Loading summary
Transcript73 lines
- [00:07]
Tyler Foggatt
Hey, Dhruv.
- [00:08]
Dhruv Kullar
Hi. Great to be here.
- [00:09]
Tyler Foggatt
So you've written for us for a long time, but in addition to being a writer, you are also a physician. And so I'm curious, you know, when you have the CDC and HHS putting out guidance that's either contradictory or maybe even, you know, based in something that's been debunked, how does that confusion show up in your conversations with patients?
- [00:31]
Dhruv Kullar
It makes it really challenging. In the past, we had a system in which scientists at the federal level and politicians at the federal level were responsible, and they put out information that you could be confident in, that you could talk about in a thoughtful way with your patients and take that information and then translate it to the person in front of you. And now that system has been kind of turned upside down. So this idea that we can rely on, on the health recommendations that are coming out of the federal government no longer stands. And that puts a lot of pressure on states and localities, professional societies, to step in to fill that very large void.
- [01:12]
Tyler Foggatt
Do you find that you have a lot of patients sort of coming in, having done their own research? Obviously they're more confused. But do you think that there's a lot more of people kind of using websites and ChatGPT to try to make sense of things?
- [01:25]
Dhruv Kullar
Well, people have been doing their own research for a long time. I think with the rise of the Internet, Google at the beginning of that era, we've seen people come in with access to information, good information and bad information that they didn't used to have. So that part isn't new. What's new now is that a lot of misinformation or low quality information is coming directly from sources of authority that you would otherwise have trusted, and now you can no longer trust it. So it was the case until recently that people who were skeptical of institutions were the ones that weren't trusting what was coming out of the government. And now the anti establishment folks are part of the establishment. And so people who previously trusted these institutions no longer can. So it seems like we're just in a really challenging position where neither side of the political spectrum can trust what's coming out of the government anymore.
- [02:22]
Tyler Foggatt
That's Dhruv Kullar, who covers medicine, healthcare and politics for the New Yorker and is a practicing physician at Weill Cornell Medical College. Under the second Trump administration. With Robert F. Kennedy Jr. At the helm of the Department of Health and Human Services and the Make America Healthy Again agenda, setting the tone, we've seen funding for vital medical research gutted career scientists, sidelined and medical guidance reshaped to fit the administration's skepticism toward vaccines. It's made getting reliable medical information incredibly difficult and confusing for most everyday people. I wanted to talk with Dhruv about the recent changes to U.S. vaccine policy, how the CDC and HHS are functioning under Trump's second term, and how the states are responding to the administration's public health agenda. This is the political scene. I'm Tyler Foggatt and I'm a senior editor at the New Yorker. Last week we saw a two day meeting of a panel of vaccine advisors to the federal government, the Advisory Committee on Immunization Practices, or acip. Why was that meeting so hotly anticipated and did it go better or worse than what you expected?
- [03:33]
Dhruv Kullar
It's a good question. A lot of it depends on your assessment of how that meeting could have gone, and it certainly could have gone worse than it did. So I think the upshot of the meeting was that there was a lot that that was discussed that ultimately could have had a more substantial practical impact on vaccine access in this country. That's not to say that the decisions that were made were correct or the ones that I would agree with, but the damage could have been a lot worse. So one of the reasons that this meeting was so anticipated was that all 17 members of ACIP had been fired by RFK Jr over the summer, and he installed his own appointees over the past few months. And some of them were seated just a few days before the meeting took place. And these are people, some of whom have pretty strong credentials to be on that type of committee, but some of them don't and have raised some pretty serious criticisms, often unfounded, of vaccines. So people were really eagerly anticipating, you know, what might come out of this meeting.
- [04:34]
Tyler Foggatt
That's interesting. So it wasn't as if RFK Jr just put 17 kind of like uninformed vaccine skeptics on the panel. Like it was a mix of, you know, people who would probably normally be on the panel and then people who were maybe more unorthodox picks.
- [04:50]
Dhruv Kullar
That's right. And one of the things that's been interesting to me as I've watched RFK Jr operate over the past few months, is that he has actually been pretty savvy a lot of the time. I mean, he is, I think, a politician at heart. He's been around politics all his life and he knows how to do things in a way that aren't going to immediately set off alarm bells, including among Republican establishment. So if you take the statements that he's Made at face value in the past. You know, the COVID vaccine is the deadliest ever made. No vaccine is safe or effective. CDC is a cesspool of corruption. You might have expected even more dramatic action as health secretary where he has basically unfettered dominion over federal health agencies. But what he's done is actually chip away at the vaccine infrastructure of the country. You know, every few weeks or every few months, there is more uncertainty. There is slightly restricted access. There are more questions that are being raised about the way that we do vaccination in this country and how we keep children and adults safe in this country. And ultimately, I think that might have an even more corrosive effect on the public health infrastructure.
- [05:59]
Tyler Foggatt
It's interesting, yeah, because you could see that if he were just a full on anti vaxxer and filled these panels with anti vaxxers, I feel like it would almost be easier to contest that. You know, like, it just already kind of seems bonkers. Whereas if you're sort of slowly and gradually encouraging people to sort of fall into a kind of vaccine skepticism, which is also the phrase he uses for himself. Right. Vaccine skeptic. That's almost more insidious.
- [06:24]
Dhruv Kullar
Right. And I think what he's trying to do is preserve enough legitimacy in the CDC and the vaccine panels such that people can still take the recommendations seriously. If he filled ACIP with 17 clones of himself, I think even a large part of the Republican Congress would balk at that type of transformation. But what he's done is he's handpicked a few people who are raising really pointed criticisms about COVID vaccines, often without data or other types of vaccines. But he also has people with pretty strong scientific credentials. And so that creates a much murkier thing against which we have to contend.
- [07:10]
Tyler Foggatt
So before we get into what exactly the ACIP decided, I'm wondering if you can just kind of explain what it is that they do and what their decisions actually mean. Like, it's not so simple as, like, all of them meeting and deciding which vaccines someone can go and get. Right. Like, it's more that they're choosing which vaccines to endorse and when someone should actually be able to get that vaccine. Like, how does it actually work?
- [07:34]
Dhruv Kullar
That's right. So the CDC typically does not have regulatory authority. It issues guidance and recommendations. And this is a critical panel. It's called the Advisory Committee on Immunization Practices. And it is a panel that gives its recommendations to the CDC director who then has to decide whether or not to accept those recommendations. And typically they do accept those recommendations. And the way it comes to the public is, number one, through a kind of bully pulpit. This is what the CDC has recommended. This is what doctors and pharmacists are gonna talk about with their patients. And so there's that aspect of it, but it also influences what health insurers are going to cover. And so in general, health insurers are required to cover the vaccines in the way that the ACIP and the CDC are recommending. And so when the ACIP says we're no longer going to recommend this vaccine or that vaccine, it could be the case that insurers no longer cover that and people have to either pay out of pocket for it or not get it at all. Exactly. May not have access to it at all.
- [08:41]
Tyler Foggatt
So it seems like the biggest decision that came out of this meeting was the sort of the decision regarding Covid vaccines. I'm wondering if you can talk about what is changing now.
- [08:50]
Dhruv Kullar
Yeah, so you're right. That's probably the most drastic decision that they unanimously decided that they're not going to recommend Covid vaccination at all for anyone. So even for the highest risk people, for serious illness and death from infection, people over the age of 65, let's say the federal government no longer is going to explicitly recommend vaccination for those people. So it's pretty remarkable.
- [09:12]
Tyler Foggatt
And let me just stop you there. Is the justification for that. Is the idea that they don't think that the vaccines work, or is it that they just have so many downsides that even someone who might die of a COVID infection would be better off not getting the vaccine? Like why? What is the problem that they are identifying here?
- [09:29]
Dhruv Kullar
So what they argue is that people should be talking about this vaccine, medical professionals, and weighing the risks and benefits and making the decision for themselves. So if you are at high risk, I think their argument would be that that would be clear upon discussion with a medical professional. And otherwise, you may not want to get this. The challenge is that it has kind of changing the default here. The default, you know, when you recommend something from the federal government, is that people ought to get this vaccine. When you change the default to talk about it with a medical professional, number one, that creates a lot of inertia. Number two, not everyone has the opportunity and to engage with a medical professional. And number three, although the panel stopped short of recommending or requiring a prescription for a vaccination, it still makes it more difficult for pharmacists who actually deliver most of the COVID vaccines in the country to adults. To go ahead and give that without some type of consultation, potentially with a doctor or a nurse. I should note that spokespeople from HHS have said that these vaccines will continue to be covered under federal insurance programs like Medicare and Medicaid, that plans on the Affordable Care act act will continue to cover them. But it may be more difficult to get those vaccines ultimately. And I think fewer people will decide to get them.
- [10:44]
Tyler Foggatt
Yeah. I mean, do you think that fewer pharmacies will carry them? Like, if I just go to my local CVS and I want a Covid shot, do you think that the chances of me being able to get it have gone down because of this decision?
- [10:54]
Dhruv Kullar
I think so. I mean, some of this. It'll be interesting to see how it all plays out. One of the upshots of all this is that it's created a lot of uncertainty. And so it's not clear whether doctor's offices and pharmacies will stock the vaccine in the way that they used to stock it. It's not clear how comfortable pharmacists will feel just administering it because someone wants the vaccine. If they haven't offered a clear justification for why they need the vaccine. You know, the biggest trade group for health insurers has said that they are going to honor coverage for these vaccines or all vaccines that were recommended before this last meeting, I think, to get ahead of some of the changes that this specific meeting has inspired. But that's all to say that there's a lot more uncertainty about who and when you can get a vaccine than there was just a few months ago.
- [11:43]
Tyler Foggatt
So let's talk about some of the other big conversations that happened during this meeting. I want to talk about hepatitis B because that was a vaccine that I remember there was sort of talk going into this meeting that there might be a recommendation to no longer endorse it. But it seems like that decision was tabled, right?
- [11:59]
Dhruv Kullar
That's right. So ultimately, the panel decided not to take a vote on this issue and kind of kick it down the road. And so the big question was whether they're going to continue to recommend a first dose of a hepatitis B vaccine, basically at birth, within 24 hours of birth. To set this up a little bit, in the 1980s, there were around 20,000 babies every year that would contract hepatitis B, which is a very serious infection that can cause liver problems and often lifelong liver problems for people. And in 1991, the CDC recommended that the first dose of this vaccine should be given right at birth. And that's because there's a very high risk as the baby comes through the birth canal of getting the virus from the mother. If the mother has the virus, that has virtually eliminated the transmission of the hepatitis B virus from mother to child. Now, there are other ways people get the virus. And so it is often thought of as a sexually transmitted virus, which is true, but it's also the case that it's a very transmissible virus just by exposure to blood in other. So if it's on someone's skin or the virus can persist even on surfaces. And so a baby in the first few months of life can pick up the virus in all sorts of ways. And so this has really been a bulwark against that type of transmission of the hepatitis B virus. And what they had proposed was waiting a month and I think potentially exposing more children to the virus unnecessarily because of that. Fortunately, ultimately they decided not to pursue that, but they may take it up again in a future meeting.
- [13:32]
Tyler Foggatt
What would be the point of waiting a month to give an infant that vaccine? Because it seems like, you know, that would indicate to me that there isn't a concern about the vaccine itself being safe or, you know, causing autism, which is something that we, you know, that Kennedy often brings up with different vaccines. Like, it doesn't seem like it's a safety issue in this case. Right. So what is the argument against giving the Hep B vaccine that early?
- [13:55]
Dhruv Kullar
Well, a lot of this doesn't have any scientific backing. And so, you know, it's like asking, you know, why. They just feel like you're giving too many vaccines at one time and we should spread them out. But it's not as if there's a clear scientific rationale for that. You know, one thing that people have brought up is that it's kind of a gateway vaccine. You're giving an immunization, right. When a child is born, that kind of acclimates parents to the idea that you're going to be giving your child vaccines. And that may be one reason why they're recommending delaying the shot. It could also be the case that people might never get that shot. You know, when you're in the hospital, you've delivered the baby, the baby's there, and you can give them the protection of a vaccine. But not everyone has reliable follow up care. And there may be children who fall through the cracks and fewer babies may get them. And so it may be just a tactic to delay and potentially reduce the number of children who end up getting this vaccine.
- [14:45]
Tyler Foggatt
That makes more sense. I mean, it doesn't make sense like, you know, logically. But I get, you know, that the problem here is that it might be a gateway vaccine as opposed to it being a vaccine that causes some, you know, terrible thing down the line. I also wanna talk to you about this decision regarding the MMRV vaccine, which is a combined vaccine that boosts protection against measles, mumps, rubella and varicella. So what's going on here? Because it seems like you can still get separate shots for each of these things. And the problem that's being identified is with the combined shot.
- [15:17]
Dhruv Kullar
Right. So the MMR vaccine is given in combination, and then sometimes it's given with this additional protection against varicella. You can still get those separately. So you can get the mm, you can get the varicella vaccine separately. The advantage of taking the combination shot is it reduces the absolute number of shots that a child might need to get and the number of visits that you take to the doctor.
- [15:40]
Tyler Foggatt
Seems like the vaccine skeptics would like that. You know, if you're worried about gateway vaccines, it's just one and done, right?
- [15:46]
Dhruv Kullar
But there is this kind of real and small increase in the risk of febrile seizures. And I should note that febrile seizures, they don't seem to have any long term effects on cognitive development or any other health problems for children. But they are frightening seizures. Yeah, they're seiz and they are a serious thing. The risk is small, but it seems to be a real risk. And so that is the argument for rescinding the endorsement for the MMRV vaccine for children under the age of 4 years old. You know, as it is, it's delivered to a pretty small minority of children in the United States right now. Something around like 10 to 15% of children get this combination shot and children will still be able to get the shot separately as the MMR and the varicella separately. So it's not necessarily going to, I think, cause a huge public health problem, but it is a change that they advance. You know, part of the way they went about doing this kind of speaks to the inexperience of the panelists. I mean, so on Thursday they voted to rescind their endorsement, but to preserve coverage for this specific vaccine in the federal program that delivers about half of vaccines to children in the US and then many panelists, or some panelists at least, seem not to have understood the question and they reversed their decision the following day. So it is no longer covered in this federal program for children.
- [17:03]
Tyler Foggatt
I just can't get over how confusing this must be for people. Like, if you have a kid and you're trying to decide which vaccines to give them, which ones are covered, which ones aren't covered, which ones were covered up until recently and might still be covered because of, you know, the programs that are kind of stepping in. I mean, how.
- [17:19]
Dhruv Kullar
But I think that's exactly the point. You know, I'm a physician. I'm someone who thinks a lot about these issues. And for me, it's difficult to follow the ins and outs of what's being recommended. And it raises a lot of questions about what is recommended and when it's recommended and why it's not being recommended anymore. And so I can imagine for most patients and families who aren't spending their whole day thinking about this, how challenging it must be to just think through what's happening, what's best for your child. And I think that's exactly the point. If one of your agenda items is to reduce the number of people that are getting vaccines or to raise more questions about the benefits of immunization, this type of uncertainty can go a long way.
- [18:05]
Tyler Foggatt
So we're going to take a quick break and then when we come back, I want to talk just more broadly about how the CDC and other public health agencies are operating under Trump's second term. This is the political scene from the New Yorker.
- [18:24]
David Remnick
Right now, we are living through some of the most tumultuous political times our country has ever known. I'm David Remnick, and each week on the New Yorker Radio Hour, I'll try to make sense of what's happened alongside politicians and thinkers like Cory Booker, Nancy Pelosi, Liz Cheney, Tim Waltz, Ketanji Brown Jackson, Newt Gingrich, Robert F. Kennedy Jr. Charlemagne, tha God, and so many more. That's all in the New Yorker Radio Hour, wherever you listen to podcasts.
- [18:53]
Jason Adam Katzenstein
Hi, I'm New Yorker cartoonist Jason Adam Katzenstein. Cooler temperatures are rolling in and as always, Quince is where I'm turning for fall. Staples that actually last. From cashmere to denim to boots, the quality holds up and the price still blows me away. This fall, I'm going to wear the 100% organic cotton denim chore jacket everywhere. Their denim is durable and fits right and their real leather jackets bring that clean, classic edge without the elevated price tag. What makes Quince different? They partner directly with ethical factories and skip the middlemen. So you get top tier fabrics and craftsmanship at half the price of similar brands. I don't know why Quince calls it a chore jacket. But I do wear it while I do my chores. So catch me washing dishes in my denim chore jacket from Quince. Keep it classy and cool this fall with long lasting staples from quints. Go to quince.compoliticalscene for free shipping on your order and 365 day returns. That's quince.com politicalscene free shipping and 365 day returns. Quince.com politicalscene.
- [20:05]
Tyler Foggatt
So Dhruv, I'd love to get a general sense of the second Trump administration's broader approach to public health and how agencies tasked with it have been operating since Trump's return to office and since the launch of the whole MAHA movement or Make America Healthy Again initiative. So how would you say that the HHS and CDC are operating now as compared to in Trump's first term? Because one thing I've been trying to figure out is the extent to which MAHA is like a totally new movement versus a continuation of Trump and the Republicans attitudes toward things like vaccines and the medical establishment, which we may have seen back in between 2016 and 2020.
- [20:42]
Dhruv Kullar
I think it's totally different. In the first term, while there were questions being raised, you might not have agreed with everything that was being done in the administration and specifically at health agencies. And it was still basically the case that the people in the Trump administration were doing things that were still tethered to science and communicating in the way that you might expect people in another conservative or Republican administration to behave. That has totally changed this time around. I mean, if you just think about something like the purging of expertise, the firing of thousands and thousands of employees across hhs, that at fda, at the cdc, at nih, the disruption of the flow of research funding coming out of the federal government, something like the canceling of half a billion dollars in funding for MRNA technology. This is an example of ideology trumping science at every turn, which you certainly wouldn't have said in the first Trump administration.
- [21:43]
Tyler Foggatt
Speaking of firings, I'm wondering if you can tell us what the state of the CDC is in the wake of RFK Jr firing the director of the CDC, Dr. Susan Menare, allegedly for refusing to commit to adopting ACIP's recommendations before she'd seen evidence like who's running the show now.
- [22:00]
Dhruv Kullar
So as you say, Susan Monarz was dismissed by Kennedy just 29 days after she was confirmed by the Senate. And what's important to note is every Senate Republican voted to confirm her, and just less than a month later, Kennedy pushes her out. And so following that, three or four other senior ranking CDT officials resigned in protest. So the CDC is really in disarray right now. There's a man named James o' Neill who has now taken over as acting director of the Centers for Disease Control and Prevention. And I mean, I think the CDC is definitely in chaos, both because of the many employees that had been forced out or fired earlier in the year, but also because of the recent departure of several high ranking officials.
- [22:48]
Tyler Foggatt
So I want to talk about some of the other big public health announcements and changes in funding that we've heard about recently. So one of them is RFK Jr. Canceling half a billion dollars in funding for MRNA technology, which is the same technology that produced the COVID shots and is technology that you once described as a genuine triumph of Trump's first term that not only is our best defense against future pandemic pathogens, but also shows potential as a treatment for autoimmune conditions and deadly cancers. So can you help me make sense of a president essentially undoing a major accomplishment of his first administration?
- [23:21]
Dhruv Kullar
I think it speaks to the idea that Trump finds Kennedy to be a very useful ally. You know, Kennedy has brought into the MAGA sphere this whole movement of people who consider themselves Maha, and that's very useful for Trump. And so much so that even though at times it seemed that he wants to take more credit for what was genuinely an amazing accomplishment. I mean, Operation Warp Speed, the idea that you could go from knowing the genetic code of a virus to having a vaccine that ends up saving millions of lives in less than a year is incredible. And what we've learned since then is not only is it kind of our best defense for a future pandemic pathogen, as I wrote, this idea that if there's something that arises that we need to develop a vaccine for very quickly, this is by far the best technology we have to keep ourselves safe. But it's also a treatment or potential treatment for a number of other conditions, things that we never had treatments for, things like pancreatic cancer. I mean, there is a lot of promise for all sorts of other conditions that by canceling this grant funding, we're stymieing an innovation that could transform many, many lives in the future.
- [24:35]
Tyler Foggatt
What's weird is that sometimes it seems like Trump can almost seem like a voice of reason against RFK Jr. Like, there's a comment that you mentioned in your most recent piece, which is that Trump once said, you have to be very careful when you say some people don't have to be vaccinated. You have Vaccines that work, plain and simple. So that's good. Right? But then there are these other times where Trump and RFK Jr seem very much aligned and where it does seem like Trump is just trying to cater to the maha wing of the party. So, on Monday, Trump and RFK Jr. Appeared together and they made this disputed link between and the use of Tylenol.
- [25:11]
Robert F. Kennedy Jr.
During pregnancy, when the alternative is that nothing bad can happen. Let's do it now. I was just saying to Bobby and the group, let's do it now. Nothing bad can happen. It can only good happen. But with Tylenol, don't take it. Don't take it. And if you can't live, if your fever is so bad, you have to take one, because there's no alternative to that, sadly. First question, what can you take instead? It's actually. There's not an alternative to that. And as you know, other of the medicines are absolutely proven bad. I mean, they've been proven bad with the aspirins and the Advils and others. Right. And they've been proven bad.
- [25:51]
Tyler Foggatt
I mean, there are so many things to worry about from that clip, but I guess the first is that, I mean, we are listening to it slightly out of context, but it seems like Trump's message is so. I mean, you hear that and you just think, like, don't take Tylenol. But it's not even clear to me as, like, someone who encounters that clip on Twitter, which is where I first saw it, that, like, there is the problem here, or the potential problem is the idea of taking Tylenol when you are pregnant. So I guess, like, what are the, I guess, potential ramifications of having someone like Trump who, I mean, even if you were, like, the biggest Trump supporter in the world, you can't pretend like he has any kind of medical or scientific expertise. And I don't think he usually purports to have that expertise. So, like, just having him go on stage and say that you shouldn't take Tylenol unless you are literally about to die.
- [26:44]
Dhruv Kullar
That whole press conference was incredibly irresponsible. You know, that is not the way that public health or science should be communicated in a country like ours. It was confusing. There were all sorts of false claims. There wasn't requisite evidence given for the claims that were being made. And you could tell at times that Trump himself felt uncomfortable delivering medical advice. As someone without any medical expertise, he said things like, this is just the way I feel about it. And one of the challenges here is that he's Using the bully pulpit of the United States to raise questions about a topic that is still disputed and inconclusive. I mean, Tylenol is one of the most widely used medications in the United States. And to say something like it causes autism if it's used in pregnancy without solid research, again, it's just incredibly irresponsible. So what we know is that there has been some links in some studies. These are observational studies. These aren't randomized controlled trials, which are difficult to do in pregnancy, of course, but very high quality studies have found no links. And so there's a large study of more than 2 million people, for instance, that tested siblings. And so if the mother took Tylenol with a pregnancy for one sibling and not with the other, there was no difference in the rate of autism. And I think by getting ahead of the evidence, imagine what he's doing here. I mean, if you're a woman who's pregnant with a child or a new mother whose child ends up having autism, the level of burden you're placing on that person, thinking back, you know, if I only had not taken that pill of Tylenol, maybe my child's life would be different. That's an incredible burden to place on someone without any evidence. The other thing that I'll just note is that they also raise this idea that leucovorin, which is a B vitamin, can treat autism based on very small studies of several dozen participants. I mean, it's something that I think requires more research. The scientists that are doing that research would tell you it's an interesting idea, and it requires further trials. But to put that out there and then to give this hope, that maybe false hope to millions of people across the country, again, I think is just irresponsible.
- [29:04]
Tyler Foggatt
Why do you think that the administration is so focused on autism? Part of this announcement was pouring money into research to study the causes of autism. But this is also. I mean, it just. It strikes me as strange given that the government also just cut almost $800 million in health research funding, I guess. Why is the MAHA movement so focused on autism in particular and not dementia? And just like other, you know, sort of like other ailments that, you know, we're all kind of searching for, you know, a cure for or a cause for.
- [29:33]
Dhruv Kullar
I think some of it is downstream of vaccine skepticism that Kennedy and others have. I mean, this is what people have pointed to as the major risk of vaccination, which has been debunked over and over again. But it also kind of bleeds into this idea that there are environmental toxins all around us and this idea of contamination that is also close to Kennedy and those around him. And can we identify the environmental toxins that are potentially contributing to what we're seeing in children and others? So I think it kind of grows out of this underlying vaccine skepticism, but it's also a genuinely really important topic, and it affects millions of people across the country. And so I'm glad that there's more attention being paid to autism, that there's more work, that there's more discussion being devoted to it. We just wish it were happening in a more responsible manner.
- [30:27]
Tyler Foggatt
So in a minute, I'd like to talk about how the various states are responding to the Trump administration's public health policies. This is the political scene from the New Yorker. America is changing and so is the world.
- [30:47]
Dhruv Kullar
But what's happening in America isn't just.
- [30:50]
Robert F. Kennedy Jr.
A cause of global upheaval. It's also a symptom of disruption that's happening everywhere.
- [30:55]
Tyler Foggatt
I'm Asma Khalid in Washington, D.C. i'm.
- [30:58]
Robert F. Kennedy Jr.
Tristan Redman in London, and this is the Global story.
- [31:02]
Tyler Foggatt
Every weekday, we'll bring you a story from this intersection where the world and America meet.
- [31:07]
Robert F. Kennedy Jr.
Listen on BBC.com or wherever you get your podcasts.
- [31:21]
Tyler Foggatt
So let's talk about what kind of response we've been seeing to Trump's efforts to roll back vaccines and kind of sow doubt in the medical establishment. I found it really interesting that in the most recent piece you wrote that in the US it's actually the states themselves that get to determine public health policy for the most part, so they can establish their own quarantines and set their own standards for medical professionals, for licensure, that kind of thing. But would you say that up until now, at least, that states have been more or less aligned when it comes to vaccine policy, or has there always been a situation where, like, some states are doing this and some states are doing something else?
- [31:55]
Dhruv Kullar
There's always been variation within small bounds. But as you say, the power for most public health interventions is at the state level. So if you think about things like issuing quarantines or enforcing curfews, regulating businesses, seatbelts, all those things really happen at the state level, not at the national level. But for most of our recent history, the federal government has influenced powerfully how states go about things like vaccination, because they've put out high quality information that can then be used by local politicians and state agencies to develop their own protocols around this thing. And this system has worked incredibly Effectively, you know, it should be noted that things like routine childhood vaccination, they've saved more than a million lives in recent decades. They've averted, you know, trillions of dollars of unnecessary health spending. And so we should be very grateful that we have this system in place. But it's now being kind of torn down, and states, as you're saying, are trying to fill the void. And sometimes that means that states are trying to come up with their own policies now. And depending on their political persuasion, they're going one of two ways. I mean, a lot of Democratic states are now trying to protect access to vaccines by requiring, for instance, that insurers cover immunizations recommended by the state's health department, as opposed to by the cdc. At the same time, a lot of red states are moving in the opposite direction. And so Idaho has passed a law that prohibits employers and schools from requiring vaccination. Florida is trying to do away with, with all vaccine mandates in the state. And so I think what we're going to end up seeing is a very fractured approach to public health policy. And that means that if you live in one state versus another state, you might have a very different health outcome.
- [33:51]
Tyler Foggatt
Yeah, I mean, I just have this question, not only as the host of this podcast, but as like a genuinely concerned and curious citizen. When you say that we're heading toward a situation where we have fractured vaccine policies, depending on whether you're in a red state or a blue state, does that also mean that we're going to have a situation where you have herd immunity in blue states to certain viruses, but not in red states?
- [34:14]
Dhruv Kullar
I think it might be more granular than that. So there are certainly pockets of low levels of vaccination in blue states and high levels of vaccination in red states, of course. But what I think it means is that, yes, depending on the community in which you live, your child's risk or your own risk for an infectious disease, or might vary greatly because of the vaccination rates and the policies of that locality.
- [34:37]
Tyler Foggatt
What have, like, the conversations in red states about vaccine rollbacks looked like? You know, in your piece, you mention West Virginia as a really interesting case of a red state that is also, you know, kind of leading the charge or has led the charge in terms of sort of vaccines and vaccine mandates. And I'm curious, sort of what conversations are being had there and whether their outlook is changing.
- [35:01]
Dhruv Kullar
So West Virginia is a really interest case study here, in part because they have some of the highest school age vaccination rates in the country. And that's because they have some of the strictest vaccine mandates for children who are entering school. So West Virginia, their vaccination rates for children before they enter school are among the lowest in the country. And as soon as they enter school, they have among the highest in the country. And this is a state, we should mention, that voted for Donald Trump by more than 40 points in the last election. It's a state that basically every county has voted for the Republican presidential nominee in each of the last four presidential elections. So it's a very, very conservative state. And it has again, some of the highest rates of vaccination for school aged children. That is something that can occur. And one of the things that I want to draw out in the piece is that vaccination is kind of different than a lot of other challenges that we face. And so if you think about how difficult it is to move the needle on childhood obesity or how difficult it is to reduce screen, screen time among children, those are really naughty, complicated problems that don't have any easy solutions. And here, a single policy, the law that West Virginia has in its state that some people are now trying to challenge has protected thousands and thousands of kids and is really a model, at least up until now, for how you can lead in a red state on vaccination. I should note that the current governor has issued an executive order to try to weaken the state's immunization requirements, and that's now being challenged in court. And the legislature has voted down legislation that would do the same. And so that's gonna work its way through the court. We'll see what happens in the coming months. But this year, the US has had one of the worst measles outbreaks in a decade. There has been more than 1400 cases across the country. There's been several deaths because of measles. It's spread to dozens of states, and West Virginia hasn't had a single case. And that's in large part due to their very high rates of vaccination.
- [37:02]
Tyler Foggatt
You have me ready to move to West Virginia. In the piece, you sort of talk about how it can look like vaccine politics are hopelessly polarized. And when we talk about this, and you know, this idea of certain blue states forming these public health coalitions and coming up with their own vaccine policies and then red states moving forward with their own rollbacks, it can definitely seem like the situation is polarized beyond repair. But then you also point out that vaccination and even vaccine mandates still have overwhelming public support. You know, among most people in the country, and that, you know, this is true in places like West Virginia, but even in other places that we think of as red. And so how do you think that we should make sense of that disconnect between the political strife that we see, you know, on TV and in these, you know, conversations about executive orders coming down from governors and then just the fact that most people seem to like vaccines.
- [37:56]
Dhruv Kullar
This is such an important point. And it gets to this idea that a lot of our conversation is driven by people at the fringes because they are the loudest and they're able to get their message in front of more people. But the reality is, as you say, that most people are in favor of vaccines. Most people are in favor of vaccine mandates. They believe that children should be vaccinated before they go to school. And that is true in red states. That's true in blue states. And I think more of our conversation, for people who want to find common ground, who want to protect our public health, needs to focus on this idea that most of us are on the same page about this. It seems like an incredibly divisive issue, and it is in some ways, but it's also something that enjoys 70, 80, 90% support among Americans. And so that's what we should really be focusing on.
- [38:49]
Tyler Foggatt
Yeah. And I guess the hope is that even these states that are kind of going along with the MAHA agenda for now, if they realize that it's alienating their own constituents, maybe they will walk away from a vaccine policy that also looks like a losing policy.
- [39:04]
Dhruv Kullar
Absolutely. I mean, part of it is winning the kind of rhetorical battle and understanding where people are on this. But part of it is every year that goes by with weaker and weaker vaccination rates is a year that places you at a higher risk for a devastating outbreak. And I don't think anyone wants this to see that in their community. And, you know, I hope it doesn't take that for people to reverse course on this. I hope we can kind of win the discursive battle. But I think at the end of the day, both Republican and Democratic politicians want what's best for their constituents. And what's best is making sure that people have access to the technologies that are gonna keep them safe.
- [39:47]
Tyler Foggatt
Thank you so much, Dhruv.
- [39:48]
Dhruv Kullar
Thanks for having me.
- [39:49]
Robert F. Kennedy Jr.
Me.
- [39:52]
Tyler Foggatt
Dhruv Kular is a contributing writer at the New Yorker. You can find his latest piece on the changes to US vaccine policy@newyorker.com this has been the political scene from the New Yorker. I'm Tyler Foggit. This episode is Produced by John LeMay with mixing by Mike Kutchman and engineering by Michael Juno. Our executive producer is Stephen Valentino. Chris Bannon is Kane Ness, head of Global Audio. Our theme music is by Alison Layton Brown. Thanks so much for listening and we'll see you next Wednesday.
- [40:33]
Katie Drummond
I'm Katie Drummond. I'm Wired's Global Editorial director.
- [40:36]
Dhruv Kullar
I'm Michael Colory, Wired's Director of Consumer Tech and Culture.
- [40:40]
Tyler Foggatt
And I'm Lauren Good. I'm a senior correspondent at Wired. And our show, Uncanny Valley is all about the people, power and influence of Silicon Valley.
- [40:49]
Katie Drummond
At Wired, we're constantly reporting on how technology is changing every aspect of our lives. So each week on the show, we get together to talk about one of the biggest stories in tech, Right?
- [40:59]
Dhruv Kullar
So whether we're talking about privacy, AI, social media, or a major tech figure, we will always explain the Silicon Valley forces behind these stories and how they affect you.
- [41:09]
Katie Drummond
Make sure you're following Uncanny Valley in your podcast app of choice so you don't miss an episode.
- [41:20]
Dhruv Kullar
From prx.