The availability of safe, effective COVID
vaccines less than a year into the pandemic marked a high point in the
300-year history of vaccination, seemingly heralding an age of
protection against infectious diseases.
Now, after backlash against public health interventions culminated in President-elect Donald Trump's nominating Robert F. Kennedy Jr.opens in a new tab or window,
the country's best-known anti-vaccine activist, as its top health
official, infectious disease and public health experts and vaccine
advocates say a confluence of factors could cause renewed, deadly
epidemics of measles, whooping cough, and meningitis, or even polio.
"The litany of things that will start to topple is profound," said
James Hodge, a public health law expert at Arizona State University's
Sandra Day O'Connor College of Law in Phoenix. "We're going to
experience a seminal change in vaccine law and policy."
"He'll make America sick again," said Lawrence Gostin, a professor of
public health law at Georgetown University in Washington, D.C.
State legislators who question vaccine safety are poised to introduce
bills to weaken school-entry vaccine requirements or do away with them
altogether, said Northe Saunders, who tracks vaccine-related legislation
for the SAFE Communities Coalition, a group supporting pro-vaccine
legislation and lawmakers.
Even states that keep existing requirements will be vulnerable to
decisions made by a Republican-controlled Congress as well as by Kennedy
and former Republican Rep. Dave Weldon, MD, of Florida, should they be
confirmed to lead HHS and the CDC, respectively.
Both men -- Kennedy as an activist, Weldon as a medical doctor and
congressman from 1995 to 2009 -- have endorsed debunked theories
blaming vaccines for autism and other chronic diseases. (Weldon has been
featured in anti-vaccine films in the years since he left Congress.)
Both have accused the CDC of covering up evidence this was so, despite
dozens of reputable scientific studies to the contrary.
Kennedy's staff did not respond to requests for comment. Karoline
Leavitt, the Trump campaign's national press secretary, did not respond
to requests for comment or interviews with Kennedy or Weldon.
Kennedy recently told NPRopens in a new tab or window that "we're not going to take vaccines away from anybody."
It's unclear how far the administration would go to discourage
vaccination, but if levels drop enough, vaccine-preventable illnesses
and deaths might soar.
"It is a fantasy to think we can lower vaccination rates and herd
immunity in the U.S. and not suffer recurrence of these diseases," said
Gregory Poland, MD, co-director of the Atria Academy of Science &
Medicine. "One in 3,000 kids who gets measles is going to die. There's
no treatment for it. They are going to die."
During a November 2019 measles epidemic that killed 80 children in
Samoa, Kennedy wrote to the country's prime minister falsely claiming
that the measles vaccine was probably causing the deaths. Scott
Gottlieb, MD, who was Trump's first FDA commissioner, said on CNBCopens in a new tab or window on Nov. 29 that Kennedy "will cost lives in this country" if he undercuts vaccination.
Kennedy's nomination validates and enshrines public mistrust of
government health programs, said Paul Offit, MD, director of the Vaccine
Education Center at Children's Hospital of Philadelphia.
"The notion that he'd even be considered for that position makes
people think he knows what he's talking about," Offit said. "He appeals
to lessened trust, the idea that 'There are things you don't see, data
they don't present, that I'm going to find out so you can really make an
informed decision.'"
Targets of Anti-Vaccine Groups
Hodge has compiled a list of 20 actionsopens in a new tab or window
the administration could take to weaken national vaccination programs,
from spreading misinformation to delaying FDA vaccine approvals to
dropping Department of Justice support for vaccine laws challenged by
groups like the Children's Health Defense, which Kennedy founded and led
before campaigning for president.
Kennedy could also cripple the National Vaccine Injury Compensation
Program, which Congress created in 1986 to take care of children
believed harmed by vaccines -- while partially protecting vaccine
makers from lawsuits.
Before the law passed, the threat of lawsuits had shrunk the number
of companies making vaccines in the U.S. -- from 26 in 1967 to 17 in
1980 -- and the remaining pertussis vaccine producers were threatening
to stop making it. The vaccine injury program "played an integral role
in keeping manufacturers in the business," Poland said.
Kennedy could abolish the CDC's Advisory Committee on Immunization
Practices, whose recommendation for using a vaccine determines whether
the government pays for it through the 30-year-old Vaccines for Children
program, which makes free immunizations available to more than half the
children in the U.S. Alternatively, Kennedy could stack the committee
with allies who oppose new vaccines, and could, in theory at least,
withdraw recommendations for vaccines like the 53-year-old
measles-mumps-rubella shot, a favorite target of the anti-vaccine
movement.
Meanwhile, infectious disease threats are on the rise or on the
horizon. Instead of preparing, as a typical incoming administration
might, Kennedy has threatened to shake up the federal health agencies.
Once in office, he'll "give infectious disease a breakopens in a new tab or window" to focus on chronic ailments, he said at a Children's Health Defense conference last month in Georgia.
The H5N1 virus, or bird flu, that has spread through cattle herds and
infected at least 55 people could erupt in a new pandemic, and other
threats like mosquito-borne dengue feveropens in a new tab or window are rising in the U.S.
Traditional childhood diseases are also making their presence felt,
in part because of neglected vaccination. The U.S. has seen 16 measles
outbreaks this year -- 89% of cases are in unvaccinated people --
and a whooping cough epidemic is the worst since 2012.
"So that's how we're starting out," said Peter Hotez, MD, PhD, a
pediatrician and virologist at the Baylor College of Medicine in
Houston. "Then you throw into the mix one of the most outspoken and
visible anti-vaccine activists at the head of HHS, and that gives me a
lot of concern."
The share prices of drug companies with big vaccine portfolios have
plunged since Kennedy's nomination. Even before Trump's victory, vaccine
exhaustion and skepticism had driven down demand for newer vaccines
like GSK's respiratory syncytial virus and shingles shots.
Kennedy has ample options to slow or stop new vaccine releases or to
slow sales of existing vaccines -- for example, by requiring
additional post-market studies or by highlighting questionable studies
that suggest safety risks.
Kennedy, who has embraced conspiracy theoriesopens in a new tab or window such as that HIV does not cause AIDS and that pesticides cause gender dysphoria, told NPR
there are "huge deficits" in vaccine safety research. "We're going to
make sure those scientific studies are done and that people can make
informed choices," he said.
Kennedy's nomination "bodes ill for the development of new vaccines
and the use of currently available vaccines," said Stanley Plotkin, MD, a
vaccine industry consultant and inventor of the rubella vaccine in the
1960s. "Vaccine development requires millions of dollars. Unless there
is prospect of profit, commercial companies are not going to do it."
Vaccine advocates, with less money on hand than the better-funded
anti-vaccine advocates, see an uphill battle to defend vaccination in
courts, legislatures, and the public square. People are rarely inclined
to celebrate the absence of a conquered illness, making vaccines a hard
sell even when they are working well.
While many wealthy people, including potion and supplement peddlers,
have funded the anti-vaccine movement, "there hasn't been an appetite
from science-friendly people to give that kind of money to our side,"
said Karen Ernst, director of Voices for Vaccines.
'He's Serious as Hell'
Kennedy "was a punch line for a lot of people, but he's serious as
hell," Ernst said. "He has a lot of power, money, and a vast network of
anti-vaccine parents who'll show up at a moment's notice." That's not
been the case with groups like hers, Ernst said.
On Oct. 22, when an Idaho health board voted to stop providing COVID
vaccines in six counties, there were no vaccine advocates at the
meeting. "We didn't even know it was on the agenda," Ernst said.
"Mobilization on our side is always lagging. But I'm not giving up."
The kaleidoscopic change has been jarring for Walter Orenstein, MD,
who persuaded states to tighten school mandates to fight measles
outbreaks as head of the CDC's immunization division from 1988 to 2004.
"People don't understand the concept of community protection, and if
they do they don't seem to care," said Orenstein, who saw some of the
last cases of smallpox as a CDC epidemiologist in India in the 1970s,
and frequently cared for children with meningitis caused by H. influenzae type B bacteria, a disease that has mostly disappeared because of a vaccine introduced in 1987.
"I was so naive," he said. "I thought that COVID would solidify acceptance of vaccines, but it was the opposite."
Lawmakers opposed to vaccines could introduce legislation to remove
school-entry requirements in nearly every state, Saunders said. One bill
to do this has been introduced in Texas, where what's known as the
vaccine choice movement has been growing since 2015 and took off during
the pandemic, fusing with parents' rights and anti-government groups
opposed to measures like mandatory shots and masking.
"The genie is out of the bottle, and you can't put it back in," said
Rekha Lakshmanan, chief strategy officer at the Immunization Partnership
in Texas. "It's become this multiheaded thing that we're having to
reckon with."
In the last full school year, more than 100,000 Texas public school
students were exempted from one or more vaccinations, she said, and many
of the 600,000 homeschooled Texas kids are also thought to be
unvaccinated.
In Louisiana, the state surgeon general distributed a form letter to
hospitals exempting medical professionals from flu vaccination, claiming
the vaccine is unlikely to work and has "real and well established"
risks. Research on flu vaccination refutesopens in a new tab or window both claims.
The biggest threat to existing vaccination policies could be plans by
the Trump administration to remove civil service protections for
federal workers. That jeopardizes workers at federal health agencies
whose day-to-day jobs are to prepare for and fight diseases and
epidemics. "If you overturn the administrative state, the impact on
public health will be long-term and serious," said Dorit Reiss, PhD, a
professor at the University of California San Francisco's Hastings
College of Law.
Billionaire Elon Musk, who has the ear of the incoming president, imagines cost-cutting plans that are also seen as a threat.
"If you damage the core functions of the FDA, it's like killing the
goose that laid the golden egg, both for our health and for the
economy," said Jesse Goodman, MD, MPH, the director of the Center on
Medical Product Access, Safety and Stewardship at Georgetown University
and a former chief science officer at the FDA. "It would be the exact
opposite of what Kennedy is saying he wants, which is safe medical
products. If we don't have independent skilled scientists and clinicians
at the agency, there's an increased risk Americans will have unsafe
foods and medicine."
Outbreaks of vaccine-preventable illness could be alarming, but would
they be enough to boost vaccination again? Ernst of Voices for Vaccines
isn't sure.
"We're already having outbreaks. It would take years before enough
children died before people said, 'I guess measles is a bad thing,'" she
said. "One kid won't be enough. The story they'll tell is, 'There was
something wrong with that kid. It can't happen to my kid.'"
https://www.medpagetoday.com/infectiousdisease/vaccines/113302?
UNDERSTANDING THE DANGER BY SAM HARRIS:
"You don’t trust what the most respected doctors have to
say—because you think they’ve all been captured by big pharma,
perhaps—so you’ve found a guy in Tijuana who says he can cure your
cancer. You don’t trust what the Mayo Clinic says about vaccines—and now
you’re afraid to get your kids vaccinated—because you’ve listened to 14
hours of RFK Jr. on podcasts. And now you’ve started trusting him as…
what?… a new authority."......
https://samharris.org/episode/SED308F227B
