Information Inoculation: Defending Against Medical Myths: Why do you need to get a flu shot every year? | Melvin Sanicas

0:00This is TED Health, a podcast from TED, and I'm your host, Dr. Shoshana Ungerleider. Welcome back to our mini-series all about vaccines. These days, misinformation is everywhere, especially when it comes to vaccinations. That's exactly why we're doing this series. We're diving into how trust in science is built and how it breaks down through real stories, honest conversations, and insights from experts on the front lines. Because at a time when our public health systems are under extreme pressure and confusion spreads faster than facts, we all need help making sense of it all. This series is here to bring a little more clarity, and hopefully a little peace of mind too.

0:43When it comes to vaccines, especially the flu shot, there's still a lot of confusion and sometimes even hesitation. But here's the truth. Vaccines are some of the most rigorously tested and closely monitored tools that we have in modern medicine. In today's TED-Ed lesson, physician scientist Dr. Melvin Sanikas breaks down why the flu shot remains a safe and essential part of keeping ourselves and our communities healthy. Influenza is a tricky virus, so the shot needs an update every year. But this rigorous approach to inoculation is worth it. Vaccines don't just protect the person getting the shot.

1:22They help safeguard newborns, older adults, and people with compromised immune systems. This lesson is a timely and empowering reminder that science is on our side and that getting vaccinated is not just a personal choice. It's a collective act of care. Then stick around after the lesson for an interview with someone who I look up to, Dr. Michael Osterholm, one of the world's leading infectious disease epidemiologists. But before we dive in, a quick break to hear from our sponsors.

1:58And now, your TED-Ed lesson of the day. All year long, researchers at hundreds of hospitals around the world collect samples from flu patients and send them to top virology experts with one goal, to design the vaccine for the next flu season. But why do we need a new one every year? Vaccines for diseases like mumps and rubella offer a lifetime of protection with two shots early in life. What's so special about the flu? Two factors make the flu a tough target. First, there are more than 100 subtypes of the influenza virus, and the ones in circulation change from season to season. And second, the flu's genetic code allows it to mutate more quickly than many other viruses.

2:49The flu spreads by turning a host's own cells into viral production factories. When the virus is engulfed by a host cell, it expels its genetic material, which makes its way to the nucleus. There, cellular machinery that normally copies the host's genes starts replicating viral genes instead, creating more and more copies of the virus. New viruses are repackaged and crammed into the cell until it bursts, sending freshly minted influenza viruses out to infect additional cells. Most viruses follow this script. The trick with the flu is that its genetic material isn't DNA, but a similar compound called RNA.

3:34And RNA viruses can mutate much faster. When cells synthesize DNA, a built-in proofreader recognizes and corrects mistakes, but the RNA synthesis mechanism doesn't have this fail-safe. If errors creep in, they stick around, creating new variants of the virus. Why is this a problem? Because vaccines depend on recognition. The flu vaccine includes some of the same substances, called antigens, found on the surface of the virus itself. The body identifies those fragments as foreign and responds by producing compounds called antibodies, tailor-made to match the antigens. When a vaccinated person encounters the actual virus, the pre-programmed antibodies help the immune system identify the threat and mobilize quickly to prevent an infection.

4:27Those antigens are different for every strain of influenza. If vaccination has prepared the immune system for one strain, a different one may still be able to sneak by. Even within the same strain of flu, those rapid genetic mutations can change the surface compounds enough that the antibodies may not recognize them. To make things even more complicated, sometimes two different strains combine to create an entirely new hybrid virus. All of this makes vaccinating for the flu like trying to hit a moving, transforming target. That's why scientists are constantly collecting data about which strains are circulating and checking to see how much those strains have mutated from previous year's versions.

5:14Twice annually, the World Health Organization pulls together experts to analyze all that data, holding one meeting for each hemisphere. The scientists determine which strains to include in that season's vaccine, picking four for the quadrivalent vaccine in use today. In spite of the flu's evasive maneuvers, in recent years the group's predictions have been almost always correct. Even when flu strains mutate further, the vaccine is often close enough that a vaccinated person who catches the flu anyway will have a milder and shorter illness than they would otherwise. Vaccination also helps protect other people in the community who may not be medically eligible for the shot by preventing those around them from carrying the virus.

6:02This is called herd immunity. The flu shot can't give you the flu. It contains an inactivated virus that isn't capable of making you sick. You might feel tired and achy after getting it, but that's not an infection. It's your normal immune response to the vaccine. Some parts of the world use, instead of a shot, an inhaled vaccine that contains a weakened live virus. This is also safe for the vast majority of people. Only those with impaired immune systems would be at risk, but they're typically not given live vaccines. Meanwhile, scientists are working to develop a universal flu vaccine that would protect against any strain, even mutated ones.

6:44But until then, the hunt for next year's vaccine is on.

6:56This TEDx lesson was created by Melvin Sanikas and narrated by Addison Anderson. And now let's dive deeper into this series with a special interview. Dr. Michael Ulsterholm is a Regents Professor and McKnight Presidential Endowed Chair at the University of Minnesota, where he directs the Center for Infectious Disease Research and Policy. He's an internationally recognized expert in infectious disease epidemiology who served in every presidential administration since Ronald Reagan and advised countless global leaders on pandemic preparedness, biosecurity, and emerging infectious threats. He's also the host of the Ulsterholm Update, a podcast that became a lifeline for so many during the pandemic, including me.

7:40Listening to Mike's voice each week was a grounding force in my life. Today, we're digging into what happens when science and public health are undermined, from vaccine misinformation to silenced data, and why truth-telling, even when it's uncomfortable, is more vital than ever. We'll explore how to lead in uncertainty, what it takes to prepare for the next pandemic, and why, despite it all, Dr. Osterholm still believes in the power of compassion and community. Dr. Osterholm, welcome. It's a real honor to be with you, so thank you. The honor and pleasure is all mine. I want to start at the beginning.

8:17When we talk about public health, we often focus on systems and strategy. But I'm curious, what made this work personal for you? Was there a moment maybe early in your career, even before when you knew this was the work that you were meant to do? You know, I actually was very, very fortunate as a young boy growing up in a small town in northeast Iowa, that the editor of the local newspaper was someone that I had grown very close to as a young boy. And she subscribed to The New Yorker, I think probably the only person in all of northeast Iowa at that time that subscribed to The New Yorker. And she thought that I might like an article that had been written by Burton Roger called Annals of Medicine.

8:59And it was a series that was in The New Yorker about kind of whodunit stories. There were a lot of CDC outbreaks were detailed in this article. And I became literally fixated on these articles when she would call and say that she had just gotten a new copy. I couldn't wait to go up and get it. So by the time I was in eighth grade, I knew I wanted to be a medical detective. And nothing really dissuaded me from that place. I stayed with it through undergraduate. The one thing in undergraduate, which I thought was probably telling is one day my senior year, I got a note in my mailbox at the college I went to, which at that time, I remember this before, internet, iPhones, et cetera.

9:35And it said on the paper, come see the head of the political science department as soon as possible. I went there and his first words were not all that friendly. He wanted to know why I was the only person that had not yet filed for my senior paper title. And I thought, well, what do you mean? And he said, well, you haven't. I said, well, I'm a biology major. I had taken enough courses to actually be a political science major. And I think that really set the tone for what public health is all about, about health policy and really trying to bring about change through that kind of area. So I did undergraduate.

10:07I came to the University of Minnesota in 1975. I knew right away what I wanted to do. And I've been here now 50 years. And that's the rest of the story. And those articles there. I just have to say one last thing. The last outbreak that Bert and Roger ever wrote up for the Annals of Medicine was actually in the 1980s, some 30 years later. I was in charge of that outbreak investigation in southwestern Minnesota and got to meet him and talk to him. And unfortunately, he died shortly after that piece was published. But I was able to go full circle with my childhood mentor. That's incredible. And that sense of purpose, I think, is so powerful and really sets the stage for everything that came next.

10:48You've been working in public health for more than 45 years. You've seen pandemics, policy shifts, and cultural change. But when you look around right now, at this particular moment in time, what feels different? What's happening that you've never seen before? Well, first of all, to start out with, public health is, I consider, one of the noblest of professions. It's all about the common good. It's about taking care of the least of us makes it all better for all of us. And this is something that from an infectious disease standpoint, our job is to cut down on serious illnesses, infections, and particularly in young individuals.

11:28I mean, when the country thinks about it, and what that was really all about was in many cases, capturing, conquering, and moving on from infectious diseases that killed young kids, that killed young adults. and that came about with vaccination, with safe water supplies, and surely antibiotics played some role in that. But the point of it is, is that it was all about improving the lot for all of us. Well, we're now under siege, and I think that's a very fair way to say it in terms of what's happening with public health. When you ask me how to respond to it, I'll sit here and say to you, which hour of the day, of which day of the week do you want me to talk about?

12:06Because in fact, things are changing so quickly. So I think we're at a point right now where we do know there's going to be major challenges in public health, whether it's at a global level, a federal level, a state level, and we are going to have to deal with what has been handed to us. We don't get a choice, but I can say for certain that never has public health been more important than it is now. Yeah. So it's remarkable to me to hear how much has shifted, right? Yet how many of the core challenges remain. And to me, at the heart of it all, something I've heard you say that really sticks with me is that public health is ultimately about how we treat one another.

12:47It's not just about vaccines or data, it's about relationships. What does that idea look like in real life, especially now, when things feel so divided? Well, first of all, let me talk about the issue of global public health. People often hear that term and think we're talking about some low-income countries somewhere in the world, and that's it. Well, all I would say is that from an infectious disease standpoint, at least, if you look around the world, any infection that's somewhere could be everywhere in a day or two. And so we have a self-protective reason to take care of the world and help in terms of reducing these infectious diseases.

13:26Measles is a classic example. We can do a lot to reduce the risk of measles in our country. We surely have a lot more to do. But again, if measles is circulating widely in many countries around the world, we're just one plane ride away from that being introduced here. That's true for a number of infectious diseases. The public health world is about preventing people from getting infected, so we don't have to worry about antibiotic resistance. It's estimated that in the next 30 years, antibiotic resistance will actually kill more people in the world than cancer and diabetes combined. And so I think that what we're all about is if we protect someone, we end up helping to protect everyone.

14:05And I think that's such an important message. This is why it is really altruistic to promote good public health. And it's one that in the end is also, and I've seen this on a global basis, it's really about soft power. It's about public health diplomacy. And when you can help young children survive, in many parts of the world and give them a fruitful life moving forward, their economy increases, their education level increases, their belief in us as a country increases because of the gift that we've provided them. And so it's a win, win, win. There's no cost in public health. It's actually one of those few things in this world.

14:46It's a win, win, and win. Dr. Olstom, you've said many times that speaking the truth, even when it's hard, is essential. But when we're living in a world where facts are questioned and it seems like disinformation spreads faster than real news, what happens to public health? What does that do to the foundation of trust? I've tried to actually model what I talk about. I've served in every presidential administration from Ronald Reagan up through the Biden administration, including as the first Trump administration. I was a science envoy for the State Department. And at this point, I was never about or wouldn't be about partisan politics.

15:28It's about the policies that make us better. And in this case, there are a lot of policies that we all can agree make us better. So for me to work on HIV AIDS in the early days of the Reagan administration, right up through COVID and the Biden administration, no one could tell you my partisan politics. It was all about, I'm just a public health private here in the army of public health to try to make the world a better place. And that should be the way it is. It shouldn't be a issue of red or blue, yes or no. And I think the challenge we have right now is I'm not sure what public health policy is other than slash and burn.

16:07You can argue that we need to do more to contain the kind of financial conditions that we're seeing in the federal government. But let's take a step back. If we're really going to cut at federal expenditures, we have to recognize that in the Department of Health and Human Services, which, of course, has Medicare, Medicaid, and so forth, the actual salaries, the payroll each week for the federal government HHS department is only about 0.9, not even 1, 0.9 % of the entire HHS budget. So if you fired everybody in HHS, you'd save less than 1%. And in fact, we'd argue you'd cost a lot more because you still have to have people do those services.

16:51You'd have to go find contractors. So this was never really about real cost savings or efficiency. Again, if we're going to be involved in cutting the cost of government, making decisions, first of all, what services get cut and how? Why do they get cut? What provides a benefit to our population? What is maybe a luxury? I think the second thing is, if you do that, you have to do that with a surgical instrument, a scalpel, not a machete. And right now, that's what we've done. And so we have a lot of work to do in public health to reimagine what it's going to look like in a resource-scarce world.

17:29And that's just not in the developing countries of the world, in low - and middle-income countries. It's also right here in the United States. I came to know about your work during the pandemic and during the height of COVID. I remember, like most of my colleagues, closely tracking the numbers, anxiously waiting to understand what the data would reveal about this new disease. As a public health professional, can you speak to why data sharing is so essential, not just during a crisis, but as an ongoing part of protecting public health? Well, one has to make good decisions in terms of recommendations about how to reduce the risk of an infection in your community.

18:09And it's pretty hard to make those kinds of decisions and promote certain policies if you don't have the data to support it. Right. So, for example, we had issues around kids attending school and there was a major concern about we were keeping kids out of school in the second and third years of the pandemic. And it was based on data from the first year of the pandemic. And it turns out that two to three times as many kids died in year two and year three than did in year one. By not having had the data in year two and three, we were basing the risk of COVID in children on data that were no longer relevant because as the new variants emerged, it had a differential impact on kids.

18:50Now, we still may have decided to not do anything different than we did. We may have decided, well, that's not necessary to close schools. But I would have said that in that second and third year, when we saw these big increases in the serious illness in kids, we might have gone more to a snow day kind of event. where if we saw, in fact, cases increasing rapidly in a school and we had the data on a daily basis to know that, we may have said, let's take the next week off because we did see transmission enhanced in close contact in schools, not closed down schools permanently, not closed schools in a way that created this angst in our society, but at the same time did a lot to reduce the risk.

19:32And there were several good studies done, particularly during the Omicron variant, where we could see that up to 70 to 80 % of transmission in households occurred because an infected kid brought the virus home from school. So if I was in a household and I had high-risk individuals for serious illness, older parents, grandparents, that would be important to know, is my child going to school but coming home with the virus that may in fact kill grandpa and grandma? We didn't have the data to address those kinds of issues. And I think as a society, we would have probably made different and I think much better and agreeable decisions if we'd had more data.

20:11And so that's just one example. I can give you many like that, but you know, public health is based on data. It's the ultimate four letter word that we love. It's not gold. It's not love. It's data. Yeah. Well, that challenge gets even tougher when officials are silenced or data is suppressed, right? Which brings us to a disturbing trend that we're seeing now, right? Lately, we've seen growing restrictions on what folks in public health are allowed to report, whether it's case counts or vaccine data or other key metrics. If federal institutions are being censored or stripped of their ability to speak freely, do you think states or other independent organizations can rise to fill that gap?

20:55What might that look like? And would it even be enough? This is a very important challenge that you have mentioned here. And let me start up by just saying all data are local. It's just like the famous political figure from Massachusetts, the Tip O 'Neill, that once said all politics are local. All data are local. And so in the system of data collection in this country, they start at local and county health departments. And then it goes to state health departments. And from there, that's what gets reported to the federal agencies. Well, it turns out that many of the state and local health departments are literally not capable of transmitting large amounts of data quickly or doing follow-up to make sure that records are complete.

21:38And it's because we have a broken system. We still have some health departments that report information on fax machines. We are not in the 21st century in these cases. So right there, you're going to have a problem with data collection just because of the mechanics. It's very difficult to transmit those pieces of information. We need to improve on that substantially. Then we need to understand how do we, in fact, at some point actually then act upon those data? What do we do? Let me give you a case in point. I had said from the very beginning of the pandemic that lockdowns were not something we should do.

22:13I wrote an op-ed piece in Washington Post in 2020 saying that. And the reason I said that was because I recognized then that this pandemic would likely last two or three years. Nobody was going to be locked down for two or three years. So what's the next best thing? What if we had really good data on what was happening in our healthcare facilities and that we could tell when we were at maximum bed count? What if we had had those data available every day? And in a community, I could say, okay, we're over what we can do right now to save lives. For the next one to two weeks, please limit your contacts.

22:48In a sense, do your own snow day, just like you do it in a snow day vacation. And then maybe in two weeks, as the numbers come back down, we can basically relax that more. But we didn't have the data. And so I think we can make decisions that are not only more effective in reducing risk, but we also can make decisions that are more acceptable to society when we're challenged with some of these complicated areas. So I think your point is just really important. And I'm glad you're emphasizing that. The data are the very fuel that runs the engine of public health. Yeah. I want to come back to something that you briefly mentioned earlier.

23:26There was a time when vaccines like the one for measles, for example, were broadly accepted as a basic part of public health. But now, even high profile leaders are casting doubt on their safety. And we're watching, I think, critical public health infrastructure come under strain, right? What do you think is really fueling this shift? And is there a path back to a shared understanding, one where conversations about health and safety are grounded in science and trust, not fear and ideology? We just have to be honest and say that we don't completely understand why we're seeing these changes in the acceptance of practices like routine childhood immunization.

24:09On top of that, we are seeing the opposite happen where misinformation is now making things more dangerous. For example, just last week here in the state of Minnesota, a group of Republican legislators in our house submitted a bill declaring that mRNA technology was bioweapon use and that it was dangerous and that people basically would be charged for using mRNA vaccines or being vaccinated or being a vaccinator. door. Now imagine that, declaring this is a weapon of mass destruction, mRNA vaccine. How could people get there? But they did. And so we have the opposite then where we're trying to get people understand the positive sides of vaccine, but we have very prominent people saying, no, they're dangerous.

24:55And if you're a parent, you say to yourself, I don't want to hurt my child. Who do I believe here? And what we don't have anymore is really a trusted source of information that people believe in. Our center is actually doing a lot to work on this. Just today, we announced the establishment of a new vaccine integrity project, which is going to attempt to actually fill in some of the holes that we're now seeing in the federal government in terms of authoritative and comprehensive information on vaccines, and trying to understand why do some parents in particular find that vaccines are actually dangerous, not helpful, not capable of saving lives, but rather causing deaths.

25:36And so this is an area that we have to do a lot more work in, we've got to understand how we got here. And right now, I don't think we really do. It's shocking, right, where we are. So we've talked about how much the science matters, but so does the heart behind it. And that's something that you model so beautifully on your show. I'm a huge fan of your podcast, the Ulster Home Update. If you haven't listened to it, check it out. And one of the things that makes your show so powerful is how human it is. You read poetry, you honor loved ones, you talk about hours of sunlight in different parts of the world.

26:12Why is that part of the science communication for you? And what does it open up that the numbers can't? I think first of all, we all need to relate to each other as humans who have basic needs, we have fears, we have hopes, we have dreams. And anytime you're trying to digest complicated health-related issues, all of those things I just mentioned come to play and help understand how do I respond. I think for me, it's just the way I was brought up in my small Iowa farm town, and that basically what you feel and how you express those feelings sometimes can be every bit as important as the biology of what condition you're experiencing.

26:52And so to me, it's just a natural extension. The second thing I have to say is that the podcast family, as we call it, you're a member of the podcast family in more than one way. And it's such an important point to recognize we all help each other. I have gotten every bit as much from doing those podcasts as I'm sure I ever could have shared with people who listen to it. And so it's about that mutual exchange of support. And that doesn't mean that everybody has to agree with it all the time. I get some wonderfully, very, very thoughtful critiques that come in and say, well, have you thought about this?

27:27Or have you thought about that? And I take those very seriously. And it's a dialogue. And so I think it's nothing better than when you're faced with challenge is to have people around you who are also experiencing that challenge, but they are also part of your team. And I think that's what the podcast is about. Well, that message means so much, especially now. And so let me end with this question. With everything going on, misinformation, burnout, a broken system, what still gives you hope? And what can each of us do, whether we work in the healthcare field or not, to help rebuild trust and to protect the public good?

28:06On my desk here, I have an electronic picture frame that takes pictures every few seconds and moves them through. And they're all of my grandkids, all six grandkids. And all I have to do is look at that frame for a few seconds. And I have no question in my mind why I do what I do. It's for my grandkids. What kind of world are we leaving them? What can I do to make it a better world, a safer world, a kinder world? And so for me, the motivation is really, really simple. There's something we can do about these things. We can make the world a better place. We're pretty much all going to have the same outcome in the end.

28:41We're all going to die. But wouldn't it be wonderful if we could all live long, healthy lives, of which we also not only are free of disease, but we live with happiness. To me, I think that's still the dream we all need to prepare for and try to make happen. That doesn't take away the science. That doesn't take away the reality of the challenge, but it also says it's a way that you can, in fact, deal with these things. So I'm just made that way. I'm wired that way. And unfortunately or fortunately, depending on how you look at it, anybody that listens to the podcast is going to be stuck with that approach.

29:14Well, that's a beautiful why. And Dr. Ulsterholm, thank you so much for this conversation. And honestly, just for everything you do. I mean, your honesty and clarity and deep humanity have been a guiding light for so many of us navigating uncertainty. And I'm incredibly grateful for the way that you show up in this work, not just as a scientist and a public health leader, but as someone who reminds us that empathy and kindness and truth telling are essential parts of the equation. And it's been an honor to speak with you today. And Shoshana, I would just say, never forget that you're part of that, okay?

29:48And that's what makes it all so special. So thank you. Thank you so much, my friend. And that's it for today's episode. Thanks so much for listening. TED Health is a podcast from TED. And I'd love to hear your thoughts about this episode. Send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah Degrunge, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Highlash.