Boosters for the young and healthy? Is Pharma dictating public health policy? What’s up with VAERS? Did Robert Malone invent the mRNA technology? AND MORE.

Check out our other shows with Dr. Paul Offit here.
Transcript in the “Transcript” tab below (scroll down)!

00:00 Intro

01:07 Boosters, the CDC, vaccine advisory committee & 3rd dose drama

05:25 Offit’s son, The Atlantic article​, booster coverage & mandates

08:34 4th dose, vaccine politicization, childhood vaccines & the anti-vax movement

16:40 mRNA spacing considerations, tribal loyalty

20:25 Pregnancy & COVID-19 vaccines

23:07 Vaccine safety reporting, VAERS pros & cons, PRISM, Vaccine Safety Datalink

26:58 Drug safety, Pharma dictating public health, vaccine effectiveness

30:40 Walenski and CDC, bureaucratic transparency & swine flu lessons learned

36:34 Yearly COVID-19 vax, Omicron parties, chicken pox tragedies & the role of natural immunity

41:53 COVID-19 testing, policy (who it helps, who it hurts)

44:00 What Robert Malone did (and didn’t do) with mRNA technology, what it takes to build a vaccine

51:10 Spike protein misinformation & real-life correlation with mass vaccination

56:25 Myocarditis in adults vs. kids, polio in children

1:03:00 The Army’s “super vaccine”, discussion of gain of function research

1:06:13 Final thoughts


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– [Zubin] Hey, Dr. Paul Offit, P. Diddy. Welcome back to the show, brother.

– [Paul] Thanks for askin’ me back. Lookin’ forward to it.

– [Zubin] Dude, it’s always fun. People were asking me, Listen, Z, you, you’re always so pro-vaccine. Why can’t you talk to or debate an anti-vaxxer on your show? And I thought, well, who’s the biggest anti-vaxxer I know? Dr. Paul Offit, right?

– [Paul] Yeah, I’m starting to regret the position I took on booster dosing. Suddenly I’ve been embraced by anti-vaccine activists who now think I’m smart, so that can’t possibly be a good thing.

– [Zubin] We’re in an alternate, we know now that we live in the Matrix, that this has happening, that Dr. Paul Offit is labeled as an anti-vaxxer, and the same thing’s actually happened to me, Paul, because I’m a little bit nuanced, and I have people on that are more heterodox or contrarian, depending on where you sit, a lot more people who would classically self label as anti-vaccine actually listen to what I’m saying, which means there’s a chance for influence, good and bad, there. And the emails I get actually show that I think the influence is actually good. So, and that goes right into what I wanna talk about. So let’s start with boosters, right? Tell me what’s going on with this, because I know you’ve taken some stances publicly that are contrary to what the public officials have been pushing. So, fill me in.

– [Paul] Right, so on August 18th, President Biden stood up in front of the American public and said “As of September 20th, roughly one month later, “we, the administration, will make available booster doses “for everybody over 16 years of age.” So we held, we the FDA’s Vaccine Advisory Committee, on which I’m a voting member, held a meeting roughly a month later, on around September 21st to discuss this issue. Of the 17 voting members on that committee, all but one voted against it, because there weren’t data to support it. The reason being that, what’s the goal of the vaccine? If the goal of the vaccine is to prevent severe illness, meaning the kind of illness that caused you to go to the doctor, go to the hospital, go to the ICU, go to the morgue, this vaccine appeared to continue to do that. It did, I mean for actually at least all the studies that have been published by the CDC showed that the vaccine protection against serious illness was holding up for both vaccine mRNA vaccines and for the Johnson and Johnson vaccine for all age groups. But we were presented data from Israel the day before, it was published in a paper the day before we met that showed clearly that if you were between 70 to 79 years of age you benefited from a third dose in terms of protection against serious illness. Fine. And so we voted that it was reasonable then to give the vaccine for people over 65 years of age. We also had agreed previously to have the vaccine available as a three-dose product for people who were immune compromised, that all made sense. Then we met again to discuss this, again, a second time, because now Pfizer had data on booster dosing, et cetera. And we, again, generally voted against it, but we’re willing to at least consider the fact that people over 50 who had comorbidities, typically more than one co-morbidity, may also benefit, although there weren’t clear data for that. And so that’s how, and the ACIP, the Advisory Committee for Immunization Practices, also agreed with that. So then Omicron hit. When Omicron had Omicron was really the reason that was given for why we need a booster dose for all. Now what’s happened since then is that a couple days ago, so this is January 24th, so a couple days ago the CDC put out a press release that highlighted the results of three papers. Two were in morbidity and mortality with a report. One was in JAMA, trying to make the case that booster dosing was of value, period, including for everybody over 18 years of age. Now, what they didn’t show was they didn’t show any evidence that it was clear that for, say, the 18- to 49-year-old healthy person, that that third dose increased your ability to be protected against serious disease. That wasn’t there. And similarly, the World Health Organization has made that same statement. Their Chief Scientific Officer, there is no evidence to date that vaccinating a healthy young person for a third dose protects against serious illness. Now, you could argue that’s not the goal. The goal is not to protect against serious illness. It’s to protect against all symptomatic illness, which would make this the first mucosal vaccine in history for which we’ve set that kind of bar. And it’s probably true. I mean, I think if you get a third dose, you will boost neutralizing antibodies, which are the mediator of protection against mild disease as distinct from severe illness where the mediator is protection against, is, I’m sorry, memory B cells and memory T-helper cells and memory cytotoxic T cells, which appear to be long lived, from everybody that’s been studying this so far, that’s long lived and consistent with that protection against serious illness is long lived. Well, how about mild illness? Because Omicron, what’s unique about Omicron is that it’s not so much that it’s more contagious. It’s that it’s immune evasive. In other words, even if you’ve been vaccinated, because the vaccine-induced immunity is somewhat off target for protection against Omicron, you can still have a mild illness, but so what? I mean, and so you have a mild illness. I mean, why is that the goal? Because if you’re trying to protect against mild illness, you will boost neutralizing antibodies for a few months and then your antibodies will come down and then you’re not protected against mild illness anymore. Is this a public health strategy that we’re gonna continue to boost and boost and boost? It’s certainly not a global health strategy. It’s not a national health strategy. It just doesn’t make sense to me. And so I got hammered for the fact that there was an Atlantic Article where I said that I had recommended that my son, my son in his 20s, not receive a booster dose. What they failed to say is that my children never listen to me? So that should have been part of the equation, but it wasn’t. Because his girlfriend said that he should get it, and so he got it. What do I matter? I’m just his father.

– [Zubin] I love that your son actually got boosted, ’cause his girlfriend said so, and his dad is like a world-renowned vaccine… This is classic. Both of my daughters are like, “Daddy, should I get boosted?” And I’m like, “Well, daddy doesn’t think so, “because of the severe disease argument you made.” And I’m a little bit oppositional defiant, too, because it’s like, well, come on, dude, if they’re gonna mandate my kids get a booster, I’m just not gonna do it. So there’s a bit of that. But the truth is, again, looking straight at the science, when CDC, when the news reported what CDC had said about their newest data, the news reported it, more mainstream media was saying CDC shows efficacy of boosters with Omicron. And I thought, well, okay. Then I looked at the study and I’m like, wait, where’s the data on prevention of severe disease in young people? It’s not there. So it, again, to unpack what you’re saying further, the question is, do we want a transient, maybe, what, 10 weeks before the neutralizing antibodies wane? How long do you think it is after the booster?

– [Paul] About three to four months.

– Three to five months.

– But the thing is, I would have been fine if they’d said that a permissive recommendation. That it should be considered. Because some people may say, look, I don’t wanna get a mild infection. I think with a mild infection maybe I would go on to develop long COVID. So, give me the option. Okay, and that’s fine. But the minute they said it was recommended, now they say it’s recommended for everybody over 12, that’s when the mandates came in. And so I’ve been getting a lot of emails from people and letters from a place like Stanford and Penn and Cornell where they’re mandating it. My future son-in-law, my daughter’s fiance, goes to Cornell. He can’t get back on campus. This young boy can’t get back on campus until he gets his third dose. That’s not fair. That’s not fair. Give him the option. Because there’s no data suggesting that he’s gonna be more protected against severe illness, that he may get a, have a mild illness, be protected against a mild illness for a few months. And that should be his option. And so I who, as you know, am a big fan of mandates as a general rule, am not a fan of this. And I just think this is where it crosses the line, and it could get you into trouble. We certainly know that myocarditis is a rare, generally rare phenomenon. It depends on what age slice you’re looking at. But say between 16 and 30 years of age, in the one in 20,000 range. But if you look at the 16 to 17 year old, it’s higher than that. Generally transient, self-resolving, benign. But we shouldn’t claim to know everything about that yet. I mean, it may be that there’s a spectrum of illness that we don’t know about yet, and so get vaccinated. People should be vaccinated. But that’s that third dose without any clear evidence of a dramatic benefit, then I think we shouldn’t do that.

– [Zubin] And the thing about the third dose, too, there’s so much just in this topic, right, Paul, because you have the question that, say, WHO and EMA, the European Medicines Agency, raised, where they vaguely said this in a press release, we’re concerned about how many boosters you’re gonna be giving. Is that gonna actually cause a weakened immune response in the future? Can you speak to that? What do they mean by that?

– [Paul] Right, so what you’re seeing, at least with the fourth dose in Israel, is that while you get a boost, it’s not what the boost was after the third dose. So it’s the law of diminishing return. So you’re just seeing a lesser response, lesser response. There’s always the concern about so-called original antigenic sin, where you sort of lock somebody into this response or the one you give them when you need a variant-specific vaccine that you’ve locked them in too much to this response, which we see, for example, the HPV vaccine. So when the HPV vaccine, the first one had four serotypes, the second one had nine serotypes, when you gave the HPV 9 to people who had already had HPV 4 they responded much better to those other four serotypes than they did to those other five, as compared to people who’d never gotten HPV 4. That’s original antigenic sin. And so you did worry about… I don’t see any evidence for that. So that’s good. But can I just say one other thing. That here’s the part that’s most upsetting for me about this. I mean, I was the on the Advisory Committee for Immunization Practices in the late 90s, early 2000s. And I was just a guy who worked in a lab. I mean, I spent a lot of time in a windowless, concrete block room at the Wistar Institute inoculating mice. I really didn’t know anything about public health, but in any case, they brought me on as a voting member of the Advisory Committee for Immunization Practices. We were working on a rotavirus vaccine. And I’ve loved those people. I mean, I thought they were dedicated and science driven, and I bonded to the CDC. Similarly, on the FDA’s Vaccine Advisory Committee. I love those people. People like Marion Gruber and Phil Krause, and Hana El Sahly, and Peter Marks. I mean, I know all those people, and I have always found them to be really science-driven, science-dedicated, let’s stick to the science, and I just, and I hope I’m wrong. I really do hope I’m wrong. I just feel there’s a political element to this that was generated when President Biden stood up there on August 18th. And I don’t know why. I don’t understand why. Maybe, I don’t know. I’m just, it’s the part that upsets me the most. I mean, I’ve known Tony Fauci for more than 30 years, because he was head of NIAID for many years. And when NIAID, the rotavirus vaccine, RotaShield, came out of NIH in the late 1990s, and we were working on our vaccine at that time. So I came to know him then, because RotaShield was only on the market for about 10 months. It was taken off because of a severe safety issue. And he’s great. I mean, I love all these people, so that’s the part I’m having trouble, that’s the part I’m struggling with is that I just feel like I don’t understand this.

– [Zubin] I’m deeply sympathetic to what you’re saying, because I’m in a similar boat. Like these are rock stars, and pre… And listen, so as much as you may be criticized for your booster stance that’s actually science based and you’re asking good questions, I get criticized in the same way for even hosting people who are asking questions about, say, hey, do we know enough about myocarditis? Are we asking these policy questions? There’s science and there’s policy questions, and I think what’s happened, Paul, and I’ve talked about this before is it’s been politicized ever since the early days. Ever since Donald Trump said, “Hey, hydroxychloroquine,” or whatever it is. And there was the concern that you and I were discussing early on, like, oh, is this vaccine gonna be politicized? Is it gonna come out before the election? It’s gonna come out after the election. What’s gonna happen? And the tribe sort of fractured, they’ve already been split, and now what’s happened is we’ve taken science, which used to be a process and a purity and an expression of a way of trying to find truth in the world. And we filtered it through our own tribal biases. And then what happens is you get stuff like this, where it’s like, well, let’s just mandate boosters for every college kid. And so what does that do, too, apart from the science? It creates a fractured tribalism within even the college students. So, I get the messages, I’m sure you do, too, from kids who are like, “Dude, I pay all this tuition. “I’m 20 years old, no other problems. “I did everything they told me. “I’m masked, I got the two doses. “Now they wanna mandate a third dose for me. “I’m a male. “I am a little concerned about myocarditis, “just because I’m so low risk. “I’ve even had COVID before. “Now they want me to have COVID, two vaccines, “and a booster, or I get expelled.” So they’re starting to actually radicalize. So they’re listening to more like, more outlandish claims because they want the validation of what they feel intuitively, this doesn’t make sense. So we’re in a very tough position. And you as a communicator, who’ve written books on medical communication, understand this better than anybody. It’s just, what’s gonna happen to childhood vaccine mandates now? What’s gonna… Are we really damaging public health for a generation? I’m just curious what you think.

– [Paul] I think that’s already happened. I mean, you’re already seeing, I think that the… How can I say that? I think the anti-vaccine movement never had a particular politics. I mean, I would argue it was born in the early 1980s with the false concern, as it turns out, that the pertussis or whooping cough vaccine caused permanent brain damage. That wasn’t true. But that’s really how they were born. And at the time, it was, on the left it was a sort of don’t inject me with anything that has a chemical name. I don’t wanna have chemical additives or manufacturing residuals or adjuvants. I just, all things natural, although I still don’t understand why the word natural has such cache, but in any case, natural infections are not a good thing. But, and then on the right, it was, it’s what you’re saying, kinda government off my back, don’t tell me what to do, don’t tell me how to raise my family. And it’s like all that now. I mean, you take somebody like RFK Jr. who’s a vigorous anti-vaccine activist, and certainly comes from a democratic family, suddenly was trying to align himself with Donald Trump. And there he is at that Washington DC rally the other day with Robert Malone and others, making the case that you shouldn’t get vaccinated, it’s almost entirely now part of the culture wars. And that part, they’re part of the culture war is this libertarian notion of government off my back. And so during the January 6th insurrection, you see, there’s Del Bigtree speaking a few hundred yards from where Donald Trump was speaking. These people are classically Democrats, by the way, but somehow they linked themselves to the right here, because it’s a zeitgeist.

– [Zubin] It’s a seismic shift in this. ‘Cause I agree with you. It had been… So I’ll say one other thing about this before we go on to things, people actually really are interested in on the science of this, but there’s a moral matrix issue that Jonathan Haidt, the social psychologist, has written about where we have these moral tastebuds. And typically the left has valued two of them in particular, fairness versus cheating and care versus harm, as morality compasses. So that’s why liberals typically will get behind a vaccine mandate or something like that, if it’s gonna, if they think it’s gonna save people’s lives and so on. Whereas conservatives value those, but they also throw in three others in equal measure, liberty versus oppression, loyalty versus betrayal, authority versus subversion, and another one, sanctity versus degradation. So this idea of these sort of holy things or sacred things that you don’t degrade, whether it’s the flag or whether it’s religion or the Bible, but what’s happened since COVID is the liberal side has gotten more of the sanctity versus degradation and loyalty versus betrayal stuff. So now, for liberals, it is a question of have you had the holy baptism of the vaccines? And if you haven’t, or if you don’t mask, you’re unclean. So there’s a purity virtue part of it. And the other side, the conservatives, have a more liberty versus oppression. You can’t tell me what to do. And their purity is don’t inject me with mRNA designed by pharmaceuticals and government. So it’s fascinating to see how this now plays out in the tribes that have emerged. And sort of standing at the center and looking at all this it’s disheartening because the question is, how do we start to unwind it? And that’s also why, Paul, you get a lotta crap from your own tribe for speaking like this, because it is a disloyalty issue. You’re not in lockstep with whatever the thing is.

– [Paul] No, I agree. And if I could just had one other sort of scientific point before we move on. The thinking, at the time, when we were, we were all discussing, and I’ve spoken with Dr. Fauci about this on the phone, as well as people like Stan Plotkin, who is another hero of mine, who’s kind of the author, the senior editor of the book “Plotkin’s Vaccines.” I mean, he’s the inventor of one vaccine, two vaccines, and has contributed to many others. So these are the stars to me, and their argument initially made a lot of sense, which is that if you look at vaccines like the inactive, whole inactivated viral vaccines, like the polio vaccine or the hepatitis A vaccine, or you look at purified protein vaccines like, say, the hepatitis B vaccine or HPV vaccine, you do need a period of time between doses, whether it’s dose one and two or dose two and three, where you have about four to six months. So you can have high frequencies of memory cells, which are responsible for protection against serious disease. Makes sense. The question is, is that also true for this vaccine? The mRNA vaccine, about which we know little. I mean, this is our first mRNA vaccine. And what you’re seeing, which completely surprises me, is that with two doses given close together, three or four weeks apart, you have these high frequencies of memory B cells, which are critical, and memory T helper and cytotoxic cells, which are also critical, a year later. I mean, who would have predicted that? And maybe in the end, and we’re gonna learn about this in time, that the mRNA vaccines are more like the whole, the live attenuated viral vaccines, because like those vaccines, the mRNA vaccine is a gene that goes into your cell, it’s then translate into a protein, which is what happens when you get a live attenuated viral vaccines like measles or mumps or German measles or chicken pox. And so maybe it’s more like that, where really even one dose, arguably, can induce high frequencies of memory. So maybe that’s what this is like. We’ll learn over time. And I think it may be that over time, two years, three years from now, we’re gonna find out that we really should have had that booster interval, that four to six month interval to allow us to develop those memory cells, but that’s not true yet. There’s no evidence for that yet. And so I just feel we should, at the moment, still be evidence-based. And it’s okay for the CDC to say, look, let’s do it this way for now. And then when they find that there’s not evidence for that to just back off and say, okay, let’s just make this more of a permissive recommendation for the less than 50 year old who doesn’t have a co-morbidity, let’s do it that way. Meaning let’s let young healthy people make that choice or let their parents make that choice. But we sort of got stuck on this.

– [Zubin] This is key. That’s actually a key scientific point that these mRNA vaccines may well, they’re different in the sense that maybe they behave like a live virus infection, like you said, the attenuated virus. Doesn’t cause disease, but causes very robust longterm memory B and T cell immunity. And ’cause there’s a lot of discussion about should the first doses have been spaced out further? Was it so close for expediency? But you’re saying when you actually measure the B and T cell memory response, it’s actually quite good. Like surprisingly good. So that’s important. And again, it relates to booster. Is it a booster, that third dose? Or is it a third dose? Is it something that’s necessary to create durable long-lasting immunity against severe disease? Like you would imagine with a purified, inactivated viral particle or something like that. Is that, am I understanding correctly what you’re saying?

– [Paul] Yes, that’s correct. You got it.

– [Zubin] So, relating to that, and I love what you said about a permissive recommendation. So then you empower people to make the decision. They’re empowered instead of getting this psychological reactance to saying, you’re telling me what to do and it doesn’t, I’m not entirely convinced it’s correct. Let me ask a question then. We talked about 50 and over with comorbidities. You said there’s not great data for it, but we are recommending that. 65 and older for sure. People with immunocompromise, for sure three doses. What about pregnant women? Because I get tons of messages from pregnant women, who, I’m sorry, I’m supposed to say pregnant people now, Paul. So, pregnant women who… It’s very hard to decondition me. Who are asking, well, I’ve had two doses, maybe I’ve been infected also or not. How are you thinking about a booster in pregnant women?

– [Paul] Well, so what do we know? We know that if you’re pregnant and you’re infected with SARS-CoV-2, that you have a two and a half to three fold increased risk of being hospitalized or go to the ICU or require mechanical ventilation and about a one and a half fold increased risk of dying, as compared to women of the same age who aren’t pregnant. Therefore, pregnant women need to get a vaccine. So, if two doses of vaccine prevents serious illness, which appears to be true. Two doses appears to be true in that it protects you against serious illness. And that’s what we’re trying to protect against. I don’t see the compelling need for a booster dose there either. I mean, and there are no data to suggest that that third dose then protects that woman from the serious diseases that I was just talking about. Now it may be that those data will be generated, but until they are generated, I think we just need to stand back and do what we’re doing, which is have a two-dose recommendation for pregnant women. But this ship has sailed. I just feel like, I mean, I can be really upset about this and write Op-Eds about this, which I’ll do, and talk about this on shows like this, but I just feel that there’s no coming back from this. I think this is what we’ve done.

– [Zubin] And the thing is, okay, I would be okay with that if it weren’t for mandates and boosters, because then you’re really compelling, and listen you only have so much policy juice to compel stuff for public health. Why do that when you’re gonna create so much reactants? But yeah, I’m with you. So that’s interesting. And the safety of the vaccine in pregnancy, is there anything new to speak to that? Because I get a lotta questions, still, about that, even though we’ve talked about it. Anything new on that front?

– [Paul] No, just continued data that if you get a vaccine during pregnancy, you compare that group to people who are pregnant that didn’t get a vaccine, there is no difference in terms of outcome of the pregnancy, in terms of outcome of the neonate, so it’s, the only difference is that you protected that pregnant woman from having severe illness. So, it’s, no it’s all good. Data continue to be.

– [Zubin] Continues to come back good. And that dovetails into another question that comes up a lot. So people talk about VAERS a lot, this sort of reporting database, but what about the other mechanisms for determining vaccine safety in near real time? The Vaccine Safety Datalink, PRISM, those kinds things. Can you speak to those? Because people very much obsess over VAERS, and we know VAERS is a hypothesis generator. So, people submit to VAERS. It could be, a lotta times there’s confusing correlating. In other words, you get a vaccine and then a bad thing happens that might’ve happened, likely would have happened anyways, but there’s correlation, but people assume causation. They say, well the vaccine then caused this old person to die of a heart attack. Whereas, in fact, they were gonna die of a heart attack anyways. Can you speak to the other mechanisms of monitoring that would help people understand how these things are studied?

– [Paul] Yeah, you know something? I can understand how people would think that. That if one event followed another, that it was caused by that, because of the name, Vaccine Adverse Events Reporting System. I mean, it should be called SVAERS, Suspected Vaccine Adverse Events Reporting System, ’cause you don’t know. I mean, this is, as you said, a hypothesis generating mechanism at best, and at worst it’s this very noisy mechanism that causes people like Tucker Carlson to go in there and say last May 3,300 people have died from a vaccine, or that’s what they were saying at this rally in Washington, DC the other day. So yeah, so the good news is the only way to really know whether something is causing something else is to have control groups. That’s really what scientific studies are at all levels. It’s the study of control. So then the groups like the Vaccine Safety Datalink, like the PRISM system, which is run, P-R-I-S-M, not P-R-I-S-O-N, which is run by the FDA, and V-safe, which is run by the CDC, are ways to look to compare groups, groups who did or didn’t get a vaccine. So you can see whether or not this was a problem. I mean, VAERS at its best will raise the hypothesis. So, for example, those initial cases of myocarditis were reported to VAERS, and so now you’ve raised a hypothesis. So now you have to look at people who did or didn’t get the vaccine, males versus females, what age, one age versus another age, to see, is there a risk? And you see that the risk was greater, not after dose, so much after dose one, but after dose two, the risk was greater in males. The risk was greater within four days, and the risk was greater in younger people, younger males. So that’s how you could get all that information, but VAERS is, at best, a hypothesis-generating mechanism, and at worst people think, well, if it’s reported to VAERS it must really happen. But remember, you can fill out that one page form online and say that my child got a vaccine and turned into the Incredible Hulk, and that’ll still end up in the VAERS system. There’s no screening. It’s incredibly noisy.

– [Zubin] Which by the way, is a desirable outcome of any vaccine.

– [Paul] Exactly right.

– [Zubin] Hulkagenesis, Paul, maybe we could speak to that, because when you were working on the rotavirus vaccine, I know Hulkagenesis was a desired outcome. You were striving towards the asymptote of incredulous… By the way, did I ever tell you my idea for a science skeptic who, whenever you make him, whenever you make him question data, he turns into the Incredulous Hulk, so… He gets green and very, he just drills right into the data. Anyways, all that aside, the interesting thing about those vaccine monitoring programs is the control group, like you said. So you may take like a Kaiser System that has very good electronic health records, very integrated, and they can actually identify controls and people who’ve gotten vaccine, and make, and drill down into that. And that’s kind of what you’re pointing at in terms of being able to do that, yeah?

– [Paul] Yeah, and that’s the advantage of having those integrated health systems. You can see who got a vaccine who didn’t, you can do it in real time, so-called sort of real-time cycle analysis and figure it out. So that’s the advantage. When vaccines first roll out, you have those systems, you can very quickly tell whether there’s a problem. And I wish the same thing existed on the drug side. It doesn’t.

– [Zubin] Oh my gosh, it would, we would find a lot of stuff, a lot of stuff. I mean, you’ve written books on this, about the kind of things that happen and somebody I have on the show a lot, and we do a joint podcast together, who I think is labeled as a contrarian on the whole vaccine for kids thing, because he’s concerned about myocarditis, Dr. Vinay Prasad, but his whole career has been spent looking at this issue. What’s safe, what’s not? How do you look at trials? How do you look at pharma bias? And things like that. So that’s kind of where he comes from. And I could see now in our tribalized world, we just get so polarized. Kind of relating to this, this question of pharmaceutical companies kind of dictating public health. So, especially in the booster scenario, it’s kind of like Alex Bourla gets up there, and he’s like, I think we should have a booster for everyone. And I don’t know what kind of accent that was. It’s not Bourla’s accent. But the idea that they are saying, okay, we are gonna do a variant specific booster. It’s gonna be needed every year. We’re gonna combine it with a flu vaccine. So we’re just gonna assume it’s gonna be annual. What do you think about that? It seems like they’re in the public health business now.

– [Paul] That’s right, they’re acting like public health agencies. I mean, the two specific examples are exactly right. So I think the most recent thing that Albert Bourla said was he said, “I don’t think we’re gonna need boosters. “I think we’re just gonna need a yearly vaccine.” Based on what? I mean, so you get a yearly flu vaccine. You do that because flu virus mutates enough from one year to the next that natural infection or immunization that previous year doesn’t protect you against severe disease, hence, the need for a yearly flu vaccine. On the other hand, coronaviruses has also mutate. They do. And this particular virus, Omicron, has really mutated. I mean, we’ve gone from like, whatever, six to eight mutations in the critical so-called receptor binding domain with Delta to like 32 mutations in Omicron. That’s like in flu world, in terms of how quickly you have developed these, this particular variant. I mean, that’s, you’re drifting, in some ways, the same way that flu drifts, but what you can say, at least so far, is that those regions, those immunological regions so-called epitopes that are recognized by memory B cells, memory T helper cells, memory cytotoxic T cells, are still relatively conserved. I mean, I think what’s the amazing thing is, remember the vaccines that were made, all the vaccines that had been made, Pfizer, Moderna, Johnson and Johnson, AstraZeneca, whatever, Sinopharm, were all made against that original Wu 2020 strain, the so-called ancestral strain. Nonetheless, for the four variants that have come into this country, the first one, D614G, which never got a Greek letter designation, followed by Alpha, followed by Delta, followed by Omicron, Still though, that region is concerned. So protection against serious disease is conserved. Now it may be that there will be a variant, and it’s possible, that is now resistant to immunity in terms of protection against serious illness. That’s possible. And so how do you define that? And we need to define that, and so for example, the Provincetown outbreak in last July, there were 346 men who were vaccinated during this July 4th celebration, who, despite being vaccinated, got COVID. Four of them were hospitalized. A hospitalization rate of 1.2%. That’s good. That’s a vaccine that’s working well, but what if it gets to 5%, 10%, 20%? What is that level at which point you say you’re no longer protected against serious illness? That’s gotta come from the CDC. You wanna hear that from the CDC. When do we cross the line to say we need a variant-specific vaccine, as compared to having Albert Bourla or CEOs of other pharmaceutical companies saying, “Okay, we made it.” To say, we’ve now linked it to the flu vaccine so we can have a yearly vaccine. It’s just, I really, again, if fantasies could come through I would really love to see Rochelle Walensky, who is great, this amazing sort of HIV researcher and educator and clinician. I love Rochelle. Well, I mean, not IN love with Rochelle Walensky, but I love Rochelle Walensky. And she is… What I’d like to see her do is do what Richard Besser did in 2009 with the swine flu pandemic, get out there every other day or so, tell us where we are, answer questions from the media, who in many ways represent the public, and just constantly tell us where we are on information, answer those questions. ‘Cause she’s great at it. I think she’s great at it. I just, but she doesn’t get to do as much of the talking. I feel like she’s sort of in the shadows, in some ways, of the administration, and NIH, but would love to hear her do more of the talking.

– [Zubin] Yeah, yeah, and you know, I wonder how much CDC as an entity itself is so bureaucratic that whether Rochelle wants to do something or not, it’s not, again, these big bureaucratic organizations are hard to move around, especially if you don’t have deep experience in moving them around. In other words, be a bureaucratic functionary all your life, which she’s not. But again-

– [Paul] Besser did it, so I think it’s doable. And I think, I dunno, I guess during the Trump administration, as you said, what I saw was you could see the FDA was, had their arm twisted, in many ways, whether it was hydroxychloroquine or convalescent plasma, where those were mistakes. I mean, quickly there was a EUA, and then the EUAs were taken away. Emergency use authorizations were taken away. And I thought with the Biden administration that would all go away, that we wouldn’t feel any sort of political pressure on decisions that were made by the CDC or the FDA, but, and I hope I’m wrong, but I just feel like there is somewhat of that pressure. And so I hope I’m wrong, ’cause I, these are institutions we have to trust. If you get to the point where you don’t trust the FDA or you don’t trust the CDC in this country, we’re in trouble.

– [Zubin] I hear lots of frontline physicians saying I don’t trust the FDA and I don’t trust the CDC. And I’ve never heard that previous to this. I mean, it really is gonna take a lot of transparency to unwind this. And from where I sit, Paul, it looks very similar. It feels political on all sides, and I think we really need to keep talking about that because there needs to be a degree of transparency that I don’t know that we’ve seen. And so you mentioned the swine flu pandemic of 2009, so draw some more parallels there, like in terms of messaging and in terms of what we’re doing to kind of manage it. ‘Cause I remember that as a hospitalist it was every, I mean the winter we got crushed. It was actually, it was the trigger that created ZDoggMD, If I’m being totally honest, because I was so destroyed that winter with my team, I remember, that I was like, I need a place to vent, and I started making videos, putting ’em on YouTube. It was swine flu that triggered that. So I’m curious your thoughts.

– [Paul] We actually did fairly well with swine flu. I mean, we made a vaccine in advance of the virus’s entrance into this country. If I told you that only about 12,500 people in this country died from that virus, from that particular strain, that’s probably a much lower number than you would have guessed. But so we actually did fairly well. But, I mean, Dr. Richard Besser, who now is at the Robert Wood Johnson Foundation, but it’s, ID guy, he’s ID guy, who was just really good, I thought. He was a very good messenger about this stuff, as Dr. Walensky can be. I mean, she is clearly that person. When I remember reading that, she was like, you get the sense she was being taken to the woodshed, that there were democratic, that there was democratic communications people who were meeting with her. I didn’t think she needed that. I mean, I think she can do it, just let her do it. She’s great at it. Just let her do it. Let her say what she thinks.

– [Zubin] Yeah, boy. We shouldn’t really let scientists say what they think, Paul, because otherwise who will sensor them. So kind of related to this, so what would determine, then, a yearly vaccine, we would really, it would have to be something like influenza where it actually escapes our ability to prevent severe disease, right?

– [Paul] Right, that the virus mutates so much from one season to the next that immunization or natural infection doesn’t protect you against severe disease the following year. But you’re not trying to prevent mild illness. You’re not. It’s too hard to do that. And it’s based on neutralizing antibodies, neutralizing antibodies fade so you’re talking about frequent boosters if you’re trying to do that. That doesn’t make sense. So let’s focus on the old and the infirm and people who are immune compromised and people who have multiple comorbidities, focus on them, and more importantly, focus on the unvaccinated, because that’s what’s the most amazing part of this virus is you probably have 90% population immunity already from natural infection or immunization. Yet still, this virus has found those people who are unvaccinated and sent them to the hospital and the ICU and the morgue. Virtually everybody we see in our hospital is unvaccinated.

– [Zubin] Yeah, and that’s a common thread. So here’s a question, Paul, how much of those severe, that severe disease we’re seeing in hospital in the unvaccinated do we think is actually Omicron and how much of that is residual Delta?

– [Paul] I think, now it’s Omicron. I think, you’re right. I think initially it was a residual Delta, but I think now you’re starting to see almost all, I mean Omicron’s like 95% of the infections out there now.

– [Zubin] Now it is, yeah.

– [Paul] I think now it is, but you’re right, I think initially it was residual Delta. I think now you’re just, I mean the Omicron thing is, I think one thing I wish Dr. Fauci could have said a little differently was when he said Omicron may be that live, sort of attenuated viral vaccine we’re all looking for. I think he didn’t say the word attenuated, but that live viral vaccine we’ve all been hoping for, but this is not an attenuated virus. There’s a difference between a less virulent and avirulent. This virus is not avirulent. It can certainly cause you to suffer and die. So the notion of sort of, well, I’m just gonna go to like an Omicron party. Let me just go get this, get my cold, get it over with. Bad idea. I’ll give you one story. This is a perfect, actually. In 2000, when we started our Vaccine Education Center, we made a video actually of sort of me talking to parents and just having them ask their questions about what they were worried about with regard vaccines. We hired a company in the city of Philadelphia named Shooters, which is kind of an odd name, but- So the cameraman who was shooting that, he told us a story about how his sister had taken her son to a chicken pox party. Because it’s true that if you get chickenpox as an adult, you’re about 10 times more likely to develop pneumonia, 10 times more likely to be hospitalized. So it’s actually better to get chickenpox as a child. And so the child went to a chicken pox party, got chicken pox, and died of hemorrhagic chickenpox. Now this was 2000. This was five years after the development of a chicken pox vaccine. The goal of the vaccine is to induce the immunity that you get from natural infection without paying the price of natural infection, and that’s what this child paid. And we actually asked this cameraman whether he would be willing to ask his sister whether she’d be willing to tell that story on camera, but not surprising, she wasn’t, and who could blame her? I mean, it’s just such a hard.

– [Zubin] And there’s a stigmatization, too, with actually even getting COVID among certain circles. So if you’re in the very hardcore, look, I’ve been masking, I triple vaxxed and all that, and then I still got infected with Omicron, there used to be a shame component, like, oh, somehow I’m less than perfect, or I’ve let the tribe down. Whereas Omicron is so infectious that even if you’ve been vaccinated, like you said, those neutralizing antibodies, that’s one thing, but you’re just not gonna get, your chance of getting severely ill are vastly reduced, and that’s the idea. So I don’t think we should shame people for getting accidentally infected. I think we should discourage going out to the… By the way, when you said Omicron party, it just sounds like you’re rushing some kinda Greek fraternity, man, those Omicron parties are the best. They have the best kegs, like Pi Alpha Beta Gamma. But the idea, too, that natural immunity, ’cause this is something that’s become a bugaboo, and you’ve said it, dude, nature has a really good PR agent. It just sounds cool. Natural just sounds better. You could just say recovered immunity. More data coming out, still kind of saying, well, it’s actually pretty good, right? If you’ve been-

– As you would expect. It’s true for every other virus. I mean, arguably with the exception of the flu. I mean, if you’ve gotten measles, there’s no reason for you to get a measles vaccine or mumps or rubella or chickenpox. I mean, you’ve been vaccinated essentially, but here, and I think it was probably more bureaucratic than anything else, when you, it is not at all surprising that if you’re a naturally infected that you will develop high frequencies of memory B and T cells, which should protect you against serious illness. And I think that that is what the CDC now has shown. And I can tell you this, I think, I don’t think this was a confidential meeting. Hopefully it wasn’t. But I was asked along with three other people to advise the administration on whether or not natural infection should count as a vaccine. I think that you just have to say how are you going to show that you were naturally infected. So I think PCR would not be the way I would go. I would show that you have antibodies, say, to viral nuclear protein, just that. ‘Cause that way you know that you’ve been naturally infected, ’cause that’s not something you would get from a vaccine. So you could do that, for example. So bureaucratically, that stuff. I understand that. But the four of us were asked to comment on did we think natural infection basically should count in situations where the vaccine is mandated. And I was one of the two people that said, yes. The other two people said no, but what was funny about that meeting, so it was Vivek Murthy, who’s the head of, who’s the U.S. Surgeon General.

– He’s a friend, yeah.

– [Paul] Yeah, from CDC. And then Francis Collins when he was still head of NIH, and Tony Fauci. So, Vivek, who’s a very sweet and kind man, started off saying, “Let’s go around and just introduce ourselves first.” So Francis Collins goes, “Francis Collins, NIH,” and Rochelle goes, “Rochelle Walensky, CDC.” It’s like, yeah, we’re not asking you to introduce yourself. We know who you are. It’s like, I’m sorry, Tony, what was that last name again? I didn’t catch that. It’s we, the four of us who nobody knows

– [Zubin] So, I’ve known Vivek for quite a few years now. He’s a, like you said, he’s just the sweetest, lovely, just wonderful guy. I could totally see that happening. And him being earnest about it, being like, “No, please Tony, say your last name. “Let’s just make sure we’re all on the same footing.” So what’s interesting in that, Paul, is that you were advocating as natural immunity counting, and I’ll say this, this one element has given so much power to people who would advocate against vaccines, meaning the Del Bigtrees and the Robert F. Kennedy’s, they don’t even acknowledge natural immunity, and I think the reason it gives them power is that most people and most scientists with common sense, like you, would say, “No, but it actually does count.” And when you’re thinking a mandate for a kid who’s already had two vaccines and now they’re mandating a booster, but they’ve gotten Omicron, it’s like, doesn’t Omicron count as the booster? It’s not like they intentionally got it, but shouldn’t it count? And isn’t there an… Even if it’s the honor… Here’s a clear, okay, here’s a, and you can cut me off at any time with anything you wanna interject here. But here’s a question, let’s say they lie. Okay, so I had Omicron, and the honor system failed, but they had two doses of the other vaccine and you have it documented, who does it harm if they’ve lied about that? Like how much is the effect on transmission? What’s the community effect of this vaccine versus not filling up the hospital with severe disease versus the individual effect? And because that affects how we design policy, ’cause policy should be the good of the many, right?

– [Paul] Yeah, so I think that one of the problems we struggle with with this virus is the testing. I mean, you have antigen detection testing, which detects viral protein, which is at least closer to infectious virus. And then you have PCR, which detects viral genome. If you look at… What you’re not testing is what you really care about, which is infectious virus titer, IVT. That’s what you really care about. You’d like to get a swab, see how many infectious virus particles is detected by either plaquing or focus-forming assays, whatever study you wanna do. Those are not commercially available tests. That’s what you really care about. So if you look, for example, and this is a recent study, of people, say, who’ve gotten vaccinated, two doses of an mRNA vaccine, and then have mild illness, and compare them to people who had, who were not vaccinated, but had a mild illness. And then you look at PCR. You find that there’s no difference. Even if you look at cycle times, which is a way of determining, presumably, the quantity of viral RNA. The lower the cycle time, the more viral RNA, that that, too, would presumably correlate with infectious virus, but it doesn’t. So, if you’ve given two dose of a vaccine and you get a mild illness, you shed much less virus for a much shorter period of time. So that’s what… Your immune system didn’t evolve to make your PCR response negative. That’s not what it did. So, this is, that’s an important observation. I think the testing has been, especially PCR, has really been hard for people. I mean, typically you shed infectious virus for about seven days, eight days. You can be PCR positive for three months. It’s just, it’s not… It’s too sensitive.

– [Zubin] That’s something that has been brought up by somebody who we should talk about actually, Robert Malone. So, this is a gentleman, a scientist, who we’ve become familiar with since the pandemic, as a voice saying, “Listen, I invented the mRNA technology “that is used in these vaccines. “Therefore, I’m gonna have a particular level “of credibility to then say, “these are all the things that are dangerous “about this vaccine and why you shouldn’t get them.” So, first of all, maybe just unpack this. What did he do? And did he invent this vaccine? Because you co-developed the rotavirus vaccine with a team of people. You talked about it before. So you, I think of anyone that I could ask, has the most experience in the space to kind of comment on this.

– [Paul] Right, so what he did, he’s an MD, I think, from Northwestern. I think he has a Bachelor of Science from his biochemistry work at one of the University of California schools. So what he did, like in ’89 and ’90, is he published papers showing that if he took messenger RNA and put it in a lipid droplet, and then in vitro, meaning in a laboratory flask, using monkey, using mouse cells, that he could get that mRNA into the cell, and that it would express some protein. And I think the original paper was like luciferase, which is an enzyme that’s very easy to tell because it’s sort of, when you add a substrate, the cell lights up. That’s it. That’s what he did . Now you can argue he was, if not the first, certainly one of the first, to show that you could take mRNA exogenous, meaning from outside the cell, put it inside a cell and then have it be translated through the ribosomal system into a protein. So that’s an important observation, but the claim that he, in any sense, was the inventor of this technology, there’s three things he didn’t do. First, and most importantly, that’s not the right lipid particle. And the lipid nanoparticle that you can use, say in a cell in a laboratory is very different than something you inject into a muscle. That had to be completely reformulated. Two, messenger RNA is an adjuvant. I mean, messenger RNA was used in the early days of, in rabies vaccines as an adjuvant, meaning it boosts the immune system, specifically the so-called innate immune system. It stimulates toll-like receptor 3. It stimulates toll-like receptor 8. So that can’t be. You can’t immunize somebody with mRNA like that. You have to modulate it, modify it, so that it doesn’t do that. To do that, what you do is you use nucleoside analogs, like pseudouridine, which is what people like Drew Weissman did, and Barney Graham and others. And there was another researcher, actually, whose name I can’t remember, who did actually the critical work on that, and Katalin Kariko and others. That had to happen in order for this to be a vaccine. And then the third thing that had to happen is the SARS-CoV-2 spike protein, I mean, can itself have certain toxic effects on cells, so you have to make it can’t enter cells. You do that by using these so-called prolines that fix it in a pre-fusion state. So it can’t possibly fuse with the cell. It’s locked in as a pre-fusion molecule. Those all had to happen. None of which he did. What he reminds me of is a man who won the Nobel Prize named Baruch Blumberg. And Baruch Blumberg won the Nobel Prize for looking in the blood of people who had hepatitis B and seeing these little particles that we now know are hepatitis B surface antigen, which forms the base of a vaccine. That’s what he noticed. Now, he didn’t think it was that at first. He thought it was something that was sort of, represented some sort of genetic phenotype in Australians, so it was called Australian antigen. Then he thought it may have been associated with cancers, which was also wrong. And it was actually Bill Prince, who I think, frankly, did most of the work showing that that actually was hepatitis B surface antigen, but he claims to have been sort of like central to the development of a vaccine. No, no. The hard part came after that and was done almost solely by Maurice Hilleman when he was at Merck to make that a vaccine. It’s not easy to do that. That’s the hard part. I remember when we, I was fortunate enough to be part of a team at Children’s Hospital Philadelphia, created the rotavirus vaccine. I mean, so we made the strains that ultimately became that vaccine in our lab, but it was Merck that did the, doing all the original studies, phase one, phase two, phase three, doing dose ranging studies, figuring the right buffer, the right stabilizing agent, the right vial, do real-time stability studies. And it was like a 16-year, $1.3 billion effort. That was the hard part. I mean, there’s research, development, implementation. That’s the way it works. So, I remember there was an article that came out when that vaccine was finally recommended in February 2006, and it said that the research was done, the principle research was done at CHOP and Merck sold it. No, no, no, no, Merck did a lot of other stuff before they sold it. But we never like to think our heroes come from pharmaceutical companies.

– [Zubin] So, basically you’re telling me he invented the mRNA vaccines. That’s what you’re saying, Paul, am I understanding that correctly? ‘Cause that’s what I’m pulling out of this.

– [Paul] He’s interesting. He’s, to me, the most interesting guy. When I was on Andrea Mitchell’s show on MSNBC at noon, and they showed this, the highlight reel from that Washington DC anti-vaccine rally. There’s Robert Malone, speaking, talking about how dangerous vaccines are. So how do you put that all together? Where in the one hand he claims he’s the inventor of a technology that he now is saying is killing people. And I think he just feels that history is gonna pass him by, that he’s being ignored for this. And I think he’s angry. That would be my guess. But he, to me, is Andrew Wakefield, too, because he really fits the part, attractive, well spoken, is able to translate science easily, has a history of doing decent scientific work early on in his career, and now he’s just completely turned tables, and it’s hard to watch, because he’s influential. When I give talks on Zoom, always, to parent groups that are upset, he’s often the one they bring up.

– [Zubin] He’s very influential, which is I, I’ve done a few things talking about his specific points, which we can touch on a couple of the big ones. But it is interesting because what you’re doing when we’re trying to figure out a motive, or, you know, you get labeled as ad hominem, first of all, and then the mind reading fallacy that we can’t get in his head, but I’ll just say this, and this is something I think just as an advocacy point in science communication, every single scientist is a human being. Which means, and you and I both know Paul, knowing ourselves, we are flawed deeply, right? And we have our own psychological baggage. We have our own unconscious stuff that we do that won’t even know about unless we’ve introspected or meditated or gone to therapy or whatever. And when I see Robert Malone and when I see someone like Peter McCullough, or when I see some of these other guys, I feel it energetically almost like, oh yeah, this is what, it’s… Very hurt, didn’t get credit for this thing, it’s now huge, now is projecting this other way and can come up with really smart reasons why this vaccine is toxic, all of which are wrong. And also is mixing in a lot of good skepticism. And the package itself is so compelling to parents because he looks like sexy Kenny Rogers before he got plastic surgery, and all of that. So it’s difficult because I think it’s incumbent on folks like you and I and others to say, okay, well, let’s look at this dispassionately, which is hard, because I get triggered. I see a guy like that, and I, I see him talk, he does his own videos. He says, “Listen, parents, as the inventor “of mRNA technology, this spike protein is toxic. “It’s an irreversible medical decision “that will damage your children. “So before you undertake this…” And I’m like, this is criminal. And then I get angry. So maybe let’s dispassionately look at a couple of his things. Again, this spike protein toxicity, he says that Merck’s, or Pfizer’s spike protein, Moderna’s spike protein was never tested. It is toxic. It develops in tissues of children and adults. How do you respond to this?

– [Paul] Never tested? I mean, there was a, I mean, so Pfizer did a 40,000-person trial, Moderna did a 30,000-person trial. These vaccines have been, I think, I think 3.5 billion people in the world have been fully vaccinated. There’s more than nine billion doses out there. We know more about this vaccine than any vaccine in history. This is the largest mass vaccination program in history at a time when there are in place systems to figure out if there is any sort of safety issue. I mean, look at the original J and J thing. When that came out that there was a, these blood clots, the so-called thrombosis with thrombocytopenia syndrome, the original estimate was about one per 500,000 people. Now, as we’re getting more and more data, it’s closer to sort of one in 200,000 people. That’s rare, and that was picked up and immediately presented to the American public. And there was a hold put on J and J’s vaccine. Myocarditis thing also was immediately picked up and very quickly put out there because we wanted to know to what extent this was doing harm. And so of course we’re looking at safety issues and of course we’re putting it out there. The notion that SARS-CoV-2 spike protein is killing people would require a vast international conspiracy involving thousands and thousands of researchers and public health officials, which is, that you can get people to believe that is remarkable to me. So, no… And also the studies, by the way, that were, and this is always true. You can get anything published. There was a paper in circulation research, and this is just one of many, where they take hamsters and inoculate them with a pseudovirus, specifically, something called vesicular stomatitis virus, which is in the rabies family, into what you clone then the gene that codes for the SAR-CoV-2 spike protein, they inoculate it intratracheally, into the windpipe, at about 500,000, infectious particles, not infectious particles, it’s replication effective, but particles, viral particles, and then shows that they’re… What does that mean? I mean, it’s like, okay. So we’re not gonna inoculate hamsters, then, any more intratracheally with this virus. It’s like, as David Weiner said, who’s one of my favorite vaccine researchers at Wistar, he said, “Mice lie and monkeys exaggerate.” That’s right, if you really wanna know whether there’s a problem with people, put it in people.

– [Zubin] That, yep . That’s exactly right. And this idea that… He said so many things. Well, here’s the best part, Paul. So, I know, ’cause I know I can get you fired up about this just because. As part of the vast global conspiracy, central to this vast global conspiracy are hospitalists. That is my specialty. So people who take care of patients in the hospitals, internists and pediatricians like myself, and I’m like guy, guy, I hate to pump the brakes on you here, but I can’t even tie my laces when I’m working in the hospital. Like I can be part of some vast global conspiracy to keep patients inpatient for longer. Paul, have you ever met a hospitalist who does not wanna discharge their patient as soon as they’re admitted? It’s just what we do. We get people out of the hospital. And Malone is like, “Well, these hospitalists “are part of the great conspiracy.” It’s like, okay, you’re done. You’re done here. Now another thing he’s-

– [Paul] It’s also not piecework, right? I mean, your salary, it’s not like piecework, right? You get paid per patient.

– [Zubin] And even if you got paid per patient, you get paid more. So this is something we can say. There are financial incentives in medicine. I’ve complained about them forever, fee for service is poisonous because it generates supply, me, generates demand. ‘Cause the more I do the more I get paid. Now, what he’s saying though, is, you keep ’em longer, this and that. No, no, no, no, no, that’s not how often we get paid. We get these DRGs, these flat fees. You get paid the most when you admit someone and discharge them right away. That’s the highest code you can pretty much charge, but there’s vague reason. It depends on your insurance and all that. So he’s not wrong to question financial incentives. I think that’s important, but he is wrong to say something like this, like natural immunity… So if you’ve been infected before and then you get vaccinated, you are in big trouble. You’re gonna have all these complications. So where is he getting this? And is there any truth to this?

– [Paul] No, none. I mean, you would think the opposite would be true. I mean, if you were vaccinated, now you have antibodies, which would ameliorate any of the effects that would be caused by the vaccine because usually those effects occur within a few weeks of getting the dose, because that’s when the proteins are made, you’re making an antibody response to that. That’s when you would see that. So if anything, it would be ameliorating. I mean, so, as for example, when Jonas Salk wanted to test his polio vaccine, the first group of people he tested it in were children who had already been infected, because he figured this would sort of slowly work back then to sort of the safety tree to eventually give you, give it to seronegative children who hadn’t been exposed to the virus, because now you’re gonna see whether or not there was any problems. So the safest group was the group who had already been infected first.

– [Zubin] Yeah, yeah. Now the only question I would have on that is, let’s say you were naturally infected and then you get a dose of vaccine, that almost acts as your second dose, and you’re a young person like 20, and you get Moderna, and you’re a little higher risk for myocarditis. I mean, is that true? Because myocarditis seems to be an immune response after that, predominantly after the second dose. Your thoughts on that?

– [Paul] I think that’s right. I think that tells you it’s an immune-mediated phenomenon, the fact that it was a second-dose phenomenon, there are a number of studies that have come out, looking at people who, after natural infection, got a dose of mRNA-containing vaccine to show that you got a booster response, and to make the case reasonably that you don’t need a second dose. Then this was, I remember something, I had wished that CDC had come out with a recommendation on this, because there were a number of studies showing that you didn’t really need that second dose ’cause you just essentially had it by getting the first dose of something you had already been naturally infected. it’s the first time I ever heard natural infection didn’t count. And I think it was because we were learning about this virus and we weren’t sure, and it was probably bureaucratic to some extent. How do you prove natural infection? So I understand that, I understand hesitancy but as we got more and more information, I guess I wish the CDC had been more directive, more prescriptive in terms of how that first dose could count. But I think it became more how do you make that a doable thing? Make it easy.

– [Zubin] I guess in retrospect, I just wonder, I know the transmission is lessened by vaccination, so there’s a community benefit. But it’s not as much as we might hope, like ideally. And so the question is, would we, could we let that slide because these kids who get, let’s say they get a single dose, and they told everyone, “Well, I was already infected,” so they just got one dose, are we creating a public health hazard by having a kid with one dose of vaccine versus the public health hazard of destroying trust and creating psychological reactants and so on? That’s what I struggle with, but I’m curious your thoughts.

– [Paul] The only thing I would say is that, what we know about these two-dose vaccines for whether Pfizer or Moderna, is that you do get high frequencies of memory B and T cells. The question is, is that also true after one dose? And I suspect it might not be true. So I think there, what worried me when this vaccine first rolled out, I remember there were people like Stan Plotkin, who was my former boss, or Ashish Jha who were on television saying, “Let’s just get as many one dose out there as possible, “and then we’ll get around to the second dose when we can.” What worried me about that was that I thought that people would, there would be some people, if not many people who would think, okay, so it’s a one-dose vaccine, I don’t need that second dose, where I think they probably do need that second dose to get those high frequencies of memory B and T cells to protect you against serious disease for a longer period of time. And you may be protected for years with this, given the sort of frequencies of memory B and T cells we’re seeing. We’ll see. We’ll see whether or not this really does act like a live attenuated viral vaccine and not an inactivated viral vaccine. We’ll see over time. But for right now, all the data or that it does. I’ve always was worried about that single-dose recommendation initially?

– [Zubin] Mmm, mmhmm, I get it, yeah. And, well so, back to kids, in terms of general public health… So you take care of sick kids at Children’s Hospital of Philadelphia, so you see kids with COVID in the hospital, what’s your take on mandating the vaccine for kids five to 11, given the best data we have? Should it be mandated? Should it be voluntary? Is it helpful? Why should people do it?

– [Paul] Yeah, I mean, well, in a better world, we wouldn’t need mandates, in a better world, a world dominated by logic and reason, a world in which we do not live, that people would look at the data and they would say, this is great. I mean, here we have now, so about 20% of five to 10 year olds have been vaccinated fully. So you figure that’s 28 million people. So 10% would be 2.8, so about five to 6 million children have been vaccinated. So, and the CDC just came out with a report looking at serious side effects in, I think the first, it was about eight million, the eight million children, it was a CDC report. Was there any myocarditis? No, in that, at least in the eight million. And you felt better because you knew that this was a problem in the 16 to 17 year old, it could be as frequent as one in 5,000, one in 7,500, depending on sort of who you were look, whether it’s U.S. or Israeli data, but the 12 to 15 year old appeared to be less. So that was reassuring. And then the five to 11 year old you know is getting a lesser dose, is getting only 10 micrograms, not 30 micrograms like the 12 to 15 year old got, so that was reassuring. And all the early data’s is that it’s less. I mean, we mandate vaccines for children coming into school. Does this vaccine count as one of those? This virus has killed about, we were presented these, we, the FDA Vaccine Advisory Committee, were presented these data on October 26th. At that time about 100 children five to 11 years of age had died. At that time, there were about 8,300 hospitalizations, a third of which were in the ICU, and a third of those kids who were hospitalized had no comorbidities. So can this affect the otherwise healthy five to 11 year old? Yes. Can it cause serious disease in the otherwise healthy five to 11 year old? Yes. Can it be fatal? Yes. And that is the age of MIS-C. I mean, that is the age range MIS-C, and it’ll be interesting to see whether Omicron is less likely to cause MIS-C, because that may be true, but Omicron’s not the last variant. And I guess to me, the strongest argument for vaccinating children is they grow up, and this virus is gonna be out there for a long time, and we’ve induced longterm memory with this vaccine, we are serving them well as they get older, because we are gonna need to have a highly immune population, either from natural infection or immunization, I think for years, if not decades. I mean, we still vaccinate against polio in this country. We haven’t had polio in this country since the 70s. We do it because polio still exists in Pakistan and Afghanistan. Although it’s interesting, with the Afghanistan, with all, we had a lot of immigrants, and immigraes coming into our hospital from Afghanistan, children who were sort of initially maintained in tents and then they were brought into our hospital. It was interesting because polio was an issue. I mean, were some of these children excreting polio asymptomatically, ’cause remember only one of every 200 people who were infected with polio will have paralysis. It was interesting to see the looks on the residents’ faces when that was brought up. That these kids, some of these kids may be shedding polio virus asymptomatically. This was something they had never considered or thought about, because they didn’t grow up with this.

– [Zubin] That’s really fascinating, because you just said something, too. One in 200 kids with polio get paralysis So, in a way it’s a very similar kind of scenario where a very small percentage of people actually get severely ill.

– [Paul] That’s exactly right.

– [Zubin] Wow, yeah, you know, so that kind of perspective is actually very helpful. Have you heard about this army super vaccine they’re developing or is this some apocryphal information?

– [Paul] No, it’s not apocryphal. It’s at Walter Reed. So what they do is they take ferritin, and then it’s in a structure that looks like a soccer ball. And then you can take these different SARS-CoV-2 spike proteins and put them all on the outside of that soccer ball. So you can, in theory, have a variety of different SARS-CoV-2 spike proteins. So this is kind of the universal coronavirus vaccine people talk about. That’s possible. I’m not sure we need it yet. I’m not sure we need a protection broader than we already have. What I worry about, and I’m sure what with people like Dr. Walensky and Dr. Fauci worry about, would be a virus that is the variant strain that is resistant to protection against serious illness, because then you’re not talking, that’s not a booster dose anymore. That’s just going back to square one again, and giving that as a, whatever, two or three dose vaccine starting from the beginning again. And hopefully that doesn’t happen. But the virus is continuing to mutate. Omicron probably came from what sounds like someone who had HIV who wasn’t being treated, in whom the virus was replicating and replicating and replicating, and the person was making antibodies, but at low level, which is really the way that you make escape mutants in a laboratory. Just keep providing low levels of antibodies and watch this virus continue to escape. And that’s what happened. We’ve gone from, whatever, eight or so critical mutations with Delta to like 30. I mean, this is flu territory when you see that level of drift.

– [Zubin] By the way, so when you’re, that approach of making escape mutants in the lab, is that considered gain of function research? Is that the same sort of thing?

– [Paul] Yeah, you could argue that.

– [Zubin] Now, as someone who’s worked with viruses, trying to develop rotavirus vaccine and successfully doing so, if say someone like Marty Makary has said, “Hey, we need a full ban on all gain of function research. “Can we say that now?” Is that incompatible with doing good science?

– [Paul] Well, so I mean, how did we make the rotavirus vaccine? We made the rotavirus vaccine by taking essentially a, what we considered to be an avirulent strain for children. I mean, well, take a step back. Rotavirus is, in fact, all mammalian species and some avian species, but species barriers are high. So calf rotavirus has caused disease in calves, but not babies. And baby rotavirus has caused disease in humans, but not in calves. So species barriers are high. So you take a calf rotavirus, and then you genetically alter it to put in human genes that are critical for inducing protective immunity, but not critical for creating virulence. So you need to make sure you define those genes. What are the genes that determined virulence? What human genes determine virulence? And make sure you don’t add those. So that’s what we did. I mean, that was, I just described 10 years’ worth of work in about 25 seconds, which is depressing, but that’s what we did. And so, is that gain of function? We thought it was loss of function research, but you wonder how that gets defined.

– [Zubin] Yeah, that’s interesting. ‘Cause you’d have to be very careful about how you define it. Maybe gain of virulence is what you’d wanna avoid, but even then. So anything else, Paul. We’re at over the hour mark here, and I wanna respect your time and sanity, ’cause you basically talk all day every day about this stuff. You’re one of the few sort of voices that’s been actually balanced across the spectrum and you’ve taken some stances that some disagree with and others. You’ve never been an ideologue about any of this, and that’s why I think a lot of people, including myself, admire and trust you. Anything else you wanna let us know that’s very important?

– [Paul] I think we’re getting there, I do. I think that as we move into the, I mean, I think the warm weather is an enemy of this virus. I think as we move into the warmer months, just like last year, when you look at the sort of number of cases and hospitalization, that’s last June, July, I mean they were down. I think that’ll be true now, too. And what’s interesting, we are at about 90% population immunity. That’s gettin’ there. But the virus is really good at finding people who are susceptible, so get vaccinated, people who are listening to ZDogg. Please get vaccinated to make ZDogg’s and my life easier, because when you’re a hospital seeing a lot of patients, it’s harder to take care of all the other patients, too, at the same time.

– [Zubin] That’s great advice, and one last thing, relating to that, when hospitals are overwhelmed, it’s not, so people make this argument, well, they’re getting admitted to the hospital WITH COVID instead of OF COVID, and therefore that doesn’t matter. Here’s why it matters . You cannot place a patient with COVID, or with a positive COVID test in a nursing home. You cannot get them into a psychiatric facility. You can’t, because they need special equipment, special beds, special isolation, PPE, et cetera. It throws this hospital logistics chain into a disaster that then affects everything else the hospital does, including the real sick COVID patients, whether they’re residual Delta or Omicron or we don’t know. But it then affects your appendicitis or your cancer surgery, or something like that. That’s one community sort of measure of why, first of all, we should vaccinate as many, especially high risk people, because then they’re not gonna end up needing an ICU bed. But also we really do have to question, okay, if you have been vaccinated and you do test positive and you don’t have symptoms, what does that mean? How do we handle you? Is there a better way to do it? So I don’t have the answer to that, Paul, unless you do.

– [Paul] No.

– [Zubin] So, in that case, just get vaccinated if you can. If you’ve been naturally infected, respect. It’s kinda nice to have a vaccine, too, just in case, because it’s a little variable, but hey, we get it. Let’s love each other, don’t you think? Instead of being so polarized? I don’t know. I don’t know, Paul.

– [Paul] Yeah, it’s the way we love each other. I mean, I think that’s true. I think it’s how we love each other is to show respect for the other person. I just, I mean, if you one don’t wanna get tetanus vaccine, that only affects you and no one’s gonna catch tetanus from you, but how do you think people get it? They get it from other people.

– [Zubin] Ah, that’s beautiful. All right, Paul, I love you brother. Thank you so much. Guys, share the show, do the usual stuff, and we are out, peace.

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