Why are people worried about vaccines and fertility? (Transcript)

Dr. Jen Gunter:
Imagine you’re a doctor like me.You’ve been seeing a patient for a few years. You’ve got a rapport. She comes back to see you regularly because you’ve helped her. And so, when you notice in the medical record that she hasn't been vaccinated against COVID-19, you offer to get her vaccinated… right now… free of charge.And she says…no. You ask: “Can you tell me why?” And she says she’s worried it will hurt her fertility. And then…it’s not just one patient, it’s quite a few. And it’s not just one doctor’s office. It’s in thousands, all across the country. I want to say this upfront: There is NO evidence that vaccines affect fertility. But for people who want to have a baby, false messages about fertility can be really powerful… particularly when they come from wellness influencers on social media — including some doctors. And with COVID-19 we’ve had unprecedented amounts of disinformation.

I’m Dr. Jen Gunter. And from the TED Audio Collective, this is Body Stuff.

Today we're talking about fertility misinformation… as a way to learn more about vaccine development and testing…

And we’re talking about the science of vaccines…because how well we communicate about the science gives us power to debunk anti-vax misinformation.

[AD BREAK]

Jessica Malaty Rivera is an infectious disease epidemiologist and a science communicator. She saw immediately how the COVID-19 vaccine misinformation was taking pages right out of what she calls the “anti-vaxxer playbook.”

Jessica Malaty Rivera:
Completely predictable. I mean, if you go back to even the history of vaccines, when the smallpox vaccine was derived, they derived it from cowpox and there were, you know, publications, there were like prints in newspapers saying if you took the vaccine, you would turn into a cow, the same types of claims. Like you are very much familiar with how the narrative on HPV vaccination was completely hijacked. To say it was a promiscuity vaccine to it caused the thing it was intending to prevent: cervical cancer. To it was going to make you infertile. It was going to mess up your menstruation.

Dr. Jen Gunter:
Misinformation about vaccines and reproductive health has been around… pretty much as long as there have been vaccines. So people had questions about whether the coronavirus vaccine had been tested on people who were pregnant.

Jessica Malaty Rivera:
It made a lot of headlines that pregnant people were excluded from the trials, which makes people wonder like, well, why is it because it's dangerous for people who are pregnant?

Dr. Jen Gunter:
Pregnant people were not included in the early Covid vaccine studies…because they generally aren’t part of the first phase of human trials. So...to better untangle reality from bad information, it’s useful to know exactly how a vaccine gets made and tested. It all starts with a potential threat.

Dr. Maria Elena Bottazzi:
For some reason you always think, right, that these emerging reemerging infections are going to always come and bite us back.

Dr. Jen Gunter:
Dr. Maria Elena Bottazzi is a professor at Baylor College of Medicine, and she is also the co-director of the Texas Children’s Hospital Center for Vaccine Development. She has a lot of experience with coronaviruses. Back in 2011, she helped develop a vaccine for SARS, which is another coronavirus. She and her collaborators made a prototype vaccine, and they even picked a manufacturer…

Dr. Maria Elena Bottazzi:
And then, you know, what happened is that all of the sudden Zika came up, Ebola came up, you know, many other things of course…So we never had the chance to move it beyond the freezer. Um, so we still have it in the freezer. Um, we hope that maybe now we can maybe even think, uh, um, a little bit out of the box and maybe even use it as a basis for a universal coronavirus vaccine.
Dr. Jen Gunter:
Because SARS was over quickly, Dr. Dr. Maria Elena Bottazzi’s vaccine was no longer needed. And this is the story for a LOT of vaccine research – make a prototype, start the trial process…and if we’re lucky, the outbreak dies down and the vaccine ends up in the bottom of a freezer in a lab. But her job is to always be one step ahead of the next outbreak…

Dr. Maria Elena Bottazzi:
We always have luring in the back of our minds, you know, a potential flu pandemic. Right. You know, you know, there's so many other things that we know we need to be prepared. And that's why we think we need to diversify how we make vaccines to make sure all these technologies can be evaluated.

Dr. Jen Gunter:
Dr. Bottazzi is never just working on one vaccine – she’s looking at the whole family of coronaviruses…along with parasites, another kind of pathogen.

Dr. Maria Elena Bottazzi:
You need to really understand the pathogen. And there leads to identifying the Achilles heel of that pathogen, right? What is, what is really essential for that pathogen that that pathogen can not live without,

Dr. Jen Gunter:
With every prototype, researchers like Dr. Dr. Maria Elena Bottazzi hope to learn something new about vaccines… to bring more knowledge to fighting the next new pathogens.

Dr. Maria Elena Bottazzi:
And in this case for the Coronavirus, fortunately for many Corona viruses, we've studied for decades, we knew that this so-called spike protein, that everybody's focusing was clearly one of the weakest links

Dr. Jen Gunter:
Coronaviruses have particular spike proteins, and some prototypes had already targeted those proteins by the time the pandemic started.

Dr. Maria Elena Bottazzi:
So that's step one, right. Having a target. And I think we were lucky that we already knew what the target was supposed to be.

Dr. Jen Gunter:
I want to underscore this point: It might have seemed that COVID-19 vaccine research moved fast, but there were decades of research – from Dr. Dr. Maria Elena Bottazzi and others – to build up a sort of vaccine library. Once there’s a vaccine candidate, the next step is a series of pre-clinical tests, often in petri dishes. The goal is to see if the vaccine truly works on the pathogen. For COVID-19, researchers wanted to see if the vaccine candidate interfered with their target – the spike protein – in the way they'd hoped. Pre-clinical trials also test the safety of a vaccine.

Dr. Maria Elena Bottazzi:
We also evaluate things like, um, toxicity in the reproductory systems of animals. So when we hear are these vaccines safe for pregnant women or for, you know, uh, um, use also in, um, very young, uh, infants or, or even, you know, fetuses for example, of a woman, we actually do all those studies in an animal system before you can go into the human. So that's definitely required.

Dr. Jen Gunter:
Before researchers are allowed to test their vaccine in humans, they have to show that it’s unlikely to harm anyone. And they do that by testing their prototype in animals. Dr. Bottazzi says, part of that is toxicity testing: using a dosage far greater than what she might use in humans – to try to force any potential safety issues to show up. For example, a researcher might look closely at how the vaccine prototype affects fertility in rats…We know this model works really well, so if they notice anything concerning happening with the rat, they know they might need to redesign the prototype.

Dr. Maria Elena Bottazzi:
And remember when you do these studies, these, especially these regulated toxicity studies is indeed to raise any potential red flags that then what would happen is you you're required to then do further studies, right? You're always improving. You're always finding ways to make them more robust. Right. And more, to be your kind of like red flag, a study that basically says we saw this. We're not really sure what it means. We have to then now expand and do more studies.

Dr. Jen Gunter:
When they’re applying for FDA approval to test the vaccine in humans, researchers have to show the results from all this early testing. Once they get the greenlight, there are three phases of testing in humans. We call them clinical trials. Let’s talk through each step and how each one helps ensure a vaccine’s safety. Phase one starts with a small group of people – typically less than a hundred very healthy adults – and by phase three researchers are working with thousands or even tens of thousands of people.

Dr. Maria Elena Bottazzi:
At the end of the day, we're all very different from each other. But you know, you do your best by doing the screening, right. You know, of how, how you do your inclusion into a study and how you do your exclusion. We also have to make sure that we take into consideration diversity. Right. And I think we've been hearing a lot during these trials, how we didn't have enough, you know, of Hispanic origin or, uh, African-American origin. Right. We know we have to be able to also within that healthy population that you have populations that represent certainly different, not only demographics, but certainly also different genetic, you know, um, backgrounds.

Dr. Jen Gunter:
Researchers like Dr. Dr. Maria Elena Bottazzi had already done a lot of work toward a coronavirus vaccine by the time COVID-19 came around. But the general public didn’t know anything about that… so the process seemed surprisingly fast to a lot of people.…and it didn’t help that the government chose to call the vaccine development effort “Operation Warp Speed.” But I want to say, loud and clear: no step was skipped in researching and developing the COVID-19 vaccines!

Dr. Maria Elena Bottazzi:
The preclinical basis was already there. So that shaved, easily shaved. You know, at least five years of work

Dr. Jen Gunter:
Once researchers had the greenlight from the FDA, they saved time by overlapping the three phases of clinical trials. So instead of waiting for Phase one to completely finish, they would use the early data to design Phase two. They did the same thing with Phase 3.

Dr. Maria Elena Bottazzi:
and honestly, it's also because a lot of money was dumped into it, right? I mean, so if I could have a portfolio of billions of dollars constantly, I can assure you that vaccine development would always be at the pace of two, three years, but since we never get those amounts of money, even in an, even in the normal business scenario, usually that's why they take five, ten years to be developed.

Dr. Jen Gunter:
Vaccine researchers are still working on COVID-19… trying to develop vaccines that will keep people immune longer, or in Dr. Dr. Maria Elena Bottazzi’s case, vaccines that are easier to produce in lower income countries. And the vaccines that are already out there… researchers continue to see how they work in the long term.

Dr. Maria Elena Bottazzi:
Usually you don't stop, you know, after you use the vaccine and evaluate its safety. You either follow up the populations for a long time. And even after you introduce the vaccines, you know, we, we do have to follow them for years and years and years. It’s a continuous ongoing process.

Dr. Jen Gunter:
These are called Phase four trials. The CDC and the FDA are gathering reports of any possible side effects… and both agencies monitor and analyze them. Often, what gets reported are just one-off coincidences…not actual side effects.

Dr. Maria Elena Bottazzi:
even after you get the vaccines authorized and licensed and approved for use, you continue evaluating them. And now we've, uh, an and there may be what you can identify are the very, very rare, very rare adverse events. And, and I know that during COVID-19 many people also focused on those very rare events, but those are, are so rare that certainly, uh, are, are the risk is so low compared to of course the risk of what you could get. If you actually don't get vaccinated. That again, everything is this balance of risk and benefit, right?

Dr. Jen Gunter:
I mean, I think it is very hard, for people, especially when everything is very scary around them to evaluate risk. If we know that something happens to one in 10,000 people, that means That's been really scrutinized. You know, think about the amount of effort and safety studies that have gone into identifying that needle in a haystack

Dr. Maria Elena Bottazzi:
That's correct. for you to be able to detect that, it means that they really did these studies with so much, um, attention to make then an assertion of, the probability of you to get, you know, one of these adverse reactions.

Dr. Jen Gunter:
This is a really important point. If you read a headline about a rare side effect that happens to one in ten thousand people… it might sound very scary! But really, we should think about it in this way: Knowing that a specific side effect happens so rarely means that researchers and health agencies are watching the vaccine like a hawk, and isn’t that what we all want? Now we’ve got a clear understanding of how the vaccines were developed and tested. But that’s only the first step…then people have to actually get vaccinated. To do that, they have to understand what they’re getting and what’s at stake. And unfortunately…a lot can get lost in conversations about vaccines! So how do we get better at talking about them?

[AD BREAK]

Jessica Malaty Rivera:
I feel like since the beginning we've been playing catch up because so often in science, science communication is an afterthought.

Dr. Jen Gunter:
This is Jessica Malaty Rivera Malaty Rivera again, the epidemiologist and science communicator I talked to earlier. Just like Dr. Dr. Maria Elena Bottazzi is trying to predict when the next outbreak might be, Jessica Malaty Rivera is trying to predict how people will interpret medical information.

Jessica Malaty Rivera:
So you’re kind of tracking two outbreaks, right? The actual pathogen and the way in which it's presented either in media or in, uh, even in journals.

Dr. Jen Gunter:
Oh, that's a really great way of putting it because we really are sort of in parallel epidemics,

Jessica Malaty Rivera:
It's kind of just the overwhelming amount of information. And there's a lot! Especially in a global pandemic when you've got, you know, competing news sources and it makes it very difficult for the average person to tell what's true and false and what's, you know, biased and unbiased and it makes it, you know, my job even more difficult too, to understand exactly what people are being exposed to both kind of literally with the pathogen and the information about the pathogen.

Dr. Jen Gunter:
Jessica Malaty Rivera says that we’ve been behind on vaccine communication from the very beginning…

Jessica Malaty Rivera:
When there was talk of these vaccine trials that were starting and they were beginning enrollment and you know, many of us who have worked in vaccine education and advocacy were like, okay, where is the comms plan to complement Operation Warp Speed, a terribly named campaign, which was already sowing a lot of like confusion and sentiment about rush and haste and all that stuff. We knew that there was going to be a group of people that were going to from the get-go have a bias against the vaccine and be obstinate the whole time. Um, so I mean, I don't know if you remember, not too long ago, the former director of the NIH, Dr. Francis Collins said something that I was just gobsmacked by. He said something like, I wish we had anticipated, you know, the, the anti-vaccine sentiment was like, are you kidding me? Like, this is one of the most predictable trends in public health. It took way too long for even the surgeon General's office to recognize that the vaccine misinformation was a public health threat. It was from the very beginning, but because they didn't prioritize a campaign all 50 states just had to, once again, scramble to do successful vaccine campaigns, and that included everything from public health messaging, translating it to all the represented languages, making sure that it was in all of the demographic groups that needed to be targeted. And it just was so patchwork. And this is part of what we call in vaccine campaign research is the last mile Vaccines don't save lives, vaccinations do. And we weren't thinking about it with the whole last mile in mind.

Dr. Jen Gunter:
So state health departments, medical clinics, and individual doctors had to figure out how to talk with people about the vaccines, and vaccine development. And, listen, talking about science is hard… not everyone is good at it. That’s why there are professionals like Jessica Malaty Rivera! …and even for her, not all of the conversations she had about the Coronavirus vaccines went well… In fact, one went particularly badly…A friend of Jessica Malaty Rivera’s had an irregular menstrual cycle after she got vaccinated..

Jessica Malaty Rivera:
I had a friend who was over 40, who didn't have any children yet was hoping to have children and her irregular period scared the shit out of her.

Dr. Jen Gunter:
It can be startling to experience a change in your body that you don’t expect. And if you notice a difference in your menstrual cycle, that’s real! There’s been a real difference. The change Jessica Malaty Rivera’s friend experienced in her cycle – paired with vaccine misinformation – got her worried about fertility.

Jessica Malaty Rivera:
It was going viral all over the internet. And I remember it took a while for the confirmation of, you know, a lot of people in your space, in the obstetric community to say, Hey, like the endometrium is part of the immune response. This is not that surprising! But that message came late, right?

Dr. Jen Gunter:
A lot of people don’t know that the endometrium – the uterine lining that sheds during a period – is part of the immune system. This helps protect the body from bacterial and viral infections and also is involved with implantation of a fertilized egg. There are a few theoretical ways that a vaccine might influence when the endometrium sheds… affecting the next menstrual period. But one or two irregular menstrual cycles are not a sign of a fertility issue. And when Jessica Malaty Rivera tried to talk to her friend about that… it didn’t go well.

Jessica Malaty Rivera:
And when I was pointing her into the direction of, Hey, you know, this is, you know, not too unexpected. She looked at that as a complete diminishing of her experience. It was horrible, it was horrible. I couldn't believe how we lost our ability to speak as friends because this topic was so inflammatory.

Dr. Jen Gunter:
And Jessica Malaty Rivera breaks down vaccines for a living! All of this was harder because we didn’t have data about menstruation and the vaccine from clinical trials. And that’s a problem! So soon after the vaccines were approved, researchers started looking more specifically at fertility. One study found that people who were vaccinated who’ve since participated in in vitro fertilization have had no issues with having embryos implanted – meaning no effect on fertility because implantation depends on a healthy, functioning endometrium. And researchers were also listening to the reports of irregular cycles so they also looked into vaccination and menstrual irregularity. They evaluated data from an app that people use to track their menstrual cycles… comparing information from more than 2,000 vaccinated people who had started tracking their menstrual cycles before they were vaccinated to data from an unvaccinated control group… And they found that, on average, the menstrual cycles of people who were vaccinated varied in length by less than one day. That finding – less than one day – is interesting…but it is not medically significant… because normal menstrual cycles vary by up to seven days. People who got two doses of the vaccine in one cycle were more likely to have a meaningful difference in their menstrual cycle… but even that was temporary – they went back to normal within two cycles. But this study did not collect information on changes in the heaviness of menstruation or spotting between periods. So more data is needed here…although the IVF information that we have showing no effect on implantation is good evidence that the endometrium doesn’t appear to be affected in a medically significant way. There is a lot of misinformation about the menstrual cycle… and we don’t talk enough or teach enough about science, research, or medicine. So when there’s suddenly all sorts of really important science information to take in, sometimes people just shut down.

Jessica Malaty Rivera:
I know many people pro-vaccine people who vaccinated themselves as adults, but repeated this thing to me multiple times "well we were just waiting to see more data." And these are people who don't read data for a living. And I would say probably don't really understand the ways in which to fully read and understand the data. And I just kept wondering like, why are they saying this? But it was because it was just too much to deal with all of the headlines, all of the claims, et cetera, et cetera, that they thought, I just need this to die down a bit so that I can like recalibrate my mind and then make a decision.

Dr. Jen Gunter:
So how do we catch up? There are a lot of answers to this question…First, Jessica Malaty Rivera says, we need to communicate calmly and patiently. And we need to understand why someone is concerned about the vaccine.

Jessica Malaty Rivera:

When we say vaccine hesitancy, it's such an overly simplistic label and it covers a multitude of people for a multitude of reasons. Um, it is definitely not a monolithic group and people have, you know, medical phobia because of like real trauma that happened, you know, communities of color that have legitimate reasons to not trust their providers, because they haven't been listened to you. You have people who kind of grew up in super crunchy anti allopathic care worlds that are kind of unpacking that and deconstructing those biases. And you have people who just feel overwhelmed by the information people who have needle phobia, like it creates paralysis. I think it's absolutely caused people to say, I can't tell up from down right now and left from right. And I'm just not going to do anything and hope for the best.

Dr. Jen Gunter:
Jessica Malaty Rivera says that one-on-one conversations have been working well for her lately. Also, it’s okay to say the same thing a few different ways, or over a few conversations.

Jessica Malaty Rivera:
It is going to require constant repetition. Right? The work of science communication can be kind of repetitive. Um, and we need to be reiterating things that are proven demonstrably proven in the science based on the data, because what is very, very successful in the anti-vaccine campaigns is repetition.

Dr. Jen Gunter:
Overall, try to stay patient, sensitive, and optimistic… even when it gets tiring.

Jessica Malaty Rivera:
It gets exhausting. I mean this whole pandemic is exhausting and many things about it feel gaslighting and like Groundhog's day for sure. But I also think that, like when you are dealing with trust, that is so broken. Our job as public health or medical providers is to help rebuild that trust. And trust has a lot to do with the way in which we talk and the way in which we, you know, help people make these choices. I think there's a lot of shame. And it makes people feel like I should've paid attention in biology class more. Or am I just not that smart that I can't read this chart. And I hate that, I hate that it makes people feel like they can't actually engage in the science. And that's why I just feel like, I mean, sorry, but we're going to be doing this for a lot longer.

Dr. Jen Gunter:
These questions about fertility and vaccination? They were personal for Jessica Malaty Rivera… when we talked, she was expecting her third child.

Jessica Malaty Rivera:
Yeah. I mean, I, so I'm pregnant. Um, and I decided, uh, to get pregnant in a pandemic, a lot of people had questions about that. And, um, it was a no brainer to me that I thought, you know, when the booster became available, that I would do that in pregnancy because I was, I was signing on to additional risk and I knew I needed to do something to protect, not just myself, but my unborn baby. Um, you know, this is my third pregnancy. I have received T-DAP and flu vaccines in both of my previous pregnancies, never had an adverse event and knew even just from the science that there wasn't any concern of the vaccine kind of affecting my baby, that the benefit was really my body sending off an antibodies to the baby, and that hopefully there'll be detectable at birth. So, I felt very confident.

Dr. Jen Gunter:
Jessica Malaty Rivera knew that vaccination during pregnancy meant her baby would be born with protective antibodies against COVID-19. And she knew that getting vaccinated really mattered for her health as well. Without vaccination, pregnant people who do get COVID-19 have a much higher chance of ending up in the ICU. I’ve heard so many horror stories of pregnant people dying awful deaths and never even seeing their babies. The data is clear, COVID-19 vaccination saves lives. And if your goal is a healthy pregnancy, one of the best ways to achieve that is by getting vaccinated.

Next time, on Body Stuff…why do we turn to opioids to treat pain so often?

Guest:
There's this mythical perception that they're our best, strongest pain pain relievers. And there’s just nothing to back that up.

Dr. Jen Gunter:
What you need to know about opioids.

Body Stuff is brought to you by the TED Audio Collective. It’s hosted and developed by me, Dr. Jen Gunter. The show is produced by TED with Transmitter Media. Our team includes Mitchell Johnson, Camille Petersen, Gretta Cohn, Michelle Quint, Banban Cheng, Sammy Case and Roxanne Hai Lash. Phoebe Wang is our sound designer and mix engineer. This episode was written and produced by Poncie Rutsch and edited by Sara Nics.
Fact checking by the TED fact checking team.

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