The City & State Q&A: Paul Offit

Even among the nation’s esteemed infectious-disease specialists, Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, occupies a place of singular authority. After all, few can claim to have personally created a vaccine – Offit is the co-creator of the 2006 rotavirus vaccine, now a routine childhood immunization – or to be an adversary of U.S. Health and Human Services Secretary Robert F. Kennedy Jr., whose unorthodox theories Offit has long critiqued in a Substack newsletter, “Beyond the Noise.”

At CHOP, Offit is a pediatrics professor in the Infectious Diseases division; he is also the Maurice R. Hilleman Professor of Vaccinology at the University of Pennsylvania’s Perelman School of Medicine. His national roles include, currently, serving on the U.S. Food and Drug Administration’s Vaccines Advisory Committee.

Amid the increasingly lockstep messaging of public-health circles, Offit is known for being unafraid to buck consensus. In 2002, as a nationwide series of anthrax pranks touched off U.S. fears of bioterrorism, Offit was the lone member of the U.S. Centers for Disease Control and Prevention’s immunization advisory panel to vote against mass smallpox vaccination, arguing that the vaccine’s risks outweighed the potential benefit. 

More recently, during the COVID-19 pandemic, he was an outlier among virologists by arguing against recommending either the updated bivalent vaccine or annual booster shots for healthy people – in both cases, citing a lack of evidence showing meaningful efficacy.

City & State caught up with Offit recently about the state of public health, what the medical establishment got right and wrong about COVID-19, and what the next pandemic will look like.

The conversation has been edited for length and clarity.

What worries you most about the current defunding and dismantling of America’s public health infrastructure?

That’s what worries me – the dismantling of our infrastructure. As a consequence, we will have fewer resources, and we will have a less educated population about the things that affect their health. The irony, of course, is that it’s all done in the name of making America healthy again, and in the process, we’re doing exactly the opposite.

I mean, you have a measles outbreak in this country that’s bigger than anything we’ve had in the last 25 years – and I think that’s just the tip of the iceberg.

And look at the decision by the administration to withdraw funds from the Global Alliance Vaccine Initiative, which provides money to countries that have, for example, measles outbreaks every year, big ones … And how does measles come into this country? Because of international travel. Global public health funding is not just an altruistic act.

This is a war on expertise, on advisory committees, all in the name of medical freedom.

You’re the rare public-health expert known for differing with the medical establishment consensus, most notably on vaccines. Why do you think there’s such a widespread reluctance to depart from mainstream public-health talking points?

What people felt was that if you’re going to promote a public health agenda – in this case, a COVID-19 vaccine – that you all had to be on the same page, because otherwise it looks like you don’t know what you’re talking about.

I see it exactly the opposite. I think that science requires a vigorous, open public debate about the quality of science behind a policy, because I think only then can people trust you – although I understand that when you have disagreements, it’s going to look like you don’t know what you’re doing to a certain percentage of population.

For me, it’s just how I was trained as a scientist. At scientific meetings, you would present your data and people would criticize you if they thought your conclusions did not clearly follow from your data. And that was good: You want it to be criticized or challenged, because that’s the only way your science got better.

Speaking of the COVID-19 pandemic, what do you think are the biggest things public health got right? 

The big thing we got right was the vaccine. This was a novel technology that had never been used, that was now designed to try and defeat a virus, SARS-COVID-2, that had unusual biological and clinical characteristics. Operation Warp Speed – an $11 billion program – got a lot of credit, reasonably, for being able to produce that vaccine quickly.

But the seeds of the research started in 1997 with National Institutes of Health funding – people like Drew Weissman and Katalin Kariko, who eventually won the Nobel Prize in Medicine 2023 for their work on mRNA. The notion that we snapped our fingers and suddenly there was an mRNA vaccine was wrong … We had work at NIH in 2000 to 2003 making an mRNA vaccine for SARS – which never came into this country, but we had a lot of knowledge that was gained from all that.

So we had 25 years of knowledge, and when COVID-19 hit, we were ready. People didn’t realize that. I think the hero of this pandemic was the National Institutes of Health.

And the No. 2 thing we got right is, we very quickly identified the virus. By January 2020, we’d sequenced it, and within 11 months, were able to do two large clinical trials that showed the vaccine against severe disease was 95% effective, meaning it kept you out of the hospital.

How prepared are we for another pandemic, such as bird flu? What could be done at the state level to bolster our preparedness? 

I don’t think bird flu’s going to be a pandemic – but we should prepare for the fact that it might be. So, how do you do that? 

Well, you have to have international collaborations that allow you to see when and where a potential outbreak happens – when viruses mutate, reproduce and spread from one person to another, which is what’s required for a pandemic. 

This administration is doing everything they can to lessen that kind of international collaboration …  You need to make the vaccine quickly, and make sure people get it. But now, we’ve backed away from masking and vaccine mandates, because we’re in the medical freedom movement, where it’s like, “I’m going to do what’s best for me and the hell with everybody else. And I don’t care if the person next to me is getting chemotherapy and depends on me to protect them … I’m just going to take care of myself.” 

So in many ways, we are less prepared … We’ve had three coronavirus pandemics in the last 20 years. I think there'll be another coronavirus pandemic; why wouldn’t there be? 

Years before he was on anybody’s radar as a potential public-health official, you were calling out the dangers of RFK Jr.’s scientific theories. Why? 

He’s a liar. That’s what caught my attention. He called me maybe 20 years ago, in 2004, and he had questions about this mercury-containing preservative in vaccines. This was four years after mercury had been taken out of vaccines; there were a lot of studies that had been done to answer the question, and I went through those studies with him. He was very polite, very nice, very thankful.

And then he wrote an article in Rolling Stone called “Deadly Immunity,” where he trashed me. He was dishonest – got the facts all wrong. I called Rolling Stone: “Here’s all the facts. Look them up.” …They ultimately withdrew the article.

What I saw in him was a virulent anti-vaccine activist, a science denialist and a conspiracy theorist. He was just incredibly dishonest. And that’s the only thing I’ve seen since.

So what’s his appeal – to the president, and to the so-called MAHA (Make America Healthy Again) crowd?

He appeals to certain things where he’s right. I mean, he’s right that people are generally dissatisfied with the health system. He’s right that for all the money we spend on health in this country, we don’t get great bang for our buck. Our longevity, our infant mortality rate is not great when compared to other developed countries. I think he’s right when he says that we have a high level of obesity in this country, and consequently things like Type 2 diabetes and high blood pressure, and when he says that we could eat better.

The problem is that he gets science wrong all the time. When he says we need to use tallow oils and not seed oils… what’s the evidence for that? He just makes stuff up.

How did this alternate view of public health become mainstream?

I think it’s the zeitgeist – the spirit of the time. It’s a rejection of expertise. And it’s not just directed towards public health agencies; whether it’s the Department of Justice, the FBI, what all of these administration hires represent is a disdain for public health and for the federal government. And they’re now in a policy-making position.

This administration has emboldened people who say “Look, all these academic Northeastern people didn’t know what they were talking about.” And I think COVID hastened that, because there were mistakes that were made. It’s always true in science that you learn as you go, and that’s okay – but I think we weren’t good at explaining that.