1. Provide the title of your story or series and the names of the journalists involved.
When Immunity Fails: The Whooping Cough Epidemic Series on radio, online, in print and a television documentary
Reporter Joanne Faryon, KPBS, public radio and television station in San Diego
Reeves Scholar Jessica Plautz, KPBS
Reporter/data analyst Kevin Crowe, Watchdog Institute, nonprofit investigative journalism center based at San Diego State University
Contributing reporter Roxana Popescu, Watchdog Institute
Intern Sandy Coronilla, Watchdog Institute
Listen to this entry (MP3 file).
Listen to this entry (MP3 file).
Listen to this entry (MP3 file).
2. List date(s) this work was published or aired.
Radio news segments: Dec. 14, 15, 16 " Radio talk show discussion: Dec. 14 " Television documentary: Dec. 16 " Television news promo: Dec. 10 " Television news program summary: Dec. 17 " Online: Two stories released Dec. 13, plus Behind the Story " Print (and online): North County Times, Dec. 15 " Print (and online): Press-Enterprise, Dec. 19
3. Provide a brief synopsis of the story or stories, including any significant findings.
The whooping cough outbreak, which has sickened thousands of people across the country and killed 23, most of them babies, was declared an epidemic last year in California. How did this disease, which was essentially wiped out 30 years ago, come back with such a vengeance? KPBS and the Watchdog Institute investigated the epidemic and the disease itself and uncovered information that ultimately contributed to the launch of new studies into a more virulent strain of the disease. Although analyzing data on whooping cough cases proved daunting because of inconsistencies in the way they were recorded, we were able to see clear trends in California cases where we knew immunization status: Between 44 and 83 percent of people who had contracted whooping cough had been vaccinated. We found similarly high percentages in Ohio and Texas. In digging into the science of whooping cough, which is also called pertussis, we found that some of the world's most prominent experts on the disease were at odds over whether a mutated, more virulent strain of the disease might be at work. We went to the Netherlands — bartered Skittles candy for television production services — and interviewed one of the leading scientists, who for years had been writing about a more virulent strain of the disease. His research had been largely ignored in the United States and by clinicians and medical professionals who influence public health policy, including immunization for pertussis. In investigating the business of vaccine research, development and sales — a multi-billion-dollar industry — we uncovered financial connections between many of those professionals and the companies that make the vaccines. Medical ethicists told us those connections can pose thorny conflicts of interest that could affect research outcomes. After months of questions from our reporting team about the efficacy of the vaccine and the possibility of a more virulent whooping cough strain, the Centers for Disease Control and Prevention (CDC) announced studies of the new strain in California and Ohio. Two members of a study group organized at UCLA in California said its project was prompted by the increasing death toll and by KPBS-Institute inquiries. Although virtually all experts continue to advocate immunization, toward the end of our investigation, local health officials began to change their statements about the disease.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Documents and resources included: government websites, NGO websites (WHO), medical journal articles, university websites, pdfs of conference publications, a powerpoint from a conference presentation, books
(via google books), news releases from the state and county to check numbers reported on given dates against our research. We requested pertussis case report information from California counties when we discovered the information dispersed by the state of California was not up to date. We also sought information on bacterial strain, vaccine type and cost, supporting documents for vaccine approval and FDA testimony. We filed a total of 31 FOI requests under federal and state law. Following is a breakout: " 21 California Public Record Act requests to local health jurisdictions " 5 to the California Department of Public Health " 3 FOIAs to the CDC " 2 to the Food and Drug Administration We had difficulty obtaining information electronically and otherwise. Federal, state and local officials often took weeks to answer straightforward requests. For example, in the early stages of the reporting, a CDC scientist said he couldn't recall what pertussis strain they found in the seven bacterial cultures they had. We had to file a FOIA to finally get the information. At the same time, the state of California, which provided these isolates to the CDC, said it didn't have straing information. They finally responded to a formal PRA with the information. Both the CDC and the California Department of Health confirmed that six out of the seven samples were the more virulent strain. Although the numbers were small, compared with the thousands of people who were sick, they told us we were on the right track in our reporting on a possible new strain. We attempted to survey 20 counties in California for pertussis case information. Most did not have the information electronically, and some refused to provide the information, citing privacy concerns. Others would provide only aggregate numbers. Obtaining immunization history was key to our investigation. That information was not electronically tracked by many counties. We also conducted a survey of 20 counties to obtain information on how pertussis case reports are filled out and when they are filed with the state. This information would aid our understanding of how data was collected and dispersed by the state. In requesting information from the vaccine companies about their research of pertussis and interaction with two expert groups the team investigated, we put out multiple requests, both via telephone and email. One company declined to respond to queries, while the other responded with a prepared statement about pertussis immunization that neglected to answer the reporters' questions.
5. Explain types of human sources used.
Medical experts and clinicians, scientists, medical ethicists, public health officials in the states of California, Texas, Michigan, and Ohio, county health officials from across California and states, families who had experience with pertussis. We used Twitter, Facebook, and radio ads to ask the public for help to tell the story. We set up a whooping cough email address where people could write their experience with the illness. We heard from six families. The one we profiled heard our radio ad in the car. They were driving their three-week-old baby to the doctor after learning he tested positive for whooping cough.
6. Results (if any).
Before the project even concluded, it was producing results. Researchers in California told us that the CDC was beginning studies of the pertussis bacterium to discover the prevalence of the more virulent strain, and the studies were prompted by the deaths of so many babies — 10 in California — and by our persistent questions about the strain and the efficacy of the current vaccine. These studies could lead to the eventual development of a new vaccine that could be more effective in protecting the public against this potentially fatal disease. Local health officials also changed their "message," toward the end of our investigation and after our stories were published and broadcast. They conceded the vaccine may not be 100 percent effective, but it was the best tool they had. During the early days of the epidemic, officials suggested lack of immunization was to blame for the increased number of cases.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No
8. Advice to other journalists planning a similar story or project.
— Persist: Our questions and reporting were challenging views long held by the experts in the United States and officials from the CDC. Some of the CDC's first responses were to say our questions about a more virulent pertussis strain were "stupid." This is the same agency that announced it would study the bacteria and the possibility of a new strain after 10 babies died and five months of questions from the KPBS-Institute team.
— Be prepared to dig deep: We encountered major difficulty in lack of transparency when it comes to a) disclosures of payments to doctors by pharmaceutical companies b) other connections between doctors and pharmaceutical companies. The lack of a centralized, searchable and comprehensive set of records meant Popescu had to conduct a unique and thorough internet search for every name she investigated. A secondary difficulty was that even when conflicts of interest or financial ties were published, they were not always evident. Doctors sometimes are recorded by their initials (making it harder to do text searches), behind paywalls, and other such obfuscating mechanisms.
— Be aware of stakeholders: Taking on the subject of vaccines is not easy. For the past two decades, there has been an anti-vaccine movement. Most of their rhetoric is not based in science. We had to be very careful and clear: this investigation was not a "pro-vaccine" versus an "anti-vaccine" debate. This was a public health crisis. Few people would publicly question the efficacy of the vaccine because it could play into the hands of the anti-vaccine movement. We used the data and the facts to present the story. We focused our reporting and investigation on efficacy, not "safety" or perceived safety issues.
— Go with your hunch: If something doesn't make sense to you, it probably doesn't make sense to a lot of other people. With this story, it didn't make sense that more people were getting whooping cough when overall immunization rates were high. A few Google searches lead us to scientific research around the world asking this same question: Why had pertussis returned despite high vaccination rates?
— Don't assume officials know what's in their data: Faryon learned the local health department was keeping track of immunization status of the people getting sick. But they failed to add up the numbers. And that's where the big story was.
— Be in it for the long haul: Faryon worked this story that the vaccine may not be completely effective for months. She had to continue her "regular" job for about half of this project, but she found time to file PRA's or FOIA's while she worked on other things.
— Report what you know when you know it: Your audience learns as you do, and it buys time with your news director who often wants to see more immediate results from your work.
— Find someone who can help you with the jargon: Faryon found a local vaccine expert without "skin in the game" willing to decipher scientific papers for her and direct her quickly to academic sources for specific questions.
— Track your every move online, early on: Every time you see a possibly relevant document, download it; You can waste time doing preliminary browsing and then going back to hunt for those pages/documents weeks later.
— Pick up the phone: In searching for one relevant detail, Popescu plumbed the depths of all online resources she could think of for days and days. She ended up finding the answer in a phone interview, with about 10 minutes of effort.