Welcome to the Vaccine Free-for-All

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In the final days before the election last fall, presidential candidate Donald Trump told a crowd in New York City about his goals for bringing Robert F.

Kennedy Jr.

into the MAGAverse.

I'm going to let him go wild on health.

I'm going to let him go wild on the food.

I'm going to let him go wild on medicines.

Wild on medicines.

Or more accurately, vaccines.

That has been apparent over the past couple of months.

There is unease, if not panic, in the medical community after HHS Secretary Robert F.

Kennedy Jr.

ousted the entire CDC vaccine advisory committee.

In Texas, an unvaccinated child has died from measles.

The first death from the disease in a decade comes amid a growing outbreak in Texas.

Confusion about who can access vaccines mirrors chaos at the CDC.

The White House named a new interim head of the agency with no medical background, prompting the resignation of four senior officials at the CDC.

I'm Hannah Rosen.

This is Radio Atlantic.

Recently, the FDA limited the next round of COVID vaccines to people 65 plus or at risk of serious health complications.

And then last week, the administration fired the director of the Centers for Disease Control, and then several key officials resigned in protest.

Now, if you're visiting the doctor this month, you're not likely to immediately notice these changes.

But behind the scenes, the American vaccine infrastructure that has been in place for decades is coming apart, and that could have massive consequences.

To explain exactly how, we have science writer Katie Wu.

Katie, welcome back to Radio Atlantic.

Always good to be here.

So, last time I talked about vaccines on this show, which was in December, Robert F.

Kennedy Jr.

was just nominated as Secretary of HHS.

And we talked a lot about vaccine infrastructure and how it was more fragile than people realized and could easily come apart.

But then it was totally theoretical.

Like, we had no idea what would actually happen.

So, when you look back at his tenure, which is seven months or so, what are are, say, like three important vaccine moments that stand out to you?

I'd say he really started setting the tune for his tenure when he began responding to the measles outbreak, a response that was delayed, and then a response that was heavily focused on vitamin A rather than vaccination, which is far and away the best way to prevent and help contain measles outbreaks, which basically only happen in this country when vaccination rates drop.

At the FDA, he has pressured his appointees to restrict COVID vaccine approval so that it will be much, much, much harder for the public to access COVID vaccines in the future.

And he's done a kind of mirror image move at CDC where he has limited the recommendations for COVID vaccines and also very recently ousted officials that he thinks would have stood in his way if he were to enact further changes in that respect.

And also, adjacent to CDC, he has totally dismissed the expert panel that advises the CDC on vaccines and replaced them with hand-picked appointees, many of whom totally lack expertise in vaccines and are openly anti-COVID vaccine or anti-all vaccine.

Right.

And those are very important data points.

Would you say definitively, I'm trying to take a temperature check since back then we were a maybe

that RFK Jr.

and the Trump administration are trying to disrupt the vaccination program, upend the vaccination program.

Like, is there a verb that you feel good definitively getting behind?

I think there's a lot of verbs I could get behind, but probably the one that is particularly apt for this moment is I would say he's dismantling vaccine infrastructure.

If you look at the immunization schedule right now, it doesn't necessarily look so different than it did last year.

The most notable difference right now is changes and recommendations for COVID vaccines.

And I do expect further change to occur.

But right now, if that's your metric, it might not look so bad.

But I think that's a very particular way to look at the vaccine situation.

If you look instead at the way vaccine policy is shaped, at the pipeline that vaccines travel through to get from like invention to approval to recommended to actually being accessible by the public, that is where everything is a mess.

And so even though it's not like, oh, we have taken away MMR and the Hep B vaccine and you can no longer get the HPV vaccine, it's not like it's that.

It's more that they have just fractured this entire pipeline so that vaccines that have any hope of reaching the public, I think it's teeing us up for disaster.

I understand.

So right now, as a parent, I am a parent.

I'm not saying theoretically as a parent.

If I look at the vaccine schedule for kids, it will look the same.

Like my daily life going to the doctor, it will will be basically the same as it was before RFK Jr.

took office.

But somewhere down the road, the whole idea of vaccines, how they get created, how they get approved, how we build trust in them, that's what's collapsing.

Yeah, I think that's right.

I think if you go to the pediatrician now, things will feel mostly the same.

But I think what RFK has done in these past few months, is he has basically,

I guess I can say, greased the axles on his anti-vaccine machine.

Basically, if he wants to make further changes to the schedule, they will come easier.

Now that he has basically staffed all the personnel at HHS with like-minded people, he has sort of set precedent in terms of changing policies at FDA and CDC that will make it easier to rip vaccines away from Americans.

Right.

I mean, what I'm taking from this is that we started his tenure alerting people that the vaccine infrastructure was indeed more fragile than it seemed.

And now we're actually seeing that play out.

This week, RFK Jr.

wrote in the Wall Street Journal about trust.

He wrote that trust has collapsed, that the American people no longer believe the CDC has their best interest at heart, and he is here to restore that trust and return the CDC to its core mission.

How do you understand this op-ed that he wrote?

Because trust is an important word, and that is true.

Like trust has collapsed in the system.

So it's an, it's, it's, you know, that sentence is correct.

Right.

And I think that's exactly it, right?

That's what makes this op-ed a potentially powerful politician's tool.

I think RFK is very good at saying things that feel incontrovertible or unimpeachable in some way, like we need more trust.

We need healthier children.

We love safe vaccines.

Great, me too.

But I think this is the thing.

The sort of evidence that he uses to support this case that trust has collapsed and the American people have been failed by this corrupt CDC, I don't see that.

And certainly the folks who have run CDC and worked at CDC and benefited from CDC, which let's be clear here is all of us.

I don't think people generally see it that way.

Sure, there have been public health missteps, including very recently during the pandemic.

The CDC is not perfect.

The government is not perfect.

Public health officials are not perfect.

There have been errors that should be, you know, faced full on and addressed in the future.

But he's painting this as an agency that has just been corrupted by pharmaceutical influence and, you know, overridden by ideology.

And vaccines are not a proud hallmark feature of their work.

And I just, I have never seen it that way.

I think you would be hard pressed to find someone who has followed the evidence, followed the facts in this country, and actually does see it that way.

It is true that, you know, the data, the polling has shown that trust in public health officials, in scientists, you know, even in primary care physicians has dipped somewhat in recent years.

And I do think some of that is attributable to the pandemic and also the increasing politicization of science.

But a lot of people still do generally trust in science and medicine.

and public health.

That is why people who have primary care physicians go to their doctors and ask, hey, what should I do?

It's why most people in this country still say they get their children vaccinated and, you know, not just because their schools require it.

They support this kind of general infrastructure and they support funding of public health initiatives, research into science and medicine.

Like people want cancer cures and they trust that there are experts in this country that are being funded to do that work.

I think Kennedy is...

spinning this narrative to support his own political agenda, which sure, that is what politicians do.

But I think he's weaponizing this skewed portrait of science to do so.

I want to talk about this at the point that it interfaces with people.

Let's start with the COVID vaccine.

So recently RFK Jr.

limited the availability of the COVID vaccine, saying that people without underlying health conditions and people under the age of 65 had to consult with their doctor.

What difference does something like that make?

I think it makes a difference on multiple fronts.

I mean, first and foremost, this is a restriction, right?

There are people under the age of 65 who want that vaccine.

You know, I'm happy to say I was planning to get a COVID vaccine this fall and I am still going to try to get one.

But frankly, I have very little sense right now of how available that vaccine will be to me, if it'll even be on the market in the same way it is now, whether my pharmacy will be willing to give it to me, if my insurer will cover it.

Like it feels like a mess.

And having that option taken away from me when the evidence itself hasn't changed makes me feel vulnerable.

Like more people will get sick if they cannot get a vaccine that has the potential to protect them.

That is just how the vaccine math works.

I think the other aspect of this is it's philosophical, it's precedent setting, right?

This was maybe an easy domino to tip over initially because there has been more ambivalence about the COVID vaccine.

This is a newer vaccine.

This is an especially politicized vaccine.

It's a little bit of pandering to Trump's face.

I mean, I think a lot of people in that group still have some lingering bitterness over the pandemic.

Understandably, that was a really difficult time.

As we mentioned before, public health messaging was not perfect during that time.

This is kind of an easy vaccine to push around.

But once you start that, it makes it a lot easier to say, we showed you this vaccine.

It's got some issues.

We restricted it.

It sort of feeds into this narrative that there was something wrong with the vaccine system.

They're pulling back on recommendations that were already issued.

Why not do the same for other vaccines?

Right.

So it's like a gateway move.

Like you take the weakest link, you establish what the narrative is, and then you apply that narrative to other vaccines.

Exactly.

And I mean, it's also like a...

an interesting way for them to sort of do like their own little beta tests like can we do this did we pull on the correct threads at fda and cdc and it seems like they certainly did now they have a playbook for the next one, and the next one, and the next one.

After the break, what different states around the country are doing as the federal government makes its anti-vax turn?

That's in a moment.

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This week has been short, but filled with vaccine news.

California, Oregon, and Washington State announced they're joining together to coordinate vaccine recommendations in a thing they're calling the West Coast Health Alliance.

On the other side of the political spectrum, you have Florida.

The state's Surgeon General, Joseph Latipo, made this announcement on Wednesday.

Which is that the Florida Department of Health, in partnership with the governor, is going to be working to end

all vaccine mandates in Florida law.

All of them.

All of them.

This news would make Florida the first state to end vaccine requirements, including for school children.

Every last one of them is wrong and drips with disdain and slavery.

Who am I as a government or anyone else?

Or who am I as a man standing here now to tell you what you should put in your body?

So, Katie, we have more liberal states organizing to develop recommendations outside the federal government, and then the most loudly anti-vax state ending vaccine mandates.

How do you make sense of this news?

I think this is more of the same of what we've already been seeing for a few weeks or months now.

This fracturing of the American landscape on vaccines.

Increasingly, scientists and public health experts across the country are feeling that the federal government is no longer an ally in keeping America safe from infectious disease.

And so different parties are striking off on their own.

You know, we've seen professional medical societies doing this, developing their own sets of recommendations.

States are now doing the same.

And a lot of them, I think, are trying to be in line with those professional medical societies so that there will be some sort of consistency.

But because not every state is doing this, and some states are going in what is essentially the opposite direction, this really will lead to kind of patchwork across the country, which is going to make it extremely confusing to live here or, God forbid, move between states.

So you've described it as a continuation of what we've been seeing, but Florida sounds like it's crossing a line.

I mean, both in the tone and the totality of that mandate.

Is that true or have you seen that before?

I do think Florida is crossing a line here, and this is pretty unprecedented in one respect.

Though I will say, you know, we did have some precedent for states striking off in different directions and lifting mandates or regulations or recommendations at different times, you know, during COVID, for instance.

So this isn't shocking in one respect, but for Florida to do this in particular with school mandates, it's especially dangerous and it's especially bold because what happens to kids in Florida does not just affect kids in Florida.

People travel between states in this country.

People travel in and out of this country constantly.

This is risking Florida becoming a reservoir for all sorts of diseases that will spill over into the rest of the country and endanger us all.

I want to talk about the Centers for Disease Control.

At Kennedy's behest, Trump removed CDC director Susan Menares, who'd only been on the job a few weeks, and then several key CDC officials resigned.

What is the CDC's role in the vaccine infrastructure?

Like, why does it matter to the average American who's in charge there?

Yeah, CDC is a huge deal.

And I think a good way to frame this is the FDA approves vaccines.

So they basically say, here are the vaccines that you can get.

And then CDC takes those available tools and recommends how people should get them.

And so CDC recommendations are incredibly powerful.

They published the National Immunization Schedule.

And, you know, these are not mandates, but they are national recommendations that guide how states require vaccines in schools, how pediatricians recommend vaccines in their offices.

It's this unified grand theory of how we do immunization in this country.

Without the national immunization schedule, there may not be a super clear, universal resource for doctors to turn to.

For example, like pediatricians do have the American Academy of Pediatrics, that's their professional society, and they also publish vaccine recommendations.

You know, other groups like family medicine physicians or obstetrics and gynecology may do something similar, but It's not the same unified, like across all of health and medicine, across the entire nation, kind of sweeping.

Here is the national recommendation for all of you to follow so that things will mostly look the same in Kentucky as they do in Florida, as they do in Massachusetts, as they do in New York.

Like it's just going to be a little bit of a mess everywhere.

Right.

Which is like so much else.

I guess what I'm taking from what you're saying is how deeply, deeply politicized vaccines have become.

So the COVID vaccine we all know was politicized and all of COVID, but now the entire vaccine infrastructure is politicized.

It's like red state, blue state vaccines.

Yeah, I mean, it may start to look that way, right?

Like, I don't think it will fall perfectly along political lines.

I think it's worth mentioning that some red states have historically been some of the ones with the highest childhood vaccination rates, in part because of how they do school entry mandates.

And that's really notable.

But it's, I mean, it's, it's hard to predict exactly where things will go, just that things are likely to look different in a lot of places.

And I think access is also going to be a big issue, right?

I mean, depending on how insurers decide to cover these vaccines, insurers have typically looked to CDC recommendations to decide what vaccines they're going to cover.

If CDC starts recommending fewer vaccines, or if CDC is telling them one thing while the American Academy of Pediatrics is telling them another,

who are they going to follow?

Is it going to differ by state?

We're already seeing a little bit of chaos with CVS and Walgreens deciding to do different things in different states when it comes to vaccines.

Immunization and just being protected from infectious diseases generally works best when as many people as possible have a degree of immunity.

Infectious diseases are everywhere all the time.

The reason that we don't get more sick more often than we do is because we have immunity.

And when we start to take those barriers down, those pathogens, those viruses, those bacteria, they're not going to pull back on their offense.

They're still going to be there and will just be more vulnerable.

We actually have seen a measles outbreak.

And there was interesting reporting in KFF Health News that showed confusion at the CDC did actually prevent the agency from correctly responding in Texas.

What did you see playing out in the measles outbreak that already happened?

Right.

And I think this is a really good example to look at because

those children were already unvaccinated before RFK took over.

But I think what's key to focus on is the response or, you know, lack thereof from HHS.

I think under a different administration, and we have had other measles outbreaks in recent decades under different administrations, there should have been a really strong concerted response led by CDC, led by the Secretary of HHS, championing vaccination, sending resources, ensuring that people were well informed about what causes these sorts of outbreaks.

Again, lower vaccination rates, and, you know, having clear corrective action.

The response this time around was muted.

It was not terribly focused on vaccines.

It pushed unproven treatments that may have endangered some people's lives.

And in Kennedy's recent op-ed that we were talking about,

he honestly had the most bizarre description of the response to this outbreak.

He praised it and said things that I fundamentally disagree with.

Like the outbreak ended quickly.

Did it?

It was the largest measles outbreak we've had in this country in decades.

Measles was declared eliminated in this country about 25 years ago, and suddenly we have this massive outbreak in which multiple people have died.

And you call that an outbreak that ended quickly?

He also proudly described the outbreak as neither pro-vax or anti-vax.

A reasonable and science-based response from HHS to a measles outbreak should fundamentally be pro-vaccine.

I have to say, I was surprised by how that played out because I think when he first took office, I had in my head: okay, one child will die or two children will die, and then it will end all this anti-vaccine sentiment.

Like people will just kind of wake up from this and realize, oh no, vaccines keep children from dying.

And that is not what happened.

I think immediately when you saw those children die, you saw people pointing to, oh, they must have had underlying conditions.

They must have been malnourished.

Look, that's support for this broader narrative about chronic diseases being the primary issue, nutrition being the primary issue.

People see what they want to see.

And I think that is a really powerful way for politicians to push their particular narrative.

I do think it was encouraging that a lot of people's response to this outbreak was to ensure that their kids were vaccinated or even get their kids early vaccines if they were close to the outbreak region.

That was a very smart move if that's what they did.

But that definitely was not universal.

And, you know, measles outbreaks are kind of a canary in the coal mine.

We start here, but it is just a prelude for many, many more similar outbreaks to come.

Right.

Okay, so we've described a situation where the infrastructure is falling apart.

It's a little bit of a free fall.

There are not people at the CDC who can stop it.

In other actions that Trump and his administration have taken, we generally have relied on the courts, say, as a backstop against some of the more extreme policies.

Is there a backstop when it comes to public health?

Like, is there someone who can say no to the secretary of HHS or the CDC?

So there certainly have been legal challenges to some of what Kennedy has done at HHS.

For example, you know, the American Academy of Pediatrics and some other professional societies sued AHS.

Individual researchers have sued HHS and Kennedy.

It definitely has happened.

But for the most part, part, I have actually not really seen as many successful legal challenges as I might have hoped to see, which to me tells me that a system of checks and balances is not really holding Kennedy to account.

And in particular, you know, in the realm of public health, the Secretary is extremely powerful.

We have seen some moves that AHS overridden by the White House, but not very many.

It seems for the most part, Trump has been pretty happy to let Kennedy do what he wants.

He does not seem to be standing in the way of his anti-vaccine moves, including moves that have fundamentally undermined Operation Warp Speed, which was, if you remember, the Trump initiative in 2020 that got us COVID vaccines so quickly.

Okay, so that's a no for the short term.

Maybe my last question then is about the long term.

Can you build back up a vaccine infrastructure?

What does that take?

And then the more difficult question, can you build back up trust?

Like a place where public health is actually meaningful.

People trust that the government is looking out for the public health and it's not state by state, parent by parent.

Yes,

but

it will take a very, very, very long time, possibly longer than it took to build these systems up in the first place.

I think in most cases, it's fundamentally more difficult to rebuild something that has been destroyed than it is to build something from the ground up.

Because when you're building something from the ground up, there isn't necessarily as much resistance and broken trust to contend with.

You know, to build things back up, we will have to tell people to trust in entities that they have learned to distrust.

We will have to tell experts to come back together.

We basically have to ask people to get along in the wake of war.

And I don't see an easy path forward in that.

Wow.

Okay.

So what do you do?

Honestly, like, do you just do your own research and find a doctor you trust?

Like, how does an average person navigate in a place where the easily trusted institution, the vaccine list, the CDC, is no longer trustworthy?

Is it just like live in a state that has good health policies and find yourself a good doctor?

Yeah.

I mean, I think for the most part, doctors across the country are still pretty unified in following the evidence, following the recommendations of their professional society,

which as far as I can tell are still hewing very closely to the evidence and trying to step in where the CDC has not been able to.

And so people should feel comfortable in trusting their doctors for the most part.

That is not something that I have any qualms about.

I think the trick with that is not everyone has access to a doctor.

Not everyone

is going to be able to get those vaccines covered.

And I think now doctors and patients are being put in a bind where their government is telling them to do one thing and the science is telling them to do another.

And when you factor in money and logistics and just all the challenges to getting adequate healthcare in this country, I think it's going to get messy very quickly.

I don't know that advice will be the problem.

It may truly be access and equity.

Katie, thank you for explaining that to us.

Of course.

Thank you for having me.

This episode of Radio Atlantic was produced by Rosie Hughes.

It was edited by Kevin Townsend.

Rob Smirciak engineered and provided original music.

And Sam Fentris fact-checked.

Claudina Bade is the executive producer of Atlantic Audio, and Andrea Valdez is our managing editor.

Listeners, if you like what you hear on Radio Atlantic, you can support our work and the work of all Atlantic journalists when you subscribe to the Atlantic at theatlantic.com/slash listener.

I'm Hannah Rosen.

Thank you for listening.