Our tick nightmare

0:00Every summer we accept that we're gonna get bit by mosquitoes. We bleed, we scratch, we kill, we complain. But in the end, we laugh it off and we head towards winter. But ticks are a much more serious concern. Let me just remind you how many tick-borne diseases there are. Lyme, you know, shout out to Connecticut. Then there's alpha-gal syndrome, which can make you allergic to red meat for the rest of your life. Also dairy, but there's so much more. Should we go alphabetical? And I apologize in advance for my pronunciations here. Anaplasmosis, babesiosis, bourbon virus, heartland virus, palwassin virus, rickettsia, parkeri, rickettsiosis, rocky mountain spotted fevers, oftic relapsing fever, starry, tularemia, 364-D rickettsiosis.

0:39Symptoms of all these range from nausea, vomiting, and bleeding to seizures, organ failure, facial paralysis, and of course, our old friend, death. For those of you who are like, NBD, that's just a Northeast thing. Well, not anymore. Our national tick nightmare on today's Explain from Vox. Support for this show today comes from Anthropic, the team behind Claude. Claude is the AI for minds that don't stop at good enough. It's the collaborator that actually understands your entire workflow and thinks with you. Whether you're debugging code at midnight or strategizing your next business move, Claude extends your thinking to tackle the problems that matter.

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2:14Sean Romsforum, Today Explained covered ticks and Lyme disease on the show way back in 2018, when the word on the trail was that this was getting much worse. We asked science writer Jonathan Mingle, who recently wrote about ticks for the New York Times newspaper, how much worse this has gotten since then. You know, some experts I talk to use the word exponential. I mean, so what's happening is that some of these tick species are spreading into areas where people aren't familiar with them. Doctors aren't familiar with them. In the last 15 years, the Lone Star tick has gone from non-existent on the island to fully abundant and everywhere.

2:56The tick is present in at least 21 states and is rapidly spreading across the eastern U.S. Emergency room visits for bites are the highest in nearly a decade as ticks spread into new parts of the country. Thanks to warmer winters, climate change, ticks are expanding their hunting season. You know, you may have a day that's like 40 degrees in January. Ticks are out looking for you, waiting for you to walk by and grab on and grab a meal. A newborn baby is suspected of contracting a rare tick-borne virus. It's called Powassan virus. Lyme's disease has been an ongoing fight on this island. I've had it.

3:32This morning, a New Jersey man is the first known person to die after a tick bite triggered a severe meat allergy. So in 2024, a pilot named Brian Waitzel, father of three in northern New Jersey, he had a hamburger, had a barbecue, went home to mow his lawn. And a few hours later, was unresponsive on the floor. And he died that night. And his family, you know, was left in shock, of course, you know, trying to figure out why he had died. and it turned out that he had likely been bitten by the Lone Star tick and had developed an allergy to red meat. And so this is referred to as alpha-gal syndrome.

4:24And alpha-gal syndrome is just the latest entrant into the files of all the many ways in which tick bites can make us sick. And the most familiar one, of course, is Lyme disease. Each year, about half a million people are treated for Lyme disease. It's the fastest growing vector-borne disease in the U.S. Cases have more than doubled over the past decade. And those cases are mostly as a result of getting bitten by the black-legged tick or the deer tick. And the thing is, both of these ticks and many other ticks that are also marching northward and westward and just, you know, expanding their empires rapidly across North America, they can deliver all kinds of pathogens.

5:20They're claiming more and more of the map and they're claiming more and more of our psychic map, right? It's like one of the results of reporting this piece is that I now have like phantom tick crawling sensations at all hours of the day. Oh, man. You know, it's like I tell people I'm not a tick expert, although I talked to a bunch of them for this story. But I've become a tick expert in the sense that I am very familiar with tick paranoia and how it can keep you from venturing out into the places you love, you know, hiking paths or picnic grounds or parks. and so that was part of the story I wanted to write about too is why are we letting the ticks keep us if not out of these places that we need and love why aren't we fighting back and why is it are we not fighting back against the ticks not really I mean this is one of the surprising takeaways from my reporting is that we're barely even trying.

6:29And one way of understanding that, you can think about two numbers. So one number is 90%. 90 % of vector-borne disease cases in the U.S. are from ticks, right? 90%. Yeah. And yet, despite the fact that 90 % of cases of vector-borne illness come from tick bites, if you look at what local city, county health agencies do in terms of vector control, 80 % of what they do is mosquito control. And about 10 or 11 % of these local health agencies around the country do any kind of tick control. So why is that? You know, it's a familiar story in the public health world. It's not enough funding or policy support for trying out, testing, deploying new approaches to controlling ticks.

7:28Even though people are dying? We're just kind of taking for granted that, oh, well, what can you do? You just tuck your pants in and spray some insecticide on your boots and that's all you can do. It's like, well, actually, we have a long history of going to war with mosquitoes. Before there was tick control, there was mosquito control. And the CDC was founded with the sole mandate in 1946 of wiping out malaria and fighting mosquitoes. scientific information on the subject is discussed and analyzed decisions are made and one of these is to design more effective equipment to combat the dreaded mosquito i did not know that yeah i didn't know it either it feels like they lost that fight because uh in my neighborhood you can't go out between the hours of seven and nine o 'clock yeah the mosquitoes haven't gone away but malaria it did for the most part.

8:27You know, in talking to experts today, they told me that, including folks at the CDC, like there's a suite of tools we could be using if we wanted to get serious about fighting ticks. As one veteran tick expert at the CDC told me, if you want to make a dent in this problem, you have to get to the deer. So the deer are the engine driving a lot of these tick species spread. And we just have way more deer than we did decades ago, especially, you know, in the Eastern US and suburban parts of America. So how do you get to the deer? You know, I had people in the comments section of my piece saying the clear answer is just we should all be hunting deer.

9:17But in talking to the experts, they'll tell you it's not really a feasible solution. You would have to knock deer populations way down to make a dent in the tick populations. What is more promising is kind of a combined approach of stuff like vaccines. You know, there are people developing vaccines that you could deliver to deer or to rodents, which are another important host for these ticks, so that when the tick bites them, they'll die. That I learned from talking to folks who do this kind of research for a living is a more promising avenue for controlling ticks than all of us picking up crossbows and becoming deer hunters.

10:07You know, what I heard from experts is that we're not even funding this research in a serious way. You know, we do this stuff for mosquitoes. People don't realize it, but like your local county health agency, they go out and they find where the mosquito breeding grounds are and stagnant pools of water and they treat it. And it takes a sustained, quiet effort, you know? It's like we saw the consequences of not doing that. Recently, you know, this is a bit tangential, but screwworm, you know, screwworm was this flesh eating larval pest that devastates cattle herds. And it was eradicated in the U.S.

10:52in 1966. And it was kept at bay by the vigilance of people at USDA and USAID who ran these programs, you know, to release millions of sterile screwworm males, you know, out of airplanes. and it created this wall that kept it from coming into the southern U.S. And now they're here. Since the beginning of June, at least a dozen animal infections have been confirmed in Texas and New Mexico, putting California and the rest of the nation on alert. His Department of Government Efficiency, run by Elon Musk, decided to cut the funding that was specifically dedicated to monitoring and containing the screw worm in Central America.

11:34And probably if we stopped doing the mosquito control, you know, at a local scale, we'd see more cases of dengue fever, West Nile virus, all these other rare but serious illnesses that climate change is making more of a threat here in the US.

12:04Jonathan Mingle wrote, We're living in a tick nightmare. It's time to go to war for the New York Times. The guy with the power to go to war is named Robert F. Kennedy Jr. And one of the kind of curious things about him is he's kind of obsessed with Lyme disease. More on that puzzle when Today Explained continues.

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16:16Today Explained. Hi, I'm Meg Terrell. I am a medical correspondent at CNN. Okay, we just spent half the show talking about Lyme disease and how the government's not doing enough to combat it, but earlier this year, our Health and Human Services Secretary, Robert F. Kennedy II, pledged to fight Lyme disease. What is RFK Jr.'s relationship to Lyme? Oh, wow. RFK Jr.'s Lyme story goes way back. Whoa. Yeah. Well, I mean, it's a really like RFK Jr.-y kind of disease, right? Because he's a falconer. He talks a lot about his work with birds of prey. He goes into the woods a lot. He posts lots of photos of himself in nature.

17:02And when you start to pay attention to RFK Jr. and Lyme disease, which I have been doing, he starts to tell the same story a few times. It involves him in a bathtub in the 1980s. I remember one day in 1987 when I stood in my bathtub and picked 29 ticks off myself. He says he did at one point get Lyme disease. He got the classic bullseye rash on his forearm. He says he took antibiotics and it was cured. But he also describes his, you know, most of his children have had Lyme disease, some with pretty severe effects of Lyme disease. So, you know, he's very focused on it. You know, it also ticks like some other RFK Jr.

17:47boxes where there is this community of people who feels like they've been neglected and ignored and, in his words, gaslit, particularly by the federal government. And those are people who have like chronic Lyme disease or long Lyme disease. So this is Lyme disease that hasn't been cured by antibiotics and that people have been living with these symptoms for a really long period of time. And so he's trying to address that population of people. He had a roundtable discussion with a lot of those patients, patient advocates, as well as doctors and people who are trying to work on this space. It is an invisible illness.

18:22for many years, this agency had a deliberate policy to refuse to engage with the Lyme community. And so, you know, he's really speaking to that group of people. But at the same time, like Lyme disease is a growing problem for, you know, anybody who lives in a tick infested area, which is so many of us. So it sounds like people who have Lyme disease have an ally in the Secretary of Health and Human Services. And, you know, of course, RFK Jr. is known to spin up conspiracy theories, peddle falsehoods. COVID-19 is targeted to attack Caucasians and black people. I find radiation opens up your blood-brain barrier.

19:09And so all these toxins that are in your body can now go into your brain. Not a fan of vaccines. Does any of that get into the Lyme disease mix? Well, I mean, so he convened this roundtable and it had, you know, it had doctors, it had lawmakers. And so you had these folks speaking around the table about different things that you could do. The Lyme Clinical Trials Network is designed to build evidence for repurposing medicines and other treatments so we can improve the lives of people suffering now. One of the things that RFK Jr. is really focused on is improving diagnostics and improving treatment.

19:42There's investments we've made in identifying new antibiotics that potentially could have longer, better effects, as well as potentially protective monoclonal antibodies that can be used as a treatment strategy. What you don't hear him talk about is a vaccine for Lyme disease. And, you know, he talks about things like we've got to make it safer for kids to go back in the woods. You know, a vaccine could be one way of doing that. And we actually have a vaccine now that is approaching the regulatory approval process from Pfizer. You know, they reported phase three results. They said they were going to take this to regulatory agencies.

20:16And so that was earlier this year. I became interested in, OK, well, RFK Jr. is a big proponent of solutions for Lyme disease. Is he going to be supportive of this vaccine? Will this be the vaccine that RFK Jr. sort of, you know, wins him over? Tell us a bit more about the history of Lyme disease vaccines, because they've been trying for some time, to my recollection. So there actually was an approved Lyme disease vaccine. It was called Lymerix. It was brought to market by GSK, the huge British drug maker. This is about 25-ish years ago. And, you know, it worked. It was something like 70 or 80 percent effective at reducing your risk of getting Lyme disease.

20:58But it had kind of this like tepid endorsement from the federal vaccine agencies. So the FDA kind of gave it a it wasn't like the most like extreme endorsement. I guess you could say the way people described it to me. They noted it was just for specific age groups. And then the CDC's group of vaccine advisors, they essentially recommended it for people who might have exposure to ticks. You know, you might consider this. So it wasn't like a strong endorsement that, like, everybody should get this vaccine. And so what we saw was that when it hit the market, the sales were, like, really tepid. And then some people thought that the vaccine was actually giving them arthritis.

21:40And so this is the kind of thing you're trying to prevent from getting Lyme disease. You're trying to prevent getting arthritis. The FDA looked into this extensively. Researchers looked at this. The signal did not play out from the conversations I've had with experts about it. But, you know, there were lawsuits that were filed. Ultimately, GSK just decided to pull the vaccine off the market. So now you have, like, 20 years later, Pfizer coming back with this vaccine. So this is approaching regulatory agencies. We might get the Lyme disease vaccine and, you know, have to see how RFK Jr.'s HHS would receive that.

22:18What's the vibe from HHS and RFK Jr.? I mean, he cares about Lyme disease. He thinks there's this forgotten population of people with chronic Lyme disease. He's in charge. He's got an incredible amount of power to do something about it. And here's this vaccine that could be the easy solution. Is it like a match made in tick heaven? Well, tick hell. preventing the ticks from being able to give us Lyme disease. Although I don't think they care if they give us Lyme disease. They just want to drink our blood. But, you know, Kennedy was asked during his confirmation hearing by Susan Collins, because Maine, of course, is very hard hit by Lyme disease, whether he would support a Lyme disease vaccine.

23:04And he told her, quote, There's nobody who will fight harder to find a vaccine or a treatment for Lyme disease than me. Now, I reached back out to HHS when I wrote this story back in March about Pfizer's Lyme vaccine application. And a spokesperson for HHS told me HHS supports rigorous gold standard science to better understand, prevent and treat Lyme disease. So I wrote back, does that include a vaccine? And they just didn't respond. Why? Why are they being cagey about this vaccine? It feels like a golden opportunity for them. You would think. And it's interesting. You know, I've reached out to other folks who are sort of in this realm, and most of them, like, are very supportive of a vaccine.

23:46Like, it's something that they would like to have as part of the toolkit. I will say there is one population that is skeptical of a vaccine, and that is certain folks who have this chronic Lyme, who live with long Lyme disease. they feel like they were burned by the first vaccine. They still believe that there were safety problems with that vaccine, at least some portion of this group who I spoke with. And so they're nervous about it. But, you know, other people really want a vaccine. Where does it leave us ultimately, you think? Is this a time to feel hopeful that there are solutions that are, like, you know, incoming here as these ticks become more and more just like a concern every summer across this country?

24:33Or is it a time to feel ultimately fearful? Well, I mean, it definitely feels like we're in a time with this like massive upsurge in ticks. You know, they're all around, they're spreading out, they're spreading newly discovered pathogens. So it definitely doesn't feel like we're on the downtrend of that by any means. And the government has put out a plan to try to at least address Lyme disease and to an extent Alpha-Gal, but it's not perceived from people I've spoken with to be enough. It's not a moonshot, you know, by any means to address these kinds of things. What's the plan? Yeah. So this came out in May.

25:21They call it a sweeping plan to combat Lyme disease and advanced treatment. So you might expect, like, you know, huge amounts of money being poured into this, like big research consortiums working with the industry. The details are less sort of powerful than that from what we see in the release that HHS put out. They say the actions include a multimillion-dollar pilot program focused on tick control, up to$2.5 million in innovation challenges. Funding for NIH researchers to combat alpha-gal syndrome and a public-private collaboration to help patients connect with experienced providers. So, you know, I think people are glad that there is focus on this.

26:01But, yeah, whether it's the moonshot that is needed, especially with the backdrop of, like, broader cuts to science funding, I think experts in this space think it leaves something to be desired.

26:18Bummer. But in the meantime, what do you do if you're going camping this weekend? Jonathan? Doing tick checks, right? And we do it in my household pretty much daily. When you come home, do a thorough tick check, throw your clothes in the dryer. Ticks hate heat. And some people like to use permethrin, you know, spray this insecticide that's designed to kill ticks, on your boots, through your pants when you go out for a hike. So there are things that, I mean, for decades, researchers have known these things are really effective if you keep doing them, if you stay vigilant, right? And all it takes is that one time, that one time you go out for a hike and you come back and you forget to do the tick check.