In Defense of Public Health: Peter Hotez, MD, on the Comeback of Preventable Diseases
By Sean Price Texas Medicine April 2020

April_20_TM_Cover_Hotez

Of all the Texas physicians who promote vaccines, none are as well-known as Peter Hotez, MD.

His resume for this self-appointed task is ideal: internationally recognized physician-scientist; professor of pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston; co-director of the Texas Children’s Hospital Center for Vaccine Development.

Dr. Hotez’s personal life also gives him a unique platform as a vaccine champion given the repeated – if profoundly wrong – attempts by the anti-vaccine movement to tie vaccines to autism.

“Here I am, the vaccine scientist parent of an adult daughter with autism,” says Dr. Hotez, who wrote the 2018 book Vaccines Did Not Cause Rachel’s Autism about both vaccines and raising his daughter. “If I don’t [speak out], who will?” (See “An In-Your-Face Confrontation With the Anti-Vaccine Movement,” March 2019 Texas Medicine, pages 44-45, www.texmed.org/InYourFace.)

But the anti-vaccine movement is just part of a much larger public health picture that Dr. Hotez will discuss as the inaugural speaker of the Louis J. Goodman Lectureship on Leadership in Medicine, scheduled for 1:30 pm May 2nd at TexMed 2020 in Fort Worth.

The talk will focus on how progress made in vaccinating the world’s children has slowed or stopped completely in some key regions in recent years.

 “It’s happening because of modern 21st century forces, many of which are social determinants like war, political collapse, and the anti-science movement, as well as a physical determinant – climate change,” he told Texas Medicine. “I’ll talk about how these forces are combining to slow down progress or actually bring back preventable diseases.”

Texas Medicine asked Dr. Hotez about how physicians can respond to those forces and what life is like as a well-known vaccine advocate.

You mentioned in your book that you’ve been interested in tropical diseases since you were a kid. That’s an odd interest for a young person. How did you develop it?

I liked to study maps and illness, and it all sort of came together around tropical disease. As a kid [I read] about yellow fever and how it affected cities along the Mississippi [River], like New Orleans and Memphis, as well as the port cities in South America. And reading about Walter Reed, [MD], and how [his commission] determined that it was transmitted by mosquitoes [in the early 1900s]. That was a very inspirational story as a kid.

How did you end up becoming a go-to person for the press on infectious disease?

I would speak out when there was a vacuum and there was no one else to do it. This started with the anthrax attack in Washington, [D.C.] in 2001. The press was very concerned, especially after 9/11. I was chair of microbiology at George Washington University, essentially the microbiology department next to the White House, so I was heavily involved in that. I was also raising awareness about neglected tropical diseases after the [United Nations’] Millennium Development Goals [in 2000], when they were mistakenly referred to as just “other diseases.” I’ve worked on vaccines since 1980, but my public defense of vaccines [increased] in 2011 after I moved to Texas and discovered that thousands of children were being denied access to life-saving vaccines due to a misinformation campaign.

You’ve faced a lot of criticism from anti-vaccine activists for your work. If you knew when you started speaking out what you know now, would you do it again?

Yes. I like to think we’re making a difference. We’ve had a few successes convincing parents across the nation that there’s no link between vaccines and autism, and we’ve also raised awareness about what autism is. I talk about how we did whole exome genetic sequencing on [my daughter] Rachel and my wife Ann and I, and how the developmental processes of autism are due to the action of genes associated with early fetal brain development. In a few instances, the anti-vaccine movement has responded by pivoting away from autism and making up new assertions. It’s like Whac-A-Mole. Now, they’re all about saying that [vaccines] causes chronic illness or depression or even suicide, with no evidence for it.

Why do Texas physicians need to take a closer look at the big global issues you’ll talk about?

It’s important for physicians to understand because what’s affecting public health now are elements that go beyond what physicians ordinarily think about. As a physician, you can say, “What does war or socioeconomic collapse or economic declines or climate change – what does that have to do with my practice?” What I’m going to be talking about is the wider view of global health – why these forces are affecting global health.

How did you become familiar with these topics?

I learned a lot serving as a U.S. science envoy in the Obama administration. I was in the Middle East and North Africa, and I could see how the conflict there was bringing down vaccination coverage and bringing back disease. … And we see the war in [the Democratic Republic of] Congo is blocking vaccination efforts [for Ebola.] And not just Ebola – it also brought back measles. Similar forces, such as political instability, are driving down vaccination coverage in countries like Venezuela, Philippines, and Samoa with catastrophic consequences, including the return of vaccine-preventable diseases. In central China, now we’re also seeing how quickly an emerging disease such as COVID-19 [the novel coronavirus] can severely damage the economy of a powerful nation.

How do these huge issues affect the average physician?

Often, if you’re a pediatrician [for example] ... you’re not necessarily going to be interested in global health. But in the case of the anti-vaccine movement, which is affecting Texas – as well as poverty and some of these other forces – I do talk about what’s going on in Texas and the Gulf Coast to bring back disease. [Physicians need to] understand that Texas and the Gulf Coast are at risk. If you look at West Nile [virus in Texas], what was the role of climate in bringing that disease back? Or what was the role of poverty where there wasn’t adequate vector control in bringing disease back? Texas and the Gulf Coast are now seeing a resurgence of tropical infections such as Chagas disease, typhus, and arbovirus infections, to name a few.

What can physicians do?

It’s clear that physicians need to think about taking on a role that goes beyond their patients and looking at the broader view of health advocacy and engaging with the public. It’s not for everybody. But it’s clear that there is a vacuum, and that people are not getting appropriate health messages, and we need to fix that.

Tex Med. 2020;116(4):24-25
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Last Updated On

March 31, 2020

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Sean Price

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(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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