This blog was written by Mauri Rapp, CHILD USA’s Content Manager, after her Q&A with Dr. Paul Offit on the importance of child immunizations, the alarming trend of anti-vaxxers, and how education is the key to ensuring the safety and health of our children. 

Dr. Paul Offit is the Director of the Vaccine Education Center, attending physician, professor of pediatrics at Children’s Hospital of Philadelphia, and an internationally recognized expert in immunology and virology. In 2020, CHILD USA presented Dr. Offit with the Public Educator Award for his work in shining the light of truth and science on children’s vaccinations and he is a valued member of our leadership team.

We thank Dr. Offit for talking with us today and for all the work he has done to help fight for children’s rights. You can follow him on his Substack “Beyond the Noise” at Beyond the Noise | Paul Offit | Substack.

“Who is Watching Out for Those Children?”

Mauri Rapp: Why is it so important for children to be immunized?

Dr. Paul Offit: Immunizations have caused us to live 30 years longer than we used to. Instead of having to watch thousands of children die every year from diphtheria, or having to watch 8,000 or so children die every year from whooping cough, or having to watch as many as 30,000 children be paralyzed every year by polio and 1500 killed, or watching 25,000 children every year have meningitis or sepsis from home office influenza type B, we’ve seen a dramatic reduction in pneumococcal invasive disease, which again causes meningitis or bloodstream infection. All of that can be prevented by vaccination.

I think the hardest thing for me in all of this is there’s so much medicine we don’t know—that there’s so much we can’t do. But this, we know. This, we can do. It’s very hard to watch parents choose not to vaccinate their children and choose to potentially put them in harm’s way. Who is watching out for those children?

MR: That leads me to my next question perfectly. Why don’t people trust vaccines? Why wouldn’t they want to prevent their children from getting sick?

PO: I think, at some level, the skepticism is understandable. In the first few years of life, we ask parents to get vaccines to prevent about 14 different diseases, which can mean as many as 25 inoculations in the first few years of life using biological fluids most people don’t understand to prevent diseases most people don’t see. So, I understand how there’s pushback. But the stories are always the same. If you look at these parent advocacy groups, like Families Fighting Flu, or Meningitis Angels, or National Meningitis Association, those parents all tell the same story. Now, I’m talking about in the United States—the story is, ‘I can’t believe this happened to me.’ They become vigorous activists for educating about the disease and the importance of the vaccine. It’s a game of Russian Roulette, not unlike, say 100 years ago, where there were far fewer empty chambers. There’s far more empty chambers now, but why play that game?

MR:  I read your book, Bad Faith, over the weekend. I have to tell you, as someone who grew up reading Stephen King, that was probably the most terrifying thing I’ve ever read. So there’s obviously a religious component for a lot of mistrust, or of not wanting to have any kind of medical intervention. But when people don’t have that religious background, why might they eschew medical interventions?

PO:  Well, again, I don’t understand the religious basis of choosing not to get them. To me, religion teaches you to care about your children, care about your family, and care about your society. Why is putting all of those groups in harm’s way a religious act? It seems to be a completely unreligious act. You could argue that the only religion that says anything about vaccines in its major texts is Christian Science, with science and health as a key to Scripture. That’s it. All the major religions like Christianity, Judaism, Muslim—all those texts were written well before vaccines were ever invented, so it doesn’t make any sense. When it comes to religion, we all throw our hands up and stand back. When people say, ‘This is how I choose to practice my faith,’ no one dares to challenge that, even when it puts children in harm’s way.

But in answer to your question about other than religion—interestingly, the other sort of pop-off to school vaccine mandates is a so-called philosophical exemption, which often makes no sense. “Phillia” is love, right? As in, Philadelphia, City of Brotherly Love. “Sophos” is wisdom—where is the wisdom that says it’s better not to get a vaccine than to get one?

And then the other term they choose, which is equally incomprehensible to me, is a personal belief exemption. Vaccines aren’t a belief system. They’re an evidence-based system, and the evidence is clear that the vaccines can help save your life. It’s not a belief system. Religion is a belief system. Vaccines aren’t a belief system any more than gravity is a belief system.

 MR: Is there any reasonable reason not to get vaccinated. I know that sometimes people might not be able to get vaccinated for medical reasons? Is there any excusable reason other than that?

PO: Other than medical reasons? No. There are some people who are allergic to specific components in vaccines: gelatin, latex, et cetera, that’s certainly true, or that somebody has had a bad reaction to a previous vaccine that can be explained based on that vaccine. But other than that, no, it’s just a preference that some parents have not to do it.

I saw a couple in our hospital last week when I was on service, and they hadn’t vaccinated their two young children. I went to them and I said, ‘Here at Children’s Hospital of Philadelphia, we think vaccines are a good thing. Is there anything I can say to you that would change your mind?’ I’ve learned to say that early on in the discussion because it’s not sensible for me to waste their time and my time for the discussion that’s going to go nowhere. And they were honest, they said, ‘Nope, there’s nothing you can say to us. We’re not going to vaccinate our children.’ And you feel awful sending them out of the hospital in a world that’s still full of pneumococcal or chickenpox. I mean, those diseases still occur, and Haemophilus Influenza still occurs. Pertussis is fairly common, mumps is still out there. So you’re taking an unnecessary risk.

It’s just like with COVID. I mean, when the interviews were done with people who were dying of COVID, and who chose not to get vaccinated, they regretted not getting vaccinated for the most part because they never thought it would happen to them. That’s what these parent advocacy groups are about—that’s that’s the subtext: ‘I can’t believe this happened to me’… until it happened to you.


MR: And speaking of COVID, we did see a notable decline in immunizations during COVID. Do you think they’re going to increase—is that, maybe, because people just couldn’t get to their doctor? Do you think we’ll see (vaccination numbers) increase in the near future, or do you think that we’re maybe stuck a little bit?

PO: I was dead wrong about how vaccines would be perceived during COVID. That virus came into this country in early 2020 and started killing thousands of people a day, and we had nothing. We didn’t have antivirals till October, we didn’t have monoclonal antibodies till November, and we didn’t have vaccines till December. All we had was limited human-to-human contact for a virus that was killing thousands of people a day. I thought vaccines would be seen for what they were, which is to get out of this pandemic—a lifesaver! They are a lifesaver.

I couldn’t wait to get vaccinated. I couldn’t wait. And I’m on the FDA Vaccine Advisory Committee. I would argue that I was fully informed about this vaccine. I reviewed the 300 pages that were given to us before we recommended authorization for the use of the Pfizer vaccine, and on December 10, 2020, the same number of pages for the Moderna vaccine week later. I think I knew everything at least that was known at that time, which doesn’t mean, you know, everything… The question is, did I know enough? I felt I knew enough to get that vaccine and couldn’t wait to get it. I finally got (the vaccine) at the end of December 2020, and I thought everybody would feel exactly the same way. We vaccinated about a million to 2 million people a day. By December of 2021, we’d vaccinated 70% of the US population, and THEN we hit a wall.

Thirty percent of the population in this country simply refused to be vaccinated. And, as a consequence, estimates are between 200,000—300,000 people lost their lives unnecessarily. They lost trust in us, I think, 1.) because there’s just a general loss of trust, not just in the FDA and CDC, but in the Department of Justice, you know, the FBI, etc. But 2.) the second reason is that we leaned into a “libertarian left hook” by mandating vaccines. That was seen by at least a certain percentage of the population as massive government overreach: ‘Don’t tell me I can’t go to my favorite bar, don’t tell me I can’t go to my favorite sporting event, don’t tell me I can’t go to my place of worship, don’t tell me I can’t go to school or work because you, the government, are making me get this vaccine.’ And that I think caused enormous backlash, so much so that anti-vaccine activists have never been better funded, and in many ways, never been more influential.


MR: You talked about the misinformation business on your Substack a couple of weeks ago, and how it’s generally funded and led by a handful of people. What drives them? Is it money, or do they actually believe what they’re touting?

PO: There’s a group called the Center for Countering Digital Hate, which looked at who was getting most of the misinformation or disinformation out there. Misinformation, at least by my definition, is information that’s wrong. Disinformation is information that’s provided by people when they know that it’s wrong. There were 12 people or groups that fell into that category—I think the New York Times ultimately labeled them the Disinformation Dozen. The biggest source of funding for them was the alternative medicine industry—the dietary supplement industry—because a lot of them are big promoters of alternative medicine. Which is, again, a chance to promote something as being a cure when it isn’t, or certainly hasn’t been proven to be, a cure. People like Joe Mercola, who’s just a big alternative medicine promoter, and others, like Mike Adams, the “Health Ranger”—they’re big promoters of alternative medicine, and they’re all funded. If you look on their websites, you can see that virtually all of them are funded by the alternative medicine industry, which is a term that’s always bothered me. If alternative medicine works, it’s medicine. If alternative medicine doesn’t work, it’s not an alternative.


MR:  It seems, from what we hear on the news, that this issue is very concentrated in the United States, that people are becoming anti-vax, and more and more specifically, coming from the Far Right. Is that true? Or do you see this in other countries as well?

PO: You definitely see it in other countries as well. There’s a woman named Heidi Larson, who runs something called the Vaccine Confidence Project out of London School of Health (and Tropical Medicine), and she looks at all these different countries to try and answer the question “Who trusts the government least of regarding vaccines?” We’re actually not number one, you’ll be happy to hear. France is number one, but a number of Western European countries fall into this category. And then as well, even some developing world countries just don’t trust the government to do the right thing. And then there are countries like Scandinavian countries where there aren’t mandates, and nonetheless, they have very high vaccine rates because they trust public health agencies, they trust the government. I know it’s hard to believe that anybody does, but they do.

MR: Where do you see this going? I know that’s a very broad question, but do you think things are going to get worse before they get better? I mean, we’re seeing outbreaks of measles like we haven’t seen in years. When I was growing up, you got a measles vaccine and that was just what you did. No one I knew ever had measles. So do you think it’s going to get worse before it gets better?

PO:  When I grew up, everybody had measles. In 1957, you had measles. We had 3 to 4 million cases a year, 48,000 hospitalizations, and about 500 deaths every year. So, I had measles, and I remember how sick that virus made me. The measles vaccine came in in 1963, and we eliminated measles from this country by the year 2000 because we had enforced school mandates and had a two-dose regimen. That was borne of outbreaks between 1989 and 1991. The second dose was recommended in the early 90s because between 1989 and 1991, we had 11,000 hospitalizations and 166 deaths, and no city suffered this more than Philadelphia. In the winter of 1990-1991, we had 1400 cases and nine deaths in the city of Philadelphia. This city was in a panic. Schools canceled trips to the city, people were scared to come into the city—it was an absolute panic. It centered, as you know, on two fundamentalist churches: First Century Gospel and Faith Tabernacle. They were the epicenter of this, and they accounted for about five hundred of the cases and six of the deaths. The remaining cases—the remaining 900 cases and three deaths—were in the surrounding communities. It was a nightmare. I lived through that. I remember it well, it was scarring.

So what do I think is going to happen? I think it’s going to get worse before it gets better. I don’t think people are scared. And you’re right. I mean, we talk about the roughly 113 cases in 17 different states or jurisdictions now, but that is a blip compared to where we were in 1989 to 1991 when we also had a vaccine. So I think it’s going to have to get worse. I think what’s going to have to happen is you’re going to have to have 1,000 to 2,000 cases. When you get there, then you’re going to start to see measles deaths again, and children will once again die from measles. And I think when that happens, there will be an outrage and people will push back again. I hope so. I mean, I hope we push back. But it is sad to me that we’re going to have to probably get to that point before we realize the dangerous game we’re playing.

MR: What is the ultimate solution? And I’m sure that’s probably something that you’ve been arguing for and thinking about for your entire career, trying to get people to see why this is important. Does it come from the government being more trustworthy? Or is it something that can be solved on your level (as an immunologist)?

PO: Well, I don’t think the federal government solves this problem. I think, like all politics, vaccine education is local. And so, a couple of things. I think, 1.) It would be good to teach about vaccines in elementary school and middle school so people can understand them. We had a fellow who was in our division years ago who’s now an attending physician at Harvard, and she had a five-year-old nephew. She was trying to explain to her nephew why he was getting vaccines because he was about to get four or five shots when he went to the doctor’s office. She spent a lot of time explaining what the purpose of all this was. So she takes him to the doctor’s office, and she’s waiting outside nervously while this boy is in the doctor’s office. And then the door opens, he steps out, he throws his hands up in the air and he screams ‘I’m immune!’ That’s number one: educate children about what vaccines are, how they work, and what the point is.

Then, 2.) I think you have to have local leaders: people who have influence in particular communities. Philadelphia is a perfect example. We had Ala Stanford, who was an African-American physician at Temple, who took it upon herself to form the Black Doctors COVID Consortium. They went into North Philadelphia, primarily in Black and Brown communities, and got 50,000 people vaccinated because she and her colleagues sat in people’s living rooms and explained to them how this all works. Many of them didn’t have doctors, and now they have someone who looked like them that they could trust. And I think you can have 1000 Ala Stanfords that can make a difference.

MR: So meeting people on their level and educating them instead of just having Big Brother tell them what they should be doing.

PO: Exactly.

MR: What else do you want people to know about getting immunized? What else is so important that people should know?

PO: I think the thing about vaccines is that when you get a vaccine, nothing happens. I mean, it’s not dramatic. I mean, not shockingly, my children are fully vaccinated. But I never really thought that we’d get any of these diseases because 1.) as a parent, that’s too awful to think about, but 2.) I think the odds are they’re not going to get them but they could get them. I’ve certainly seen many of these diseases, so it was easy for me to know to vaccinate my children. In the end, we just have to be able to explain that there are no risk-free choices, that there’s only a choice to take different risks. The goal as a parent is to put your child in the safest position possible and (immunization) does that.

I think we can even be more dramatic, actually, about what these diseases look like and have parents tell their stories about what happened. They watch their children suffer them. I mean, really dramatic. I don’t think you can be too dramatic in this. I remember when the varicella vaccine, the chickenpox vaccine, first came out in 1995, the uptake of those first few years was very slow. People thought of the varicella chicken pox virus as a rite of childhood passage: “I had it, I’m fine.” Although, I would like to point out that 75 to 100 people died every year of chicken pox. Those people were never around to tell their stories.

So then Merck sort of had a much more heavy-handed campaign. They showed children who died of chickenpox, they showed hemorrhagic chickenpox, which was gruesome, and they were really criticized for that campaign, but that actually pretty dramatically increased rates.

Sadly, it is fear that compels people to act.