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With Robert F Kennedy Jr at the head of the Department of Health and Human Services, antivaccination rhetoric is dominating the largest federal US agency and its responsibility to protect health. Recent developments that have caused concern include removing all members of a scientific committee that advises the Centers for Disease Control and Prevention (CDC) on vaccines and replacing them with people who are highly conflicted and mostly involved in antivaccine activism.1 This decision was based on an antivaccination talking point: that scientists and doctors were on the payroll of the drug industry. This was, unsurprisingly, shown to be incorrect.23 In its first meeting the new panel said that it would review vaccination schedules.4
Kennedy also appointed the oncologist and haematologist Vinay Prasad as the Food and Drug Administration’s (FDA) top vaccine official.5 Prasad, an outspoken critic of the drug industry and covid vaccines, has called for more research into links between childhood vaccination and autism.5
The language of conspiracy and misinformation has been used by Kennedy to suggest a need for new studies on whether vaccines cause autism.6 Suggesting that vaccines should be studied with placebo trials implies that vaccines are understudied and of near equal value to no vaccines. Using a scientific veneer to disguise antivaccination talking points will result in unnecessary placebo trials—a big ethical problem when effective vaccination exists.7
Antivaccine sentiment among the leadership of US health agencies will likely mean that vaccination information campaigns are reduced, vaccine hesitancy increases, insurance coverage for vaccinations is limited, and public sector capacity to vaccinate is reduced. Research money will be wasted on investigating already debunked links between autism and vaccination, while vaccination infrastructure, such as vaccination programmes run by local governments, will be eroded.
Kennedy has said that people should be free to use vaccines if they want to, but his individualist view wrongly assumes that vaccines are a consumer product like any other. This is not how vaccines work. By reducing transmission, vaccines also reduce the risk to other people, such as young children, who may not be eligible for vaccination. To reach herd immunity, it is imperative that most of the population are vaccinated.
Circumventing experts
In the US, vaccine recommendations are a key part of maintaining access to vaccines. If a vaccine is recommended by the CDC, health insurance must cover it.8 Only vaccines recommended for children or during pregnancy are covered under the National Vaccine Injury Compensation Program or purchased for the Vaccines for Children Program, which covers children from lower income backgrounds.910
Kennedy has already interfered with the authorisation of Novavax’s covid-19 vaccine and has now removed the recommendation that it should be given to children and during pregnancy11—circumventing the expert panel that determines such recommendations.
If the Department of Health and Human Services continues to remove recommendations for vaccines and to limit market authorisations, this will create barriers to vaccination—for example, by stopping purchases for government programmes. Risks will increase, as vaccines will no longer be part of the no-fault compensation programme. It will make it harder for vaccine manufacturers to continue to invest in the market. Moderna has had its contract to develop an H5N1 vaccine cancelled.12 The company has read the writing on the wall and has pulled a combined covid-19 and influenza mRNA vaccine from FDA submission.13
The hard power and money of the US federal government is being directed towards undermining vaccine acceptance, science, and production. These decisions could have a detrimental effect on the rest of the world. If vaccines are not recommended or authorised fairly in the US, drug companies will reconsider the value of vaccine research and development, so other countries might find that there are fewer or only more costly vaccine options. In a future pandemic the US government and researchers will be less helpful than they were in developing covid-19 vaccines.
Antivaccination sentiment in US federal government will empower antivaccination groups worldwide. The volume of questionable and problematic science that is likely to be funded and publicised will exacerbate the challenges of science communication and countering misinformation everywhere. CDC and FDA publications and websites may be used to disseminate poor science and to increase vaccine hesitancy worldwide.
Preventable illness
What remains of US international aid and policy apparatus may be instrumentalised by antivaccination activists. Earlier in his career Kennedy promoted vaccine resistance in Samoa. His intervention there contributed to reduced vaccination rates and was followed by a measles outbreak that infected thousands of people and killed 83.14 Vaccine preventable illnesses are already increasing in many countries, including measles outbreaks in the US, Canada, and Mexico.15
It remains to be seen whether US health and science advocates can push back against the global antivaccine movement.16 There may be a backlash in favour of vaccines, but it would be unwise to expect this automatically. Actions we can take to help amplify provaccine messages range from clinicians and providers educating people about vaccines, to local governments and healthcare systems advocating for vaccines, to the media and those with influence over social media making clear that vaccines work well and that the Trump administration’s actions are ideologically motivated.
Much of the antivaccination movement’s success happened in the absence of vaccine advocacy. Despite that movement’s work, most people around the world are not vaccine hesitant17: we can work to mobilise them in defence of their personal and collective health, as well as the healthcare workforce. People with more power can do more, but almost anybody can stand up and say that undermining vaccinations hurts us all.
Footnotes
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Competing interests: AK is author of Vaccine Court: The Law and Politics of Injury. She has no conflicts of interest. SLG is an editor of the forthcoming Vaccination Politics: The Comparative Politics and Policy of COVID-19 Vaccinations. He has no conflicts of interest.
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Provenance: Commissioned; not externally peer reviewed.
