RFK Jr.'s vaccine dream team

0:00During his eulogy for Charlie Kirk yesterday, President Trump said this. And tomorrow we're going to have one of the biggest announcements, really medically, I think, in the history of our country. We're going to be doing it with Bobby and Oz and all of the professionals. I think you're going to find it to be amazing. I think we found an answer to autism. How about that? Autism tomorrow. An announcement is coming later today. Trump's HHS Secretary Bobby has spent years suggesting a link between vaccines and autism. Last week, RFK Jr.'s hand-picked panel of vaccine experts met to update U.S. vaccine guidance, and honestly, it was not boring.

0:45Thank you. Sorry to prolong it. I'm going to abstain because I'm not quite sure what I'm voting for here. Ahead on Today Explained from Vox, the new vaccine recommendations. We'll see you next time.

1:23January 21st at your partner. More on opel.de.

1:53for Disease Control and Prevention to advise American civilians on what vaccines they should get. There has been quite a bit of a shakeup this year in that the experts who were on it were all fired a few months ago, and Health Secretary Robert F. Kennedy Jr. just replaced them all, some earlier in the summer and some just early last week. Many of the people who were on the panel were pretty much gold standard vaccine experts. And I think the general sense in the public health world is that there's a concern that some of the folks who've replaced them are noted vaccine skeptics who, in some cases, have expressed views that don't really jibe with the evidence.

2:39I hereby invite each of the nine former CDC directors to have a live public debate with me concerning vaccines. The chair, Martin Kaldorf, you know, was a famous opponent of COVID vaccine mandates. And the public health establishment was saying this is a highly protective thing. And Martin Kaldorf was saying. CDC and other agencies lied about the vaccine. And that's the reason why we now have plummeted confidence in vaccines. People will then start asking, well, if they lied about the COVID vaccine, are they lying also about the other vaccines? I think that that kind of gives you a sense of the general mood of this committee.

3:19All right. So with that all in mind, the panel met last week, correct? Yes. How did it go? Good morning. We're calling the meeting to order. Good morning, everyone. My name is Mina Zadeh and I'm serving as... The meeting was, by all accounts, pretty chaotic. There was some arguing and some fighting. And, you know, in one case, they voted on an issue one way on Thursday. We had one vote, but this is the follow-up vote for the VFC vote to make sure that everything is covered under CMS, Medicare, Medicaid. Then it became clear that members didn't fully understand the wording of what they were voting on.

3:59I'm going to abstain because I'm not quite sure what I'm voting for here. Then they re-voted and then that vote came out with the opposite conclusion. So that kind of gives you a sense. Cody and I share the same confusion here. I'm still confused. If we vote no on this. I'm sorry, sir, I didn't hear appropriately. Perhaps I'm getting tired. If you had to choose between buying similar hot dogs with or without mercury for your kids, raise your hand if you would pick the mercury-containing hot dogs. Nobody would? Yeah, it gives you a sense that maybe this was not the most sort of professional performance by the new Dream Team.

4:45No. And I think it gives you a sense that some of the members who were only recently added to the committee may not have fully understood the procedures and practices of the committee itself. We are rookies. And with one exception, this was either our first ACIP meeting or our second. All right. So their job was to issue recommendations. And they did, in fact, make some new recommendations starting with the COVID vaccine. What did they say about that? And so for the COVID vaccine, they kind of walked back or narrowed the recommendation before this committee recommended that people get the vaccine.

5:30And now they're saying people above six months of age should talk with their doctors about whether it's right for them to get the vaccine. I think there's general concern among the public health world that this narrowed recommendation will cause confusion and or just increase hesitancy to actually get vaccines. There was also guidance on the MMRV vaccine for kids. That's measles, mumps, rubella and varicella. I just learned this. This means chickenpox. Um, RFK Jr. has been RFK junioring about this particular vaccine for quite some time. Are you recommending the measles vaccine or not? What I've said and what I said...

6:15Doesn't sound like you are if that's... Are you going to let me answer? Are you going to keep it? Are you, are you not? What did the panel recommend here? So the panel recommended something that the CDC in some ways had already recommended, but they kind of made it more stringent in a sense. So you can get either MMR with the V separate, so that's measles, mumps, rubella, and varicella separate, or you can get them all together in one vaccine. That's the MMR V. And the committee recommended separating those, so getting those as two separate shots. And that was already something that the CDC had recommended because with whatever route you take, there's a low risk of febrile seizures.

7:08And the risk is even lower with separate doses and slightly higher with the combined dose. And so we're talking 0.04 % versus 0.08%, so very small percentages. That said, with the new recommendation, low-income kids will no longer have access to the combined shot and will only have access to the separated shots. Can you explain why that matters? So I think people in general in the public health world realize that just getting people into doctor's offices can sometimes be a hurdle to getting them the protection against illnesses that they need. And so, you know, one shot versus two could make the difference between getting those vaccines and not.

8:01So that's one of the considerations here. And again, public health experts worry that this could just increase confusion and vaccine hesitancy overall. This panel was supposed to issue new guidance on the timing of the hepatitis B vaccine for babies. The big news late last week was that they didn't. The panel did not do that. What exactly happened here? Tell us the backstory and then walk us through where we landed. So there has been quite a lot of hubbub about the hepatitis B vaccine because some people have said, and this is in the eyes of many, a little bit of an oversimplification. Why do we need to give babies a vaccine for a disease that is transmitted sexually or through intravenous drug use?

8:54You get it through drug use and sexually transmitted. That's how you get hepatitis B. But you're telling me my kid has to take it at one day old. You're not. That's not science. And folks in the public health world say, whoa, whoa, whoa. This is the best way to actually protect people throughout their lifetimes because not all mothers are tested for hepatitis B in the United States and it's possible for mothers to transmit this disease to their babies if you vaccinate in the first hours of the first 24 hours of life that provides protection. For those who say why should a child be vaccinated for a sexually transmitted disease when they're at birth, the child passes through the birth canal and is exposed to the same secretions as one would otherwise.

9:41And that passage through the birth canal makes that child vulnerable to the virus being transmitted. There was a lot of discussion before this meeting about whether they delay that recommendation, delay the age at which that vaccine was recommended. And by the way, as Dr. Menoros says, this doesn't mandate. It doesn't say you can't leave the hospital unless you get it. It just says that if the mother accepts, then the insurance company has to pay. It's not mandated. And ultimately, this committee decided, we don't know that that's actually going to be more protective rather than harmful. And so let's just keep the recommendation as is until we can vote at a later date.

10:25So the committee exhibited some restraint there. Yes. And I think people expected this to go a different way. Eric, how did these recommendations materially affect people as we go forward? Like, if a parent is okay with the way things used to be, can they ignore the recommendations and just do it the way they used to do it? In general, yes. There is, you know, for some subset, that combined MMRV vaccine is no longer paid for. But insurance should still cover COVID vaccines for people if they decide that that's what they want. I think essentially the trust in this committee is beginning to erode among public health experts, where the American Academy of Pediatrics has now broken with this committee, which is a pretty big deal.

11:23And, you know, they're recommending different things. And I think generally public health experts are wary of what this committee has to say. If parents can ignore the recommendations from this panel, if they can say, I like the way that it went before, I had no problems, I'm going to keep doing what I did. Why do this committee's recommendations matter so much? Do they matter a lot? So this committee's recommendations matter for a few reasons. They can influence what vaccines get paid for by insurers. and I think there's a general sense that this committee is helping the nation as a whole understand what vaccines they should get.

12:08And so for trust to be eroding in this committee is essentially a kind of reversal of what's been going on since this committee was formed in the 1960s. That was Stats Eric Budman. Coming up, we are divided over vaccines. a pediatrician and infectious disease expert on what to do about it.

13:26We'll see you next time.

13:48We'll be right back.

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16:57My name is William Moss. I'm a pediatrician by training, a specialist in infectious diseases. I'm a professor in the Department of Epidemiology here at the Johns Hopkins Bloomberg School of Public Health and the executive director of the International Vaccine Access Center. When and why did we first start thinking that kids should be getting vaccines on this unified schedule? Yeah, so there's actually a long history of guidance on immunizations here in this country.

17:33And it's gotten obviously more complicated as more vaccines have been introduced. But you can trace it all the way back to the 1930s when the American Academy of Pediatrics started issuing guidance on childhood vaccines. It is no longer necessary to remember the doses by age, weight, etc. The important thing to know is how long the patient has been ill and to appreciate the severity of the disease. At that time, it was really just the smallpox vaccine and the diphtheria, tetanus and pertussis vaccine. Then as more vaccines got added, so for example, in the mid-1950s, the inactivated polio vaccine.

18:12Make use of increasing supplies of vaccine. Help your child grow up strong and straight, free from crippling polio. In the early 1960s, the measles vaccine and the oral polio vaccine. But today, Mama has learned that Johnny doesn't even have to get measles. We have a vaccine to prevent it. Isn't that nice? It was recognized that we needed really kind of think through what the appropriate schedule should be, immunization schedule should be for children. Protect the Johnny in your life from measles. Have him immunized. And so in 1964, the Advisory Committee on Immunization Practices was established.

18:59The committee is charged with the responsibility of advising the Surgeon General regarding the most effective application in public health practice of specific preventative agents. So that committee has a 60-year history, and they kind of issued ad hoc recommendations. The American Academy of Pediatrics continued to issue their guidelines. But I would say it was in 1995 that ACIP, the Advisory Committee on Immunization Practices, kind of got together with the American Academy of Pediatrics and issued what is really considered kind of this first unified immunization schedule for children.

19:46I don't know if you were around and working in the field in 1995, but I would imagine that the feeling at the time was, okay, we are now organized. We have this under control. Everybody's going to be more or less following the same rules. Do I have that right? Yes, I think there was. I was in my early days of my pediatric training in 1995, and I think there was a recognition that we needed to have this unification of the immunization schedule or standardization, maybe a better word, of this immunization schedule. and it was really bringing together the key expert groups, getting them aligned. There were some differences before that, which created some confusion.

20:35So having this unified immunization schedule in the mid-1990s was a big advance. You've worked a lot all across the world, and so you know that these vaccine schedules differ, even across developed countries. If the schedule that we have here in the U.S. is what is best, why do Denmark and the U.K. have different schedules for childhood vaccinations? Yeah, so the way I would think about it is that there's not one true, you know, the best immunization schedule. These immunization schedules involve tradeoffs. So, for example, you know, one thing, a big consideration, is just the disease burden, the epidemiology of a particular disease.

21:24How big of a problem is it in a particular country? What age is most impacted by that disease? Is it, you know, multiple doses or a single dose of a vaccine? Can the vaccine doses be aligned so that you can minimize the number of healthcare visits? And then lastly, economic consideration. the cost of the vaccine, who's paying for the vaccine in that setting. The UK and the United States have very different healthcare financing systems. And so that could drive differences in decisions. You can see that not having one right answer, even though that is a fairly common occurrence in like human life, not having one answer, one right answer gives people pause.

22:14Yeah, I think I can understand that, but I don't think it should. I think people can understand that, like you said, in many things in life, there's not one right answer. And I think that also opens the door for some flexibility. If a parent wants to space out a vaccine, they can do that in consultation with their health care provider. But there are risks, obviously, in delaying vaccination because then their child is at risk for that disease in that longer period before they're vaccinated. Vaccines and the schedule on which they're administered have become really contentious, right? And we know that there is some conversation that just isn't helpful.

23:00It only serves to confuse and cloud things. But we also know there are some well-meaning parents who are very lost and very overwhelmed by the process. And one of the questions that I think you hear again and again, this is what I've been seeing in my reading, is that there is concern that infants are getting too many vaccines at the same time. What is the best way for parents to think about that question? I'll say there are a couple things kind of nested within that. One is just, you know, seeing their child get multiple injections with a needle at the same time, knowing that that causes their child discomfort.

23:47And I think that is part of it. And sometimes parents are concerned, and I think this is where the evidence is less supportive, is that their child's immune system is being exposed to too much at one time. I'm not a parent who can blindly just walk into a doctor's office and say, yes, please give my child three shots today. So that never sat right with me, but I'm not anti-vax. So instead of dumping all of that into my baby's body at two months old, I decided to do an alternate vaccine schedule. I don't think there's any kind of biological or immunological kind of basis for that. Our bodies are being exposed to foreign antigens, as we call them, you know, all the time.

24:34So I think it's very important for those of us in public health and certainly those on the front line administering vaccines to listen to parents, to hear their concerns, but to also try to allay any kind of unfounded fears. There has been a drawing of sides here that seems very unfortunate to me. So, for example, if you have questions about the vaccine schedule, people will say, you're a conspiracist. You're a threat to public health. You're a threat to my kids. Y 'all have forgotten what it looks like to have to contend with those diseases. But trust, y 'all do not want to find out. Go get vaccinated.

25:16Vaccinate your children. I'm asking you to do it for yourselves and for my daughters. If you feel comfortable with the existing science around vaccines, then you're participating in a broken system. You're not asking the kinds of questions you should ask on behalf of your kids. My big point on vaccines in general is why the hell is a parent a bad person to ask a question about what they're injecting into their child's arm? That is my choice as a mother. I thought mom shaming was something of the past. I don't tell you how to raise your child. Don't tell me how to raise mine. What do you make of this divide?

25:52The way I kind of look at it when I put my pediatrician's hat on is that all parents want to do what's right for their child. But what I see sometimes is that the risk of the disease can be underestimated. And that's a large part due to the success of vaccines and the fact that we don't see many of these vaccine-preventable diseases anymore. Is there any room for improvement on our childhood vaccine schedules? The design of them, the way that they're updated, the messaging around them, or is everything being done exactly right? Oh, I would certainly say not everything's being done exactly right, and there's always room for improvement.

26:36But what I'll emphasize is what's really important is that process by which the immunization schedule is reviewed and updated. That's so critical to making sure that good, sound decisions are being made and to enlist and ensure the trust in those decisions.

27:14William Moss of the Johns Hopkins Bloomberg School of Public Health and the International Vaccine Access Center. Today's team, Peter Balanon-Rosen, Ariana Espuru, Jolie Myers, Patrick Boyd, Adrienne Lilly and Laura Bullard. Do you like a sale? If so, you should consider becoming a Vox member now, today. Members get ad-free versions of this show, unlimited reading on Vox.com, a member-exclusive newsletter, pics of Sean's feet. That can't be right. We can't do this without members. Sign up now and you will save more than 30 % off an annual membership. Go to Vox.com slash members to join.