ACIP Chair Dr. Kirk Milhoan on the Future of America’s Vaccine Policy

A wide-ranging discussion about personal autonomy, vaccine safety and rebuilding trust.

This week, we were joined by Dr. Kirk Milhoan, chair of the Advisory Committee on Immunization Practices (ACIP). Dr. Milhoan joined ACIP in September and was named chair in December, in time to lead the meeting that resulted in a change to the recommendation around the Hepatitis B vaccine. He is part of Robert F. Kennedy Jr.’s revamped ACIP, the independent panel of experts that reviews the data and makes recommendations to the CDC on America’s vaccine policy.

Dr. Milhoan’s role places him at the center of the red-hot battles over vaccines in America today. A pediatric cardiologist and former U.S. Air Force flight surgeon who served two tours in Iraq, he has dedicated his life to providing philanthropic medical care to children, which has taken him to 12 different countries, comprising 48 trips to Mongolia, 40 to Iraq, 20 to Africa, and 15 to Kosovo.

We had a wide-ranging conversation with the new ACIP chair, covering how he sees the committee’s role; whether vaccine safety has been a priority for past ACIPs; his views on the MMR vaccine for measles and the safety of the Covid vaccine; how he weighs personal autonomy and medical freedom against public health; what he was referring to when a hot mic picked up him saying he felt like a puppet on a string; his response to HHS sidestepping ACIP in its recent changes to childhood vaccine recommendations; and how he feels trust in public health and medicine can be restored.

Below is the transcript of our discussion.

---

Brinda Adhikari -- WSITY

Dr Milhoan, welcome to Why Should I Trust You?

Kirk Milhoan, MD, PhD, FACC, FAAP

Thank you so much. A pleasure to be here.

Brinda Adhikari -- WSITY

So you’re the newly appointed chair of the ACIP Committee, which, of course, helps set America’s vaccine policy. And given that, and given the fact that, you know, you’re a physician, we just thought it might be good to, might be useful for you to talk about your philosophy towards vaccines. I mean, do you like them? Like which are your favorite? Which ones don’t you like so much?

Kirk Milhoan, MD, PhD, FACC, FAAP

What an appropriate podcast for me to be on, why should I trust you? Since there are many in the press that are trying to convince people not to trust me and and I would say that trusting an individual is dangerous. I think trusting the actions of the individual are much more appropriate, I think that we live in a polarity where you are not allowed to be in the middle. You are either to be this or that. You’re either to be pro or anti, for or against. And so I think one of the reasons they chose me first to be on the committee and then to be given the chairmanship, was the the measuredness I bring to a discussion. When I was doing my PhD, it was very clear to me that in my own mind, I had a confirmation bias. I had a hypothesis, and I really needed that hypothesis to be right, and if it weren’t right, I could have wasted years and years and years but, but if you’re going to have character and have integrity, then you have to exam your confirmation bias and decide, why am I doing this? So I come to this. I don’t have a a favored vaccine. I don’t have a vaccine I that I have any personal, emotional, necessarily, opinions about. I look at what the data are, and I’m not afraid to say, Wow, that’s a really good vaccine, or that’s a really bad vaccine. I look at medicines the same way there there are medicines. I try to use the least amount of things I do to make somebody better, the least, the less I do, the less I have a chance of doing harm to somebody. And so I think that we’ve talked a lot about the efficacy of vaccines, but I think what has been neglected is really looking deeply at what the risks are. And everything I do, especially if we inject something that bypasses first pass elimination and detoxification, it’s a bigger deal than if we take something orally, usually, so there’s a risk for everything we do medically, from a simple antibiotic to heart surgery, there’s their risks, and people act differently. So I think this is what I what I desire to bring is sort of pulling back the curtain and telling people what do we know, what don’t we know? So when I give informed consent, I can be honest.

Brinda Adhikari -- WSITY

You know, you’re you’re right that when we talk about vaccines, like their ice cream flavors, you know, what’s your favorite, it can seem a little like off. So let me just ask you even more specifically. Like you take something like MMR and you take something like the polio vaccine, you know, you deal with children in your practice, what do you think about those two vaccines when you you know, you just framed it as efficacy versus risk, you know, help put it through that framework. Even for those two vaccines,

Kirk Milhoan, MD, PhD, FACC, FAAP

let’s take with polio, because it’s probably one of the ones that’s most known, most talked about. Jonas Salk, his work. There’s a Salk Institute in San Diego, the university I did my PhD at. So in my lifetime, I watched us go that we like. If you can take an oral if something goes through the infectious process goes through your gut, a vaccine works better if it goes through your gut. So there was an oral polio vaccine, and then there is an injected polio vaccine. And in my lifetime, we what was found is that there was, we were giving people polio with the oral vaccine. And so we switched to, while I was still a resident in pediatrics, we switched to, first to giving the injected dead vaccine without a live polio virus, and then we went to oral doses after that. Now that’s even changed a little bit more, but that was evaluating risk and saying what was right, what was wrong. I think also, as you look at polio, we need to not be afraid to consider that we are in a different time now than we were then. Our sanitation is different, our risk of disease is different, and so that those all play into the evaluation of whether this is worthwhile of taking a risk for a vaccine or not, we have to take we have to take into account that, are we enjoying herd immunity right now, that it may look like it’s better not to get a vaccine than to get a vaccine, but if we take away all of the herd immunity, does that? Does that switch? Does that teeter totter switch in a different direction? So that’s how I would look at both oral polio or polio vaccine and the MMR vaccine, the MMR vaccine. And you guys have probably seen this data, is that often that the incidence of disease is going down even before the vaccine have been started. When we look at the risk and we talk about the risk of, let’s say, measles, many of those risks of not getting measles without having a vaccine is was in the 1960s, we take care of children much differently. Now, our ability to have pediatric hospitals, children’s hospitals, pediatric ICUs, how we look at the whole gamut of how we can treat Measles is different. So that’s a that’s something that comes into play. Are we looking at real today data with our population? And are you traveling? Are people traveling to you? What I see in Africa is much different. I see diseases in Africa that I don’t see here. I’ve never seen a case of congenital rubella affecting a child in my career. Now, it may happen, but I haven’t seen it. In Africa, I saw three in a day.

Brinda Adhikari -- WSITY

So Dr Milhoan, you wouldn’t necessarily, you wouldn’t be in favor of getting rid of the MMR vaccine. You wouldn’t be in favor because, as from, from the data that that exists out there currently, measles is a highly infectious disease. You know, pre vaccine, it was killing hundreds of children a year, hospitalizing 10s of 1000s of people, but that was before the vaccine. And so the vaccine is you’re you’re right, and I don’t think anyone disputes the fact that you know, things like sanitation and the way we live our lives absolutely played in effect. But I think it’s also fair to say that the vaccine played an enormous effect in the reducing of of this disease burden in children almost entirely. So I just, I think, you know, as people look at ACIP and and as they look at this, I know there’s a lot of people out there who think that, you know, is, is MMR or MMR and polio safe, you know, in terms of this schedule, because it feels like those two vaccines in particular have proven to really stem the disease in its tracks.

Kirk Milhoan, MD, PhD, FACC, FAAP 18:17

I think that proven might be a little bit harsh, a little bit stronger for what it’s done because of the pre vaccine decrease in incidence of disease. But I understand what you’re saying. If you look at the current outbreak of measles that’s happening in the US right now, I believe 75 to 80% in those numbers are unvaccinated. What we’re going to have is a real world experience of when unvaccinated people get measles, what is the new incidence of hospitalization? What’s the incidence of death? So I think to go back to a bigger question about what ACIP is doing, remember, we’re just an advisory panel. We can’t make any declarations. We can tell you what we believe the evidence shows, and we try to do that as transparently and and honestly as the data supports and present data. But it’s been very important to us, the members of committee, is that what we are doing is returning individual autonomy to the first order, not public health, but individual autonomy to the first order. And so what you’ll see is a change in wording and a change in in words that we use, but it’s much more of who’s the patient and the doctor, and they know each other, and they should be making the decisions on what the risks are of disease, what the risks are of vaccines, which is different for each person, what the family history is, and then make a decision from there, as opposed to what was sort of more of a heavy handed, authoritarian thought of the vaccine schedule that led to mandates that if you didn’t have this set of vaccines exactly how they were prescribed, then you didn’t get in school. So just my own life, but I’d have to do is people come to me often because so the press would like to label me as an anti Vaxxer, which I’m not, but it’s a label you’re either pro Vax or anti Vax. So they’ve labeled me. So then some people seek me out because they’ve been labeled. I’ve been labeled an anti Vaxxer. One was a 17 year old girl who was two months away from her 18th birthday, which means that she wouldn’t necessarily need all the catch up vaccines, but she wasn’t allowed to be allowed to graduate in a month unless she was fully vaccinated to the childhood schedule. So it made a difference two months and then one month after, it wasn’t as big of a deal. That’s really sort of nonsensical medical thing. Just that we have this rule, and you have to abide by this rule. If I saw 17 and and 17 years old and 10 months, I wouldn’t think, oh my gosh, we’ve got to get this childhood schedule finished in her or we’re in big trouble. I wouldn’t look at it like that. But what, what has happened in the past, and this is different, where we’re an outlier to much of the rest of the world, is that often the ACIP recommendations became mandates because of funding and other issues that were involved. Because the funding of vaccines for kids was often tied to the recommendations of not only ACIP, but the CDC. We make a recommendation, CDC has to basically canonize it.

Tom W. Johnson -- WSITY 21:49

I just want to ask you about your philosophy around individual autonomy, and I’m wondering if you are looking at the vaccine schedule for our children, sort of in two camps, like there’s one camp that’s diseases that, if I don’t vaccinate and I get that disease, or my child gets that disease, they’re not going to spread it to somebody else. Most likely. There’s other diseases that are highly contagious. So an individual’s autonomy, an individual choice not to be vaccinated suddenly means that my immune compromised child is at threat. You very well could pass Measles. Easily pass measles to my child. So where do you see the line for individual autonomy versus you are infringing on my child’s safety by the choice you are making. It doesn’t just affect you. It affects my child.

Kirk Milhoan, MD, PhD, FACC, FAAP 22:51

Yeah, and so I would say, I agree. There’s, there are two different things at play here. We don’t take one over the other. Let me just put it just, let’s just flip that the other way around. What if the child gets a measles vaccine to protect your immunocompromised child and gets a negative consequence from that? Wasn’t that your child causing that child to be harmed?

Tom W. Johnson -- WSITY 23:16

So, but it’s predicated on you feel there’s a greater risk than what established science says about something like the measles vaccine, you feel the risk is high enough that it the children. It’s a very it’s a very acceptable, even perhaps laudable, decision to not vaccinate your child because of the risk of an adverse effect from measles, and that outweighs the risk of your child spreading it to another child, or a child who’s, God forbid, immunocompromised?

Kirk Milhoan, MD, PhD, FACC, FAAP 23:47

No, I think this is hard when you’re trying to do autonomy versus public health. I think these are hard, hard decisions to make. This isn’t this is why it’s nuanced. This is why I don’t like these. The different camps that that come up with this is really hard. I think that couple things, I wouldn’t use established science. We’ve gotten trouble with that.

Tom W. Johnson -- WSITY 24:11

But that’s interesting, someone who’s chairing the ACIP committee, you don’t like that.

Kirk Milhoan, MD, PhD, FACC, FAAP

I don’t like ‘established science.

Tom W. Johnson -- WSITY

I mean, I’m not criticizing. I’m just, I’m curious what you’re you’re probably going to be getting a lot of reports and a lot of files and a lot of data that’s been established, things that we’ve looked at and pursued and invested

Kirk Milhoan, MD, PhD, FACC, FAAP 24:28

that’s not science. Science is what I observe, and is there a confirmation bias in what is established science? So this is what I’m saying is, if you’re looking for right now, we have a there’s a major pertussis outbreak in Texas, and 100% of the people who got pertussis were vaccinated

At a school.

Kirk Milhoan, MD, PhD, FACC, FAAP 24:57

What we know is is a lot of times for respiratory viruses that inactivated injectable viruses aren’t very good at blocking transmission. It can decrease the burden of the disease, which is what you’d want in something like whooping cough. But it’s much more complicated than no risk to get the vaccine all risk for someone who’s immunocompromised, it’s it’s more complicated that when I as a physician, have an obligation to do no harm, right? So if I give something as a physician, I recommend to my patient, I personally assume some responsibility, and the Hippocratic Oath talks about basically doing no harm, so especially when I’m using something that is for prevention, that has a higher standard to clear when I look at risks.

Dr. Mark Abdelmalek- WSITY 25:52

Yeah, you said something interesting to me, that you said science is what I observe, and as a doctor and a scientist, in a sense, I agree that observation is the starting point of science. Very often. It’s not necessarily, you know, the conclusion science is systematic testing of observations, and then we do trials, and then we have data, and then we see if we can reproduce it, and then we have verification. Now, I just wanted you to go back to that point, because, as the chair of the ACIP committee, can you tell us that you’re approaching your work there, not on your observations, but on science?

Kirk Milhoan, MD, PhD, FACC, FAAP 26:37

That’s what I’m saying, is I’m looking at the observable science. And what I’m saying is, is that there is a emotion that it is when people use the word proven. This is scientifically proven. It’s a contradiction to the word science. When you’re looking at observations, and when we look at something that’s statistically significant, you’re still saying it’s at a 95 let’s say it’s at a 95% confidence interval. What does that tell you? Well, 5% you’re wrong. So I think it’s not that I’m being anti science. What I’m saying is, let’s be honest about the words. So I don’t like to use the word safety. Safety is on a scientific word. Safety is an emotional response to a risk. Does someone feel safe, right? That that’s a feeling depending on what the risk is. So when I have discussions with people and and I understand this is that people have different emotions depending on what their perceived risk is, or what they what risk they’re looking at. So I will talk to somebody and say, Well, why wouldn’t you get an MMR vaccine, if you could avoid, avoid measles. I have someone else who will say, and it’s as well, why would I get it a vaccine if it has a risk associated with my child developing encephalitis? So people can look at a risk, what they choose is the risk is what they’re often will say, Well, I’m more concerned about something being injected into my body than getting a disease. Other people are more concerned about getting the disease.

Dr. Mark Abdelmalek- WSITY 28:10

So are you? Are you saying you’re describing safety as something that’s subjective, yeah. So I think that a lot of people who study safety and do the work. You know, don’t view it as subjective. Obviously, you know,

Kirk Milhoan, MD, PhD, FACC, FAAP 28:24

I think they use the word risk,

Dr. Mark Abdelmalek- WSITY 28:26

risk, so you would like prefer us to use the word risk as opposed to safety.

Kirk Milhoan, MD, PhD, FACC, FAAP 28:31

Yes,

Dr. Mark Abdelmalek- WSITY 28:32

Do you think that the vaccines are appropriately studied for safety?

Kirk Milhoan, MD, PhD, FACC, FAAP 28:37

No, they haven’t been. They’ve been mostly studied for efficacy.

Dr. Mark Abdelmalek- WSITY 28:42

And what about all of the monitoring that happens in the,

Kirk Milhoan, MD, PhD, FACC, FAAP

It’s very poor.

Kirk Milhoan, MD, PhD, FACC, FAAP 28:47

It’s very poor. (crosstalk) I’m just explaining to you what I have observed when I ask and I look and what you see, what recently happened that came out from the FDA is there was a very large death signal in children.

Tom W. Johnson -- WSITY 29:03

Have we seen the data? Have you that’s a great point. Have you seen the data behind that?

Kirk Milhoan, MD, PhD, FACC, FAAP 29:08

Yes, I’m also a pediatric cardiologist, so I’m very acutely aware of myocarditis,

Tom W. Johnson -- WSITY 29:12

but the data that hasn’t been made public. You’ve seen that?

Kirk Milhoan, MD, PhD, FACC, FAAP

Yeah. (crostalk)

Brinda Adhikari -- WSITY 29:18

Dr Milhoan, just just for a little context, we’re talking about when Vinay Prasad wrote that memo talking specifically about the covid vaccine causing deaths in children, and you’re saying you have seen that data?

Kirk Milhoan, MD, PhD, FACC, FAAP

Yeah, exactly.

Brinda Adhikari -- WSITY

That has not been produced publicly.

Kirk Milhoan, MD, PhD, FACC, FAAP 29:35

So let me explain what a lot of the safety signals have been looking at us, ICD-9 and ICD-10 codes, okay, those come off the end of the chart. And probably the person who’s done the most work on this was Tracy Beth Hoeg, and she came and actually presented. She’s presented in our work group. She’s part of the work group, and she’s presented at the ACIP meeting, the most recent one, and when there were at least 10 cases, when you did a chart review, not just an ICD, ICD review, that it was clear that the it was the vaccine that had positives. What you also see is, if you look at the Nordic nations that have been studying this very, very closely, they had such a signal for myocarditis that they said, We’re not going to give this, especially Moderna, to anyone under 40. So they saw a signal, and we saw signals early. And so what happened is that safety net, so with the vaccine safety data link and VAERS, those are sort of early early warning systems, especially when you roll out a new vaccine on a new platform.

Dr. Mark Abdelmalek- WSITY 30:51

So a couple of things on that. I mean, I think that we have a lot of data that people are looking at and, you know, I think that there’s a sense that myocarditis can happen. And we all have agreed that the risk of myocarditis after covid vaccine is there for a certain subset, but it’s a much lower rate than people who have a say, natural infection. We’re talking like one. Sorry. (crosstalk)

Kirk Milhoan, MD, PhD, FACC, FAAP 31:21

If you look at the Nordic data that looked at 23 million vaccinated children, the lowest rate of myocarditis was in the unvaccinated. As you increase the number of vaccines, Moderna was worse than Pfizer. This was the Jama cardiology article. Yeah. And the lowest, what they use is their baseline rate was the unvaccinated, because that was the lowest rate, and so they based it off the unvaccinated. And the more vaccines you got, the higher your risk was for myocarditis.

Dr. Mark Abdelmalek- WSITY 31:49

But the Nordic data did indeed say that there was an increased risk of of myocarditis and unvaccinated, sorry, in the unvaccinated population.

Kirk Milhoan, MD, PhD, FACC, FAAP 32:01

Not over the not over the vaccinated population.

Tom W. Johnson -- WSITY 32:06

But doesn’t that just establish that what we know, which is there is a very rare risk of myocarditis for vaccinated children?

Kirk Milhoan, MD, PhD, FACC, FAAP 32:18

I wouldn’t say what 2500 is rare for someone has a very, very, very low risk of complications from covid.

Dr. Mark Abdelmalek- WSITY 32:29

Do you agree that it’s much higher if you have just a natural infection? The risk (crosstalk)

Kirk Milhoan, MD, PhD, FACC, FAAP

The data don’t support that.

Dr. Mark Abdelmalek- WSITY

Okay, I mean, I guess that’s just a point of disagreement, because I think much of the literature does say that.

Kirk Milhoan, MD, PhD, FACC, FAAP 32:44

I think that that is said without data,

Dr. Mark Abdelmalek- WSITY

No.

Kirk Milhoan, MD, PhD, FACC, FAAP

And you have to look at what they consider unvaccinated. Remember for a long time what we were doing this, if you didn’t have every booster, you were considered unvaccinated. If you only had one, you were considered unvaccinated. You weren’t considered partially vaccinated. The definition of that being vaccinated was having all of the recommended shots. If you look at the methods, that was much of what was going on. It’s not clean data. When people say it’s only the those risks were higher in the (inaudible).

Dr. Mark Abdelmalek- WSITY 33:15

I think what you’re talking about is that we have a lot of people in a hybrid situation, that you have a natural infection and you’ve had the vaccine, so it makes it makes it more difficult to understand. But let’s just move on from that. And just, I think, just agree, I guess, agree to disagree a little bit, that the risk of myocarditis is indeed higher if you have an (inaudible) and that mild, if you, you know, do get back. And obviously, there are some subsets of the population that it was shown to be higher.

Kirk Milhoan, MD, PhD, FACC, FAAP 33:41

If you look at the (inaudible) they showed that people enhanced money on the MRI with (inaudble) enhancement, that after 90 days when everything else was (inaudible) of those patients still had LG positive MRIs with with arrhythmia. I think that, I think the data out there is when, when I the world meetings, and I think about the MRIs, I will tell you just that are looking at the MRIs in a subset of children that are very low risk for this disease. And when you listen to Paul Offit talk about, he told her Faucco that this is a very low risk patient group, and they don’t need to be given a vaccine. And Faucci said that we’re going to do the same for everyone. That’s concerning.

Dr. Mark Abdelmalek- WSITY 34:29

let it and just, let’s go back to the philosophical question for you. You’ve talked about freedom of choice and how important for parents when they’re deciding about when get a vaccine. And you know, as a doctor and you, I think you could also probably vouch for us that (inaudible) can digitalize care. We rely on evidence based mentions as a foundation, as a baseline. And is this idea about freedom of choice? Is it really about expanding choice, or is it something more? Are we like taking a step back from making our choices based on evidence based recommendations, and like you’re in a position of power now. So we know that this guidance is important and falling on a lot of ears. I mean, when guidance is softened, you know fewer people you know if they’re listening to your guidance, right now, I think a lot of people and fewer people are going to get the vaccine. You know, how is that an increased freedom, and why did not just reduce, you know, protection from vaccines?

Kirk Milhoan, MD, PhD, FACC, FAAP 35:32

Well, I guess that’s one way to look at it. I think that the concerns that that are coming forward of what happens when you stimulate an immune system over and over again, concerns for increasing incidences of non disease related allergic, hyper allergic responses in children is concerning, asthma, eczema, other things have been concerned so this is a risk benefit that I believe is needs to be discussed with everything. But there’s always going to be a tension between what is supposedly good for all and what is good for the individual. There is going to be that tension between doctor patient relationship and public health. So we can run through lots of different scenarios in terms of of you got the vaccine, the disease was prevalent. You didn’t get it, no side effects from the vaccine. Great, 100% great for you. Let’s say you got it back for something that you weren’t going to be exposed to in your life, and you had a negative response to that. That was not beneficial to you at all. So what we’re trying to do is is, is have the discussion over that there is a nuance here in terms of autonomy and public health, and when you look at the ethics of doing things to people, autonomy is very important as we look at malfeasance, autonomy, all the sort of standard pillars of ethics. Are we allowing people to have body autonomy? So I just feel like this is part of the discussion.

Dr. Mark Abdelmalek- WSITY 37:18

I guess, do you, do you hope that less people get vaccinated.

Kirk Milhoan, MD, PhD, FACC, FAAP 37:22

That’s not my help. My hope is that it’s more of an informed decision.

Dr. Mark Abdelmalek- WSITY 37:26

But if you’re talking about numbers and there and people,

Kirk Milhoan, MD, PhD, FACC, FAAP 37:29

I don’t have a desire for less people to get vaccinated. I want, my desire is to have have a little of a side effect profile as we can that has the maximum efficacy in preventing disease or preventing horrible outcomes. That’s my desire. I don’t have this I’m looking for a vaccine free world. That’s, I don’t have that as, I want to have an honest discussion right now, when I have a try to have a discussion with data, what often I have is I immediately get name called. They don’t bring data back to me. I get name called. I’m just trying to have a have a discussion of what is out there and what I see.

Brinda Adhikari -- WSITY 38:06

Yeah, we don’t want to name call. So we, we are in favor of those.

Kirk Milhoan, MD, PhD, FACC, FAAP 38:11

This is why I love this platform to have this discussion my whatever. I believe it should be challenged. It should be

Brinda Adhikari -- WSITY 38:21

Dr Milhoan, let’s talk a little bit about, so Secretary Kennedy, recently, along with the Trump administration, made the move to overhaul the schedule. And this had happened, you know, just a few, gosh, weeks, months after ACIP had made the recommendation to change the the hep B dose. So my question was like, how did that land with you? Like, did it bother you that ACIP wasn’t like, consulted This is the most dramatic change to the vaccine schedule in generations. What went through your mind? Did you wish ACIP had been consulted first?

Kirk Milhoan, MD, PhD, FACC, FAAP 39:07

I believe ACIP had been consulted to get all those things approved, and then what they what the discussion was, is, and if you did, I don’t know if you guys had a chance to read the the executive summary by Koldorf and Dr. Hoeg, what they were looking at is we’re an outlier for the rest of the world, and our childhood wellness isn’t better than the rest of the world. It’s just not. Our mortality isn’t better than than the Western world. So they looked at those vaccine schedules, and they said, what do they all have in common? What do we see as best practices, and how do they do so really, they use those to bring together. But I didn’t have a lot. I didn’t have a, I didn’t feel offended that they didn’t consult ACIP, because they weren’t, they weren’t necessarily adding something new, and they didn’t take anything away financially or doctor patient relationship wise,

Brinda Adhikari -- WSITY 40:05

just so here’s why I ask.

Kirk Milhoan, MD, PhD, FACC, FAAP 40:06

You’re saying like we’re taking these things away. We haven’t taken anything away. We’ve made sure everyone has access to any vaccine, doctor patient agree they should have.

Dr. Mark Abdelmalek- WSITY 40:14

So you’ve changed recommendations. What you’ve changed the recommendations?

Kirk Milhoan, MD, PhD, FACC, FAAP 40:18

Yeah, because we were concerned about mandates, and mandates have really harmed and increased hesitancy.

Brinda Adhikari -- WSITY 40:25

So let me, let me ask about that, because I think so I want to get a couple of things in here. This is good. This is good stuff. I just want to make sure we’re untangling some of the different threads. So back to what Secretary Kennedy did. I think the question I have, Dr Milhoan, is, we have ACIP for a reason, right? It’s a committee where, you know you’ve got various types of people working with experts themselves, pediatricians and practitioners. You have these meetings where, you know they’re open to the public, for people to sort of see a process take place and try to understand and make sense of decisions, and I think, and I’m speaking on, I think, on behalf of many people, and I want you to sort of empathize with this for one second, which is, can you see how a process whereby the head of HHS, along with the President, comes out and says, we are no longer recommending a whole slew of vaccines because we want to be more like other countries. And here you go. And there’s no real workflow that’s presented. There’s no evidence and data that’s presented. It’s just like, ‘This is what we’ve decided’. And I imagine if you’re ACIP and your entire job is to work through a process so that you can make the case to the American people that you’re recommending something that you truly think is in their best interest. Can you see why some people are head scratching in this moment?

Kirk Milhoan, MD, PhD, FACC, FAAP 42:35

Yeah, I understand what you’re saying. I think to say that this there wasn’t data presented, I think that’s ignoring the executive summary that was put up by Koldorf and Hoeg. I think that they also looked at much more risk based like, let’s say rotavirus. It’s a very popular one. Rotavirus is an interesting vaccine because it got pulled very shortly after, and they knew beforehand that it was a risk, and they brought up before ACIP that it was a risk, and they said still, still went ahead with it, and then within a year, they had to pull it because of the risk that they saw, but they, in a sense, ignored, said, it’s probably okay.

Brinda Adhikari -- WSITY 43:07

Are you talking about, when you say the risk? Are you talking about, like, way back in the day, right? So, like, decades ago.

Kirk Milhoan, MD, PhD, FACC, FAAP 43:19

1994. So when you look at that in Africa, the death from dehydration secondary to rotavirus is dramatic, dramatic. Hundreds of thousands of kids. The number for rotavirus deaths in the US, if you look at all takers, is one to 1 to 3, million kids have a death from rotavirus.

Brinda Adhikari -- WSITY 43:49

Sorry, I just want to make sure I understand. So, like, I think Sorry to interrupt, I just, I think that number, it’s like one out of 3 million, may seem, but I think it was like pre vaccine. It was like 20 to 50 deaths a year from rotavirus

Tom W. Johnson -- WSITY 44:01

in America?

Brinda Adhikari -- WSITY 44:01

In America and like, something like 50,000 hospitalizations a year.

Kirk Milhoan, MD, PhD, FACC, FAAP 44:05

Yeah, so. And also remember that how we do dehydration and over time, our care of children and our care of sick children is dramatically different in the US than others. So that is one that was risk based, and other countries are, have done that same thing and made it basically optional for doctors. Now, if you’re, if you’re going to be traveling internationally, and you’re these are all things that should be in the discussion of what are risks and benefits about everything. Do I put everybody on prophylaxis internationally? No, because I’m really respect the gut biome, and I don’t want to kill off a whole bunch of very helpful bacteria that live in our gut. So I think that this is not something that came out new. It’s been a discussion. And so when, when, even in our ACIP meetings, we were having the same discussions over what’s the best way to put it, I live on an island where there’s a lot of tourism, a lot of hotels, and as a hotel gets old, everybody knows the hotel is getting old, and sometimes you can just destroy the hotel, or sometimes you just say, well, it’s okay, it’s old, but it’s okay. What I like is, I don’t necessarily want to destroy the hotel, but I also am not afraid to say that the hotel needs to be renovated with new times and new data. And so I look at things like, this is a renovation, and we’ll see. We’ll we’ll see. But remember, this is, I don’t know if you guys saw the lawsuit that was brought by a number of different medical organizations against HHS and the secretary, one of the things they said is that we don’t have enough time to give proper informed consent. If you ask us to do this, we can’t do it. But they tell us they give informed consent.

Kirk Milhoan, MD, PhD, FACC, FAAP 46:02

So this is a big issue if they’re confessing they don’t have enough time in a doctor patient relationship to give informed consent.

Brinda Adhikari -- WSITY 46:07

So you’re bringing up something that I think is so important, because I’ll tell you as a mother, you know, if someone tells me that they don’t have enough time to sort of talk to me about vaccines like that, would make me upset. I agree with you on that, and I’ve heard that, you know, I think I told you this, that we have a lot of MAHA folks on our show, and they tell us about their experiences, where they had, they were supportive of vaccines, until they had a really negative experience at the doctor with one. But here’s, here’s where, and I want to come back to rotavirus in a second. I have a couple of questions, but we’re just, we’re just shooting off in so many directions. I want to keep going here, which is the thing that really is persuasive to me, Dr Milhoan, is that there are people who are increasingly losing trust in vaccines in this country. We’re seeing that in our work. We’re seeing that in data, (crosstalk) right, what I am not persuaded by is at ACIP, at the ACIP meetings, like, if that was what you guys led with, which is like, look, people are really not trusting this stuff, and if they’re not trusting it, we got to either work with them in this informed consent world and figure out what works for them based on their risk profile, the way they live their lives, like or we need to, you know, hold on. I lost my train of thought that we need to work with them based on the way that they live their lives and their risk profile. But what it felt like the meeting was turning into was talking about the safety profiles of these vaccines without showing a lot of evidence for whether or not the safety was in question, to the point where I think Cody Meissner and even Robert Malone at one point towards the end, said we’re making this recommendation not because we think, on Hep B, because we think the vaccine is inherently unsafe, but because we don’t necessarily think that the birth dose is necessary in the first 24 hours, we can talk about the two month thing later. I have some questions about that. But do you see what I’m saying? Like, I actually know public health officials and doctors and experts who are, like, willing to talk about flexibility on the schedule if the goal is that, if you allow flexibility on certain vaccines, you actually then, like, enhance uptake in other ones that are really crucial, like MMR and polio and things like that. And I guess, like, react to that. Like, could there have been, and can there be a really like an evidence based argument on trust, as opposed to a lack of evidence based argument on safety for certain ones of these, which is not to say I don’t want to talk about safety. We absolutely should.

Kirk Milhoan, MD, PhD, FACC, FAAP 48:54

I would address the issue as I was in the work group that talked about hepatitis B and birth dose, and there were plenty of data presented. Going back to your issue of, do we bring up the hesitancy? This is one of the reasons why I wanted to join ACIP, because I’m really concerned about the loss of trust in physicians. And it doesn’t just it’s not just vaccines, it goes across the whole board of do they trust any medicine we’re giving them? The concern that there is money to be made in medicine, and doctors are somehow all bought off and paid for by pharma, that they’re not looking out the best interest, but they’re looking out for their pocketbooks, is really a quite a prevalent view, and this is really hurting all aspects of medicine, just not vaccine medicine. So we brought up one of the things we brought up in the first one, I remember, I’ve only been to, I was in September and I was in December, but I haven’t been

Brinda Adhikari -- WSITY 49:51

you’re the new guy, yeah.

Kirk Milhoan, MD, PhD, FACC, FAAP 49:53

So, but in, in, in September, we talked about, you know what the healthcare provider uptake of the covid vaccine when it was fully recommended by CDC, 10%, healthcare providers, 10%. You know why that was is because when the mandate went away, stop people stopped taking it. You know what the uptake is for flu? 80% you know why that largely is in the medical community. Is because if you don’t get the flu vaccine, you don’t get an exemption, you have to wear a mask for the entire flu season.

Brinda Adhikari -- WSITY 50:26

So isn’t the flu uptake a lot lower in this country now?

Tom W. Johnson -- WSITY 50:28

you’re saying among healthcare workers.

Brinda Adhikari -- WSITY 50:33

I see what you’re saying. Dr Milhoan.

Kirk Milhoan, MD, PhD, FACC, FAAP 50:37

So what I brought up, I actually brought up at the ACIP meeting, and other people did as well, is that if we don’t bring back trust in the CDC recommendations that we truly do talk about the risks and benefits, we talk about the safety the safety profiles, if you will, of these things we become irrelevant when the CDC recommends something, and only 10% of the healthcare providers who should know best, who should know what the real risks are, how concerned they are about a disease. I will tell you, if I was an animal catcher, you know, I have a rabies vaccine.

Dr. Mark Abdelmalek- WSITY 51:11

Dr Milhoan, though, yeah, you’re talking about people not wanting to trust it. And then how does that like play out when you give out a recommendation? But right now, like pediatricians across the country are literally ignoring the advice that you’re putting out. The lawsuit that you mentioned, you know, one of the defendants in there is the American Academy of Pediatrics as like an entirety. How are you building trust? If that’s how you’re being received?

Kirk Milhoan, MD, PhD, FACC, FAAP 51:43

Yeah, well, how am I building trusted patients? So my primary, my primary, right? I don’t have just one agenda, right? I’m not, I haven’t come to be, I look at, I look at the totality of what the difficulties are, right? AMA makes recommendations, you know, how many doctors are signed up to be in the AMA? About 10 to 15% of the population. Most of those are medical students, because you get a free JAMA article in medical school. So is that speaking for doctors? Not necessarily. And so what we’re Yeah, this is, this is, this is a real problem, right? Because I don’t just, I don’t just, I’m not my my whole life as a pediatrician isn’t about just vaccines. My whole life as a pediatric cardiologist isn’t just about myocarditis. But I see this bleed, and it changed when things were mandated and people couldn’t go to school, and they couldn’t do this, and they couldn’t do this, to get a vaccine that has really been a large failure. So, I mean, Cody Meisner even said, he goes, the dishonesty regarding the covid vaccine is monumental. He said that at ACIP meeting, right? Because we have to be honest with it, right? When was the last time you needed to get four boosters a year if you were over 65 for a vaccine?

Brinda Adhikari -- WSITY 53:06

I mean, listen, I’m with you on the boosters.

Kirk Milhoan, MD, PhD, FACC, FAAP 53:09

See, IGG subclass switches to IGG four, which is it’s recognizing it as really an allergen, is ignoring it. So this is a real problem,

Brinda Adhikari -- WSITY 53:19

but, but you don’t even see its efficacy in the early stages of covid when the vaccine just came out, in terms of lowering hospitalization rates, lowering death rate. Like you’re right as far as transmission went, like once those other waves started coming on, I think there you’ll get very little argument from a lot of folks that like whether or not it was preventing transmission. I think you’re absolutely right that, in my estimation, public health oversold whether or not it could prevent disease, but I or prevent transmission. But do you also think that it did not reduce disease burden?

Kirk Milhoan, MD, PhD, FACC, FAAP 53:55

I think it helped in the first well, Alpha was out. I think as soon as delta came out, it was it was largely ineffective. But, yeah, absolutely, I saw that clinically. When I remember I treated a whole bunch of covid patients on this island in their homes because the hospitals were rejecting seeing them.

Tom W. Johnson -- WSITY 54:12

Let me just stick with trust for a moment. In you know, according to the Wall Street Journal, during the December meeting, you were picked up on a hot mic, a mic that was open, talking to Dr Cody Meisner. And you said, I want to talk to some of the higher ups. You went on to say a little bit more of a discussion of where we want to go with this, and what do we think the pressing issues are, and what are those things that aren’t so pressing? And then obviously the quote that I think a lot of people heard, which was, you know, that that you were sort of comparing yourself and the committee to puppets on a string, as opposed to be to really being an independent advisory panel. So I just straight up, what were you referring to?

Kirk Milhoan, MD, PhD, FACC, FAAP 54:55

I was referring to what it’s like to be a committee member when there are, are lots of different pressures and threats coming in. You know, we have a whole email thread of all the threats we get as a ACIPs. So what we’re trying to be as independent. But if you were at the ACIP meeting, how much really good science was, was given by the by the organizations that came up? Were they questioning science? There were a lot of ad hominem attacks. How many children were going to die because of our this or stuff like that?

Tom W. Johnson -- WSITY 55:29

So you weren’t referring to, the puppet master is not Robert F. Kennedy?

Kirk Milhoan, MD, PhD, FACC, FAAP

No. (crosstalk)

Tom W. Johnson -- WSITY

It’s not HHS?

Kirk Milhoan, MD, PhD, FACC, FAAP 55:38

I haven’t had anyone say. Kirk, this is what we want you to make sure is voted on. I have not had that happen. This next, this next meeting that we have coming up the subjects we’re going to be we’re going to we’re finishing up the details about what we’re going to be talking about. And we’re in groups, work groups, even today, I have one and a half an hour that we will, that we don’t have any, I haven’t felt any pressure. I haven’t felt like, Kirk, you need to do this so nobody anything I felt like from the White House, they wanted me because they felt I was going to be not one extreme or the other.

Tom W. Johnson -- WSITY 56:15

Got it. So there’s no meeting where someone says, Hey, take this on next? We want

Kirk Milhoan, MD, PhD, FACC, FAAP

No.

Tom W. Johnson -- WSITY

you to look at this now?

Kirk Milhoan, MD, PhD, FACC, FAAP 56:21

Now, we can be asked for an advisory panel. So the CDC can ask us, HHS can ask us, if there’s a new product that comes out, we’re going to be asked to look at it. But we have a lot. The charter gives us a large breadth to if we’re seeing signals that have been ignored, then we can go back and look at that. I mean, Brinda, you brought up something about the CDC. Remember? Remember initially they said how effective it was if you

Brinda Adhikari -- WSITY

95%.

Kirk Milhoan, MD, PhD, FACC, FAAP

100% then 95% then 90% then 85% and 75% remember that?

Dr. Mark Abdelmalek- WSITY 56:59

Yeah, but that effective at what I think we should clarify. What do you mean by that?

Kirk Milhoan, MD, PhD, FACC, FAAP 57:03

Well, let’s, let’s clarify that. Because, you know what? When people get a vaccine, when they get a vaccine for tetanus, do they expect to get tetanus? No.

Dr. Mark Abdelmalek- WSITY 57:12

What that what the 95% was, was preventing clinical disease. It wasn’t preventing an infection. (crosstalk)

Brinda Adhikari -- WSITY 57:19

To be fair, Dr Mark, I have, I’m with Kirk on this one. I think that maybe you and I have disagreed on this too.

Kirk Milhoan, MD, PhD, FACC, FAAP 57:26

et me bring up another point.

Brinda Adhikari -- WSITY 57:28

Let me wait. Let me just, let me say one thing. Dr Kirk, I’m with you on this one. I think that the what was happening, happening at the study level and at the clinical level, was not being communicated that way to the public, Mark.

Dr. Mark Abdelmalek- WSITY 57:41

We can talk about communication.

Brinda Adhikari -- WSITY 57:43

It was being sold as a vaccine that could, like, prevent Covid, it could prevent transmission, and it could prevent Covid. That’s what how it was being (crosstalk).

Kirk Milhoan, MD, PhD, FACC, FAAP 57:53

In the early studies. In the early studies, if you look at the early studies, and what hospitals were doing is, if you were vaccinated when you came in with a Covid like illness, they did not test you for Covid because you had been vaccinated. And let’s what and the CDC also changed. It had to change its definition of vaccines from preventing to ameliorating symptoms or hospitalization.

Dr. Mark Abdelmalek- WSITY 58:21

Yeah, I mean, this sounds like a lot of the nuance that you’re asking for.

Kirk Milhoan, MD, PhD, FACC, FAAP

Absolutely. (inaudible)

Dr. Mark Abdelmalek- WSITY

Let’s talk about you mentioned the charter and what ACIP is supposed to be doing. I want to ask you how the new ACIP is working. Specifically, are you still using sort of the best practices that have been set in place for ACIP, you know, for decades, for example, like the grade framework, which is, you know, how we assess the quality of evidence. Are you still using the evidence to recommendation framework? One of the criticisms that we’re hearing is that it’s not necessarily being applied. Can you commit that you are still using those best practices of ACIP, are you revamping the entire way it’s being used?

Kirk Milhoan, MD, PhD, FACC, FAAP 59:04

Those best practices were used for the best last five years, and how did they do to protect the society?

Dr. Mark Abdelmalek- WSITY 59:12

Brinda Adhikari -- WSITY

Well, one might say (Crostalk)

Brinda Adhikari -- WSITY 59:14

Kirk, right now, we have a measles outbreak in this country. And you know, there’s real fear that infectious disease is going to come back.

Kirk Milhoan, MD, PhD, FACC, FAAP 59:27

That is a different, that’s a hesitancy issue, not an ACIP issue, right? That is not an ACIP issue. That’s a hesitancy issue. But what you were referring, what you’re referring to is, how do we evaluate evidence? If you look at grade, if you look at evidence to treat, they are looking primarily at efficacy. They are not looking at safety signals. So we had a major failure in following safety signals with Covid, even though grade and ETR. So what we are looking at now is, how do we incorporate aspects of the ideas of and the concepts of grade, how do we evaluate data, and how do, but at the same time, have within that framework that we’re not looking just at evidence to treat, but we’re looking at safety signals and well, which is, which is not really set up in grade and evidence to treat so are we? Are do we? Are we bringing scientific rigor to this? Absolutely, I would say we’re probably bringing in an increased level to examine safety, because if you’re not specifically setting up studies to look for safety, you’re going to miss it, and you have to especially vaccines for children. It’s not a three day study or a five day study or a seven day study, like they did with newborn doses of hepatitis, you have to watch them for a while.

Dr. Mark Abdelmalek- WSITY 1:00:49

So are you saying you’re just so, I just so I’m clear. You’re saying that the old ACIP wasn’t studying safety adequately, and you are trying to reinvigorate safety as a priority. And do you believe that the current post marketing and surveillance systems and the VAERS and the FDA databases and the CDC databases, none of those are able to do safety in the way you want. And you have a new solution on safety.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:01:19

I don’t have a new solution. We’re working to figure out why it broke. And so when we bring up VAERS, people say, Well, you can’t use VAERS. Well, it’s CDCs invention. So we have to, we actually have to look. And that’s why one of the people on the on the ACIP, is a safety expert. He’s looking at, he looks at all aspects of safety. So this is, I think that I think families demand this. There’s an assumption that it’s safe. But have we looked at it and have we studied it? And we need to have rigor in doing that, because my obligation as a physician, and it should be as a public health official as well, that we do no harm.

Dr. Mark Abdelmalek- WSITY 1:01:58

Yeah, I think you’ve mentioned that, and maybe the audience doesn’t know, but you’ve done a lot of mission work. I think you you one have talked about the impact of delaying care, and I think you even talked about how you were finding children in various states of cardiac diseases that were so late, and how delaying or withholding care led to this irreversible harm. And I think that, and I wonder, have you reflected on your words today and your position today that a lot of what you’re saying is influencing parents to delay or refuse vaccination, because you’re really raising this question of safety, and how do you weigh the this like possibility that you’re going to have unintended harm. You know, I believe that you want to do good for patients and and make sure that everybody gets the vaccines they need, but there could be some unintended harm. Do you recognize that, especially to this population that you’re trying to protect?

Kirk Milhoan, MD, PhD, FACC, FAAP 1:02:58

Yeah, absolutely. And Mark, do you recognize there could be unintended harm if we give it? That’s what I’m trying to have the discussion. There’s possible for unintended harm both ways. There’s possible for unintended harm if you don’t get it, and it’s possible for unintended harm if you get it. And let’s just have them both as a discussion and not be afraid to talk about it. (crosstalk)

Dr. Mark Abdelmalek- WSITY 1:03:17

They’re not equal, though, I guess the I guess, for parents, it’s so hard to understand you’re here.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:03:23

Mark, it depends on which vaccine which person’s in front of you, and what their risks are. It’s not the same. It’s nuanced. And to make a one size fits all, which is what has happened, right? If you look at RSV, what was RSV? We used to treat RSV with monoclonals, and it was for the ones who are at most risk. So, so the ones who are at most risk, right? I’m taking care of a kid who has RSV and has a heart defect, right? They were nine months old. They didn’t get any RSV protection at all. I’ve had them in the ICU for three months, right? Do, am I aware of these things? Absolutely, but do we need to give does it needs to be mandated for you to go to kindergarten that these kids have every one of these vaccines that are recommended, that that should be individually based that? That is what I do as a doctor.

Tom W. Johnson -- WSITY 1:04:14

So you don’t think the medical exceptions for those school mandates. You don’t think that’s working. You don’t think there’s enough.

Kirk Milhoan, MD, PhD, FACC, FAAP

Californians are not allowed.

Brinda Adhikari -- WSITY 1:04:23

(crosstalk) There’s only a couple of states, right? Dr Milhoan, it’s California, New York, like there’s a couple of states,

Dr. Mark Abdelmalek- WSITY

Those are other exceptions.

Brinda Adhikari -- WSITY

But let me ask you exemptions, let me, let me ask you, just following up from Mark on that, which is, it seems to me that you’re weighing the risk of disease equally with the risk of adverse event. Does that sound accurate?

Kirk Milhoan, MD, PhD, FACC, FAAP 1:04:47

No. It’s not true, because each vaccine is different, right? There are

Brinda Adhikari -- WSITY 1:04:50

let’s just take measles, for instance. I think you talked about MMR and polio up top. We’re doing a return to theme here as we wrap up. So let’s go back. You know, you’ve got a measles outbreak right now, can you look into the camera and say the best prevention against measles is the vaccine?

Kirk Milhoan, MD, PhD, FACC, FAAP 1:05:13

I think it’s, I think it’s very helpful. Is it 100%? No. But is it very helpful?

Brinda Adhikari -- WSITY 1:05:17

Pretty damn close.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:05:20

Do you have data for that?

Dr. Mark Abdelmalek- WSITY 1:05:24

Yeah. I mean, like we do, like, for example, like, if you have a natural measles infection, like, the risk of, like, terrible pneumonia is like six per 100, or death is like, you know, one to three per 1000. But if you talk about the adverse events from the measles, one

Kirk Milhoan, MD, PhD, FACC, FAAP 1:05:43

One to three per 1000 in the US. For measles?

Dr. Mark Abdelmalek- WSITY 1:05:47

in developed countries.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:05:49

One to three? Current data?

Dr. Mark Abdelmalek- WSITY 1:05:50

For natural if you have a natural measles complication,

Kirk Milhoan, MD, PhD, FACC, FAAP

This is not current data.

Dr. Mark Abdelmalek- WSITY

that is, that’s in the New England Journal of Medicine. But that’s okay, we can double check it.,

Brinda Adhikari -- WSITY 1:06:00

let’s double check it. Kirk, let’s make sure we’re right on that. I agree with you, but I just want to make sure that, like

Dr. Mark Abdelmalek- WSITY 1:06:10

(crosstalk) the point is that for for the adverse events are not even in the order of per 100 or per 1000s. They’re per million per you know, anaphylaxis is per million doses. You know, seizures as per, like three to 4000 doses, like the complications from, you know, the platelet complications that you might get, or the encephalitis, they’re not even in the same order of magnitude. So, yes, as physicians, as doctors, you know, we all want to, like, put these, like risks and benefits in the appropriate context. And I just, I’m wondering, do you, do you see that, do you feel like you have a little bit of bias towards, like, putting them on equal playing field there?

Kirk Milhoan, MD, PhD, FACC, FAAP 1:06:52

I don’t put them on equal playing field, so, but I started out talking about bias, right? I was honest about that. I talked about bias, right? So let’s be honest what all the biases are here. It’s okay, right? I’m really concerned about my role as a doctor and informing somebody, and now I have the AAP saying we don’t have enough time to inform people, but they were telling us before that everybody got informed consent. So when I told people, when I was giving children, when I was a general pediatrician, I was giving people children oral polio, I talked about immune people, people with immune deficiency in the house. Is it? It’s not smart to get a live virus when you know people with immune deficiency in the house. So we needed to do things differently and separated things right? And wouldn’t change the baby’s diaper, right? We did those things. So all I’m saying is this, do we have real data that we can say this is your risk of encephalitis, if today you get measles in the US, and this is your risk of doing that? I think we should be able to make a very, very strong, compelling argument from data to convince people to get things, whether that’s

Brinda Adhikari -- WSITY 1:08:04

even with something like as contagious as measles, like are not

Kirk Milhoan, MD, PhD, FACC, FAAP 1:08:09

very few things that are as contagious as measles, right?

Brinda Adhikari -- WSITY 1:08:12

And you think that can still be like an informed consent situation where mandates aren’t necessary to go to public school. You don’t need a measles shot to go to public school because

Kirk Milhoan, MD, PhD, FACC, FAAP 1:08:22

they don’t, they don’t have, you know, most countries around have very limited things that are mandated, and they have high uptake of vaccines, right?

Tom W. Johnson -- WSITY 1:08:32

But they’re obviously, you know this, you travel the globe. I mean, yeah, there’s a million reasons why other countries have high uptake, and America has lots of systemic problems, issues, deficiencies, and I just want to clarify, every state allows a child to be exempted from the mandates to go to school for a medical reason. Some states

Kirk Milhoan, MD, PhD, FACC, FAAP 1:08:53

that’s not true. I just had a phone call yesterday from a person in California whose child was dramatically affected. They have, they have. They did genetic testing. They had the Mercer gene and the other two kids for the whole time, they’ve, they’ve had doctors saying these other two kids should not get the MMR. They should not. They should not. They put it three for the because you can no longer as doctors, you can no longer write exemptions for children that has to go through a medical board. And they were refused exemptions, even though years (crosstalk)

Tom W. Johnson -- WSITY 1:09:25

you’re saying anecdotally, you’re finding people the system’s not working for them. They they’re making the case, and they’re getting rebuffed. They’re getting rejected.

Brinda Adhikari -- WSITY 1:09:32

on medical exemptions. (crosstalk)

Tom W. Johnson -- WSITY 1:09:36

But sounds like your legacy, as if you could craft it for your time at ACIP would be to break from the past and start to really examine in the data, hearing observationally from doctors across the country, what is the safety signal? You feel from, your suspicion, your hunch, although you said at the beginning, you could be wrong. Your hunch is there’s, there’s safety issues that have not been surfaced, that that were maybe looking at tip of an iceberg. Would you put it in those in that stark a term?

Kirk Milhoan, MD, PhD, FACC, FAAP 1:10:11

I’m not sure tip of the iceberg is the thing?

Tom W. Johnson -- WSITY

How would you put it?

Kirk Milhoan, MD, PhD, FACC, FAAP

I wouldn’t put it as tip of the iceberg. I think what I would like to be able to do is give people medical freedom, and I would like to, and I would, I think there are things that I would, I would compel them that I think this is a good thing. And I would say, well, in terms of your whole risk and everything else, you’re not going to Africa, so I probably wouldn’t give you yellow fever. You’re not a dog handler, so I’m not going to give you rabies. But this is what I’m concerned about, and this is what I these are what the benefits that I, that I see from this vaccine. This is what you can expect from it, and this is the risk of taking it. What I would what I’d like my legacy to be is not that we destroyed the vaccine schedule, but I would like it to be that, wow, he he had a compassion for children and families and wanted to do everything we could to keep them healthy. And I have those in a balance, and there are some things that it’ll go like this, and other times it’ll go like this, but I don’t like, I don’t like the medicine. I feel medicine is going into a algorithmic place that leaves the outliers vulnerable.

Brinda Adhikari -- WSITY 1:11:30

Dr Milhoan As we Dr Milhoan As we start to wrap, I just want to reflect one viewpoint you know, which is that we’ve talked about distrust and vaccines and how there’s hesitancy, and we need to figure out a way to empower the American people with good information to be able to make good choices in their lives, empower doctors to be able to, you know, recommend the right choices. There’s also a lot of people who do trust vaccines in the country, and there’s people who really rely on them to keep their kids safe. And you’re absolutely right. They are weighing that cost benefit analysis, I have made the decision to vaccinate my children based on my decision to trust data and trust that they will benefit more than they will be harmed. I guess my question is, can you assure people listening that ACIP is going to be making recommendations for everybody, not just the people who are not trusting of something and may require a different like process, quite honestly, but it’s also going to protect people who rely on these tools. I mean, like 80% of this country, including 66% of MAGA supporters, say that they would be very upset if the childhood vaccine schedule were to be altered, or that the even that they support the public school requirements for them. So can you help me just to feel assured, as a mom and other moms feel assured that, like you guys, aren’t trying to take away our vaccines,

Kirk Milhoan, MD, PhD, FACC, FAAP 1:13:20

One, we haven’t taken any of them away. If you want your vaccine, you can have if you want to use the old schedule, you can use it. We haven’t taken anything away. It will still be paid by all the major insurance companies, Vaccines for Children program, the CHIP program, Medicaid program, all those things. We haven’t taken any any of that away, right? If you would like it, and you and your doctor think it’s important that it’s still available to you. What going back to the other things? What we’re trying to do is we’re trying to update the vaccine safety sheets. And sort of like the handouts. I saw pediatric practice recently, they had a QR code that patients could scan they were given before the appointment. And here’s the vaccine safety sheets for all the vaccines your child is scheduled to get on this date, we’d like you to go over them, and if you have any questions, there’s a very nice novel way of getting information out, so people could have time to really go out and then bring questions to the I think those are beautiful things to do. That’s what I would like to do, is I just like to have really true informed consent for an intervention. That’s all I’m asking for, right? I like I said I don’t have a dog on this fight, like, Oh, I really want this, or I really want this. That’s not how I’m coming to, coming to that is that some people are going to think, and this is why I go against the word safety. If I were to say it’s one in 10,000 chance, some people say, Okay, I’ll go with that. That’s safe to me. Other people go, I want, is it a one a million chance? It’s not. It’s worse. It’s it’s not as good as a one a million. Then I’m not going to go for that, right? Those are numbers I’d like to give and then what is the reality of of those things? I had a professor when I was in fellowship, and he said, you know, Kirk, when you’re the person you’re it’s either 100, zero or 100% for you, right? It doesn’t matter if it’s 99% that you’re not going to get it. If you’re the 1% it was 100% for you.

Brinda Adhikari -- WSITY 1:15:12

And if those, if those diseases start making a comeback, like, you know, say people really listen to the recommendation that you don’t need to get rotavirus, and you don’t need to get this, and you don’t need to get that, you know. And someone people really start, and I’ve been hearing anecdotally, Dr Milhoan, of people calling their pediatricians offices saying, it sounds like I don’t need to get this, if diseases start to make a comeback, would ACIP change its recommendation?

Kirk Milhoan, MD, PhD, FACC, FAAP 1:15:39

Oh, I think that’s absolutely true, right? We’re not, this is not, and we’re also not. We’re not God here, right? People are giving us power we don’t have. We can, we can advise that we’re saying that we didn’t change anything, and we’re letting doctor patient relationship back in, back on board, right? And we’re encouraging doctors to take that place and look at the nuance of the patient in front of them. So, so if we look at something and we go, wow, okay, we did this and look what happened. This is this isn’t this is not good. Everyone got upset because we recommended that that you not give MMR and varicella together at the one year dose. You can give it at the five year dose, but not at the one year dose. We didn’t take them off, but 85% of the people already weren’t giving them together, and because the risk was twice as high for febrile seizures if you gave them together, and that was because they had, they had to increase, they had to increase the the quantity of varicella vaccine in the MMRV to seven times its regular dose, seven times its regular dose, to get it effective, because it was fighting against all those other the other three in the compound. So we said, give it separate. You give it separately on the same day, and there was no increased risk. But people said that you’re removing, no, we didn’t remove anything, yeah.

Dr. Mark Abdelmalek- WSITY 1:17:01

Dr Milhoan, you said, you know, we’re not God, and you’re a man of faith, correct?

Kirk Milhoan, MD, PhD, FACC, FAAP

Yeah.

Dr. Mark Abdelmalek- WSITY

And you’ve asked God before what to do. I mean, I’ve read some of your work, and you’ve said, God, what do you want me to do? And that’s how you ended up being a pastor. I think that’s how you started some of your mission work.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:17:23

How I got to be on ACIP

Dr. Mark Abdelmalek- WSITY 1:17:26

How I got to be on AC IP, I you know, and you trust God if you were wrong, okay, if you’re wrong, and you said you could be wrong, and your current stance has caused some harm, how are you going to recognize that what in your life has positioned you to recognize that, who is there somebody in your life that has permission to tell you that? Like, how are you going to know if you’re not on the right path, especially when you’re so you know, visible now, I guess, like, take a moment to think about how.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:18:01

I don’t have to take a moment to think about that? I’m wrong about things all the time. I can tell you what I what I hate to be wrong. So if I’m wrong, I want to be right as soon as I can. Adam Grant talked about that in his book, Think Again. I’m not afraid to think again. I’m not afraid to revisit data. I like the work of Malcolm Gladwell. He looks at things differently. I like the work of the book Freakonomics. I like to look at things that am I looking at this clearly, I came on here telling you that I’m concerned that I even had a bias when I was a PhD student. So and you know what, and my higher authority for me is I stand before God, and if I harm children by action or inaction, both of those are critical to me. You know, there’s a quote by Charles Dickens. It says, “I love these little ones, and it is no small thing when those who are so fresh from God love us”, these families and these children, by designee of their families, are trusting me, and so I want to make sure that what I’m doing for them is what is best for them, and I take that very, very seriously. You know, this is, this is, I recently got contacted by someone on the web, and they said, Well, you have a horrible online profile. We’re going to give you a d minus for favorability, and between 18 and $22,000 we can clean up your Google profile. I said, How do you do that? Oh, well, we just move things up on the Google page and make makes you look better. We’ll get people to write nice articles about you, and we’ll move you up and we I’ll tell you what I make as ACIP, when I’m there in the CDC, I make $250 a day. I’ll do that three times, it’ll be about $1,500 so what I’m getting from ACIP is $1,500 a year. A negative profile on a career that I love, to be a doctor, and an offer to spend $18,000 to bring back my credibility for something I’m getting paid $1,500 a year for, and my son bought me bullet proof clothing for Christmas.

Brinda Adhikari -- WSITY 1:20:43

That is not okay.

Kirk Milhoan, MD, PhD, FACC, FAAP

That’s the reality of my life.

Brinda Adhikari -- WSITY

Dr Milhoan, I want you to know that that is not okay. We have spoken with doctors who’ve received death threats from public health, from from people such as yourself. I know Robert F Kennedy has done it. I just want you to know that none of us, ever, ever, no matter how much we disagree on things, want to live in a country where our medical professionals are getting death threats.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:21:13

And I know, and this is why I welcome being on here, right? Because I love, I love. What your statement of your Why should I trust you? It’s a good point, right? Trust and verify, yeah. So I don’t feel this way from you. This is the kind of discussion I think we should have all the time. Yeah.

Tom W. Johnson -- WSITY 1:21:31

And I also have to say that, what your career of traveling the globe? Let me say that again, your career of traveling the globe and helping children get access to medical care is so moving and so profound. Like in another universe, we’d love to have you back just to talk about that and the lessons you’ve learned, because it is if people could hear that, I think they would. I don’t think you have to pay the 18k to do whatever to your profile online. It’s we. Thank you for that, that that’s that is. It’s a really moving thing that you’ve been doing.

Kirk Milhoan, MD, PhD, FACC, FAAP 1:22:06

Well, I’d love to talk about that, because what my what my desire is, is for healthy children around the world, right? And so I’m willing to look at everything. I’m really to think again about my own thoughts, my own preconceived notions. I think what’s very important is we need to make sure we don’t parrot. So in medical school and in grad, in residency and as an attending, often what you would hear is a third year medical student tell you everything that their team is going to do for this patient, and you realize they didn’t know any of that, they just parroted what they heard. And I think it’s very important in science that we don’t pair it, that we actually go back and look at first sources, because we can often hear someone give us a conclusion after they’ve read the abstract. But have you read, have you gone back to primary sources and asked the question? Because when I ask questions as a PhD pharmacology pharmacologist, have have we studied this? Have we studied its its pharmacokinetics? Do we know when it’s out of the body? I’m surprised that I have no primary data. When I look at contamination, I have no primary data. And so this is why I’m so, I’m advocating so much that we have been missing looking at the risks and and what is the perceived safety of these interventions. Because I’ve asked basic pharmacological questions on pharmacokinetics, and there are no answers. So this is where my concern is. Is my concern is? Is that? Is that? How do I help children with all of my heart and do as little harm as possible?

Brinda Adhikari -- WSITY 1:23:53

Dr Milhoan, I want to thank you so much for joining us. I know we lose you in a couple minutes. I ask, you know, one request from me as a mom is at your next ACIP meeting. You know you hold space for people, of course, who are hesitant about vaccines. You hold space for conversations about its safety profile. And I also ask that you hold space for those moms who are really worried about infectious disease and are really worried about them making a comeback should uptake of these vaccines go crashing down to hold space for all of that, because I think that is what I am in entrusting in my government to, you know, not make decisions for me, but also not hurt me and look out for me in some way. So I just asked you hold space for all those types of voices. Will you do that for me?

Kirk Milhoan, MD, PhD, FACC, FAAP

Yes. I already am.

Brinda Adhikari -- WSITY

I want to thank you for joining us on Why Should I Trust You? Dr Milhoan, thank you so much for coming on air.