Robert F. Kennedy Jr.’s Impact So Far: ‘The Worst Possible Case’

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0:31This is The Opinions, a show that brings you a mix of voices from New York Times opinion. You've heard the news. Here's what to make of it.

0:47I'm David Wallace-Wells, a writer for New York Times Opinion and a columnist for The New York Times Magazine. And I'm here with Emily Oster, an economist and CEO of Parent Data, a data-driven website about parenting and health. Emily, thanks for being here. Thanks so much for having me. I'm excited for this conversation. So last week, an armed man opened fire on the main campus of the CDC, killing an officer and dying himself. And this was an attack that was reportedly motivated by the shooter's belief that the COVID vaccine had made him sick. Now, I don't want to draw too direct a line between this shooting and national attitudes towards American public health institutions.

1:22But I do think it's important context for what we're here to talk about, which is RFK Jr.'s role at HHS and what he's doing to American public health. We're going to talk specifically about vaccines, but also about food. First, though, vaccines. Last week, RFK announced that he was cutting$500 million in funding for mRNA vaccine research and development. And I wanted to start just to ask you to reflect a little bit on that announcement. announcement. Like, in the context of RFK's broader, you know, work at HHS since taking over, how big a deal is this cancellation of the mRNA research? How do you make sense of it?

2:02I think it's a great question, and it's a somewhat hard thing to make sense of. On the one hand, this should not have been unexpected. You know, generally, this administration has suggested a high level of skepticism towards vaccines. And the skepticism towards vaccines is most acute towards the COVID vaccine. So the fact that they would make moves like this should not have been very, very surprising. I think the place where maybe it's a little surprising is if you think about in the context of what is, in my view, the greatest public health achievement of President Trump's first term, which was the Operation Warp Speed, which, you know, saved millions and millions of lives and somehow has become something we're not really talking about.

2:48I'm always continually surprised Trump does not want to take more credit for that. Yeah, I often say it's like, you know, he can lead his followers anywhere but to support of the vaccines, or at least I used to say that before Jeffrey Epstein came back into the news. That's like the second big cleavage in his constituency. Yeah, I mean, it's been it's in some ways been very surprising he doesn't want to trumpet that more. But at any rate, given what they have said about vaccines, I didn't find this this too surprising. I think it is problematic. It's probably worth outlining for people. What are the things that we lose with this pulling back of research in this space?

3:21I think there's two really core issues for the future. One is that this is the fastest technology we have to generate vaccines, full stop. I mean, the difference in the amount of time it takes to make a vaccine in the traditional manner versus with this technology is very, very large. And if you think about a future pandemic, you know, having access to this technology is the difference between a vaccine in, you know, three months or four months or six months and a vaccine in two years. The second thing that comes to mind is that there is real potential here to improve our protection against, for example, the flu, which kills many people every year.

3:58Because with a faster vaccine, you can generate a more well-matched vaccine to the current flu strain. And so the possibility in a world of mRNA vaccines is that we would all get a well-matched COVID booster and flu vaccine and maybe RSV vaccine, or at least the elderly would get that, and it would really protect them. And by taking away this funding, I think we've turned off that possibility or at least made it somewhat less likely. And, you know, I think that's one bundle. There's another bundle that's really relevant here, which is applications outside of respiratory illnesses. So we have a lot of promising work on true vaccination for HIV.

4:38It doesn't look like it's going to be a sort of silver bullet cure-all for this disease, but very promising nevertheless. And then maybe even more exciting in theory is this huge new application to cancer, which is not really a vaccine. It's more a tool to use in immunotherapy. But the basic idea is that we're using the same platform to train someone with cancer's ability to fight off the cancer in their body using their own immune system. And if we're really backing away from mRNA entirely, then we're putting ourselves really behind the eight ball when it comes to cutting edge cancer research as well.

5:12Yeah. And I mean, in some ways, this technology is really, really cool and has many potential opportunities. And it's sort of surprising is, again, not the right word, but to sort of back off from something with so much potential. I think it's too strong to say that this will, you know, completely eliminate research in these spaces. There's other funders. But this is a lot of funding, and generally the federal government does do a fair amount of funding of sort of particularly this kind of basic research, and we're not going to have so much of that. So the way that I think of it is, you know, I knew who RFK was when he was confirmed.

5:48He made some gestures, you know, in the confirmation hearings that he was going to be better on many of these issues than he's ultimately been. But I would say what we've seen over the last six months or so is a confirmation of something like his critics' worst-case scenarios. And as a big picture story, it seems to me like it's a war on vaccines in a pretty direct frontal way. How did we get here? I mean, how did we get to a place where America's public health is being charted by a figure with this set of convictions? How do you understand that? So I think part of the issue is that there's really many sides to the Maha movement, to the RFK movement.

6:26You know, there's the side that's about vaccines that we've been talking about. And then there's this other side about food. food. And it's a sort of interesting set of bedfellows because this side about, you know, improving the quality of food, improving the quality of nutrition for kids, the lower and elder processed foods, et cetera, you know, that's really not been the purview of the right in the past. That's something, you know, Michelle Obama was into this. I mean, this has been - And mocked mercilessly by the right for it. Yeah. Remember the Let's Move campaign? Remember, you know, she planted a garden.

6:54People were just like vicious. And, you know, now we're back to the presidential fitness test. I'm not really sure why that's so different. And so I think there's a really interesting set of bedfellows on this stuff. And there are people who I think would genuinely say, you know, I'm here for the vegetables. I'm here for the lack of ultra processed foods. And, you know, I'm maybe less worried about the vaccines. And I think, unfortunately, what has happened from my standpoint is the worst of both worlds in that the changes that are being made on the food side are minor, performative, irrelevant, and the changes that are being made on the vaccine side are enormous and terrible.

7:35And so we've somehow landed in exactly the worst possible case. But is that how you see it? Or are you more optimistic? You know, I found myself saying a lot the last couple of weeks that I can imagine an alternate history in which RFK was made the head of the EPA and, like, you know, Vivek was the head of HHS. And I was like, that would be a pretty good outcome, actually, all things considered. So, yeah, there's a way of sort of like rearranging the Maha coalition in a way that I think would be beneficial, maybe still full of some hysteria and some bad science, but nevertheless, on both fronts, on the public health front and on the sort of environmental pollution front, moving in the right direction, moving in a good direction.

8:12And I do want to talk about food in a minute since you wrote a great piece about RFK's food policy. But before we do that, I just want to like drill down on a few beats on this particular point. One is when you look at what RFK is doing, when you think about Maha as a kind of an ascendant movement, I think it's easy to fall into a trap when you think that that's essentially like the whole Republican Party or something like a majority of the American public. And there have been measured declines in faith in Americans' public health institutions, measured declines in vaccines, but they are also on some level relatively small.

8:44It's not a majority of Americans. It's really still a vocal minority growing but still small. And one of the injustices or tragedies of this moment is that many of those people making those arguments are now in positions of real power to shape not just direct policy, but also our culture around what is acceptable, what is good science, what is not. And for many disengaged Americans, they're just going to be hearing a lot more about new research, you know, revisiting old questions and their faith in public health and vaccines may fall further as a result. And then I would just want to emphasize the particular role of the cohort of, I call them COVID contrarians who are empowered under RFK in America's health infrastructure now.

9:29I'm thinking of, you know, Marty Makary, Jay Bhattacharya, Vinay Prasad. And what is really interesting to me about their story in this context is that they were some of the most vocal people promoting the vaccines in 2021. They were quite, you know, aggressive in saying, if you've got the shots, you really don't have to worry about COVID anymore. You can move on with your life. And now when you see RFK walking back from mRNA technology generally, what he's emphasizing is that these vaccines don't deliver long-lasting, sterilizing immunity in respiratory illness. And that is true. It's something I wrote about at the time.

10:06So I think that the basic proposition that RFK is putting forward is correct that COVID vaccines, mRNA vaccines did not truly end the pandemic in the way that many people expected them to. And yet many of the people who are, if not direct architects of this policy, then going along with it as part of the new public health regime were people who just a few years ago were the biggest boosters of these vaccines. I think that raises some really basic questions about what are we doing here? Like, what is the story that takes us from 2021 to 2025? And why is it that so many people who had so much faith in those shots are now part of a program to walk back from that technology generally?

10:45Yeah. So let me say two things. So on the first question of vaccine hesitancy, I think the end case scenario that I am most concerned about is one in which in some way this administration manages to make it quite difficult to get your kid vaccinated. And so sort of changing some aspect of, you know, what's approved or what's covered by Medicaid. That's a really bad case scenario. On the COVID vaccine, I think you and I probably have a different position on this, but I do lay some blame at the feet of some of the public health advice that post-dated the early 2021 COVID vaccines. And to sort of play devil's advocate or try to express what somebody like Jay Bhattacharya, the director of the NIH, would say here is that these vaccines were an incredible breakthrough.

11:37They saved millions of lives. But when we started telling people your seven-year-old needs a third booster in 2023, you lost a lot of people. And that is when a lot of this resistance, particularly among parents, became more extreme. extreme and that perhaps if the sort of left-leaning public health establishment had talked a bit differently about, you know, how to think about vaccines in the period post sort of immediate vaccination, if there had been more nuance or understanding in that conversation, things might have gone differently. I don't think that it's insane to have a different position about the value of vaccination in February 2021 and the value of vaccination in August 2025 for COVID.

12:23I think that's just what science would say in my position, but we may not agree there. Yeah, I mean, I would say for sure the public health messaging about whether you should get a booster in 2024, 2025 should not be what it was. And, you know, about the original shots in 2021, I had a lot of questions and problems with the way that the messaging was undertaken at the time, too. I thought that there was much too much confidence placed in long-term sterilizing immunity. When we first started seeing breakthrough infections, it was not the case that the public health establishment really took that seriously.

12:53As a question of science, I think there was something irresponsible about that. I think that they were basically overlooking signals from the population in order to try to meet the public where they were. And on that point, you know, I do think that there is a political logic as you lay out that, you know, people got frustrated and exhausted and fed up with a lot of COVID mitigation messaging over the course of the pandemic. And And there's a political logic to adjusting. But I also think we're now in a period of what looks to me like a massive, massive overcorrection on that point. Now I think we're in a place where we've sort of so overlearned the lesson of COVID that people want to be able to navigate the landscape of risk on their own, don't want to be told what to do, don't want to even really intersect with or interact with public health guidance, that we're left much more vulnerable going forward.

13:41Yeah, I think that's fair. I mean, I think particularly on the vaccines, I think, to kind of dismiss what was really the speed with which that happened and the safety profile and then the number of people who were saved. I mean, that was really, you know, it was a miracle. And I think to come back and say, well, you know, like that was kind of useless is, as you say, a complete overcorrection and totally not consistent with reality and puts us behind the eight ball on the next pandemic. So we talked a lot about vaccines, but of course, that's just like one half of the program here. And there is a consistent thread, I think, which we'll probably tug on as we go into the other big area, which is food.

14:20Tell me your assessment of RFK's actions on food. How do you think about what he's doing there and how it compares to the sort of war on vaccines on the sort of public health and medicine side? So far, the moves on food have been, I would say, entirely performative and focused in tiny and unimportant directions. So, you know, food dyes, I mean, just to be clear, I don't think your food needs to be dyed. There's no health benefit to dyeing your food. But many of the dyes, virtually all of the ones that he has targeted, the evidence supporting any link with, you know, hyperactivity or whatever, you know, any of the kind of neuro issues that are associated, none of those links are supported in good data.

15:09So taking, you know, Red Dye 40 out of Swedish Fish or Skittles is not likely to improve anyone's health. And what he's achieved is he's gotten people to say more or less that they'll think about doing that. I would say that's about where we have landed. I do not think that the changes that have been promised, even if they happened, I do not think they would matter very much or at all for health. And I don't think they're going to happen. So I would say on those kind of like, I got this company to promise to do blah, you know, we're going to make some Coke that has sugar instead of high fructose corn syrup.

15:43That's not improving people's health. There is one thing that has happened, which I think actually does have the potential to improve health, although is ethically quite a bit more complicated. He has allowed the USDA to issue waivers to a number of states to take soda off of the approved items that you can purchase with your EBT, with your SNAP benefits. With food stamps, yep. With food stamps. And I actually think there's a reasonable chance that that may affect people's consumption of soda. And that actually could have some health effect. This is like catnip for economists. And so I'm sure we will, in two years, we will see some papers about whether that has mattered.

16:23But everything else I can think of that he has done on the food stuff is just useless. And then how do you make sense of that as a political choice? I mean, when I think about these two areas, right, I think that basically there are maybe some questions we want to ask about some of the vaccines we're giving. Maybe. But basically we know that they're really effective and powerful. And on the food side, the questions seem much larger and more consequential. and I'd be much more willing to follow a quasi-conspiratorial quest to get to the bottom of our ill health on that front than I would on vaccines.

16:55And when I think about the makeup of the Maha movement, obviously there are people who are focused on vaccination, but I think there's a natural constituency that's much larger that's like, we shouldn't be eating the food that's so bad for us. How do we reform our agricultural practices? How do we change our eating practices, as our diet? How do we change that at a large scale level to make sure that the country is healthier? It seems to me, almost just at an intuitive level, that that would be a larger, more natural constituency. Why are we seeing so much more action on the kind of vaccine side than we are on the food, diet, and environmental health side?

17:28What's that about? I think it's about the fact that it's hard. There's really maybe two things. So one is, this is running up against much more directly many of the political barriers that are put up by many people, but in particular by the right. So many of the changes that one would like to make are going to be vehemently opposed by lobbyists with enormous budgets. And ultimately, some of these changes would need to be made through Congress, and that's going to be an uphill battle. Much easier to get a company to stand up and say, you know, we'll think about taking dies out of our Skittles sometimes than to actually change some significant environmental or agricultural practice.

18:10The second piece is that a lot of the changes that probably need to be made, real meaningful change involves getting people to change how they are eating, and that is very hard. It is very, very difficult to get people to change how they're eating, whereas changing out everybody on the vaccine advisory committee and then changing your advice there is actually comparatively quite straightforward. And that is therefore an easier win. I think the wins here are really tough. And do you see a possible hopeful future where Maha makes more progress over the next couple of years on the food side? Or do you think it's going to continue being sort of empty and performative?

18:57Maybe. I'm not very optimistic. I think there's an increasing set of evidence around ultra-processed foods in particular. And so could I see some changes that might impact the share of our diet, which is in ultra-processed foods, which has also already gone down a bit? I think that would be interesting. I have to be honest. I think that if we are looking to improve the metabolic health of the U.S., probably the answer to that is going to come from putting GLP-1s on the Medicaid and Medicare formularies rather than from this movement. And I realize that's probably not a politically especially popular thing to say, but probably going to have more impact.

19:47It could be very popular. I mean, people love taking those meds. What is it like? Like, there's some astonishingly large percentage of Americans who have already taken them, right? And I don't think they want to be paying. And Eli Lilly has just come out with a fairly compelling trial on the pill form of those. Right, which would make it much more popular even. Yeah. If we got a good quality pill, it's cheaper. It's more popular. So, I don't know. I mean, I would love to see movement on healthiness of food, in particular around kids, where I just think the potential to, like, make school lunches fun.

20:21and interesting and get people to eat vegetables. Like, I've occasionally talked to people who work in this space who I find incredibly inspiring, but for the most part, we haven't really done it. I think the GLP-1 discussion is really illuminating because, at least as I understand the sort of fractured lay of the land of the Maha coalition, like, this is not a Maha solution. The Maha solution is diet, behavior, exercise. And that just illustrates to me something that's really profound here, which is, you Much of what has been gathered together under this particular rubric, Maha, is really a kind of public health libertarianism, which is to say it's about bodily autonomy.

21:00It's about how I can be made even more in charge of my own health and well-being and therefore see my own healthiness as a reflection of some kind of behavioral virtue. and that this whole category of thing that counts as, you know, what the system is telling me to do, I'm going to just dismiss out of hand, even though, like, what's the difference between RFK Jr. taking testosterone supplements versus, like, some, you know, some obese person getting on GLP-1s as opposed to going on a diet? There's not really a categorical difference there, but in the worldview of Maha, these are very, very different ideas, one of which involves an individual seeking out a solution on their own, independent of official advice, And the other is basically just like, you know, we imagine Americans like opening up their gullets and just getting like drowned in big pharma sludge.

21:50And like that is much more offensive. On the other hand, as you say, if we really want to get America's obesity problem under control, we actually did invent a miracle drug to deal with obesity. If we were really serious about literally making America healthy again, we have a tool to make an enormous difference there. And the culture that is calling for exactly that, that has made that their slogan, their calling card, is resistant to it because their philosophy is really not about making America healthy again. And I worry that we're heading, because of that, into a darker future where we are much less aware of or focused on the opportunities that we share and instead push down paths where we're responsible for our own well -being as sort of independent autonomous units without even being able to count on new meds like GLP-1s coming down the pike.

22:41This is sort of, for me, like the sort of dark future of Maha lies in that direction. I think that's a fair assessment. I mean, I would go back to what you said before, which is, you know, if your goal is really to make America healthy again, you should think about the full range of possible ways to do that. There are many avenues there, but to sort of say, well, we're only going to consider the avenues that we've decided are associated with virtue, which always is how this feels to me. You know, like we're going to focus on the avenues that are standing outside and drinking lemon water and, you know, intermittent fasting and, you know, whatever else it is.

23:16And we're not going to think about some of the avenues that might help a much larger share of people. You know, that feels like you're not really doing the thing that you said. You're not making America healthy again. That's it. That's one distinction, right? It's about the individual versus the collective. But another is about institutional wisdom versus sort of individual entrepreneurial detective work. Doing my own research. We're all going to do our own research. So on some level, we all know that we are in a place where people distrust authority and want to do their own research. This often gets described as a kind of crisis of trust in American public health and American science.

23:50At a level of kind of cultural discourse, we are in a much more distrustful place than we were five years ago. How do you see that playing out? I mean, can we recover some of that on a relatively short timeline? What are our chances here? I am not very optimistic about restoring trust in these broader public health institutions, in part because I feel that it was lost for some set of people. And it's really hard to regain trust once you've lost it. And then we brought in a group which now another set of people distrust. And so we're now in a place where no one trusts what the CDC has up on their website, either because of before or because of now.

24:33We've made the problem sort of twice as large as it was, you know, eight months ago. I will say that I think if you look at these same kinds of surveys, you know, parents, people trust their pediatricians, even if they don't trust the CDC. And that is an opportunity to actually keep people's health supported, but maybe through a different kind of messaging or maybe through a messaging that's a little more tailored to individuals. And the problem is that that takes more time. But that trust feels that it has not decayed in the same way. When I take the longer term view, I think something like, you know, the decline in vaccination rates that we're seeing before the pandemic was the simple result of the fact that it had been a full generation since we had really seen the costs of non-vaccination.

25:23And, you know, in the same way that people talk about, you know, we're seeing rise of populism veering into fascism in part because people have forgotten the lessons of World War II. I think there's a sort of a parallel here with vaccination and with science. And I sort of wonder in a grotesque way if future public health challenges will push us back in the direction of trust, which is to say, if bird flu starts to spread through the human population person to person, are we really going to say that we don't trust the CDC's guidance? Are we really going to say that we don't want a rapid development of the mRNA vaccine?