Q&A with Dr. Paul Offit
Every year, the Albert B. Sabin Gold Medal is given to a distinguished member of the public health community who has made extraordinary contributions in the field of vaccinology or a complementary field. This year's award will honor Dr. Paul Offit for his contributions as co-inventor of an oral rotavirus vaccine and his leadership as one of the United States’ most vocal and dedicated advocates for immunization. Dr. Offit is the author of numerous books and currently serves as the Maurice R. Hilleman professor of vaccinology and a professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
You spent two decades as a researcher working on rotavirus to develop a vaccine and then in 2000, you established the Vaccine Education Center at the Children’s Hospital of Philadelphia. Why?
I learned how hard it was to make vaccines – the 26-year effort, the $1 billion collaboration between academia and industry to prove in a 70,000 child, $350 million trial that the vaccine was safe and effective. So on the one hand, you see how hard it is to make vaccines and then at the same time you're watching how easy it is to damn them.
In 1998, right when we were in the midst of the rotavirus vaccine program, a paper was published in the Lancet claiming that the measles, mumps, rubella vaccine caused autism. It wasn't even a study it was just a case series. But the media ran with it and thousands of people stopped immunizing their children with the MMR vaccine in the United Kingdom and the United States. It struck me that scientists weren't weighing in.
No one was really countering the science. No one was explaining exactly how what Wakefield had said didn't make any sense. And it was the same with the issue of thimerosal or the ‘too many vaccines too soon’ argument. I thought that's what we could offer here as a group of scientists at Children's Hospital of Philadelphia.
I fear we have slipped from scientific illiteracy to science denialism. At this time, it's more important than ever that, as scientists, we explain what we do. Let's get scientists out there locally at P.T.A. meetings, synagogues and church groups to talk about why they do what they do.
We're paid by the taxpayer to do this work and it's not a right, it's a privilege. It’s the taxpayer, the voter, who pays our salaries. And they could just as easily stop paying it.
Tell me about your work on the Rotateq vaccine, the first oral rotavirus vaccine to be pre-qualified by the World Health Organization.
When I did my first year of research in the early 1980s, not much was known about rotavirus. The program had just started at Children’s Hospital of Philadelphia. Although rotavirus was known to be a veterinary pathogen – something that infected animals – it had really only been described as a cause of human disease in the 1970s, although it had probably been a human disease since we first crawled out of the ocean onto land. It was a wide open field. Therefore, I thought there was much one could do.
My goal was to learn as much as possible about the virus. Although the first paragraph of my grants to the National Institutes of Health always talked about how this is an international killer and a vaccine is needed to prevent this, you never really think you’re making a vaccine. You know, it's not like you think, ok, if I could do this, there'll be a vaccine. You don’t really believe the first paragraph of your grant.
Our goal was to try and figure out which genes code for proteins that make the animals sick, what are the diarrhea genes if you will, what genes code for proteins that provoke a protective immune response, and hope that those groups of genes are different enough so that you can combine these attenuated, or weakened, virulence characteristics of the animal strains and then include the human genes that would induce a protective response. It took about 10 years to figure that out and then the development with Merck took 16 years. You had to prove that each of strains actually needed to be there. You had to show you had the right dose, proof of concept studies, the right buffering agent, the right stabilizer – all of that took an enormous amount of time and money. It's probably a little over a billion dollars to do the research of development.
Obviously the development can only be done by a pharmaceutical company. They're the only ones who have the resources and expertise. And you go to phase one, phase two, phase three trials, and you know, ended up in a phase three trial, there was a prospective placebo controlled, 11 country, 70,000 child, $350 million trial to prove the vaccine was safe and effective.
You wrote a book exploring previously seven accepted practices in science and medicine that are regarded with horror today. How much can we trust the findings of experts and scientists?
What I was trying to do with this book was to separate scientists from science. In other words, scientists get it wrong all the time. A Nobel Prize was awarded in 1926 for the finding that a worm caused cancer, which was not true. We had cold fusion, we had the notion of the heart healthy diet, which basically drove us into the waiting arms of transfats.
We get it wrong all the time. And I think some people see that and think, “See, you can't trust science.” You can't trust the occasional scientist who gets it wrong but what you can trust is science, because science ultimately gets it right. Worms don't cause cancer. Cold fusion wasn't true. Using partially-hydrogenated vegetable oils was a bad idea. But you learn that over time. When you're open to it – you're immutable, you're changing – you are willing to be wrong. That's what makes science.
And that’s distinct from the gurus we are drawn to who believe that they have a truth and that it is immutable. That's an anti-scientific point of view. Science is incredibly open minded. We are willing to throw textbooks over our shoulder without a backward glance, knowing that we're always learning new information. I think anyone who does science is humbled by that.
How has vaccine hesitancy evolved in the last few years? Do you think it is a threat to public health? What is the best response?
If you look at it in terms of how the mainstream media is covering vaccines, it is much better. The media is much more responsible. They are no longer covering this as a story with two sides when only one side is supported by the science. They don’t go to the professional anti-vaccine folks for the “parents” point of view. On the other hand, the fact of the matter is that vaccines are victims of their own success.
We ask parents in this country to give vaccines to prevent 14 different diseases in the first few years of life. During that time a child can receive as many as 27 inoculations and as many as five shots at one time to prevent diseases most people don't see using biological fluids that most people don’t understand. It's not at all surprising that there's pushback. So people choose not get vaccines because they are more scared of the vaccine than they are of the disease. Because they haven't seen these diseases. My parents saw diphtheria as a routine killer of teenagers. They saw polio as a crippler of children and young adults. I was a child of the sixties. I had measles, I had mumps, I had German measles, chickenpox. I've seen children die of measles. I know what measles looks like. But many people don't see these diseases today. I can see how they could be hesitant.
Efforts like ours at the Vaccine Education Center are constantly trying to provide information. I think it does help to some extent. But in the end, nothing educates like the virus. And so when we have measles outbreaks, then people get vaccinated. When they realize the virus is knocking at their door, then they're scared and then they get vaccinated. Fear wins out over reason. It’s just too bad that it has to come to that.
What is the best approach to reassure parents who may have concerns about vaccines?
You need to find out what it is they are worried about and explain how studies have been done to show that it is not a concern. You have to surround and frame the science in an emotional and compelling way. You have to make it clear that the choice to not get a vaccine is not a risk-free choice. It is just a choice to take a different and more serious risk and this is what that risk looks like, this is what we see in the hospital every year, this is what happened to a child in my practice.
I think pediatricians need to be more prescriptive and say don't put me in a situation where you're asking me to send you out of this room into a world where there's more measles, more mumps, more whooping cough, where flu is common. Don't put me in that position. I can't do it. Let me love your child.
Do you think the public’s understanding of science is improving?
No, I don’t. How can it? The media has largely abandoned science – only one of every 300 minutes on cable news is devoted to any scientific or technological issue. The Boston Globe and CNN eliminated their science and technology units; now it’s only consumer health reporting. I think we're wholly illiterate and that's our fault as scientists. We have a very good story to tell. I just don't think we've been good at telling it.
What is your next book about?
The title is “Bad Advice or Why Celebrities, Politicians, and Activists Aren't Your Best Source of Health Information,” but the more accurate title would have been “How to communicate science to the public--or die trying.” It is a lot of personal stories about what I've learned in the last 25 years of dealing with mainstream media and trying to get scientific truths out there.
My goal with this book is to say scientists need to get out there. We are the people who need to communicate this and there are many obstacles, including the scientific method. The scientific method is not good for the media because you can't really say MMR doesn’t cause autism because you can't prove a negative, but how we word things matters. The words we use matter.
I think while we're being careful to stick to the scientific method, we need to realize that people see us at best as waffling and at worst, as covering something up. You have to be much more definitive.
I'm tired of watching children suffer and die from something they don't have to suffer and die from. I've worked in a hospital and watch this happen. I saw a child die of influenza last year. It is hard to watch and that is what drives me.
What health issue(s) should the public be most concerned about?
We don’t know where the real risks lie. We tend to be scared of radon and dioxin and vaccines but not the things that really should scare us. We should care about what we do to the environment – if not for us immediately, certainly for our children. Rising ocean levels are already an issue. What humans are doing to the climate regarding excessive amounts of CO2 being dumped into the environment is an issue that we ignore at our peril. We don’t think it has anything to do with us and it has everything to do with us.
Do you have any advice for students embarking on medical or researcher careers?
Do what you love and realize that you learn as you go. When people ask you at the beginning of your career, “Why do you want to be a doctor? Why do you want to do research?” you really don’t have any idea because you haven’t done it yet! Just be flexible, things change as you get older, you see things a little differently. Always do what you love. Always do what’s fun because then it’s not a job.
Learn more about Dr. Offit and the 2018 Albert B. Sabin Gold Medal here.