How MAHA Is Sowing Vaccine Confusion

0:06Hey, Dhruv. Hi, great to be here. So you've written for us for a long time, but in addition to being a writer, you are also a physician. And so I'm curious, you know, when you have the CDC and HHS putting out guidance that's either contradictory or maybe even, you know, based in something that's been debunked, How does that confusion show up in your conversations with patients? It makes it really challenging. You know, in the past, we had a system in which scientists at the federal level and politicians at the federal level were responsible. And they put out information that you could be confident in, that you could talk about in a thoughtful way with your patients and take that information and then translate it to the person in front of you.

0:52And now that system has been kind of turned upside down. So this idea that we can rely on the health recommendations that are coming out of the federal government no longer stands. And that puts a lot of pressure on states and localities, professional societies to step in to fill that very large void. Do you find that you have a lot of patients sort of coming in having done their own research? Like they obviously they're more confused, but do you think that there's a lot more people kind of using websites and chat GPT to try to make sense of things? Well, you know, people have been, you know, quote unquote, doing their own research for a long time.

1:28I think with the rise of the Internet, Google at the beginning of that era, we've seen people come in with access to information, good information and bad information that they didn't used to have. So that part isn't new. What's new now is that a lot of misinformation or low quality information is coming directly from sources of authority that you would otherwise have trusted. And now you can no longer trust it. So it was the case until recently that people who were, you know, skeptical of institutions were the ones that weren't trusting what was coming out of the government. And now the anti-establishment folks are part of the establishment.

2:06And so people who previously trusted these institutions no longer can. So it seems like we're just in a really challenging position where neither side of the political spectrum can trust what's coming out of the government anymore.

2:21That's Dhruv Kular, who covers medicine, health care, and politics for The New Yorker and is a practicing physician at Weill Cornell Medical College. Under the second Trump administration, with Robert F. Kennedy Jr. at the helm of the Department of Health and Human Services and the Make America Healthy Again agenda setting the tone, we've seen funding for vital medical research gutted, career scientists sidelined, and medical guidance reshaped to fit the administration's skepticism toward vaccines. It's made getting reliable medical information incredibly difficult and confusing for most everyday people.

2:53I wanted to talk with Dhruv about the recent changes to U.S. vaccine policy, how the CDC and HHS are functioning under Trump's second term, and how the states are responding to the administration's public health agenda. This is The Political Scene. I'm Tyler Foggett, and I'm a senior editor at The New Yorker.

3:17Last week, we saw a two-day meeting of a panel of vaccine advisors to the federal government, the Advisory Committee on Immunization Practices, or ACIP. Why was that meeting so hotly anticipated, and did it go better or worse than what you expected? It's a good question. A lot of it depends on your assessment of how that meeting could have gone, and it certainly could have gone worse than it did. So I think the upshot of the meeting was that there was a lot that was discussed that ultimately could have had a more substantial practical impact on vaccine access in this country. That's not to say that the decisions that were made were correct or the ones that I would agree with, but the damage could have been a lot worse.

3:59So one of the reasons that this meeting was so anticipated was that all 17 members of ACIP had been fired by RFK Jr. over the summer. And he installed his own appointees over the past few months. And some of them were seated just a few days before the meeting took place. And these are people, some of whom have pretty strong credentials to be on that type of committee, but some of them don't and have raised some pretty serious criticisms, often unfounded, of vaccines. So people were really eagerly anticipating, you know, what might come out of this meeting. That's interesting. So it wasn't as if RFK Jr.

4:37just put 17 kind of like uninformed vaccine skeptics on the panel. Like it was a mix of, you know, people who would probably normally be on the panel and then people who were maybe more unorthodox picks. That's right. And one of the things that's been interesting to me as I've watched RFK Jr. operate over the past few months is that he has actually been pretty savvy a lot of the time. I mean, he is, I think, a politician at heart. He's been around politics all his life. And he knows how to do things in a way that aren't going to immediately set off alarm bells, including among the Republican establishment.

5:12So if you take the statements that he's made at face value in the past, you know, the COVID vaccine is the deadliest ever made. No vaccine is safe or effective. CDC is a cesspool of corruption. You might have expected even more dramatic action as health secretary, where he has basically unfettered dominion over federal health agencies. But what he's done is actually chip away at the vaccine infrastructure of the country. You know, every few weeks or every few months, there is more uncertainty. There is slightly restricted access. There are more questions that are being raised about the way that we do vaccination in this country and how we keep children and adults safe in this country.

5:53And ultimately, I think that might have an even more corrosive effect on the public health infrastructure. Sure. It's interesting. Yeah, because you could see that if he were just a full on anti-vaxxer and filled these panels with anti-vaxxers, I feel like it would almost be easier to contest that, you know, like it just already kind of seems bonkers. Whereas if you're slowly and gradually encouraging people to, you know, sort of fall into a kind of vaccine skepticism, which is also the phrase he uses for himself, right? Vaccine skeptic. That's almost more insidious. Right. And I think what he's trying to do is preserve enough legitimacy in the CDC and the vaccine panels such that people can still take the recommendations seriously.

6:36If he filled ACIP with 17 clones of himself, I think even a large part of the Republican Congress would balk at that type of transformation. But what he's done is he's handpicked a few people who are raising really pointed criticisms about COVID vaccines, often without data or other types of vaccines. But he also has people with pretty strong scientific credentials. And so that creates a much murkier thing against which we have to contend. So before we get into what exactly the ACIP decided, I'm wondering if you can just kind of explain what it is that they do and what their decisions actually mean.

7:20Like, it's not so simple as, like, all of them meeting and deciding which vaccines someone can go and get, right? Like, it's more that they're choosing which vaccines to endorse and when someone should actually be able to get that vaccine. Like, how does it actually work? That's right. So the CDC typically does not have regulatory authority. authority. It issues guidance and recommendations. And this is a critical panel. It's called the Advisory Committee on Immunization Practices. And it is a panel that gives its recommendations to the CDC director, who then has to decide whether or not to accept those recommendations.

7:55And typically, they do accept those recommendations. And the way it comes to the public is, number one, through a kind of bully pulpit. You know, this is what the CDC has recommended. This is what doctors and pharmacists are going to talk about with their patients. And so there's that aspect of it. But it also influences what health insurers are going to cover. And so in general, health insurers are required to cover the vaccines in the way that the ACIP and the CDC are recommending. And so when the ACIP says we're no longer going to recommend this vaccine or that vaccine, it could be the case that insurers no longer cover that and people have to either pay out of pocket for it or may not have access to it at all.

8:40So it seems like the biggest decision that came out of this meeting was the sort of the decision regarding COVID vaccines. I'm wondering if you can talk about what is changing now. Yeah. So you're right. That's probably the most drastic decision that they unanimously decided that they're not going to recommend COVID vaccination at all for anyone. So even for the highest risk people for serious illness and death from infection, people over the age of 65, let's say, the federal government no longer is going to explicitly recommend vaccination for those people. So it's pretty remarkable. And let me just stop you there.

9:13Is the justification for that, is the idea that they don't think that the vaccines work? Or is it that they just have so many downsides that even someone who might die of a COVID infection would be better off not getting the vaccine? Like why, what is the problem that they are identifying here? So what they argue is that people should be talking about this vaccine with medical professionals and weighing the risks and benefits and making the decision for themselves. So if you are at high risk, I think their argument would be that that would be clear upon discussion with a medical professional, and otherwise you may not want to get this.

9:46The challenge is that it is kind of changing the default here. The default, you know, when you recommend something from the federal government is that people ought to get this vaccine. When you change the default to talk about it with a medical professional, number one, that creates a lot of inertia. Number two, not everyone has the opportunity to engage with a medical professional. And number three, although the panel stopped short of recommending or requiring a prescription for a vaccination, it still makes it more difficult for pharmacists who actually deliver most of the COVID vaccines in the country to adults to go ahead and give that without some type of consultation potentially with a doctor or a nurse.

10:24I should note that spokespeople from HHS have said that these vaccines will continue to be covered under federal insurance programs like Medicare and Medicaid, that plans on the Affordable Care Act will continue to cover them. But it may be more difficult to get those vaccines ultimately, and I think fewer people will decide to get them. Yeah, I mean, do you think that fewer pharmacies will carry them? Like if I just go to my local CVS and I want a COVID shot, do you think that the chances of me being able to get it have gone down because of this decision? I think so. I mean, some of this, it'll be interesting to see how it all plays out.

10:57One of the upshots of all this is that it's created a lot of uncertainty. And so it's not clear whether doctors' offices and pharmacies will stock the vaccine in the way that they used to stock it. It's not clear how comfortable pharmacists will feel just administering it because someone wants the vaccine if they haven't offered a clear justification for why they need the vaccine. You know, the biggest trade group for health insurers has said that they are going to honor coverage for these vaccines or all vaccines that were recommended before this last meeting, I think, to get ahead of some of the changes that this specific meeting has inspired.

11:34But that's all to say that there's a lot more uncertainty about who and when you can get a vaccine than there was just a few months ago. So let's talk about some of the other big conversations that happened during this meeting. I want to talk about hepatitis B because that was a vaccine that I remember there was sort of talk going into this meeting that there might be a recommendation to no longer endorse it. But it seems like that decision was tabled, right? That's right. So ultimately, the panel decided not to take a vote on this issue and kind of kick it down the road. And so the big question was whether they're going to continue to recommend a first dose of a hepatitis B vaccine basically at birth, within 24 hours of birth.

12:16To set this up a little bit, you know, in the 1980s, there were around 20 ,000 babies every year that would contract hepatitis B, which is a very serious infection that can cause liver problems and often lifelong liver problems for people. And in 1991, the CDC recommended that the first dose of this vaccine should be given right at birth. And that's because there's a very high risk as the baby comes through the birth canal of getting the virus from the mother if the mother has the virus. That has virtually eliminated the transmission of the hepatitis B virus from mother to child. Now, there are other ways people get the virus.

12:52And so it is often thought of as a sexually transmitted virus, which is true. But it's also the case that it's a very transmissible virus just by exposure to blood in other areas. area. So if it's on someone's skin, or the virus can persist even on surfaces. And so a baby in the first few months of life can pick up the virus in all sorts of ways. And so this has really been a bulwark against that type of transmission of the hepatitis B virus. And what they had proposed was waiting a month, and I think potentially exposing more children to the virus unnecessarily because of that. Fortunately, ultimately, they decided not to pursue that, but they may take it up again in a future meeting.

13:32What would be the point of waiting a month to give an infant that vaccine? Because it seems like, you know, that would indicate to me that there isn't a concern about the vaccine itself being safe or, you know, causing autism, which is something that we, you know, that Kennedy often brings up with different vaccines. Like, it doesn't seem like it's a safety issue in this case, right? So what is the argument against giving the hep B vaccine that early? Well, a lot of this doesn't have any scientific backing. And so, you know, it's like asking, why they just feel like you're giving too many vaccines at one time and we should spread them out.

14:03But it's not as if there's a clear scientific rationale for that. One thing that people have brought up is that it's kind of a gateway vaccine. You're giving an immunization right when a child is born that kind of acclimates parents to the idea that you're going to be giving your child vaccines. And that may be one reason why they're recommending delaying the shot. It could also be the case that people might never get that shot. You know, when you're in the hospital, you've delivered the baby, the baby's there and you can give them the protection of a vaccine. But not everyone has reliable follow-up care.

14:35And there may be children who fall through the cracks and fewer babies may get them. And so it may be just a tactic to delay and potentially reduce the number of children who end up getting this vaccine. That makes more sense. I mean, it doesn't make sense like, you know, logically, but I get, you know, that the problem here is that it might be a gateway vaccine as opposed to it being a vaccine that causes some, you know, terrible thing down the line. I also want to talk to you about this decision regarding the MMRV vaccine, which is a combined vaccine that boosts protection against measles, mumps, rubella, and varicella.

15:07So what's going on here? Because it seems like you can still get separate shots for each of these things, and the problem that's being identified is with the combined shot. Right. So the MMR vaccine is given in combination, and then sometimes it's given with this additional protection against varicella. You can still get those separately. So you get the MMR and then you can get the varicella vaccine separately. The advantage of taking the combination shot is it reduces the absolute number of shots that a child might need to get and the number of visits that you take to the doctor. Seems like the vaccine skeptics would like that, you know?

15:42Right. If you're worried about gateway vaccines, it's just one and done. Right. But there is this kind of real and small increase in the risk of febrile seizures. And I should note that febrile seizures, they don't seem to have any long-term effects on cognitive development or any other health problems for children, but they are frightening to see. They're seizures, and they are a serious thing. The risk is small, but it seems to be a real risk. And so that is the argument for rescinding the endorsement for the MMRV vaccine for children under the age of four years old. You know, as it is, it's delivered to a pretty small minority of children in the United States right now, something around like 10 to 15 percent of children get this combination shot and children will still be able to get the shot separately as the MMR and the varicella separately.

16:28So it's not necessarily going to, I think, cause a huge public health problem, but it is a change that they advance. You know, part of the way they went about doing this kind of speaks to the inexperience of the panelists. I mean, so on Thursday, they voted to present their endorsement, but to preserve coverage for this specific vaccine in the federal program that delivers about half of vaccines to children in the U.S. And then many panelists, or some panelists at least, seem not to have understood the question, and they reversed their decision the following day. So it is no longer covered in this federal program for children.

17:03I just can't get over how confusing this must be for people. Like, if you have a kid and you're trying to decide which vaccines to give them, which ones are covered, which ones aren't covered, which ones were covered up until recently and might still be covered because of, you know, the programs that are kind of stepping in. I mean, how— I think that's exactly the point. You know, I'm a physician. I'm someone who thinks a lot about these issues. And for me, it's difficult to follow the ins and outs of what's being recommended. And it raises a lot of questions about what is recommended and when it's recommended and why it's not being recommended anymore.

17:36And so I can imagine for most patients and families who aren't spending their whole day thinking about this, how challenging it must be to just think through what's happening, what's best for your child. And I think that's exactly the point. If one of your agenda items is to reduce the number of people that are getting vaccines or to raise more questions about the benefits of immunization, this type of uncertainty can go a long way. So we're going to take a quick break. And then when we come back, I want to talk just more broadly about how the CDC and other public health agencies are operating under Trump's second term.

18:13This is the political scene from The New Yorker. Thank you.

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19:18So, Drew, I'd love to get a general sense of the second Trump administration's broader approach to public health and how agencies tasked with it have been operating since Trump's return to office and since the launch of the whole Maha movement or Make America Healthy Again initiative. So how would you say that the HHS and CDC are operating now as compared to in Trump's first term? Because one thing I've been trying to figure out is the extent to which Maha is like a totally new movement versus a continuation of Trump and the Republicans' attitudes toward things like vaccines and the medical establishment, which we may have seen, you know, back in, you know, between 2016 and 2020.

19:55I think it's totally different. In the first term, while there were questions being raised, you might not have agreed with everything that was being done in the administration and specifically at health agencies. It was still basically the case that the people in the Trump administration were doing things that were still tethered to science and communicating in the way that you might expect people in another conservative or Republican administration to behave. That has totally changed this time around. I mean, if you just think about something like the purging of expertise, the firing of thousands and thousands of employees across HHS at FDA, at the CDC, at NIH, the disruption of the flow of research funding coming out of the federal government, something like the canceling of half a billion dollars in funding for mRNA technology.

20:48This is an example of ideology trumping science at every turn, which you certainly wouldn't have said in the first Trump administration. Speaking of firings, I'm wondering if you can tell us what the state of the CDC is in the wake of RFK Jr. firing the director of the CDC, Dr. Susan Menares, allegedly for refusing to commit to adopting ACIP's recommendations before she'd seen evidence. Like, who's running the show now? So as you say, Susan Menares was dismissed by Kennedy just 29 days after she was confirmed by the Senate. And what's important to note is every Senate Republican voted to confirm her.

21:27And just less than a month later, Kennedy pushes her out. And so following that, three or four other senior ranking CDT officials resigned in protest. So the CDC is really in disarray right now. There's a man named James O 'Neill who has now taken over as acting director of the Centers for Disease Control and Prevention. And I mean, I think the CDC is definitely in chaos, both because of the many employees that had been forced out or fired earlier in the year, but also because of the recent departure of several high-ranking officials. So I want to talk about some of the other big public health announcements and changes in funding that we've heard about recently.

22:07So one of them is RFK Jr. canceling half a billion dollars in funding for mRNA technology, which is the same technology that produced the COVID shots and is technology that you once described as a genuine triumph of Trump's first term that not only is our best defense against future pandemic pathogens, but also shows potential as a treatment for autoimmune conditions and deadly cancers. So can you help me make sense of a president essentially undoing a major accomplishment of his first administration? I think it speaks to the idea that Trump finds Kennedy to be a very useful ally. You know, Kennedy has brought into the MAGA sphere this whole movement of people who consider themselves MAHA.

22:49And that's very useful for Trump. And so much so that even though at times it seemed that he wants to take more credit for what was genuinely an amazing accomplishment. I mean, Operation Warp Speed, the idea that you could go from knowing the genetic code of a virus to having a vaccine that ends up saving millions of lives in less than a year is incredible. And what we've learned since then is not only is it kind of our best defense for a future pandemic pathogen, as I wrote, this idea that if there's something that arises that we need to develop a vaccine for very quickly, this is by far the best technology we have to keep ourselves safe.

23:28But it's also a treatment or potential treatment for a number of other conditions, things that we never had treatments for, things like pancreatic cancer. I mean, there is a lot of promise for all sorts of other conditions that by canceling this grant funding, we're stymieing an innovation that could transform many, many lives in the future. What's weird is that sometimes it seems like Trump can almost seem like a voice of reason against RFK Jr. Like there's a comment that you mentioned in your most recent piece, which is that Trump once said, you have to be very careful when you say some people don't have to be vaccinated.

24:04You have vaccines that work, plain and simple. So that's good, right? But then there are these other times where Trump and RFK Jr. seem very much aligned and where it does seem like Trump is just trying to cater to the Maha wing of the party. So on Monday, Trump and RFK Jr. appeared together and they made this disputed link between autism and the use of Tylenol during pregnancy. When the alternative is that nothing bad can happen, let's do it now. I was just saying to Bobby and the group, let's do it now. Nothing bad can happen. It can only good happen. But with Tylenol, don't take it. Don't take it.