commercially available ones at daycares,
Speaker 1: and she found that Plotkin's vaccine, in contrast to the
Speaker 1: two commercially available ones, produced an immune response and the
Speaker 1: types of antibodies that mimicked natural infection, making the immune
Speaker 1: memory last much longer, so there was a clear winner
Speaker 1: in this race. Following Horsemen's research, Plotkin's w I thirty
Speaker 1: eight rebella vaccine was finally licensed in nineteen seventy eight,
Speaker 1: and the only other competitor, a vaccine made from animal cells,
Speaker 1: was withdrawn the following year. Wow w II thirty eight
Speaker 1: cells have gone on to make vaccines that have been
Speaker 1: given to over three hundred million people, and similar methods
Speaker 1: were used to make an additional six billion vaccines 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 cells function and
Speaker 1: for examining the safety in application of potential pharmaceuticals that
Speaker 1: they are displayed in little glass tubes at the National
Speaker 1: Museum of American History Wood.
Speaker 5: Yeah.
Speaker 1: Oh, I was just there, and I didn't know those
Speaker 1: were there.
Speaker 2: I would have sought them out, just went straight to
Speaker 2: 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 book The Vaccine Race. The widespread success
Speaker 1: of various vaccination programs led to record lows and diseases
Speaker 1: that previously killed or disabled millions each year. Arguably, the
Speaker 1: biggest accomplishment in vaccine history, besides the invention of vaccines themselves,
Speaker 1: happened when the world was officially declared smallpox free in
Speaker 1: nineteen eighty, with the last known wild case occurring in
Speaker 1: nineteen seventy seven in Somalia. The effort to eradicate smallpox
Speaker 1: left a larger legacy than just eliminating the disease, though,
Speaker 1: so by assembling this global team to target this disease,
Speaker 1: it had built a vaccine infrastructure that could be used
Speaker 1: to deliver vaccines all over the world. So the WHO
Speaker 1: used this already existing infrastructure to deploy additional vaccines, which
Speaker 1: I'm sure we'll hear more about, and they set up
Speaker 1: in the WHO also set up the Expanded Program on
Speaker 1: 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 chicken pox, strep, pneumonia, niceria, meningititis, hepatitis B,
Speaker 1: hemophlosinflalenza type b q feever, hepatitis A, rotavirus, typhoid, human
Speaker 1: papalomma virus. I mean, just it's amazing, tickbore and cephalitis.
Speaker 1: Gotta throw that in there. I wanted to illustrate just
Speaker 1: how many lives vaccines have saved and improved since being developed.
Speaker 1: So this is what I'll call vaccines by the numbers,
Speaker 1: and this just compares us numbers because that's all I
Speaker 1: could find in a table format. So if anyone has
Speaker 1: global comparisons between the pre vaccination era and the post
Speaker 1: vaccination era, please send them our way. Diphtheria before vaccines
Speaker 1: annually twenty one thousand cases, eighteen hundred deaths twenty first
Speaker 1: century annually zero cases, zero deaths. Measles in the US
Speaker 1: before vaccines annually five hundred and thirty thousand cases Jesus
Speaker 1: four hundred and forty deaths twenty first century tbd, but
Speaker 1: let's just say for now, tentatively over one hundred cases annually. Yeah.
Speaker 1: Average protessis annually before vaccines two hundred thousand cases, four
Speaker 1: thousand deaths twenty first century on average fifteen thousand, six
Speaker 1: hundred cases annually, twenty seven deaths. A lot higher than
Speaker 1: I thought. Actually, it's a lot of waiting immunity with
Speaker 1: the protessas vaccine. Yeah. Paralytic polio before vaccines annually sixteen thousand,
Speaker 1: three hundred cases, nineteen hundred deaths twenty first century zero zero. 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. So between
Speaker 1: those years the number of congenital rebella cases in the
Speaker 1: US declined by thirty six percent. But at the turn
Speaker 1: of the twenty first century there were one hundred and
Speaker 1: seventy six reported cases of rebella and nine cases of
Speaker 1: congenital rebella.
Speaker 4: Wow.
Speaker 1: That amazing, That is absolutely incredible. In two thousand and five,
Speaker 1: the CDC announced that endemic rebella had been eliminated from
Speaker 1: the US, and ten years later, in April twenty fifteen, PAHO,
Speaker 1: the Pan American Health Organization, announced that endemic rebella had
Speaker 1: been eliminated from the Western hemisphere. Just got chills me too.
Speaker 1: It's hot in this room. Smallpox, there are so many
Speaker 1: of these. Smallpox in the first half of the twentieth century,
Speaker 1: twenty nine thousand cases and three hundred and thirty seven
Speaker 1: deaths annually. Zero obviously in the twenty first century, Yeah,
Speaker 1: it's gone. It's gone. Tetanus in the first half the
Speaker 1: twenty first century, five hundred and eighty cases and four
Speaker 1: hundred and seventy two deaths annually twenty first century, forty
Speaker 1: one cases four deaths. Before the vaccine homophlous influenza type B.
Speaker 1: It caused meningitis, bloodstream infections, and pneumonia, and twenty thousand
Speaker 1: children every year, killing one thousand of them and causing
Speaker 1: permanent brain damage and many more. When fear drove down
Speaker 1: vaccination rates, outbreaks happened in two thousand and eight. In
Speaker 1: two thousand and nine in Minnesota, Pennsylvania, New York, Oklahoma,
Speaker 1: and Maine, with at least four children dying because those
Speaker 1: parents chose not to vaccinate them.
Speaker 4: Uh.
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, Yes they do, It
Speaker 1: declined by ninety percent after it became part of the
Speaker 1: routine schedule. Wow. And when a booster was added, the
Speaker 1: incidents fell another eighty one percent.
Speaker 5: Wow.
Speaker 1: No one younger than twenty years old has died of
Speaker 1: chicken pox in the US since twenty ten. Wow. Yeah, Okay,
Speaker 1: two more numbers. It is estimated that the work done
Speaker 1: by John Enders and his teams enters fame has saved
Speaker 1: over one hundred and twenty million lives as of twenty seventeen.
Speaker 1: And I said it before, but I want to say
Speaker 1: it again. Maurice Hillman's work is estimated to save eight
Speaker 1: million lives each year, so he has saved more lives
Speaker 1: than any other scientist. So let's hear it for Maurice.
Speaker 1: I kind of want that to be the title of
Speaker 1: our episode. Let's hear it from Maurice. I like it. Yeah, Okay, good,
Speaker 1: I really like it. The need for vaccines has never
Speaker 1: been finished, and the recent resurgence in vaccine preventable illnesses
Speaker 1: only highlight their importance. Aaron, I'm hoping you'll tell me
Speaker 1: some good news about vaccines today. All right, after one
Speaker 1: more short.
Speaker 2: Break, all right, so let's talk about some of the vaccines.
Speaker 2: What the vaccine recommendations are around the world. Okay, great,
Speaker 2: So the World Health Organization has a list of recommended
Speaker 2: routine vaccinations, so I'll kind of just go through this.
Speaker 2: You've already mentioned a lot of these, because, as it
Speaker 2: turns out, these recommended vaccinations are, in general, the ones
Speaker 2: that have had the biggest impact around the world in
Speaker 2: terms of decreasing the number of disease.
Speaker 1: Outbreaks that we see.
Speaker 2: So the World Health Organization recommends as a blanket statement
Speaker 2: for all countries with vaccination programs that they include BCG,
Speaker 2: which is the tuberculosis vaccine, which I think is interesting
Speaker 2: because that's the one that the US does not vaccinate for,
Speaker 2: but that one the World Health Organization recommends as a
Speaker 2: general recommendation.
Speaker 1: Does the US vaccinate against that?
Speaker 2: So the BCG vaccine is a vaccine for tuberculosis that's
Speaker 2: good at preventing disseminated so like full body tuberculosis in infants.
Speaker 2: For some reason that's not entirely clear, it's not great
Speaker 2: at protecting adults, so it doesn't adults from getting TB.
Speaker 1: Huh.
Speaker 2: Yeah, it's not good in adults. It's just good in kids.
Speaker 2: And it's really just good against disseminated infection. And so
Speaker 2: infants in a lot of countries get BCG like at birth,
Speaker 2: but in the US we don't have high enough rates
Speaker 2: of tuberculosis to justify giving the BCG vaccine. Essentially interesting. Yeah,
Speaker 2: and then some countries only give it to certain certain
Speaker 2: subsets of their population if they have if those children
Speaker 2: happen to be at high.
Speaker 1: Risk or something like that, okay, So all.
Speaker 2: Right, We've also got hepatitis B, which is another vaccine
Speaker 2: giving to infants at birth, polio DTP which is diphtheria, tetanus,
Speaker 2: and protessis hib homophluous influence A type B, the horrible
Speaker 2: one that causes meningitis, The new Macco vaccine, which there's
Speaker 2: actually a couple different new macacco vaccines, but this protects
Speaker 2: against meningitis as well as pneumonia, okay in children and adults.
Speaker 2: There's different ones for children and adults, rotavirus, measles, rubella,
Speaker 2: and HPV. So these are the ones that who says
Speaker 2: every country should vaccinate for sure for these at a minimum.
Speaker 2: There's a few more that we vaccinate for in the
Speaker 2: US that the World Health Organization has on their list
Speaker 2: as recommending for countries that have strong vaccination programs where
Speaker 2: they can generally achieve at least eighty percent vaccination coverage,
Speaker 2: and so those are mumps, vericella which is chicken pox,
Speaker 2: and seasonal influenza. Great, so that's the US vaccine list.
Speaker 2: We actually also vaccinate against niceria meningitis in the US,
Speaker 2: which is truly horrible illness that causes meningitis and that
Speaker 2: one is recommended by the WHO for some countries, so
Speaker 2: the US is one of the countries that has that
Speaker 2: on their recommendations list. And then there's a whole number
Speaker 2: of other vaccines that are recommended in certain geographic areas
Speaker 2: or for certain populations. So, for example, some countries like
Speaker 2: China have Japanese encephalitis as a recommended vaccine for all children.
Speaker 2: Hepatitis A is recommended.
Speaker 1: A lot for travelers.
Speaker 2: It's probably going to be put on the routine vaccination
Speaker 2: list here in the US pretty soon. And then there's
Speaker 2: things like typhoid, cholera, yellow fever, tick born encephalitis.
Speaker 1: Okay, I'm getting that this week. Yeah, that's throwing. So yeah.
Speaker 2: So basically, recommendations differ around the world because every country
Speaker 2: is going to decide what is the most important diseases
Speaker 2: that they want to vaccinate their people against, and different
Speaker 2: geographic regions are going to have different risk profiles, so
Speaker 2: they're going to vaccinate against different diseases. But something that's
Speaker 2: really important to keep in mind about all of these
Speaker 2: recommendations is that vaccine are always recommended to be given
Speaker 2: to the youngest age group that's at risk for developing
Speaker 2: that disease. So that's a very important part, is that
Speaker 2: we always want to vaccinate before someone has a risk
Speaker 2: of being exposed to that pathogen, right, and in populations
Speaker 2: whose members we know are going to respond to that immunization.
Speaker 2: So some vaccines we don't give to infants, for example,
Speaker 2: because they might have maternal antibodies still circulating that would
Speaker 2: neutralize that vaccination. So we have to wait to give
Speaker 2: some vaccines to infants until they're a little bit older.
Speaker 1: But in general, we.
Speaker 2: Give vaccines to people before they're ever exposed, because a
Speaker 2: vaccine doesn't do you any good if you've already been
Speaker 2: exposed to the pathogen.
Speaker 1: Yeah, makes sense. What about rabies, Oh.
Speaker 2: So rabies is a Yeah, rabies is an interesting one.
Speaker 2: We give that after because in that case it actually
Speaker 2: does help protect you after because when the rabies virus
Speaker 2: is in, once it makes it into your central nervous system,
Speaker 2: your body can't produce antibodies against it. So by giving
Speaker 2: you a vaccine that circulates for longer in your bloodstream,
Speaker 2: you have time to actually create those antibodies against it.
Speaker 4: Right.
Speaker 2: So in the case of rabies, it does work to
Speaker 2: immunize after, Okay, But for most other pathogens, it doesn't. Okay,
Speaker 2: So how does coverage actually differ across the globe when
Speaker 2: we look at all these different vaccines. Yeah, honestly, it
Speaker 2: differs so much that it's hard to even get a
Speaker 2: handle on it. The World Health Organization has numbers ranging
Speaker 2: from fifty percent of all children have gotten the polio
Speaker 2: vaccine who should have gotten the polio vaccine, like in
Speaker 2: twenty eighteen, eighty five percent of children have gotten MMR
Speaker 2: and DTP and things like that. But the thing is
Speaker 2: that those numbers don't really tell us much because geographic
Speaker 2: variation is so high that in some countries you're going
Speaker 2: to have over ninety nine percent coverage and in some
Speaker 2: countries you're gonna have extremely low coverage. And so even
Speaker 2: for example, in the United States, so the way that
Speaker 2: the US mandates vaccinations is that children have to be
Speaker 2: vaccinated by the time they enter public school. So by
Speaker 2: the time you're in kindergarten, if you're going to a
Speaker 2: public school, you have to be vaccinated. But every state
Speaker 2: handles differently how they enforce that mandatory vaccination. So some
Speaker 2: states make it easier to get exemptions, whether for medical
Speaker 2: or religious or personal reasons. You can request exemptions, and
Speaker 2: some states make it really really difficult, where you basically
Speaker 2: can only get an exemption from vaccines if you have
Speaker 2: a very legitimate medical reason like a serious allergy or
Speaker 2: immune 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 2: I can guess what one of them is, although I
Speaker 2: didn't look up which states they were. But so in
Speaker 2: twenty seventeen, twenty eighteen, in forty nine states that reported
Speaker 2: their vaccine coverage rates for kindergarteners. While you look at
Speaker 2: the US overall vaccination rates were very high for things
Speaker 2: like DTP and MMR and verriicella, anything from about usually
Speaker 2: about ninety five percent. If you look at the whole
Speaker 2: United States, in Washington.
Speaker 5: D C.
Speaker 2: Which had the lowest coverage, it was only eighty one
Speaker 2: percent oof and in mississippy ninety nine percent coverage of kindergarteners.
Speaker 1: Okay, interesting, Does Mississippi have philosophical exemptions? No, they do not.
Speaker 2: You cannot get exemptions for religious, philosophical, or conscientious reasons
Speaker 2: in Mississippi only medical page.
Speaker 1: Yeah, I didn't know that. Fascinating. That's high five Mississippi
Speaker 1: right way to go.
Speaker 2: So you can see that even within the US, which
Speaker 2: is a very small part of the world, we have
Speaker 2: huge variation in vaccine coverage. And what happens when you
Speaker 2: have variation in vaccine coverage is that you can have
Speaker 2: pockets of the population that have very low vaccination rates
Speaker 2: and this does lead to outbreaks. We can see this
Speaker 2: in the data. And what we also see in the data,
Speaker 2: and I do think this is really interesting, is that
Speaker 2: a lot of the outbreaks do tend to happen in
Speaker 2: populations that choose not to vaccinate.
Speaker 1: Right.
Speaker 2: So for example, a recent review found that seventy percent
Speaker 2: of measles cases that happened in vaccine eligible individuals, meaning
Speaker 2: not including the babies that were too young to be vaccinated,
Speaker 2: seventy percent of those cases were among children with non
Speaker 2: medical exemptions. So that's personal or religious exemptions to vaccination
Speaker 2: in Protessa's outbreaks. And what's interesting about Protessis outbreaks is that,
Speaker 2: unlike Measol's outbreaks, we do see pretessis happening in previously
Speaker 2: vaccinated people because immunity can wane as you get older.
Speaker 2: Right with the protestis vaccine, That's why you need. They
Speaker 2: recommend boosters for the protesters vaccine, but even among protessis
Speaker 2: outbreaks between twenty five and forty five percent. In some
Speaker 2: outbreaks of cases were among unvaccinated or under vaccinated individuals,
Speaker 2: and very often a large percentage of those unvaccinated individuals
Speaker 2: are 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, yes, kids, what
Speaker 1: is the other thirty percent?
Speaker 2: So it was it was seventy percent of cases were
Speaker 2: children with non medical exemptions. So then the other ones
Speaker 2: might have been kids that had either medical exemptions or
Speaker 2: another reason that they weren't vaccinated, okay, other than being
Speaker 2: 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 2: It wasn't a non medical exemption issue. Yeah, yeah, okay,
Speaker 2: they could have also been under vaccinated. So studies have
Speaker 2: also found that the kids who tend to be completely unvaccinated,
Speaker 2: and especially intentionally unvaccinated, so families who are choosing to
Speaker 2: not vaccinate their kids, those kids tend to be from
Speaker 2: families of higher so to economic and higher education status. Yeah,
Speaker 2: whereas kids who are undervaccinated, meaning they have some of
Speaker 2: their vaccinations but not all of them, and those kids
Speaker 2: are still at risk for getting disease. Those kids tend
Speaker 2: to be from families of lower education and lower sisieconomic status,
Speaker 2: which suggests that they might be facing barriers to getting vaccinated.
Speaker 2: So 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 2: I would agree with you entirely. So let's talk about
Speaker 2: what the costs of vaccinations are.
Speaker 1: Fantastic, what a transition.
Speaker 2: So in the US, if you have health insurance, vaccines
Speaker 2: are covered. All of the recommended vaccines are required to
Speaker 2: be covered by your health insurance provider, so you might
Speaker 2: have copays or other out of pocket fees, you might have.
Speaker 1: To pay facilities fees at your hospital.
Speaker 2: No shade show shade, but the vaccines themselves are covered
Speaker 2: by health insurance. In the US, however, this is only
Speaker 2: true for recommended vaccines. So if you, for example, are
Speaker 2: outside of the age range of what is recommended for
Speaker 2: the HPV vaccine, your insurance is not required to cover that,
Speaker 2: which means it will cost you two hundred dollars out
Speaker 2: of pocket per vaccine, by.
Speaker 1: The way, and so this also applies to travel like
Speaker 1: travel vaccines, it does, and so on.
Speaker 2: Yeah, so those are pretty expensive. What was the yellow
Speaker 2: fever one, like one hundred and fifty bucks or something.
Speaker 1: At least I think it might have been a little more.
Speaker 2: Yeah, if a child, So, if we're talking about childhood vaccines,
Speaker 2: which is most of what we've talked about so far
Speaker 2: in this episode, if a child does not have insurance
Speaker 2: in the US, they qualify for the Vaccines for Children's Program,
Speaker 2: which is a federally funded program that covers the cost
Speaker 2: of all the recommended vaccines for children. It is not
Speaker 2: always super easy to access. I think in general you
Speaker 2: have to go to a federally qualified health center to
Speaker 2: get those vaccines. So for example, in Champagne, kids can
Speaker 2: go to some school based health clinics or the Champagne
Speaker 2: Public Health Department. But in theory, there are programs in
Speaker 2: place to make sure that kids, even if they don't
Speaker 2: have insurance, have access to vaccines. Doesn't mean that they're
Speaker 2: always getting vaccinated. Around the world, every different country does
Speaker 2: things a little bit differently, so some countries have entirely
Speaker 2: free vaccines. Some countries, like Australia actually pay people to vaccinate.
Speaker 1: That's I love that me too.
Speaker 2: I think it's so great because some countries also find
Speaker 2: you if you don't or if you're.
Speaker 1: Not up to date.
Speaker 2: 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 the other.
Speaker 5: Right.
Speaker 2: And then there's also something called the Global Alliance for
Speaker 2: Vaccines Immunization GOVEY or GAVY.
Speaker 1: I don't know, let's say.
Speaker 2: Govey because it sounds fancier.
Speaker 1: Govy, Govey. GOVEY was established AVI GAVY.
Speaker 4: I like that.
Speaker 1: Let's go with that. GAVY.
Speaker 2: They're gonna hate us was established in two thousand and
Speaker 2: their goal is improving vaccine coverage around the world. So
Speaker 2: they provide funding for a number of different vaccines for
Speaker 2: countries and to establish vaccine programs to keep them up
Speaker 2: and running and things like that.
Speaker 1: The Bill and.
Speaker 2: Melinda Gates Foundation helped GAVY. Gavey helped them get started,
Speaker 2: and in the first sixteen years of the program, more
Speaker 2: than six hundred and forty million children had access to
Speaker 2: vaccines because of GOV and it's estimated that more than
Speaker 2: nine million lives were saved. Awesome, pretty great, and then
Speaker 2: the World Health Organization and UNICEF also have programs in
Speaker 2: place to help subsidize the cost of vaccines in a
Speaker 2: lot of countries. Fantastic And to bring you even more
Speaker 2: information about the future of vaccines and vaccines initiatives and
Speaker 2: what's really going on around the world today, we talked
Speaker 2: with doctor Padmini Streakantaya, who's another senior program officer at
Speaker 2: 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 5: Sure, So, as you know, my name is Pudmini Shrikantaya.
Speaker 5: I am an infectious disease position by training and also
Speaker 5: an epidemiologist. So I trained in internal medicine, but knew
Speaker 5: I was interested in public health and about almost twenty
Speaker 5: years ago trained at the CDC in a program called
Speaker 5: the Epidemic Intelligence Service, which is a training program in
Speaker 5: applied public health and epidemiology and since then have been
Speaker 5: focused on infectious diseases in public health. And I came
Speaker 5: to the Gates Foundation about a year and a half ago,
Speaker 5: and here I work in the Global Health Division in
Speaker 5: the Pneumonia team, which is headed by doctor Keith Kligman,
Speaker 5: and I lead three initiatives or initiatives on three different
Speaker 5: pathogens or syndromes. One is on antimicrobial resistance or antibiotic resistance.
Speaker 5: The second is on a virus called respiratory sensicial virus,
Speaker 5: which is a leading call of pneumonia in young children
Speaker 5: and especially in infants under six months of age. And
Speaker 5: the third is on influenza, which, as you know, is
Speaker 5: a major killer globally and here in the United States
Speaker 5: as well.
Speaker 1: Very cool.
Speaker 2: Yeah, So, I think when a lot of us hear
Speaker 2: about vaccines, we usually think about the vaccines that we
Speaker 2: got as children, like the MMR vaccine or the DETAP vaccine,
Speaker 2: or even sometimes this seasonal influenza vaccine. But there are
Speaker 2: so many other vaccines out there that are incredibly important
Speaker 2: and save millions of lives and also help to reduce
Speaker 2: poverty worldwide. So can you tell us about some of
Speaker 2: the global vaccine initiatives that are high priorities at the
Speaker 2: Gates Foundation.
Speaker 5: Sure, so within the Pneumonia team, actually, I can tell
Speaker 5: you that we are focused on vaccines as our major
Speaker 5: lever for preventing the infectious pathogens that cause pneumonia and
Speaker 5: lower respiratory tract infections, which remain among the leading causes
Speaker 5: of mortality among young children under the age of five.
Speaker 5: So within the pneumonia team, our focus is on the
Speaker 5: new macaucus, which is a bacteria that causes pneumonia and
Speaker 5: invasive disease and for which there is a very effective
Speaker 5: vaccine which has been in use in the US for
Speaker 5: a number of years and has shown remarkable reductions in
Speaker 5: invasive infections due to new maacaccus as well as what's
Speaker 5: called herd immunity. In the area that I'm focused on,
Speaker 5: we are very interested in the and keenly working towards
Speaker 5: the development of a vaccine for RSV or respiratory syncesicial virus,
Speaker 5: as they mentioned, very important and one of the leading
Speaker 5: causes of pneumonia and an important cause of pneumonia related
Speaker 5: mortality in infant under the age of six months. So
Speaker 5: this population is particularly because the mortality is seen in
Speaker 5: very young infancy in the first three months of age.
Speaker 5: This population is it presents an important or presents a
Speaker 5: challenge for how we approach vaccination. And in this case
Speaker 5: for RSV, what we're pursuing with our partners is maternal vaccination.
Speaker 5: So in this scenario, a pregnant woman is vaccinated in
Speaker 5: her third trimester of pregnancy, mounts an immune response to
Speaker 5: the vaccine, and those antibodies are passed through the placenta
Speaker 5: to to the fetus, and so the baby at birth
Speaker 5: now has levels of antibodies that are protective against the
Speaker 5: against RSV, or the idea that they would have protective
Speaker 5: levels of antibody against RSVU, and then those young infants
Speaker 5: would be protect against pneumonia for their first few to
Speaker 5: several months of life. So RSV is one example, and
Speaker 5: the field is full of a number of other developers
Speaker 5: who are working on vaccines to protect both young infants
Speaker 5: as well as elderly populations who are also at greater
Speaker 5: risk of severe disease and poor outcomes. The other that
Speaker 5: I'm focused on, or that we are focused on in
Speaker 5: the Foundation is influenza, and as you mentioned right now,
Speaker 5: much of the effort for influenza is on seasonal influenza vaccination.
Speaker 5: The goal and the focus of our influence of vaccine
Speaker 5: development efforts is really on universal influenza vaccine. So this
Speaker 5: idea is that a vaccine that is effective against the
Speaker 5: strains of influenza that are circulating and then as well
Speaker 5: as the strains of influenza that may urge. Particularly, the
Speaker 5: concern is for a pandemic influenza or influenza that is
Speaker 5: dramatically different than the than what the circulating strains are.
Speaker 5: So this is a tall order and uh, and this
Speaker 5: is our efforts through our partners are in pre clinical
Speaker 5: stages primarily at this point, but I think this is
Speaker 5: the what what we're really aiming for with with influenza.
Speaker 5: And maybe the last thing I'll talk about is is
Speaker 5: the work that I'm doing with our partners again on
Speaker 5: animicropial resistance. Most of the efforts and most of the
Speaker 5: focus globally when people are talking about animicropial resistance has
Speaker 5: really been on specific bacterial and fast growing bacterial pathogens.
Speaker 5: But specific to the efforts that I want to mention
Speaker 5: today are trying to understand the burden of disease due
Speaker 5: to resistant pathogens and and bacteria in particular, and in
Speaker 5: our efforts, our focus is really on neonatal or newborn
Speaker 5: substis and pathogens. Are bacteria that are causing sepsist and
Speaker 5: mortality in these populations then become our potential target for vaccination.
Speaker 5: And maybe that's a good point to just mention in
Speaker 5: terms of how we select what are targets for vaccination,
Speaker 5: it's really driven by trying to understand where the disease
Speaker 5: burden lies and where the where mortality and disease mortality lies,
Speaker 5: and where there is that significant burden of disease burden
Speaker 5: and disease mortality will be our focus for trying to
Speaker 5: figure out what is the best method of preventing this
Speaker 5: illness and how could vaccines potentially be an important and
Speaker 5: successful lever. So maybe I'll stop there and turn it
Speaker 5: over back 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. Yeah. So one of the
Speaker 1: things about a lot of these these global vaccine initiative
Speaker 1: initiatives in the places where they are targeted, resources might
Speaker 1: be limited or there might not be a strong public
Speaker 1: health infrastructure set up yet. So what are some of
Speaker 1: the challenges that you face on the ground and actually
Speaker 1: getting vaccines to the people who need them, and how
Speaker 1: are you at the Gates Foundation working to overcome those challenges.
Speaker 5: Yeah, so within the Foundation there is a large group
Speaker 5: and team that actually works on vaccine delivery that has
Speaker 5: really focused on a lot of these issues that you raise.
Speaker 5: And I think that one of the things is many
Speaker 5: of the countries where we're folks in South Asia, in
Speaker 5: Sub Saharan Africa, where health systems aren't that strong, most
Speaker 5: of these countries do have routine immunization programs, and we
Speaker 5: certainly advocate for countries to invest further in their routine
Speaker 5: immunization programs, which lays the foundation not only for a
Speaker 5: stronger health system, but also helps to protect the most
Speaker 5: vulnerable populations and therefore have a more resilient population as
Speaker 5: these young children grow up. So, in terms of thinking
Speaker 5: about these challenges, one for example that I can mention
Speaker 5: is when we are interested in maternal vaccines and maternal immunization,
Speaker 5: where we have to think about not just the challenges
Speaker 5: in a routine immunization program where children will be brought
Speaker 5: at certain time points you mentioned for example, you know,
Speaker 5: at birth, at six weeks, at at six months or
Speaker 5: nine months, and thereafter at routine immunization time points. Here
Speaker 5: in a maternal vaccine situation, we actually need to target
Speaker 5: the mother, the pregnant mother in the anti natal care system,
Speaker 5: and so our challenge has been together with many experts
Speaker 5: and colleagues in the field, is to figure out how
Speaker 5: when we do have an effective a maternal vaccine like
Speaker 5: for RSB or our group B strep or other pathogens
Speaker 5: that we feel are important pathogens to target with maternal vaccination,
Speaker 5: will need to figure out and we are working hard
Speaker 5: to try to figure out how do we access and
Speaker 5: how do we work with the obstetric and anti natal
Speaker 5: care populations to leverage those platforms and help to strengthen
Speaker 5: those platforms to provide immunization to the mother that will
Speaker 5: ultimately protect the infant.
Speaker 1: While we see.
Speaker 5: These challenge lenges, we also see that many of these interventions,
Speaker 5: and particularly vaccination interventions, can be used in and of
Speaker 5: themselves to help strengthen what might not be the strongest
Speaker 5: healthcare systems to begin with.
Speaker 2: That's excellent and kind of really leads into the next
Speaker 2: question we were going to ask you, which is that
Speaker 2: we talk in this episode about how the benefits of vaccines,
Speaker 2: you know, include that you are protected and like you
Speaker 2: mentioned herd immunity, your neighbor is protected from infectious disease.
Speaker 2: But vaccines are indirectly tied to a lot of other
Speaker 2: improvements in health and poverty reduction. So can you talk
Speaker 2: a little bit more about how this works, how vaccines
Speaker 2: have had this very multifaceted impact on health and the economy.
Speaker 5: Yeah, so, you know, I think that vaccines, I think
Speaker 5: what is one of the things important to remember is
Speaker 5: vaccines are one of the most cost effective health tools
Speaker 5: that have ever been invented. Every dollar spent all childhood
Speaker 5: immunization returns up to forty four dollars in economic and
Speaker 5: social benefits. And while we prevent a specific illness through
Speaker 5: a vaccine or a specific pathogen, many of these illnesses.
Speaker 5: RSV is a great example. When an infant contracts RSV,
Speaker 5: not only are they at risk for the poor outcomes
Speaker 5: of the RSV infection, not only does that lead to
Speaker 5: the infection and episode of that acute illness, but they
Speaker 5: are also then potentially at greater risk for subsequent infections.
Speaker 5: So you can see how for a family where each
Speaker 5: health shock is a potential for a drop in economic gains,
Speaker 5: not only are they concerned about the health and well
Speaker 5: being of that one child, but that illness impacts their
Speaker 5: ability to earn as a family, their ability to provide
Speaker 5: for themselves and for other members in the family. That
Speaker 5: if there is a subsequent superinfection or a subsequent new
Speaker 5: macoccal infection, for example, then there is a whole next
Speaker 5: shock that actually happens. And through vaccination, if you're preventing
Speaker 5: that first instance, you are actually helping to prevent that
Speaker 5: 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 5: Sure, so, I think the best place to go is
Speaker 5: just to our Gates Foundation website, which is www. Dot
Speaker 5: Gatesfoundation dot gorg, and they'll be able to navigate through
Speaker 5: the plethora of different global health efforts that the Foundation
Speaker 5: is engaged on. I've just touched on just a few
Speaker 5: that I'm specifically involved with in the pneumonia team, but
Speaker 5: within global health there are teams that are focused on
Speaker 5: TV on HIV, on enteric and diarrheal diseases, other pathogens
Speaker 5: within pneumonia, malaria, as well as neglected tropical diseases, just
Speaker 5: to name a few. So I hope your listeners have
Speaker 5: a chance to learn more about all of these different efforts.
Speaker 1: Great, we do too.
Speaker 2: Thank you so much. I think those are all of
Speaker 2: the big questions that we had for you today. Thank
Speaker 2: you so much for taking time out of your busy
Speaker 2: schedule to talk with us. We really appreciate it and
Speaker 2: I feel like we covered so much ground in a
Speaker 2: short time.
Speaker 1: Yeah, thank you, my pleasure.
Speaker 5: 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 targeted and what's going on around
Speaker 1: the world. That was amazing.
Speaker 2: We're so lucky that we get to do like this, Aaron, No,
Speaker 2: it's in thrilling. Thank you so much to Amber's eddies
Speaker 2: 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 2: 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 2: Wow, that's incredibly, that amazing, that's incredible. So overall, vaccines
Speaker 2: are safe, they're effective, and we know that there's a
Speaker 2: lot of misinformation out there right now about vaccines. So
Speaker 2: next week, next week week, you don't have to wait
Speaker 2: two weeks.
Speaker 1: Guys, this is a surprise. We're doing this a week early.
Speaker 2: Because we don't want you to have to wait a
Speaker 2: single more day. So next week we will be addressing
Speaker 2: the history of vaccine hesitancy, which, as it turns out,
Speaker 2: isn't so modern, no, And then we're also going to
Speaker 2: address a lot of the specific concerns that you have
Speaker 2: that you've written to us about and that many people
Speaker 2: have about vaccines. So that you can feel good about them,
Speaker 2: and you can explain to your aunt Martha why she
Speaker 2: should feel good about vaccines too.
Speaker 1: It's going to be fantastic.
Speaker 2: Oh, it's gonna be great, and we have such great
Speaker 2: guests lined up. We can't wait to tell you about it.
Speaker 1: Yes, oh my gosh, you guys all right? So should
Speaker 1: we do sources? Yes? Absolutely? Okay. I have a few
Speaker 1: books that I've read. Vaccines did Not Cause Rachel's Autism
Speaker 1: by doctor Peter Hotez, 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 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. Excellent.
Speaker 2: I have more sources for this at next week's episode
Speaker 2: than I've ever had in my life. So we're gonna
Speaker 2: post all of our sources, as we always do on
Speaker 2: our website this podcast will kill you dot com. Under
Speaker 2: the episodes tab, you can find every single source we've.
Speaker 1: Ever used for every episode. Yeah, so so thank you
Speaker 1: to Bloodmobile for providing the music for this episode and
Speaker 1: all of our episodes.
Speaker 2: And you can find Bloodmobile's music now on band camp.
Speaker 1: Band Camp. We'll post a link on our website, but
Speaker 1: I think it's the real Bloodmobile or something like that. Okay, cool. Yeah,
Speaker 1: and also thank you to you all for listening. Thank
Speaker 1: you so mudy.
Speaker 2: This is a really fun episode and we hope that
Speaker 2: you loved it and learned a lot. And we can't
Speaker 2: wait for next week's episode. It's gonna be so fun.
Speaker 1: Okay, wash your hands, you filthy animals.