EVERY SPOKEN WORD
150 min read · 30,080 words- 0:07 – 1:16
Why Hotez is here: tropical disease vaccines vs. the autism/vaccine controversy
- JRJoe Rogan
And we're live. How are you, sir?
- PHPeter Hotez
How are you?
- JRJoe Rogan
Good to see you again.
- PHPeter Hotez
I'm thrilled to be here. Thanks for-
- JRJoe Rogan
Thanks for doing this, man.
- PHPeter Hotez
... thanks for having me.
- JRJoe Rogan
I... No, I should tell people before we get started, I did not know when I asked you to come back on that you were heavily involved in this whole vaccine debate. What I wanted to have you on to talk about is tropical diseases, because, uh, I remember when we did that sci-fi show, um, you explained to me that some ungodly percentage of people that live in tropical climates are infected by parasites.
- PHPeter Hotez
That's right. Well, my day job is developing vaccines for tropical diseases. We develop the vaccines no one else will make because, uh, they're for the world's poorest people. So we call them tropical diseases, but they really are diseases of poverty. The vaccine issue, the ad- the advocacy issue around vaccines and autism is kind of a new thing that I got drawn into just because I'm a, a parent of an adult daughter with autism and I make vaccines, so it was a natural that I'd get drawn into it.
- JRJoe Rogan
Yeah, so when I said that you were gonna come on, then I got inundated by people that are... You know, the- the vaccine thing is such a polarizing issue.
- PHPeter Hotez
Yeah, it's awful. Yeah.
- 1:16 – 4:56
Autism prevalence, changing diagnoses, and what “spectrum” really means
- JRJoe Rogan
And, uh, so many people seem to think they absolutely know what causes what, especially when it comes to something like autism, which is a, it's a huge issue in this country, it's a huge issue around the world, and it doesn't, didn't used to seem to be. The question is, was that because it was undiagnosed? Was that because i- it just, there's m- it's more prevalent today?
- PHPeter Hotez
Yeah.
- JRJoe Rogan
What do you think? What is your take on this?
- PHPeter Hotez
Well, I don't think we really know. Um, one thing's for sure, we're diagnosing people with autism who we diagnose wi- as something else in the past, you know, whether it was, you know, really horrible diagnoses, we'd use pejorative terms like mental retardation-
- JRJoe Rogan
What's the matter, Jamie? Sorry. I, my bad. Just telling you the clock was off. Oh, okay. Sorry. Sorry.
- PHPeter Hotez
Should we start again?
- JRJoe Rogan
No, no, no, it's okay. He was just saying-
- PHPeter Hotez
(laughs)
- JRJoe Rogan
... he was just telling me that the, our clock is screwed up because of the daylight savings time thing.
- PHPeter Hotez
Oh, right, right.
- JRJoe Rogan
Sorry. And totally unrelated to what you were saying.
- PHPeter Hotez
The whole country's clock is screwed up because of daylight savings time.
- JRJoe Rogan
Yeah, yeah.
- PHPeter Hotez
Right.
- JRJoe Rogan
Um, so, so we don't know. We don't-
- PHPeter Hotez
Well, you know, o- one thing's clear, that the number of diagnoses is going up, but part of that is because what we used to call pejorative things like mental retardation now get thrown into the autism category. The other thing now-
- JRJoe Rogan
They do?
- PHPeter Hotez
... absolutely. You know what I mean?
- JRJoe Rogan
How so?
- PHPeter Hotez
Well, you know, now we call it as part of the autism spectrum. Um, we also, because autism often has a lot of associated intellectual disabilities, not always, but sometimes. Uh, the other is that, um-
- JRJoe Rogan
Can I pause there for a second?
- PHPeter Hotez
Yeah, sure.
- JRJoe Rogan
Is that based on, uh, apt- aptitude tests? Like, how do you, how do they decide?
- PHPeter Hotez
How do they decide what's autism?
- JRJoe Rogan
Yes.
- PHPeter Hotez
They, they have a list of diagnostic, uh, categories, criteria.
- JRJoe Rogan
But it's not based... It's not like you could test someone if they test positive for a disease?
- PHPeter Hotez
That's right. That's right. Well, although it... You know, one of the interesting side pieces to this is, you know, w- the, there's a group of, in people out there who self-identify themselves as the autistics and they get very resentful or hurt when they're called a disease or a disorder. The, and, because they say, "Well, we're not an epidemic, we're, we're a person," and they, it's part of this whole neurodiversity movement, which is quite interesting.
- JRJoe Rogan
Neurodiversity movement.
- PHPeter Hotez
Right. They say they're neurodiverse, that they, you know, maybe think differently from others and they respond differently than others, but they're not, quote, "abnormal" and, and I think they have a good argument.
- 4:56 – 9:40
Can autism be tested biologically? Genes, brain development, and early markers
- JRJoe Rogan
Um, but, so there's no, uh, there's, it's not like you could test positive for syphilis or you can test positive for the flu.
- PHPeter Hotez
Right. Although now, you know, as I say, you know, so that's why I don't like using those, those terms because it, uh, it puts people on the autism spectrum as though they have a disease or disorder-
- JRJoe Rogan
Right.
- PHPeter Hotez
... which I don't like to do. Um-
- JRJoe Rogan
But if, if it is a disorder, no?
- PHPeter Hotez
But, but, but, well, you know, now we know there are 99 genes, uh, that are linked to autism.
- JRJoe Rogan
But why is it a bad thing to say that you have a disorder if it's just a disorder?
- PHPeter Hotez
Well-
- JRJoe Rogan
You know, people have disorders. It's a fact.
- PHPeter Hotez
Well, you know, uh, a lot of the individuals in that, uh, that self-identify themselves as the autistics don't like to think of themselves as a d- disorder. They like to think of themselves as different. It's different, but not necessarily as a disorder.
- JRJoe Rogan
Right. But that doesn't help us when we're trying to discuss it, does it?
- PHPeter Hotez
Yeah, it gets very... It, it's ha- it's hard, it gets hard to talk about, and you have to be very-
- JRJoe Rogan
Well, and also they're, they're trying to stop you from talking about it in a certain fashion, which is actually accurate, right?
- PHPeter Hotez
Uh.
- JRJoe Rogan
They, they're, when, they have an issue. There is an issue. To say there's no issue is kind of ridiculous. It's-
- PHPeter Hotez
(sighs)
- JRJoe Rogan
I mean, there's a reason why so many people are so concerned about autism and vaccines and just autism in general-
- PHPeter Hotez
Right.
- JRJoe Rogan
... whether it's environmental pollution factors or whatever.
- PHPeter Hotez
Right. Right. Well, what they like to do is they like to make the distinction between autism...... that neurodiversity thing and actually having intellectual disabilities that go along with it.
- JRJoe Rogan
Okay.
- PHPeter Hotez
And maybe it's a bit of semantics also, but they feel strongly about it.
- JRJoe Rogan
Right. Now, if we don't know what causes autism, how-
- PHPeter Hotez
Well, we do.
- JRJoe Rogan
We do?
- PHPeter Hotez
Well, we're getting there very closely. So we've now ... There was a very important paper produced by, uh, written by a group at the Broad Institute at Harvard and MIT, which is one of the premier genetics genomics organizations in the country, and they've now identified 99 genes. It's a, it's a huge team of scientists, not only at the Broad, including p- scientists at Baylor College of Medicine. 99 genes involved in autism, uh, all involved in early fetal development, uh, early brain development, uh, in the first and second trimester of pregnancy. So now, we're starting to really get our arms around what autism is. And that's one of the things I talk about in the book. I mean, we, we have learned so much in the last couple of years about autism, how it begins early fetal development, well before kids ever see vaccines, and that's one of the reasons I say vaccines did not cause Rachel's autism. Vaccines don't cause autism, because autism was already underway in early, uh, early brain development.
- JRJoe Rogan
Is it possible that some people have this tendency towards autism and it's exacerbated by vaccines?
- PHPeter Hotez
I don't think so. Um, I think what, what happens is the sequence of events happens, uh, during pregnancy, but the full clinical expression of autism often doesn't happen until 18 or 19 months of age. Like Rachel, for instance, wasn't actually diagnosed till 19 months of age. And there's some fe- fabulous studies now showing that that clinical expression of autism actually coincides with a big increase in the ex- in the volume of the brain. You can actually show on serial magnet- magnetic resonance imaging, serial MRI, how the brain starts to, the brain volume starts to increase. And that's very important, because parents, uh, will often remember, "Oh, my kid got vaccinated around 18 months of age or, or 15 months of age," and want to link the two. But now you can go back to six months of age, and this is studies done at the University of North Carolina Chapel Hill showing so that you can do an MRI at six months of age and they can predict now with, they say, with 90% accuracy which of the kids will go on to develop autism. And then you can take it-
- JRJoe Rogan
What are they seeing?
- PHPeter Hotez
What?
- 9:40 – 15:51
Anecdotes vs. epidemiology: why MMR gets blamed and what large studies show
- JRJoe Rogan
Why do you think there's so many people that have these anecdotal stories of their child getting vaccinated, especially large doses of vaccines when they hit them with like 10 in a row, and then all of a sudden... or measles, measles, mumps, and rubella is the one that gets repeated over and over again. "That's the one that made my child have autism." I've heard that so many times, and I've heard it from friends, from friends that have children that have autism. They had a child. Their child got the measles, mumps, and rubella shot, and then immediately there was a very distinct change in the child's behavior.
- PHPeter Hotez
Well, no question when you get the measles, mumps, rubella vaccine, many times kids cry and, and things like that. And then autism will then begin sometime between the first and second year of life. So it's logical to want to connect the two, but now we know it's not even plausible, because we know that if you go back to that MRI at six months of age, or go back prenatally, we can even, uh, determine which kids are gonna go on to develop autism.
- JRJoe Rogan
So even though this vaccine-
- PHPeter Hotez
And, and, and, and then, and then complementing it, complementing it are massive epidemiologic studies done on over one million kids that... In fact, a new paper was just released this week showing that, um, kids who get the MR- get the MMR vaccine are no more likely to get autism than kids who don't, who don't get the MMR vaccine. And the con- converse is also true. Kids on the autism spectrum are no more li- likely to have gotten the MMR vaccine than kids not on the autism spectrum.
- JRJoe Rogan
Okay. So-
- PHPeter Hotez
So, so it's the combination of that, those big studies of over one million kids, together with knowing what autism is, that completely rules out the possibility.
- JRJoe Rogan
Right, so these genes... (clears throat) Excuse me. And the, and the issue with these genes, and then the ability to scan the brain with the serial MRI, and the... so you can tell which children have the propensity. Is it possible that children have all these issues and then do not get autism, or do 100% of those children with those issues get autism?
- PHPeter Hotez
That's a good question. Uh, I don't know. I'm a vaccine scientist, so I'm, you know, the, the-
- JRJoe Rogan
You're not a biologist?
- PHPeter Hotez
... the re- well, well, I'm a biologist, but I'm a vaccine scientist who, who's really tried to do a deep dive in autism doing research on the book.
- JRJoe Rogan
Versus human development?
- PHPeter Hotez
Right, right.
- JRJoe Rogan
Right. Okay, so, uh, so what you're saying, though, is that if a child does not have these mutations and does not have these issues that are present in, uh, during serial MRI, that they will not go on to develop autism, is that true?
- PHPeter Hotez
As far as we can tell, yeah.
- JRJoe Rogan
As far as we can tell.
- PHPeter Hotez
Yeah.
- JRJoe Rogan
So children without those issues who get vaccinated have z- have no problems, which most children have no problems.
- PHPeter Hotez
Right. Yeah, I mean the, you know, we've learned a lot about the, the risk of vaccines and, um, them numbers are extraordinary. I mean, the risk of a severe adverse event happening after getting a vaccine is roughly on the order of one in a million between- between one in a million and one in 10 million. Um, so and I found an internet report once that the li- likelihood of getting struck by lightning is one in 700,000 so it's, you know, the likelihood-
- JRJoe Rogan
Right.
- PHPeter Hotez
... of having a severe event after a vaccine is your bet- odds are better, uh, of getting struck by lightning than-
- JRJoe Rogan
And when you say severe event, what do you mean by severe event though?
- PHPeter Hotez
Oh well, the, there's actually a table that's put out, uh, by the National Vaccine, uh, Compensation Act, um, that includes, um, uh, shoulder injury, uh, that's one, uh, encephalitis, encephalomyelitis-
- JRJoe Rogan
Shoulder injury?
- PHPeter Hotez
Yeah, that's actually on the list.
- JRJoe Rogan
From the actual injection point?
- PHPeter Hotez
Yeah, put getting injecting it in the wrong place.
- JRJoe Rogan
Oh. So it goes into the joint or something like that?
- PHPeter Hotez
Yeah, yeah.
- JRJoe Rogan
Yeah. Is that common?
- PHPeter Hotez
No.
- 15:51 – 17:54
Vaccine safety and “too many shots”: combination vaccines and immune system capacity
- JRJoe Rogan
And do you think that it's just when you look at, say, if there's one in a million that has an issue with this and there's-
- PHPeter Hotez
And it's not autism, by the way.
- JRJoe Rogan
So whatev- whatever those i- issues are, that they hear these stories and these stories do accumulate because there's 300-plus million people in this country and over 10, 20 years of one in a million you develop a significant history of cases where children did have issues with vaccines. So these people hear about these stories and people are terrified. Obviously you're ... I have children. You become very overprotective of your children. You worry a lot.
- PHPeter Hotez
Right, right.
- JRJoe Rogan
And then you also don't know, like why do they get so many shots all in a row like that? Why does a baby get 10 shots in a day? That seems crazy.
- PHPeter Hotez
Well, they don't get 10 shots in a day. Most of the vac-
- JRJoe Rogan
Ever?
- PHPeter Hotez
Most of the vaccines are now combined. So for instance, in one vaccine, we can vaccinate against diphtheria, pertussis, tetanus, um, polio, uh, haemophilus influenza type B, which is a terrible cause of, of meningitis and in some cases now even hepatitis. So one shot is protecting-
- JRJoe Rogan
So they just give like soup of all these things?
- PHPeter Hotez
Well, it's combined.
- JRJoe Rogan
Right.
- PHPeter Hotez
And there's all sorts of studies showing that it's safe to combine them and, and it's fantastic. Now you can vaccinate with one shot against six diseases. And these-
- JRJoe Rogan
So-
- PHPeter Hotez
... are life-threatening diseases.
- JRJoe Rogan
Right. So the only concern is the child's immune system when they're bombarded with this one ... So a lot of times it causes them-
- PHPeter Hotez
Does-
- JRJoe Rogan
... to be tired or they get sick or they don't feel very good.
- PHPeter Hotez
Yeah, well the point is the immune system is not bombarded.
- JRJoe Rogan
Right.
- PHPeter Hotez
I think that's another kind of a-
- JRJoe Rogan
It's not?
- PHPeter Hotez
... misnomer that the, or a misunderstanding that's put out by the anti-vaccine lobby. Remember, the child's gut, the intestines and the respiratory tree is, is this, or are organs of antigen presentation. A baby on average is exposed to hundreds of new antigens every day. So the idea that you're gonna, quote, "overwhelm" the immune system with a vaccine against six diseases just doesn't make any sense either.
- JRJoe Rogan
Mm-hmm.
- 17:54 – 20:17
The anti-vaccine “media empire”: websites, social amplification, Amazon, and politics
- PHPeter Hotez
Again, this is all phony baloney stuff put out by the anti-vaccine lobby. Let's, let's be clear. The anti-vaccine lobby owns the internet right now. They've-
- JRJoe Rogan
What does that mean?
- PHPeter Hotez
What that means is they've got ... they've put out now by some estimates 500 anti-vaccine websites so that every time you put the word vaccine into a search engine, whether it's Yahoo or Google, you're gonna get anti-vaccine misinformation. That's number one. Second, we know now it's amplified on social media.... like Facebook, uh, other forms of social media. So, uh, third, um, you know, the, look at the Amazon site. I mean, it's, it's incredible. So my book, this book, the good news is it's ... I think it's ... Right now, it's the highest-rated pro-vaccine book on Amazon. The bad news is overall it's ranked about 20 because there's 19 other phony baloney anti-vaccine books-
- JRJoe Rogan
So who-
- PHPeter Hotez
... ahead of it. So the Amazon is the biggest purveyor now of anti-vaccine books. And wait, it gets even worse. Then you also have now they've be- become politicized. They have political action committees in multiple states lobbying state legislators about, uh, um, false ... Uh, with ... Plying them with false information about what vax- vaccines do. So and, and the problem is we don't have a robust system of pro-vaccine advocacy to counter it. So we don't really hear as much as we need to from the federal government, from the CDC, from the surgeon general. So unfortunately, in this country, the defense of vaccines falls to a handful of academics like myself. And, you know, I'm an academic. I wrote a book. (laughs) Uh, what, what chance do I stand against this major, uh, media empire that's anti-vaccine?
- JRJoe Rogan
Why do you think that exists? Why do you think there is this major media empire that's against vaccines?
- PHPeter Hotez
That's a great question. What's the motiv- ... What's the motivation-
- JRJoe Rogan
Yes.
- PHPeter Hotez
... number one? And number two, where's the money coming from?
- JRJoe Rogan
Right.
- PHPeter Hotez
Right? There's real money behind this, millions of dollars behind this to put out phony documentaries and phony books.
- JRJoe Rogan
What's a good phony documentary to point to?
- PHPeter Hotez
Well, I'm a little reluctant to do it, say it because they're so litigious.
- JRJoe Rogan
Okay.
- PHPeter Hotez
And, and, uh, and, you know, I, I don't have the means to defend the lawsuit and things-
- JRJoe Rogan
Right.
- PHPeter Hotez
... like that. So ... But-
- JRJoe Rogan
So-
- PHPeter Hotez
... but they're out there.
- JRJoe Rogan
... these, um, documentaries-
- PHPeter Hotez
That's why I, I usually don't name specific names-
- JRJoe Rogan
Sure.
- PHPeter Hotez
... or-
- JRJoe Rogan
I understand.
- PHPeter Hotez
Yeah.
- 20:17 – 27:46
Motivations and harms: dangerous “autism cures,” trolls/bots, and vaccine-hesitant parents
- JRJoe Rogan
These documentaries, what do you think their motivation is? Did, do, do you think they, they earnestly believe that vaccines do cause harm or vaccines do cause-
- PHPeter Hotez
I, I, I don't, I don't-
- JRJoe Rogan
... diseases or, excuse me, uh, autism?
- PHPeter Hotez
I don't know. I mean, is there some kind of other agenda that they have? I mean, we do know in some cases that, um, the, uh, some elements of the anti-vaccine lobby are promoting phony autism therapies, right? They're doing terrible things like this thing called MMS, which are bleach enemas.
- JRJoe Rogan
What?
- PHPeter Hotez
Yeah, bleach, giving bleach enemas to kids. You can Google it.
- JRJoe Rogan
To children?
- PHPeter Hotez
To children.
- JRJoe Rogan
Bleach? Why bleach?
- PHPeter Hotez
Uh, because they're cleansing the immune system.
- JRJoe Rogan
Oh, Jesus Christ.
- PHPeter Hotez
They're cleansing them of toxin. No, it's really awful stuff.
- JRJoe Rogan
(coughs) Wow.
- PHPeter Hotez
Um, and they're doing chelation therapy, which is very dangerous.
- JRJoe Rogan
What is that?
- PHPeter Hotez
That's where they, they claim, you know, kids are overdosed with toxic metals, so they give a chemical that actually can chelate the metal. But it can chelate your calcium and then put you into a fatal arrhythmia as well. There are also, um-
- JRJoe Rogan
Who is doing this chelation therapy? Like what-
- PHPeter Hotez
You, you, you can Google it.
- JRJoe Rogan
Okay.
- PHPeter Hotez
Um, it's, uh ... Or whatever suggestion-
- JRJoe Rogan
But are the- is ... Are these doctors? Like who-
- PHPeter Hotez
S- in some cases, they're, uh, doctors, unfortunately, or other health professionals.
- JRJoe Rogan
And what is ... I mean, I'm sure you've studied this.
- PHPeter Hotez
But wait, it gets wor-
- JRJoe Rogan
What is the evidence though? Okay, go ahead.
- PHPeter Hotez
Wait, it gets worse. There's no evidence. And then, and then they're doing hyperbaric therapy, uh, which is really bad. So in some-
- JRJoe Rogan
H- wait a minute. Hyperbaric therapy is bad?
- PHPeter Hotez
Well, for ... It doesn't do anything for autism, that's for sure.
- JRJoe Rogan
Okay.
- PHPeter Hotez
Uh-
- 27:46 – 42:32
Measles’ real risk and why outbreaks endanger infants too young to vaccinate
- JRJoe Rogan
What are the ... What's the danger of a child getting measles?
- PHPeter Hotez
So we-
- JRJoe Rogan
I mean, is there any benefit to a child getting measles in terms of their immune system?
- PHPeter Hotez
No, there's no benefit, and that's one of the phony books they put out-
- JRJoe Rogan
Yes.
- PHPeter Hotez
... it's called Melanie's Marvelous Measles. I mean, it's- it's awful. So, um, uh-
- JRJoe Rogan
What do they say in that book?
- PHPeter Hotez
They say build your immune system.
- JRJoe Rogan
It does not?
- PHPeter Hotez
It does not. It's ... Remember, um, after ... So let's go back a little bit. Smallpox was eradicated in the late 1970s through vaccination. Once smallpox was eradicated- eradicated, measles was arguably the single leading killer of children globally. 2.6 million children died every year of measles because it causes measles pneumonia, measles encephalitis. Talk about permanent neurologic injury, that's a bad actor, measles. Uh, and then deafness and all. And then through global vaccination campaigns, we brought it down by the year 2000 to about half a million kids dying, and then the Gates Foundation put up $750 million to create the Gavi Alliance, the Global Alliance for Vaccines and Immunization. We've brought it down now to 100,000, but now measles is coming back. Europe's a disaster right now. We've got 80,000 measle cases in 2018 in Europe and now it's coming back to the US. And so my worry is this me- anti-vaccine media empire is n- it started out as a fringe group, but now it's really affecting public health, allowing a deadly disease like measles to come back.
- JRJoe Rogan
Do you think if there's some sort of definitive evidence that shows to the general public, like you could- you could show it to them, like, "This is what causes autism. We've narrowed it down to these genes and it- it has nothing to do with vaccines. If you give these vaccines to people without these genes, there is no way they're gonna get autism. They get autism specifically because of these variations in their genes."
- PHPeter Hotez
You just ... You- you just summarized the book.
- JRJoe Rogan
Right.
- PHPeter Hotez
Yeah. Yeah.
- JRJoe Rogan
But I mean the- that we n-
- PHPeter Hotez
We'd need more than a book, right? (laughs)
- JRJoe Rogan
Right.
- PHPeter Hotez
Yeah. (laughs)
- JRJoe Rogan
It- it does disturb me when I hear about all these kids getting measles, and- and not just measles but means ... In some places polio has made a resurgence. You know?
- PHPeter Hotez
Well- well, polio, you know, we're down to about three- three countries that still have transmission of wild-type polio. It's Nigeria, Pakistan, Afghanistan, so ho- hopefully we're getting our arms around polio, but measles has now come back- roaring back with a vengeance.
- JRJoe Rogan
But hasn't- haven't people contracted polio outside of those areas? I mean, those are the areas where it's common.
- PHPeter Hotez
E- ev- every now and then some cases pop up.
- JRJoe Rogan
Right.
- PHPeter Hotez
We had some in ... You know, wherever ... And this can get, uh, into a whole nother topic. Wherever there's collapse in health systems infrastructure-
- JRJoe Rogan
Yeah.
- PHPeter Hotez
... such as during tu- from war or political instability, these diseases can come back.
- JRJoe Rogan
They can come back and the people that are vulnerable, the children that are not immunized.
- PHPeter Hotez
That's right.
- JRJoe Rogan
And when you're immunized, you're not vulnerable?
- PHPeter Hotez
That's right.
- 42:32 – 51:00
Flu shots, risk perception, and how vaccines mitigate severity even with imperfect matches
- JRJoe Rogan
Ta- I mean, th- besides measles, uh, what other diseases are more prevalent now because of people not vaccinating their kids?
- PHPeter Hotez
The ones that ... There's three diseases that I worry about the most. Actually four. Well, whooping cough is another one, so that, that's one.
- JRJoe Rogan
Mm-hmm.
- PHPeter Hotez
But the other one I worried about is the flu vaccine. Kids aren't getting their flu vaccine. Last year in the 2018 flu epidemic, 150 unvaccinated kids died of influenza despite the recommendation of vaccinating against flu.
- JRJoe Rogan
Can you enlighten me on this? Because what I've been told is that sometimes they get the flu vaccine wrong, so you can get vaccinated but it doesn't ... it doesn't protect you for the strain of flu that everybody's getting.
- PHPeter Hotez
Well, so that's again something that was heavil- an idea that was heavily pushed by the anti-vaccine lobby. Here's the story. Uh, l- you're right. Last ... partially right. Last year, the, there was not a p-... perfect match between the, between the v- the virus and the vaccine, the killed virus in the vaccine and the wild type flu strain that was out there. But it was good enough to prevent you from dying, and it was good enough t- to, would likely prevent you from being hospitalized. So-
- JRJoe Rogan
So it would have an effect even if you did get the flu?
- PHPeter Hotez
That's right, 'cause there was enough cross-protection so that it would, it would mitigate the symptoms. And-
- JRJoe Rogan
That's confusing to people because if they have the flu, they say, "Oh, well, then it didn't work."
- PHPeter Hotez
That's right, but it did, because it prevented you from getting sick and dying. And, and again, that was, that was a message that never really got out in 2018.
- JRJoe Rogan
Okay, but let's talk about someone like me-
- PHPeter Hotez
Mm-hmm.
- JRJoe Rogan
... who's a healthy person. I've had the flu before, um, but I don't usually get a flu shot.
- PHPeter Hotez
That's crazy. You should.
- JRJoe Rogan
Why is that? Why is that crazy?
- PHPeter Hotez
Especially now, es- especially now as you're getting older.
- JRJoe Rogan
Why is that?
- PHPeter Hotez
Um, because flu is, uh, one of the leading, is probably the single leading infectious disease killer of, of, of adults in the United States. It-
- JRJoe Rogan
But every time I've had it, it's really been like, just a couple of days out, I rest, I-
- PHPeter Hotez
Well, you got, y- you-
- JRJoe Rogan
... I drink a lot of fluids.
- PHPeter Hotez
... you got lucky, my friend. So, yeah, yeah-
- JRJoe Rogan
Is that what it is? Is it luck or-
- PHPeter Hotez
Yeah.
- JRJoe Rogan
... is it health?
- PHPeter Hotez
Well, you know-
- JRJoe Rogan
Taking care of yourself?
- PHPeter Hotez
Eh, well sure, taking care-
- JRJoe Rogan
Maintaining your immune system?
- PHPeter Hotez
I mean, let's, so if you look at the, uh, 80,000 adults who died in the influenza epidemic of 2018 in the United States, you're right, a lot of them had underlying, um, uh, things like diabetes or, or, or non-communicable, you know, cardiovascular disease or underlying respiratory disease.
- 51:00 – 59:13
What vaccines we still need: RSV, shingles, and the economics of new vaccine development
- JRJoe Rogan
Right. Now, um, what is missing from, uh, today's vaccine protocol, if anything?
- PHPeter Hotez
In terms of diseases we should be vaccinating for but we're not?
- JRJoe Rogan
Is there anything?
- PHPeter Hotez
Yeah, there certainly are. Um, you know, one of them is a big im- big problem among young infants, especially premature infants, called RSV, respiratory syncytial virus infection. So-
- JRJoe Rogan
Where does that come from?
- PHPeter Hotez
It- it's, um, you know, it's a respiratory virus that peaks around the same time that flu does, so it's a very severe respiratory illness. So this is, again, one of those vaccines that's not a big money-maker, so the Bill & Melinda Gates Foundation is trying to, uh, provide grants for supporting that one. That- that's a good one. And then there are all the diseases that affect poor people, both in developing countries and even among the poor in the United States that we're trying to make a vac-
- JRJoe Rogan
And that was the subject of this book?
- PHPeter Hotez
That's, that's the next one.
- JRJoe Rogan
Yeah.
- PHPeter Hotez
Called Blue Marble Health.
- JRJoe Rogan
The next one? So is this not released yet?
- PHPeter Hotez
No, this is out. This actually-
- JRJoe Rogan
Okay.
- PHPeter Hotez
This actually preceded the-
- JRJoe Rogan
Oh, okay.
- PHPeter Hotez
... the- this one.
- JRJoe Rogan
Now this book is all about poor people and infectious diseases and the, the rise of these infectious diseases even in the United States.
- PHPeter Hotez
That's right. So, you know, when we think about ... So I, I, you know, le- led this big campaign to raise awareness of something called neglected tropical diseases, or NTDs. These are the most common afflictions of people living in poverty. Um, I call them the most important disease you've never heard of. They're diseases like schistosomiasis and Chagas disease and leishmaniasis. And I've been devoting my life to seeing if we could develop vaccines for those diseases in the nonprofit sector, you know, because the big pharmaceutical companies just don't see- just aren't gonna take these on.
- JRJoe Rogan
Mm.
- PHPeter Hotez
So we're trying to do it in the nonprofit sector, but the- this book, the Blue Marble Health book, came out of, uh, some number crunching that I did using data from the World Health Organization or something called the Institute for Health Metrics and Evaluation, which is based in Seattle, Washington, that found something very surprising. And that is most of the world's poverty-related diseases are not necessarily in the poorest, most devastated countries of Africa, meaning, like, Democratic Republic of Congo or Central African Republic. They're there, but on a numbers basis, most of these poverty-related diseases are actually in the G20 economies, the 20 wealthiest economies, um, together with Nigeria, which is not a G20 country, but it has an economy bigger than the bottom three or four. So that was pretty amaz- amazing for me to find that out, because, you know, at first I w- I didn't believe the numbers, because I said, "Well, how can it be? If they're poverty-related diseases, why are they in the 20 wealthiest economies?" And then I realized that it's among the poor living in wealthy countries. So the poorest of the rich today now account for most of the world's poverty-related diseases.
- JRJoe Rogan
And what, what's the cause of this?
- PHPeter Hotez
So wh- why, why the link with poverty?
- JRJoe Rogan
Yes.
- PHPeter Hotez
So that's a great ques- So one of the things I do in the book is I ask that. "Well, what is it about poverty that's making you susceptible?" And I don't think we really know. I mean, clearly in some cases, if you live in poor, dilapidated housing without window screens, things like mosquitoes and kissing bugs and sandflies can get inside the house. Or if you look, um, in, in poor neighborhoods, like in and around Houston, you see a lot of environmental degradation arou- around the neighborhood.
- JRJoe Rogan
Mm.
- PHPeter Hotez
Um, you see discarded tires that breed Aedes aegypti mosquito or standing water. But I don't, I don't think-
- JRJoe Rogan
Wait. What, what, what did the tires do?
- PHPeter Hotez
The discarded tires-
- JRJoe Rogan
Discarded tires?
- PHPeter Hotez
So yeah, so one of the best habitats for the mosquito that transmits dengue and Zika and, uh, Chikungunya and yellow fever are discarded tires. That's what they love living-
- 59:13 – 1:12:39
Blue Marble Health: neglected tropical diseases as diseases of poverty—including in rich countries
- JRJoe Rogan
So this brings me to the thing that, uh, I wanted to talk to you about in the first place, 'cause this is what you brought up to me, um, when we were doing this, uh, sci-fi show. And, uh, you, you said something to me that has been haunting me ever since, that the vast majority of people that live in tropical climates have parasites.
- PHPeter Hotez
Mm-hmm.
- JRJoe Rogan
Vast majority.
- PHPeter Hotez
That's the ... Yeah. That's right.
- JRJoe Rogan
That-
- PHPeter Hotez
That's right.
- JRJoe Rogan
There's things like Toxoplasma gondii and-
- PHPeter Hotez
So let's look at the, let's look at the hit parade, right? The top one is one called ascariasis, intestinal roundworm. Uh, the estimates are around 800 million people have ascaris roundworms in their bellies.
- JRJoe Rogan
Whoa!
- PHPeter Hotez
So-
- JRJoe Rogan
800 million.
- PHPeter Hotez
So, so more than one in 10 people on the planet, mostly people who live in extreme poverty. Um, 400 million have hookworm infection, 400 million have whipworms. And a lot of these are wormy diseases. 200 million people with scabies, which is an ectoparasite on, on the skin that causes terrible itching and, and secondary bacterial infections. Schistosomiasis is another one. The point is, every ... Almost every single person who is in extreme poverty has one of these, what I call, neglected tropical diseases. And one of the interesting features about them is they're very debilitating. They not ... So they not only occur in the setting of poverty, but I think they reinforce poverty 'cause they make people too sick to go to work.
- JRJoe Rogan
Yes.
- PHPeter Hotez
They make, uh ... They actually sha- We can show they shave IQ points off of kids when they have them, uh-
- JRJoe Rogan
Well, this is the hookworm connection to-
- PHPeter Hotez
Right.
- JRJoe Rogan
... the idea of the slack-jawed, dumb southerner, right?
- PHPeter Hotez
Right, right, right.
- JRJoe Rogan
In the United States of America.
- PHPeter Hotez
Right, right. And now one of the things that we have found ... So Rogelio Mejia on my faculty, uh, working with an environmental activist named Catherine Coleman Flowers in Alabama found that hookworm is still present in Alabama.
- JRJoe Rogan
Mm-hmm.
- PHPeter Hotez
It's among the poor, among the poor.
- JRJoe Rogan
Explain that to people so they, they understand what we're talking about because for the longest time, there was this stereotype about people that lived in the South, that they were dull minded-
- PHPeter Hotez
Right.
- JRJoe Rogan
... and that this could be di- directly connected-... to hookworm infection, which had run rampant.
- PHPeter Hotez
Right. There was even the term given called, they called it the germ of laziness-
- JRJoe Rogan
Mm.
- PHPeter Hotez
That, that hookworm infection, because it causes severe anemia. So if you're walking around with terrible anemia, of course, you're, you're too... You're not feeling up to working a full day and, and all that sort of stuff.
- JRJoe Rogan
Right.
- PHPeter Hotez
So hookworm was widely president- present in the Southeastern United States at the turn of the 20th century. And then as malaria went down with economic development, so, so did hookworm infection as well. But we still have pockets in this country.
- 1:12:39 – 1:18:54
U.S. neglected infections you’ve never heard of: toxocariasis, Chagas, cysticercosis, West Nile
- JRJoe Rogan
So, um, there's no, no, no, um, vaccine for toxoplasmosis. Is there anything on the horizon? Is there anything being worked on? Because that's a big one, right?
- PHPeter Hotez
It, it's a real big problem among people with HIV AIDS, for instance. That's, uh, because it reactivates your toxoplasmosis and we even see it in, I even see it in kids sometimes, but the thinking is it-
- JRJoe Rogan
Reac- reactivates it? How so?
- PHPeter Hotez
Well, what happens is, um, uh, it's ... In some countries, up to 30% of people are actually infected with toxoplasma.And the parasite has the ability to undergo a dormancy state in the body until your immune system gets compromised, either because of AIDS or because if you get some kind of, uh, medicine that suppresses your immune system, and then it can reactivate it and cause what's called cerebral toxoplasmosis, which is quite serious. So most people handle their toxoplasmosis very well. You know, you, you, you die with it and don't even know you have it, but in some cases it gets reactivated. Right now, um, there doesn't seem to be a lot of incentive for developing a toxoplasmosis vaccine, although I'd be very interested to, to work on something like that.
Episode duration: 1:51:11
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