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Special Edition: CDC Shake-Up – Trust, Vaccines & Future of Public Health
00:29:11
The CDC is in turmoil after its director was fired and several senior leaders resigned in protest. At the same time, new vaccine guidelines are fueling confusion and debate. We break down what these shake-ups mean for science, public trust, and...
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- [00:00]
Erica Mandy
Today is Saturday, September 13th. We're taking a closer look at public health in America, from chaos at the CDC to questions around vaccine policy and trust. Coming up later, you'll hear from Dr. Caitlin Jettalina, an epidemiologist professor at Yale and the co founder of the Health Trust Initiative. She also publishes the popular newsletter your Local Epidemiologist and was named one of time's most influential people in health. She's been going to make America healthy again, AKA maha meetings. So so she's going to be sharing her takeaways from why she agrees the health system is failing some Americans to what can actually be done about it. But first, Dr. Celine Gounder joins me. She's an internist, infectious disease specialist and epidemiologist. She's also editor at large for public health at KFF Health News, a CBS News medical contributor and a clinical associate professor at nyu. She'll help us break down what's been going on inside the CDC lately and why trust in science itself may be at stake. Welcome. Welcome to the Newsworthy special edition Saturday when we sit down with a different expert or celebrity every Saturday to talk about something in the news. Don't forget to tune in every Monday through Friday for our regular episodes when we provide all the day's news in just 10 minutes. It's fast, fair, fun and on the go. I'm Erica Mandy. It's time for today's special edition Saturday. You ready? Let's do this.
- [01:21]
Interviewer/Host
Dr. Celine Gounder, thank you so much for joining us here on the Newsworthy.
- [01:24]
Dr. Celine Gounder
It's my pleasure.
- [01:26]
Interviewer/Host
So let's just start with the more recent news and some of the turmoil that's been happening at the cdc. The agency's director was ousted. Several other senior leaders have quit in protest. So we've been covering this on our daily news show. But what do you think is the most important thing or takeaway for the average American to know about the situation?
- [01:45]
Dr. Celine Gounder
Yeah, I think what you're seeing are senior officials who were resigning in protest after the CDC director had been fired. There were a couple things that led to her firing, but most importantly, her refusal to, quote, rubber stamp vaccine policy that Secretary Kennedy was dictating to her. I think it's important for people to understand science is not the Bible. It is not a body of knowledge. It is a process for seeking out the truth. And it is a very different approach from what I would call lawyerly thinking, which is you start with a conclusion and you try to support that. The scientific method or scientific process is you come up with hypotheses, questions, you test them out. You actually try to disprove a hypothesis. And that's how you build on knowledge over time.
- [02:34]
Interviewer/Host
And so what do you say to people who say, secretary Kennedy says that's not true, that Dr. Monorez had said she's not trustworthy? What was your takeaway from his testimony on Capitol Hill?
- [02:46]
Dr. Celine Gounder
Well, I mean, let's just look at that claim that she said she's not trustworthy. Who would be asked, you know, are you trustworthy or not? And would answer, no. If you're not trustworthy, you would say I'm trustworthy. If you are trustworthy, he would say you're trustworthy. So, I mean, that just is sort of a ludicrous scenario that you really have to shake your head as to who's telling the truth here.
- [03:07]
Interviewer/Host
And this is at a time when, yeah, if people don't know what to trust and they're already losing trust in science and public health. Because I do want to bring up that perspective. I mean, I was talking with a doctor I personally knew who was suggesting that she doesn't like the methods being used, but she does think there's value in bringing some, you know, doubt questions, review of the status quo. And that is actually what can help science move forward. Is there a point there?
- [03:34]
Dr. Celine Gounder
Basing decisions in the scientific process is what allows us to trust the conclusions. And if you take away the process, even if it comes to the conclusion you want. I think another example here would be vaginal estrogen for women who have perimenopausal or menopausal symptoms. The process that the FDA went through was not the standard process. A lot of women were cheering at the decision. But I think it's important. Whether you're talking about vaccines or estrogen for women or whatever it is, the process does need to be done in a way that has scientific integrity so that everyone will trust it, regardless of what the conclusion might be.
- [04:15]
Interviewer/Host
So let's talk a little bit about some changes in vaccine recommendations. We've seen a significant change in the recommendations and FDA approval for the COVID vaccine. So can you briefly remind people what the change is and then what do you think the potential impact of that specifically will be this six season?
- [04:32]
Dr. Celine Gounder
Well, the FDA approval is now for people 65 and older or people between the ages of 6 months and 64 years who have at least one risk factor for severe Covid. And the issue is that a lot of people don't know that they have underlying risk factors, that they have a risk factor for severe Covid, you have a large proportion of the population that does not have a primary care provider, so is not getting routine care that would help them be aware of some of those issues. And for infants, a lot of infants are not diagnosed with a immunocompromising condition or some other underlying risk factor until they're older, their older kids. And that period of six months to two years is a very high risk period, even if that infant is healthy, because one, they're not being protected by maternal antibodies, they have smaller airways, which means that any inflammation or phlegm is more likely to get them into trouble, and their own immune systems are still developing. And so this is why the American Academy of Pediatrics actually recommended and went in opposition to what the FDA had said and recommended that infants between the ages of 6 months and 2 years be vaccinated against Covid.
- [05:45]
Interviewer/Host
And that was the first time in what, 30 years that they've gone their own direction compared to the cdc.
- [05:51]
Dr. Celine Gounder
I think this is an important point. People talk about groupthink in science. It's not that they're a bunch of lemmings jumping off a cliff together. They are actually looking at this issue from different perspectives, analyzing the science and the data. And scientific consensus is when different scientists from different areas of overlapping expertise on the issue come to the same consensus or conclusion. And that tells you that the scientific method is working, that this is not just a question of opinion or values. And the fact that for the first time you're seeing this divergence when in the past, professional societies, the cdc, the FDA, very closely aligned on their recommendations.
- [06:36]
Interviewer/Host
And to be clear, the recommendations for pregnant people specifically have changed because that's not considered an underlying condition, Correct?
- [06:44]
Dr. Celine Gounder
Well, this is very confusing because if you look at the New England Journal of Medicine article that was published by Dr. Marty Macri, who's the head of the FDA now, and Dr. Vinay Prasad, who is head of basically vetting vaccines at the fda, in their paper in the New England Journal of Medicine announcing the new FDA guidance, they include pregnancy as a risk factor for severe Covid. And in fact, it is a risk factor for severe Covid. Pregnancy is a period of immunosuppression. It's how a pregnant woman can tolerate foreign tissue because it's a mix of her DNA and her partner's DNA. And so that is a period we know women are more likely to, whether it's from the flu or Covid or other infections, they're more likely to run into trouble, to end up in the ICU to die, to have various different pregnancy complications, including miscarriage or stillbirth. And so that scientifically does not make sense to say that healthy pregnant women are low risk and do not need to be vaccinated.
- [07:43]
Interviewer/Host
And yet that is what the Secretary Kennedy is saying. I'm not sure about the cdc.
- [07:48]
Dr. Celine Gounder
Yeah. So there's an internal contradiction. Secretary Kennedy has said pregnant women don't need to be vaccinated. The FDA has said they do. We are still waiting for what the CDC will say. Their next ACIP meeting is next week, September 18th and 19th. And so they will be weighing in on Covid and other vaccines at that time.
- [08:06]
Interviewer/Host
And have you heard how insurance companies are responding at this point?
- [08:10]
Dr. Celine Gounder
Right now, insurance companies appear to continue to cover as they had been. I think the situation is just too chaotic right now and they don't want to add more chaos to the mix.
- [08:20]
Interviewer/Host
So beyond Covid when we're looking, no other vaccine recommendations have changed yet, but some, I believe, based on reports, are expecting more vaccine guidelines from the CDC to be changed potentially after next week's advisory meeting. So what are you expecting to see next when it comes to vaccine recommendations beyond those for Covid and that potential impact?
- [08:43]
Dr. Celine Gounder
Yeah, I think some of the other ones that we'll see reevaluated include measles. This goes back a couple decades now to a retracted paper by Andrew Wakefield, which erroneously and fraudulently, I should add, manufactured a connection between the measles vaccine and autism. But I do think that will rear its head again. I think we'll also see the reevaluation of varicella vaccine. You have the measles, mumps and varicella as a fourth component of that vaccine. Now, varicella is the virus that causes chickenpox. There have been questions about whether every newborn needs a hepatitis B vaccine. Unfortunately, a not insignificant proportion of women do not have prenatal care and do not know their hepatitis status at the time of delivery. We've also heard conversations about whooping cough or pertussis vaccine. It's really, and this applies to all vaccines, the number one purpose is to prevent severe disease, hospitalization and death. And it's a bonus if you're preventing infection and transmission. And in very young children, again, in infants, a pertussis infection can be very dangerous, can lead to hospitalizations and even death. And I think it's unfortunate that we're seeing conversations about whether we should be vaccinating and pertussis again.
- [10:01]
Interviewer/Host
What do you want people to know who say, but there are vaccine injuries or what's wrong with more research and review?
- [10:08]
Dr. Celine Gounder
Because almost every single child is vaccinated for these routine childhood preventable infections. Anyone could claim that anything that happens after that could be related to the vaccine. And it can be very hard to disprove that or to prove it. The benefits far outweigh the risks. And I think, unfortunately, most people don't remember the days when kids were kept home from swimming pools because of polio outbreaks. They don't remember the time when measles infections could progress to encephalitis, which is a brain infection where people could have permanent brain damage. We don't have unlimited resources, so I do think you have to be careful about where you spend your money.
- [10:50]
Interviewer/Host
And despite some of the changes in doubt, most American families are still choosing to vaccinate their children.
- [10:55]
Erica Mandy
Is it enough to prevent outbreaks?
- [10:57]
Interviewer/Host
And do you expect that percentage to start dropping as we're seeing some of these changes? And questions asked around vaccine recommendations?
- [11:05]
Dr. Celine Gounder
Well, we have seen rates of vaccination drop. This is what led to the measles outbreak in west Texas, which spread to other adjacent states earlier this year. And that outbreak is ongoing in the southwest with measles. And that's usually the first one you'll see in these situations. The measles virus is the most infectious virus known to man, or at least thought to be. And you need very high levels of vaccination to prevent an outbreak. And with measles, that's 95% of the population needs to be vaccinated. We've seen on average that drop to about 92% nationwide. But you have some areas where that is drastically lower, like west Texas or Idaho or certain other parts of the country. And so those areas are very high risk. Fortunately, with some of the other vaccinations, it's not quite such a high threshold, but, you know, it's still concerning. And if we see, for example, the resurgence of rubella, rubella is an infection that, if a woman gets during pregnancy, can cause congenital birth defects. So children might be born deaf, they might be born with congenital heart defects. These are the kinds of things that just have been forgotten, relegated to history that we may well see. Come back.
- [12:21]
Interviewer/Host
One more thing about vaccines. I want to talk about funding for mRNA, the technology that we saw really speed up the ability to create a COVID vaccine. My understanding is that the funding and development of that tech has stopped, at least for vaccines for infectious diseases. Can you explain why that's happening and what your view of that is?
- [12:40]
Dr. Celine Gounder
I think there's A frankly real PTSD from the pandemic, which has led some people to blame the cdc, the NIH vaccines and so on for all of the pain and suffering of the pandemic. And unfortunately, that leaves us less well prepared for the next pandemic. So we saw a half a billion dollar contract with Moderna to develop a bird flu MRNA vaccine that has been pulled. Other MRNA vaccine research has also been canceled. And when you're in a pandemic, MRNA vaccines are the fastest technology because it's a technology. It's the fastest technology to develop a vaccine in a crisis, in an emergency. It's not necessarily the best vaccine, but it is the fastest. And so it is a critical technology to have at your disposal for those situations. There are other applications of MRNA vaccines. Cancer is a really good example of that. And I think it goes to show you that some of what people have said, oh, MRNA vaccines might change your DNA. First of all, that's biologically not possible. That's a much longer conversation to explain why. It's clear that's not a genuine concern if it is, quote, unquote, okay to be doing MRNA vaccine research for other applications.
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Interviewer/Host
Yeah, I was going to ask about that because it is being still used for cancer vaccine development, although there's some concern that might also be halted.
- [14:05]
Dr. Celine Gounder
Yes.
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Interviewer/Host
What else do you want to add or just a final thought about everything that's going on? What do you want people to take away from this?
- [14:11]
Dr. Celine Gounder
I think we are seeing a crisis of trust in public health, whether that's vaccines or public health agencies, institutions more broadly. I think we're also going to see states diverge in what they do. You now have a West coast health alliance that includes California, Oregon, Washington and Hawaii. You have a looser coalition of states in the northeast of the United States. And I think you're going to see those states diverge from what others like Florida are doing. And you know, Justice Brandeis said back in the day, laboratories of democracy. Well, we are going to see laboratories of public health, for better or for worse.
- [14:53]
Erica Mandy
Still ahead, Dr. Caitlin Jettalina is an epidemiologist, data scientist, professor at Yale and publisher of the popular newsletter, your Local Epidemiologist. You may know her as someone who translates complex science into straightforward insights for the public. Today she's sharing insights from the Make America Healthy Again or MAHA meetings that she's been attending, including why she agrees the health system is failing some Americans and whether the changes being made now at the federal level are actually the answer, plus what families can expect for this year's six season that's coming up. But first, a quick break for our sponsors. The right outfit can make you feel great, but the right foundation layer that can take your confidence to the next level.
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- [15:33]
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- [16:50]
Interviewer/Host
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- [16:51]
Erica Mandy
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- [17:32]
Interviewer/Host
So I know that you've personally taken part in some meetings with Make America Healthy Again or MAHA groups. Can you first share a little bit about your main differences in beliefs there and why you still wanted to make an effort to show up there and reach out?
- [17:48]
Dr. Caitlin Jettalina
Yeah, I mean, I think that right now is a time to be listening. I think that if we are truly honest with ourselves in the field of public health, the systems that health is built on are from the 20th century and they're not keeping up with the needs of Americans today. Right. The world has changed, the information landscape has shifted dramatically, and there's this genuine power of this curiosity driven public that's been unleashed. And I think those of us in the health world are now at a crossroads. Right. We can either double down on what we know, which is the old systems, the old way of doing things, or we can listen and we can learn and we can evolve. And I think both instincts are understandable. I think both instincts are necessary. But for me at least, I'm far more interested in the latter. Figuring out better ways to serve Americans where they are now, not where we wish they were.
- [18:43]
Interviewer/Host
And to be clear, when you're talking about old ways of doing things, are you talking strictly about communication or are you also talking about the systems to make scientific decisions?
- [18:53]
Dr. Caitlin Jettalina
Mainly the systems. Right. One of the most powerful themes that have emerged from my meetings with Maha is that it's very clear that everyone in the room has a story with a very common thread that the health system has failed them. And that has led to heartbreak, it's led to betrayal, it's led to mistrust. And it's what we are, I think, seeing is this huge backlash against institutions right now, against ivory towers. And so I do think that we need to reimagine these health systems to be better responsive to the needs on the ground. And communication is one part of that system, but certainly not all of them.
- [19:35]
Interviewer/Host
And so what's your take on all of the changes happening at the federal level then? Because some might argue that is bringing doubt and questioning and shaking up the status quo.
- [19:45]
Dr. Caitlin Jettalina
It is. There's no doubt. It's shaking up the status quo. I agree that things need to be done. I think there's a difference, though, between complete destruction and reimagination with a vision. I am not seeing, from what I have been watching at the federal level, any sort of interest in reimagination, in trying to actually fix the system. All I'm really seeing is complete destruction and to me, the biggest question is then, okay, fine, if we look around, you know, in a year, three years, and all the rubble is around us, what's the plan? And I, I have, I have yet to see that.
- [20:25]
Erica Mandy
I am curious to hear your take.
- [20:26]
Interviewer/Host
On some of the specifics. I mean, we recently heard Florida wants to get rid of vaccine mandates, even for children in schools. So what was your take on that?
- [20:36]
Dr. Caitlin Jettalina
I think it's dangerous that we know the evidence that a school, school immunization requirements help decrease disease, it helps keep kids in schools. And if we start chipping away at that like they are going to be doing in Florida, we're going to see an increase in these vaccine preventable illnesses. 70 to 90% of parents agree that school vaccination requirements are a good thing. And so I think we have to be really care like one. I mean, I'm an epidemiologist. Right. Be driven in data, in polls rather than ideology. That may not be representative of what Americans need and want.
- [21:17]
Erica Mandy
And let's also touch base on some.
- [21:18]
Interviewer/Host
Of the specifics that have happened at the cdc. The CDC director being ousted, other leaders quitting in protest. We've seen the vaccine advisory panel being, all the people on there replaced. Do you think that things could be better if approached from here in the right way? Or is this just the destruction you.
- [21:39]
Dr. Caitlin Jettalina
Were talking about, is just destruction? I. These weren't just bureaucratic decisions, right? These weren't just experts. They are very steady hands and trusted voices showing up in a lot of moments over the past 10, 20 years across number of different administrations, Republicans and Democrats in crisis and with clarity, with compassion, with commitment to public good. And when leaders like this are pushed out, it's not just the agency that suffers, it's all of us. And a weaker CDC means, quite frankly, more vulnerable communities. And this foundation is eroding at a speed that I never thought possible. And I truly think that if this course is not corrected quickly, our nation's health security is at risk.
- [22:31]
Interviewer/Host
And what does that mean for the average person?
- [22:33]
Dr. Caitlin Jettalina
I mean, it means everything from access to, for states, for access to health data to help make decisions around outbreaks, to chronic disease support and programs that CDC funds, all the way to emergency responses to gun violence injuries. CDC's footprint is very large in very invisible ways to the public. And when we remove that invisible shield, disease is going to increase and more preventable injury and death will increase as well.
- [23:10]
Interviewer/Host
What direction would you like to see us move toward?
- [23:13]
Dr. Caitlin Jettalina
I mean, I would love to see radical transformation and rethinking of our systems grounded in a number of principles that is needed to achieve, I don't know, the vision of our future that we all deserve. Empowering people with the tools they need to stay healthy, like access to their vaccination records or STD testing. That is getting dismantled right now. It means strengthening systems that shape health like clean air and clean water. All of those systems are getting dismantled right now over at the EPA and usda. I think it means definitely integration of services for accessibility, which means if you go to one doctor for a heart palpitation, your other doctor, your primary care physician or OB knows exactly what prescription they're giving you. So there's not this fragmentation or even disinvestment. I think it means being responsive, like protecting Medicaid when 80% of Americans support it instead of slashing it. And I think it means, and this is the hardest part, I think, for our health ecosystem, at least in the United States, is making an accountable health ecosystem where for profit companies are challenged for the good of Americans. It's no secret that this isn't the reality in America, but I don't think it's unattainable.
- [24:38]
Interviewer/Host
So what are you hearing at these MAHA groups who it sounds like you agree there's a problem, but are they feeling like the Trump administration is doing what they should?
- [24:48]
Dr. Caitlin Jettalina
You know, it's really interesting. This is another thing that I've learned with a partnership with MAHA is that some have acknowledged that hitching their movement to the broader MAGA movement was a very risky bet. I've heard very clearly cuts to research on diabetes and maternal health and even Medicaid they were pissed about Medicaid are hurting their ability to make progress. I think they still, they're definitely still aligned with rfk. But I do start seeing these fractures between MAHA and maga and it'll be very interesting to see how that plays out in the next couple months or years.
- [25:31]
Interviewer/Host
I want to talk a little bit about this year's sick season, especially for parents as the school is, is now back and kids are getting sick again. So can you tell us anything about what's going on right now and what are we in for coming up?
- [25:44]
Dr. Caitlin Jettalina
Yeah, it is six season. As a parent, I am not looking forward to it. But right now we find ourselves in the middle of a COVID 19 summer wave and we've had one the past five years. I don't think anyone, no epidemiologists are surprised it continues to happen. RSV should start upticking here soon, maybe end of September. And that is very hard on our little infants and then flu thereafter, and then we expect a Covid, another COVID wave in winter. The good news is we have vaccines for all three of these things. Flu and RSV are business as usual. Go get your vaccinations. They should be available very soon at pharmacies. COVID 19 vaccines is a bit of a mess right now, but I hope will soon be available to a lot of Americans.
- [26:35]
Interviewer/Host
Yeah, and I just want to make the point again on the RSV vaccines, even though it's only for small segments, young kids and then senior citizens.
- [26:42]
Erica Mandy
I know last year or a couple.
- [26:44]
Interviewer/Host
Years ago when it first came out and we talked about it, I heard directly from parents saying, thank you for telling me because I asked my pediatrician about it and got it because I asked for it.
- [26:53]
Dr. Caitlin Jettalina
That is amazing to hear that they advocated for themselves. It breaks my heart that the pediatrician didn't, but yeah. So rsv. So there's a few options. One is women can get it during pregnancy between 32 and 36 weeks. And that's important because antibodies are then passed to the baby for protection in the first six months of life, and that's when they're most vulnerable. The other option, if the mom doesn't get the vaccine during pregnancy, infants can get something called a monoclonal antibody. This is not a vaccine, but it's rather like a medication, basically providing antibodies. It doesn't teach your body how to make antibodies. And so all infants under 8 months old can get it and should. It works incredibly well. I mean, we're talking like 80 to 99% efficacy and typically get it between October and March.
- [27:47]
Interviewer/Host
Other than the COVID vaccine, where there's some confusion of what insurance will cover and things have changed about who should. Who's recommended and approved to get it, Are there any other things that could be of concern this sixth season that.
- [28:01]
Erica Mandy
Parents need to know because of all.
- [28:03]
Interviewer/Host
The changes happening right now other than the COVID vaccine? Vaccine, that's the big one at this point.
- [28:08]
Dr. Caitlin Jettalina
That is the big one. Yeah, it's a billion dollar question mark right now. But other than that, like I said, flu and RSV are business as usual and everyone should be able to have access and should get protected because it's the best thing that they can do this fall.
- [28:27]
Erica Mandy
Well, that's it for today's conversation. Please know we did our best to at least bring up some of the many perspectives on this topic, to discuss them with two different but highly qualified epidemiologists who have the credentials and experience.
- [28:38]
Interviewer/Host
To speak about this.
- [28:39]
Erica Mandy
And while there's plenty about public health we didn't have time today to get to, we will continue to cover any major developments in our daily news episodes Monday through Friday, as we have been doing already. So a big thank you to Dr. Celine Gounder and Dr. Caitlin Jettalina. Head to our episode notes on our website thenewsworthy.com to learn more about them and read more of their work. And again, we'll be back on Monday with all the day's News in about 10 minutes. Until then, have a great rest of your weekend.
- [29:04]
Dr. Celine Gounder
Sam.