How Robert F. Kennedy, Jr.,’s Anti-Vax Agenda Is Infecting America

For months, President Donald Trump’s Administration has launched a full-scale attack, led by his Secretary of Health and Human Services, Robert F. Kennedy, Jr., on America’s public-health system. In the past week, however, the efforts escalated: Kennedy, who rose to fame in part owing to his conspiracy theories about vaccinations, pushed to fire Susan Monarez, the director of the Centers for Disease Control and Prevention, which is part of H.H.S. This came after Monarez refused to follow the lead of Kennedy’s advisers, who have tried to restrict vaccine access. (Trump has now named a Kennedy deputy, Jim O’Neill, as her replacement; Monarez’s lawyer claims that her firing was “legally deficient.”) The Trump Administration has already tried to limit access to COVID vaccines; earlier this month, the F.D.A. approved updated COVID vaccines but limited access to them to people sixty-five and older, and those with certain preëxisting conditions that put them at risk of severe illness. In mid-September, a C.D.C. advisory committee will meet and is expected to make a recommendation on who should be able to get the shots.

I spoke about the crisis at the C.D.C. with Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, and a professor of pediatrics at the Perelman School of Medicine, at the University of Pennsylvania. During our conversation, which has been edited for length and clarity, we discussed the extent to which the federal government can deter or restrict vaccine access, what Kennedy is really trying to accomplish, and why making it more difficult for pharmacies to inoculate patients may change public health in America.

How important are C.D.C. recommendations to vaccine uptake? How centralized a process is this?

Everyone who is involved in administering vaccines looks to the C.D.C. for their recommendations. So the Food and Drug Administration (F.D.A.) is a licensing body. It says a company can sell their vaccine, but it’s the C.D.C., specifically the Advisory Committee on Immunization Practices (A.C.I.P.), that gives specific recommendations. They say, O.K., now that it’s licensed, you can administer this vaccine to these people at these time intervals. And they have always been the central source, so they’re critical. They are the group that people look to for advice.

And so, when you say “people,” you’re talking about doctors, pharmacies, insurance companies, everyone, essentially.

Yes. I think parents look to their doctors for advice, but I think the doctors and the pharmacists and others are looking to the A.C.I.P. for advice.

I imagine there will be a lot of doctors, a majority of doctors in the United States, who are going to end up disagreeing with the Trump Administration’s guidance about vaccines. What, then, do doctors have the ability or inability to do, based on what the C.D.C. does?

So, for example, the C.D.C.—prior to Kennedy becoming the Secretary of H.H.S.—had recommended that young children receive a vaccine based on data that were presented in April of this year showing that thousands of children were being hospitalized, that one in five of those children hospitalized were being sent to the intensive-care unit, that a hundred and fifty-two children had died, that virtually none who died were vaccinated, and that half who died were previously healthy. Most of those children were less than four years old, and many were less than six months of age. So therefore there was a clear, firm recommendation by the C.D.C. to vaccinate young children. Then, at the end of May, Robert F. Kennedy, Jr., stood and said H.H.S. is no longer recommending the COVID vaccine for healthy young children and for pregnant women, even though children under six months of age could only be protected by vaccinating their mother [during pregnancy].

That threw a wrench into the system, and here’s how it played out. The American Academy of Pediatrics is going to publish a clear recommendation in its journal saying that all children six months and older who have not been vaccinated should be; and that children less than two years of age should clearly be vaccinated because of the data showing that COVID can be a serious and occasionally fatal infection in that age group. Then the American College of Obstetricians and Gynecologists stood up in the defense of pregnant women and said that pregnant women should receive a vaccine.

The only vaccine available for children less than five is Moderna’s vaccine. And that is licensed only for children in a high-risk category. So now you’re stuck. You’re wondering, Is insurance going to cover this? Is insurance going to cover a young child, a healthy child getting a vaccine? Are physicians going to feel comfortable, in terms of liability, giving that? And, for the most part, physicians are covered by the National Childhood Vaccine Injury Act, so, more important, are pharmacists going to feel comfortable? And, even though that act does not include COVID vaccines, another act does. I talked to two lawyers and my understanding is that it doesn’t cover pharmacists, so they are being left in the lurch. It’s all confusing, and I think that’s the point. I think Kennedy’s point is to make it confusing.

Why is Moderna the only one making a vaccine for kids, and why did they only recommend it for kids who are not healthy?

Moderna and Pfizer initially had a vaccine approved under an emergency-use authorization (E.U.A.), and then Moderna advanced that from the emergency-use authorization to a licensed product. But that licensure through the F.D.A. unfortunately only included children who were at high risk, because what the Trump F.D.A. did was they basically usurped the role of the C.D.C. The job of the F.D.A. is to say, O.K., if this vaccine is safe and effective, then it’s licensed and the company can sell it. Then it’s up to the C.D.C. to say, O.K., looking at the epidemiological data that we have, it looks like all children older than six months benefit. But the F.D.A. preëmpted that, and basically they took over the role of the C.D.C. Project 2src25 wants to eliminate C.D.C. as a recommending body. And one way to do this is what the F.D.A. just did, which is to limit the vaccines to just those children who are at high risk. Pfizer’s vaccine was approved through an emergency-use authorization for children less than five years old, but they just didn’t advance the license quickly enough. And so Kennedy saw an opportunity and basically said, We’re not going to approve anything through E.U.A. anymore. And that eliminated Pfizer’s vaccine for children.

I have read that some countries in Europe have a more relaxed attitude to children’s vaccinations than we did before Trump. Is that accurate? And do you think that there’s anything to be said for that?

The goal of the vaccine is to keep people out of the hospital, keep them out of the intensive-care unit, keep them out of the morgue. You’re not going to be protected against mild to moderate disease for long after either a natural infection or a vaccination. Four to six months later, your antibody response will fade; you’re still going to be protected against severe disease for a fairly long time, but you’ll still be at risk for mild to moderate disease. So then the question becomes who’s getting hospitalized? Who’s dying? That’s who you’re trying to protect. It really falls into four groups: people who are pregnant, people who are over seventy-five, people who are immunocompromised, and people who have high-risk medical conditions like chronic lung or heart disease. The logical response is to say, O.K., let’s just target those groups. Let’s give the vaccine every year to those groups, the groups most likely to be hospitalized or suffer serious illness.

We didn’t. We just kept saying everybody over six months of age should get a yearly vaccine—and I think that was wrong. Very early on, actually, I started to say that we should target the groups who are being hospitalized. That’s the goal of the vaccine. I was getting a lot of criticism for saying that we should just target the high-risk groups. I suddenly had gotten off the bus, and I think, in the public-health world, you’re either on the bus or off the bus. Someone I talked to in that world said that would be seen as a nuanced recommendation, which is going to be seen as a garbled recommendation. And the best way to get everybody vaccinated who should be vaccinated is to make a universal recommendation. I guess it’s a testable hypothesis, but I don’t agree with that. And so it was always seen as a messaging issue. And the A.C.I.P., in April of this year, started to discuss whether they should just target high-risk groups. But then those people got fired and replaced by this group with members who are science-averse and anti-vaccine.