Well something very odd happened yesterday: RFK Jr. released an opinion article on Fox News entitled “Measles Outbreak is Call to Action for All of Us: MMR vaccine is crucial to avoiding potentially deadly disease.” Today, the same statement was released via the HHS press room. There are some things in it that I didn’t expect to see, because they don’t seem to be at all aligned with any of RFK’s statements or actions since he took office, such as “As healthcare providers, community leaders, and policymakers, we have a shared responsibility to protect public health. This includes ensuring that accurate information about vaccine safety and efficacy is disseminated. We must engage with communities to understand their concerns, provide culturally competent education, and make vaccines readily accessible for all those who want them.” There was also “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”
However, the statement also says “Tens of thousands died with, or of, measles annually in 19th Century America. By 1960 — before the vaccine’s introduction — improvements in sanitation and nutrition had eliminated 98% of measles deaths. Good nutrition remains a best defense against most chronic and infectious illnesses. Vitamins A, C, and D, and foods rich in vitamins B12, C, and E should be part of a balanced diet.” (The statement about good nutrition remaining a best defense links to an article about micronutrients on cdc.gov, which says “Children with vitamin A deficiency face an increased risk of blindness and death from infections such as measles and diarrhea,” but doesn’t otherwise mention measles, or how good nutrition might be protective against measles.)
The statement also notes that CDC has recently updated their recommendation supporting administration of vitamin A under the supervision of a physician for those with mild, moderate, and severe infection…which happened Feb 27, after RFK Jr. was in charge of HHS. That updated recommendation says “Vaccination remains the best defense against measles infection. Measles does not have a specific antiviral treatment. Supportive care, including vitamin A administration under the direction of a physician, may be appropriate.”
To be clear, I’m not at all against good nutrition. Vitamin deficiencies cause all sort of health issues. But it’s very difficult to take this statement at face value, for a lot of reasons (even if you don’t count the big reason: that vaccines are one of the most safe and effective lifesaving interventions in the history of the United States). First, it was released with the label “Opinion” and it was released first on Fox News. That’s strange behavior for our nation’s top health official. Second, the subtitle calling the MMR vaccine “crucial” is the strongest pro-vaccine statement in the whole piece; anyone only reading the headline might think there’s a lot more changing in RFK Jr.’s notorious anti-vax stance than there really is. But third, a statement that “the MMR vaccine is crucial”, that “we must make vaccines readily accessible”, and that “we have a shared responsibility to protect public health” are in direct contrast to his other actions taken since he was confirmed as HHS Secretary, including just in the last few days:
–Cancelling the March 13 meeting of the Vaccines and Related Biological Products Advisory Committee (VRBPAC). This is like the “indefinite postponement” of the Advisory Committee on Immunization Practices (ACIP), which happened on Feb 20. ACIP drives vaccine recommendations that come out of CDC, while the VRBPAC is the external vaccine advisory committee for FDA. Why does it matter that the VRBPAC meeting was cancelled without explanation? This was the meeting that would have determined the formula for this fall’s flu vaccine. It takes about 6 months for manufacturers to develop the vaccines, so if we want them this fall, we need to decide the formula now. According to FDA, this won’t mean there won’t be a flu vaccine this fall, because they will still submit a recommended formula to manufacturers in time. This is probably because the US usually aligns with WHO recommendations, and WHO released their formula recommendation on Feb 28. If that’s the case, though, it’s ironic, since the US is withdrawing from the WHO but in this case is also using their work and scientists instead of allowing ours to meet. Without ACIP and VRBPAC, will health insurance be required to cover the cost of flu vaccines? Likely no, since under the ACA, private health plans (both individually purchased and employer-sponsored) are required to provide full coverage without cost-sharing for plan members to receive vaccines recommended by ACIP. No ACIP recommendation, no requirement to cover the cost of vaccines.
–Formally publishing a statement in the Federal Register today that will stop HHS’s longstanding practice of giving the public a chance to comment on its plans. Since 1971, HHS has given the public (including expert scientists, public health professionals, and healthcare providers who don’t work for HHS, along with anyone who might personally be affected) the opportunity to submit written comments with feedback about new proposed rules or regulations, before they are enacted. However, RFK Jr. has decided that when the agency is making decisions about “matters relating to agency management or personnel or to public property, loans, grants, benefits, or contracts,” they no longer need to seek any public input. The statement also notes that they may “forgo these requirements for ‘good cause’ when the agency finds that the procedures are ‘impracticable, unnecessary, or contrary to the public interest.’” To be clear, a very large portion of what HHS—a $1.8 trillion agency paid for with taxpayer dollars—does falls under this definition. Why are they rescinding the waiver that required HHS to seek public comment before making rules or regulations official? They “impose costs on the Department and the public, are contrary to the efficient operation of the Department, and impede the Department’s flexibility to adapt quickly to legal and policy mandates.” So in other words, it’s quicker and easier for us to just change rules (including about benefits or contracts relating to vaccine access) without giving taxpayers a chance to weigh in on those changes.
–Not new in the last few days, but many websites specifically designed to illustrate our “shared responsibility to protect public health,” such as CDC’s Social Vulnerability Index, came back online following a court order on February 11. However, they all now have a banner at the top that states: “Any information on this page promoting gender ideology is extremely inaccurate and disconnected from the immutable biological reality that there are two sexes, male and female. The Trump Administration rejects gender ideology and condemns the harms it causes to children, by promoting their chemical and surgical mutilation, and to women, by depriving them of their dignity, safety, well-being, and opportunities. This page does not reflect biological reality and therefore the Administration and this Department rejects it.” Even if that statement being put at the top of a CDC webpage doesn’t seriously distress you (it should, as it’s intentionally stigmatizing and not based in actual science), the even weirder thing is that any website they had to restore per that court order now bears this banner whether they had been removed or altered for trans or non-binary references in the first place. The Social Vulnerability Index page(s) use language and methods addressing the very real ways that the socioeconomic status or racial and ethnic demographics of particular neighborhoods in the US affects those communities’ vulnerability to disasters. Nothing in the index or on the page even mentions gender (except its mention twice in the newly-added banner).
On another note, not all under RFK Jr’s purview but distressing nonetheless: numerous US government-funded health research studies have now been halted throughout the globe (and this will probably only get worse given the dismantling of USAID and firings within HHS that have occurred since RFK Jr. was confirmed). These have not resumed. This means that researchers in South Africa had to violate the executive order to ask women who’d had vaginal rings implanted to prevent HIV and pregnancy to return anyway to the study site for removal, so they weren’t left with them implanted with no monitoring or follow-up. People who had volunteered for a malaria vaccine study in England were told there would be no more monitoring to see if they had any adverse reactions to the vaccine. There is a long list. Can you imagine if you volunteered for a research trial of something experimental, signed a form saying you understood the risks but also that the study staff were taking steps to mitigate those risks, and then suddenly you got a message that said “Never mind, we have no more money and can’t hold up our end of the bargain anymore—good luck!” This violates some of the most basic tenants of human subjects research ethics, and we should all be outraged that this is happening under the United States’ watch.