Daniel Engber
Appearances
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
You know, a worst-case scenario is there's some dramatic shift in policy at the CDC. There could be dramatic shifts at the FDA, which approves new vaccines. You know, they could choose not to approve them. Or there could be new safety requirements for vaccines, which— just slow things down.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
I mean, that's another bad scenario that, you know, it's not like vaccines are banned or taken away, but just the release of new vaccines is slowed dramatically. I mean, we could have another pandemic in the next few years, H5N1, bird flu, right? And so if we have RFK and Dave Weldon in charge, like, how fast is the next Operation Warp Speed? That's very unclear to me, and that strikes...
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
me as a potential terrible scenario. What RFK could do, what someone in a position of power could do, is just create obstacles, right? If the big dramatic success of national vaccination over the past 30 years has been providing access to children who didn't have that access before, if that's what brought the measles vaccination rate up from 80-something percent to 90%,
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Then just undo that, right? Like just create obstacles for people to get the vaccines they want. Just take away the whole choice architecture that leads people to get vaccinated if they don't have strong opinions on it one way or another. Take away the clinics that provide the shots, right? That's how you would lower the rates if that was your only goal.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
I thought, I can't believe this is really happening.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
So I remember Trump had a meeting with RFK in early 2017. And RFK, do you remember, he came out of Trump Tower and he was like, I'm going to be the head of a new vaccine safety commission. And I and many other science journalists immediately got to work thinking about what will we do if that happens? And then it didn't happen.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Trump was just sort of toying with him as he toyed with Mitt Romney and many others. So in the back of my head, I kind of thought, well, maybe that's going to happen again. But it's different this time.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
No. I mean, so RFK has been tapped for health and human services, but then there's a whole host of kind of contrarian characters in public health who are similarly being put up for important positions.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
What all of these people seem to have in common, with the exception of Weldon maybe, is they were critics of the COVID response. But other than that, I mean, there are clear differences among these people, too. Some of them are, you know, very conventional thinkers on the value of vaccination. Others are really on the kind of anti-vaccine end of the spectrum.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
I think when an LLM tells you something that appears to be sentient, it's just mimicking human data.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Well, I think RFK is kind of like the king of the anti-vaxxers category.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
I mean, he describes himself as not being anti-vaccine. I don't think there's anyone who describes themselves as being anti-vaccine. So, you know, perhaps we should retire that term or maybe we should use it despite these people's protestations. But in any case...
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
He's very worried about the conflicts of interest behind the decisions that are made to approve and distribute vaccines, and particularly concerned about safety issues with certain vaccines. The measles, mumps, and rubella vaccine in particular, he's spread a lot of doubt about that and its potential link to autism, which has been demonstrated not to be a real connection.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
And also, he has a lot of concerns about mercury in vaccines, and he stepped away from it recently to run for president. But he was in charge of children's health defense, which described doubts about vaccines arising during the pandemic as the pandemic's silver lining and as good news that vaccination rates were dropping for the nation's children.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
So I would say this is a radical organization on vaccine issues. So that's RFK. And then Dave Weldon, the former member of Congress from Florida, who has now been nominated to run the Centers for Disease Control and Prevention. He has a long history of also being wary of vaccination, believing in the link between the MMR vaccine and autism.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
He invited Andrew Wakefield, who's best known for producing a study of the MMR vaccine and its alleged link to autism that has since been debunked. So Weldon invited Wakefield to come to Congress. You know, this is a couple of decades ago, but still, that's You know, that's the track record we have for Weldon, who has not really done a lot in public life recently.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Okay, well, I mean, fully out of the mainstream is how I would describe it, just in the sense that what we're talking about here really is rejecting standard public health advice, and standard public health advice is very mainstream. So more than 90% of the nation's children are getting this sort of standard set of immunizations. They're required for entry into school at kindergarten.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
This is like not particularly a controversial issue for most Americans. It's even an understate for almost all Americans, right? So it's more than 90% of kids are getting these shots. And the people who don't, it often is as much to do with access or various other reasons that have nothing to do with like an ideological opposition or a dispositional skepticism of vaccines.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Well, it is unclear, right? In simple terms, the vaccine mandates for children, let's say, to get into public school, that's handled at the state level. There's nothing RFK could do or any of the people that he appoints under him to change the requirements for kindergarteners in California or New York or Florida. That's going to be handled locally. So that's just one thing that's off the table.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
However, as secretary of HHS, Kennedy would have control over the recommendations made by the CDC. And of course, Dave Weldon also would be in that line of decision making. So at the CDC, there's a committee that comes together and decides which vaccines are going to be recommended for which age groups, and they decide sort of the nature of the recommendation.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
If it's, I mean, there's sort of these technical distinctions here, but is it as a strong recommendation? Is it a recommendation that the vaccine be discussed between the patient and their healthcare provider? That sort of thing. Now, once those recommendations are made, insurance companies tend to pay for the vaccines, and state public health officials tend to mandate them.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
So everyone takes their cues from CDC on this. Not always, always, but generally, this is how it works. So what happens if people with fringe beliefs are in control of this committee? If that committee starts making recommendations, let's say, I don't think this is going to happen, but against recommending the MMR shot for children, What would happen at the state level? Who knows?
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
That would be, I think, uncharted territory. But again, the decision, the actual decision would be made, the policy decision would be made at the local level.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
And sometimes, you know, the vaccine schedule will change. The standard set will change. And when there are new vaccines in the mix, the HPV vaccine, for example, or the COVID vaccine and COVID boosters of recent years, then, you know, there's real discussion. Well, this booster, should it be recommended for people of all ages or only older people?
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Should there be, you know, different guidance for young men, let's say, given that there's some evidence of some adverse heart-related effects for young men who take the mRNA vaccines? So then there's no, you know, business as usual. There's discussion and debate and decisions are made, right?
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
There's another part of it which I should mention also, which is the federal government administers something called the Vaccines for Children Program, which provides something like half of the immunizations for children in the country. That's a multibillion-dollar program. That's just another place where if you had vaccine skeptics in control, who knows what might happen.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Yeah, vaccination rates for children have increased pretty dramatically since the early 90s. And that's largely due to this program. And the issue, again, it's not like there were lots of vaccine skeptical parents in the early 90s. who have now been converted to the proper way of thinking, in quotes.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
No, it's just that there were a lot of children who didn't have access to vaccines, and now they do because of the Vaccines for Children program.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Yeah. Like I said, it's kind of uncharted territory. It's hard to know how these things will play out, right? You know, at the level of the CDC recommendations, if there was just a dramatic shift in what was being recommended, how would the system respond? it's really hard to imagine, right?
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Because I think you would still have most doctors in the country believing that these vaccines were extremely important for their patients. You would still have most parents believing that. I mean, the large majority of parents strongly endorse the value of vaccines and many, many local health officials. So I don't know. I mean, it's It's hard to say.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
I do think about what's going on in Florida as maybe a case study. So, you know, Ron DeSantis, when he was challenging Trump for the nomination, seemed to have made a decision to run as the vaccine skeptical candidate. Trump's history here is a little weird, right? He took credit reasonably for Operation Warp Speed, which developed the COVID vaccine really quickly.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Was proud of it, endorsed it initially, and then kind of following his constituents, drifted a little bit in the other direction over time and then came out against vaccine mandates in schools and then... seems to have an ambivalent attitude towards the COVID vaccine, let's say. But DeSantis, I think, saw this as an opening and said, okay, I'm going to really lean into this.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
There are a lot of Republican voters for whom this is an important issue. So DeSantis himself had been very excited about the COVID vaccine initially and then kind of turned against it. And he brought in a guy named Joseph Latipo to head the Florida Health Department in the end of 2021.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
And LATIPO has been, among other things, quite an aggressive opponent of COVID vaccination, not just of vaccine mandates. That's kind of the standard position. LATIPO has been warning people in Florida that the COVID mRNA vaccines are potentially unsafe. and that no one should get them ever. At first, he was like, well, you know, they're dangerous for young people.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
And most recently, he's just said mRNA vaccines are potentially dangerous, period. For a statewide official to be so aggressive about recommending against the use of a CDC-recommended vaccine, that's very unusual.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
So he's been in charge since late 2021. COVID booster uptake has been low everywhere. But what I thought was quite interesting is when I started looking at the stats for Florida, it was really hard to find like a Latipo effect. Again, this would be an effect of having the person in charge of your statewide public health department recommending against vaccination. Like you might think,
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
coming to this fresh that, well, that person is going to have so much power and control. Their word is going to be so influential. So you would expect their vaccination rates, COVID vaccination rates in Florida to fall off a cliff. They didn't. And age-adjusted COVID mortality rates did not increase.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
under Latipo, it was just kind of hard to find evidence for that Latipo effect that I was looking for, which I, again, was sort of imagining as this is what happens when you put someone who's suspicious of vaccines in charge.
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
Yeah, I mean, it just sort of supports my general belief that there's a lot of inertia in the system and, you know, people are going to behave the way they're going to behave by and large. It's not as easy to push parents as a giant group of people in the United States to suddenly stop vaccinating their kids, right?
Radio Atlantic
How Fragile Is Our Vaccine Infrastructure?
So that's kind of my baseline expectation is that it is hard to budge this system. But again, I've never, you know, in my life seen people like RFK and Dave Weldon standing, you know, on the bridge, right? So this is just something that we haven't seen before. So it's not really analogous to Latipo in Florida, who's just one state surgeon general saying, don't get your COVID booster. Right.