'If You Can Keep It': HHS Versus The Science

0:07You're listening to the 1A Podcast. I'm Jen White. And I'm Todd Zwilich. We're back this week for If You Can Keep It, where we talk about the latest political news and what it means for the health of our democracy. This time, how politics is reshaping public health, dividing institutions, and eroding trust. In recent weeks, we've seen a seismic shakeup inside the Department of Health and Human Services and unprecedented discord between the agency, scientists and doctors. HHS Secretary Robert F. Kennedy Jr. is defying decades of scientific data and proven life-saving benefit, especially when it comes to vaccines.

0:43All along the way, he's bucking the science-backed guidance of doctors groups. And Senator Bernie Sanders of Vermont had something to say about that at a Senate hearing on Thursday where Kennedy was called to testify. Who are the organizations that are agreeing with you in casting aspersions on vaccines? the uh the the the primary advisors are marty mccary uh jay butchara doctor oz then i proceed you got a few doctors who agree with you and i'm giving you the name not a few doctors what you're talking about is there's a big difference senator between established science and the scientific establishment which has been co-opted by the So you're telling me, you're telling the American people that the American Medical Association, representing hundreds of thousands of people, have been co-opted and that they should not trust their doctors.

1:39The American Academy of Pediatrics, the American, and by the way, just for the record, every single Republican, I don't mean to be political here, Mr. Chairman, has received PAC money from the pharmaceutical industry. Are they all corrupt as well? So what happens when political ideology outweighs medical consensus? We talk about it today with our guests right after this. Stay with us.

2:06Let's get into the conversation with our guests. Julie Rovner is Chief Washington Correspondent at KFF Health News and host of the What the Health podcast. She joins us in studio in Washington. Julie, welcome back. Thanks for having me. And back again is Dr. Paul Offit. He's director of the Vaccine Education Center at the Children's Hospital of Philadelphia. Dr. Offit, hello again. Happy to be back. Well, Dr. Offit, some news since you were last on the show just a week and a half ago. You were removed from the FDA's Vaccine Advisory Committee despite having accepted a third term. Walk us through what happened.

2:42Right, so I served the first term between 2017 and 2021. These are usually four-year terms, then I served a second term until 2025. And as far as I was concerned, I was finished. But a senior official at the FDA wanted me to be on for another four years. I said that I would do that for another two years. And he said, great. And I was then on the roster until 2027. There's forms you have to fill out every time you rotate through, which is the so-called special government employee forms, which I sent in. And this was usually just a pro forma thing. It breezed through the FDA. And then it got stuck at Health and Human Services.

3:19and it's not clear to me why. It was never explained to me why they had made that decision. All I knew was that because Health and Human Services wouldn't sign off on my reappointment, I was no longer on the committee. What do you make of this change? Well, I mean, the obvious thing would be to say that because I have been, I think, a plain-spoken critic of Robert F. Kennedy Jr., that he held up my nomination. But I don't know that for certain. All I know is I'm not on the committee anymore. Um, Julie, the ousted CDC director, Susan Minaris said last week that she was pressured to pre-approve vaccine panel recommendations without scientific review at the CDC.

3:59That's the same committee from which Dr. Offit was dismissed. Four other top CDC officials resigned in protest after that firing was big news a couple weeks ago. What does this tell us about the current state of scientific integrity within federal agencies, especially at HHS? You know, I've been doing this for a long time, as you know, about almost 40 years. I have never seen sort of the tension between public health and the rest of politics at the level that it is right now. I mean, every public health organization, people who've spent their entire careers in public health are basically calling this a five alarm fire.

4:40that basically we are seeing public health wiped out effectively in the United States. Morale has never been so low at the CDC, which has long enjoyed bipartisan support. I mean, there are controversial things about public health. There always will be. It's this tension between what an individual wants and what's good for the community. That's what public health is. But we've never seen so much hostility directed towards public health, I think, as we're seeing right now. perhaps back during the Spanish flu pandemic. But you have to go back that far. You have to go back that far. Dr. Offit, when you look at the drain of expertise at HHS and you think about the long-term prospects for public health in the U.S., what concerns you?

5:29Well, many things. One is that one can no longer turn to the Advisory Committee for Immunization Practice or frankly by extension the CDC to know that you're getting reliable, up-to-date, scientifically accurate advice. Two is it's just been a shredding of CDC in terms of its surveillance capacity, in terms of its ability to fund immunization programs that are needed in high-risk areas. Three, you've seen sort of just a complete elimination of many grants at NIH having to do with chronic diseases Robert F. Kennedy Jr. says he's interested in, like Alzheimer's or Parkinson's or diabetes, heart disease.

6:07So it's just sort of a total dissolution of public health as we know it, because it's being directed by someone who has for 20 years been a virulent anti-vaccine propagandist and science denialist and conspiracy theorist. And that's what you heard in that little clip. He always resorts to that everybody's in the pocket of industry except him. Well, Julie, more than 1 ,000 current and former HHS employees signed a letter last week calling for Kennedy's resignation. Give us an overview of what's happening inside the agency to garner that reaction. Well, first of all, almost a fifth of the agency's workers have either resigned, been laid off, taken early retirement.

6:50I mean, there's really, the brain drain is really remarkable. This is not just at CDC. This is across HHS at agencies like the NIH and the FDA. So we do have an enormous lack of expertise of people really walking out the door. So the people who are still there are very concerned about their ability to do their job. They're there to protect the nation's health. That is what they signed up for. A lot of the people who work at HHS could be making more money working in private industry, but they do it because they have a mission. I live in the Washington area. I live around a lot of people who work at these federal health agencies, and they actually believe in what they're doing, and they're very upset right now because they feel like they cannot do their jobs.

7:36Dr. Offit, RFK Jr., in a lot of places, including the pages of the Wall Street Journal recently, criticizes the CDC's previous leadership and emphasizes a shift towards alternative health approaches. He's been banging on that drum for many decades. He argued that the CDC's failures during COVID, during the pandemic, were because of politicized science and bureaucratic inertia. I think we could spend an hour on the so-called failures of the CDC and who has branded them a failure. That's a whole other show, maybe. Why do you think Kennedy is doing this? You already said that he's spent 20 or 30 years as a vaccine, anti-vaccine propagandist.

8:24Why attack the CDC in this way? What is he getting out of it? I think what happened is that we lost a significant amount of trust in the first two years of the pandemic. In the first year, when we didn't have anything, we didn't have antivirals or monoclonals or vaccines until the end of the year. So all we could do was, you know, shutter schools, close businesses, restrict travel, social distance, isolate quarantine. And I think a lot of people saw that as massive government overreach and were angry. They were angry at some level reasonably that schools were closed for as long as they were, businesses were closed for as long as they were.

8:58And I think the following year in 2021 when we had a vaccine, again, you know, you couldn't go anywhere that you wanted to go unless you had your vaccine card to your favorite bar or restaurant or sporting event or place of worship. You may be fired from your job. And again, I think people saw that as massive government overreach where they weren't allowed to participate in that decision. It was being dictated to them and presented in a dictatorial manner. And I think those two years, in those two years, we leaned into this sort of libertarian left hook. And one thing Robert F. Kennedy Jr. said I agree with, he said, I'm a product of this COVID pandemic because I think the COVID pandemic caused us to, in some ways, have disdain for these agencies.

9:34And that's what he has. He comes into that position with disdain for these agencies. If he spent any time with the CDC, he would be incredibly impressed by the people there, how hardworking they are and how much they want to do the right thing. I think he has no idea of what goes on at the CDC. We heard Kennedy erroneously cast doubt on the COVID-19 vaccine, Dr. Offit. How much other research is there about lives saved? What does it reveal? Right. So different groups have come up with somewhat different numbers, but somewhere between two to three million people had their lives saved by this vaccine.

10:11And somewhere between 200 ,000 and 250 ,000 people lost their lives because they chose not to get the vaccine. But it's interesting that you bring that up because during that hearing, he refused to say that vaccines saved one life. He just, one life, he just can't do it. He just can't bring himself to say anything supportive of vaccines because that's not who he is. We heard from Amber who emailed, I just returned to Massachusetts last week from visiting my family in Oklahoma. The difference between a red state and blue state is striking. My daughter is pregnant with twins and now will not be able to protect her babies with a COVID booster.

10:45I'm thankful for our governor and that I will still be able to get my COVID booster, my shingles vaccination and my pneumonia vaccination, and that my insurance will be required to cover them. I'm frustrated and sad by the circular logic of this administration. These decisions are only making us weaker as a nation. Coming up, what fragmenting health policies mean for schools and how families can navigate vaccination decisions in this environment of misinformation. We'll be right back.

11:16Let's get back to the conversation with this clip from Health Secretary Kennedy's Senate hearing. Republican Senator Bill Cassidy of Louisiana, a physician, spoke there. An email from a physician friend of mine. Hey, Bill, I'm not even sure what I'm asking you. But we're all confused and concerned about who can get the COVID vaccine. We are having our attorney try and render an opinion. But there's no firm guidance and concern about liability if vaccines are given to a patient, request it, but not on the current CDC list. Pharmacists are requiring a prescription now even for patients over 65, creating a huge headache.

11:50I submit these for the record. Without objection. I would say effectively we're denying people vaccine. I hate it wrong. Let's hear now from one of you. I live in southwest Florida. I live in Naples, and yesterday I went to CVS to pick up a prescription for my husband, and the tech there asked me if I wanted to get the new flu vaccine, and she said they also had the COVID. I did not want to do the flu vaccine right away, but I'm going to be traveling in a month, so I wanted to do the COVID vaccine, and I was just told as a senior woman in Southwest Florida that I must have a prescription for my physician in order to get a shot, a COVID shot at CVS.

12:34And last night at dinner, I was told by friends the same thing happened to them at Walgreens. So obviously this is going to be an issue. We heard from so many people in preparation for the show about difficulty getting vaccines. Todd, you tried to get one. I tried to get one yesterday in the District of Columbia to sign up for my seasonal flu shot and my COVID vaccine. I am not a senior citizen. I did go to CVS. I was denied a COVID vaccine, was told online I'm not eligible and that I can't get it. So unlike our listener in Southwest Florida, I'm not a senior citizen yet and couldn't get one. I don't know if that's a CVS thing or a District of Columbia thing, but it is true.

13:16I could not get one. And I've heard this from many people. Julie, what are the COVID guidelines at this point? Who can get a shot or should be able to get a shot and who's paying for it? What do we know? Well, let's talk about how this normally works. The FDA comes out with its approval of the, usually the annual flu vaccine sometime in August and this year also COVID. It was the FDA that said it's only going to be recommended for those over 65 and those with some preexisting health condition. Normally what happens is that ACIP, the Advisory Committee on Immunization Practices at CDC, meets within a few days and basically makes it either usually just ratifies what the FDA has done or makes its own recommendations.

13:58And that goes to the head of the CDC, who then approves it. And then we trigger all of the laws about needing a prescription. Can a pharmacist give this vaccine? Who's eligible? Obviously, as we know, the ACIP meeting hasn't happened yet. It's scheduled for a couple of weeks from now. Senator Cassidy has called for it to be delayed because we don't know what the new ACIP might do. So in the absence of that, it's kind of reverting to all of the states and to some of these pharmacies. And there's this just huge confusion about who's eligible for what. And Julie, we should say ACIP meeting hasn't happened, which is an important part of the bureaucratic and scientific approval.

14:39ACIP hasn't happened because RFK fired them all, fired them all and is reconstituting the committee in his image. That's right. It's reconstituting committee with people who are, you know, known vaccine skeptics, I think is the phrase that's mostly being used. So no one knows what the new ACIP will do when they meet, if they meet. So that's the confusion. So in some cases, you might be able to get the vaccine, but it's not necessarily going to be reimbursed by your insurance because these are all things that are now tied to this whole federal process that is stalled at the moment. Well, Dr. Offit, what does this mean in practice for doctors, pharmacists, and patients who are trying to figure out how to navigate this new environment?

15:28I think confusion is the point. I honestly think RFK Jr. is getting what he wants, which is that people are confused about whether they should get a vaccine or not or whether they can get a vaccine or not. I mean, for example, RFK Jr. stood up and said, we, HHS, are no longer recommending the COVID vaccine for pregnant women when pregnancy is clearly a high-risk condition for severe COVID. And so there are pregnant women who can't get the vaccine. I mean, the data were presented by the CDC, by Fiona Havers, that healthy young children can be hospitalized and can go to the intensive care unit and can die.

16:02There were about 152 deaths in young children last year, primarily less than four-year-olds. And half of them were healthy. And so, but as Julie said, you know, the vaccine is only licensed for those less than 65 who are in high-risk groups. And there are a lot of people who aren't in high-risk groups who can reasonably get that vaccine or understand why you would want them to get a vaccine, like people who work in nursing homes or people who are taking care of an elderly family member or people who are scared of long COVID, which is why the ACP has always allowed the vaccine to be given to anybody who wanted it.

16:35And now that's not true anymore. So it's just incredibly confusing. Julie, I want you to take us inside the politics of this. At Thursday's Senate hearing, lawmakers from both parties criticized Kennedy's decision, including canceling$500 million in vaccine contracts. Where are the political lines around this discussion and what does it mean not just for members of Congress, but also for President Trump? Yeah, well, you know, there's been this sort of thread of anti-vaccine sentiment around for years, you know, going back to the Revolutionary War when they first started vaccinating against smallpox.

17:12This is the first time it has really sort of come into power, if you will, that we have somebody who is anti-vaccine at the helm of the Department of Health and Human Services and trying to basically impose his will on the rest of the department and thus the rest of the health care system. We know President Trump is of two minds on this, as he is on so many things. I was amused that several of the Republicans at the Senate hearing started out their comments by saying, you know, the president really deserves the Nobel Prize for his spearheading of Operation Warp Speed, which gave us the COVID vaccine in a very short time after COVID began.

17:50On the other hand, you, Secretary Kennedy, may be going too far with some of your anti-vaccine sentiment. They were trying to bifurcate this between they they're criticizing the secretary without trying to criticize the president, perhaps in hopes of driving a wedge between the secretary and the president. We have yet to see, although the president has the last few times he's talked about this, he's talked about the value of vaccines. So we do get the feeling that he's looking at this polling and he's seeing that vaccines, among other things, are still very popular, even with Republicans, even with people in the MAGA base.

18:23So he's a little bit concerned, I suspect, about how far his secretary is pushing this. Julie, during his confirmation hearings in front of the Senate, though, Robert F. Kennedy told senators, including Republican physician senators like Bill Cassidy, don't worry. Yes, I have a past. I'm not going to do anything anti-science. I'm not going to do anything to hurt access to vaccines. He lied about that. He lied to their faces and he lied in front of the countries. Aren't they upset about that? Aren't they up in arms about that? Or are they kind of navigating their disappointment and concern? I know that they are upset because, among other things, Democratic senators tell us that they are talking to Republican senators who are upset.

19:06The question is what they're willing to do in public. I thought Senator Cassidy actually kind of pulled his punches. It was Senator Barrasso, who's the number two Republican in the Senate leadership and is also a physician, surgeon. He was much more strongly sort of anti-RFK on vaccines than Senator Cassidy even was. You know, they're caught between this rock and a hard place. They don't want to anger the president. But they were, as you point out, I mean, things that RFK Jr. said in his confirmation hearing, he has simply not carried out. He has not done the things that he said he was going to do.

19:39And he has done things that he explicitly said he wouldn't do. We got this email from one of you. Public health was politicized long before Robert F. Kennedy Jr. ever entered the conversation. Institutions like the CDC, FDA, AMA, and APA have long been influenced by ideology, often allowing politics to shape their guidance at the expense of rigorous, unbiased science. Their credibility problems are largely self-inflicted, built on years of questionable recommendations, shifting standards, and an unwillingness to admit error. Too often, these organizations present public health as absolute dogma rather than a scientific process that depends on an open inquiry, debate, and correction.

20:18Dr. Offit, I'd love to hear your response to that. Well, so public health requires resources. Therefore, to some extent, it will always be political. But it doesn't have to be partisan. I actually don't agree with the comments that were made by that caller. I think that, I mean, I was on the Advisory Committee for Immunization Practices for five years between 1998 and 2003. I was on the FDA's Vaccine Advisory Committee. So I came to know the people that work there. And I think they're trying to make decisions based on good scientific evidence. I just didn't see, I mean, to some extent, there's political influence because I think that's always at some level going to happen.

20:54I think, for example, in Biden in August, the president Biden stood up in August of 2021 and said, as of September of 2021, we are going to recommend a third dose. That was political because I think vaccines were a good story for him. But there was no reason at that time to recommend a third dose. This was pre-Omicron. And when it came to a vote then in front of both the FDA Vaccine Advisory Committee and the ACIP, when we still had an ACIP, they both voted no. So they didn't support that recommendation. So I think that was an example of politics. But I don't think that's the usual story. Julie, anything from you?

21:28Yeah, I mean, we could do a whole hour on the AMA and it's political history. And I do think that one of the big problems that public health has had over many, many years is its inability to communicate to lay people. There are people at FDA and CDC and NIH who are doing really good science and trying very hard to explain that science. And it often gets lost. And we do have a habit of sort of presenting things to people as, if not dogma, then at least fact when we don't know. Everything is sort of, you know, risks versus benefits. That's what health care is. It is as much an art as a science. And I think it's difficult for people to say, this is what we know now.

22:12This is what we think. This is the best that we have. And I think some people were able to do that during the pandemic. But obviously, you know, in a pandemic when everybody is frightened and there's a lot, so much that we didn't know, it was hard for people to communicate. This is the best advice we have at this point. it might change. And I think there was not enough of people saying that. Here's a message we got from Wes in Malibu. I'm not a particular fan of Kennedy, although he does make some valid points. And here's some facts. The most recent COVID vaccination made me extremely violently ill, and I had neurological reactions to it.

22:51I'm not an anti-vaxxer, but that's a fact. I also nearly died in 1976 from the bungled swine flu vaccine. So don't sit there on the air and claim that vaccines are entirely harmless any more than it's okay for Kennedy to sit there and claim that they're entirely harmful. The truth lies in between those two. It's a spectrum. So some context. In 1976, a swine flu outbreak at a military base sparked fears of a pandemic. President Gerald Ford launched a plan to vaccinate every American. By year's end, a quarter of the country got the shot, but the pandemic never came and public health officials' credibility suffered.

23:28The CDC later found the vaccine slightly raised the risk of Guillain-Barre syndrome. That's a rare condition where the immune system attacks nerve cells, causing weakness and movement problems. Dr. Offit, I'd love to hear your response to Wes's message, especially within the context of what Julie just said about the risk versus benefit proposition around vaccines. First of all, I don't think anybody's claiming that vaccines are entirely harmless. The Guillain-Barre syndrome in 1976 with that flu outbreak that didn't happen just was one of many examples. I mean, look at the Johnson & Johnson COVID vaccine, which was approved in February of 2021, was found to be a rare cause of clotting, including severe clotting, including clotting in the brain, which could be fatal.

24:10And so ultimately that vaccine was taken off the market. I mean, you've had other examples. The oral polio vaccine was a rare cause of paralysis. That was the Albert Sabin vaccine that was introduced in the early 1960s. So much so that finally, by 2000, we switched back to Albert Sabin's or Jonas Salk's inactivated polio vaccine. There was a flu vaccine given in 2009 in England called Pandemrix, which was a rare cause of narcolepsy, which is a permanent disorder of wakefulness. It was maybe one in 50 ,000 people, but it was real. So I think we're always looking for those possible rare side effects.

24:46And if it's so severe, as was the case with Johnson & Johnson's COVID vaccine, then it comes off the market. Or a Rotoshield vaccine, a rotavirus vaccine that was on the market for 10 months between 1998 and 1999. So no one's claiming that vaccines don't cause harm. The question is, do the benefits of the vaccine outweigh the risk? And that's what safety means in the medical world. It doesn't mean absolute safety. It means that the benefits outweigh the risk. And in the case of the COVID vaccine, the mRNA vaccine, which was a rare cause of myocarditis, meaning inflammation of the heart, muscle, and about maybe 1 in 50 ,000 people overall.

25:20But that was transient, self-resolving, self-limited. And so the benefits clearly outweighed the risk. But nobody ever claims there's no risk. Frankly, anything that has a positive effect will always have a negative effect. And if it doesn't have any negative effect, it probably never had a positive effect. Julie, from what you were describing about public health information before, I just want to say that there is a stunning cynicism here, really, of capitalizing on the uncertainty of the COVID pandemic when we had a novel respiratory virus, as Dr. Offit was describing. didn't have a vaccine yet, didn't have treatments yet, monoclonal antibodies and such.