..
Frank Han MD Pediatric/ACHD/GUCH Cardiologist @han_francis
UIC Adult Congenital and Pediatric Cardiologist.
Bill Ackman @BillAckman
CEO Pershing Square, Co-trustee @PershingSqFdn
..
..
This pediatric subspecialist responds to Ackman’s comments, line by line:
1) you could create a drug in a much shorter period of time, a year or two, rather than 10-15 years, and the total cost to get it approved and marketed to patients was a fraction of the cost of a typical drug. ____________
Some vaccines actually take extremely long times to create. For example, we just now, in 2022-2023, have FDA approval for an RSV vaccine in certain age groups – this vaccine has been worked on for decades https://fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine . Many vaccines take much longer than 2 years due to the amount of time required to get. Example 2: The pertussis vaccine took > 100y to get to its modern incarnation https://academic.oup.com/jpids/article/8/4/334/5359449.
(2) the new drug is prescribed for everyone, regardless of their health, and therefore the market for the drug is every newborn or potentially everyone on the planet.
____________
The reason that vaccines are recommended for almost every child is because every child on the planet is potentially susceptible to each of our major vaccine preventable diseases. While it looks like traditional vaccines net pharma a lot of money, they are one of the least profitable products pharma makes compared to things like cancer drugs and biologics.
(3) the drug is prescribed for everyone regardless of their age or consent and they need to take it in order to attend school or keep their job, and the gov’t pays for it.
____________
An infant cannot provide informed consent that they don’t want a hepatitis infection. We protect kids from vaccine preventable diseases because those diseases can harm kids before medical aid can get to them (and many of them like hepatitis B, have no curative medications). We vaccine college students against meningitis because these are one of the places where these outbreaks most commonly occur.
(5) the drug needs to be taken every year regardless of the health of the individual who takes it. ____________
No, most vaccines need periodic boosters due to waning immunity, but only a small fraction of the vaccines are once yearly like influenza. Vaccine researchers actually are aware of the shortcomings of the influenza vaccine and are trying to make a better vaccine that circumvents the problems of the yearly flu vaccine.
(6) the drug companies who manufacture these new drugs are exempt from liability for these drugs even if they cause serious harm or death.
____________
It is actually possible to sue a pharma company into cessation of vaccine production. A group opposed to the Lyme vaccine managed to successfully get enough negative attention against LymeRIX that it no longer exists despite lack of evidence that the possible side effects may be concerning https://time.com/6073576/lyme-disease-vaccine/ . With a lack of vaccine, vaccine preventable diseases nearly always have a chance to have a resurgence. It is easy to dismiss these diseases when you have never witnessed them.
____________
If you were a citizen, however, you would want the above drugs to receive the highest scrutiny for safety and efficacy, and you would want longitudinal studies to understand the long-term effects and the potential cumulative effects of these drugs, in particular, on children
____________
This is precisely what a phase 3 clinical trial, post marketing surveillance, and international pharmacovigilance are for. I can’t help @RobertKennedyJr if he is upset that the vaccine regulatory agencies produce results that he doesn’t want to hear – which is a different issue. I could understand if a CEO not in the medical field hasn’t reviewed the primary source literature on vaccine safety monitoring, but we can certainly do that together if needed. That RFK pretends the safety monitoring hasn’t been done, doesn’t on its own mean it hasn’t been done.
____________
Now, if the num
ber of doses of these drugs taken by children increased from 3 to 72 in the last 30 or so years ____________
The 72 number is arrived at from duplicating multiple vaccinations for the same virus/ bacteria. The reason it has increased is because vaccine researchers have figured out a way to make more vaccines for more vaccine preventable diseases (note that military get even more vaccines than civilians get). RFK chose the higher number just for pure emotional effect, not that the 72 actually signifies anything. ____________
and over the same period there was a massive unexplained increase in the percentage of kids that suffered from debilitating diseases like autism and other less debilitating, but concerning issues, like allergies and eczema, you would look deeper until you understood what was causing the massive increase in these issues.
____________
There are professi
onal researchers in the field of allergy and autism that are doing exactly this. Autism is at its most basic level a difference in brain wiring and can be found even before baby is born https://scitechdaily.com/autism-associated-brain-differences-can-be-observed-in-prenatal-mri-scans-in-the-womb/ . An introduction to asthma from someone who professionally studies the topic can be found here https://ncbi.nlm.nih.gov/pmc/articles/PMC7061151/ .
____________
attack anyone who dares to raise these concerns. This is not how we get to the truth.
___________
No, the small group of pediatricians and health journalists who are still left on Twitter point out mistakes. Some of the most extremist users on Twitter love to conflate this with attacking/ censorship/ emotional trigger word of the day, but pointing out mistakes is not the same thing. Dedicated antivaxxers have been using the same talking points for an extremely long time https://washingtonpost.com/history/2021/11/14/smallpox-anti-vaccine-england-jenner .
Discussion is fine, and I am here for that. I do not engage with anyone engaged in bad faith discussion (meaning those who are here just to pick a fight). While it’s not commonly broadcast on the media, the vaccine development ecosystem has thought through most of the concerns and questions that the public brings up. That’s what scientific conferences and journal article peer review is for.
____________
For certain vaccines, the risk-reward calculation is clear.
____________
In the US, the VRBPAC, and later post-marketing surveillance, is constantly working on the risk/ benefit calculation. Those meetings are recorded on Youtube for the public to read. People who think like RFK rarely have to deal with the actual consequences of getting sick with actual vaccine preventable diseases. Pediatricians on the other hand, especially ICU physicians, have collectively seen most of the vaccine preventable diseases first hand. We pediatricians are well aware of the consequences. Yes vaccine preventable diseases are not causing thousands of hospitalizations a week – but this is a case of vaccines being a victim of their own success. You can pretty reliably count on there being an outbreak everytime antivax sentiment rises in a community, of which one of the most famous ones in Samoa is directly a result of RFK Jr’s actions: https://telegraph.co.uk/news/measles-in-samoa/
____________
Alternatively, should it be standard of care for a one-day-old child to get a Hepatitis B vaccine or should we first assess what is the probability of this child being exposed to Hep B in the first few years of her life, and perhaps postpone her injection?
____________
This line of thinking is used commonly by hepatitis minimizers, who forget that hepatitis B is currently a chronic infection that can lead to future liver failure and liver cancer. It’s great that not a lot of people get this, but during 2020, 44 states reported 2,157 acute hepatitis B cases resulting in an estimated 14,000 infections. After a decade of stable rates, the rate of acute hepatitis B abruptly decreased by 32% after 2019 (https://cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-b.htm). The logical hole here is that young children can get exposed to hepatitis B through several different places, and not just unprotected sex/ IV drug use. Without postexposure immunoprophylaxis, approximately 40% of infants born to HBV-infected mothers in the United States will develop chronic HBV infection, approximately one-fourth of whom will eventually die from chronic liver disease (https://cdc.gov/hepatitis/hbv/perinatalxmtn.htm). One also cannot guarantee that every scrape/ cut/ skin break will not come in contact with hepatitis B viruses (https://urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02517#:~:text=Hepatitis%20B&text=It%20can%20be%20spread%20through,or%20through%20scrapes%20or%20cuts.).
____________
In short, @RobertKennedyJr doesn’t actually support any vaccine – he has antivax products to sell in the bookstore. If anyone can do it directly, they should ask him point blank, what vaccine would he consider to be safe and effective. I can guarantee that the collective vaccine researcher and primary care community have thought about all the points that RFK thinks are concerns but have been addressed already https://sciencebasedmedicine.org
..
..
weehingthong 