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.<\/p>\n
Now, after backlash against public health interventions culminated in President-elect Donald Trump\u2019s nominating Robert F. Kennedy Jr., the country\u2019s 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.<\/p>\n
\u201cThe litany of things that will start to topple is profound,\u201d said James Hodge, a public health law expert at Arizona State University\u2019s Sandra Day O\u2019Connor College of Law. \u201cWe\u2019re going to experience a seminal change in vaccine law and policy.\u201d<\/p>\n
\u201cHe\u2019ll make America sick again,\u201d said Lawrence Gostin, a professor of public health law at Georgetown University.<\/p>\n
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.<\/p>\n
Even states that keep existing requirements will be vulnerable to decisions made by a Republican-controlled Congress as well as by Kennedy and former House member Dave Weldon, should they be confirmed to lead the Department of Health and Human Services and the Centers for Disease Control and Prevention, respectively.<\/p>\n
Both men \u2014 Kennedy as an activist, Weldon as a medical doctor and congressman from 1995 to 2009\u2014 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.<\/p>\n
Kennedy\u2019s staff did not respond to requests for comment. Karoline Leavitt, the Trump campaign\u2019s national press secretary, did not respond to requests for comment or interviews with Kennedy or Weldon.<\/p>\n
Kennedy recently told NPR that<\/a> \u201cwe\u2019re not going to take vaccines away from anybody.\u201d<\/p>\n It\u2019s unclear how far the administration would go to discourage vaccination, but if levels drop enough, vaccine-preventable illnesses and deaths might soar.<\/p>\n \u201cIt is a fantasy to think we can lower vaccination rates and herd immunity in the U.S. and not suffer recurrence of these diseases,\u201d said Gregory Poland, co-director of the Atria Academy of Science & Medicine<\/a>. \u201cOne in 3,000 kids who gets measles is going to die. There\u2019s no treatment for it. They are going to die.\u201d<\/p>\n During a November 2019 measles epidemic that killed 80 children in Samoa, Kennedy wrote to the country\u2019s prime minister falsely claiming that the measles vaccine was probably causing the deaths. Scott Gottlieb, who was Trump\u2019s first FDA commissioner, said on CNBC<\/a> on Nov. 29 that Kennedy \u201cwill cost lives in this country\u201d if he undercuts vaccination.<\/p>\n Kennedy\u2019s nomination validates and enshrines public mistrust of government health programs, said Paul Offit, director of the Vaccine Education Center at Children\u2019s Hospital of Philadelphia.<\/p>\n \u201cThe notion that he\u2019d even be considered for that position makes people think he knows what he\u2019s talking about,\u201d Offit said. \u201cHe appeals to lessened trust, the idea that \u2018There are things you don\u2019t see, data they don\u2019t present, that I\u2019m going to find out so you can really make an informed decision.\u2019\u201d<\/p>\n Targets of Anti-Vaccine Groups<\/strong><\/p>\n Hodge has compiled a list of 20 actions<\/a> 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 Children\u2019s Health Defense, which Kennedy founded and led before campaigning for president.<\/p>\n Kennedy could also cripple the National Vaccine Injury Compensation Program, which Congress created in 1986 to take care of children believed harmed by vaccines \u2014 while partially protecting vaccine makers from lawsuits.<\/p>\n Before the law passed, the threat of lawsuits had shrunk the number of companies making vaccines in the United States \u2014 from 26 in 1967 to 17 in 1980 \u2014 and the remaining pertussis vaccine producers were threatening to stop making it. The vaccine injury program \u201cplayed an integral role in keeping manufacturers in the business,\u201d Poland said.<\/p>\n Kennedy could abolish the CDC\u2019s 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 United States. 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.<\/p>\n 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\u2019ll \u201cgive infectious disease a break<\/a>\u201d to focus on chronic ailments, he said at a Children\u2019s Health Defense conference last month in Georgia.<\/p>\n 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 fever<\/a> are rising in the U.S.<\/p>\n 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 \u2014 89% of cases are in unvaccinated people \u2014 and a whooping cough epidemic is the worst since 2012.<\/p>\n \u201cSo that\u2019s how we\u2019re starting out,\u201d said Peter Hotez, a pediatrician and virologist at the Baylor College of Medicine. \u201cThen 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.\u201d<\/p>\n The share prices of drug companies with big vaccine portfolios have plunged since Kennedy\u2019s nomination. Even before Trump\u2019s victory, vaccine exhaustion and skepticism had driven down demand for newer vaccines like GSK\u2019s RSV and shingles shots.<\/p>\n Kennedy has ample options to slow or stop new vaccine releases or to slow sales of existing vaccines \u2014 for example, by requiring additional post-market studies or by highlighting questionable studies that suggest safety risks.<\/p>\n Kennedy, who has embraced conspiracy theories such as that HIV does not cause AIDS and that pesticides cause gender dysphoria, told NPR there are \u201chuge deficits\u201d in vaccine safety research. \u201cWe\u2019re going to make sure those scientific studies are done and that people can make informed choices,\u201d he said.<\/p>\n Kennedy\u2019s nomination \u201cbodes ill for the development of new vaccines and the use of currently available vaccines,\u201d said Stanley Plotkin, a vaccine industry consultant and inventor of the rubella vaccine in the 1960s. \u201cVaccine development requires millions of dollars. Unless there is prospect of profit, commercial companies are not going to do it.\u201d<\/p>\n 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.<\/p>\n While many wealthy people, including potion and supplement peddlers, have funded the anti-vaccine movement, \u201cthere hasn\u2019t been an appetite from science-friendly people to give that kind of money to our side,\u201d said Karen Ernst, director of Voices for Vaccines.<\/p>\n \u2018He\u2019s Serious as Hell\u2019<\/strong><\/p>\n \u201cRFK Jr. was a punch line for a lot of people, but he\u2019s serious as hell,\u201d Ernst said. \u201cHe has a lot of power, money, and a vast network of anti-vaccine parents who\u2019ll show up at a moment\u2019s notice.\u201d That\u2019s not been the case with groups like hers, Ernst said.<\/p>\n 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. \u201cWe didn\u2019t even know it was on the agenda,\u201d Ernst said. \u201cMobilization on our side is always lagging. But I\u2019m not giving up.\u201d<\/p>\n The kaleidoscopic change has been jarring for Walter Orenstein, who persuaded states to tighten school mandates to fight measles outbreaks as head of the CDC\u2019s immunization division from 1988 to 2004.<\/p>\n \u201cPeople don\u2019t understand the concept of community protection, and if they do they don\u2019t seem to care,\u201d 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<\/em> type B bacteria, a disease that has mostly disappeared because of a vaccine introduced in 1987.<\/p>\n \u201cI was so na\u00efve,\u201d he said. \u201cI thought that covid would solidify acceptance of vaccines, but it was the opposite.\u201d<\/p>\n 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\u2019s known as the vaccine choice movement has been growing since 2015 and took off during the pandemic, fusing with parents\u2019 rights and anti-government groups opposed to measures like mandatory shots and masking.<\/p>\n \u201cThe genie is out of the bottle, and you can\u2019t put it back in,\u201d said Rekha Lakshmanan, chief strategy officer at the Immunization Partnership in Texas. \u201cIt\u2019s become this multiheaded thing that we\u2019re having to reckon with.\u201d<\/p>\n 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.<\/p>\n 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 \u201creal and well established\u201d risks. Research on flu vaccination refutes<\/a> both claims.<\/p>\n 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. \u201cIf you overturn the administrative state, the impact on public health will be long-term and serious,\u201d said Dorit Reiss, a professor at the University of California\u2019s Hastings College of Law.<\/p>\n Billionaire Elon Musk, who has the ear of the incoming president, imagines cost-cutting plans that are also seen as a threat.<\/p>\n \u201cIf you damage the core functions of the FDA, it\u2019s like killing the goose that laid the golden egg, both for our health and for the economy,\u201d said Jesse Goodman, the director of the Center on Medical Product Access, Safety and Stewardship at Georgetown University and a former chief science officer at the FDA. \u201cIt would be the exact opposite of what Kennedy is saying he wants, which is safe medical products. If we don\u2019t have independent skilled scientists and clinicians at the agency, there\u2019s an increased risk Americans will have unsafe foods and medicine.\u201d<\/p>\n Outbreaks of vaccine-preventable illness could be alarming, but would they be enough to boost vaccination again? Ernst of Voices for Vaccines isn\u2019t sure.<\/p>\n \u201cWe\u2019re already having outbreaks. It would take years before enough children died before people said, \u2018I guess measles is a bad thing,\u2019\u201d she said. \u201cOne kid won\u2019t be enough. The story they\u2019ll tell is, \u2018There was something wrong with that kid. It can\u2019t happen to my kid.\u2019\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n