Trump Wants ‘5 Little Shots.’ What Does That Mean? with Dr. Céline Gounder

0:00Let me know. Welcome to That Can't Be True, a show that sorts of fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton. And as kids head back to school around the country, vaccines are understandably a top of mind for many parents and families. So especially true is measles outbreaks continue in communities across the country, and as we confront heartbreaking reports of measles associated deaths. At the same time, a new executive order from President Trump is calling for changes to federal childhood vaccine recommendations, and it's not clear how those recommendations would be put into practice or really if there's any evidence for them. So today we're going to separate fact from fiction with someone who has dedicated her career to helping people understand infectious diseases, public health, what the evidence

1:04says and doesn't say, behind how we should think about vaccines and other choices that affect our families. Dr. Celine Gounder is an internist infectious disease physician epidemiologist and CBS news medical correspondent. She's also someone I'm really lucky to call my friend. Hi. Hi, good morning. How are you? I'm good. Celine, it's so nice to see you. Thank you for your time today. It's a very timely topic. There's been more stuff over the weekend. I don't know how much you've been following. I read the heartbreaking article in the Atlantic this morning. Yeah. There is also manipulation of the CDC website over the weekend with respect to the death counts. Well, let's get into all of that. This feels like an always timely conversation, but particularly acutely timely given the measles associated deaths recently in Pennsylvania and also that we're in back to school season. And I wonder if we can start with you just telling us kind of what you think it's most

2:08important that parents and people are paying attention to right now. I think the most important thing cutting through the noise is that the measles vaccine is safe and effective. We've actually heard this from Secretary Kennedy from Dr. Oz from others in the administration, the acknowledgement that that is true and that heading back to school, make sure that your child is up to date with their vaccinations, all of their vaccinations, but especially the MMR vaccine. That's given us two doses, one at 12 to 15 months. And then the second dose at four to six years to protect kids before they hit back into the classroom. So that's a perfect segue into what we call that can't be true, where we kind of play some tape of recent news and then get your reactions. Because I really, I want to talk about so much, but I particularly want to talk about kind of what you just mentioned, which is that historically this has been a two-shot vaccination.

3:08And the president and others want to change that. So here's some recent video from President Trump on this topic and his associated executive order. We're strongly requesting even telling people when you get your shots for your young child, and this has to do with preventing autism, that you go to the doctor for five small shots and set a one big massive shot. You do it in five different shots, five different shots, small little shots where those beautiful little bodies can handle it. And I think you're going to see a very big difference in the rate of autism, which is like an epidemic, what's happened with autism. So Celine, what is he referring to? Like what are the five little shots? Yeah, I'm a little confused about his math, honestly, because you're talking about splitting up the MMR vaccine, says three different vaccines really built into one into two doses.

4:13So three times two is six last I checked, not five. But the argument being here, and this is not just the president who has advanced this argument, but this idea of immune overload, which, first of all, is not a thing. And I think people are also confusing sometimes the number of injections, the number of times a needle penetrates the skin versus how many infectious diseases you're protecting somebody against at once. And I think there's concern about both. There are parents who just want to have fewer needles, fewer shots. There are parents who have fear of immune overload. And immune overload, again, is not a thing. And if you were to compare older shots that you and I got or our parents, grandparents got. Vaccines we use today are actually much more targeted and you could say pure. And so the smallpox vaccine or the whole cell pertussis vaccine, so the old whooping cough

5:14vaccine, each of those had more antigens. So those are the targets that vaccines are protecting against. Each of those vaccines had more antigens than the entire modern childhood vaccine schedule right now. So you could also compare it with what kids are getting on the playground. That also is a much bigger immune challenge. I don't want to say overload because again, that's a false idea. That's not a scientifically valid term. But that is a bigger challenge immunologically than getting the vaccines that you're getting at your pediatrician's office. And the president has talked about autism in the context of vaccines now for a very long time. I mean, he talked about it on a debate stage in 2016 and now he's talking about it here as we chat in 2026. Why do you think he's so persistent in making this linkage that science has repeatedly

6:17shown does not exist? Yeah, I can't really get into his mind and why Secretary Kennedy is also perseverating on this connection when this is one of the best studies questions in all of medical science. So it's not as if this hasn't been examined. We have examined this in many different ways and different populations. There is no evidence that vaccines cause autism. And I think unfortunately this is not just harming vaccine uptake, but it's also harming research on autism because it's distracting from the things that might actually help prevent autism, might help families who have children with autism now. There's widespread agreement among specialists on autism that this is a disease that's caused by the interplay of genetics and the environment. And so what you really have is many, many different diseases. You could think of it kind of like chronic fatigue syndrome or long COVID where you have many,

7:19many different conditions that fall under that label of, in this case, autism. And that does merit real research. The comments that we just played came a couple of weeks after Trump signed an executive order calling for pretty radical changes to the vaccine guidelines. And also as he referenced in his comments, asking pharmaceutical companies to split up multiple vaccines, including the MMR vaccine. In your view, is there any evidence for any of those proposed changes and how would those work in practice? Well, this is part of the problem. Merck stopped manufacturing individual vaccines back in 2008. And it's not as simple as turning the system on and off like a light switch. There are all kinds of steps in terms of regulatory steps, in terms of manufacturing steps.

8:24And Merck has estimated it would take about 10 years to actually go through all of that in order to have a measles specific vaccine. And we actually have real, real experience with trying to split up the MMR vaccine in Japan. That's what they did. So in Japan, they split up measles, rebella from mumps into two vaccines. And they started to have big spikes of mumps. Many people don't realize can cause deafness. It can cause issues with infertility. And they had hundreds of kids who ended up permanently deaf as a result of that experiment. And they learned from that experience, it took time again to go back to an MMR vaccine. So they were going in a different direction from what we're proposing. But that took time. And finally this year, they approved a new MMR vaccine to address the shortfalls of splitting up the vaccines in Japan. I had mumps, a kid.

9:25Oh, you did. I did. It was miserable. I am very thankful that my kids, you know, knock on wood, have not had mumps or any of the diseases that thankfully they've been vaccinated against. And before we turn specifically to what's happening in Pennsylvania, really around the country with measles, I do want to return to kind of what we were talking briefly about earlier, which is, I think the understandable sense of being overwhelmed that many parents have when they think, oh, wait, oh my gosh, like my kid needs how many vaccine doses. What do you say to parents who, I think, understandably think, wow, that sounds so overwhelming. And also want to do, of course, like the right and best things to protect their kids. Well, so first of all, we can't be an expert in everything. When I have issues at home with my sink, with my lights, I call an electrician, I call a plumber. I don't try to YouTube it.

10:26You don't go it alone and try to figure it all out by yourself. And so I think understanding that it's okay to actually turn to an expert for advice on what to do, somebody who's actually spent their entire career studying this and managing it among their own patients. And I think a lot of what's happening now is people just feeling confused. And when people feel confused, they feel paralyzed. They would rather just not make a decision. And unfortunately not making a decision, not getting vaccinated is a decision. And I know we're going to talk about the family in Pennsylvania shortly. But that family was not against vaccination. They just, you know, the mother had not been vaccinated. She didn't really know why her parents had chosen not to vaccinate her. She just didn't really have an opinion about it. And unfortunately that was a situation where had she been with a trusted pediatrician following her children and her pregnancy more closely, perhaps she would have gotten the right advice

11:29and I don't think based on how that story was described in the Atlantic that she would have actually been skeptical or pushed back or refused. And I just want to call out Tom Bartlett for the Atlantic, did some amazing what I would call shoe leather epidemiology reporting. He went to the family. He spoke to the family and understood what was happening. This was a family where they had not gotten vaccinated but didn't really have strong opinions either way. I think they had 12 children in the family, something like that. And the kids get sick with measles. Several of them fall sick. Mother who's pregnant then also gets sick. And then the mother goes into labor. She has the baby. The baby is not breathing. And this gets referred to the medical examiner, which is the corner, which is normal in these situations. And they did detect measles in the baby.

12:31And there's been a lot of confusion about what measles tests were used and so on. But now having more clarity from this reporting, it's very clear to me, mother was not vaccinated. So she did not have antibodies to pass on to the baby. So the baby, if they had measles, this was real measles. And for a baby to die, you know, there's been all of this debate about this splenic rupture elaceration, whatever. For me, the question is, had the baby not gotten measles, would the baby still be alive? And I strongly believe that yes, this baby would still be alive. So did the baby die from measles? Yes. And I think this, it is bizarre to me that there's been such a desire to refute that, to say, and that's, if I had a question I could ask of Secretary Kennedy, I would ask, why is it so important to you that this baby not have died from measles? Well, it's similar to what happened in Texas, yeah, last year, with how they push back

13:33against measles being a cause of death for children there too. Right. Well, in that case, it sounds like the children developed bacterial infections after the measles because of the immunosuppression caused by measles. And again, would those children have died had they not gotten measles? And to me, that's, that's all that matters here. And an analogy I give here is, you're in a car accident caused by a drunk driver. You die from blunt force injury. What is on your death certificate? Blunt force injury. It's not drunk driver killed you, but did a drunk driver kill you? Yes. And I don't think anyone would debate that. The other thing that happened over the weekend, which is related to all of this, with respect to measles deaths, what happens is the state health departments will collect that data and send that on to the CDC. And then the CDC compiles that and they report that out, including on the website. And initially they had on the CDC website two deaths from measles, then over the weekend,

14:35and it goes back and forth and back and forth multiple times yesterday, two to zero, back to two to zero. And now there's an asterisk, a star, because they are still trying to decide what to do with this. And the CDC director, newly Senate confirmed CDC director, Eric Ashworth, who had said that she would be evidence-based during her Senate confirmation hearing is clearly not fulfilling that promise already. And I find it really disturbing that public health data is being manipulated for political ends in this moment. And so, Slein, what do you think the CDC website should say right now? I think it should say two deaths from measles. You know, as an infectious disease specialist and epidemiologist, we now have enough information. I wasn't sure until I saw Tom Bartlett reporting. I still had some questions. But now that I understand, mother was not vaccinated.

15:37She did not have antibodies to provide to the baby. She gets the measles, and clearly that was not just her, but other members of the family. And then she has a baby who has measles positive tests. That baby died from measles. In this moment, where we have increasing numbers of measles cases, you know, year over year, where we've had, you know, five measles associated deaths in the last two years, more than the previous three decades combined. What do you think we should be doing now? What do we still need to understand possibly about the people who tragically lost their lives to measles? Like, what do we do now? Well, there are different situations. So for example, with this family, we can talk them about the Pennsylvania family a little bit more as well. But that was really a question of not having outrage, not knowing.

16:41So there are people like that. There are people who are confused. They're getting mixed messages. And so don't know what is the right thing to do so they don't do anything. And then you have people who are really entrenched in their views somewhere along the vaccine, hesitant, skeptic, completely against vaccines, spectrum. And those each require different approaches, right? So the family in Pennsylvania, there should have been some efforts to do outreach in the community. What we have seen is when you make vaccination as convenient and accessible as possible, which actually includes also combining vaccines into one visit. So it's fewer visits for a parent. But locating vaccination in places that are more convenient, maybe it's not the pediatrician's office, maybe it's the retail pharmacy that's next to your grocery store, maybe it's at school. But making those kinds of options available makes a big difference. I think also in terms of the confusion that does require spending time as a pediatrician

17:45or healthcare provider with the family is explaining some of these things. And then in terms of the more vaccine skeptical, anti-vax perspective, I think that's going to take longer. I think some of that is related to the COVID pandemic. People not wanting to be told what to do. I think that's fundamentally where the backlash from the COVID pandemic comes from. And I think that pushback has also affected childhood vaccinations. And so that's going to require a different solution. It's not a solution about more information. That is a solution about how can you deliver something they need. And I think a great example of this was in West Texas at that time, Demetri Dostoklakis, who has since resigned from the CDC, was still running the measles response out of the CDC. And what they realized on the ground was these families wanted access to healthcare.

18:49And they were not getting some of the basic access they needed. And so sometimes you have to pull back and say, okay, these are my priorities. What is it that the community actually needs and wants? Let's address that first and we can table this until then. And that is, it takes longer. It doesn't necessarily fit our timeline, but sometimes that is actually the best way there. The CDC released new data showing that the nationwide vaccine exemption rate among kindergartners has reached a recent record high. We were at 2% 10 years ago and now we're at 4.2%. What does that percentage mean on the ground and what should parents know about what that percentage could mean in their kids' schools? So there's two different kinds of exemptions, right? If medical exemptions, so people who have immunocompromising conditions, maybe cancer, who cannot receive certain vaccines. That is a real thing. The rates of medical exemptions have remained stable because the rates at which you have those medical issues is basically the same year after year.

19:53What you see is variation in non medical exemptions. Many people call them religious exemptions, but when you drill down on it, the Catholic Church, the Vatican has actually encouraged people to get their measles vaccinations and other vaccinations. The Jewish clerics, the Muslim jurists, the Amish and Menonite churches, all of them have been actually coming out in support of vaccination. So it's a religious exemption is actually a misnomer. It's what I would say, it's more of an ideological or partisan desire to be exempted from vaccination. Again, this goes back to, I don't want you to tell me what to do. What does this mean on the ground? Well, we're seeing it, right? We're seeing outbreaks of measles in Texas, in Utah, South Carolina, Pennsylvania, and elsewhere. And I think one of the things that's really underappreciated about measles is the damage it does to your immune system.

20:53If you have all these people who want to immune max or boost their immune system, measles is the worst thing you can do for your immune system, except for maybe something like HIV or cancer chemotherapy. Measles infects your immune cells and destroys your antibody immunity for about two to three years. So you lose all of that immune memory of everything that you've seen up until that point. And this is why very often children who get measles then end up dying from a bacterial pneumonia or a diurel disease that they would not have been at risk for had they not gotten the measles. The measles left them susceptible to that. It's a little bit like HIV. The HIV destroys your immune system and then you die from what we call the opportunistic infections. And it's a very similar situation with measles. Sling, what do you say or what advice do you have for parents with children too young to be vaccinated against measles in this moment?

21:54How do we protect the youngest among us? So in the first couple months of life, it's the mother's antibodies that are protecting the baby. So if a mother is unvaccinated, heading into pregnancy, that's a problem. And you cannot give the measles vaccine during pregnancy. That is not, it's a live virus vaccine. So it's not safe to be given during pregnancy. So first of all, women should be making sure they're up to date with their vaccinations before they get pregnant. After that, during the first two, three months of life of a newborn, the mother's antibodies are protecting, but then those antibodies fade away. And by six months of age, they have faded away. So in many countries outside the US, where you have measles circulating in the community, they actually start to vaccinate at six to nine months of age. We have not done that because we have actually eliminated measles here. So we could afford to wait a little bit longer. You get a better immune response at 12 to 15 months of age.

22:56So we opted to wait a little bit longer. But in places where measles is actively circulating again, many pediatricians are giving an additional dose of vaccine to newborns at six months of age or so. But that does not count towards your normal two doses to be fully immunized. So if that is something that you're doing, you still should be getting the 12 to 15 month and the 46 year doses for your child. I think that's really important for people to understand as a possible option. And Celine, you've had the experience of having to combat misentist information as a doctor and also, personally, after the tragic death of your husband. And I wonder through all of those experiences for anyone who also wants to be an ally and helping to thoughtfully and forcefully push back against misentist information, what advice do you have?

23:58Well, I think for parents who are getting their kids vaccinated, to just be maybe a little bit more public about that, because I think so much of this is actually about just normalizing. What actually is normal? Because yes, measles vaccination rates have dropped from 95% to something like 92.5% across the country. Unfortunately for measles because it is so contagious, that is low enough that you're having these big outbreaks now. And you have pockets of the country measles vaccination rates have dipped significantly lower. But the vast majority of parents are still getting their kids vaccinated. And I think there's this perception that's not the case. And that creates more questions, more confusion for a lot of people. I think just sharing that you're doing this, that alone helps other parents understand that this is actually normal. And I don't mean normal like you're following peer pressure or the crowd, but that this is what is normal if you are a parent who cares about your child's health and well-being.

25:02And for anyone listening who wants to support, you know, parents who may not have gotten their children vaccinated yet, but of course want to do the right thing for their kids, what advice would you have for a friend or family member who's engaged in conversations like that? I would express curiosity, not judgment. I think when people are condescending, when they act superior, when they judge, you're closing off the conversation to where whatever you have to say that might be helpful is not going to be received. I think it's much more effective to ask about somebody else's experience, where their concerns come from, why they're worried, and to show empathy. What I have found is I don't oftentimes even have to push a message at that point. What happens is if you're curious enough, if you ask enough questions,

26:05it's socially awkward for the other person not to then ask you questions. And so they do. And then that becomes an opening to share, and again, without judgment, but to share your perspective. That's just generally good life advice, I think, Celine. Yeah. What about for adults, when we're, you know, we now have our new COVID vaccines, it's all about to be flu vaccine season, and we've seen, you know, pretty radical declines in seasonal vaccinations for adults and kids alike. What advice do you have there? Yeah, I think on that front, if you have a child who has never gotten the COVID vaccine series, same thing with flu, I would say get your child vaccinated. If your child is under five, get them vaccinated. If you or someone else in your family has any underlying medical condition, you should

27:06get vaccinated. If you're over 50, you should get vaccinated. And if you don't want to have your child staying home from school because they're sick, where maybe you can't take them to, you know, you don't have childcare, it would mean you staying home from work. All of that is a real burden, get vaccinated. I mean, I'm really excited to get my seasonal shots. The flu is terrible having had it. I would like to hopefully avoid it if possible. Well, in college, I think it was my sophomore year of college, I got a bad case of the flu. It was right around finals. And after that, I have never skipped a flu vaccine again. It was so miserable, first of all, to get sick like that, but then to have to reschedule all of that and the amount of hassle, it just wasn't worth it. Wasn't worth it. Well, thank you. We end each episode with a factor fiction segment. Some of this we've addressed, but I'd like to put a, you know, a finer point on it and some of this we haven't. So I'm

28:09going to throw out some statements and you'll tell us whether they're fact or fiction or if there's nuance. There's no other vaccine currently available for measles, mumps, and rubella, except the combined MMR vaccine factor fiction. That is fact. If you live in an area with the measles outbreak, if you're traveling to an area with a measles outbreak, it may be recommended that you give your baby the MMR vaccine before 12 months factor fiction fact. And your expert opinion, the current measles outbreak case count is likely an undercount factor fiction. Oh, I think that's a massive undercount. Why? Because a lot of people are not necessarily presenting for health care and may not even know that they are their children had measles. And so I think you're getting the tip of the iceberg. Getting multiple routine vaccines at 1 p.d. atric appointment can overwhelm

29:14a child's immune system factor fiction fiction. Spacing out vaccines in a way that is not currently recommended makes them safer factor fiction. Fiction and there's a reason we time the vaccines the way we do. It has a lot to do with when does maternal protection, so protection from mom fade away. And when are you best able to respond? When is your immune system best able to respond to the vaccines? And also when are you most likely to encounter those specific infections? And so there's a lot of overlap across infectious diseases, but it's not exactly the same for all of them, which is why you have a little bit of variation. But where possible, you also have them combined into one vaccine or one visit. Something I certainly think we hear a lot these days, which is getting a measles infection will provide better long term protection than getting a vaccine.

30:15It's very much the opposite. Your measles infection is wiping out immunity for two to three years, leaving you highly susceptible to other infections. And we don't actually know what it means for other vaccinations. Maybe you got your D-Tap, diphtheria, tetanus, protusis vaccine. We don't know if you get measles after that. Should we re-vaccinate? But big picture, this is harming your immunity to a whole host of different infections. And in fact, the more we learn about measles, the more we understand that to be true. Yeah. I think of it as like mini HIV, a transient HIV. And so if you reframe it in those terms, I think that becomes a lot more frightening. And it's not an exaggeration to put it that way. You know, Sling, thank you. You speak with such empathy and clarity. And we need both of those arguably now more than ever, because in America in the 21st century, we all deserve to not

31:17have our children die of measles. So really, thank you for all you're doing. And thank you for your time today. Thanks, Chelsea, for having me. You can follow Dr. Sling Gounder at Dr. Sling Gounder on Instagram. And her sub-stack is called Underline Conditions, which you can find at SlingGounder.com. Thanks for listening. Talk to you next week. That can't be true is a production of Limonata Media and the Clinton Foundation. The show is produced by Catherine Barnes, Mix and Sound Design by Johnny Ben Evans. Kristen Lapor is senior director of new content and Jackie Danziger is VP of narrative and production. Maggie Crowe Shore is our managing director of partnerships. Executive producers are Jessica Court of Accraimer, Stephanie Woodles-Wax and me, Chelsea Clinton. Special thanks to Erica Goodmanson, Sarah Horowitz, Francesca Ernst Conn, Caroline Lewis, Sage Spalter, Barry Lurie Westoburg, Emily Young and the entire team at the Clinton Foundation. You can help others find our show by leaving us

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