The future of vaccines
Epidemiologist Yvonne “Bonnie” Maldonado is an expert in vaccine research and public health.
Look back centuries, and the story is always the same, she says: Death rates from viruses have plummeted, especially in children and the elderly. And yet, millions of children die each year from vaccine-preventable diseases. Vaccines need a return of public confidence, and that starts with better messaging and greater support of nongovernmental messengers like herself. The bottom line is that vaccines are safe, she says. Vaccines work and we have saved many lives because of them, Maldonado reminds host Russ Altman on this episode of Stanford Engineering’s The Future of Everything podcast.
Transcript
[00:00:00] Russ Altman: This is Stanford's The Future of Everything, and I'm your host Russ Altman. Since we started this podcast eight years ago, it's become an archive of the amazing and impactful work done by my colleagues at Stanford University. In a time when the sheer volume of information available to us can make our head spin and make it hard to determine what's accurate, I'm proud to be able to bring you experts in law, medicine, engineering, technology, and much more.
[00:00:27] Bonnie Maldonado: Vaccines are safe, that they work, that we have saved millions of lives because of them. And to really trust in your, if you find somebody that you trust, ask that trusted person to show you data and facts about, you know, what your questions might be about.
[00:00:47] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. If this episode makes you laugh, learn, or just roll your eyes, go ahead and share it with your favorite human. Personal recommendations are a great way to spread news about the show, grow our audience, and improve public understanding of the future of everything. Today, Bonnie Maldonado will tell us that vaccines have become controversial, yes. But they save lives for sure. It's the future of vaccines. Just a reminder that today we're continuing our feature, the Future In a Minute where I ask the guests some rapid questions and they give us hopefully some rapid answers. It'll be at the end, so stay tuned. And before we get started, another reminder to share this episode with people you care about so that we can grow the show and improve public understanding of The Future of Everything.
[00:01:45] So viruses have created a ton of human suffering. Smallpox, measles, rubella, and many others, HIV, these have created diseases that kill people, that disfigure people, and that create lifetime disability. But starting in the late 19th, early 20th century, we started getting knowledge and ideas about how to stop viruses through vaccination. There was some amazing brave, and you'll hear about some experiments that people did to test these ideas and they started to work. And we know this because looking back 100, 200, even 700 years, we know that the rates of death from viruses have plummeted, especially in children and the elderly.
[00:02:30] And many, many of the bad outcomes have been significantly alleviated. And yet there's questions about whether vaccines are worthwhile. What's up with that? Well, Bonnie Maldonado is a professor of pediatrics, epidemiology and population health at Stanford University, and she's an expert on viruses, how they work, how they are used, how they're approved by the agencies that approve them, and why the public has some issues with them these days. We're gonna get into all of that in this episode of The Future of Everything.
[00:03:01] Bonnie. Let's just start with basics. Why have you dedicated so much of your career to understanding vaccines, how they're developed ,and how are they best used?
[00:03:11] Bonnie Maldonado: Well, um, I don't know. How far back do you wanna go? I am, uh,
[00:03:13] Russ Altman: As far as you want.
[00:03:15] Bonnie Maldonado: Loved, always loved science. I was always that kid back in the day. I don't think they have 'em anymore, but little chemistry sets and things like that. Always trying to figure things out. Didn't pull animals apart or any of that, but just trying to understand the world around me and just loved the idea of, uh, science. It was just really fun for me. And then in college, decided, uh, you know, do I wanna do a PhD in this new field called molecular biology or do I wanna go to med school or do I wanna do community work and do a master's in public health?
[00:03:44] So I kind of decided to go down medical school route because I thought it was the hardest thing at the moment, and just like tackle the harder one first. Loved it. Um, wanted to do science and also serve communities. And I realized that the best way to do that was prevention. And there's no better place to start with prevention than the fetus and newborn. And I realized that 90 uh, million, uh, 20 million children a year were dying from vaccine preventable diseases. Low hanging fruit. So, and I love, love, love, I discovered, I love, love, love viruses. Not that they're my friends, but I love studying them.
[00:04:22] They're actually simple to study, which makes it easy for, easier than bacteria, et cetera, and realized that vaccines were a magic bullet. And I thought, why aren't we doing this? So that was, you know, 40 plus years ago. Now, in retrospect, I thought, well, you know, it was a bit of a uphill climb, but it was the easiest climb of all the problems we've had to solve. So that's, you know, we now have 5 million children a year who die under the age of 5 around the world. Uh, those are mostly preventable, but most of the vaccine related deaths are gone now, which is great.
[00:04:53] Russ Altman: Great, thank you. So just so we get everybody on a playing field that's even, can we start with the basics of vaccines? Uh, maybe a little history, you decide, but like, where do they come from? How do they work? What's the basic idea?
[00:05:06] Bonnie Maldonado: So, the basic idea of vaccines is to expose yourself to a, uh, a something in the environment, preferably that isn't harmful, that will protect you from all of the pathogens, all of the organisms in the world that are out there that, um, I wouldn't say they're trying to kill you. They're just trying to survive like we are. But how can we either keep them at bay or be more symbiotic with these things? Now we know and you, you're the expert here, um, there's a lot in the world that's out there that, um, that's good for us, right? That we don't, we never really knew about.
[00:05:43] David Relman, for example, created essentially this whole new field of microbiome. We talk about it like it's not a big deal, but I remember when David was talking about this idea of microbiome. And we all thought, ah, I don't know how you're gonna ever study that. We didn't have the computer capacity, et cetera, but we realized there's a lot of good out there. But then there's the occasional bad actors, um, and uh, again, not to anthropomorphize them, but they basically are just trying to survive like we are. So how do we get them to, uh, to not hurt us, to not kill us?
[00:06:14] And so what you do is you engineer something that's either in that organism or like that organism to then, uh, prime your immune system to recognize it so that when you see the real thing, you suppress it immediately. It's kind of like your, you know, your frontline, uh, first responders, you know, they come right out guns blazing and they knock it down. You know, you might still get a little bit infected or sick, but you're not gonna get the full blown disease. You're not gonna die and you're not gonna have complications. So, that's it in a nutshell.
[00:06:46] Russ Altman: So, uh, what are the sources of variability in the response? I know this is something that you study a lot. Um, I know that sometimes we have people who get a vaccine and it works great and sometimes there's like a breakthrough infection, in the sense that you weren't supposed to get it, but you get it. So what do we know about the individual response to vaccines?
[00:07:04] Bonnie Maldonado: Well, remarkably little. This is all hit and miss, and I think this is why, uh, we're seeing what we're seeing today around, oh, vaccines are toxic substances and we have all these bad effects. Because in reality, we have been able to knock out most of those, uh, products. We don't take them very far because we find out early enough that something might not, uh, might, the harm might be worse than the cure, if you will. Um, because we don't really understand very much about not only the, the immune system and how it responds to different, uh, different, uh, elements in the environment, but we also don't understand those viruses, bacteria.
[00:07:42] Each one is very, very different in the way it can cause disease or in the way we can suppress it. We've been very fortunate in spreading a wide array, a menu of, of ways to attack organisms in the, in the, in the world and figure out which responses work best and which ones don't work at all. And so unfortunately, that is something that I'm hoping we could learn better. How do we understand our immune system? It's incredibly complex. I mean, obviously the brain is more complex, but the immune system is just, you know, very complicated.
[00:08:17] And we are basically hitting it at this point with a, with a very wide approach. Um, but again, we still are able to measure, uh, we measure very broad outcomes like, uh, symptoms, harm, uh, you know, are there symptoms that a vaccine will cause, for example, and we stop those studies immediately. So, so unfortunately we don't know much, but we do have general markers like, first of all, can you develop immunity? Can you develop an antibody response? Can you develop a T-cell response of some sort? Our T-cell response is as important as antibody responses.
[00:08:54] And then we, you know, we study these in test tubes first. We study these in animals. Um, we're gonna have to move away from animals, which is not a bad idea, looking at biomarkers. And then can we take those into clinical trials? So it's a long, long process. It takes, you know, what, 5 to 10 years, or more, sometimes multiple decades to develop an understanding of which vaccines work and which don't. But, um, in the end, they're very fairly crude markers of outcome.
[00:09:22] Russ Altman: When we do study them and we see some side effects, um, is, is it the case that they look at how bad the infection would be and how bad the side effects, and is it like a little bit of a sliding scale? If it's a, if it's a terrible disease, you might accept more side effects, whereas if it's, if it's like inconvenient and like bad, but like not terrible, maybe you have a higher bar or is that not part of the calculation?
[00:09:44] Bonnie Maldonado: Absolutely. You know, it's, we're always, as we learn from COVID, this is always about risk, risk benefit. I, I think everything we do every day from the minute we wake up until the minute we go to bed and in between is all about risk benefit. Should I cross the street? Should I drink, uh, this particular brand of, uh, beverage, et cetera? And it's no, no different with organisms, on a higher scale, obviously. So, um, smallpox, for example, one of the greatest achievements of mankind, humankind, is that we eradicated a whole disease that had been plaguing humans for millennia. Um, we were able to eradicate smallpox. Now, the reason it needed to be eradicated is it had a 30 to 50% mortality rate, and the people who survived had many, many complications thereafter and the infection rate was pretty high.
[00:10:38] Um, and it was a scourge. So, and there was something that you could do to prevent it, so why not try that? Now, the vaccine themselves were not, initially not easy, they had a lot of side effects, but they didn't kill you. I guess that was the bar, right? You didn't die, but you actually, um, you know, it, it did manage to cure you and you might've gotten pretty sick with the vaccine. So that's a good example at the one end of the scale. At the other end of the scale, uh, let's just say, uh, vaccines for Lyme disease, which there have been vaccines for Lyme disease, and that you, you know, and again, apologies to people who've had Lyme disease.
[00:11:14] It's a, it can be a terrible illness with lots of complications, but in the overall scheme of things, it's not that prevalent that we know of and it's hard to understand how to get rid of it or how to, how to, whether vaccines really work. And so the first round of vaccines were relatively safe, but nobody cared, uh, sadly, because they thought, well, I, I don't live in an area that has Lyme disease, or, it's really not that bad for many, many people. And so we, it's also part of it as a market value, right? Is it really gonna sell on the market? Meaning are providers, are patients gonna want it? So that, that's kind of the very rough way that these things are done.
[00:11:53] Russ Altman: Great. And, and in fact, in fact you, you mentioned smallpox and you made a reference to, um, uh, kind of deadly vaccines that, deadly viruses. Um, I always have wondered this, and maybe you can help me, um, why would a virus kill us? And I know that sounds crazy, but like they need us to, for, to, to survive and to replicate. So is there an understanding of when, when a virus goes too far and actually kills its host and therefore it's kind of shooting itself in, its in its viral foot? Um, do we understand what's going on there?
[00:12:23] Bonnie Maldonado: Nope. I mean, that's a teleological question. We have many of those, right? I have a whole book of, you know, teleological questions about these organisms. And you're right, some of them don't make sense. Like anything else, they evolve just like we do. And sometimes they hit a dead end and they're gone, right? I mean, that happens to species throughout the history of, of the, of the, of natural world. There are mistakes out there and the, the smart virus, if you will, will live long enough, um, will let you live long enough to let it propagate, right?
[00:12:54] So here's a perfect example, HIV. HIV makes you, without therapy it's a hundred percent fatal, we know, but it doesn't make you sick until 10, 20, 30 years into your infection. So you've been able to propagate that virus around the world, um, in the, in absent any treatment or prevention. And that's the perfect pathogen in some ways because we, it, and it also, the other really smart thing about it is it attacks your immune system. Your, the host is your immune system. So not only does it take a long time for you to recognize it and allow it to spread, but it attacks the very thing that should be protecting you.
[00:13:35] Now, it wasn't smart, obviously it just evolved. This is something that just evolved. So this is the kind of thing that we see with most of these organisms. They are just random mutations over time. Obviously, if you believe in a higher power, you could say, well, this is a scourge sent from whoever you believe in. But I don't think about it that way. I think about this is natural mutation and how do we understand that so we can prevent the next bad natural mutation.
[00:13:59] Russ Altman: Great. And, and that leads me to my final kind of, uh, ground setting question, which is, could you remind us why sometimes we get it once in our life and we never have to think about it again? Sometimes we have to get a series of two or three, and sometimes we have to get it every year or on a regular basis. What determines that?
[00:14:17] Bonnie Maldonado: We don't know. But yeah, so I'm telling you, you know, whoever's out there, let's look at AI or, I mean, AI I think can really help us, uh, under, try to understand this. Of course, we're gonna need more than just AI, but we, the complexities of what it takes to understand all the different molecular biomarkers and how they go into play, we just don't know. And how they interplay in the human side and the, and the virus or bacteria side is very complex and we don't know. I will say that there are, that for me as an epidemiologist, and I also have a lab. So I, I work in the lab and I use my lab to help me understand my epidemiologic, uh, research, uh, and not the other way around. My epi doesn't inform my lab.
[00:15:02] It's the other way around. So I take viral samples, I take blood samples from kids from all over the world after different diseases or after vaccination. One of the things I try to understand is, um, is, um, associations, right? What is associated with what? I can't prove any of these things. That's not the kind of lab I have, but I can show that a particular set of vaccines is associated with this kind of outcome. And that's, that's very blunt, a blunt, broad way to do it, but that's how we do it now. So we can, for example, the easiest way to look at these diseases is to go back in time. I teach a history on, uh, a class on the history of pandemics, and you can just see over 2000, 3000 years what has infected us over time. And you get a, a sense of, um, what the, what disease will do what.
[00:15:52] Like we, you know, a classic example is, um, smallpox again, I hate to come back to that one, but it's just easy. When, um, Edward Jenner realized that, um, cow maids, milk maids did not get smallpox. They just, when you have a whole population dying and one group of people is not dying or not even getting infected, you have to figure that out. That's an epidemiologic question. What's different about that person? Well, there's nothing different about them. It's the fact that they were milking cows that had cowpox. And they would get cowpox lesions. Now, cowpox and smallpox are not the same virus.
[00:16:29] They're not even, they're cousins, but they're not in the same, um, species. They're not the same virus. And so this was providing cross protection. And in his, you know, in his way, he figured that out. And, but he took a big step. He scraped the udders of cows, uh, inoculated that into a 6-year-old boy. Yeah, which is, you know, no informed consent, right? And then expose that child later on to smallpox, and lo and behold, the child did not die, which was probably good for both the boy and for him. Couldn't do that today, and we shouldn't do that. But again, it's more about associations in the real world and what can we draw inference from so that we can then start to build our hypotheses about why that might happen.
[00:17:14] Russ Altman: Great. Great. And, and then what about this concept of herd immunity? I'm sure it's an epidemiologic, it's important to epidemiologists 'cause you guys look at populations. And this is a population effect. So can you walk us through what that means? And is it, do we always see it with, um, with, with infectious agents or is it a special situation that is required to have it emerge?
[00:17:36] Bonnie Maldonado: Yeah, it depends on the, the type of transmission. So, uh, again, organisms adapt to us and to the natural environment. And so, depending on routes of transmission, herd immunity may be more or less important. Uh, measles is a perfect example. Measles, as far as we know right now, and I say that now because another virus could show up tomorrow, but it is very contagious. Probably the most infectious agent we know of. TB and chicken pox are the other two. Um, maybe Ebola, but in a different way. And the reason is that measles can aerosolize into very tiny, less than five micron droplets. And because they're so small, they come from the lower airway, they're expelled when you breathe or cough.
[00:18:19] They can sit in the air with Brownian motion for up to two hours. They can sit out there, just like you see dust moats in the air. If you walk into a room where somebody has been, who had measles, you can get infected even though the person's not there. So it's highly contagious. And so the question then is, um, how, um, how do you, how do you prevent transmissions? Well, turns out a virus like that is gonna be much more transmissible because the opportunity to infect people is much broader. But the other thing that you have to take into account is we can see lots and lots of viruses who might be able to do something like that, but for some reason they don't affect us the same way.
[00:18:57] They may not be as infectious to us. There are many, as we talked about at the beginning, there are many organisms, in fact, most organisms out there don't make us sick. But measles does. So that's the other piece of it. Not only does it have to have an effective transmission, but it has to make us sick. When you put those two together, there are formulas that we can come up with and we can calculate what's the risk of this disease. Now, in general, the more you have people in the community who are not susceptible, the less likely this ping pong of, or this, um, this pinball effect isn't diminished, right? So you've got this virus randomly moving in a community. If, if it bounces against the, you know, golden shield of immunity, it's not gonna affect you and then therefore not spread in that community. So that's basically how herd immunity works.
[00:19:45] Russ Altman: And so the idea of herd immunity is you don't need, I mean, is this true that you don't need every, you can get protection without vaccination, if everybody around you is, is protected and they create this shield. Is that the general idea?
[00:20:00] Bonnie Maldonado: Yeah. And you know, again, it's not a hundred percent but it's pretty darn close. And the more infectious something is, the more susceptible, the more immune people you need. So if you have a very low risk, if there's a disease that's not super contagious, you don't need everybody to be immune. You just need so many people. That's why measles is the canary in the coal mine. 'Cause it's so infectious that if you're not vaccinated at a high enough level, it's the first disease that's gonna show itself. It's just the harbinger of others to come who, that are less infectious.
[00:20:30] Russ Altman: This is The Future of Everything with Russ Altman. We'll have more with Bonnie Maldonado next. Welcome back to The Future of Everything. I'm Russ Altman and I'm speaking with Bonnie Maldonado from Stanford University. In the last segment, we discussed the basics of vaccines, how they work, why they work, how they're approved, stuff like that. In this segment, we get down to the issue of why have they become controversial. Bonnie will give us a really nice understanding of some of those issues and what we can do to improve public trust and acceptance of vaccines so that we don't go back, literally, to the Middle Ages. Don't forget, after the end of our conversation, we'll move to the Future In a Minute where I'll ask Bonnie some questions and she'll give me some answers.
[00:21:22] Bonnie, in this next segment I wanted to ask you kind of an obvious question, why have vaccines become so controversial?
[00:21:29] Bonnie Maldonado: You know, there's not one answer to that question. I scratch my head every single day wondering that. But I think if you take the very meta view of this, I have to look at the history of humankind. We have, we are the healthiest, most entitled generation of people, um, that have ever existed. We live better than Kings in Queens did in the Middle Ages. Now that's not that, the bar was pretty low there, but we are advancing there. If you look at data around child mortality, children up until the middle of the 20th century, the child mortality rate was still 50%.
[00:22:07] So it wasn't until the 1920s to 50's that we started to see child mortality drop. We are doing remarkably well. The thing is that we have very short vision. We're looking at yesterday, today, and tomorrow. But overall, we're doing great. We're living longer, we're living healthier, but we're also suffering from effects of all of the great things that we've been able to do. We eat more 'cause we have more food. We don't, we don't exercise because we don't have to. Um, and so we're, you know, we're dying of diseases, of lifestyle diseases. And so it's, there's a backlash now. I think people, people are seeing all of these effects.
[00:22:45] And then they include, they embrace vaccines in that. Vaccines must be bad too, because they put chemicals in your body. Well, that's generally not true. We're not putting lots of chemicals in people's body and the things that they get are very safe. But here's the real issue. The real issue is that you have a, and I've seen this time and time again just in my shortish career, meaning when you're, when we're talking about millennium, 30 years is a short time, but I have seen a 75% reduction in child deaths around the world in my time. When I first started doing research, a million children a year were dying for measles. Today it's about a hundred thousand, 90% reduction.
[00:23:23] So I'm still thinking, I still think we're doing a good job, but the point is, our doctors haven't seen measles. Our patients don't see measles. If you have mild side effects from the measles vaccine, but you know, never saw anybody with measles, why would you get the vaccine? It doesn't exist in their mind. So we haven't done a great job of communicating why these things are important and the fact that these diseases aren't gone, we're just protected. Um, at the same time, there are a lot of influencers out there, social media saying, look, you don't need the vaccine. Just take more of this vitamin or take more of that supplement.
[00:23:59] So we're facing colliding, um, messaging, and I think we need to do a better job of communicating. And really reminding people that a hundred years ago, this country was a developed, developing third world type country where children were dying. Uh, 30% of children under five were still dying, uh, in the first 5 years of life. We, imagine seeing that today, that wouldn't, that would be unthinkable, but, um, but we don't remember that. So I think a lot of it is messaging.
[00:24:27] Russ Altman: Yeah. It reminds me of that old saying about if you don't learn history, then you might be doomed to repeat it. And that would be really terrible to, I mean, people, people do hear about things like infections in the Civil War, and so there might be some hooks about some famous examples. So let me ask you, is this, um, is this a global phenomenon? So, you know, there, we're, I'm very aware of this controversy, controversy where we live 'cause it's in the news, we hear about it every day, pretty much. Um, is this happening all over the world in different flavors or is it not even happening? What do you see globally?
[00:25:02] Bonnie Maldonado: Oh, absolutely it's happening globally. I mean, there is mistrust in big pharma. In, you know, these big organizations, um, there is mistrust in communication. And frankly, you know, people sometimes don't trust their governments. They see that their governments are maybe not telling them the truth about other things. So why should they believe this? And in many cases, I work with the American Academy of Pediatrics, it's a very trusted organization. In general, when I go around the world talking about vaccines, the pediatric societies within those groups, first of all, they don't represent the government.
[00:25:36] These are usually, uh, uh, nonprofit institutions. They have a lot of trust and those are the people that can go out, but they also don't have the same bully pulpit that say the government might have, or other politicians. And so there's definitely a move over the last 20 years, we definitely have seen this reduction in, in confidence. Some of it is, yes, some bad, bad products were rolled out in lower, uh, developed countries that didn't have access to the better products. And the other thing is that they're also starting to see reductions in, in deaths. And so they're also saying, I don't need this anymore.
[00:26:12] Um, I haven't seen that disease. What, lemme tell you a brief story. When I was my very first NIH grant, when I was a brand new faculty member, was working with the Mayan population in southern Mexico and I came in to study polio. I walked in the door, we set up a field trial. It was a great field trial, published a lot of work there, found out a lot of stuff. But the first thing the Mayan population told me is, sure, we'll participate, but we want you to give us the measles vaccine first. I was stunned. Nobody ever says that. And it turned out that three years before I got there, there had been a big measles outbreak.
[00:26:46] And a lot of children had died. And so again, this reminds you that we have a very short memory and attention span. They remembered this bad virus and they wanted their children to be protected. Go back 5, 10 years later, they're gonna forget about that. And so we also, we have, again, this is why messaging is so important.
[00:27:07] Russ Altman: So you said something, uh, a few minutes ago that was really interesting. I think it was at the end of our first segment, you said that measles is something of a canary in the coal mine as a, as it would be the first thing to pop up if trouble is brewing. So what does the future look like? So you, you're very well aware, you do the research, but you're also on the front lines. Uh, tell me about, um, we're talking about The Future of Everything. What is the future of vaccines?
[00:27:30] Bonnie Maldonado: Well, um, I don't, you know, we're, they're here to stay. Whether people like it or not, they are here to stay. We may have, you know, and by the way, I think the MAHA movement is a great idea. We do, there's so many things we do need to address, and my colleagues Tina Cheng and uh, uh, Jim, uh, Perrin from, uh, uh, Cincinnati and from Harvard, they've talked about, yes, MAHA is a great idea, but here's what you meant. Here's the topics that we,
[00:27:58] Russ Altman: This is a make America healthy again.
[00:28:00] Bonnie Maldonado: Make America healthy again. I agree. I do believe that we are all thinking around the same thoughts. Lifestyle is different now. We need to change that, but we need to use data science and evidence to make those decisions and not make them, uh, you know, you know, influencers need to actually have some real, some real data and numbers to help support that, and that's not happening. So my view is as we go forward, I think we're gonna unfortunately start to see that some of these things aren't gonna work, but vaccines aren't gonna go away. We're not gonna see them, we can't. Um, human nature is, uh, we're very resilient, but we also respond to crises and outbreaks. Unfortunately, we're very reactive at times. And the minute we see some of these things tend to come back to harm us, I think people are gonna say, I want a cure. And then we'll just have to keep working on making sure that they believe in that cure through more than one generation.
[00:28:55] Russ Altman: Yeah. And so you're optimistic.
[00:28:56] Bonnie Maldonado: I'm, I'm always, I mean, look at the history of humankind. We've done so well. We are always victims of, of our own success, but then we, but we seem to tend to learn, uh, from our mistakes.
[00:29:08] Russ Altman: And then how are we doing as, as, as healthcare providers in preparing for big things like COVID and other epidemics or pandemics that might emerge. Um, are, is this next generation of, of, uh, healthcare providers, are they ready to, ready to rumble?
[00:29:24] Bonnie Maldonado: You know, I, I would like to hope that they are. I would say, I just did a, uh, I helped the American Academy of Pediatrics on a task force for the wellbeing of the pediatric workforce. They are being under, they're under siege right now because of gun violence, uh, gender affirming care, vaccines, all of the things that people don't want them to talk about, but are actually very important for child safety. They're being attacked by some people. Um, so we're really trying to help them become more resilient. And it all comes down to making sure that we keep them informed about the latest science that is really applied. What can you say to your immediate patient in front of you?
[00:30:01] Not the researcher at a big conference about some product that might come out 20 years from now, and pediatricians and general providers are very good at that. Now, our first responders, we do have plans. The problem is there needs to be political will to enforce them. Now, as bad as COVID was, for example, I will say that operational warp speed was amazing. It worked really, I participated in it here at Stanford. It worked really, really well as an operational opportunity. What you need to do is, you know, keep that in mind as you're moving forward and making sure that it's informed by the best data so that you are deploying the proper interventions to make sure people are safe. So we can do it. We have the tools.
[00:30:43] Russ Altman: That's great. Well, before we end, I wanna move to, uh, our, our, our features section, which we call the Future In a Minute, where I ask you a few, uh, rapid questions and you give me a few rapid answers. So I just wanted to ask if you're ready to give it a go?
[00:30:56] Bonnie Maldonado: Yep. I'll give it a shot.
[00:30:57] Russ Altman: Okay. First question, what is one thing that gives you the most hope about the future?
[00:31:02] Bonnie Maldonado: Well, just as I said, I look at the history of humankind and we just keep getting better and better, but we stumble along the way. We, and we hopefully learn from our mistakes. So I believe in that humanity will survive and one of the ways they have to survive is by vanquishing these diseases.
[00:31:16] Russ Altman: What's one thing you want people to walk away from this episode remembering?
[00:31:20] Bonnie Maldonado: I want them to remember that vaccines are safe, that they work, that we have saved millions of lives because of them. And to really trust in your, if you find somebody that you trust, ask that trusted person to show you data and facts about you know what your questions might be about.
[00:31:36] Russ Altman: Aside from money, what is the one thing you need to succeed in your research?
[00:31:40] Bonnie Maldonado: Public confidence. Public will, um, and government support, uh, for message, proper messaging.
[00:31:46] Russ Altman: If all goes well, what does the future look like?
[00:31:49] Bonnie Maldonado: Well, the future's gonna look like it, I mean, this, this is the future. We're living in the future. I mean, you of all people know we're in this AI interesting phase. I'm excited about it. There's obviously things we, we have to worry about, but you know, we said that about the laptop. We said that about, you know, all kinds of things. You know, running water, electricity, um, we just need to learn that change management is good. We just need to learn how to do it properly and make sure that we're all educated and that there's equity in access to all people.
[00:32:18] Russ Altman: And if you were starting over again, and you needed to get your certification or your degree in a different discipline, what would it be?
[00:32:25] Bonnie Maldonado: You know, I can't imagine doing anything different. Of course, I'm looking back at a long career, but, um, I love people. If I couldn't do this work, I probably would be a birder or, you know, doing something with nature conservancy. 'Cause I think climate change and nature is really the basis for our, our success as well. We have to learn how to live with our non-human, uh, fellow beings on this planet. So that would be really fun to me if I could reinvent my career.
[00:32:54] Russ Altman: Thanks to Bonnie Maldonado, that was the future of vaccines. Thank you for listening to this episode. Remember, we have like 300 of them in the back catalog, and so you can really dive deep into a lot of topics related to The Future of Everything. If you like what you hear, please follow the show. We think that your future self will thank you, and it's also a great way to be alerted to the new episodes as they come out in fresh new form. You can connect with me on many social media where I'm @RussBAltman, or @RBAltman. That includes Threads, Mastodon, Bluesky, and LinkedIn. You can follow the Stanford School of Engineering @StanfordSchoolOfEngineering, or more simply @StanfordENG.
