When Dr Peter Hotez began his career in paediatric medicine and vaccine research, he harboured no ambitions of becoming a household name in the United States. Nor did he imagine his work would lead to him receiving swastikas as hate mail or having to liaise with the FBI and Houston Police Department to ensure his personal security. Today’s public discourse, he says, is remarkably less friendly to science than it was decades ago. “When I got my MD and PhD 40 years ago, I knew I wanted to develop vaccines, but I never thought I’d have to defend vaccines,” he says. “I became public enemy number one.”
Hotez has been a vocal champion of the benefits of immunisation programmes, frequently responding to media requests, writing books on the subject and engaging with the hundreds of thousands of people who follow him on social media.
The highs and lows of speaking out against what he calls the “anti-science agenda” are worth it, he says, not only because it’s the right thing to do — but because lives depend on it. The World Health Organization estimates that more than 1.1 million people died in the United States due to COVID-19 infections, tragically a large portion of which perished because US vaccination rates lag behind other similarly rich nations. Just 68% of Americans are fully vaccinated against COVID-19, whereas that figure climbs to 84% north of the border in Canada. In some southern US states, such as Alabama and Mississippi, vaccination rates linger just above the 50% mark.
In 2022, researchers at Brown University in Rhode Island, United States, and AI for Health, a philanthropic programme launched by Microsoft Research, analysed weekly numbers of infections, deaths and vaccinations for each US state. Using this data, they were able to create an algorithm to examine how things might have progressed if vaccination rates reached 100% of the adult population. They concluded that at least 318,000 COVID-19 deaths in the United States could have been prevented between January 2021 and April 2022 if vaccination rates were higher. Figures like this bring the fight against fake news into sharp focus, says Hotez.
Setting things straight
Hotez’s desire to correct the record is also something of a personal mission. A paediatrician and professor of paediatrics and molecular virology and microbiology at Baylor College of Medicine in Texas, he is keenly aware of the need to engage with misconceptions around vaccinations and autism. In 2018, he wrote the book, Vaccines did not cause Rachel’s autism, referring to his own daughter, who was diagnosed with autism spectrum disorder at a young age. That’s where it all began for Hotez, born of a frustration at seeing people brandish shoddy science – which has long since been retracted – that alleged a link between the measles, mumps and rubella (MMR) vaccine and the onset of developmental disorders.
It was from a single paper, published back in 1998 by The Lancet, that the modern anti-vax movement originated. The research was based on a small number of cases, had no controls and relied on parental memory rather than medical records. The paper’s author, a former British doctor, was eventually struck off the medical register and prevented from practicing, but it in many ways, it was too late. It took 20 years for MMR vaccination rates in the United Kingdom to bounce back, and in the interim more than 12,000 cases of measles surfaced, leading to hospitalisations and deaths. The proverb is true: A lie gets halfway around the world before truth has a chance to get its trousers on. “The scientific community was chasing its tail [on the issue],” Hotez laments.
MMR immunisation have since recovered, but the anti-vax movement has mutated, taking on a new form to spread around the globe. It has become especially virulent in the United States by entrenching itself in the partisan culture wars.
The anti-vaccine movement is embedded in the talking points of the far right here [in the United States],” says Hotez. “It’s right alongside the other assertions, such as that the election was stolen. That’s why you have the Proud Boys [a male far-right neo-fascist militant organisation in the United States] marching against vaccines at rallies on a regular basis. Everyone is, of course, entitled to conservative views, but we somehow need to uncouple science from all of this for the simple reason that it’s directly killing people.”
That uncoupling requires a strong communications strategy, and that’s why Hotez has decided not to get bogged down in the minutia of the anti-vax movement. “I keep bringing it back to the hundreds of thousands of deaths,” he says.
As the COVID-19 pandemic unfolded in early 2020, Hotez and his colleagues at Baylor College of Medicine began working on a vaccine that incorporates a harmless piece of the spike protein that causes COVID-19. In the same way that more well-established vaccines, such as the Flu vaccine, work by stimulating the immune system and teaching it how to respond to an infection, Hotez and his team developed a vaccine that stimulates an immune response by exposing it to an attenuated dose of the COVID-19 virus. They called the vaccine CORBEVAX, and in 2021, it received its first approval from the Indian government. The US vaccine development program – dubbed operation “warp speed” – meanwhile focused on research coming from pharmaceutical companies rather than university-driven research such as CORBEVAX.
Crucially, Hotez and his team did not apply for a patent, which means the vaccine technology is under open license so manufacturers don’t need to pay royalty fees to produce it.
Despite the success of COVID-19 vaccines, which are estimated to have prevented more than 14 million deaths around the world in the first year of the pandemic alone, according to a 2022 study, the anti-vaccine rhetoric has not been deterred, says Hotez. “[The anti-vax community] calls me a pharma shill, but we actually provided a path that shows you don’t need to be a big pharmaceutical company to make a difference,” he says.
That isn’t the worst of it; Hotez has endured antisemitic abuse and received threats to his safety. Sadly, he says, such personal attacks are not surprising. “Sometimes, I ask myself why I speak out. But what’s happening with COVID-19 vaccines is just the warmup – we’ll see it in all of the childhood immunisations soon,” he says. “My contribution is to point out the problem, report on it and describe it. You have to know what the enemy is like if you are going to counter it.”
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Story by Benj Plackett