Vaccinations are in the headlines again with the surprising nomination of Robert F. Kennedy Jr., an internationally prominent vaccine skeptic, to be the Secretary of the U.S. Department of Health and Human Services.
It’s safe to say that the issue of vaccines was not a significant factor in influencing votes in the recent election, but it will be for Mr. Kennedy’s chances for U.S. Senate confirmation. As part of the vetting of his candidacy, the Senate will be reviewing considerable information pertaining to his previous actions, beliefs and public statements about many issues, but in particular, vaccines. His recent pronouncement that there is “no vaccine that is safe and effective” is remarkable in its lie and threat to public health.
The benefits-risk experience over decades is proof of the value of vaccines in preventing illness and death. Just look at the near-total decline of childhood vaccine preventable diseases (VPD), such as polio, after the introduction of disease-specific vaccines, one of the greatest public health accomplishments of the 20th century and in the first decade of the 21st.
The Senate would be advised to also consider recent reports on vaccination rates of our most vulnerable populations, published by the Centers for Disease Control and Prevention. It’s clear there is an increasing risk of VPD transmission and outbreaks because of declining vaccination rates. Moreover, Mr. Kennedy’s nomination threatens to accelerate the decline in vaccination rates through potentially adverse policies and pronouncements, further undermining confidence in the life-saving benefits of vaccines.
We all should be worried about these developments and trends and their potential impact on our lives and on those of our families, friends and neighbors.
Based on their constitutional authority to protect public health, all states mandate the provision of basic childhood vaccines as a requirement for school entry/attendance. The most recent analysis shows that vaccination rates in the U.S. for four state-required vaccinations — targeting eight diseases — of kindergarten children declined from 95% overall in the 2019-2020 school year to less than 93% in the 2023-2024 school year. That level is where we really begin to worry about a higher likelihood of community outbreaks.
Ten or more jurisdictions had rates less than 90% for these vaccines. Coverage with all four vaccines declined in 80% of jurisdictions. These declines are in line with the rise in nonmedical requested exemptions to required vaccinations in many states.
Fortunately, Pennsylvania, Delaware, New York and New Jersey rates were above 93% for all four vaccines.
In a separate report, the overall flu vaccination rate in children 6 months – 17 years was 55.4%, with the highest in those 6 months – 4 years at 64.2%, and the lowest in those 13 – 17 years at 46.1%. There has been a steady decline in these rates since the peak in the 2019-2020 season, including in adults of all ages
The COVID-19 pandemic had a significant negative impact on childhood vaccination rates for multiple reasons, including increasing mistrust of government advice. Rates slowly rose as the pandemic ebbed and children returned to the classrooms, but not to pre-pandemic levels, until the latest data showed a renewed decline.
Recommendations for improving vaccination rates are not new. These include increasing confidence in the safety and efficacy of vaccines; addressing cultural issues and vaccine hesitancy that may be barriers to vaccination; facilitating access to vaccines; and ensuring administrators adhere to state/local vaccine requirements where they exist. These measures are intended to protect and benefit individuals and their close contacts who may not be able to be vaccinated for medical and other reasons. Whether ongoing implementation of these recommendations can reverse the falling trends is debatable. At best, they may only be enough to prevent further declines.
At a time when we need our public health leaders promoting vaccinations even more aggressively, we are faced with the real prospect of our federal government downplaying the importance of vaccinations. Worse still, it is possible, based on conspiracy theories and dissemination of misinformation, disinformation and unscientific data under Mr. Kennedy’s leadership of DHHS, the department could advocate that people (especially children) not get vaccinated at all. Imagine the confusion this will generate with states requiring vaccinations of children.
The possible confirmation of Mr. Kennedy by the U.S. Senate is one of the more frightening early actions of the incoming Trump administration. Some of Mr. Kennedy’s other ideas, such as removing fluoride from water and approving drugs that have been shown to be ineffective, are also disqualifying factors of his candidacy.
At the least, his confirmation would be the harbinger of a surge of childhood vaccine preventable diseases, with their attendant morbidity and mortality, at a level we experienced in the last century. His role in a deadly measles outbreak in Samoa, and the recent surge in measles incidence in the U.S. and globally are warning signs we should all heed.
What can the public do to impact the deliberations of the Senate? Voicing opinions on the need for a qualified health policy leader of DHHS and its agencies is probably the most we can do at this point in the process. Opinions that suggest that the professional community can work with Mr. Kennedy to achieve his stated health goals are misguided or at the least, premature, especially on the topic of vaccinations.
By now, we should all know that Mr. Kennedy’s ideas on this are immutable, given his years-long position alleging links between vaccines and autism, an association that has been extensively debunked through numerous studies. Perhaps there will be sufficient opposition and outcry — and senatorial backbone — to his nomination, leading to his voluntary withdrawal from consideration. The country needs a health care policy leader who believes in science, not a science skeptic.
Mr. Kennedy should not be given the opportunity to undermine the undeniable health benefits of vaccines by using the bully pulpit and authority of the most important federal health agency in the world. Should he be confirmed, we should all be prepared to make more health care and hospital visits and attend more funerals.
