Trusting medicine in an age of doubt

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0:42And even change you. I literally feel like I'm a different person. Yes. Do you feel that way? Ideas worth spreading. From TED and NPR, I'm Manoush Zomorodi. In the summer of 2018, Kizmekia Corbett had just gotten a great job offer. She was living in Washington, D.C. and up for anything. I was having fun. I was living this single life in D.C., which is amazing for that. And I kind of came into that summer saying I'm just going to take on new experiences. One night, she went on a first date. The guy was attractive. They ordered tacos and beer. Then more tacos and beer. He was fun. Why not? As the night went on, they talked about their families, whether or not they wanted kids.

1:42And then Kizmikia asked her go-to question. Do you plan on vaccinating your future children? And this is going to sound maybe not the best, but the reason why I always ask that question, especially with guys that I was maybe interested in having a future with, is that it helped me to weed out what I would have then considered to be just not smart. That may seem kind of harsh, but Kismikia at the time was an up-and-coming immunologist, dedicating her life to developing new vaccines. So his response was important. He said something to the tune of, yes, I plan to vaccinate my kids, except for flu.

2:28And essentially, he said when he gets the flu vaccine, he gets sick, which is a bundle of a lot of things. The idea that a vaccine could make you sick just because you get the vaccine, you should not get sick at all. There is misinformation in there, right? So I was shocked. I'm sitting across a man who I consider to be much smarter than me. He has his PhD in educational psychology, so he studied children and all of these things. Fascinating. It's like, wow, he thinks this. That was kind of like, ding, ding, ding, ding, ding. Oh, my goodness. We have a major problem here. I guess he didn't realize that he was sitting across the table from a woman who had just invented a novel flu vaccine that was then slated for clinical trial.

3:20Kizmikia Corbett picks up from the TED stage. At the same time, I was a research fellow at the National Institutes of Health Vaccine Research Center. And so normally that answer would have sent me packing on to my next first date, but I like this guy. And so I stayed and I answered a few questions after getting another beer. I told him that, yes, the flu vaccine does have viruses in it, but those viruses are not alive, and so they technically cannot make you sick. Sure, you may feel a little groggy after getting the shot, but that's just a sign that your immune system is working. And I asked him a simple question.

4:02Did he know that there are 200 or more viruses that can cause flu-like symptoms or the common cold. Surprisingly, he was not offended, and he asked me out on a second date. And I got more than a second date out of this guy. I got my first understanding of what I now like to call vaccine inquisitiveness. It wasn't that he was just reluctant to get himself vaccines or to get his future children vaccinated. It was that he had questions, concerns, misinformation buried deep down for which he needed an expert like myself to answer without scorn and without judgment. So you it's interesting to me because there's this key moment where you slowed down and you took the time to sort of talk it out with him and be patient.

4:55And is that what sort of made you realize like, OK, my job is not only research, but it's communicating around the incredible research I do? I always considered my job to be communication. I remember actually hearing an ad in DC, very clearly a radio station that mostly Black people would listen to. And I remember the ad was about joining HIV clinical trials from my center. But the voice was one that most Black people wouldn't resonate with. I believe it was this high-pitched, Like super like, please join this trial. Go ahead, say it. A really white voice. I remember telling my boss at the time that there's no way that anyone would join the clinical trial after listening to that ad.

5:48So I always knew that communication was a part of it. What I didn't necessarily realize before that moment was that listening was the biggest part. Mm-hmm. Everyone has their own story. Everyone has their own reasons for not being vaccinated or getting vaccinated. And most of what I did during that time was just hear someone out that I wouldn't normally write off. That was the most important thing that I did. It wasn't what I said. It was what I did around listening. There is a lot of confusion around science and medicine right now. On the one hand, we hear that AI and gene editing may eventually eradicate all disease.

6:36On the other hand, misinformation breeds mistrust in the scientists doing this research, sometimes for understandable reasons. So today on the show, two stories about what medicine can and can't achieve, and ideas about staying connected to our humanity in our high-tech era. Later, you'll hear a father's story about accepting the limitations of science for his son. But first, back to Kismikia Corbett. A year and a half after that first date, she was still seeing that guy and working on creating vaccines for when a pandemic might hit. And then it did. Hundreds in China has now reached the United States.

7:23It is a pandemic at this point. Let's talk about what that means. the criteria of a pandemic. In January of 2020, that virus that was circulating was deemed to be a coronavirus. This was a moment that me and my team had prepared for. We joined forces with Moderna and we promised ourselves that we were going to get in a phase one clinical trial in only 100 days. A purely scientific goal, by the way, but as I look back and I write this speech, I think there was probably a little bit of ego attached to it too. But that's okay because we did it. I mean...

8:07After countless hours in the lab, that vaccine, mRNA-1273, or what you now know to be called spike-vax, went into a phase one clinical trial in only 66 days, a world record. now at the end of the year that vaccine was determined to be 94 effective against severe disease but what was the gut punch for me was that 20 of people said that they were not going to take that vaccine 20 of people were what the who would call vaccine hesitant now vaccine hesitancy is not new even prior to the pandemic vaccine hesitancy was deemed to be one of top 10 global health threats. And the truth of the matter is that vaccinologists like myself had long ignored this population of people who just were not going to take vaccines for one reason or the other.

9:04We were too busy publishing our data in world-renowned journals, kind of talking to ourselves. What I appreciated was that in your talk, you showed a little bit of regret that you were so focused, so intent on creating this vaccine to deal with the coronavirus in record time that maybe you forgot some of these things because you were a little bit in the scientific bubble? I am currently in the scientific bubble because that's how I've been trained. I've been trained since I was 19 to think about science strictly for the purpose of science. There was at one point, you know, I mean, there were tens of thousands of people dying a day.

9:50There was no, I mean, we should have gone faster, frankly. What happened was a series of very miraculous scientific feats that led to really good vaccines in very short period of time. So I will not ever regret that. But what I will always regret is that we didn't take our time helping people to understand what was happening in real time. There was one moment where I said, oh yeah, the vaccines are protecting against transmission. Absolutely true in that moment. Absolutely. This is when the mask started coming off. It was like one of the first nights where I, on a Friday, I almost remember like shutting my computer down and saying, I don't need to work this weekend.

10:40I'm good. like we did what we we did what we came to do um so scientifically a very key moment in the pandemic but a moment not explaining that it was a moment was a was a communication failure what i should have said is that over time as the virus mutates the vaccine may not be as good at covering transmission. And then we should have taken just a little bit more care and tenderness to talk to people about the possibility of vaccine injury. Even if vaccine injury didn't turn up in our clinical trials, there was always this possibility. And those types of stats didn't matter to someone who was reading headlines about vaccine injury and deciding whether they were going to get themselves or their loved ones vaccinated.

11:33One of the major concerns was that we were moving too fast. There was so much research that was done prior to the pandemic. People studied coronavirus' basic biology. The Nobel laureates studied how to make mRNA feasible to deliver medicines into the body. We even did our thing too. All of that research pushed the coronavirus vaccine out quicker, safer, and more effective. All of that withstanding, some people still had questions that needed to be answered. They were unconvinced. And it was our job as scientists to make them convinced, except that failed communication lingered on. And I'm afraid that maybe some of that failed communication is the reason why today we have a rise in vaccine refusal.

12:24Kindergarteners are showing up to kindergarten without their full vaccine regimens. Measles is on the rise in many communities. And measles, by the way, is a vaccine-preventable disease. And for me, that's really unfortunate because I know that there are 23 viral families that have the potential to infect humans. So it's not a question of whether there will be another pandemic. It's a matter of when. In a minute, vaccine researcher Kizmikia Corbett on how she now talks to people who distrust vaccines. The phrase she came up with that she thinks can crack open the conversation. Today on the show, honest conversations about what medicine can and can't achieve.

13:12I'm Manoush Zomorodi, and you're listening to the TED Radio Hour from NPR. Stay with us.

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15:14Thank you, Claire. Please consider leaving a rating or review of your own. It helps more people find us. Okay, back to the show. It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. Today on the show, how we can talk more frankly about what medical innovations can and can't achieve. We were just hearing from vaccine researcher Kiznikia Corbett, who is now at the Harvard T.H. Chan School of Public Health. During the pandemic, she served as scientific lead on the Moderna COVID vaccine, which was developed in a world record 66 days. It is credited with saving millions of lives. But But millions of people also refused to take the vaccine, which was incredibly frustrating for Kizmekia and her team.

16:04In 2021, she went on TV for an interview and tried to offer an olive branch to skeptics. Doctor, thank you so much. I'm saying thank you because... I was on ABC Good Morning America. Thank you for that. Thank you for getting vaccinated. In 2021, so this is around the time that it started to be known that COVID vaccines were safe for children. Vaccines and getting the vaccines, there was a big push of yours. Is it getting better, that hesitancy going away a little bit? He said to me, you know, so what do you think about, are people just vaccine hesitant? And I said, no, people aren't vaccine hesitant.

16:44Many people are vaccine inquisitive. Vaccine inquisitive. And you know what? It is getting better. People have questions, but they are seeking the answers in the right place. And we are seeing high turnout. I never said that before. That had been a seed, but I never put language to it. And to some, it might feel ridiculous. We no longer say homeless person, but we say unhoused. For people who might have mental illness, different levels of mental capacities or learning abilities, we say neurodivergent. And those types of things change the way that people view themselves. But it also changes the way that we view them.

17:28It's so easy to say, I won't take the vaccine. It's a few words. It's a tweet. But there is a reason behind that. Sometimes it's a hard no, and that's fine. But there are very few people who are like that. Most people exist in the gray area. And I'd say 95 % of that gray area is question marks. To me, the word inquisitive is very warm and inviting. It's saying you are an interested person. You are a curious person. You are a person who likes to learn instead of saying you are cautious and making choices out of fear. Oh, yeah. I mean, I use that phrase to humanize the idea that it is OK to have questions and concerns around anything medically that could be happening to you.

18:25But in my case, particularly vaccines. Vaccine technology is going to go on and on and on. But I like to believe that vaccine hesitancy does not have to go on with it. if researchers would just open their minds to vaccine inquisitiveness in the same way that we open our mind to scientific inquisitiveness, if community and science were to meet. And that's not really that revolutionary. We already know that when community and science meet, science advances faster. Vaccine refusal turns into vaccine acceptance. Actually, when vaccine inquisitive meets a scientist on a date, it turns into a marriage.

19:14And you know one thing about this is that my husband still has questions every single time we take our children to get their vaccines. And I still have to find the answers. Not just as a scientist, but now as a mother. because I'm concerned about my children's safety and my children's lives depend on it. So let's say someone is a vaccine skeptic or is vaccine inquisitive, as you would say. What do they need to know about, say, this next pandemic that might be on the rise? Because we're hearing a lot of things. We're hearing Hantavirus and Ebola. And then we're also hearing an administration and state houses that are trying to roll back science funding and are anti-vaccine.

20:03What should someone be thinking about? What I want to come out of this conversation is that outbreaks are going to happen because that is what viruses do to survive. And all of us should be thinking about how we can keep the lines of communication open. The idea that we only talk about viruses and vaccines and all of this when the moment and the outbreak is happening helps to actually increase the skepticism. Because like, where did this come from? I think about that. If I were to put myself in someone else's shoes, oh, my gosh, a new virus, a new type of vaccine. These people say they're going to have it out to me by the end of the year in record speed.

20:50No one's ever done this before. Or why wouldn't I be skeptical of that? And so I think we have a lot of work to do around keeping the lines of communication open.

21:05So let me ask you, what are you working on right now? Tell us about it. I'm making vaccines in the form of nanoparticles. One of the things that we do that's really cool is we create very small linkers. So just protein sequences that can link different viral proteins to those nanoparticles. And so we can put many different viral proteins on the surface of nanoparticles, give them as a vaccine, and then hypothetically protect against many viruses at the same time. Oh. And many people have done that, but the secret sauce in my lab is using those very small linkers to drive the immune response in the direction that we want.

21:50So we can target the protein in the right direction to get the best type of immune response that we would want. That's exciting. I am a vaccine believer, but I've realized I am also vaccine inquisitive in that I want to learn more. And so there, there's a meeting point right there, right? We can all be inquisitive. We can all, even myself. The truth of the matter is that curiosity and science exist right here as I look out of the window. Why are the leaves blowing in this direction and not the other? The sun shining here versus somewhere else. you'd be surprised how many little small questions you have throughout the day simply have do not have answers or theories behind them yet so at any point you become a scientist and inviting that type of curiosity from the community into science particularly into vaccine development and understanding can only make what we do better.

23:02That was Kizmikia Corbett. She is a viral immunologist and now a professor at Harvard's T.H. Chan School of Public Health and also married to the man she had that date with with two children. You can see her full talk at TED.com. Today on the show, what medical treatments can achieve and being honest about what they cannot. As Kizmikia pointed out, there are still so many mysteries about how the world and the human body work. And accepting, even embracing those mysteries, is at the heart of our next story. There are wonders all around us. And the mystery of what it means to live and why all this happens is both terrifying and wonderful.

23:49And I think there is wonder and joy to be found even in the most difficult situations. This is James Robinson. I have known James ever since our boys were in kindergarten together. After we first met, I quickly learned that he and his wife, Tali, also had toddler twins. And that one of those twins, a boy named Nadav, was very sick. Hi, my name is James. I live in Brooklyn, New York with my wife, Tali, and I'm a dad. This past year, James Robinson told Nadav's story on the TED stage. And when people hear that, they always ask me the same question. How many kids do you have? Well, the answer is three.

24:32Three amazing boys. And then they say, how old are they? And that's where things get a little complicated. Because one of them, Nadav, was born with a heart defect. and died nine years ago at the age of five. When I tell people this, they always have the same reaction. That's the worst thing I could ever imagine. In fact, some of you are probably feeling that right now. But they don't realize what a privilege it was to be his father, and how grateful I am for having had that experience. And today, I'm going to explain why. When he was born, they told us that his heart had not formed correctly, that it would require three surgeries before the age of four, the first at only five days old, that these surgeries would not cure his underlying condition, that there was no fixing his heart, and that the goal was to get him to teenage years where he might be eligible for a heart transplant.

25:27And how did you and your family cope during those first years? We coped as best we could. What was important to us was to have as much information as possible. The irony of the situation was that we quickly learned that there was a lot of ambiguity in medicine, that even though the doctors were extraordinary, there were still limits to what they could know, and that what we had to do was find a way to collaborate with them on caring for our son, both medically and as his parents. Let me tell you what it is like to get that news. It is absolutely terrifying because it makes you realize how little you know.

26:05I didn't know whether these operations would be a success. I didn't know whether Nadav would live or die. And worst of all, if he did die, I didn't know how I would tell his brothers. Parenting is all about making choices. We wrestle with the unknown as best we can, hoping that things will work out for the best. We hope that the decisions we make are the right ones. And when things go wrong, we worry that there are no right decisions at all. We simply do not know. but there is also wonder to be found in the unknown. When we are first conceived, on the outside of the embryo are tiny hairs called cilia.

26:46Their job is to beat the amniotic fluid around the embryo. This lays out the proteins that tell our organs how to form. If the cilia are not working quite right, and this is what happened with Nadav, the flow is erratic. the proteins are in the wrong position and our organs are malformed this happens in the span of three hours in time for dinner and a movie your fate is sealed it absolutely blew my mind to learn this and had he not been warned of the heart defect i never would have appreciated it forget that anything ever goes wrong how incredible is it that anything ever goes right

27:34of course as the parent of a medically complicated child you don't have a lot of time for philosophy suddenly we have to start thinking like doctors i realized how ambiguous the practice of medicine is everything is open to interpretation we learned that doctors are not magicians or gods the best doctors were the ones who are honest and humble about what they didn't know. And one thing doctors do nothing about was how to parent our children. As one doctor said to us, never forget that he is our patient, but he is your son. Those first few years of Nadav's life were full of endless medical appointments, giving him medication, getting him to physical therapy.

28:20But you guys also had a lot of fun with your three boys, like despite how sick he was. Yeah, there was normalcy and normalcy is chaos and normalcy is unpredictable. We love to play in the house. It was fantastic to just be silly a lot. We would wake them up every morning by singing them college football fight songs, for example. We would read books in silly voices, which got on their nerves, which as a father, I think, is always very gratifying. We went for long walks. We went to museums. We went to aquariums. We went to zoos. We just tried to get out and experience life as best we could. Okay.

29:03So with the chaos in mind, you and your wife, Tali, decided to take the kids to a place that was really important to you. Can you tell us about that decision? Yes. So Nadav had three surgeries before the age of four, all of which went sort of well. But after the third surgery, I got an invitation to give a talk at a conference in Australia, and they were going to fly me business class. And I said to them just off the cuff, like, could you turn that to economy tickets? And they said yes. And so I suddenly had the opportunity to take our whole family down to Australia for very little money. You know, we're not rich.

29:38And this was an opportunity to sort of like show them a country that we loved because my mother is from there. We used to go every summer to Australia and I would see my grandparents. And so this was kind of a tempting opportunity. And it was one of those moments, and there are many of them when you have a kid who's medically complicated, where you have to weigh different things. The risk was that he was obviously a medically complicated child who had just had a surgery. The benefits were that this was a place that we wanted him and his brothers to experience. And so we had long conversations with his doctors.

30:09They went back and consulted amongst themselves. Eventually, we decided that we were going to go. So you go to Australia, you get there. What were the first few days like? It was great. It was absolutely great. I mean, we love the country for a reason. There's just something about being there that makes us feel whole. It was fantastic for two weeks. And then two days before we were due to return home, we noticed that Nadav was not looking well. We sent a photo to his cardiologist in New York, and she said, you should get him checked out. So we found ourselves going to the hospital on a day where we should have been going to the Blue Mountains and exploring the Australian wilderness bush.