IamA (scientist and author) AMA!

How do you recommend talking with well-meaning parents who remain confused about whether to vaccinate despite the preponderance of evidence of its benefits? Specifically, how do you advise framing the conversation to dispel the false equivalence between real science and non-science without appearing dismissive?

I think you have to find out what the person is most concerned about. Then, hopefully, there are data to answer the question. But often data aren't enough. So I think it's also important to talk about what is at stake in the decision. I think it's reasonable to be fearful of anything injected into your body. So it's certainly not of value to be dismissive.

Do you think a massive outbreak of a VPD, with fatalities, is inevitable in the US at this point? If so, what disease do you think is at biggest risk for this?

Side note: I consider you to be on the list of our American heroes! To look at my two young children and know they were spared the horrors of rotavirus, is an amazing feeling. Thank you so much for all you have done, and continue to do!

I don't think it would be a massive outbreak. Rather, I think it would be like what's been happening with measles in the last couple of years. Small outbreaks followed by people who had originally chosen not to vaccinate now scared of the disease and choosing to get vaccines. I think that's exactly what happened during the Disney outbreak in southern California.

Are you worried about Trump as president in regards to vaccine policy in the US?

Lord yes. Trump has given new life to the anti-vaccine movement. They, like he, deny the evidence in front of them. But I don't think Trump could do much at the federal level. He's not going to disable the Vaccine for Children's Program without the consent of Congress. Same would hold for the National Vaccine Injury Compensation Program. Everything else important about vaccines occurs at the state level.

Dr. Offit, I am a huge fan. I've read almost all of your books and am looking forward to the new one. I would suggest that when you do an AMA in the future, make sure you put your name and part of your bio in the title. There are lots of "scientists and authors" but there is only one world famous vaccine expert and researcher Paul Offit.

Since the rules here say I have to ask a question... I'm a practicing oncologist and I've been advocating for people to get the HPV vaccine for their children. I see a lot of head and neck cancer and am currently treating a 31-year-old for HPV associated head and neck cancer. Do you recommend adults who were not vaccinated also get the shot?

I think that if an adult is sexually active, it is reasonable to get 3 doses of the HPV-9 vaccine.

And thanks for the tip about mentioning my name. Although I might be better off this way. Not everyone is a fan.

Thanks for the response. I think it's fair to say that the Reddit community at large are big fans. Almost all anti-vax posts are downvoted to oblivion and there are many active scientists, physicians, and researchers in this online community.

Thanks and good to know. Hopefully, I'll be better at this next time. Already my son has gone online and told me to include my name.

Is it worth it to get the flu shot every year? I've only gotten once because I was pregnant and you have to, but I've never had the flu.

Your lucky. Most people have suffered influenza at one time during their lifetime. But influenza can be deadly. So it's definitely worthwhile getting the vaccine. There is not a year that goes by at our hospital where at least one child dies from influenza.

Scientifically speaking, what's your perfect sandwich?

Hamburgers.

I don't think I can adequately express my gratitude for the rotavirus vaccine. I work with children under 5 in privet and institutional settings, the year that it was added to the recommended course of vaccinations was a huge improvement.

My question is: what other childhood illnesses are good candidates for vaccines? It seems that we have a good handle on the major ones, like chicken pox and measles.

I think the vaccine that would have the greatest impact on children (for which we don't yet have a vaccine) would be for respiratory syncytial virus (RSV). RSV still causes tens of thousands of hospitalizations and thousands of deaths a year in the US. But most of those deaths are in very young infants or premature infants. So this would probably work best as a maternal immunization.

So one of the many criticisms I see from anti-vaxxers is that researchers are either forced or paid to falsify data on vaccines so that "Big Pharma" can make tons of money. What are the checks and balances in the scientific community that keep this from happening? Any other helps that can disprove this theory?

Studies that are submitted to the FDA for licensure are invariably placebo controlled and double blinded making it virtually impossible to cheat. Also, once a vaccine is licensed, phase IV and post-marketing studies using the Vaccine Safety DataLink can quickly and in real time see whether a vaccine has a significant side effect, which is what happened with the RotaShield vaccine in the late 1990s. And that vaccine was taken off the market in a year. Apart from the fact that it is not in the interest of vaccine makers to make products that hurt children, there is no hiding. If a vaccine is unsafe, it will be shown to be unsafe.

Of your seven stories in your latest book,which do you think is the most frightening?

The chapter titled, "America's Master Race," because there are so many analogies to Trump's success. Basically, it's the story of a popular scientific treatise called The Passing of the Great Race, written by a New York City conservationist and lawyer named Madison Grant. He made a case for race purity that translated to Draconian immigration restrictions. Ultimately, the book was translated into German, read by a young German soldier imprisoned in Landsberg, who then took whole sections of Grant's book and plagerized it for his: Mein Kampf. The Passing of the Great Race became required reading for Nazi Germany and race purity reached its hideous illogical end.

One tiny correction: Hitler was Austrian, not German. :)

Yes. You're right.

Hi, Dr. Offit! Love your books. Do you think we're making headway against the anti-vaccine movement?

Yes. Definitely. 10 years ago the media covered this story as if there were two sides, even though only one was supported by the science. Not true anymore. You rarely hear the voices of the anti-vaccine leaders in mainstream media. Oddly, I think in some ways Andrew Wakefield was good for science. It wasn't that he was only wrong, he was fraudulent and wrong. The anti-vaccine groups attached themselves to his star and crashed and burned with him. No one likes a fraud.

Your bio mentions a new book--what's one of things science got wrong?

In the 1970s, we assumed that all saturated fats were bad and all unsaturated fats were good, driving us away from butter (animal fat) and into the arms of margarine, which contained partially hydrogenated vegetable oils (trans fats). Trans fats were estimated to cause about 250,000 heart-related deaths a yea.

What do you make of recent research suggesting that antibiotics early in childhood might have lasting negative effects on things like brain development, gut microbes, and social behavior? This seems very preliminary (I think just documented in mice so far), but still very troubling.

I know you specialize more in viruses and vaccines, but this seems very reminiscent of concerns about vaccines.

I think it is a fascinating area of research. The microbiome does clearly have an effect and it makes sense that it would, influencing the development of asthma, allergies, obesity, diabetes and others. Two researchers in our ID group are studying the microbiome. Yet another reason not to use antibiotics unnecessarily.

Who was your favorite scientist/doctor growing up?

My pediatrician, Milton Markowitz. It was amazing that he was in private practice. Later in his career he wrote the definitive text on rheumatic fever and then became chairman of the department of pediatrics at the University of Connecticut School of Medicine. Usually academic pediatricians aren't in private practice. I just caught him at the right time. Good thing, too, he diagnosed my ruptured spleen when other doctors had missed it.

What effect are Donald Trump's decisions going to have on vaccines and science and how do we ensure that our children don't get sick as a result?

I tried to answer this one in a similar question above.

When is a door not a door?

Favourite Burger?

If I were to tell you that the next thing I say would be true, but the last thing I said was a lie, would you believe me?

A door is not a door when it's ajar.

Hello,

Can you explain why some vaccines can be given through the nose (flu) but others need to be injected?

Are there any other theoretical means of delivering a vaccine?

What is the best way to reduce injection pain?

Sincerely,

A trypanophobe

For viruses that reproduce themselves only at mucosal surfaces, like rotavirus or influenza, it's best to induce an immune response active at the mucosal surface. Hence, the nasal spray flu vaccine and the oral rotavirus vaccine. But these are more difficult vaccines to make, because you have to make sure that each of the different strains of virus reproduce themselves at the mucosal surface in the same way. This problem is what felled the nasal spray flu vaccine, which I hope will be back in the near future.

What do you think of anti-vaccination? And also, can you provide proof?

I think that the anti-vaccine movement in this country has hurt children, causing them to suffer vaccine-preventable diseases needlessly. I've added links to my Facebook and twitter accounts as proof. I'm struggling on how to put a picture on this site.

How does one go about entering the research world after getting a degree?

It depends on the degree and the research world you're interested in. For MDs or PhDs in science or medicine, you usually hook up with a successful laboratory following your degree and go from there. Invariably, you're already had some lab experience at the time of the degree.