Q&A with Vaccine Expert and Task Force Board Member Dr. Walter Orenstein

Immunization expert Dr. Walter Orenstein has served on The Task Force’s board of directors since 2019 and has been working in immunization for more than 40 years. He worked with The Task Force when it was first formed in 1984 to reduce vaccine-preventable diseases and continued his engagement as Director of the United States Immunization Program at the CDC from 1988-2004. 

In September 2023, he became Professor Emeritus at Emory University. Dr. Orenstein was a Professor of Medicine, Epidemiology, Global Health, and Pediatrics at the Emory University School of Medicine (2004-2008, 2011-2023) as well as the Associate Director of the Emory Vaccine Center and Director of the Emory Program on Vaccine Policy and Development (2011-2023). While he was President of the National Foundation for Infectious Diseases (2014-2016), Dr. Orenstein helped lead efforts to provide education about the causes, prevention, and treatment of infectious diseases across the lifespan, including influenza (flu).

We spoke to Dr. Orenstein about his work with The Task Force, and vaccine acceptance in the U.S.

In 1975, Dr. Walter Orenstein working on a smallpox eradication program in India. Photo courtesy of Dr. Walter Orenstein.
Photo courtesy of Dr. Walter Orenstein

How did you first connect with The Task Force for Global Health?

I was working at the CDC when The Task Force was formed [in 1984]. When I was Director of the National Immunization Program, we spent a lot of time working with The Task Force, particularly trying to enhance efforts to decrease vaccine preventable diseases in the world.

What brought you to The Task Force board?

I was in the National Immunization Program for 26 years, and for 16 years I was director – so my goal in joining the board was to assist The Task Force in reducing the burden of preventable disease around the world. My expertise clearly is on the vaccine side, but there is a lot more than just dealing with vaccine preventable diseases. My goal is to take my knowledge and my contacts and help in terms of improving The Task Force’s global disease prevention programs, particularly regarding vaccine preventable diseases.

It is so critical for equity, that we not only reduce the burden of vaccine preventable diseases in the United States, but that we do it globally. It’s a win-win situation. It helps countries where there are high burdens of vaccine preventable diseases to improve their vaccination programs. And it also increases our own domestic health security by decreasing the likelihood that infectious agents will be transmitted into the United States.

Can you tell us about some of the work you’ve done with the Task Force since joining the board?

I’ve worked very closely with the Center for Vaccine Equity team. I’ve seen its real commitment, particularly on polio eradication. Both in finding better ways to enhance uptake of vaccines, to deal with threats, and to the eventual eradication through development of antiviral drugs that could be used for immune deficient people.

What are some surprising or ‘a-ha!’ things you’ve seen since joining the board?

The quality of the Task Force’s staff, their understanding, and the great efforts they’re making are remarkable. They’re getting me to not only look at my own particular area, but to the wider overall effort to improve global health. It makes me happy to be a member of the board.

Why do you think there’s been a decline in vaccine acceptance in the U.S.?

Two issues are responsible for the decline. The first is COVID-19 and its impact on the health care system. For example, people weren’t coming in for well-child care visits, and clinics in many places were not open to give out vaccines. So that’s one issue.

The second issue is that vaccines are victims of their own success. People don’t recognize the benefits in part because they don’t have fear of these diseases. With social media, people are able to communicate conspiracy theories about myths, such as vaccine contamination with computer chips, or that vaccines are not tested or safe.

I think we need to make the case with parents and others that vaccines are very safe, that recommended vaccines are very effective, and that there is a major process to assure safety and effectiveness. We need to make clear that the diseases we are preventing are not trivial. They are significant diseases.

In my opinion, we need to invest in implementation science research. Vaccines don’t save lives. Vaccinations save lives. A vaccine dose that remains in the vial is 0% effective, no matter what the clinical trials showed. So we need to better understand what motivates parents and adults to take recommended vaccines, but it’s often more difficult to get resources for the implementation side than for the vaccine development and production. 

[To learn about The Task Force’s engagement with parents, check out our Voices for Vaccines program and, for our vaccine safety work, see Brighton Collaboration information.]

Are there any historical examples that we can learn from to address vaccine acceptance?

Yeah, we’ve had problems before in the U.S. For example, there was a 1998 paper from the U.K. suggesting that the Measles Mumps and Rubella vaccine (MMR) could cause autism. [This paper was later retracted.] This caused concern in some communities and they were not taking the vaccines. We had outbreaks and had to work with them, and with their trusted people, to overcome that hesitancy.

Who are the trusted messengers? Often they are the primary care physicians, because if you’re bringing your child to a primary care physician, you must already have some trust in that person if that’s your main source of medical care. So it’s critical to get the primary care providers involved in dealing with this.

If you’re explaining to someone who’s never heard of Task Force why it’s important, what do you say? 

What is so good about The Task Force is it brings health care to some of the poorest places in the world. It works with local health authorities and other local groups to implement public health programs to reduce the burden of disease. And it has an expertise in understanding not only the science of the intervention, but the science of the implementation of the intervention. And it has been able to coordinate with multiple other groups and often play a leadership role in public health programs around the world. I think the world is a better place because of The Task Force.

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