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Beyond the Expected: To Vaccinate or Not to Vaccinate – Sharon Nachman

March 2, 2020


Welcome to the ‘Beyond the Expected’ podcast,
Dr. Sharon Nachman. Thank you so much for taking time to talk
with us. Let’s start with a quick question about you,
I always like to ask my guests. What got you interested in becoming a
physician and more specifically a specialist in pediatric infectious disease? So, I was always interested in being a detective.
And infectious disease means you get to be a detective every day of your working career. I’m the child of immigrants. My parents came to the United States after
World War II, after being in DP (Displaced Persons) camps, after surviving Nazi Germany
and they had no education. They didn’t have any college. They had maybe some high school when they
got here, and they always pushed their children to get educated because you could always take
it with you. I went to high school and then I was very
fortunate to get to the six year BS MD program at City College. The good news is it was six years and the
great news is, it was free, so I very much benefited from New York State’s CUNY/SUNY
partnerships for funding my academic career. When in college, I was very excited about
microbiology. The whole idea of these are pathogens: they’re
smarter than us. That we have to be smarter than them really
intrigued me and that was the first part of me being interested in infectious disease. I did my residency in New York. I did my fellowship at Lincoln in the South
Bronx, which meant I used to do international medicine, but I went home every day. When I was at Lincoln, I saw the first measles
outbreak that we had in the United States in New York, and we had an entire ward full
of children with measles. You can only imagine how much it bothered
me to say, “we could have prevented this infection and we didn’t.” I saw kids with malaria. I saw kids with leprosy and I was just fascinated. So you knew all along, you’d made the right
career choice. There’s never any doubt here? I mean, roads not taken? Anything like that? No, I went to work happy every day. What am I going to see next? You can only imagine when my first case of
leprosy came in, and I called all my friends, “Guess what I saw today? Leprosy! Isn’t that exciting?” You can imagine they weren’t as excited as
I was. Not as not as excited as you. You mentioned some extraordinary experiences
just now. Is there a particular most challenging, most
memorable case that you reflect on? When I was at Stony Brook, as a young
physician, I joined Stony Brook in the 1990s, our first child came in with a resistant, vancomycin-resistant
enterococcal infection. It was a three year old, she had been born
premature. She had multiple gut issues, her gut was not
connected and she was basically dying of this resistant bacteria and I remembered in those
days, we took notes. We didn’t have computers, we didn’t have tablets. When you went to a conference, you wrote everything
down. I went through my notes and I found an antibiotic
that was not licensed, not approved, didn’t even have a name and I called a pharmacy company
that was making it and I said, “Hey, it’s Sharon, I have a kid, I’d love to try this
antibiotic on.” And after they recovered from their shock and said, “Who are you? What do you want from us?” I said, “Can
you ship me some drug? I have a kid who needs it.” We contacted
the FDA emergently at that time. They said, “If you write a compassionate
use study, we’ll ship you the drug.” I sat down on that day, wrote a study. We got compassionate use approval from the
IRB (Institutional Review Board). The company shipped us the drug on a Saturday,
I sat there waited for FedEx, walked it over to the pediatric ICU and hung it up for that
child and the good news is she survived and that really was a life changer, not only for
me, but actually for the company because they had no intentions of ever looking to study
that drug in children because they thought, children don’t get those kind of infections. I was called to testify before Congress and
that was part of what went into the bill that said you must actually test every medication,
you’re approving now: for children as well. So, you not only saved a life, but you actually
saved a drug. It sounds like this company was going to back
shelf it, but then realized there was real potential here. They were going to not study children. They were going to use it in adults and kind
of sign off as kids are not appropriate, we don’t need it and that really changed it. What a great memory. Well, speaking of challenging diseases, we’re
confronting something as we speak, globally, the Coronavirus outbreak that seems to have
started in China. In your view, interested in your impressions
about this episode, but perhaps most importantly given your opening comments, could this thing
have been prevented? What do you see happening here that might
have gone in a different way? I don’t think infections can be prevented
globally. I think they should be thought about, caught
as soon as they can, and then treated, preventing more infections from happening. This Coronavirus is similar to two other outbreaks
of Coronavirus we’ve had in the past decade. The first one was SARS, also a Coronavirus
that went from animal host to humans and progressed. Good news the epidemic stopped and MERS, which
is the Middle Eastern variety of it, which also started in animals passed to humans, which
is occurring episodically now only in the Middle East, but not passing to the US. So, this is not the first time we’re seeing
a novel coronavirus. These all have similar types of presentations
with respiratory illness and look almost like the flu illness that we’re having. What’s really nice now, is we have the tools
to identify when the epidemic is starting and also have the tools to say how to stop
and prevent it from traveling further. So, I think we’re smarter now than we were a decade
ago, but you and I both know that it’s going to happen again in the future. We have to use the tools that we have now
or the next generation of those tools to also prevent that one from spreading. Well, and you mentioned, it’s interesting,
all of these episodes involving these microbes, transitioning from animal hosts to human beings,
so it sounds like there’s something in the background there about how we’re managing
animal stocks and how humans are interacting. Well, of course, humans are going into where
the animals are living. We’re going into their environment. We’re in much more close contact with them
and also we have to feed people around the world and that requires having animals and
humans again, come into close contact, so there’s lots of interesting data about animal
hosts and there’s even a nice study that looked at cat animals carrying antibiotic resistance,
and if they do, how do they get it? Is it us giving them feed that contains antibiotics? Or more interestingly, is it the animals being
around flies that contain antibiotic resistance, passing it to the animals and then passing
it to us? So the answer is, it’s probably a bit of both. Antibiotic overuse really hurts all of us
and we have to be very, very careful and when I hear people today, talking about, “Oh,
I have the flu. I need an antibiotic.” I really want to
say, “stop!” It’s viral. Don’t take an antibiotic. Don’t take an antibiotic. Just lie down and take a few days to recover. More importantly, don’t cough on your friends. Well, let’s talk a bit about a topic that’s
on the minds of many, many, well, many of us in New York, but especially parents with
school aged children, here in the state of New York, which are your thoughts on the new
vaccine law that’s been proposed in the state. This is a law that would require grade school
students to receive the HPV vaccine, for example. Obviously there’s a broader debate going on
about vaccination requirements, but interested in your impression of this law. So the first is, I’m very excited that New
York State is one of the state’s taking the lead on requiring vaccination for school-aged
children. I think that’s very important to protect our
community. As you know, vaccines are good for the person,
good for their family, and good for the community, so community protection is the kind of thing
we in New York state, as well as other states, should take very seriously. When you get in a car and you want to take
my child in the car with you, I want you to seatbelt my kid, put them in a car seat. I kind of don’t want them just hanging out
in the backseat. I think of vaccines the same way. They’re there, we should use them, and they
can prevent further damage. With regard to the HPV vaccine, I’ve heard
all sorts of interesting talk about it: oh, it’s going to make children think they should
have sex. That’s not going to happen. Number one, children think lots of things
without us parents knowing about them and I have three kids, so believe me, I know that
they think about lots of things, so a vaccine isn’t going to tell them go ahead and have
sex. But when you realize that countries like Australia,
who have mandated HPV vaccine for all children, have actually shown that the rates of cervical
and genitourinary cancer have dropped, don’t we want to be that country as well? Don’t we want to be those parents to say,
great, I’m protecting you and your partners from all of the viruses in the vaccine, so
that means ten, twenty years from now, you’re not going to get those cancers. You’ll be safe. You’ve commented generally about vaccines
and you’ve drawn this very powerful analogy, to seatbelts, so vaccines are safe. Yes? I think vaccines are safe. I’ve been vaccinated. My children have been vaccinated and my grandchildren
have also been vaccinated. What’s your sense of how communities in particular
here on Long Island are responding to these issues? Long Island is made up of multiple communities. We have communities that are low income, high
income, everything in the middle. Communities that are born in New York, raised
here or immigrated here from other countries, so there’s not one community in Long Island. On the other hand, I think we have for the
most part, doctors that encourage vaccination and we should be very careful about listening
to the parents who don’t want to vaccinate, understanding why? Well, you’ve anticipated another question. I mean, obviously, you must deal with parents
with all sorts of points of view. All the time. Obviously, you must come in contact with parents
who do not believe vaccines are safe. They’re hesitant about their children being
vaccinated. How do you deal with that? So, the first question I ask is were they
vaccinated and if the parents were vaccinated, I say if you were vaccinated and it was safe
for you, it’s going to be safe for your child, but more importantly, tell me what you’re
worried about. Oftentimes, they’re responding to some chatter
they saw online about vaccines containing chemicals that aren’t true anymore. We don’t have any thimerosal in our vaccines,
so worrying about that, that’s not an issue. Worrying about the side effects, everyone
worries that HPV causes illness in girls. What’s interesting is that that illness or
fainting that they talk about hasn’t happened in boys or any other country, so you have
to worry, was it real or not real? With regard to some of the other toxicities
people talk about vaccines, I say, tell me where you saw that. Let’s read it together. Let’s interpret it together and let’s talk
about it. The vast majority of parents who are hesitant,
will actually be talked around and say and explained to and say, Yes, I want my vaccine. The minority of them that don’t want to get
vaccinated or any vaccine, you have to explain to them the risks of those illnesses because
the last thing I want someone to say is, she didn’t explain it well to me, that’s why I
didn’t get vaccinated. As you can imagine, not all illnesses are
the same. Do I want to prevent meningitis in my kid? Absolutely. Those vaccines, meningococcal and pneumococcal,
are fantastic, great and we want every kid to get them. When they think about other vaccines, I say,
“well, you’re right. We don’t have any polio now, but you realize
your child can never leave Long Island, because if they’re going to get on a plane and travel,
we don’t know who they’re going to see and what they’re going to see. Tetanus, I guess you don’t want your child
to play outside because tetanus is not spread from person to person, but from dirt and that
means that anytime they’re in the garden or in the playground, they are at risk of exposure. Do you really want your child to miss out
on all that playing activity?” Has it been your experience that these kinds
of conversations are transformative for these parents or is it hard to judge? I think for 90% it is. The 10% that it’s not, there’s nothing you
can say or do. They will not budge on their opinion and I
say all right, that’s okay, but at anytime you want to come back and talk again. I’m here to talk to you. Do you feel given all your work with infectious
diseases, especially in pediatric setting, do you feel that this is the most important
aspect of the work? What do you think is the most important aspect
of your work on Long Island? You know, I think there’s more than one thing. You can’t say one is more important than the
other. Do I think vaccines are important? Yes. Do I think antibiotics and using them appropriately
is important? Yes. Do I think preventing illness is important? Yes. So the answer is what I want to do one and
ignore the others, no. I’d really put them all equally and say we
want the best for your child. We want to keep your kids healthy. If that means I have to think about more than
one thing at any time, I will. But in the span of your practice today, is
it reasonable to say that things have changed in recent years that you’re confronting opposition
questions and anxieties in ways you hadn’t? Earlier in your career? Has it been a steady pattern? I think the vaccine movement has gotten more
resistant. Perhaps it’s due to social media. Perhaps it’s due to the fact that they are
getting what they perceive as more vaccines. In the old days, when diphtheria, tetanus
and pertussis vaccine was first developed, it was a whole cell vaccine and that meant
it had 1000 different antigens in it. The current DTaP has maybe three or four pertussis
antigens. Their perception is oh, it’s a new vaccine. It’s not safe. Actually, it’s got less in it and it’s much
safer than the old vaccine that you and I got. So, go with the new vaccine. Parents are nervous that we’re exposing their
children to too many things in their vaccines. So I asked them, so does your kid crawl on
the floor? Yeah. Do they eat the shoes and the carriage wheels
like my kids did? Are they teething? They’re seeing more antigens every day by
crawling on the floor, then they see at anytime from the vaccines we give them and if your
kid goes to daycare, you can only imagine they’re seeing infinitely more illnesses in
daycare and exposures more in daycare than anything we would have in our vaccines. We are vaccinating for more things today than
in our generation. Which is great news. Right. It’s an interesting point, you might have
never thought of it in quite those terms that then parents are thinking, oh, they are all
these vaccines that never existed before. Right. We just had the diseases then. Yes, right. It’s not like these are new diseases, the
diseases were there. Good news is we’re preventing some of them
now and that’s kind of really nice for us. I guess a version of this question would be
what keeps you up at night? Do you feel this is the most important challenge
right now for pediatric infectious disease specialists like yourself or what are the
things that you worry about the most? The things I worry about the most are more
resistant bacteria because I think that’s a global problem that keeps marching forward. We’re losing antibiotics at a fast clip and
the bacteria, as I think of them are much smarter than we are. So when you say losing antibiotics, you mean
their effectiveness? Their effectiveness is no longer as good. If you go to sub-Saharan Africa and you get
a diarrheal illness or typhoid or something, the routine antibiotics won’t work. If you get malaria, what we would have used
routinely 10 years ago or five years ago, doesn’t work anymore. So, we need to develop
bigger and better antibiotics and prevent them from being abused, or overused and we’re
not so good at that. As you can imagine, with our current flu outbreaks,
we’re seeing tons of children going to local walk-in centers and everybody’s walking out
with an antibiotic, but they have the flu. They shouldn’t be, but the idea is that I
need to give them something to make them better. Here, take this, and the parents want to give
their kids something because the perception is you’re a bad parent if you do nothing and
you’re a good parent if you’re giving your kid a medicine. Unfortunately, as you can imagine, with viral
illnesses, that just doesn’t work. Right. I mean, it’s an interesting point and it’s
certainly the messaging that comes through from advertising and so forth. Use this, use this, use this. We have to give you something. Right. That those days of chicken soup and tea with
honey are not on advertising. I have vivid memories of when I came down
with a pretty good case of chickenpox and when the word went out in the neighborhood,
all the kids came to play with me. We don’t like to do that anymore. No, not anymore, but back then I was like
great I want my kid to get it too. So she’ll be immuned. Unfortunately, they were immune because they
got their chickenpox, but those are the patients that we’re seeing now that have zoster. Right. And the good news is the kids that got chickenpox
vaccine will never get shingles and when you weigh it out, I’m really kind of excited that
that next generation of children won’t suffer as adults from that. Won’t suffer from that. That’s a very good point. I always like to ask my guests, so if you
could go back and speak to the young Sharon, the Sharon in high school who was you know,
anticipating going on to, to advanced study in college and beyond. Given all that you now know, what would you
tell her? Study more. You know, it’s interesting. When I was a young medical student and then
a resident, I tried to read everything and then I blew stuff off. Back in the early 1980s, I read an MMW or
a publication from the CDC, ‘Morbidity and Mortality Weekly Report’, and it talked about
a couple of patients, out in California in San Francisco, who came down with a respiratory
illness and they all hung out in bathhouses and only men and I thought, oh, this has nothing
to do with me. It’s men. It’s adults. They’re in a bathhouse in California, it
has nothing to do with me. Of course, that was the first case of PCP pneumonia
in HIV infected patients. I was wrong. It has a lot to do with me and since then
I’ve spent countless years working on HIV; new treatments, new diagnosis, therapeutics
and prevention. So, I would say to the younger Sharon, don’t blow those papers off. Well, and one final question in that regard,
what would you say to the younger Sharon? You were you were a trailblazer in your generation,
a woman going on to medical school. I mean, there are more women in medicine today. Correct. But it’s thanks to people like you and your
generation said, I’m pursuing this path, even though it’s not been the traditional path
for women. So what advice would you give in that regard? I guess, follow your dreams. The worst thing someone can tell me is no,
you can’t do that. I think it was true, then. It’s true, now. Anyone that says to me, no, you can’t. That’s sort of the red flag in front of me
going, of course I can and I’m going to show you how. I remember when I was applying to the six
year BS MD program, the principal of my high school said, “you know, if you want to marry
a doctor, there’s a much easier way to do that.” You could imagine my husband is not a physician. Well, that’s a great point and I want to thank
you Dr. Sharon Nachman for spending some time with us today. It’s a fascinating conversation. Thank you so much. Thank you.

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