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Transcript: Vaccine Hesitancy and Skepticism

Jun 8, 2021

In this episode of ”To Health and Back,” we’ll hear from Dr. René F. Najera — an epidemiologist and editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia — to see explore the history of vaccines and vaccine skepticism, and how that same skepticism exists today.

Check out the show notes here.

NOTE TO LISTENERS: This conversation was recorded before the U.S. resumed Johnson & Johnson vaccinations. 

0:13, Madeline Laguaite: Hello, and welcome to “To Health and Back,” a podcast about how health, medicine, and wellness decisions from the past help inform us today. I’m your host, Madeline Laguaite.

Laguaite: In this episode, I’m sitting down with Dr. Najera to talk about the history of vaccine skepticism and how those past instances reflect what we’re seeing today with the COVID-19 vaccines.

0:36, René F. Najera: You know, there was vaccine skepticism before there were vaccines and that’s something that always kind of befuddled people like, “What do you...? What do you mean?”

0:44, Laguaite: Vaccines skepticism today comes in light of the COVID-19 pandemic. On December 11, 2020, the U.S. Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of COVID-19 and people 16 years and older, which allowed the Pfizer-BioNTech vaccine to be distributed in the U.S. Later, the Moderna and Johnson & Johnson vaccines were approved as well.

Laguaite: However, on April 13, 2021, the Centers for Disease Control and Prevention (CDC) and the FDA recommended a pause in the use of Johnson & Johnson vaccine. Of the almost 7 million doses administered so far in the U.S., a small number of reports of a rare and serious type of blood clot had been reported and people after receiving it. All reports happened among women from the ages of 18-48, and symptoms occurred 6-13 days after vaccination. Dr. Richard Besser, who was the acting CDC director in 2009, spoke about the implications of the Johnson pause on C-SPAN on April 18, 2021.

1:53, Richard Besser on C-SPAN: First, I do think taking a pause was the right response. We have a number of systems to report what are called vaccine adverse events. And then they’re investigated to see is this something that was just occurring in a timeframe related to vaccination, like someone that had a heart attack and they had a vaccine last week, but it wasn’t caused by the vaccine? Or is it something that the vaccine actually could have caused? And so, in these systems of reporting, they detected six cases of a very rare type of blood clot in women who were all younger than 50 within 2 weeks of having received the J & J vaccine.

2:36, Laguaite: Although the Johnson & Johnson vaccine use resumed on April 23 at the recommendation of both the CDC and the FDA, public health experts were worried and still worry about how that pause could impact vaccine hesitancy and skepticism in the U.S. Still, vaccine hesitancy isn’t new. Here with me to talk more about vaccines and the history behind them is Dr. Najera. Hi, Dr. Najera, and welcome to the show.

Najera: Hi, how are you?

Laguaite: Hi, I’m good. How are you?

Najera: I’m doing well.

Laguaite: Could you state your name and sort of tell the audience who you are?

3:11, Najera: Yeah, so my name is René Najera. I am an epidemiologist, Dr. Public Health. I’m a senior epidemiologist at a local health department that shall go unnamed. But my reason for being here is that I’m the editor/project director of the History of Vaccines project by the College of Physicians of Philadelphia.

3:30, Laguaite: Although public mistrust of vaccines is currently an issue, it’s been a problem in the world of public health for some time now. We could look to the case series published in The Lancet in 1998, by Andrew Wakefield and 12 of his colleagues that suggested the measles, mumps, and rubella — the MMR vaccine — could cause autism in children.

Laguaite: Like I mentioned, vaccine skepticism begins way before that study. And like Dr. Najera said earlier, vaccine skepticism precedes vaccines themselves. He pointed to waves of smallpox in the 18th century and gave me an idea of what it was like.

4:05, Najera: So, back in the early 1700s — smallpox a disease that was terrible, horrible, horrible disease, 30% death rate. If you survive that, you were scarred. A lot of people would actually commit suicide from the scarring because they just couldn’t bear looking at themselves. And almost everybody got it, you know? It would go around in waves, not pandemics, which is like, it happens worldwide at the same time, right? It would go around in waves every 15-20 years. So every generation, you build up enough people who are susceptible, and then boom, it would hit you. Everybody who knew something about medicine had to find a way to stop it. And at the time, we scientists didn’t know what a virus was. There was no such thing as a microscope. There were hints that there was something infectious going on. There were hints that your body that’s something to protect you after infection because once you got it, you know, you were immune afterward. So there were these little hints here and there.

4:58, Laguaite: But inoculation techniques didn’t originate in Europe. Researchers and historians say that the two most likely origins were either China or India, and Dr. Najera spoke about the former.

5:10, Najera: But if you go back 1,000 years, the Chinese would...  they realized that if you took some of the scabs from the smallpox and you dried it out in the sun, and then you ground it up into dust, and if you inhale that you got some sort of immunity from it, again, probably a lot of trial and error, probably a lot of observational studies, nothing really scientific. And so they did it. And it worked. And it was called variation or inoculation. And this practice then leaves China through the Silk Road, heads to West India, they pick it up. Middle East, they pick it up. North Africa, they pick it up, but it doesn’t make any inroads into Europe; It just kind of, you know, “It’s one of those things, those people over there do. They’re kind of weird. You know, they’re not like us, sophisticated Western people.”

5:57, Najera: This practice didn’t make it to America until much later, in the early 1700s. This enslaved man is picked up in Africa and taken into Boston and he is sold to a congregation at a church and the congregation gives him as a gift to their Reverend Cotton Mather. Cotton Mather was involved in the Salem witch trials. But he basically notices that the slave, Onesimus, is immune to smallpox; he doesn’t have any scarring. He’s fairly older. And he says, “What is protecting you and why do you have this scar? And what is that?” And he said, “Well, they gave us smallpox without actually giving it to us.” And Cotton Mather got kind of curious and says, “Tell me more.” And so Onesimus describes a procedure where they would take somebody with smallpox and take a little lancet and lance the pox and get the tissue or the fluid and then put it in their arms. And they were sold at a higher price because they were now immune from smallpox, and that would make them profitable.

Najera: And so Cotton Mather goes to a friend who’s a physician last name of Boylston, and says, “Hey, is there anything to this?” And so most write some letters to some friends and colleagues in Europe, and they say, “There’s this woman who is married to the British ambassador, her name is Lady Mary Montague.” And they traveled to Turkey — a British ambassador to Turkey went there. And it wasn’t called Turkey. At the time, it was the Ottoman Empire. And she had written back saying that there’s this practice of doing that in the Ottoman Empire, and people are immune. And there’s this whole process to it. It’s very controlled, you know, you don’t want to get too much of the smallpox; you want to get just enough to give immunity. You want to do it under the supervision of somebody who knows what they’re doing. And they didn’t know this at the time ... a major variola and a minor variola, and they said, “You don’t want to get the bad one, major. You want to get the minor and give that to people.” It wasn’t that minor. It was like 5% death rate. So she writes letters to her friends and colleagues again, and my colleagues, I mean, people in the higher echelons of society in Britain, say, “Look, I just had my child inoculated. And he had a fever for a little bit, but he got over it, and he didn’t develop smallpox. You guys should look into this.”

Najera: But her letters, Boylston’s letters, other people’s letters start traveling the world and there’s confirmation that it works. So then a ship arrives in Boston in the early 1700s, 1710s or so. And the sailors have smallpox and it had been a while since the last smallpox outbreak. So here we are. We are beginning with smallpox outbreak, and Cotton Mathers immediately tells Boylston, “Hey, this inoculation thing — Let’s try it. It’s worth doing. Let’s just go for it.” So they inoculate themselves. They inoculate their families. They inoculate of the slaves working for them. And it seems to work. If you look at the death rates of people who got smallpox the natural way, it was about 10 times worse than the people who were inoculated, because you then inoculate everybody on time, some of them were already infected.

8:50, Laguaite: But just like today, not everyone was a fan of the inoculation idea.

8:56, Najera: So Boylston and Mathers say that to the townspeople, “Hey, let’s do inoculation.” And people lose their minds. They firebombed Cotton Mather’s house. They wrote very dissenting opinions in the press. Cartoons were made. They were saying, “No. 1, why would you put the filth in us? No. 2, what are you doing listening to a slave? What does he know? No. 3, what are you doing listening to the Ottomans? What do they know?” It snowballs from there. And this is kind of the same reaction that you get in other places. You know, they just have this adverse reaction to inoculation.

Najera: Later on, in the Revolutionary War, Washington is defeated at a battle up in New York State or what would be New York State and he realizes that it’s because his troops are sick with smallpox, that the British had smallpox and a lot of them already are in that immunized. Now they’re immune from get having smallpox, they are the ones that survived. Right? And so he hears about inoculation, and he forcefully inoculates his troops. Like he actually had people held down and given the inoculation against their will, because he said, “Look, we’re not going to lose the war because you get smallpox.” And you have several instances of this. Benjamin Franklin writes the opening to a pamphlet talking about the benefits of inoculation. Like in “Hamilton,” “To every action, there’s an equal opposite reaction” and people rebel against it. They’re like, “No. 1, the government is not going to tell me what to do with my body. No. 2, yeah. You don’t know what you’re doing.” This is all before the first vaccine.

10:21, Laguaite: But the first true anti-vaccine sentiment evolved around the early 19th century with the first vaccine.

10:28, Najera: The first vaccine happens in 1796, which is a smallpox vaccine that is taking cowpox and doing the same thing that you did with smallpox; you just did it with cowpox. Cowpox doesn’t cause severe diseases that causes the scarring, doesn’t cause death. You kind of feel icky for a while, but you get over it. And then you’re immune against not just smallpox, but others as we found since and other smaller poxviruses. That is the first time that there’s this anti-vaxxer sentiment growing. So by the time the first vaccine comes around, it’s already the groundwork is already laid out. They already have their talking points. They already have their celebrity figures who are opposed to this. President John Adams was, you know, he heard about the smallpox vaccine. And he was like, “I know.” Thomas Jefferson, he heard about it. He was like, “Oh, that’s interesting. Let’s look into it.” And he kind of helped promote it. So the groundwork was already there by the time the first vaccine comes around.

Najera: First vaccine comes around and you see the cartoons, “Oh, this cowpox vaccination is going to turn you into a cow.” If that sounds familiar, you know, to the COVID vaccines, “The mRNA vaccine is gonna alter your DNA, make you into something nonhuman,” you know? “They’re taking the cells from the cow and putting into you.” Now we hear, “They’re taking fetal cells and putting them into you.” Moral grounds and religious grounds. “If God wanted you to die from this, and you’re just gonna die from it, sorry.” And now you hear religious figures saying the same thing: “No, no, don’t get tested. Don’t get vaccinated. If God wants you to suffer, then you’re going to suffer, OK?” You know, those kinds of things. Unfortunately, now you have mass media, social media, you have people who have huge followings on the internet that they say something and a lot of people listen to them. And we found in our research in public health that people listen to people who are like them. And so all you need is a critical mass of people listening to you as an influencer. And that critical mass will influence a ton of more people just spreads. And so it’s the same thing with pro-vaccine, we try to reach the critical mass of people who will tell their peers the benefits of vaccination and, and get that going. And it’s kind of the reason why vaccination programs for kids are so successful, you still have vaccination for school requirements up in the ‘90s. Because for the most part, you don’t you know, you hear about things that happened, but you don’t see them. You don’t see... they say that children turn autistic. “Well, no, they were always autistic.” They just kind of figured it out later on.

Najera: You don’t see the deaths that anti-vaccine people say that exist. You don’t see those kind of things. And so that’s why it’s been it’s been so successful. The only problem is that there’s things like measles, that if you drop down below 95-96%, you start messing with herd immunity, and outbreaks come back. But the history of the anti-vaccine movement has been around longer than vaccines, and it’s kind of it’s kind of annoying that it hasn’t died out, and they just keep recycling the same thing over and over again. You know, in the mid-1800s, the British Empire said, “OK, everybody get vaccinated against smallpox,” and they actually call themselves the National Anti-Vaccine League because they couldn’t sound like a villain more than that. And then they spread their tentacles throughout the whole world, sending letters everywhere, and then there was one created in the U.S. that would actually fundraise off of the fear of vaccines. Using the talking points of “the government can’t tell you what to put into your body,” “you’re healthy enough as it is,” “just live a healthy life and you won’t get sick.”

Najera: And then the moral grounds. If it was meant to be, it was meant to be and things like that. And so they came about and they start suffering some blows in the 1900s because science has advanced now we have microscopes. Now, we know what things are. There’s more respect towards scientists. It was a golden era of science. People like Pasteur who found the vaccine for rabies were hailed as a hero. There was a doctor, Haffkine, who found the vaccine for cholera and for the plague in India — probably averted millions of deaths from those in India. They’re held as heroes and  there’s more of that happening.

14:21, Laguaite: Mandatory COVID vaccinations are a hot topic as various colleges like Yale and Columbia just to name a few plan on requiring COVID vaccinations come fall. Government intervention in the context of vaccinations and public health is especially relevant today. But it’s historically relevant as well.

14:38, Najera: And then the Supreme Court steps in. There was a man by the name of Jacobson in Massachusetts who didn’t want to pay a fine of he wasn’t vaccinated. He said that he had some really bad vaccine reactions when he was a kid and he wasn’t going to get the vaccine and neither were anybody that he would look after. And the state said, “That’s fine, but you pay a $5 fine,” which in today’s dollars is close to $100, $50? And he said, “No, I’m not.” And he took it all the way to the Supreme Court. Supreme Court said, “Actually, yeah, the state cannot forcefully vaccinate you, but they can fine you because they have that power.” Under the 10th amendment is the police powers of the states. And that echoes in us with us today, 100 years later, because the interventions for COVID that you see — whether to wear a mask or not, whether to social distance or not — is very locally controlled or state-controlled because of that decision. Because the Supreme Court then said, “Yes, it’s not up to the federal government. It’s up to the state and local governments to enforce public health laws.” And it came from this anti-vaxx sentiment of “No, I’m not. I’m not getting it.” And it happens today.

Najera: Later on, another court decision is Zucht v. King. They sued the school system saying, “No, you cannot require me to be vaccinated for school” and again, the Supreme Court said,”Yes, yes, they can. Your right to be free of vaccination does not preclude the right of the entire population to be free from disease.  They cannot force you to get vaccinated, but they can fine you or they can prevent you access to public spaces.” And you see that now, right? “You can’t make me wear a mask.” Well, no, but we won’t let you into the store, or we won’t let you into public buildings and stuff like that. That’s the thing about history. That’s the thing I’ve learned in managing the history of vaccines and running the project as it keeps repeating itself over and over and over and over again. So whenever somebody brings to me something “new,” quote, unquote, that the anti-vaxxers have done, I’ve been like, “No, there’s nothing new under the sun when it comes to them.” I’m not surprised anymore by the things that they say. I’m disappointed.

16:30, Laguaite: Although Black, Latino, and indigenous people, along with other people of color, are overrepresented in serious COVID-19 cases, vaccine hesitancy among these communities can complicate the decision to be vaccinated. And Dr. Najera spoke to the skepticism.

16:47, Najera: So you’re talking about 300+ years of terrible abuses to people whose origins come out of Africa. And that community alone — which is not a community, it’s many communities — is just time after time, the abuses you read about these and you become more as I say, “woke.” But you become more aware of all of that has happened and you’re like “Well, no wonder they’re going to be skeptical of the vaccines given by the government. It’s the same government that enslaved their ancestors.” And in some cases, you still have some people who are alive whose grandparents were enslaved.

Najera: You have the Tuskegee experiment in which you know that there’s a misconception in the African-American community that people were given syphilis. That’s not what happened. What happened is that people who had syphilis were told not to seek care. They were told that they were already getting care when they were not. And this is in an era of an era of antibiotics already. So they could have been given antibiotics and cured from syphilis, but because the scientists wanted to see what syphilis will do to people, when there was already plenty of documentation of what syphilis would do, again, the government and the scientists could have prevented a lot of death and suffering, and they didn’t because they were racist.

Najera: And then you have Henrietta Lacks. Henrietta Lacks neither she nor any of her relatives, or anybody close to her, benefited from her cells but so many other people have. You have institutions located in cities that are predominantly Black, that conduct a lot of a lot of research, and use a lot of people of color, for their research. And then it never— the benefits of that research rarely, if ever, gets back to them. So you have this history that just goes way back and keeps repeating itself. Anybody who knows anybody knows about this, and you cannot be surprised that they would be skeptical of a vaccine. So that is mostly in the African-American community.

18:34, Laguaite: The Latino community has also historically faced discrimination in the medical sphere.

18:40, Najera: In the Latino community, what you have going on there with Central Americans is that there was a time in the ‘70s and ‘80s when pharmaceutical companies went to Central America. They conducted experiments that actually benefited the people who were in the experiment of medicine work, but then they said, “Oh, the medicine works. We’re out.” And then the people were like, “Well, can we get the medicine?” and like you have to pay thousands of dollars for the doses? Why? And so there was that abuse.

Najera: There were medical experiments on the contraception pill in Puerto Rico that went sideways. Because contraception pills cause a higher rate of blood clots and other things. And when they were perfecting that, there were side effects, and people in Puerto Rico — remember that the people of Puerto Rico as well had an island, a beautiful island that I’ve been to, called Vieques and it was being bombed by the U.S. Navy for target practice. So you have that history in the Latino community. You have the fear of those who are undocumented, “No, I’m not gonna put myself on any registry. I’m not going to register for the vaccine. I’m just going to keep me laying low because I don’t want to be deported.” And you have all of that going on as well. So it’s understandable.

19:40, Laguaite: Dr. Najera touched on some of the abuses indigenous people in particular face at the hands of the U.S. as well.

19:47, Najera: And then you get to the Native Americans, right? And then the Trail of Tears, the forced removal from their land, the taking of their children to make them whiter — things of that nature. And again, it’s like, “OK, well, yeah I understand why you wouldn’t you trust what is called the Indian Health Service to give you the vaccines that you need.” And it’s sad because they are the ones that are being affected the most by COVID-19. And they are the ones who are being targeted the most as well by anti-vaccine groups. You see it all the time. You see these luminaries, anti-vaccine luminaries reaching out and saying, “We’re doing this for social justice. Stay away from the vaccine,” when in fact, they’re doing the opposite. They’re causing more death and disability in those groups, as we know. I don’t know what the solution to that would be. I sometimes I think that a model like South Africa of the Truth and Reconciliation efforts that were done after apartheid kind of really worked, and having something like that here where we as scientists sit down and say, “Yes, our predecessors were horrible to your predecessors, even to yourself and we don’t want to do that anymore.” And including more people of color, a little bit more diversity in the scientists that speak out.

Najera: I was I was watching the Congress hearings, just now Dr. Fauci all the white guy, right? So while he is very appealing to a scientist or geeks about him, he doesn’t really have that impact with a young urban African-American kid who’s barely getting by who probably has lead poisoning from the house that he lives in or she and so “Fauci? Fauci? Who’s that? I have other people that I look up to who don’t encourage me to get vaccinated.” And so yeah, it’s a struggle. It’s a struggle. We’re making inroads through scientific means: focus groups, surveys, we recruit marketing people who know how to sell things to people because that’s what we’re doing. Basically, we’re selling the vaccine without actually cashing in on it. Contrary to popular belief, so it’s an issue and it’s rough.

21:43, Laguaite: The history behind and surrounding the polio vaccine is a good example of health inequity regarding vaccinations.

21:51, Najera: I wrote an article on medium.com called when the vaccine — and I wrote this back in September of last year — and when the COVID vaccine rolls out, it’s not going to be equitable, is it? I use the example of the polio vaccine. When the polio vaccine rolled out, the kids who were left out in the cold were the African-American children, for the most part, because this was done in collaboration with schools. So you’re targeting children. So who better to target than the schools or to partner with than the schools, and this was shortly after Brown v. Board. So the schools were not desegregated yet, although they were on their way. And so who benefits the most? White, affluent children and even there’s some evidence that even white poor children in the South did not benefit from the polio vaccine as much as their white, affluent counterparts. And so you know, you have those inequities. Time after time it happened. Then with the polio vaccine, it has happened with the HPV vaccine. At the very beginning of it, if you didn’t have insurance, you couldn’t get it. And so who doesn’t have insurance? More often than not, poor individuals who are people of color, who, because of their lack of health insurance, don’t go and get their annual exams, and they end up being the women who have cervical cancer because of something that was completely preventable, and completely treatable, and then it got out of control. So you know, those kind of issues  always pop up.

23:03, Laguaite: It’s these inequities and discrimination within medical settings that led to what Dr. Najera calls public health 3.0.

23:11, Najera: We call it public health 3.0. So public health 1.0 was going after these infectious diseases, so, potable water to get rid of things like cholera; sanitation, to get rid of communicable diseases; STI, sexually transmitted infections. So that was probably 1.0. Then we moved into public health 2.0 and we went through after chronic diseases, cancer, diabetes, obesity, things like that. Mental health. And then now we’re moving into public health 3.0, where we are bringing it all together, along with the social determinants of health, you know, where do you live? How much money do you have? How old is your house, things that you cannot really control that much also influenced your health. And so that’s where we are now, where do you come from? What zip code do you live in? And there’s this whole campaign about zip codes, and they say, “Oh, what zip code you live in determines your health.” It’s called the ecological fallacy and epidemiology, but I can see where they’re going. I’m not going get too technical on that. But yeah, yeah, we’re probably health 3.0.

Najera: We’re looking at the environment and influence social environment, physical environment, and environment to comment affects public health, and in that vaccines play a role. Because as climate change happens, for whatever reason, it happens, right? When you have that nonsense debate going on, as climate change happens, you have more mosquito-borne diseases Zika. Taught us a lesson back in 2016. We’re going to need a vaccine for that, eventually. Yellow fever: there’s a safe and effective vaccine for that. And then dengue fever, there was a vaccine, but it had to be pulled from the market because it was causing more trouble than the disease itself, mostly in children. So that needs to be refined. As that happens, as populations migrate, we’re going to need to catch them all up on their vaccines before we integrate them into the school systems. We see that with the kids at the border right now, even though there’s really good vaccination programs in Central America and Mexico, they still need to be caught up with some of their vaccines. A couple of years ago, when measles was going around, there was a shelter in Texas that just had a huge measles outbreak. They had a couple of children who died from influenza. Things that don’t usually happen.

25:14, Laguaite: The political environment also has an effect on public trust in vaccines.

25:22, Najera: On the one hand, the Trump administration botched the response to COVID-19 kind of. Things could have been much better. On the other hand, they did throw a lot of money at the vaccine development, and that’s probably why we have a vaccine so fast, although we could talk about mRNA vaccines being around since 1990. But you know, it’s part of that. There was that to be said. Because people like to say that to me sometimes, like, “Can you say anything good about the Trump administration and COVID-19?” Yeah, the vaccines. Operation Warp Speed. And that’s it. So yeah, the political environment as well has an influence in all of this and going back to the anti-vaxxers, they latch onto those things. You know, we used to think that anti-vaccine people were mostly suburban crunchy granola moms, right? More likely than not: liberal, well educated, college-educated. Blah, blah, blah. But now it’s shifted. Now you see in anti-vaccine groups and individuals targeting right-wing, anti-government from supporting people for their fundraising efforts that goes back and forth like that as well in the future if it suits them, they’ll go after a whole other group because that’s kind of how they operate. They try to get to the to majority of people that can fill their bank accounts.

26:34, Laguaite: I also wanted to ask Dr. Najera about mRNA vaccines and the history behind them. Although there’s lots of discussions today about these types of vaccines, they’re not exactly new.

26:46, Najera: Yeah, so back in the 1990s. Well, actually, before the 1990s, scientists figured out that your cells, when you had to make a protein, or when your cell had to multiply the DNA in your nucleus, the nucleus of your cell would send a signal out to the rest of the cell: “Hey, started making insulin,” for example. And that message went in the form of mRNA — messenger RNA — and messenger RNA goes out and gives you instructions, a template for a protein and then your ribosomes make the protein. Insulin, saliva, tears, whatever you need to make. It comes in that single hormones, etc. And in the 1990s, scientists figured out that there were these mice who had what is called diabetes insipidus, they’re missing an antidiuretic hormone. And they said, “Well, what if we were to send the message the mRNA in there and say, “Hey, make the make the hormone.” And so they did. And they were very successful at it. And it started from there.

Najera: The problem was that they couldn’t scale it up because more advanced immune systems like apes, as we are, would take the mRNA and immediately attack and get rid of it before it could do its job. Then in 2005, while eating — this is my theory — while eating M&Ms, something somebody figured out like, “Oh, what if we put the mRNA in a shell?” And so they did it. They put it in lipid nanoparticle shell. Lipid is fat. And so that way, it would elude the immune system and get to the cells where it needed to work. The mRNA gets to the cell, the cell absorbs it. And then the mRNA signal says, “Hey, make protein hormone antibodies against cancer cells.” That’s what it was being used for. Then COVID-19 happened.

Najera: Shortly before COVID-19, they were already working on other infectious diseases. They said, “Hey, what if we tell the cells to make the spike protein that looks like the spike protein on the virus and that way, the cell will make that protein and your immune system will react against that protein and make antibodies in your you’re good to go.” So I said, “OK, let’s let’s get a shot.” And instead of going sequentially, they — because of the money that came in from Operation Warp Speed — they did everything they had to do at the same time. So at the same time that they were perfecting the lipid nanoparticle, they were recruiting people for the vaccine trial, at the same time that they were splicing the mRNA with the proper signal that they needed, they were already looking at people’s immune responses to other to the previous infection from COVID. This is 6 months already into the COVID pandemic. They said, “OK, this is the mRNA signal that works. This is the outcome of it. This is the safety of the preservative. So let’s just go and run with it.”

Najera: My wife actually participated in the Moderna mRNA trial, starting in July. And she reports the same symptoms that I got, when I got the vaccine of my arm. It really hurt the first one, the first shot. Second shot, I actually got like a flu-like illness and was laid out. And if you know the man flu, it’s pretty bad. I was laid out for a day, but then feel fine by the third day. Same thing with her. And so the mRNA vaccine is just a new technology. Now we’ve hit this new leap with the mRNA technology, we don’t need to grow the virus in the lab, we just need to know some lab in China opened up the virus and did the DNA analysis or RNA analysis on it and gave us a sequence and then here in our lab, we put the mRNA together, we don’t even need to grow the virus, we don’t need to worry about biosecurity here. We just have the mRNA we package it and that’s the vaccine minutes good to go. So that’s a that’s a heck of a leap, right? You don’t need these enhanced biosecurity labs all over the place; you just need to wherever the disease pops up, you want to you want to look into it. You can text message the with the code of the virus, it’s that short. ATC GTT. I guess it’s you because it’s RNA. So, yeah, this is a heck of a leap because now, we can crack open any virus out there any bacteria out there, create the mRNA and then our own cells will create the proteins against which will react and give immunity.

Najera: And that is huge. I personally don’t invest in BioPharm, biopharma or Big Pharma to not have conflicts of interest. But I’m very curious and very enthusiastic about what is coming down the pike because a lot of vaccines are going to be made this way now. It’s super safe. It’s quick turnaround. So if anything else pops up on the horizon, another pandemic we’ll have a vaccine just as fast if not faster, and it seems to be it seems to be working right at the county where I work. The number of cases and deaths and long-term care, which were the first ones to get vaccinated have dropped precipitously, and they’re super low. The safety profile is excellent as well, you know, almost 100 plus million people vaccinated in the United States, nothing like what we saw with Johnson & Johnson.

31:28, Laguaite: We recorded our conversation a few days after the Johnson & Johnson vaccine was paused. I asked Dr. Najera for his take.

31:37, Najera: Johnson & Johnson, there’s issues there that are being sorted out, which is actually a good thing. You know, it’s a good thing that six cases of 7 million people actually triggered this pause, because that means that the system is working, that the system that anti-vaxxers say is nonexistent for safety, it actually exists. And it’s actually there. You know, I tweeted out a few anti-vaxxers. And I said, “Well, you’ve said that nobody’s watching out for safety. But yeah, this happens with Johnson & Johnson, do you have any comment?” and it’s crickets or I get blocked. So yeah, you know, we’re into a brave new world of vaccination with mRNA. And hopefully, that’ll make vaccines even safer, because in the future, I can swab myself send it up to send out to a company like we do now with 23andme and other others, and they can look at the genes that’ll make up my immune system and say, “OK, you know what? We were going to tailor the vaccine to your immune system, so you don’t get hives, you don’t get a bad allergic reaction, a fever, etc.” You get immune, but you don’t get all those other things with it. Personalized vaccines in the future. It’s coming, and I’m super excited about it.

32:40, Laguaite: Some people are left wondering why they need to get a COVID-19 vaccine, especially if they’re not at high risk for the disease. Dr. Najera shed some light on the importance of getting vaccinated.

32:51, Najera: For the most part, COVID is... this is the honest truth, it’s a benign disease, right? It’s not the 5%, 10%, 30% mortality rate that we see with other diseases. That’s all fine and good. Children are not being affected. My daughter has been going to daycare hasn’t had any issues. On the other hand, it’s not a benign disease. Enough people are dying and people are getting sick from it. We have the long haulers from COVID and we don’t really know what’s going to be the long-term effects of even an asymptomatic infection. We’re learning more from it, you know, but why? Why do we even need to go through that if we can end it all with a vaccine? For other coronaviruses and the human populations, they cause head colds, they cause severe respiratory illness at times, not not a big deal. We kind of become adapted to them. This is probably going to be the fifth one that does that. But why if you can avoid a cold a year, you know, why not? When something that it’s very safe. It’s very effective.

Najera: We humans are really, really bad at estimating risk. When the 737 aircraft had issues, there were two crashes. Terrible, sad. A few 100 people died. That’s not good. But at the same time, millions of people traveled on those planes without any issues. We grounded them, right? We grounded them. I know of people who didn’t want to fly anymore, not even 737. That was another time. Not that not the one that had issues. They just didn’t want to do it. You know, they went online when they bought their tickets and made sure that it wasn’t a 737 flight, they were getting. Flying is the safest — to quote Superman — is one of the safest ways to travel. But we get scared by those instances. There’s about 30,000 people a year that die in car accidents, and yet we jump on a car all the time. I drive. I commute to work and back and I never think about those 30,000 people that have died and it doesn’t horrify me. I guess there’s something about falling out of the sky that horrifies people. And so you know, risk and that’s that’s the kind of thing, a lot of anti-vaccine or vaccine-hesitant parents are talking to me and they say, “There’s a 1 in a million but why be the one the 1 in a million?” And I said, “Well, you had more risk of getting killed on your way to groceries, than then you do on your way to getting the vaccine” and they kind of like, you see the wheels turning. And so while on the one hand, yes, it’s true when people say, “Oh, it’s less than 1% of people who get COVID will die.” Yes, it’s true, but enough people are dying, it’s going to become endemic if we don’t do something about it. So it’s going to cause disease in the future. More children have died from COVID during the pandemic than that from influenza on average, in the last 5 years. So it’s obviously affecting children at some degree. Just why go through that if we can get out if you can get a shot and that’s it and we ended and it’s over?

Najera: The other thing is the you have to think long-term. This is not going to be our last pandemic. We had one in 2009 and we got super lucky because we already had testing for flu. We already had the flu vaccine ready to go. We had a certain time of year that although it doesn’t work as well as it should, it does prevent severe disease. So all those things were in place and you know, most of us were already used to getting a flu shot every year so there wasn’t as much hesitancy there. And so we got super lucky. This one we got kind of lucky that even with a relatively not good response from our government, we still managed to not get a lot of people killed, although half a million, still a lot. We’re sort of lucky that mRNA technology exists. And so this is all a learning towards the next thing.

Najera: One of the things that keeps me up at night, it’s called Nipah virus out in Australia and Southeast Asia in one of its cousins. They’re both cousins of rabies, and they’re airborne. And so you can imagine airborne rabies, that does keep me up at night. Because if we had one of those pandemic epidemic of that up to up to 30-70% mortality rate, that’s an extinction-level event, right? And so when you say, “Well, what is me getting a vaccine now have to do with, if something like that happens?” Because now we get to practice for that happening, should it ever happen. And the chances of it happening are increasing because people are moving into the animal habitats, animals are moving into where we live, we’re coming into close contact with bats and with wild animals that carry these things. And you could have a situation like that. And so we need to be prepared. As a society, I need to, as an individual, I need to learn to get my vaccines on time to follow my physicians’ advice, it’s just part of being a responsible part of society.

37:24, Laguaite: For those who are nervous and haven’t gotten their vaccines yet, but are eligible, Dr. Najera recommends it.

37:30, Najera: So, it would be very easy for me to say to not be afraid, right? Like I know the science. I’ve read the books, and I’ve done it. I crunched the math. I’ve taken the vaccine myself. My wife took it as well. But I must say that when I went to take my toddler to get her first shots when she was a baby, I did kind of have a visceral response. When I saw those, the needles go into her like, it did make me afraid. And like for a quarter of a second, I thought, “Well, what if I’m wrong? What if the science is wrong?” And then and then the rational brain took over and said, “No, no, no, like, you know it’s safe. She’ll be OK.” The same thing with me when I do these, you know, I do these interviews and stuff like that. A lot of them are in Spanish. And I try to connect to people in that way, saying, “Look, I’m an immigrant. I grew up in Mexico, I’m here now and I totally get it. I’m you.” I did I, for the longest time, even though I came here legally, I didn’t want to get on any registry because I had heard about the importation. I heard about all these things. And so you know, people were like, “Oh, yeah,” and we hadn’t, and then wanted to get the vaccine. So that those are the kind of conversations a peer to peer more than authority on down. That seemed to work. And so in that we in public health, we are reaching out to community leaders to religious leaders, and others and partnering up with them to deliver those messages.

38:45, Laguaite: Because the COVID-19 pandemic was so politicized, some experts think that added to the fear of vaccines and the public mistrust surrounding them.

38:54, Najera: I think that we need to put things aside that get in the way or make us fearful. For some people, it’s politics. You know, they like to believe President Trump when he says, “I got COVID and I got through it fine.” You didn’t. You ended up in the hospital and you were lucky in that, by the way, you’re the president of United States. And by the way, you’re a millionaire. You know, other people cannot be that lucky. We need to put aside the politics. We need to put aside the skepticism in science. And there’s a lot of that rolling around, too. It’s shifted a little bit it went from, “No, there’s no such thing as global warming. No, there’s no such thing as climate change” to “OK, maybe there is, but we’re not causing it.” So maybe we can keep pushing in that direction of like, “No, there isn’t, we really should get off of fossil fuels.” So you know, we need to get rid of those things. We need to put those things aside, but it’s a very difficult conversation to have. And we tend to again, we tend to listen more to our peers. In your example, your dad is more likely to listen to people who are like him in every sense of the word. And so if you can find somebody the counterfactual to your dad, somebody his age, socioeconomic status, his family history, etc, who has gotten the vaccine, use them as an example. And that would probably push him more than an authority figure saying you must get your vaccine. And even you, you might even be an authority figure in that equation. So somebody who are their peers, and we see this all the time we see it with gun safety. So people who the government says, “Hey, you probably should put away your guns because the kids might get it.” “Oh, no, you’re trying to take away my second amendment rights.” Fair enough. But then when you have the local Gun Club, sell gun safes, or sell gun locks, they buy it up, like, “Oh, yeah, absolutely. So it’s a good idea. I thank you for thank you for doing it.” It’s super interesting, right from a bystander have like, what happened, what just happened? But that’s how human psychology works, and that the big liberal sociology works in that. Yeah, we tend to listen to our peers and so that is what I would say to somebody. Like if your dad came to me and said, “I’m really worried about the vaccine,” I would say, “Well, look, there’s so and so and so and so, who are of your generation, they would understand and they got their vaccine, why don’t you listen to them?”

41:08, Laguaite: Dr. Najera also emphasized the importance of those untold stories in the history of vaccines.

41:14, Najera: I think there’s a lot of untold stories in the history of vaccines. A lot of people that were involved in, we make the mistake sometimes of glorifying one person out. You know, the Jonas Salk for the polio vaccine. And in doing that, we exclude a lot of people from that discussion, because I didn’t know somebody might say, “I didn’t go to college, I’m not a doctor, I’m not white, I’m not blah blah blah, I’m not that person.” But the history of vaccines is very varied and very rich. And so you have  Onesimus, who was enslaved, was African, became African American. You know, he was deeply involved in the history of it seems very, very influential in that. There are women there are, there are LGBT people who were involved in it. And I think telling those stories, and it’s coming. What the project is also aiming to do in the next few months or next few years, telling those stories also matter. Because it also helps avert some of the influence that anti-vaccine people have. If you look at the anti-vaccine movement in the United States, they’re mostly white men or white women have an upper socioeconomic status. They do not represent the variety of people in the U.S. and but they still reach out. And they’re doing a really good job of marketing like that. And so I think we can counter with the stories of men and women and people of color and LGBT community, people who contributed to the history of vaccines that have led us to this moment when we can really for the first time, probably, in the history of humanity, stop a pandemic without letting it run its natural course. And I’ve heard the next one. And so yeah, I think that’s worth saying that people should really research that when people say online, do your own research. Yeah, do your own research, but look into the history of vaccines, as it relates to people who are like you and who are not like you, and the contributions that they made, because those are also interesting stories and that game that we can model towards our own understanding of history and understanding of science.

43:16, Laguaite: This was such a great conversation. I really appreciate you taking so much time to talk to me.

43:20: Najera: Yeah, no problem anytime.

43:24, Laguaite: As of June 5, 2021, the U.S. has administered 301.6 million doses and that number will continue to rise. For us vaccinated folks, it sounds like the next thing we’ll need to do could be the COVID-19 booster shots, but scientists still don’t have many answers about that yet. For now, the CDC recommends that everyone 12 years old and older get a COVID vaccine for children 12 and older the Pfizer vaccine is the only one available.

43:56, Laguaite: This has been “To Health and Back.” Thanks again for joining me on this health history journey. Tune in next time for a discussion on the politicization of COVID. Until then, don’t forget to rate the podcast and subscribe. Feel free to shoot me an email at healthandback@gmail.com and I’m also on Twitter, Instagram and Facebook as @healthandback. Thanks. See you next time.