In Good Health: Vaccines, Menopause, And Cardiovascular Disease

0:07Health and Human Services Secretary Robert F. Kennedy Jr. promised not to take away vaccine access during his confirmation hearing earlier this year. But it's not a promise he appears to be keeping. Last week, Kennedy announced the U.S. would not renew its$1.2 billion commitment to the global vaccine agency, Gavi. Unfortunately, in its zeal to promote universal vaccination, it has neglected the key issue of vaccine safety. When vaccine safety issues have come before Gavi, Gavi has treated them not as a patient health problem, but as a public relations problem. Just as a note, we did reach out to Gavi for comment.

0:49They did not get back to us in time for air. The U.S. is one of the global vaccine agency's largest donors, funding roughly 13 percent of its budget. The new Advisory Committee on Immunization Practices also met for the first time last week since Kennedy fired and then replaced its members. That's the committee that recommends vaccines to Americans. The panel voted to effectively remove the ingredient thimerosal from flu shots, even though studies show it's safe. And some worry that this is just the beginning. The secretary is going after issues that have long been bugaboos of him and his anti-vax group, Children's Health Defense.

1:29I don't think that's unmistakable at this point. I think that he would probably acknowledge that, that he's taking on issues that he's championed for the last 20 years. To restrict access to certain vaccines, that's going to grow. The list is growing and it's going to start to be very tangible for people and go well beyond just the COVID vaccine. That was former Food and Drug Administration Commissioner Scott Gottlieb speaking to CBS News on Sunday. Later on in the podcast, we'll talk about the link between menopause and an increased risk of cardiovascular disease. But first, for this installment of our health series, In Good Health, we start with a check-in on how public health at home and around the world is changing under Secretary Kennedy's policies.

2:10I'm Naila Boodoo, in for Jen White. You're listening to the 1A Podcast. Stay with us. We've got a lot to get into.

2:21Joining us in studio is Julie Rovner. She's chief Washington correspondent for KFF Health News. She also hosts the weekly health policy news podcast, What the Health? Julie, it's great to have you back. Always nice to be here. Also joining us is Apoorva Mandavilli. She's a science and global health reporter for The New York Times. Apoorva, welcome back to 1A as well. Always a pleasure. Apoorva, let's talk about GAVI. That's the international vaccine agency that says it's helped vaccinate 1.1 billion children around the world against diseases like polio, malaria and measles. How significant is Kennedy's decision to halt this funding?

2:59It's extremely significant for children in low and middle income countries because in a lot of those countries, Gavi is the mechanism that procures vaccines for those kids. And so not having the U.S. provide funding, as you pointed out, it's 13 percent of Gavi's funding. That is a very big blow to this organization and to the vaccinations that they hope to deliver. Gavi has estimated that not having this money from the U.S. will mean that something like 75 million kids will not get vaccinated over the next five years and maybe up to 1.2 million kids will die. Julie, Secretary Kennedy has accused the agency of not adhering to scientific data on vaccines.

3:41How legitimate are those claims? Well, these are the same claims that he's making about the U.S. And, you know, we'll get to him replacing the entire Advisory Committee on Immunization Practices, which is basically the domestic group that recommends vaccines. And, you know, Secretary Kennedy throughout his career has basically been a vaccine skeptic and a vaccine denier and does not believe any of the science. And most of these things that he is saying have been studied over and over and over again. And the scientists who recommend these take all of the possible risks into account and say that the benefits outweigh them.

4:22Apoorva, as you have been talking about, vaccines account for about 40 % of the global decrease in infant mortality rates. That's over the last 50 years, according to the medical journal Lancet. And a new study from Lancet also found that global vaccination rates are dropping. With this loss of funding, what do we expect that will affect that will have on vaccination rates globally? We're going to see a drop in vaccination rates for routine childhood immunization. So we have already been seeing some shortage of vaccines in places like Kenya. The polio eradication initiative is supposed to see something like a 40 % shortfall in 2026.

5:01And this isn't just a problem for other parts of the world, you know, other parts of the world where kids need these vaccines. It's also a problem for the US. It's also a problem for Europe, any part of the world, because when these diseases resurge anywhere in the world, whether it's measles, whether it's polio, pretty much all the measles cases that we have in this country come from abroad. And so when we see these cases resurged everywhere, the whole world is again at risk. Right. We saw that, of course, during the pandemic, Julie. You're nodding your head here that the entire global community is connected.

5:35What else? I mean, Apoorva mentioned measles. Are we seeing this in other cases as well of different diseases that are reemerging now because of vaccination rates dropping? Yes, we are. I mean, we're seeing cases of pertussis, whooping cough. We're seeing other things that have been essentially, if not eliminated, certainly reduced to almost non-existent levels that are all coming back because we're seeing all of this vaccine skepticism around the world. I think a lot of it, you know, comes from COVID and comes from the debate over the COVID vaccine, and people are extrapolating that to other vaccines.

6:11But now we have someone at the helm of the U.S. Department of Health and Human Services, who is himself a vaccine skeptic and is basically blasting this out and giving it even more credibility. And I think what Apoorva said was really important about how this is part of the U.S. soft power, if you will, helping, you know, keep people healthy in other countries. But as long as people can get on airplanes and move around, it is also protecting us here. Dampening or eliminating these diseases around the world means they're not going to come to our shores too. And we saw with COVID that you can't just shut yourself off and assume that things aren't going to get in.

6:50Communicable diseases communicate. That's how they exist. And are we also seeing this with diseases like polio? Well, polio is one of those that, and I think Apoor probably knows more about this than I do, is almost eradicated. They're just small pockets internationally where it still exists. But polio So vaccination in the U.S., I believe, is still fairly robust. So we have not seen a lot of polio in the wild yet. But again, if, you know, this has been part of an enormous worldwide effort. Gavi is a public-private partnership founded by the Gates Foundation, but with a number of countries who are also giving money to it.

7:30And this has really been a huge effort really over the last couple of decades to try and, you know, basically eradicate as many communicable diseases as we have good vaccines for. So, Julie, yeah, to your point, under President Biden, the U.S. had pledged more than$2.5 billion between 2022 and 2030 to Gavi. Roughly$880 million of that money had been dispersed. Apoorva, if the U.S. does not fund this, who else will? Well, the UK pledged a little bit more than they said they would. So that was a nice surprise for Gavi. And the Gates Foundation gave about$1.6 billion. And some other countries like Australia and Canada stepped up and gave more than they had before.

8:09Some new countries like Indonesia and India stepped forward. However, at the end of the day, Gavi still doesn't have the amount of money that it said it needed to vaccinate kids over the next five years. And so we're still looking at a shortfall of almost$3 billion for this organization to be able to do what it needs to do by 2030. And so we are going to see all of those estimates that Gavi said about the drop in vaccinations, the rise in child mortality elsewhere in the world. And polio, I want to come back to for just a second. We didn't just take money away from Gavi. domestic budget in the U.S., the big bill, that also eliminates funding for the CDC's Global Health Center, which includes$230 million for global vaccinations.

8:54And that's$180 million for polio and$50 for measles and other diseases. And so we are hitting these vaccination efforts in multiple ways through Gavi, but also through the domestic budget. As we talk about domestic, Apoorva, can we turn to the new CDC vaccine panel? You were at the committee's first meetings last week. What was it like to be on the ground during those meetings? What's your big takeaway, first of all? Let's start with that. Well, the big takeaway is I think that Mr. Kennedy is definitely going after childhood vaccines because the panel pretty much said that there will be new workshops to look at the childhood and adolescent immunization schedule.

9:31So not just looking at individual vaccines and whether they're safe, but they want to examine what it means to have as many shots as kids get together. And so this has been a common anti-vaccine talking point, oh, kids get too many vaccines today, which is a basic misunderstanding of immunology. The vaccines today are actually a lot cleaner than they used to be. But this is one of Mr. Kennedy's frequent talking points. And so they are going to examine the childhood and adolescent immunization schedules. And so I think we can expect them to revisit that. At the moment, they really only went after one particular thing, thimerosal, which is a mercury-based ingredient.

10:07And to tell you how crazy this meeting was, I sat next to Lynn Redwood, who is a former leader of the anti-vaccine group that Mr. Kennedy founded. I did not think that day would ever come. Julie, can I switch topics to something else? Health departments around the country are saying they're not receiving funding promised to them from the CDC. They also haven't gotten any communication from the agency about why. That's according to NPR. Most of the funding that the CDC distributes goes to local and state health departments. What do they use this money for? Basically everything in public health.

10:40I mean, this is how public health is funded in this country. A lot of it does come from the CDC, and some comes from state and local taxes, but much of it does come from the federal government. And we're seeing this across the Department of Health and Human Services, and this actually predates Secretary Kennedy's confirmation. This was something that Doge did. It went in and basically stopped the movement of a lot of money. And what I'm hearing is that money is starting to move but still not at the level that— And do we know why? Basically because it has to now go through several layers of political appointees.

11:17They've basically done everything they can to slow the money going out the door. And even money that courts have ordered to be resumed is only resuming in part. And, you know, basically everyone who's sort of reliant on this federal funding that has not only been promised but was approved by Congress and signed by President Trump, there's a lot of money that is not getting where it is supposed to go. To that point, Apoorva, earlier this year, the National Institutes of Health and the National Science Foundation, which are two of the biggest funders in biomedical research, cut billions of dollars in science funding.

11:53The NIH alone has cut about an estimated$12 billion, terminated more than 2 ,000 research grants since President Trump took office. These are grants that fund everything from research in diabetes to heart disease to cancer. Where does that funding stand right now? They have already canceled many grants, as you pointed out. But the other thing that my colleagues found when they looked very deeply into the NIH is that there are a lot of grants that are not technically canceled, but they just haven't received the money. And that's another huge pile of money that has not gone out to scientists, that's not being talked about.

12:28It's really hard to trace because it's these sort of shadow cancellations. And of course, the NIH is also again on the docket for more cuts when the budget is approved. Another, you know, overall about a 40 % cut to the NIH, to the CDC. We're talking massive cuts across the federal research and health infrastructure. You both have been covering public health for years. As journalists with The Long View, what else do you see as particularly unique about this moment? Apoorva, can I start with you? Yeah, I mean, I've not really lived through any moment like this in my career of 20 plus years. It really feels like we are unwinding a lot of good that was done in previous decades, whether you're talking about HIV and HIV prevention and access to treatment, whether you're talking about vaccinations, whether you're talking about, you know, understanding of chronic diseases, all of those things, I feel like we are taking giant steps backward.

13:27And it's been actually surreal and really hard to report on because there's so much happening. And I also have the sense from talking to the people that I talk to that we are going to see the effects of all of these cuts and all of these moves that the administration is making for a very long time, because it's extremely easy to take things down with a hatchet or saw, but it's extremely difficult to put it back together. And I'm not sure how we're going to be able to do that. Yeah, I've been doing this since the 1980s, and I, you know, I have seen so many sort of creation of some of these programs through struggles and compromises and scientists talking to policymakers.

14:11Bipartisan compromises. Bipartisan compromises. The National Institutes of Health was doubled under Republicans. This has always been, you know, public health and health research have always been a bipartisan effort. And so it's a combination of seeing these things rapidly dismantled, but also the doubt that's being laid in the mind to the public about the worth of public health, of global health, of domestic public health. I think it's going to make it that much harder to build it back. We're going to take a quick pause here. When we return, we take a closer look at the link between menopause and an increased risk of cardiovascular disease.

14:49Stay with us.

14:55Let's get back to our conversation and switch gears and talk about a different health topic, cardiovascular disease in people experiencing menopause. Heart disease is the leading cause of death in women in the U.S. That's according to the American Heart Association. But what's the connection between heart health and menopause, and how can awareness help curb the risks associated with that connection? Joining us to talk about this is Dr. Samar El-Kaudry. She's a professor of epidemiology at the University of Pittsburgh School of Public Health. Her research focuses on menopause and cardiovascular disease.

15:27Dr. El-Kaudry, it's great to have you. Oh, thank you. Also with us is Dr. Anam Minhas. She's an assistant professor of medicine and director of the Cardioobstetrics Program at Johns Hopkins Medical. Her clinical focus is on women's cardiovascular health. Dr. Minhas, welcome. Hi. Let's start with a message that we got from a listener, Heather. I am through menopause, finished at age 49, probably started about age 46, 47. I have noticed joint pain, dryness, brain fog. Brain fog is one of the biggest symptoms I have had. I did start hormone replacement. I also have noticed differences in my heart with some palpitations, some irregular beats.

16:19It doesn't seem like it's extremely affected my heart, but definitely there have been some changes. Heather, thank you for sharing that message. Dr. El-Khoudari, can we start with some of the changes that occur during menopause as we're hearing Heather talk about what's happened to her? What happens to the body during this period? Yes, absolutely. So as women go through menopause, they experience multiple changes. Maybe I will start with the hormonal changes. We know that mainly estrogen would go down while follicle stimulating hormone would go up. Other hormones may change, but these are really the main hormonal changes we kind of focus on in research.

16:59Additionally, of course, periods would become irregular and eventually will stop. and women usually experience vaginal dryness as well as atrophy and loss of fertility. In terms of physical symptoms, women experience vasomotor symptoms or what we call the hot flashes and night sweat. These are sudden warmth, often with the sweating and flushing. Almost 75 to 80 percent of the women would experience these symptoms. The menopause transition also brings sleep disturbance, insomnia, disturbance in sleep patterns. Your hair and skin also change as well as changes to the breast. I hear in the clip the women were describing emotional and cognitive effects and these happening also.

17:48So women experience mood swings, irritability, depression sometimes, anxiety. And we hear a lot of women talk about brain fog. Bone is not an exception. There's changes in the bone density accompany the menopause transition. And finally, the main topic of this today is really the cardiovascular system. There are changes that happen during the menopause transition put women at higher risk of cardiovascular disease. These include changes in lipids. For example, the bad cholesterol usually increases. That's the bad cholesterol, right? Yes, the bad cholesterol. And then your good cholesterol also, the quality of this change during the menopause transition.

18:33So we have studies showing that it may not be as good as it used to be before menopause. We hear a lot about, you know, that, you know, women gain weight and whether this weight is related to the transition. In fact, what really matters for menopause is really where you store fat in your body. So it's important where the weight is gained. Yeah, Dr. Minhas, can I ask you, as Dr. El-Kudari is talking about just cardiovascular disease in general, I know that's a very broad term. Can you just explain what diseases we're talking about when we say cardiovascular disease? Yeah, so that's a great question.

19:13So among the things that we're talking about when we're talking about cardiovascular disease, primarily we're talking about coronary heart disease or heart attacks. So that would be blockages of the arteries that supply blood to the heart. We're also talking about heart failure, which is the heart getting weak in its pumping function or unable to supply enough oxygen for the rest of the body. We're talking about things like stroke. So typically stroke falls under cardiovascular disease. And then we're also talking about very common conditions like high blood pressure. Dr. El-Khoudari, now that we understand that, as you were talking about different fat deposits, for example, how can that affect our heart?

19:54Yeah, so as I said, women usually start to notice that they accumulate more fat in the abdomen. And research also showed that the fat around the organs increase, such as the fat around your heart. This kind of fat is different. It's kind of, you know, more active fat. And it's able actually to produce some inflammatory marker directly into your circulation, into the blood. So that's make this fat more dangerous. It could actually impact the possibility of developing diabetes as well as cardiometabolic risk here. Dr. El-Khudari, what do we know about, what does research reveal about the connection between menopausal people and the risk of cardiovascular disease?

20:40Yes. So we have learned a lot over the last two to three decades on the relationship between menopause and cardiovascular disease. And as I indicated, we learned that there are multiple changes happening to women, that women need to be aware of that change in their lipids. As I said, the bad cholesterol, the good cholesterol, how become not good anymore. And then the weight change. The vessels, your vessels also change, become vulnerable to the disease. So the vessels or the arteries become thicker and stiffer. The symptoms that you just mentioned, which almost 75 to 80 % of the women experience, the research has been showing a link between hot flashes, night sweat, and cardiovascular risk later in life, whether that link related to lipids, related to inflammatory markers, as well as to cardiovascular events.

21:35So there has been really a good research showing how menopause might contribute to cardiovascular risk. The timing of menopause also matters. If you experience menopause earlier, you are at greater risk than experiencing menopause at a later time. Dr. Minhas, if you're a patient and your doctor isn't talking about this, or if you're asking and not getting the answers you need, what would you advise? I think it's really important for patients to bring up these concerns and these questions during their annual doctor's visits. So especially for women patients to bring up their pregnancy history, to bring up their menopause history, to bring up whether they had fertility trouble, because all of those things can be an indicator of their long-term cardiovascular disease risk.

22:22And it's very, very helpful for the provider to know about these things because some of these are called risk enhancing factors. So what that means is we know, for example, high blood pressure, high cholesterol being a certain weight category puts an individual at clear risk for heart disease. But so do these female-specific risk factors, like going through menopause prematurely or early on or being after menopause. And that can really help the provider figure out what sort of treatments should be considered for that patient, whether there should be additional testing. So even if your physician does not bring it up, I encourage the patient to always bring it up because clinic visits are busy.

23:02There's a lot going on. And often these very, very basic things can get overlooked. So it's always helpful when the patients bring them up. As we're talking about patient education, Dr. Minhas, what are some of the main symptoms of cardiovascular disease that people should be cognizant of? And how do these symptoms present differently depending on gender? Yeah, so I think most people recognize that chest pain is a key feature regardless of gender for heart attack. So often people having a heart attack will have this crushing chest pain, a chest pain that really weakens them. They have trouble getting around with it.

23:40But then also there can be more subtle symptoms. So things like shortness of breath, particularly in women, there might also be more shortness of breath. There can be sweating. Sometimes it could just be profound fatigue. Aside from heart attacks, we're talking about stroke. It could be trouble finding words. So all of a sudden noticing that you can't find a certain word or that you can't speak, communicate your thoughts, you can't hear, that you're weak in an arm or a leg, that your face is drooping. All of those subtle signs could be there for things like stroke. Now, heart attacks and strokes are generally acute things, whereas something like heart failure could be a more longstanding condition.

24:18And in that case, the symptoms can be pretty subtle. So it could be things like in the past, I was able to walk around the grocery store for 20 minutes without needing to stop. And now I get really short of breath pushing the cart and I need to sit and rest or noticing that your legs are swelling more or that you're putting on weight for unclear reasons, particularly if it's coming on pretty fast, like five pounds in a week. It's very, very unusual to have that kind of weight gain just from dietary changes. Almost always that's related to fluid buildup. So those are some subtle clues that there could be heart disease that should be evaluated.

24:55We're getting a few questions from our listeners I wanted to go to. Mimi asks, Dr. El-Khoudari, if you can handle this one, is there a biomarker that can tell if an individual is prone to cardiovascular disease during menopause? Oh, that's a very excellent and interesting question. I wish we have just one biomarker, but definitely, you know, screening for the main important cardiovascular risk factor would be important during this time. I'm talking about lipids. I'm talking about glucose. I'm talking about, you know, body mass index as well as waist circumference. So these are important biomarkers and markers that a clinician usually do during the clinical visit.

25:45And it's helped stratify where women during this, whether they are at higher risk and they should be careful of the additional risk that the menopause transition will put on top of where they are or whether everything seemed to be normal. So it's important to keep eye on these biomarkers that the American Heart Association has been used also to measure cardiovascular health in the population, which we called the life essential aid. There are other factors, not just risk factors, but behavioral factors. We are talking about smoking. We are talking about physical activity. We are talking about sleep, which most recently added.