Robert F. Kennedy Jr., the nominee to lead the Department of Health and Human Services, has completed a marathon of meetings to shore up his confirmation votes in the new year. As his “Make America Healthy Again” movement moves closer to a seat of power in the federal government, onlookers are wondering how Kennedy’s sweeping criticisms of food, pharmaceuticals and health care will translate into actual policy.
Some general areas of agreement—ripe for policymaking—have emerged, including on limiting corporate influence in government and improving food supplies so that healthy food is accessible to more Americans. There also appears to be a bipartisan consensus that federal health officials should respond to the public’s distrust with transparency and clear communication. That, in turn, can rebuild trust that has waned over time and especially during the Covid pandemic.
STAT contacted Michael Osterholm, an epidemiologist, flu expert and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, to discuss the sketches Kennedy has made on vaccine policy and public health, what could actually happen improve and what could be counterproductive.
This interview has been edited for brevity and clarity.
Are there places where you agree with Kennedy or some of these “Make America Healthy Again” concepts?
While these appointments are clearly very important, when you are dealing with an agency with a budget of almost $2 trillion, involving 13 different directorates or agencies, senior leadership is often not in a position to really make decisions on a day-to-day basis. direct impact on what these agencies do. It all comes down to: How do they manage the current expertise within the federal government? And those are the Title 42 employees. These are the senior scientists and policymakers who are among the very best in the world at what they do.
There could be mass layoffs early in the administration, as they have stated at least. And that would be like cutting off someone’s head and then telling the body to run a marathon. If that does indeed happen, we will be so unprepared for almost anything that comes our way that, I mean, there has never been a time in the modern history of public health when we would be so vulnerable. A policy won’t matter if there is no one with expertise to move it forward.
Are there legitimate reasons to push for more transparency or better public health reporting at the federal level?
There are two major problems surrounding vaccination. One of them is: how well did the vaccines work? But the second thing is that the public is also really focused on the safety of the vaccines. For them, that is the immediate problem right now: will my son or daughter have a reaction to these vaccines? It seems far away for them to think of the 550 deaths a year from measles in the late 1950s or early 1960s. That just doesn’t connect. And I think as a public health community we need to do a much better job of detailing the safety issues and the fact that nothing in this world is absolutely guaranteed to be completely safe.
We know that young adolescent boys who were vaccinated with the Covid vaccine had a very rare but real event of acute myocarditis, an inflammation of the heart. These cases were generally mild. On the other hand, getting Covid itself posed a much, much greater risk of developing myocarditis, which was life-threatening, with cases of death occurring.
When I hear [Kennedy] talking about the need to “get the data” so he can look at it – as if he can somehow only understand data that no one else can understand – my first reaction is, “What data are you talking about?” The safety data on vaccines for licensing is public. Post-licensure vaccine data is public. We have not tried to cover this up. I am an example of this. In 1976, I was one of the people at the Minnesota Department of Health who first identified Guillain-Barré syndrome in swine flu vaccine recipients. We raised this issue, which led to the campaign being halted.
Given the way these ideas and the vaccine-skeptical sentiment have taken hold, do you think it’s worth opening this all up again?
We owe it to the public to share with them in detail how well the vaccines work and what they have done to prevent many, many, many thousands and thousands of deaths, especially in younger children, but also: it’s not abstract – “My child is due for their first dose of measles vaccine, should they get it or not?” I don’t think we’re doing enough to share with them the system that exists to assess safety, how that safety is interpreted and how that is shared with the public. Confidence in public health action is at an all-time low, at least in my lifetime. We just fire people like RFK Jr. or Andrew Wakefield or people like that. And we’re not doing enough to say what’s being done and what that looks like.
Do you think some of this has to do with corporate influence, as some people claim?
I’ve never seen anything with corporate influence. My big concern is actually that we will see more and more companies reconsider making vaccines. Look at the future sales of oncology drugs and neurological drugs. Today, vaccines are very, very low on the return on investment scale. We assume that these companies will always be there and that they will always continue to do so. I’m afraid we’ll find a day ahead – and we’ve seen this in the international market. Look at cholera vaccines and mpox vaccines, I can go through a laundry list of vaccines that we are really short of. Are we going to drive these companies away from making vaccines?
What would happen in that case?
Don’t know. That’s what really worries me. In the early 2000s, we had one company that was responsible for a large portion of the flu vaccine for one season and they ran into a major production challenge. We had a major shortage of flu vaccine that year. In high-income countries, we just assume that these vaccines will be there. It’s like waking up every morning and assuming you’ll have electricity and water. It’s a crisis if it doesn’t happen.
And if I hear correctly, the supply of US companies would also have global consequences, right if they were to cut back?
Absolute. Yes, the whole world is dependent. And that is such an important point. It’s easy to talk about how bad vaccines are when there are still very few people who get this infectious disease. But we are at a tipping point, where the rate at which parents are no longer vaccinating their children, by essentially abandoning a vaccine mandate, will catch up with us and accelerate.
It sounds like you don’t agree with the idea of rescinding or relaxing vaccine mandates.
No, no, no. I have spoken out against Covid vaccine mandates because, in my opinion, a mandate should be reserved for a vaccine that is highly effective, long-lasting and actually impacts community transmission. Measles, mumps and rubella are good examples of those vaccines. They meet all these criteria.
Right, so I should have separated that. You are not against repealing vaccine mandates for long-term childhood vaccinations?
How well do they work? Do they actually stop transmission in the community? Then I can claim that this is a public good. There will be a child in one of these schools who will have an underlying immune deficiency that, even if vaccinated, still puts them at risk of developing an infection and dying. It helps to buffer that risk by having everyone vaccinated. I strongly support that kind of vaccine.
I hear people say to me, “I thought you would be in favor of all these vaccines.” Well, I certainly encourage them. Even though the flu vaccine may only be that [offer] A reduction of 30 to 40% [the risk of] A hospital admission is a lot better than not being vaccinated at all. But at the same time, it doesn’t stop transmission in the community. That is a completely different vaccine than a childhood vaccine.
What about liability protection for vaccine manufacturers? Do you think these should be removed?
Before personal injury legislation, companies quickly exited the vaccine market. Individuals who have had legitimate side effects related to a vaccine should be fully compensated – without and, if, or but. At the same time, we need a process that, in a sense, helps buffer the industry so that they don’t bear the consequences. Otherwise they’re gone. That’s why the $0.75 per dose tax on vaccine production is intended to provide that.
STAT’s coverage of chronic health conditions is supported by a grant from Bloomberg Philanthropies. Us financial supporters are not involved in decisions about our journalism.