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Kennedy’s Vaccine Panel Is a Calamity
00:30:37
“We should be thinking that we’re heading for more damaging changes.”
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Mass. General Brigham in Boston is an integrated hospital system that's redefining patient care through groundbreaking research and medical innovation. Top researchers and clinicians like Dr. Pamela Jones are helping shape the future of healthcare. Mass General Brigham is pushing the frontier of what's possible, scientists collaborating with clinicians, clinicians pushing forward research. I think it raises the level of care completely.
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B
To learn more about Mass. Gen. Brigham's multidisciplinary approach to care, go.
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A
To nytimes.com mgb that's nytimes.com mgb.
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B
This is the Opinions, a show that brings you a mix of voices from New York Times opinion. You've heard the news. Here's what to make of it.
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C
I'm David Wallace Wells. I'm an opinion writer for the New York Times and a columnist for the Times Magazine. On Thursday, a CDC advisory panel voted to recommend limiting the combination measles, mumps, rubella varicella vaccine. And on Friday, the panel will vote on COVID vaccine recommendations, as well as whether or not to continue recommending the hepatitis B vaccine for infants within 24 hours of birth. It was the most substantive meeting since RFK Jr had broken his promise to senators made during his confirmation hearing and totally reconstituted the vaccine advisory panel called acep, firing everyone on the panel in one fell swoop and replacing them with a hodgepodge group of allies, almost all of whom were less qualified than the people they replaced by any conventional measure, and almost all of whom were considerably more skeptical about the benefits of vaccination. Since RFK Jr. Took over HHS, there's been a lot of worry about just where a longtime anti vaxxer would take the country's vaccine policy, and today was probably the clearest, biggest glimpse we've gotten yet. So I wanted to talk through what we should take from that meeting with Dr. Paul Offit. He's a pediatrician who specializes in infectious disease, a former member of ACEP himself, and someone who took some nuanced positions on Covid vaccination during the pandemic, but has been pretty alarmed about the changes being put into place by RFK Jr. And a final note, we're recording this on Thursday evening, just after the panel made their votes.
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A
Paul, thank you so much for joining me.
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D
Thank you, David.
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A
The last time we spoke was a few months ago when you sketched out a few different ways that RFK and his team might do damage on vaccines. They could soften recommendations, leaving decisions a bit more in the hands of parents and doctors. They could withdraw recommendations, leaving insurance in an uncertain spot. And they could make it a lot easier for families to sue over claims of vaccine injury, potentially including autism. You called that last one a kind of worst case scenario which could functionally destroy vaccine infrastructure in this country. After today's vote by a sip, where are we on that spectrum? How should we think about how bad it is and where we're heading?
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D
So I guess the issue that worried me the most today was the hepatitis B birth dose. And let me put this in perspective. Normally, the way this works is there's a question that's raised. So is the hepatitis B birth dose necessary? Would it be safer or more effective if you gave it at one month of age or two months of age, as some countries do? And then what you do is you form a working group and you examine those issues. That wasn't done. This was just a kind of hodgepodge of what people are thinking about without really having the kind of evidence to answer any of those questions. But let me put this in perspective. So in 1982, we had a hepatitis B vaccine. And so that vaccine was recommended for all children at birth if their mother was detected as being infected with hepatitis B. And then in 1988, that was extended to include the birth dose for all children born to mothers who had hepatitis B, as well as people who were in a racial or ethnic background that put them at risk for hepatitis B. And what they found in those years is that there were still tens of thousands of children who got hepatitis B. 10,000 to 15,000 children less than 10 years of age who would get hepatitis B. And they weren't getting it from their mothers. They were getting it from relatively casual contact with people who had chronic hepatitis B. There are millions of people who have chronic hepatitis B in this country, and they were coming in contact with them.
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A
Yeah. So these days you hear a lot from folks who are skeptical of the hep B vaccine that this is a sexually transmitted disease. Maybe we should recommend it for mothers who are positive. But we don't need to worry about exposure of infants because they're not sexually active. Of course, what you're saying is this experience, which we had in the relatively recent past, shows pretty emphatically that there's a large population who is still vulnerable to infection because it is not simply a sexually transmitted disease. It can be transmitted in all these other ways as well.
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D
That's right. Now you're especially vulnerable as an infant. So you want to make sure that those children are protected in that first year. And hence the birth dose. And with the birth dose we virtually eliminated hepatitis B virus in less than 10 year olds. I don't understand understand why we're having this discussion.
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A
That's actually what I was gonna ask is so we can see in some very clear way the benefits of this vaccination. Why has this vaccine in particular animated so much pushback among, you know, the cohort that we're talking about, RFK and his allies, why do they seem so especially focused on Hep B as opposed to many of the other vaccines that American kids now get pretty routinely?
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D
Because it's a birth dose. So they call it the gateway vaccine to vaccine hesitancy. That's the way that's described. And you can understand it to some extent. I mean, here your child's just been born and now you're injecting them with a biological agent that many people don't understand. So you can see the hesitancy. And so I think that's why those who are concerned about vaccines, skeptical and arguably cynical about vaccines target Hepatitis B birth dose So I just think they've raised the question that has already been answered in the data showing that we virtually eliminated this disease in children.
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A
And I mean, just from the way that they spoke about that today and in the past, it's not as though they're coming with new information, new research, new perspective. It's kind of the same old talking points. You know the line you mentioned earlier that this is the gateway drug. It's like on some intuitive level it makes sense that they would open with an assault on this vaccine. Not because there's clear sign of population scale damage, in fact quite the opposite, but just because. Because it's the one that's organized so much of their thinking in the past.
- [06:54]
D
That's exactly right. And Robert Malone, who's now one of the voting members of the ACIP and clearly a self proclaimed anti vaccine activist, he said, people call me an anti vaccine activist and I'm proud of that. I don't think it should be used pejoratively. But he said, when asked the question, why are we looking at this? He said, because parents are concerned. That's what he said. But see, I think it's in many ways a communication issue. I think people don't understand, they don't understand what that biological agent is, what hepatitis B vaccine is. I think they many have the false notion that this is just trying to protect against a disease that would only be encountered by people who either were born to mother who has hepatitis or someone who's going to go on to be an intravenous drug user or sex worker, which just isn't the facts.
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A
I mean, I saw one of the slides that was presented also showing a declining exposure to hep B in the American population. But of course, that is in part a function of the widespread vaccination of the population. But it does suggest one of the dynamics undergirding this cultural phenomenon more generally, which is that we used to live among many more infectious diseases. Diseases we have, through vaccination, defeated many of them, pushed them back, or at least to the margins of our lives in America. And now some portion of us are looking at that landscape and being like, do we really need to worry about a child getting exposed to hep B if we've cut circulation of the disease that much? You could say the same thing for many of these diseases. It feels like on some level what we're seeing is, you know, people talk about, you know, immune amnesia. We're kind of having a cultural immunological amnesia here where we've forgotten what it's like to really confront some of this stuff head on and now have the luxury of thinking that they don't represent meaningful risk to children.
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D
You're right. I think vaccines have largely been a victim of their own success. What amazes me is that, I mean, I'm a child of the 50s, so I had measles, I had mumps, I had rubella, German measles, I had varicella. I had all those diseases. And I certainly remember polio as my parents certainly did. And it's not just that we largely eliminated measles from this country in 2000. I think we eliminated the memory of measles, but that's not hepatitis B. There's at least 2 million people out there that are infected with hepatitis B. Many don't know it's called the silent epidemic for that reason. And they're highly contagious. This is a far more contagious disease than, say, hiv because there's such a huge amount of virus in the bloodstream. You have between 100 million to 10 billion infectious particles per milliliter of blood. If you're infected with hepatitis B, and that virus lives well on surfaces, it can live up to seven days on surfaces.
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A
And what do you expect is going to happen tomorrow? I mean, can we just count on them changing the recommendation in some meaningful way? What do you. What do you think will happen? They didn't get around to a vote today. They ran out of time, I think.
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D
I'm going to guess that they're going to say that that obviously anybody who's born to a mother who has hepatitis B needs to get a birth dose. And then if you're born to a mother who isn't detected as having hepatitis B in that first trimester, that you can wait at least one month before you give that vaccine. And I think that they'll do that in the name of restoring public trust, because that's what RFK Jr constantly says. We need to restore the public stress. And they'll see this as an issue for parents, and this will help restore public trust. And I guess I don't see it that way. I could be wrong. But the reason I don't see it that way is that I lived through the 1999, 2000thimerosal issue because I was on the advisory committee for immunization practices between 1998 and 2003. And at that time we were adding more and more vaccines to the schedule. And some of those vaccines contained an ethylmercury containing preservative called thimerosal. And so that got raised as an issue. Now we live on this planet, we're all exposed to methylmercury, which has a half life of about 50 days. We all have mercury in anything we drink. Ethylmercury has a much shorter half life and is eliminated from the body much quicker. And if you look at children's bloodstreams who got thimerosal or ethylmercury containing vaccines, you can't tell that we've in any way increased the burden of mercury from living on this planet. And there are about nine studies that have shown that you're at no greater risk of any neurodevelopmental problem if you got ethylmercury containing vaccines or if you didn't. And so my feeling about that, cause I was on the ACLB at the time, was I voted no when the issue was can we sort of insist that pharmaceutical companies move from multi dose vials to single dose vials? Cause that's why you had preservative vaccines. Because in a multi dose vial, you may inadvertently introduce bacteria into the vial. And then the child who gets the 8th or 9th or 10th dose can inadvertently be inoculated with bacteria, which can cause abscesses or cellulitis or sepsis or death. Which is why we started adding mercury containing preservatives and vaccines in the 1930s, which eliminated that. So it's really a trivial or arguably even undetectable amount of mercury that you're adding. But it doesn't sound good, right I mean, it's not like there was the national center for the Appreciation of Heavy Metals rising to stand up in defense of Mercury. I actually had to testify in front of a congressional hearing where one of the congressmen rose up and said, when it comes to Mercury, I have zero tolerance. Well, got zero tolerance for Mercury. Gotta move to another planet. On this planet there's mercury.
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A
But pulling back from that particular history and just to talk a little bit about where we are and where we're going more generally, I mean, we are in a place where there is declining trust in vaccines. I often think that that gets somewhat overhyped. We're talking about, you know, declines on the margins, but they are epidemiologically meaningful because they're pulling the rates of coverage below, you know, herd immunity levels and meaning that there can be more outbreaks of a lot of this stuff that was preceding the pandemic. But it picked up a little bit in the pandemic. And so there is on some level an intuitive, you know, it's natural to think, okay, we should do something to restore public trust in these programs and these vaccines. And yet when I hear figures like the members of this panel and up to and including rfk, not to mention many other people who are sort of back skeptical in one way or another, it doesn't inspire any kind of confidence in me. And what it sounds like they're saying is whether or not there are any questions about these tools, we have to change our recommendations, we have to change our messaging not because there's any real risk, but because there's some imagined risk or exaggerated sense of risk in a certain subset of the population. Now maybe for those 3 or 5 or 8% of parents that will feel like some kind of concession, but what about for the 90% of parents who are still getting their kids all the vaccines that are recommended and have been doing so without much protest or pushback for many years.
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D
So that's exactly right. And the reason I only reason I brought up that thimerosal story was it was couched in the same way this is being couched, which is that we need to be open hearted and open minded to the parents concerns. And so let's then take thimerosal out of vaccines. Oh, that certainly didn't make vaccines safer. It only made them frankly more expensive and in the developing world. Cause now you only had single dose vials much less available. And that hurt children, I think by doing it that way because we elevated this theoretical risk above a real risk. And the result was the opposite. I mean, people were saying, wait, why was this ever in there? Now they're taking it out in a precipitous manner. It must have been harmful. It gave birth to anti vaccine movement. It was the opposite of what we had expected. And I feel the same way, and I think you're alluding to this here. Why can't we just explain better why we're doing what we're doing so that people can understand the need for a birth dose rather than saying, okay, let's just loosen it up. Because then it looks like it was really never that important to begin with. And I think what you do when you say that, and we'll see how they vote on this tomorrow, is that you're only going to lessen actually the degree to which people get the vaccine because they're thinking, yeah, it really wasn't that important to begin with.
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A
And the panel did give one vote today which was on the MMRV vaccine. Do you wanna maybe walk us through a little bit what that vote said and what it means for coverage for these diseases? Which again is, that's measles, mumps, rubella and varicella, which is chickenpox.
- [14:42]
D
Right. So the measles, mumps, rubella and varicella vaccines are given twice. They're given at 12 to 15 months of age and then given again at 4 to 6 years of age. What is true is that at 12 to 15 months of age, which is an age where children are more susceptible to febrile seizures, which although they don't have any sort of long term sequelae, are certainly hard to watch and there was an increased risk. Anything that caused the sequelae.
- [15:08]
A
Just to pause on that, just for a brief second, I wanna be really clear about this. Cause this is one of the things that gives people some real pause about this is there's a low risk of a febrile seizure. So there is something that is vivid and scary, but has no measurable impact on the long term health of the child. So, you know, not to say that we shouldn't feel the animal feelings that we feel when we see someone having a seizure. That's all completely natural and as a parent would be terrifying. But from the perspective of public health policy, we are saying that that event, even when it happens, which itself is quite rare, has no meaningful consequence for the child going forward.
- [15:48]
D
That's exactly right. People hear the word seizure and they think epilepsy, that this now is the gateway to having epilepsy. But none of that's true. There's no Change in neurodevelopmental outcome or attention deficit disorder, hyperactivity disorder, et cetera. But it is hard to watch. And so our hospital, for example, gives measles, mumps, rubella and varicella separately as the first dose and then gives MMRV as the second dose in the four to six year range. You increase your risk. By the way, anything that causes fever, vaccines or otherwise, you know, viral infections, can increase your chance of having a febrile seizure. But we do that because at least in our hospital we made the decision that that excess risk, which is not common, was enough. That that's why we made that decision. But certainly one can argue that for parents, they may say, well, you know, I understand it's a small increased risk, but I also understand that there's no long term sequelae and I'd rather my child get two shots rather than four. I think what the vote did today, because they basically said that they didn't recommend the MMRV vaccine for that 12 to 15 month old, is that may eliminate the parent's choice.
- [16:51]
A
Looking at the presentations that were made today, the conversations that you watched today, that I watched today, what does that make you think about where we're heading? Putting aside for a moment MMORV and Hep B, but just in general, how do these proceedings make you think about which way the wind is blowing here? Is it possible to look at Hep B and MMRV and say, well, they're kind of tinkering around the margins and these aren't the recommendations I would make, but they're not going to be all that consequential or catastrophic. Or should we be thinking that we're heading for some more significant and more damaging changes in the sort of months and years ahead?
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D
B, we should be thinking that we're heading for more damaging changes in the months and years ahead.
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A
So tell that story. Where are we headed?
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D
So right now I agree, I think we're sort of tinkering at the margins. I think in the June meeting, the ACIP voted against the use of thimerosal containing flu vaccines. That was an anti science vote today. Also the MMR V versus MMR plus V. I think that's not a monumental decision. Hep B, you're starting to get there. Because now if you really say, okay, you can wait a month or more knowing that there can be false negative testing, knowing that a lot of people don't get testing, so this was a safeguard, we now are jumping within that and we'll have to see how that plays out. So then what happens as we move down the line knowing we have a secretary of Health and Human Services who is a virulent anti vaccine activist and science denialist who will do everything he can to make vaccines less available, less affordable, more feared. He means it. He believes, as he said, that we have simply substituted chronic diseases for infectious diseases. And he wants to do everything he can. As he said, God has put him on this earth to eliminate chronic disease in children. And I think he sees vaccines as one of those causes and, you know, so what could he do? He could make it so that the advisory committee for immunization practices doesn't vote through the Vaccine for Children's program to approve certain vaccines. He says, I don't think they've been tested enough. I don't think they did placebo controlled trials. I don't think they did gold standard science. I think the people that published studies were in the pocket of industry. And then you'll see a gradual erosion of the Vaccine for Children's program. Or if you really want to end vaccine manufacturing in this country, go with the vaccine injury compensation program, which was created in the mid-1980s to prevent sort of frivolous civil litigation and keep companies making vaccines. We went from 18 companies that made vaccines in 1980 to four by the end of the decade because they were driven out by litigation. That vaccine injury compensation program stop the bleeding. And I think he wants to reopen that wound. And when at that confirmation hearing he was asked by Elizabeth Warren, will you promise me that you won't reconfigure the vaccine injury compensation program to financially benefit yourself and your personal injury lawyer friends? He said, no, I'm not going to stop suing pharmaceutical companies. He loves this. And I think that's where he's at. I think at some point Congress or the president of this country are going to have to stand up for the health of America's children and realize they can still have their MAHA movement. Because there was a lot of in the MAHA movement that are likable and not have an anti vaccine agenda at the center of it.
- [20:02]
A
Yeah, I mean, what you're saying now, and I think is really important is that there is this big looming risk about the vaccine injury compensation program. And the real threat there, as I understand it, is in this upcoming report about autism, which is to say, if it becomes the position of RFK and hhs, which is to say cdc, et cetera, that vaccines are contributing in a meaningful way to the autism epidemic in this country, that will truly open up a can of worms for the entire vaccine infrastructure and make it very, very hard for us to preserve anything like the systems that we've had in place over the previous decades. What do you expect that report to say? How worried should we be about it? And how consequential do you think that report will be?
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D
It's hard to know. I mean it used to be that we made policy decisions based on solid, reproducible, robust scientific studies. That's not true anymore. Where the anti vaccine activists like Robert F. Kennedy Jr. Were shouting from the sidelines for a couple decades, now they're making policy based on their fixed, immutable, science resistant beliefs. And so he has said that, he has said autism is preventable. That's what he said. Which goes against frankly all the evidence today. I mean there's not a single cause for autism. But certainly there are a number of factors that predispose one to autism. I mean one is paternal age. The second, to a lesser extent is maternal age. It's certainly known that there's certain infections during pregnancy that increases the risk like cytomegalovirus infection or rubella infection. There are certain drugs you can take like valproic acid, which is an anti seizure medicine that increases your risk of autism. There are certain maternal health issues like obesity and diabetes that increase your risk of autism. So what those all though point to is one thing, which is you're probably born with autism. And so the notion that it's preventable, meaning that there's something you're being exposed to after birth that's causing you to have autism, is probably wrong on his face. But I fear he's gonna hold up some bogus paper cause that's what he does. And then he makes a decision based on that. And will it be the birth dose of hepatitis B? Will it be aluminum adjuvants in vaccines? Who knows? You just don't know. Because everything that used to matter in this world regarding science dictating policy doesn't matter anymore. Because we have a Secretary of health and human services as well as an advisory committee for immunization practices that supports him. And so we've lost all guardrails here.
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A
I wanted to kind of close by talking about something that you mentioned a few minutes ago, which is to say one could imagine moving forward taking some inspiration from Maha in a scientifically rigorous, public health oriented way. And I just wanted to ask you to, to tell us what that would look like for you. I mean, what are the good questions to ask about the vaccine schedule as it exists? Today, what are the open questions? What should researchers worrying about this sort of bundle of concerns be focused on? What would be a reasonable, laudable version of Maha's in charge and they're taking on vaccines, but they're doing so in a responsible way. What would that look like to you?
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D
Well, so I'd like to sort of of divide up something in one way, which is I think that the Make America Healthy Again movement has a lot of features in it that are excellent. I do think we are generally more overweight and obese in this country than other developed world countries. I think that definitely ultra processed foods play a role in that. It's not simply that. I think there are also socioeconomic factors and behavioral factors that are part of that, but that is part of it. I think we do overmedicate our children. I think that's all true. When I talk to people in the Maha group, and there's a podcaster named Brinda Adakari who has a podcast called why should I trust you? And so she has Maha people on at the same time she has public health people on. And the Maha people aren't necessarily anti vaccine. That's not necessarily part of their movement. That's RFK Jr. And it's certainly some part of their movement. There are a lot of Maha people that don't like getting diverted with this anti vaccine story. But I do think some people are watching CDC getting torn down limb from limb and liking it because of what happened during the COVID pandemic. So how do we get the trust back? I do think in terms of. Of vaccines. I think we need to explain ourselves better. I think that we assume that because vaccines have been so remarkably successful at making us live longer, better lives, I mean, we probably live longer than we did 100 years ago, in large part because of vaccines and sanitation. And we take that for granted. I think we are, it is a victim of our own success. I mean, it amazes me. We had a child come in with measles to our hospital last year. And many doctors came up to me and said, I've never seen a case of measles before, which shocked me. I just never thought that. So it's not only that I think parents aren't compelled by these infectious diseases. I think young doctors are less compelled because they didn't grow up with them. They didn't see them.
- [24:52]
A
Yeah. I mean, the way that I see the politics of this moment is a little different than you in the sense that I agree that RFK is the marriage between anti vaccine feeling and anti public health and feeling and sort of behavioral, individualistic approach to these questions. All of that came together because of the pandemic in a big way, whereas they might have been somewhat separated before. But I also look back on the experience of the pandemic and I think as you do, some mistakes were made around vaccine recommendations and guidance. I would like to go back and tweak some of those policies, some of those positions, but I think much more damage was done by the people who are sowing doubt and distrust throughout about much bigger questions about was this even a disease worth worrying about? Are these people even dying of COVID or are they dying of vaccination? And I see on some level, you know, the RFK arrival at HHS has a perfect illustration of this, which is to say there are a lot of Americans who felt let down. But how many Americans out there want no more vaccines? How many Americans out there, whatever they think about whether we over promised that the COVID vaccine was gonna deliver long lasting sterilizing immunity, we did over promise that, you know, we probably shouldn't have because we probably should have known better. But nevertheless those promises were made. And yet how many Americans does that lead to think we need to like throw all the bums out, burn the institutions down, completely change the standards. I just find myself thinking that the number of people who have that attitude towards all of these questions are much smaller and came to the pandemic with those commitments already, as RFK did. And the number of people who have grown a little bit more skeptical or a little bit more worried or a little bit more distrustful. They're not in this hardcore camp of anti vaxxers and it shouldn't be that hard to bring them back onto the side of trusting the authorities. And I don't even know whether the current regime, you know, that the RFK regime is going to appeal to them, you know, six months from now, two years from now, in the same way that it might have appealed to them 18 months ago when they were still kind of reeling from the experience of.
- [26:57]
D
COVID I completely agree with you and I'm heartened by that. I think that there was a Trump friendly pollster, I think his name was Fabrizio, something like that, but he did a poll on, on looking at Republicans and Democratic parents in terms of their attitudes about vaccines is exactly what you said. Most parents support vaccines and it's not partisan. I mean most parents support vaccines. And I think that's your question. How do we appeal to them? Because I think you're right. RFK Jr doesn't represent most parents at all. He represents a small slice of parents who may have come into this pandemic that way and just hardened their position, but didn't necessarily create their position.
- [27:32]
A
Well, that's the last question I wanted to ask you, which is to say, you know, there's a sort of a dark timeline, which you walked us through a little bit, where some quite profound fundamental damage could be done to America's vaccination system and program. But there's also a timeline that we may find ourselves in, where some changes are made. Maybe they're not quite optimal, but they're not catastrophic. And it seems to me like that timeline is still in play. So if someone were to ask you, if I were to ask you right now, how can we try to keep the country on the. That brighter timeline as opposed to that darker timeline, what can we do as citizens, as voters, as just Americans in social circles? What can we do to try to limit the blast radius of the RFK junior bomb and preserve as much of this infrastructure as we might hope to? What are we looking for when we're looking at whether we're going on this path or that path? And is there anything to do to direct the country more on the more palatable, less damaging ones?
- [28:37]
D
So I think my sense is it's a political problem. I mean, we have a president who has asked RFK Jr. To be the Secretary of Health and Human Services, and he's doing a terrible job. At no point has he ever stood up and said, we need to make sure you vaccinate your children, because that's not who he is. So it's a political problem, and I think it therefore has a political solution. And what was interesting about that sort of Fabrizio poll is it was shown to a number of senators. I know for a fact it was shown to a number of Republican senators on the Hill. That last committee meeting, the Finance Committee, when Senator Barrasso, Senator Tillis, Senator Cassidy, sort of all three Republican senators all sort of went at RFK Jr. They had seen that poll. And so I just think that as things start to continue to erode, it would be nice that parents write letters to their congressmen. Because when I've talked to people in Congress, they all say that if we get thousands of letters about one issue, that impresses us. So I do think eventually people will stand up. There's an old expression which is that if everybody shows a little courage, no one needs to be a hero. So maybe that'll happen.
- [29:44]
A
Well, thank you, Paul. Grateful for your wisdom and for your time. Thanks for coming on.
- [29:48]
D
Thank you, David. That was fun.
- [30:15]
B
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