Darrell Rebouche (Host): Hello and welcome to Health on Point, presented by Willis Knighton Health. Vaccines are very prominent in the news cycle these days, and our guest today is a pediatric infectious disease specialist, Dr. Joseph Bocchini. Well, he went to medical school at St. Louis University. He did internship and residency at the University of Connecticut, and he did his fellowship at Johns Hopkins University. Dr. Bocchini, thank you for joining us.

Joseph A. Bocchini, MD, FAAP: My pleasure, Darrell. Happy to be here.

Host: Vaccines, why are they so prominent? And why are there so many ongoing conversations about them?

Joseph A. Bocchini, MD, FAAP: Well, I think one of the most important things about vaccines is that they have changed the life of children pretty dramatically. So if you go back to the 1940s and 1950s where we had very few vaccines, childhood illnesses due to vaccine-preventable diseases were responsible for many of the top 10 causes of death in children. That's changed dramatically in the last 50 or 60 years, and it's all because of vaccines.

So when the CDC put together the top 10 public health advances in the 20th century, they chose vaccines as number one. And the reason they did that is because vaccines have lowered the morbidity and mortality, the number of illnesses and deaths that occur in children pretty dramatically over the last 50 or 60 years.

And just to give you some figures, the CDC published an article probably two years ago where they looked at a cohort of 40 years of children who would have gotten the vaccines that were in existence during that 40-year stretch. And in that 40-year time period, the estimated number of illnesses prevented were over 508 million, 32 million hospitalizations prevented, and 1.1 million deaths. That's in the United States alone.

So around the world, vaccines have had a remarkable history of improving the lives of children. So, parents who used to worry about a number of these vaccine-preventable diseases causing their children to be severely ill, or perhaps even dying of the illness, now don't even have to worry about them. And many parents and grandparents have not even seen them.

Host: Well, you used the phrase vaccine-preventable diseases. Can you be specific about what some of those are and how those numbers have changed over these generations?

Joseph A. Bocchini, MD, FAAP: I can. The American Academy of Pediatrics has published a vaccine schedule since the 1930s. That's a schedule that has been developed over time based on science and based on evidence of the safety and effectiveness of vaccines. So currently, that vaccine schedule has 18 different vaccines that we can routinely use to protect children from what we call vaccine-preventable diseases.

So, we have the capacity to make children healthier by reducing their risk of acquiring 18 different infections or, in some cases, if the infection still occurs after vaccination, making them less severe and less likely to cause consequences.

Host: Our guest is Dr. Joseph Bocchini, a pediatric infectious disease specialist. It means you treat kids, you're looking out for them, you're looking out for preventative health, you're looking out, of course, when things occur that require treatment. But can you define for us what an infectious disease is? Can you give us a general explanation of that?

Joseph A. Bocchini, MD, FAAP: Yes. We encounter germs, viruses, bacteria, and other organisms, routinely every day. And they populate our skin, they populate our intestinal tract, our sinuses. So, these organisms interact with us on a routine basis. In some cases, those organisms have the capacity to produce disease. So not only are they living with us, but they can cause disease. So, vaccines are really given to children to try and prevent disease when a child comes in contact with one of these germs.

Host: And these means are effective. I think you want to emphasize the effectiveness of them, because there's some skepticism out there in the world.

Joseph A. Bocchini, MD, FAAP: There is. And I think that the important thing is that some of that skepticism is based on misinformation. So, parents are reading things or seeing things on social media on the internet that makes them worried about some consequences that are not really associated with vaccines.

When a vaccine is first licensed to be used in children, it's already undergone a long series of clinical trials where we look for the safety and the effectiveness of the vaccine. And then once the vaccine is licensed, we also look for any rarer consequences that might occur with a vaccine through a series of safety networks that the United States has put together through the CDC and the FDA. So, we have a long history that tell us that vaccines are safe and effective, and we're constantly looking at that data to make sure that there are no new findings that might change the risk-benefit ratio of getting the vaccine. So, we can certainly indicate that vaccine recommendations through the American Academy of Pediatrics are made based on a body of evidence on safety and effectiveness that has been demonstrated over many, many years. And in part, it's demonstrated by the fact that these diseases that we're trying to prevent with vaccines have largely come under control because of the vaccines that we're using.

Host: Is the reverse also true that if vaccination rates begin to decline that we may see some reemergence of diseases that we thought were under control?

Joseph A. Bocchini, MD, FAAP: Well, unfortunately, we're seeing that now. I think one of the things that we have to say about vaccines is that vaccines have a personal benefit. They protect a child from infection after being exposed to a variety of different germs. But in addition, they also protect society. Because if you get enough people vaccinated, you develop what we call community protection or herd immunity, whereby a agent that comes into the community can't spread because there are enough people vaccinated.

It is true that over the past few years, we've seen a significant decrease in the likelihood that a child will be vaccinated on schedule. Now, we still have 85%, of the population vaccinated against these pathogens on schedule. But that 15% is very dangerous because sometimes it takes 90 to 95% of the population vaccinated to prevent an outbreak from occurring in a community.

So, what we're seeing, for example, measles is one of the most highly contagious infections amongst all the viruses that produce infections in the human population. Because of that. If you drop below 94% of the population immunized and have measles reintroduced into a community, that virus will spread effectively amongst the susceptible individuals. So right now, in the United States, we're seeing more measles outbreaks. And in fact, in 2025, we saw over 2000 cases of measles with outbreaks, some big outbreaks in a couple of states. And already we're now at the end of the first two months of 2026, and we have over 1100 cases of measles with ongoing outbreaks and two major outbreaks in states with additional infections in various other counties and other areas of the country. So, measles is making a comeback. Those are more cases than we've had in over 30 years. So, that's a problem. And if you look at the data, the vast majority of people who have measles are individuals who have never been vaccinated.

Host: Dr. Bocchini, what is the risk of measles if a child contracts measles? Is it discomfort, can be a little bit disfiguring, maybe leave you some scars? But really, tell me what is the upshot of enduring measles?

Joseph A. Bocchini, MD, FAAP: Measles is a terrible disease. In fact, for everybody who gets measles, the infection's pretty much the same. You have five to seven days of high fever, cough coryza, conjunctivitis developed a classic rash, but the real problem of measles is that even with our current healthcare system, modern medications, intensive care units, one to two children with measles per thousand will die of measles. That's how severe the infection is. And they mostly will die of pneumonia for which there is no specific treatment or they will develop an encephalitis, an infection, or inflammation around the brain. And for those people who survive the encephalitis, there's significant brain damage as a result of that. So, it's certainly a very serious disease with significant consequences for children who have them.

Host: We're also seeing a reemergence of pertussis. Can you tell us a little bit more about that? Is that true?

Joseph A. Bocchini, MD, FAAP: Yeah, that's a very similar problem. Pertussis is a disease that's a respiratory infection that causes a significant cough. And that cough is a deep cough from the larger airways in the lungs. But for young children, it's a very serious infection because the cough can be so severe and occurs with such rapidity over a long enough period of time that some children lose their ability to breathe. They get lower oxygen levels. And for children under three months of age who have pertussis. That's where the mortality occurs. So, it's a fatal disease for young children and a very serious disease for older children and adults. And sometimes, an adolescent, for example, with pertussis could cough for up to 90 days.

Host: The timeline of receiving vaccinations is important as well. You mentioned that pertussis can be especially troubling, even fatal in infants. It's still very serious as they get older. But for pertussis and measles and these other vaccinations, the schedule of their deployment is vital to maintain. Correct?

Joseph A. Bocchini, MD, FAAP: That's correct. The schedule is critical. the schedule is based on two things. One, when is the patient's immune system capable of responding to the vaccine so that we can get good protection against the infection we're trying to prevent? And the second thing is, when is a child likely to be exposed to this agent or this pathogen? So, we always try and initiate immunizations at a time that the patient can respond, at a time before they're likely to develop severe disease. And so, the schedule is really put together in a very careful way to try and get the maximum degree of protection for every child. Delaying the schedule or postponing vaccines for a period of time puts the child in a position where they remain susceptible for a longer period of time, much longer than they need to, which makes them at risk for infection during that time period.

Host: Decades ago, one of the most feared diseases was polio. There's a sense that polio isn't a problem anymore. But polio, it is still important to talk about that, isn't it?

Joseph A. Bocchini, MD, FAAP: Well, polio is a really important example of the development of the vaccine era. Because in the 1950s, thousands of children every summer would develop polio. And half of the children, somewhere around 18 per thousand children a year, in the 1950s would develop paralytic polio. That would mean they would lose the use of a leg or an arm or, even worse, they could lose their ability to breathe and spend the rest of their days in an iron lung. And it was such a common illness that parents during the summer were very worried about it. If there were cases in a community, pools closed, movie theaters closed, children could not go outside, because of the risk of acquiring polio.

Within 10 years of the first polio vaccine, polio cases in the United States dropped by 90%. Now, we have full control of polio in the United States. However, there are still a few countries where polio occurs and people who may be carrying the virus can come back to the United States. So, it's really important that we keep up with the vaccine against polio until that virus is eliminated from the world. We are very close to eradicating polio because of our vaccine program. And the reason is humans are the only animal that can carry polio. And because of the vaccine program, we can prevent that carrying, and then reduce the likelihood that virus will continue to spread amongst the human population.

And in fact, we are now at a point where only two countries in the world have endemic polio. But it's really important that polio can be transmitted and, as long as the virus is out there, we need to keep everybody vaccinated until we can completely eradicate it. And it might be another virus that we could then ultimately stop vaccinating against the way we did against smallpox, because smallpox is another virus that was eradicated through vaccines.

Host: Dr. Bocchini, we hear that some parents have concerns about the hepatitis B vaccine. Why do you think that is?

Joseph A. Bocchini, MD, FAAP: One of the things that we know for sure is that hepatitis B is transmitted from mother to baby very effectively. And so, we do have a system in place where we screen mothers for hepatitis B. If the mother is a carrier, in other words, she's in a infectious stage of hepatitis B. We attempt to identify the baby so that we can give the baby vaccine and an immune globulin to protect them from acquiring hepatitis B. We've expanded that recommendation to include all babies to get their first dose of hepatitis B vaccine in the newborn nursery before they go home. And that's because there was somewhere between 16,000 to 20,000 cases of hepatitis B reported each year in children in the United States. Half of them were from maternal-infant transmission at the time of birth. The other half occurred in children under 14 years of age from contacts in their families or in the community. So, it's really important that we recognize that maternal-child transmission is not the only way hepatitis B is transmitted. We now have a 99% reduction in cases by using the vaccine in all babies in the newborn period. So, what that means is that it's safe. There've been no evidence of any negative consequences of getting hepatitis B vaccine starting in newborn period. So, we recommend that all babies get hepatitis B vaccine at the time they're born. That's really important, and we don't want to delay the vaccine.

Host: You mentioned parents talking among themselves, grandparents as well. There's a lot of information. People are reading things out there, seeing things and watching videos. And there's a just a glut of misinformation. I'm sure there's also some really solid, credible information out there. So, how do you combat that misinformation? There's a glut of it.

Joseph A. Bocchini, MD, FAAP: Well, I think the first thing for people to understand is that there is misinformation out there. There are people who are providing guidelines that are not based on science, not based on an understanding of the benefits of vaccines compared to the risks of the diseases the vaccine prevent.

So, the first thing to do is to find trusted resources for the information that you need to make the decisions for the health of your children. And so, the first step, I think, is always to talk to your pediatrician. Physicians who train in pediatrics, train in gaining the information on the safety and effectiveness of vaccines. We promote vaccines because we know they're safe and effective for the children that we care for. And that will help make children healthier and be at less risk for consequences of a variety of these vaccine-preventable diseases.

So, your first resource, I think, is your pediatrician or primary care provider. Based on what parents might be concerned about, your pediatrician can provide you with information to trusted sites. For example, the American Academy of Pediatrics has a Healthy Children website that parents can go to. It's geared towards parents to provide them with information on vaccines. It also includes some of the more common questions that parents might have about vaccines. So, it's a very useful and helpful website that you can trust.

There are others, the Children's Hospital of Pennsylvania, Philadelphia has a very good vaccine information website as well. So, your pediatrician can help you potentially answer questions that you might have if a parent has heard something and is concerned about it, or maybe be able to provide you with additional sites to get information that a parent may need to help make a final decision.

Host: You've dedicated your life to making children better and to preventing them from getting sick. Just tell us a little bit about you. What got you here? What gives you joy in terms of being a pediatric subspecialist as you are?

Joseph A. Bocchini, MD, FAAP: I really enjoy taking care of children. I enjoy working with parents. Much of pediatrics is education to the parents. Much of it is preventive medicine and vaccines are just a really excellent example of preventive medicine. We don't see these diseases because vaccines prevent them. So, some of the enjoyment of pediatrics is being able to provide that information to protect children. Also, children are very resilient. You treat them for a variety of different infections, they bounce back pretty quickly. They're fun to work with. So, it's a real joy to be a pediatrician.

Host: What would you like everyone to take away from this today? What is your best piece of advice?

Joseph A. Bocchini, MD, FAAP: I think the most important thing that I would like people to realize is that this vaccine program and the recommendations of the American Academy of Pediatrics are science-based. They're based on a long history of safety and effectiveness. They are based on evidence that provides us with enough information to allow us to recommend to families, how important vaccines are and how effective they have been in changing the lives of children so that parents who used to worry about children becoming ill with a serious infection. We don't have to worry about that as much anymore because of our ability to control up to 18 different vaccine-preventable diseases.

Host: Dr. Bocchini, you are a strong advocate and you make an outstanding case for vaccines. Can you explain to us the basics of how they work?

Joseph A. Bocchini, MD, FAAP: So, you can think about vaccines as sort of a fire drill, something that's teaching your system, to prepare it. So, what we do with the vaccine is we give either a killed germ, a weakened germ, or a portion of a germ to teach the immune system what to expect if they saw that full germ in real life. So, this drill prepares your immune system so that if your child gets exposed to one of these illnesses, your immune system can respond immediately. And by responding immediately, it could prevent infection or it could produce enough of a protection to if the infection gets through the immune system to modify to make it milder and less likely to cause serious consequences.

Host: Dr. Joseph Bocchini, thank you so much. It's been a pleasure being with you today, and we'd like to thank everyone for joining us for Health on Point, presented by Willis Knighton Health.