Episode 146 - Childhood vaccinations with Dr. Joel Warsh

April 13, 2025

We invite Dr. Joel Warsh (Paediatrician) to discuss newborn and childhood vaccine options from his upcoming book, ‘between a shot and a hard place: tackling difficult vaccine questions with balance data and clarity’

We remind our listeners that this podcast does not give advice about your medical choices, they are for you to make.

You can learn more about Dr. Warsh @drjoelgator (instagram) and www.theshotbook.com

Here in Australia Midwives and heath care providers are required to recommend the Australian Immunisation Handbook as the guidance for immunisation strategies. This includes the Australian Immunisation schedule

See the Australian Immunisations Handbook here

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The information and resources provided on this podcast does not, and is not intended to, constitute or replace medical or midwifery advice. Instead, all information provided is intended for education, with its application intended for discussion between yourself and your care provider and/or workplace if you are a health professional.

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The below transcript was created with AI and may contain errors.

Episode Transcript

Episode 146 - Childhood vaccinations with Dr. Joel Warsh

Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. And each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Welcome to today's episode of the Great Birth Rebellion podcast.

Mel:
[0:29] Today is the day I finally tackle the topic of newborn vaccinations. I've been incredibly hesitant to address this because as my podcast guest today talks about in his book, it's a bit like Fight Club. The first rule of vaccines is that we don't talk about vaccines. We'll be talking about newborn vaccines with Dr. Joel Warsh, a US-based pediatrician and epidemiologist who has just written a book called Between a Shot and a Hard Place. And this book aims to tackle the difficult vaccine questions with balance, data, and clarity.

Mel:
[1:11] We don't want to come at this from an emotional standpoint there's a lot of emotion around this topic from both sides so the idea for today from us myself and Joel is to not pick a side we are simply sharing what we know from clinical research clinical practice and world realities and the topic is highly emotional with strong arguments both for and against and discussions often become heated and divisive so the aim of today is to make every effort not to contribute to the divide. So right up front here also, I will say that as a registered midwife here in Australia, my registration body asks healthcare providers, registered healthcare providers, to only promote and follow the information in the Australian Immunizations Handbook. So before we start, you need to know that myself and any other registered healthcare provider in Australia is prevented from recommending anything that contradicts the information in the Australian immunisations handbook. I'm also required as a registered healthcare provider to provide evidence-based information to my clients in order to facilitate woman-centred care and shared decision making.

Mel:
[2:25] Which is part of the purpose of today's episode. I will put a link to the Australian Immunizations Handbook in the resources for this podcast episode. So if you're on the mailing list, you can access all of those resources. The details are in the show notes. So in this episode, we are not advising you to deviate from the current vaccine schedule. In fact, we are not advising you of anything. This podcast is not about giving medical advice or recommendations. It's just about giving information so conflicted parents should consider a risk benefit analysis when addressing this topic as with all other decisions that we make for ourselves and our children so in the interest of information we'll be sharing specifically about newborn vaccinations in the first year of the baby's life including the day one hepatitis b vaccine so vaccine recommendations are not for me to make. All I ever do is offer my clients information, all the information I can, including the recommendations from the Australian Immunizations Handbook, so that they can make the decisions that are right for them and their family. And today I'll be doing that with my guest, Dr. Joel Warsh, who is speaking from his expertise as a pediatrician, epidemiologist, and a public author of the book Between a Shot and a Hard Place. The book is currently available for pre-order and it's going to be released for sale May 2025.

Mel:
[3:53] So welcome to the Great Birth Rebellion podcast, Joel.

Joel:
[3:57] Thanks for having me on.

Mel:
[3:59] I'm going to just jump straight in with my questions. I'm wondering if you can first explain to our listeners, why are you the person who should have written this book? Why should we listen to you on this topic of vaccinations?

Joel:
[4:12] I think it goes back on my background a little bit. I am a pediatrician and I did all the regular training and went to a great program. I'm one of the top five in America in terms of pediatrics and learned all the Western American regular medical things that there is to learn. And while I was in training, I met my wife and she's very holistic minded. And so it opened up my eyes a little bit to.

Joel:
[4:39] A little bit more of what's out there in the integrative space. And I'm not against Western medicine or medicine at all. I just think that there is a time and a place and I believe in balancing the best of both worlds. And unfortunately, you know, as you go through a decade, vaccines have been very censored and it's not a topic that you could talk about. And I never really talked about it. And obviously I talked about it in the office and I noticed more and more that people were coming into my office. A lot of the questions I get are around vaccines and you just can't talk about it. But over the last, six months to a year, I feel like things have changed a lot. People are much more interested to talk about vaccines. And I just got really frustrated during the pandemic and COVID as well. And I really wanted to have discussions on. I'm not against vaccines.

Joel:
[5:24] I'm not, you know, anti or pro anything. I'm pro health and pro kids. And that's really it. And really unfortunate that we can't have conversations around this. And so I thought that, you know, the best thing I could really do is really dive into the research, figure out what's out there, try to synthesize that. What I've really noticed over the years is almost any book or any platform that's talking about vaccines is very one-sided. It seems like it's very much, these are the best things ever and everybody should get them on schedule. Or then the other information out there is like, these are the worst things ever and you should never get one. And there's really not much that's in between. And I don't feel like that's very helpful to most of the parents that are out there, which are somewhere in the middle. They've heard about the concerns around vaccines, or they've heard stories, or maybe they had a reaction themselves to one. And they're not against vaccines, but they want to discuss the research and information, and they want them to be as safe as possible.

Joel:
[6:17] And I wanted to really dive into that. So that's why I wrote the book. I also have a master's in epidemiology, which is health research. And so I think that also helps to come at this from a scientific perspective. So I think all those things together really led me here to write the book.

Mel:
[6:32] It comes out in May 2025. Is that right?

Joel:
[6:35] Yeah. So not too many people have read it yet. You're one of the few that have read it. I mean, all my friends are still talking to me that have read it. So that's good, I guess. But you never know what vaccines was going to happen.

Mel:
[6:46] Yes. And I'm glad that you mentioned the divide because even my own children are older now. They're eight and 12. But when I was trying to make decisions for them on vaccines, I found a lot of the information on both sides was just emotionally charged. There wasn't a lot of actual information that I could use to make my decision. And what I was comforted with your book is that you very much didn't sit in either camp and intentionally used the scientific research to present the information. And in the book, You say that the current vaccine books on the market cherry-pick research and they shape the narratives to neatly conform to the particular author's bias and their agenda.

Mel:
[7:35] Can you describe to somebody who hasn't read the book yet, how is your book different to those books that are clearly pushing one agenda over another?

Joel:
[7:45] I mean, that's just a great point. And I think if you have, if anyone's read a vaccine book or if they do pick up other vaccine books that are out there, it's very obvious right away, which, you know, what they're trying to do. I mean, they're either trying to convince you to get all the vaccines, they're trying to convince you really not to get vaccines. and my perspective is different because I didn't really write the book in any way different than I speak to patients in the office. I mean, I learned a lot going through it. I knew a lot, obviously, but there's so much more to know and there's a lot that I learned by going through the research, but I really don't believe in forcing people to do things. It's important to give people information and then let them make the best decision that's right for them. I don't force people to do anything in my office. That is really the way that the book takes shape and not telling you what to do. Won't have any sort of schedule that you should follow specifically from my book, it's really important that we give out information so that we can ask questions and that people can make decisions that make sense for them. Because we don't have a crystal ball and you don't know who's going to be the child that's going to get measles and get really sick, or you don't know who's going to be the kid that's going to have a reaction to a vaccine. So you have to make decisions based on the best information that we have. And there really aren't a lot of resources that put things that are maybe contrary to their point of view in their book and you read their books and they're really good, but there really isn't almost any information that goes contrary to their belief. They'll say things like, oh, the vaccines don't cause allergies. They don't cause autism.

Joel:
[9:12] There isn't research to show these things. And if you look at the research, there is research to show some of these things. The majority of the research doesn't, but there actually is still a good chunk of research to show the other side. and some things that are mentioned that there's a ton of research don't really have. A ton of research at least that I could find. And I think that's important because instead of holding these things up on a pedestal, we need to look at them realistically as a product and we need to figure out how we can move forward in a way that's best for our kids. And the way to do that is not to say that they're perfect, but to say like, okay, where are the gaps in our knowledge? Where might they be causing some issues or harm? What might they be related to? And then how do we improve them? Is there an ingredient we could change? Is there something that we need to do differently? Maybe the schedule should be different? I don't know. I don't know the answer. Maybe we have the best possible schedule ever, but that's unlikely, right? We should always be improving. And right now there's, not a lot of that going on. It's a lot more of like, just do it because I said so. And that's a problem.

Joel:
[10:13] And why we're getting so much pushback from parents about getting vaccines.

Mel:
[10:18] Can you explain what a vaccine is and what its intended or theoretical purpose is?

Joel:
[10:25] Yeah, at the very, at a very basic level, you are providing your body with a stimulus an antigen that you're exposing it to before you actually are exposed to the thing so let's say for a virus like you're either giving your body an exposure to a virus or a part of the virus so that way you can mount a response to it and that way your body has some memory so that way in the future if you actually are exposed to the infection you have some pre-made or some memory of how to fight that infection off. And hopefully you can fight it off before you ever get sick. And that's the main benefit of vaccines is that you're creating antibodies, you're creating a memory of either the whole infection, the whole virus, a part of it. And then next time you see it, you are prepared to fight it off, as opposed to if you've never seen it before, it takes some time for your body potentially to ramp up and to figure out how to kill the infection or stop the infection. And in that time, you might get really sick. So it just decreases your risk. If the vaccine works, it decreases your risk to get really sick, even have any symptoms at all. And that's the goal of a vaccine. And ideally, is that it prevents you from ever getting sick or certainly from dying or going to the hospital.

Mel:
[11:44] And in theory, it's really cool.

Joel:
[11:48] You know, a perfectly working vaccine is amazing, right? Or anything. I mean, if you could just take a pill, let's just imagine you could give your kid a pill or, you know, something in a liquid. And it's like, all right, drink this. You're never going to have any problems with it. And it's going to prevent you from ever getting sick. I mean, that's great. That's magic. And vaccines in general, to some degree, are magic. It's an amazing concept. But the reality of the world is not that. The reality of the world is there are risks and side effects to everything that we take. If you drink too much water, you could get sick. Everything has a risk and a benefit, and you have to decide what's reasonable and try to maximize your benefits and minimize your risks. But unfortunately, with vaccines, it seems like we don't discuss the risks very often, and we don't have a total picture on what the risks are. And that's what makes it difficult to make some of these decisions because the general mantras, just do it. But now that the information is kind of out there and people have heard stories, they are concerned about the potential risks.

Mel:
[12:46] Yeah. And on the surface, it sounds like, yeah, it's a great idea to get vaccinated because it's got all this benefit. And people can kind of understand the process of an antigen.

Mel:
[13:01] And I'm a home birth midwife, so a lot of my clients are already making choices that are not in line with the current maternity care system and medical ways of managing things. And many of them love the theory of a vaccination, but their concerns are about the other things that are in a vaccine. So, you know, additives and adjuvants, if I'm saying that word correctly. Because people worry about things like aluminium, formaldehyde, mercury. Firstly, my question is, do they contain those things?

Joel:
[13:37] They do? So, yes, they do. A lot of the vaccines have aluminum in it. Mercury, so that's thimerosal, which was in the vaccines. It's not so much in the vaccines anymore. It's in the multi-dose flu vaccines. It was mostly taken out, but it was and is in some of them. And formaldehyde, they do use formaldehyde. So there are trace amounts in the final product.

Mel:
[14:01] And so I feel like it's those parts of the vaccine that parents feel concerned about.

Mel:
[14:11] What experience have you had with parents who come into your office and their primary concerns with vaccinations? And then I have another question about the additives after that. So when they come in, what are their main concerns? Concerns when they're thinking about vaccinating?

Joel:
[14:27] That is certainly one of the big concerns in the office or just online in general. I mean, these ingredients sound concerning, right? I mean, you're injecting aluminum, you're injecting formaldehyde, and these are things that we have heard cause issues for us. And we know they do in large amounts. The question really comes down to in the small doses that we get them in a vaccine, does that cause an issue? Does that have a risk? What is that risk? Because we minimize that risk in medicine. The common wisdom, the common understanding, the common science would say, no, it's a really, really small dose. It doesn't really cause an issue. It's nothing to worry about. But we have seen that kind of conversation happen before. We've seen this shift many times in the past, especially with metals. And I think if anything, if parents are concerned, it's most about aluminum right now. But any ingredient, I mean, we should be concerned about all ingredients. We should be concerned about all the ingredients in our food. We should be concerned about all the ingredients in anything. We shouldn't assume that something is safe just because somebody says so or somebody said so years ago.

Joel:
[15:29] I think it warrants research and at least respect for concern around these things. It's not crazy to be concerned about aluminum. I mean, in America, we have standards of how much aluminum we can have in water. We have standards of how much aluminum we can breathe. So there is an understanding that it can cause a problem in large doses. We know that. That's not woo-woo or out there. It's just about vaccines in the small dose. But we used to say that lead didn't cause an issue, right? Lead was in everything. Lead was in paint, and it was in the pipes and everywhere. And over time, we realized that it's not so good for us. The same thing happened with mercury. You know, nobody really talked about mercury. And then we were worried about it in fish. And then in the late 90s, early 2000s, it was realized that there was more mercury in vaccines than was even allowed in

Joel:
[16:16] Um the food and so that led to concern it was a different kind of mercury but still mercury and the dosing the amount was higher than what was concerned so they they you know reasonably people started saying well if the dose is higher than what we're okay with in food then are we really okay with it injected into our kids and shouldn't we get some research on this because they didn't really have any research on its safety at that time which is crazy but that is how it was like then they just used things and didn't really study it very specifically for safety they they never truly found conclusive evidence that it caused an issue. And especially the biggest concern was around autism.

Joel:
[16:49] But they did pull it out of the vaccines here anyways, at a precaution. And so it's not really in the vaccines anymore. And now there's a conversation around aluminum, because aluminum is in a lot of the vaccines. It's an adjuvant, it's there, basically meaning it's a helper for the vaccine, it helps stimulate the immune system when you have a part of a disease. So some of the vaccines are live, like you get the whole virus, but they're attenuated or killed. And then you have a bunch of other vaccines where it's just a part of the vaccine, maybe just a protein in the vaccines, which is a part of that disease. And that doesn't necessarily stimulate a very strong immune response to help get that memory. And so they add aluminum, which helps stimulate the immune response. And that gives you a better response to the vaccine and it works better in terms of its efficacy. So that's why it's in there. But the flip side of that, the concern around it is, well, does that also cause problems for you down the road? And again, the chronoism is no, but it's a reasonable question and a reasonable concern, especially if we're talking about a subset of kids. But you would have to really study that in an unbiased way to have a good answer.

Mel:
[17:56] So, yeah, you can check one vaccine and how that responds in a person's body. Has anybody ever thought to check what happens when you give multiples? So here in Australia, in the first year, a child will have at least 17 injections over their first year. Has anybody checked if when you combine all the vaccines and all the additives into one body, what happens to that person at those doses?

Joel:
[18:28] Not not really. So in the reality of how they're tested is, for the most part, the company who's creating the product is studying them before they come out on the market, they are doing safety testing, they're doing clinical trials, but they're looking at their product. They're looking at it for only a few months. In general, it could be a couple days could be a few weeks, sometimes a couple months, maybe a year if you're lucky, but they're not following things long term, they might look at the truck, they might look at the trial and have some of the other vaccines included. So you might be getting that vaccine with some of the other vaccines versus someone who doesn't get the one thing that you're looking at, or maybe you're studying your vaccine against a different vaccine. It's very rare, almost non-existent to study your vaccine versus nothing that doesn't exist. And so it's without that kind of research, it's really hard to know what the cumulative effect is. You would have to study kids that were vaccinated versus unvaccinated and follow them forward for years to really have a true understanding of the safety profile and to be able to answer that question. That's not the way that research is done. There aren't really any vaccinated versus unvaccinated studies, certainly not any long-term prospective studies. It's never really been done. And there are a lot of vaccines that are new. So there really isn't a lot that looks at many vaccines. There's a few of the clinical trials to look at some, but it's still like an

Joel:
[19:40] old whooping cough versus the new whooping cough in the setting of getting some other vaccines. So you don't really have a good understanding of the baseline of safety and kids that are vaccinated versus unvaccinated and then what kind of long-term issues might come from the vaccines, if any, and maybe they don't, but we just don't have a good understanding of that.

Mel:
[19:57] So if I'm hearing you correctly, we don't really have any scientific understanding of the, It's vaccinating versus not vaccinating because most of the research is more short term to work out if that vaccine has risks and what are the benefits and the efficacy of it.

Joel:
[20:18] Right. The trials before a vaccine come on the market are done by the company. They're trying to prove that their product works. They're looking at safety, but they're looking at it in probably a biased way because obviously they're a company and they want to show their product working the best and having the fewest side effects. And so to get that kind of research somebody else would have to do it you'd have to look at kids very long term and nobody nobody does that so it really doesn't exist and that doesn't mean that a vaccine is unsafe but it's really hard to have a true understanding of how a vaccine could be related to any of the chronic conditions that we're seeing without that kind of research and the issue today is we have a lot of these chronic conditions that we didn't have before they're certainly skyrocketing. And we're seeing a lot more autoimmune conditions and asthma and allergies, ADHD, autism, and we don't have a good answer exactly for why that's happening. Now to blame it all on vaccines, I think that's, you know, a little bit much. There are many things that are going on and many things that are different. But whether vaccines have some part of that, I think is a very reasonable question. And that's not something that's been answered, because you can't pick that kind of information up in the current literature. And the easiest example to think of is, let's just say, for example, the hepatitis B vaccine caused cancer 10 years from now.

Joel:
[21:38] How would you know that by looking at the research? How would you know that it did that unless you were following kids forward and you saw, oh, all the kids that got all these vaccines have a lot more hepatitis B vaccines and a lot more cancer. Well, is that related. It may or may not be, but you would have to know that. Other than that now, unless you're reporting that you got cancer and you had, it's because of your hepatitis B vaccine, looking backwards, and how would you relate those two things 10 years later? You would never know. So everything that we have right now doesn't look for those kinds of things.

Joel:
[22:06] So it doesn't mean it does, but it's just that we don't have a way to know. And given that there is such an increasing rate of chronic conditions, I think it's reasonable we should be looking into everything.

Mel:
[22:16] Yeah, that's the.

Joel:
[22:17] Main thing for healthcare providers

Mel:
[22:18] To be able to tell parents is that we don't know the long-term outcomes of vaccines when people are asking what are the long-term issues we don't really have any idea because it's not researched.

Joel:
[22:29] Right right risks so we have a very good understanding of the long-term implications of the benefits we just don't know the long-term implications of the risks and that's a big part of it because when you're making a vaccine or any sort of medical decision you are weighing the pros versus the cons the risk versus the benefits and if you don't know the the risks and you don't have the full picture of that it it makes it harder to make a decision and it's really important i think at this point for vaccines because we are in a different place in the world where not everybody's dying of measles right that was a big issue

Joel:
[23:04] 100 years ago, you know, it's a very, very different world. If you're talking decades and decades ago, where people were living till 40, and they were dying of all sorts of infectious diseases versus a lot of what we're seeing, these things are basically gone, we don't see very much of it. And then you know, the argument would be well, that's because of vaccines. And I get that. But also a lot of these diseases were way on the downslope before vaccines were ever created. And in either way, it's still important to discuss the pros versus the cons, because otherwise, we could just keep adding more and more vaccines. And at some point, that might be too much. And also, no matter whether you are a full 100% believer in vaccines, you think everyone should get all of them. That doesn't mean there aren't ways that we couldn't do it more safely. Maybe the schedule that we're using now increases your risk for asthma. And maybe if you push back one of the vaccines two years, you would decrease risk for asthma. Why wouldn't we want to do that? There's so many questions we could ask. It's not black or white. But we have to acknowledge that there's a possibility they could cause problems first before we can make them better.

Mel:
[24:03] Yeah, because the pervasive language is that vaccines are great, we should all use them. And that puts us in a bit of a dangerous position because then if you question their use or you want to research that, there's pushback because the messaging is, but hang on a second, it's fine. What's the problem? And I wonder, too, if it's difficult to research vaccines long term, because research takes a lot of money. And who is interested in researching the long term risks of a vaccine?

Joel:
[24:39] Right, right. I mean, that's the perfect point. That's exactly correct, right? To do a long term prospective trial is extraordinarily expensive. I mean, we're talking billions of dollars. And companies are not going to do that. Why would a company try to find problems with their own products? They're not going to do it unless they were forced to. That's a problem. I mean, maybe there's some philanthropic ways that this could be done. And that might also occur over the next decade because people are interested in this now. I think people are concerned enough. And like you said, why I think it's really important is because there's a lot of pushback. I mean, parents are very concerned. They don't feel like the medical community is discussing this. They don't feel like safety is a priority. It's more, you know, pharmaceutical companies making money. And we are seeing the outcomes of that. We're seeing the highest rates of kids that are unvaccinated ever. We're seeing the highest rates of kids not fully vaccinated ever. We're seeing the highest rates of exemptions we've ever seen. And the trust in medicine is gone. And a lot of that is to do with the fact that we're not willing to talk about it and where people feel like they're being forced to do things. And I don't think that's a good long-term solution a much better long-term solution is to acknowledge people's concerns and to figure out the holes in the research what people think are the gaps and

Joel:
[25:52] Do those studies do more research in that way and then you'll find what you find and you'll find things that are problems and then you're going to be like oh okay I didn't realize there were issues let's fix them or you'll find everything's perfect and that's going to be the research and evidence to make people feel confident to do it and you shouldn't feel forced you should feel comfortable doing this, especially when you're talking about giving your kid many, many injections, you should

Joel:
[26:13] feel comfortable that it's helping their health instead of harming it. And a lot of people in the back of their minds, at least are like, you know, my kid's really healthy. Do I really want to do this? How worried should I be about a diphtheria? You know, how worried should I be about polio? Like, do I really need to do this vaccine right now? Can it wait? Do I need to do hepatitis B vaccine on the day one of life? These are questions that parents have, And I don't feel like they have all the information they need to feel comfortable doing that because I don't think it exists. I don't think some of that research that they're looking for exists.

Mel:
[26:43] An argument directed towards parents who are openly choosing not to vaccinate their children is from other members in the community who feel slighted because it's like those parents aren't doing their part for herd immunity. And so this argument of herd immunity where if you vaccinate enough people, that will help keep the more vulnerable members of our community as safe as possible. Can you explain this idea of herd immunity? And is herd immunity just a theory or is there some kind of scientific basis? And actually does herd immunity exist at the percentage it needs to exist to have these theoretical benefits?

Joel:
[27:30] This brings up one of the most interesting aspects of vaccines. It's called the social contract is one of the ways that it's usually referred to. And what you're referring to with herd immunity is the fact that if enough people get vaccinated, then the virus or the infection doesn't have anywhere to go in the community because most people are vaccinated, they're protected against it. And so for the individuals that are not able to get vaccinated, they don't get sick because the virus infection never gets to them because most people are vaccinated. And And then that really stops the disease from really spreading in the community. So that it's a real concept, for sure. It works for a lot of the vaccines, not all of them, but certainly there are some vaccines where herd immunity makes a big difference. And every disease is different because it depends on how it spreads and many factors. But the easiest one to really understand is measles just because it's top of mind right now.

Joel:
[28:19] And the theory or the research shows that about 95% of the population needs to be vaccinated to create herd immunity, which stops the spread of measles because it really just doesn't have anywhere to go. And then it stops. And so really, most individuals are protected. You're usually thinking in terms of the fact that you're protecting babies that couldn't be vaccinated yet because they're too young, or individuals that have some sort of immune conditions. I think it's a really important argument. And it's one of those that is really philosophical. And I don't have a perfect answer to it, because everyone has a different opinion on responsibility we have to others and where that line is drawn. Because I would say, like, obviously, we want to protect everybody, right? I mean, there are very few people that are like, no, no, no, we don't want to protect a child with cancer. Like, of course we do.

Joel:
[29:07] And but the reality is more complicated than that. There are many, many, many infections out there, you can only protect against a couple of them. And so just getting a vaccine doesn't protect a child from cancer from all the diseases, It does protect them a little bit against that disease, but it's not so simple. And, and,

Joel:
[29:24] Everybody has a different opinion of what is reasonable for what they should have to do for somebody else. And there isn't a clear cut answer for that, because you could say, well, there are people that need a transplant. So everybody who you're required to give one kidney, if you have a match, and there's someone that needs a kidney, and people won't necessarily do that, they're not going to be willing to go through a surgery. Obviously, that's more invasive than a vaccine, but there is a line. And so everyone would look at that in a different way. And some parents that don't want to vaccinate or feel like vaccines would cause harm for their kids. I mean, maybe they have a very sensitive kid. Maybe they have had a vaccine before and had an issue and they don't feel like their kid, they should take the risks for their kid for having further vaccines because their kids already had a bad reaction. And so the question is, where do you draw the line? And there's no exact easy answer because there is some moral, there's some morality to protecting others, but there's also a line to be drawn. And especially when we're talking about more and more vaccines and more and more risk. I mean, even if it's a small risk, that risk increases and compounds with 20, 30, 50, 70 vaccines. And if you add, you know, 50 more in the next 20 years, like at what point should you, if you feel like they're causing an issue, should you be required to do that to potentially protect somebody else? And on top of that, many of the vaccines don't create herd immunity at all. They have nothing to do with herd immunity. So certainly some of them do, but other vaccines just protect you.

Joel:
[30:49] And they don't, they don't protect anybody else. And you can still pass it on even if you have the vaccine or they're like, for example, tetanus is in the soil. So you're not stopping any sort of herd immunity. It has nothing to do with that.

Joel:
[31:01] So it's not so simple to say that, but people want to simplify it again. And this is one of those things where I go back to like, what am I what do I hope out of the book? Like my hope is for debate and discussion. I don't want people to do or not do anything. I want them to understand what's going on. I want them to discuss it because this is the kind of question that should be debated. At major universities and in ethics classes. It's not a simple answer.

Joel:
[31:26] There is no simple answer with the social contract and protecting others. We need to hear varying perspectives.

Mel:
[31:33] Regarding a child's immune system, we have been told that a child has an immature immune system and they have trouble responding to diseases. Part of the benefit of breastfeeding is that that can help with that. I've always been curious about giving lots of vaccines to small babies who have these immature immune systems. And the theory of how vaccines work is to create an immune response against these diseases.

Mel:
[32:06] Is a newborn immune system or even a child immune system, you know, say under six months, capable of mounting an effective immune response to a vaccine, given how immature they are.

Joel:
[32:24] So this question is something that I have come to question as well, I would say in general. To the specific question that you asked, they are capable of mounting an immune response. I mean, we know that because we can measure it. There are different vaccines that we give later or earlier depending on it, but certainly you can look at the research and look at, you know, hepatitis B and the increasing risks versus decreased risks of giving a vaccine at a certain time, the risks of getting hospitalized versus not for a lot of these diseases, and you can look at their antibody response. So you are capable of mounting a response. Just because a baby gets sick doesn't mean they die. Like they have an immune system. It's just an immature immune system and it develops over time as it's supposed to.

Joel:
[33:04] Breastfeeding helps early on because you're giving those passive antibodies, but you're supposed to develop your immune system over time and through life and through exposure to your environment, you develop that immune system. I think the bigger question, and if you would have asked me this in medical school or residency, I would have said no of course not but the like the the question is around like can it cause problems right you know does it does it affect the immune system in a way that creates or potentially sets you up for problems in the long run does it affect your immune system in a negative way or does it change your immune system in some conventional wisdom says no conventional wisdom says no you're doing a good thing you're providing their body with an antigen you're providing them with some memory of this disease. And it's a good thing because then you don't get sick from it later.

Joel:
[33:55] The flip side of that concern is just like you said, you're developing an immune system over time. You're stimulating it artificially. It's not, the vaccine's not the same thing as getting sick in the real world. I mean, you're trying to mimic it, but it's not the same. Just like formula is not the same thing as breast milk. It's similar, but it's not the same. And so what are the consequences of doing that downstream? Are there things that we're not taking into account? Is it stimulating the immune system in a way that we're not totally understanding? And that change sets up some kids based on their genetics to have an increased risk of allergies or autoimmune conditions. I don't know. And that's the question. I mean, that's the question that people have. And again, mainstream research would say no, but there is a fair amount of research and concern and theory that maybe for some kids it does or maybe it's related. And I think even though they say there's no biological possibility, I think there is. There's a lot of plausible mechanisms as to how it could affect some kids. I don't think we have that research yet or that understanding yet. We just kind of say no.

Mel:
[34:56] Well, even the very fact that we give, and a lot of vaccines have multiple diseases in them, vaccines in them. The fact that we give so many in one go, it also seems like it's an unnatural way to be getting illnesses. If you were out in the world, you would never be exposed to whooping cough, diphtheria, pertussis, and hep B all in one sitting.

Joel:
[35:27] I mean, I agree with that. I think that the counter to that is we're exposed to a lot of stuff all the time. I mean, you bite on an apple and there's, you know, how many billions or millions of bacteria and all sorts of things on there. So your body is exposed to a lot of things all the time. But my counter to that is, but not from a vaccine. Like, it's not the same thing. First of all, a vaccine, the antigen is not the same thing as in the real world, even if it's, you know, killed or whatever. There's all sorts of other stuff in the vaccine that creates a response. And you're injecting it versus getting it through the normal ways that you would be exposed. You know, if you're touching something and it goes in your nose or your mouth or you're eating it, that's how you would be normally exposed to an infection versus an injection.

Joel:
[36:12] It's bypassing your normal external immune system. And so it's just different. And so it's not unreasonable to think that your body might react differently, at least sometimes.

Joel:
[36:22] And, you know, if you're talking about something that happens once in a million or once in a hundred thousand times, like that's not unreasonable to assume that your body couldn't react in a weird way. But for whatever reason, there's this crazy double standard for vaccines versus everything else. It's like, we know that, you know, some people are allergic to peanuts, right? Or you can walk by someone who has a peanut, serious allergy and peanuts out in the room and they can have anaphylaxis. Like your whole body could basically shut down just from one bite of something. And that could happen, but it couldn't happen for some people from a vaccine that you're injecting. Like that doesn't make sense. you take an antibiotic like amoxicillin

Joel:
[37:02] And uh in the midst of being sick and you get a rash and everyone's like no no no no never don't take amoxicillin anymore you could have an allergy to amoxicillin uh and then kids get a vaccine and have a seizure and you're like oh that's not from the vaccine right and it's just this weird double standard not to say that they're super super causing problems for everybody but it's like why couldn't happen for some people why couldn't these things be related for some people and why do we just assume that it's not um and and that to me is this crazy double standard in medicine, that it just seems to be unthinkable that vaccine could cause an issue. But every other medicine does. So why couldn't the vaccine? I just don't understand how we got here. I think we just are trained in a certain way. And we're just trained, you know, here are the vaccines, here's the schedule, they help so much, they're the best thing ever. They have saved humanity, we live longer, go vaccines, like, that's it. That's, that's kind of the mentality in medicine. And I think with the internet and the change in social media, people are opening up. I never, I just didn't think about it before. You just did it. And I think when you look in the research, you realize there's a little more to the story.

Mel:
[38:09] Well, can we go into some specific vaccine? Here in Australia, there's 17 needles that our children will receive if they stick to the schedule. Many of them have combined vaccines in them. So separately, it would be 35 vaccines over their first year. If we can start with the very first, the hepatitis B vaccine dose on day one of a baby's life. I find it really hard to counsel my clients on this one because they say, well, should I get it? And I said, well, I can't tell you if you should or shouldn't. Of course, the vaccine schedule says, yes, that's day one. We get the hepatitis B vaccine. But let's think about how your baby might contract hepatitis B. So if the mother herself doesn't have hepatitis B or anyone in the family doesn't have hepatitis B in the household. The other ways to catch it are unprotected sex, IV drug use. It's shared by bodily fluids and feces. And so talking to parents about, you know, how at risk do you feel your baby is of hepatitis B at this stage of its life and using that context to help make vaccine decisions.

Mel:
[39:28] Can you just talk through the rationale of this day one hepatitis B vaccine? Because then there's three more doses before the baby's one. Is there a reason that we do hep B so early for babies?

Joel:
[39:45] Great question. Hep B is the, I don't want to say the most controversial, but it's certainly the thing that's done the least on the actual schedule, which is recommended. I mean, you know, for my patients, same thing. You know, I said the exact same thing. I obviously can't, as a practitioner, tell somebody not to do something that's on the schedule, but you can do one at birth or you can do them later. For the schedule for vaccines, why you do them, when you do them, I mean, that's just based on the research that has been done in the past of how many doses are needed to give you the best or most optimal efficacy. So they look and they give one and it works 30% of the time. They give two, it works 50. They give three, it works 95 or whatever it is for the vaccine. And that's why they choose to do it. That's why they do that many doses. But why you give it on day one, I still think that's a big question. I mean, I still think it's a weird one. It used to be when it first came out, it was for high risk populations. And then that changed. There were still many people getting hepatitis B after just giving it to high risk populations. And so they decided that they could move it to the younger ages. So that way you're getting ahead of it and you're giving it to young children, babies when they're, when they're young,

Joel:
[40:54] before they're exposed. And that will just in the population decrease it. Cause if everyone is protected as they get older, then there's no circulating hepatitis B and it worked. I mean, hepatitis B rates have gone down significantly. So that, that part's good. Um, but yeah.

Joel:
[41:10] Why give it to a baby on day one? I mean, there's not a lot of good reason for that unless you have hepatitis B. We have testing now for hepatitis B. So you know if mom has hepatitis B. So that's one reason because if you just vaccine everybody, then you never miss anybody. You could theoretically be exposed to hepatitis B. So somebody could have it and not know it. And that's not super common, but it's still possible. So I mean, these are the things I talk about with parents. Like you do have some risk, but I mean, it's infinitely small. It's something that should be discussed with your doctor because you need to know your own risk. If you have hepatitis B, your partner has hepatitis B, that's a very different risk profile. I mean, there's a reasonable chance your baby's going to get it. And I don't think it's unreasonable to get a vaccine then. That makes sense because you want to protect your baby from getting hepatitis B. But if you don't have it and your partner doesn't have it and nobody that you know has it, at least that you know, I mean, your risk is really small and it's there, but there's a risk to many things. And you have to weigh those pros and the cons for yourself and to inject a baby on day one with something with such a low risk.

Joel:
[42:11] To me, it doesn't make a lot of sense from a plus minus scale or risk benefit scale. You know, if you want to do it and you want to protect yourself later in life, that's fine. I'm not opposed to the vaccine. I mean, it works pretty well. But I think that that if we were to start anywhere with making some change to the schedule, that's the place to start. And that one to me has the lowest benefit to highest risk of the vaccines that just to me in common sense would say, we don't need to do this for babies on day one, give it to them later, unless you have a known exposure or a known risk.

Joel:
[42:43] But that's kind of my feeling on it. But that's not the recommendation. Recommendation is to do it. And I mean, it works, but it's just, I wonder what kind of risk we're giving to a baby by injecting them on day one. They just got out of the womb. I mean, you're telling parents not to give their kids food till six months but like inject them within 24 hours with a bunch of chemicals it just doesn't make a lot of sense to me like i understand the concept of vaccines i really do but you have to weigh their risk versus benefits like you don't just vaccinate someone just because like we don't give the smallpox vaccine anymore because there's no smallpox but we could say oh let's give everybody smallpox vaccine just in case somebody would ever get it again in the future it's like you can't just give everyone every vaccine just because you have them yeah

Mel:
[43:27] Yeah and the other one that And I guess this could be living in a Western country, not exposed or understanding, but we're still vaccinating against polio.

Joel:
[43:41] That's another one it's it's the same it's the same thing it's the same argument it's hard because there's such there's such a history behind polio um and and polio still exists in the world so the the concern i guess the the you know the major worry would be that it would start to come back if everyone stops vaccinating um but again i i think that there's something to be said for maybe

Joel:
[44:01] Given that we haven't had you know cases in a very long time that you could minimize the doses people get you could move them later in life you know maybe maybe maybe there there is something we could do about that and again you're you're explaining the risks the benefits of parents like it's still available you know if people want to do it that's fine if they if they feel comfortable that they want to give the hepatitis b vaccine they want to give the polio vaccine the first couple months that's fine i think i think that's totally reasonable and they're available and and that's where everyone has to weigh those risks for themselves but if if you were to say to me like look there hasn't been polio in america in you know 30 years 40 years that's a low risk proposition, maybe that's one of the things where we could be like, all right, we have a lot of vaccines for young kids. Let's put it in one of the older kid vaccines. You know, I'm not, yeah, there's a little risk you get polio. And if you don't want that risk, then give it to your kid when they're two months old. That's fine. But we have to have some recognition that we're just adding more and more and more.

Joel:
[44:53] Because, you know, we've added the RSV vaccine now and there's the COVID vaccine. And then there's meningitis vaccines and pneumococcus vaccines. Like there are a lot of vaccines that have come on the market and have started in the last 20 years or 30 years. And we we have to have some recognition that there could be too many at some point or at least we're just giving parents fatigue over like so many vaccines that it's like well let's let's be reasonable with what's actually in the world today and let's prioritize like all right there's whooping cough let's prioritize that these ones are less important so they're available if you want them but like unless we have some sort of resurgence we're not going to prioritize those ones i mean i don't think that's unreasonable that's public health and they can change i mean you could be like okay we don't need to do polio vaccines anymore for two months old you have to just reassess.

Mel:
[45:36] Well, and I think this too is where parents can pick and choose for themselves. So we know how many are available. We know which vaccines are available. And then possibly parents could say, okay, now that I know there hasn't been a polio case in 30 years, maybe I'm happy not to give my child the polio one. But if we're going to be traveling to countries, for example, where polio still exists, maybe then it would be considered more like a travel vaccination, you know, a precaution in that scenario. And same with hepatitis B. You know, I've had clients who having their babies here in Australia and then intended on traveling to places where there's a high

Mel:
[46:17] hepatitis B load in the community. And, you know, my advice to them might be a little bit different. I'm like, actually, maybe your risk profile for your baby is quite different. So, you know, that's something for you to think about. Now, the other one that I'm really curious about and that I find hard to reconcile is my generation went to chicken pox parties where if one child had chicken pox, then your mum would send you there to try and get it too, as young as possible, so that you had chicken pox and you're immune. And now we're vaccinating for chicken pox. And so few children get it.

Mel:
[46:58] But I'm hearing along the grapevine that then what happens is later as the immunity wears off, now we're actually exposing the population to chickenpox later in life, which is much harder to manage as an older person versus when you're younger. So, yeah, I don't know. I mean, that's just an anecdote, really. I just feel like sometimes we're pushing problems up.

Joel:
[47:22] Yeah. It's true. So first of all i mean those are the three that people have the most concern about in general in terms of things they push up because it it goes back to risks versus benefits and the benefits are not huge uh for any of those three in comparison to some of the others potentially so for chicken pox just like you said most people had it i mean we all had it when we were little it wasn't a big deal for the most part but but at a population level and that's what public health looks at it can be i mean you can if you have a bad rash then kids get bad infections with that So you can get a cellulitis, a skin infection. You can get meningitis and pneumonia. I mean, not commonly, but it happens when you're talking about millions of kids getting sick. A few kids get really sick and that's true of any infection. So there is a public health part of that in terms of minimizing the risk of those few kids that get really sick. Whether that again means that every kid should get the vaccine. I don't know that that's a public health decision, but I would say that those vaccines should be more in the recommended world versus like, you know, everybody just gets it. And there are countries that do that. I mean, there are plenty of countries that don't require chickenpox, and they just have it as a recommended vaccine. And

Joel:
[48:30] What you brought up is just really interesting, but it goes back to what we were talking about before. Like we, we try to simplify things and not everything is just so simple with the human body and with a vaccine. And yes, you might decrease your risk of chickenpox, but then what does that do to you long-term? I mean, I think that's the big missing piece to the vaccine puzzle that we have

Joel:
[48:49] a lot. I have a lot of questions around is, okay, what are these things doing to you long-term? Because there is no question that shingles is on the rise. I mean, that has been on the rise in the last 30 40 years since the chickenpox vaccine came out now whether that's because of the chickenpox vaccine or not that's debated still there there is a lot of evidence or thought that that it does impact it so the the theory so chickenpox when you get it it stays in your body for your lifetime

Joel:
[49:12] Most people it never gets reactivated for but some people it does especially when you get sick or stressed or your immune system is worn down and and over the last few years we've seen more cases of shingles and shingles is generally much more severe and much more painful than chickenpox And because you used to have a lot of chickenpox, you're exposed to it constantly. So your body is continually exposed to other kids with it. You don't get sick, but your body still mounts an immune response to it. And theoretically, that keeps you from getting shingles. At least that's the theory. And then now we're seeing more shingles. So they think that maybe the reason we're seeing more shingles is because you're not being exposed to chickenpox constantly. And so you get a reactivation later in life or you get chickenpox for the first time. your antibodies wear off because a vaccine doesn't give you the same response as an actual disease does. I mean, that's true pretty much of any disease, which makes sense. I mean, if you fight off an infection, that's the real infection, your body mounts in response to all the different parts.

Joel:
[50:06] And it makes a much more robust response as opposed to just seeing one part or a killed virus. It's not exactly the same. So you're probably not going to mount quite as good a response. It's still pretty good, but it's not the same as the original. And so maybe you have more chance for things to wear off and we're seeing that we're seeing with a lot of conditions uh where now because most people are vaccinated over time the the antibodies and the memory wear off you know with mumps is is really common the mumps have increased a lot we see it with whooping cough i mean the new whooping cough vaccine the one that was replaced from the original is much worse than the original the original was the whole cell there now we have the the dtap the a cellar pertussis so it's not creating as robust a response that's why you need so many you need boosters but even with all that it's still the immunity wears off pretty quickly so we are seeing this this decrease of immunity from some of these diseases like we get we get protection from the vaccine but we we don't get the protection from the diseases and and that it's a very it's like it's controversial to talk about but it shouldn't be it's just you have to live through the disease right so so um you know getting sick is not good but if you do get sick and you do get over it you have better protection so it doesn't mean that we shouldn't have vaccines anymore but it's just something to take into account when we're talking about this subject yeah because

Joel:
[51:26] If you get measles and you get better, you have a better protection. That's just how it works. But you'll have to not die from the disease. So you have to weigh those two things when you're making that thought. But there is a benefit in a way to getting sick from natural disease and getting better, assuming you get better.

Mel:
[51:43] Yes. Well, this is the thought in a lot of parents' heads is particularly, you know, with chickenpox. We know that if you get chickenpox when you're little, the impact is a lot less. The symptoms are a lot less severe than if you were to get it as an adult. And so it's almost like, yeah, we're pushing all the problems upstream.

Mel:
[52:05] When everybody's artificial immunity is worn off, we're still left to navigate that health scenario. You know, you talked about the possible risks of vaccines. When we go, when parents go to their doctor to talk about them, we're given the usual message of, yeah, vaccinations are great. They're going to help keep your child safe and help the community keep safe. But we very, very rarely get to see a list of the possible risks so that we can actually weigh up the risks and benefits. What should parents know could happen to their children if they do choose the full vaccine schedule? What are the possibilities of them having a short-term reaction?

Joel:
[52:51] Short-term reactions are very common. you know, mild, mild, moderate thing. So the stuff that we see all the time, well, I guess, first of all, most kids that they get a vaccine, they do, they do fine, at least from what I've seen. In the short term, they don't really have much of a reaction. I mean, you know, it hurts a little bit. But other than that, the things that you would think about when, you know, most people they've had a vaccine, like it hurts, they get a little swelling, get some redness, you get a little bump there. You don't feel good for a day or two or three, a little bit of a fever, you maybe you're a little more likely to get sick in the next week. I mean, those are the things that we would see fairly commonly, and those would be the mild to moderate things. Severe reactions are reported as very rare. The things that evidence-based that is stated that definitely occur with vaccines that are related on the on the charts would be I mean death would be on there but that would be mostly from like anaphylaxis so a reaction to an ingredient there that you're allergic to seizures would be of the everything would be rare but more common that we would see it Guillain-Barre is a neurologic condition with muscle weakness encephalitis encephalopathy so inflammation of the brain I mean those are those are really the things that are reported. There's not a ton more. And there are many other things that people are concerned about,

Joel:
[54:07] but those are not things that are reported as being caused by it on any sort of consistent basis.

Mel:
[54:13] And one of the big arguments that some people make is that vaccines have been linked to autism. Can you talk to us about where that idea came from that they're linked to autism And is there any skerrick of evidence that suggests that could be possible?

Joel:
[54:31] Yeah, of all the vaccines are controversial in their own right. And then of all the controversial topics, vaccines and autism are probably at the top of the hill. When I was in training and up until even more recently, we're told over and over again, vaccines don't cause autism. I mean, based on the scientific literature, this has been studied and it's settled. And that's pretty much what you hear over and over again. And that's what everybody says. If you don't say that, you're a crazy crackpot. And that's just what it is. And that's what you're taught and you don't really look into it anymore. You know, for the book, I was really interested in this topic. Nothing blew me away more than the autism section. Because when you really do look at the research, it's pretty mind-blowing what doesn't exist. I mean, the science is not settled. There's no question about it. You have to have really good research to be able to say that. And I don't think that we do. The reason why they're thought to be related at least originally was you know parents

Joel:
[55:28] Got a vaccine for their kid, and then they got the diagnosis of autism, you know, and they related those two things together, they thought they were causative, you know, may or may not be true. But but, you know, if you if you if you have a vaccine this morning, and you have a heart attack this afternoon, it could be from the vaccine, but it could just be that you're having a heart attack this afternoon, you got a vaccine, there were certainly a lot of anecdotes and more building anecdotes about feeling that vaccines cause autism. But but back then, there wasn't a lot of research. We're talking he's in 90s. And then Andrew Wakefield came out with his research that showed that, well, he basically at least posited that MMR could be related to autism. Then following that, there were some concern around the thimerosal mercury that we were talking about before and whether that could be related to autism. And so really that spiraled out from there that there was just this concern around it. The original Wakefield research was not the best And I think was appropriately debunked. But ever since then, there's been this strong push to push back on vaccines and autism as a concept. And we've just heard over and over again that they don't cause it. But the reality is the research is actually mostly on MMR and thimerosal.

Joel:
[56:40] There are certainly reports and certainly parents have noted and talked about more commonly, it's more slow, slowly notice, not like you get a vaccine and then you notice a massive change the next day. But I think that that's important information. And I don't think we should discount it. I mean, autism is not one thing. And I think there are many probably triggers and causes. And some kids are, I'm sure, you know, some people are born with it. And sometimes it's maybe prenatal, maybe it's to do with toxins for some people, maybe for others. That's just how their brain is wired. And that's just just normal for them. And so I think it's many, many things. But it's really important to look into something that there's there's so much concern around and so many stories and not to discount it. Without question, this has been brought to the forefront because of Andrew Wakefield's research in the in the 90s and him potentially connecting MMR to autism. And then there was more concern around thimerosal and the mercury.

Joel:
[57:35] And nothing's been proven. And when you look at the research, you certainly can't say that vaccines cause autism. I mean, that doesn't exist in the research. But you also can't say that vaccines don't cause autism. The research really just focuses on MMR and thimerosal, and it doesn't focus on all vaccines. I mean, there really haven't been any studies that focus on vaccinated versus unvaccinated kids. There really aren't any studies to look at all vaccines. There are many vaccines that you get in the first year before MMR. So to say that vaccines don't cause autism doesn't make any sense, because you're basing it on a different question. I mean, there is some decent evidence to show that MMR might not cause autism, or thimerosal might not cause autism. We took out thimerosal, and autism rates are still going up, so I think that's plausible.

Joel:
[58:21] But to say that all vaccines don't cause autism, we don't have that research at all. You can't say it does or it doesn't, and there are many interviews and court cases where people have been deposed and and the reason that vaccines don't cause autism is because there's no research to show that it does and that's circular thinking that doesn't make any sense especially when you're being so adamant that vaccines don't cause autism it doesn't it doesn't make sense like you have to have good research to to to have that position and and there haven't really been studies to do that

Mel:
[58:55] Why do vaccine manufacturers need and have legal protections against cases brought against them? There's like a no-fault legal protection for vaccine companies. They don't have to pay potential damages that are caused by vaccines. So why do they need that level of protection?

Joel:
[59:20] In the 80s, there were increasing legal cases and lawsuits brought, especially against the diphtheria pertussis tetanus vaccine. And there was increasing concern around side effects and risks and neurologic complications. It was never totally proven, but they were concerned about it nonetheless. And so many or a number of vaccine manufacturers left the market because of concerns over too many lawsuits and not making money and at that time the the government basically wanted to stabilize the market and so they they gave them immunity uh or almost almost full immunity from from vaccine liability so that way they they couldn't get sued and that's the way that it's been since then so they just they don't have any liability or very little liability from issues And the problem with that, big problem with that is it doesn't force them to make their products better. It doesn't force them to make sure their products are safe because one of the big ways that we kind of stabilize a market, especially a capitalist market, would be lawsuits. Like you have to have a good product and people have to want it. And if they don't want it, it causes problems, you can sue them. But we don't have that with vaccines. And so that has created this vacuum where you have these huge companies that can make products that can make billions and billions of dollars, but don't have to worry about them being safe. And it doesn't mean they're not safe, but they just don't have to theoretically worry about it unless it causes so many problems that it's so obvious.

Joel:
[1:00:50] And we're not there yet, I guess. So that is why it exists.

Mel:
[1:00:55] Okay. And the other argument I hear from parents is that doctors are incentivized to give vaccines and that's why they're encouraging them, that they actually get financial benefit from vaccinating their clients. Is it true that doctors are paid to give individual vaccines by manufacturers? Yeah.

Joel:
[1:01:21] They're not paid by manufacturers, but I mean, it depends on where you are. But mostly you are paid. I mean, you're paid by insurance or you're paid to do it. I think the key with this is doctors are not giving vaccines because of money. That's a weird way to look at it. Most doctors are salaried in the world. So it doesn't really matter how many vaccines they give. They still make the same amount of money. From an administrative perspective, I'm sure there is a push. You know, you make some money from vaccines. And so the more you give, the more that you make as a big business. And doctors should get paid to get vaccines. I mean, you should get paid to do anything. You know, if you're working as a business and they cost money and you have staff and you have problems with some of them, like, you know, you have to have a fridge. So there's a cost.

Mel:
[1:02:07] They're not paid extra in a sense of like, if you give this vaccine for every vaccine you give, we'll give you an extra $7 or something like that. But is it like there's an incentive program to encourage?

Joel:
[1:02:24] Not mostly. So there's kind of two ways. So you get paid for it like anything else that you do. If you're seeing a patient, you get paid. That's what happens in business. So if you give a vaccine, the vaccine costs $100. You might get paid $120. But you have to administer it. You have to pay your staff. They got to do it. I mean, you should make some money. If you're doing anything, it's a big thing to do vaccines. And you have to counsel and talk about it. So you do make some money, but not a ton. And I would say, again, I think if doctors made zero dollars, they would still give the exact same amount of vaccines. So I don't I don't think that is a thing. But there are in some places, in some ways, incentive programs to some some bigger systems, especially will incentivize you by giving you a bonus. Usually it's not very big, even though we hear these crazy big bonuses, but doctors are not getting huge bonuses, especially not pediatricians. But they'll say like, oh, if you have like 80 percent of your patients vaccinated, you get a little bit extra. so that does exist, it is true it happens, but again, I think that that doesn't cause people to do vaccines. It's like the other way around, but they do, they do get a, they do it. So it exists. But I think if people go after doctors for giving vaccines, that's the wrong angle because the vast majority of them would say I would do it for nothing. And vaccines are one of the most annoying headaches you have to deal with as a pediatrician because they cost a lot of money to have. You got to keep them safe and it's a whole to do. So it's, doctors are generally not doing it for money. I'm sure there are some, some bad apples out there, but even for that, it's like, they're not, they're not doing it because of that. They're because they believe in vaccines.

Mel:
[1:03:50] I have two more questions. For people who are really interested in the actual research behind the vaccines, it's very hard once you start digging in and reading the actual papers when you discover that a lot of the papers are designed, written, funded, staffed, all by the manufacturing company who are making the vaccine. And as a researcher myself, you know we have to declare lots of conflicts of interest and if there's way too many and that you could introduce bias into that scenario perhaps you might be suggested as not the best person to be researching this particular topic because the conflicts of interest are going to interrupt the, study what I'm coming at is that a lot of the research seems to be coming out of, companies who are testing their product to check that it's safe to go to market and to get approval for it to go to market because they can demonstrate the safety of it. But that's where the research ends and we're only asking for the information that will allow a product to be manufactured and sold.

Mel:
[1:04:56] Would that be an accurate way of looking at the current vaccine research?

Joel:
[1:05:03] I would say yes, it's pretty accurate. The ones that are doing the research are the companies that are doing the research for their product.

Joel:
[1:05:12] And you have the issue of bias, of course, they're biased, they want their product to get sold. So they're going to try to create trials in whatever way they can to be as to show as effective a product as possible and minimize the risks. And they do that they they set them up in that way. There's only so much that you can do if you do it correctly. I mean, sure, they could be just totally lying and cheating and doing that. But I don't I don't think that's what happens. most of the time i just think they're setting it up in a way to succeed and they're showing the best things maybe not not always showing things that don't look as good but that's our problem that's a big mistake in humanity's part that we kind of letting these companies run amok with with research a company's job is to make money so they're going to do whatever they need to do they need to have checks and balances and that's somebody else's job and and they've gotten so big that they know how to play the game and the the organizations that are supposed to be monitoring them can't and don't do a great job of that. And we just need to, I think, require a lot more transparency. We need to have things being open so that way people can look at the data outside. We need to have outside bodies going over things. We need to have a lot stricter standards before something can get to market. Ultimately, I don't know there's going to be independent research for billions of dollars to look at new vaccines. I mean, they have the incentive to do it and that's why we have these things. So I don't know that it's going to go anywhere or even the best thing to do. I mean, there's a lot of great medical products out there. And companies have incentive to do it because they can make a lot of money. So we don't necessarily want to stop that.

Joel:
[1:06:39] We don't want to stop innovation, but we do need to

Joel:
[1:06:43] Have some checks and balances that are somewhat reasonable at least like better than nothing you know better than having the people that work in the companies go work for the organizations that that um try to monitor them and vice versa i mean that's what's happening right now and and we just don't have those those checks and balances and and that's why we're seeing such an issue not just vaccines but just everything i mean food uh toxins everywhere the the companies are so big they know how to play the game and and they get things out and and then to try to get it off the market's really hard because they're like oh where where's the research where's the double blind study to show that it's a problem and you're like well where's your double insight to show that it was good and perfectly well

Mel:
[1:07:20] I think that's the upsetting thing is that when parents do their due diligence and even if they're capable of going right back to the original research on a particular product and only to discover that the paper and the companies are openly sharing you know when you read the papers yes this was funded staffed designed executed and analyzed by the company who made the

Mel:
[1:07:45] product do you know of many independent papers that review vaccine safety.

Joel:
[1:07:52] No i mean there there is research after but not before i mean before it's just the company so basically all the research from before is going to be the company or the subsidiaries of the company because they're they're trying to get it to market there there certainly is research after the fact of looking at you know especially retrospectively on some of the vaccines or certain issues or if there are safety signals that that people notice then they'll do research on that to see if there is a problem so i mean we have caught things before like you know covid they caught myocarditis um as a risk so we we have some mechanisms to look for some of those things but it's not it's not very robust so yeah i mean we definitely we definitely do look into things and there are independent research but not a lot of it i

Mel:
[1:08:38] Think what what's coming across as we talk is that there are definitely risks and benefits for vaccines and that the understanding your own personal risk would be important depending on your context depending on where you are in the world the risks and benefits would be different and I've got one more question in your book, you tell the story of turtles all the way down there'll be people who are listening to this podcast who haven't read the book but can you share the story of turtles all the way down and the point of telling that story in the book.

Joel:
[1:09:16] Yeah, so there's another, there are a few vaccine books that I would say are, you know, the bigger books that a lot of people have read and Turtles is one of them. It's a really good book. It's unfortunate because that book, the author didn't even say who they are. So we don't even necessarily know. I have some theories, but they obviously didn't feel comfortable enough to put their name on it for many varying and obvious reasons. Um but it is so it's a proverb in the past that basically was like you know a turtle standing on another turtle and another turtle but but there we don't know what the bottom turtle is actually standing on and that's kind of their metaphor for the book and they use that metaphor to talk about vaccines and vaccine research because a lot of the vaccine research you're studying your new product versus an older product versus an older product so for example you know the easiest one to think about is the whooping cough vaccine.

Joel:
[1:10:06] So the new diphtheria tetanus acellar pertussis vaccine was studied against the old DTP, which is the whole cell, but the whole cell was taken off the market for safety issues. So you're comparing the two, not to a baseline, you're saying your new one is safe when you're comparing it, but you're comparing it to something that wasn't found necessarily to be overly safe, and it was taken off the market here. And then that was against even older research, which was not done in the way that we do research today. So not necessarily randomized or blinded, and maybe just on a few patients. So the initial research when you're talking about things in the 30s, 40s, 50s, 60s, is not the same kind of research that we have today. And we're just assuming that these things are based on this strong foundation of research, especially when we're comparing one thing to the other, but you're actually comparing stuff that isn't apples to apples, it's very different from the past. And so that's the metaphor of like, okay you're comparing one thing to another one turtle to another but what's it standing on and is it a strong foundation. And there's no question that the vaccine literature doesn't have a strong foundation.

Joel:
[1:11:09] Almost nothing in the pediatric schedule was studied in the optimal way.

Joel:
[1:11:14] You hear this often about clinical trials, randomized controlled trials, placebo controlled trials, and where people go wrong. And what's really important to understand is every, basically every study or every, every vaccine has been studied in a placebo controlled trial. They have had some of those, but a placebo doesn't necessarily mean what you think placebo means. Placebo doesn't mean it's some inert substance like water. The placebo in a lot of the studies, most of the studies is another vaccine. It's either the earlier version of vaccine or a different vaccine. And so you're getting a relative safety. You're comparing one vaccine to another, not a vaccine to nothing. Right. And so that's, that's, that's a big hole in the literature. Because just because you study two vaccines, if three kids get seizures in both groups, okay, well, then there's no increased risk. But if zero kids would have had a seizure, if you didn't give them a vaccine, that's important to know. And we are missing that research. And that's the bottom of the turtles that we don't have.

Mel:
[1:12:13] So what you're saying, for people who aren't in the scientific world, so if you created a medicine, you would normally have a control group which was the no-medicine group. And then you would have a group that would receive the medicine and each group wouldn't know which one they received because they'd give a placebo to one that's supposed to be inert, be nothing in it, not have a pharmaceutical impact. And then you compare that to the group that got the medicine. And then you can see a clear difference between what the medicine can do versus if you do nothing. So that would be considered... The usual approach to testing a medicine?

Joel:
[1:12:58] I wouldn't say usual, but I would say the best. That would be the best way. That would be the way that you'd get the best information. Or you could study one vaccine versus another vaccine and have a third group that's got nothing. And there are many ways to do it. But I guess the ultimate point there is,

Joel:
[1:13:15] If you study it against something that doesn't have an effect, you

Joel:
[1:13:18] Can actually see what the effect of your substances you can see what reactions how well it works because if you're giving salt water it shouldn't do anything yeah right um but but you want to see how those things compare so if you're giving you know tylenol for fever versus salt water you should see a difference in those two groups because the tylenol does something and the salt water doesn't but if you study tylenol versus motrin then you don't know what it does against nothing so they could both work they could both work equally they could both have some side effect um that is equal so both if both Tylenol and Motrin um cause leg pain then you could say that doesn't do anything because they both cause leg pain so that's just normal there's not an increased risk of a safety concern that's how they get around it it's a trick um it's a way to to minimize your risks because you say oh it doesn't cause any increased safety risks but you're not actually studying it against nothing so it doesn't mean that there's a problem but you're setting up your trial in the way that gives you the best chance to show that there are no harms um which which is just not the best kind of study so then when people say they want the best kind of research that's what they're saying that's what's missing from the literature and again it doesn't mean that there's a problem it may be no problem if you're studying if you're studying one whooping cough versus the other whooping cough both vaccines could be safe but but you don't have the best research to state that definitively,

Joel:
[1:14:46] Which is the way that this research is supposed to be done, especially if you're giving it to a kid, especially a newborn baby,

Joel:
[1:14:51] You should have the best, most robust research possible. And you could certainly do that with a new vaccine, but we don't.

Mel:
[1:14:59] Well, and it makes it hard because now even if for people who genuinely want information about how to make their decision, it introduces a new suspicion into the decision making process.

Joel:
[1:15:12] It's a huge suspicion and it's a problem now because now that it wasn't ever done, it's infinitely harder to do it now because you now say, well, you cannot give kids vaccines because that protects them. So we have to give them all the regular vaccines. And if you want to have a new vaccine, we have to give them at least the old vaccine. Or you're not protecting them. And so we're in this catch where we want the best research, but you can't actually do it because it's not ethical to not give kids vaccines unless the way that ethics is at least looked at right now. And so you have this huge ethical dilemma and it makes it really hard to do a vaccinated versus unvaccinated study because you can't get ethics to approve

Joel:
[1:15:49] that and not give kids vaccines. So there are ways to do it. I mean, you can have people choose what groups they're in. So that's one way to do it. It's not perfect, but it would be better than nothing but we don't even have that we don't even have studies where where people are allowed to choose and say i don't want to get vaccinated um none of it exists well

Mel:
[1:16:05] I suppose no one's really interested in understanding the experience of families who don't vaccinate.

Joel:
[1:16:12] But right but i i think people are interested now i think people realize and i think it could happen and i hope that some very wealthy people come together uh maybe kids that had vaccine injuries. I don't know. And they put some billions of dollars into it and they open up a GoFundMe and it could be done. I mean, it would not be very hard to get 100,000 kids, 50,000 kids and maybe 10,000 kids or 5,000 kids that don't want to vaccinate and just follow them for 10 years. It could be done. People, I guarantee you for sure, parents would volunteer for that study. They would do it happily. There's a lot of bias there. I mean, it's just what it is. But you could follow kids prospectively and I hope that we do it.

Mel:
[1:16:52] Yeah, I have one more question that is my own personal question. Um, so we're vaccinating against viruses, but viruses typically will morph and change and adapt over time to survive. Do the vaccines adapt and change at the same speed as the viruses?

Joel:
[1:17:16] No. So the vaccines don't change unless you change them. And you could. I mean, we saw that with the newer vaccines, with the mRNA vaccines, you can change them a lot easier. Than the old ones. But usually you're not changing the vaccines. Most of them are pretty much the same for many years. And the viruses certainly can change. A lot of them don't change very much, but some of them do, like flu changes all the time. So that's what makes it really hard to make a vaccine because they're mutating and changing often. And if it changes in a way that... So if you give a vaccine and it's, let's say, looking for a certain protein, if that protein changes on the virus, then the vaccine doesn't work anymore.

Mel:
[1:17:54] So is it possible that, that people are receiving vaccines that are obsolete for the virus that's circulating?

Joel:
[1:18:03] For respiratory viruses, sometimes, yeah. So, I mean, that's the issue with the flu vaccine, really, is that it changes and then it's not really useful for the flu that's circulating. The other ones don't change as frequently, presumably as long as you're not seeing a bunch of, I don't know, polio or whatever, then it hasn't changed and hasn't come back. I mean, if you saw a whole bunch of it then that would be a reasonable question to say like hey well why is the vaccine not working anymore maybe the infection changed yeah um so i i think that mostly they they work or they're just not around anymore but um it's a it's a good you know it's important to think about yeah

Mel:
[1:18:38] I could keep asking questions forever but i won't is there anything that you feel like we haven't touched on that you see is a big pain point for your clients that when they coming to talk about vaccines, something that you frequently have to answer for your clients.

Joel:
[1:18:57] I would say the big thing is not to feel bad about having questions. I think it's important to have questions. I think that a lot of parents are made to feel like woo woo or out there. They have questions or concerns around vaccines. And it's ridiculous that someone should feel bad about having questions. I mean, something you're injecting into your kids and we should have questions and we should push back and we should force the discussion. And we should make sure that these things are as safe as possible. And the only way we're going to do that is to continue asking questions. And it's a different world now. And people are much more open having this discussion. And I go back to again, I wrote this book, Between a Shot and a Hard Place, not to tell you what to do, but to hopefully bring this debate into the open and to have discussions just like this. And I think people are ready for it and they're interested and a lot of people want to talk about it. And I hope that it moves the conversation forward because I don't have all the answers. I don't know the things that I don't know. I think they just don't exist. And I think if we can acknowledge that there's a big, or there are several big holes in the research, then we can get better research.

Mel:
[1:20:04] Absolutely. Thank you so much for your time. Your book comes out May, 2025. People can pre-order it and I'll put the link in the show notes. And thank you so much for being brave enough to write this book. I know that in a lot of places, registered practitioners are restricted but we are allowed to give information and our clients are allowed to make their own decisions and I feel like that's the pocket where this, book fits thanks for being here on the great birth rebellion to get access to the resources for each podcast episode join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me mel @melaniethemidwife on socials and the show @thegreatbirthrebellion all the details are in the show notes.

Episode 146 - Childhood vaccinations with Dr. Joel Warsh

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