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Robert F. Kennedy Jr., who is nominated to be the next Secretary of Health and Human Services, is America’s most prominent vaccine skeptic. The advocacy group he founded and chaired called for the decline in child immunization rates in the country.good news”, he said, blaming COVID-19 for parents’ deep-rooted doubts about regular injections.silver lining” Now, Kennedy may soon be overseeing a range of federal agencies that authorize and recommend vaccines, as well as billions of dollars worth of vaccines. program This covers vaccinations for children of almost half of the population.
That means America’s most prominent vaccine skeptic may have the power to overturn, derail, or even undermine the foundations of public health. Raising U.S. vaccination rates to today’s levels took decades of investment. For example, in 1991, 82 percent of infants had been vaccinated against measles. By 2019, that number had increased to 92%. In fact, the first Trump administration presided over a historic high point in the nation’s vaccination service. The second may focus on promoting suspected vaccines. hidden harm. Kennedy said: I don’t want to take the shotbut even if he emphasizes “choice,” his leadership will be a difficult test of Americans’ commitment to vaccines.
In many ways, this situation is unprecedented. Never before has someone with Kennedy’s combination of inexperience and paranoid mistrust taken the reins of HHS. He is trained as a lawyer and has no training in biostatistics or other legitimate research, the kind of qualifications expected of someone who reliably assesses the effectiveness of vaccines. But in the post-pandemic era, there is at least one small-scale experiment along these lines. In Florida, vaccine policy has been overseen since 2021 by state Surgeon General Joseph Ladapo, another prominent skeptic in the pharmaceutical industry. (Kennedy likened Ladapo to Galileo, the astronomer who fought against the Roman Inquisition.) Under Ladapo’s direction, the state has actively resisted federal guidance on COVID-19 vaccinations. The state health department has twice refused vaccinations. advised Floridians will not receive mRNA-based booster shots. “These vaccines are not suitable for human use” Ladapo declared in January. His public health contrarianism is beginning to spill over into more routine vaccination practices. Ladapo was abandoned during a measles outbreak in Florida schools last winter. standard practice Allowed unvaccinated children to attend classes. He also seemed to get the point across of do not have Measles vaccination is recommended for children who may need it.
Jeffrey Goldhagen, a professor of pediatrics at the University of Florida and former Duval County health director, believes this vaccine skepticism has led to significant costs. He said the “death and suffering of thousands of Floridians” could be linked to Ladapo’s policies, especially regarding COVID-19 vaccinations. But in the years since Ladapo took office, Florida has not immediately become an outlier in terms of coronavirus vaccinations or age-adjusted coronavirus death rates. And, at least so far, the state’s performance on other vaccination metrics isn’t far off from the rest of the country. That doesn’t mean Florida’s numbers are good: The routine immunization rate among kindergarteners in the state has decreased from 93.3% of children enrolled in fall 2020 to 88.1% in 2023, and the percentage of children receiving non-medical exemptions from vaccination requirements. rose from 2.7% to 2.7%. During the same period, it was 4.5%. These changes increase the risk of further outbreaks of measles and other infectious diseases that can kill children, but they are not unique to Ladapo residents. National statistics are moving in the same direction. (In other words, non-medical exemption rates across the United States increased at about the same rate as in Florida.)
All of these disturbing trends are fueled by right-wing influencers in the wake of COVID-19 and can be linked to growing doubts about vaccines. Alternatively, there could be lingering effects of the widespread health care collapse of 2020, during which many young children were unable to receive vaccines. (Kids who started public school in 2023 may still be catching up.)
In any case, Florida’s other vaccination rates look pretty good. Under Ladapo, the state actually obtain We are among the best in the country when it comes to influenza vaccinations for adults, as well as diphtheria, tetanus and pertussis vaccinations for young children. Even at Ladapo eccentric The choice to send unvaccinated children back to school during an active measles outbreak last winter did not yield results. If more than that sick. In short, as I pointed out in February, Ladapo’s anti-vaccination efforts have had little or no appreciable effect. (Ladapo did not respond to questions asking why his policies have failed to disrupt the state’s vaccination rate.)
If Florida’s immunization rate remains strong, the U.S.’s immunization rate could be even better in the coming years. Rupali Limaye, a health behaviorist and professor at Johns Hopkins University, told me that’s because the most important vaccine policy decisions are made at the state and local level. Each state will decide whether and how to require vaccinations for school-age children and during the pandemic. States and local governments are responsible for distributing (or selecting). Don’t let it out) Vaccines recommended and sometimes paid for by the federal government.
However, the presence of vaccine-skeptical leaders in Washington and across the Republican Party could still put pressure on local decision-makers to support parental choice at the expense of maximizing immunization rates. She went on to say that it could encourage policies that As a Cabinet member, Mr. Kennedy has an unprecedented platform from which he can continue to spread falsehoods about vaccines. “When you start giving people more choices and exposing them to disinformation and misinformation, people tend to make decisions that are not based on evidence,” Limae said. (according to new york timesmany experts say.worry the most” on this aspect of Kennedy’s leadership. )
But how important is this really? The prominence of Kennedy’s ideas may not, by itself, do much to reduce vaccination rates. Noel Brewer, a behavioral scientist and professor of public health at the UNC Gillings School of Global Public Health, said attempts to change people’s thoughts and feelings about vaccines are often futile. Research shows that speaking out loud about the value of getting the shot has little effect on behavior. Similarly, speaking might be reasonably expected under The value of a vaccine (as Kennedy and Ladapo always do) will be a wasted effort. “It may have little effect for public figures to talk about this,” Brewer said.
Indeed, much has been said about Kennedy’s apparent interference during the 2019 presidential campaign. measles crisis In Samoa. He arrived there for a visit in mid-year, not long after measles vaccinations were discontinued and child immunization rates plummeted. (The crisis began in 2018 when two infants died from vaccine-related medical errors.) Kennedy said: linked A deadly case of measles broke out in the months that followed, but if his presence really helped… assistance For the local anti-vaccination movement, the movement’s broader objectives have been frustrated. The government declared: emergency situation Measles vaccination rates quickly rose that fall. more than doubled.
But as HHS secretary, Mr. Kennedy will take on the kind of efforts that have been needed in Samoa, directly managing federal programs that provide vaccine access to those who need it most. For example, it would oversee the agency that pays for and administers childhood vaccines, which distributes immunizations to children in every state. All the experts I spoke to warned that interfering with the program could have serious consequences. Other potential actions, such as requiring further vaccine safety studies and consideration of evidence, could delay decision-making and delay the introduction of new vaccines.
President Kennedy will also have the opportunity to influence the nation’s childhood vaccination requirements and safety and surveillance systems at the highest level. he will be in charge Member selection The Advisory Committee on Immunization Practices typically makes recommendations on vaccines that are adopted by each state and result in standardized insurance coverage. He will also oversee the CDC Director, who has the authority to overturn or modify individual ACIP recommendations.
Even if he didn’t intend to completely stifle decisions, President Kennedy’s goal of giving parents more latitude could play out differently. Brewer, who is currently a voting member of ACIP (though he stressed he was not speaking in that capacity), said the committee could do the following: several different types Part of the ruling is broadly consistent with ACIP’s position, which states that Americans: should than that May Administer specific vaccines. This distinction can be very consequential, Brewer said. For example, injections that are “routinely” given by ACIP will be prioritized in the clinic, while injections that are subject to “shared clinical decision-making” may be given for patients who request them. . in particular. Transitioning national vaccination programs from traditional ones should to May The administration “will destroy intake,” Brewer told me.
Those seem to be the stakes. Florida’s case study in vaccine-skeptical governance may not be so dire, at least not in concrete terms. But Kennedy’s advantage may be more than that. Kennedy could throw the public health agency off a trajectory it has been on for years, and it could take many more years to get it back to where it is today.
