Dr. Adam Ratner
Appearances
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And that has been through a tremendous amount of work, and some of that has been scientific work, but some of that has also been policy work in building an infrastructure that can withstand – fluctuations in funding and can provide support for getting vaccines to children whose families may not be able to afford them and all sorts of other things that have been built over time.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
Thanks so much. Delighted to be here.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
The successes that we have And the point that we are at in children's public health is not guaranteed. And I am worried that actions taken in the next year, two years, may have long-lasting effects on the health of children, not just in the United States. I think it'll be in the United States first, but I think worldwide.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
As we were talking about with the infrastructure for vaccine delivery, the biomedical research enterprise in the United States is incredible. And there have been advances that have helped All Americans. And we would never have had the COVID-19 vaccines without NIH research. We would never have the chemotherapies that we have or the gene therapies that are emerging to cure diseases.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
That is all of those advances are are built on the back of NIH-funded basic research. It is absolutely critical to people's health in both the short and the long term. I think that the executive order capping NIH indirect costs at 15% and making it effective immediately and apply to existing grants is going to be an enormous budgetary strain on universities and other research institutions.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And it has the potential to have people lose their jobs, to drive scientists out of the field, to have universities shut down labs that they can't afford to run because they haven't budgeted for this abrupt change. And I think that the effects of this may be long-lasting.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
There were a few things. There was the unmasking of the Tuskegee syphilis study in which government scientists had observed as black men with syphilis had gone through the stages of disease and not provided them with medicine. medication that was available and was known to work.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
When that came to light, that generated and still does very reasonably a tremendous amount of mistrust in the government and in scientists. There were other smaller scale incidents that also shook people's trust. There were trials of vaccines and trials of other kinds of medication that were carried out in institutions for children, and those were not carried out
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
When I first started writing the book, the question that I got most often was, why measles? Because I think a lot of people I talked to thought of measles as a solved problem. And really, so did I. And that's... kind of the encapsulation of the measles story put very simply in the sense that measles thrives on being underestimated.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
with the ethical standards that we would expect today and in some cases with no informed consent at all. And some of these trials were horrific and should never have been allowed to happen. And I think when those came to light, there was a growth of distrust in medicine as a whole. And I think that that hindered people's trust in vaccines at the time as well.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
It's not easy. I think that pediatricians still, even today, I think are in a place of trust for most families. I think that very reasonably, most families think that those of us who have devoted our lives, our careers to taking care of kids and trying to keep them safe, realize that we bring something valuable to the conversation. And so I think it's really important to use that trust wisely.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And I think the other thing that sometimes gets lost is that – and this is a conversation I have with my colleagues a lot – Parents who are hesitant about vaccines and parents who are frankly anti-vaccine, these are people who love their kids. These are not people who want harm to come to their children. It's the opposite. There is nobody who is on team disease.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
There's nobody who wants a child to get sick. Right. And I think that, you know, for me, that's the grounding point. You know, that's the place where I think that I or any other pediatrician can come together with a family. And then we can talk about the details.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And we can talk about balancing risks and benefits, which is something that we all do all the time and often with not enough information available. for people to feel entirely comfortable. Some of it is talking about the diseases that we're trying to prevent, which can get minimized in anti-vaccine rhetoric, but can be really serious.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
I'm old enough that I'm able to use my personal experience often in those conversations. I've seen a lot of the diseases, although not all of them, that we vaccinate against. And I think building that trust and building on the fact that we're all pulling for the same thing is the most important piece of the conversation. But it's hard, and it's usually not one conversation.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
Variably. So I'm not a primary pediatrician. Like I am an infectious disease specialist and I see kids in the hospital. So I see families at kind of a different time than their primary pediatricians do. And the primary pediatricians are really the heroes in pediatricians. this piece of things.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
Like, I think they're the ones who have repeated conversations with families who develop trust over time and who can help families take in good science-based messaging and help bring them around to vaccination. I see parents at a different time. There is no family who wants to be where I work, which is a children's hospital.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
So all throughout my training, I learned to take care of children with all sorts of diseases. And then as I focused on infectious diseases, I learned to take care of kids with complicated infections and sometimes with unusual infections. And Measles was something that in my mind had been filed under solved problems.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
Yes. And so I sometimes have families, I sometimes have conversations with families who are in the hospital because their child has a vaccine-preventable disease. And that's a different conversation. And it's one that can very easily go south in the sense that People can often feel like they're being blamed, which is never my intention.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And people can feel like it's not an appropriate conversation to have at the time. And I think it's a conversation that needs to be had, but it needs to be done carefully. Like you need to choose your words carefully. It needs to be done with empathy because when I'm seeing children, it's usually because they have a child who's sick enough to be in the hospital.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
But it needs to be done clearly because the story that this family is going to tell themselves and tell their relatives and their friends about what happened may hinge on how you talk about vaccines in that moment.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
That came as a surprise to me, and it is unbelievable to me now that you know, five years after the start of the pandemic, that we are in the situation that we're in. I thought that we would be in a place where vaccine skepticism was rare and where people had gotten to see firsthand the incredible beneficial effects of vaccination on the population. And, you know, the COVID vaccines...
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
saved millions and millions of lives, and they are an incredible success story. Amazingly, that's not the story that is generally being told, and it's not the story that most people believe.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
So I think that there are a couple of things to be concerned about here. And I think that first and foremost, what we know about the avian flu and how it has spread and the situation that we're in right now is because there is a robust surveillance system. And it points to the importance of funding for CDC and for state and local health departments to do that crucial work.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
It was a thing that we had had a vaccine for since the mid-1960s and that we very, very rarely saw. I saw a handful of cases in my training. And then in 2018 and 2019, we had a huge measles outbreak in New York City with about 650 cases and some kids who were very, very sick. I took care of children in intensive care units due to complications of measles. And
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
That is the only reason that we know what's going on. I think that avian flu has the potential to affect humans and has made some humans sick already in the current outbreak. I think that we need ongoing surveillance and we need to understand the extent of the problem and to be able to do things like rapidly type the flu strains that people have when they go to their hospitals or go to doctors.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
It is something that is done sometimes now, but a lot of our diagnostics don't tell us exactly what sort of someone has, and that's important to understanding the scope of the problem. But really, what needs to happen is strengthening and keeping them strong of public health systems in order to keep this under control.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
A fundamental issue in how we think about measles is memory. In the same way that the measles virus kills the cells that are the keepers of immune memories, our temporary successes and competing priorities distract us from the toll that it continues to exact every day of every year.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
When we forget, measles thrives, both within the body of an individual and in a society making decisions about whether to prioritize vaccination. Both kinds of amnesia leave us vulnerable to a host of conditions beyond measles. Measles is a master at infiltrating and revealing the cracks in our human systems.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
When we forget to use the tools that we have, when we allow anti-scientific voices to influence policy, when we ignore the places that it is difficult to deliver care, there it is. For all these reasons, you can think of measles cases as a probe for whether we are paying attention.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
As outbreaks pop up, we should ask ourselves what we could have done better and what other warning signs we are ignoring. While measles is often first, it is a harbinger of problems to come.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
This is... the prime problem of modern public health communication. It is a different world than it was in the stories that I told about the measles vaccine development and vaccines for children and things like that, where there were limited news sources. There was often collaboration between public health entities and news outlets.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And now we're in a very different situation where there is unlimited information. Much of it is bad. Some of it is malicious. And I don't have a simple answer to this question. I will go back to what I said about pediatricians being trusted sources and about personal family-to-family type discussions that are difficult to scale but that are effective. And I think that's it.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
I mean, I think there certainly does need to be direct countering of misinformation and disinformation that are put out there by anti-vaccine groups. And that is something that CDC and public health departments should be doing. But there's also the direct outreach to individual families and to communities and
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
bringing good information and being willing to sit and listen to what people have heard and try to help them disentangle the bad information that they may have gotten and to explain the science-based information that hopefully your pediatricians and your trusted community members are bringing.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
My pleasure. It was wonderful to speak to you. Thank you.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
That was the point at which I dug deeper into the measles story and I realized that there was so much here that people don't think about and that when we start to see measles, it's evidence of faltering of our public health systems and of fomenting of distrust of vaccines and that measles outbreaks and measles cases are so much more than just the rash that you see.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
Absolutely. I mean, I think the the pandemic, we all experienced together, but we each experienced in kind of a different way. The way that I experienced it was in the hospital, taking care of children with COVID and some children who were very sick from it. And also, of course, in my home life, worried about my wife, worried about my daughter, worried about my parents. And
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
I think we all got to see the evolution of a pandemic, which is something I had never seen before. We also got to see an incredible scientific triumph, which was the development of the mRNA COVID-19 vaccines. And I think back to how I felt when, you know, those first trials of the mRNA vaccines came out and they were enormously effective against hospitalization and disease. And they still are.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And they were highly effective against catching COVID-19. Although that effect is limited in time, which we didn't know then, and we didn't know then that boosters would be necessary. But there was such a feeling of relief when I saw those data. And I remember the moment I got my first dose of the mRNA vaccine. I remember the day my wife got hers. I cried.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
I cried when my daughter got hers because... I felt like we had won. Like I felt like science had saved us. Vaccine science had saved us. And in the back of my mind, I thought, this is the end of the anti-vaccine movement. Like how do they possibly recover from everyone in the world seeing what we can do?
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And, of course, looking back now, five years after the start of the pandemic, I was naive and I was wrong at that time about how the anti-vaccine movement would respond to the COVID-19 vaccines and where we would be just a few years later.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
To start, I want to be clear that my comments about RFK and about everything that we talk about today are my personal opinion and aren't meant to represent the institutions I work for or anyone else I'm affiliated with. The It's very disconcerting.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
It's very disturbing that someone who has spent so much of his career trying to undermine confidence in vaccines, trying to tear down the infrastructure that approves and recommends vaccines, has the potential to be in a position of power over the infrastructure that has— those goals.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
I worry about vaccine availability in the United States, but more than that, I worry about vaccine confidence, which many of us have worked for years and years and years to build. And as mentors of mine have said many times over the years, it is much easier to scare people than to unscare them.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And I think that just by elevating anti-vaccine views in the guise of RFK, I think that we risk a crisis in vaccine confidence in the U.S.,
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
That is the crux of what I was trying to get at in the book. I trained in pediatrics and then in infectious diseases at this incredible inflection point where the generation before mine had seen their diseases that – I was not seeing as a resident. There were things that vaccines just made disappear between that generation and my generation.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
So there was a horrible disease called Hib, which is a bacterium that can cause sepsis and pneumonia and meningitis and death in children. There were a couple hundred thousand cases of this in the United States every year. And pediatricians worried about Hib all the time.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
When my mother trained, so my mother is also a pediatrician, a generation before me, she had tons of patients with Hib, and she lost patients with this disease. And then in the late 1980s, a Hib vaccine came out, it was widely adopted, and I did not see a single case over the course of my training. And so there was this – it was like a switch.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
There was this incredible power of vaccines that was visible right in front of me in real time. But if you look at people who are parents today and people who may have questions about vaccines and are weighing risks and benefits, which is a fully reasonable thing for parents to do – They may say, I've never seen someone with polio. I've never seen someone with whooping cough.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
One person says that there are side effects of the vaccine. The other person says that there aren't. Why would I take a chance by giving the vaccine for something I've barely heard of? And the answer to that, of course, is that you've never seen these things. You've never heard of these things because of vaccines. But that's a hard thing to communicate.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And it's sort of the difference between—I found this during the measles outbreak in 2018, 2019. Talking to the parents of the children with measles and talking to the grandparents of those children was entirely different. The grandparents had seen tons of children with measles. They had probably had measles themselves. Their kids had had measles.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And they knew that even though most kids do fine with measles and are better after about a week, there are rare cases where children have to go to the hospital, they have pneumonia, and occasionally, unfortunately, they die.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
So measles is the most contagious disease that we know of. It is more contagious than flu. It is more contagious than polio. It's more contagious than Ebola. It's more contagious than COVID. So in a susceptible population, measles can infect 90% of the population immediately. Easily.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
If someone with measles walks into a room of people who have not been vaccinated and haven't had measles before, 90% of those people will get infected with measles from that one person. And that is much more infectious than most things that we generally deal with. And so it's a...
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
And so measles is an indicator for whether there is vaccination going on, whether people are protected because it is so very infectious. The thing about measles is that most kids with measles do fine, but there are these rare measles. There are kids who get pneumonia. There are kids who die of measles. One or two in a thousand children who get measles will die.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
One or two in a thousand children who get measles will have encephalitis, which is swelling of the brain, and that can lead to deafness or seizures or other bad outcomes. If you're one family, you may not ever have known someone who had one of those bad outcomes. And so usually when kids get sick, they feel sick for a week and then they get better. And so that was most people's experience with it.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
If you listen to RFK talk about his experience with the measles, what he says is that, oh, it was my 10 siblings and I all had measles at the same time. It was a week off from school and we got to watch television and eat soup.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
So that's fine, but he also comes from the most privileged background imaginable, and that is not everyone's experience of measles.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
I have many concerns about that. My greatest concern is that he will harm or disable the vaccine infrastructure, that he will make vaccines unavailable to people who want to get them, and that he will make people who are unsure of whether they should vaccinate their children feel like they should not vaccinate their children. I think he has spent...
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
a lot of his adult life fighting against vaccines, and I see no reason that that is going to stop.
Fresh Air
What Measles Outbreaks Tell Us About Public Health In America
I think about how hard it has been to get to the point that we're at right now. And I think the most important message that I want to come across from my book is that we live in a time when children, for the most part, grow up happy and healthy, and where infectious diseases that used to kill large numbers of children have been brought under control through vaccines.