Anti-vaccine sentiment is, more or less, as old as vaccines. When Cotton Mather promoted inoculations against smallpox in the 1720s, someone threw a firebomb through his window with a message attached: “Mather, you dog, Damn you, I’ll inoculate you with this.” Today's vaccines are as safe and effective as ever. So why, suddenly, is the anti-vax movement at the height of its power and influence? Robert F. Kennedy Jr., the nominee to be the next secretary of the Department of Health and Human Services, is “the king of the anti-vaxxers,” says Atlantic senior editor Daniel Engber. But RFK Jr. isn’t alone. An array of nominees across the fringe-science belief spectrum appears ready to take the reins in Trump’s new administration. In this episode, we discuss this disorienting moment, when anti-vaccine conspiracy theorists may soon be in charge of the agencies that fund, recommend, and research vaccines, with Engber and Arthur Allen, author of Vaccines: The Controversial Story of Medicine’s Greatest Lifesaver. What levers could the anti-vaxxers in charge pull to disrupt vaccine distribution? How could they affect vaccine recommendations and research? And what happens if there is an outbreak? Ultimately, how fragile is the nation’s vaccine infrastructure? --- Share understanding this holiday season. For less than $2 a week, give a year-long Atlantic subscription to someone special. They’ll get unlimited access to Atlantic journalism, including magazine issues, narrated articles, puzzles, and more. Give today at TheAtlantic.com/podgift. Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What is the history of anti-vaccine sentiment?
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For all the parents listening, I bet you remember this moment. You have this tiny new creature in your life. You feel vulnerable. The new baby seems extra vulnerable. And one of the first things you have to do to this tiny creature is let the doctor inject into her small amounts of disease.
Chapter 2: How are vaccines related to government trust?
But you almost certainly have to do it for a kid to go to school, which makes vaccines a very real way that people feel the presence of the state in their lives. And so vaccines turn out to be a very excellent way to examine this moment we've landed in, where people who deeply mistrust the government are suddenly in charge of critical parts of it. I'm Hannah Rosen. This is Radio Atlantic.
And today, we're going to talk about vaccines — more specifically, the anti-vaxxers who Trump has nominated to run our health institutions and how they might change our world. One critical dividing line between the two parties right now — maybe the critical dividing line — is trust in expertise, in authority, in institutions.
And this showdown, which in the coming administration will play out over lots of arenas — the military, education, intelligence — it's been brewing in the vaccine world for years, maybe centuries. Let's start in the modern world with Trump's nominees, who they are, what they believe, and what they might do. To help me with that, we have Atlantic science writer and editor Daniel Engber.
Dan, welcome to the show.
Thanks, Anna.
So when Trump announced RFK as his pick to be the next Secretary of Health and Human Services, what was your reaction?
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Chapter 3: Who are Trump's controversial health nominees?
I thought, I can't believe this is really happening.
Uh-huh.
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.
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.
Yeah. And it's not just RFK, right?
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.
President-elect Donald Trump has selected one of the nation's most prominent critics of COVID-19-era lockdowns and mandates to lead the National Institutes of Health.
Trump tapping yet another television personality to join his administration. This time, Dr. Mehmet Oz. Trump naming the TV doctor to oversee Medicare and Medicaid for more than 160 million Americans.
Former Florida Congressman Dr. Dave Weldon for CDC director.
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Chapter 4: What influence do anti-vaxxers have on vaccine policy?
OK, so let's talk about this broad category of anti-vaxxers or vaccine skeptics or vaccine doubters. Who are they and what do we know about what they believe?
Well, I think RFK is kind of like the king of the anti-vaxxers category.
There's no vaccine that is, you know, safe and effective. I do believe that autism does come from vaccines. You know, all I've said about vaccines, we should have good science.
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...
Chapter 5: How is vaccine safety perceived by skeptics?
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.
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.
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.
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.
Now, Weldon said in an interview that, like you said, he would not describe himself as anti-vaccine. His own children are vaccinated and that he administers vaccines in his own clinic. So help me understand how to categorize these guys. I mean, we've got RFK and Dave Weldon who are specifically associated with skepticism about vaccines.
How would you as a science journalist characterize their skepticism? How should we understand it?
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.
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.
So I would say this is a fringe belief.
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Chapter 6: What is the Vaccines for Children Program?
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.
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?
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.
So right now the state of affairs is that there are this fairly standard and commonly accepted list of vaccines that are approved year by year by the CDC. And then that translates down to insurance companies and schools. And it's basically a kind of routine process now. Like it doesn't have that many hitches, even though there's some number of people who opt out of getting vaccines for their kids.
Chapter 7: How does public health respond to vaccine skepticism?
Mostly it's just gone through as a standard part of American childhood. Yeah. check, check, check, get these vaccines.
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?
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?
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.
Just so I understand, that's like, you know, let's say there's a group of people who only can get their vaccines through a public clinic. This is federally funded, like federally funded vaccines. So if people can't afford vaccines or don't have insurance, their children can still get vaccinated and go to school.
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.
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Chapter 8: What could happen if vaccine recommendations change?
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.
Okay, I have to say what you just described seems like a tremendous amount of influence or potential influence over routine vaccinations.
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?
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.
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.
Seemed proud of it, in fact.
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.
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.
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.
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