Kendra Pierre-Louis: For Scientific AmericanIt is Science quickly, My name is Kendra Pierre-Louis, I’m replacing Rachel Feltman.
This week, federal officials announced major revisions to the U.S. childhood immunization schedule.
The number of vaccinations now recommended by the health agency has been reduced from 17 to 11 diseases.
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And the changes come as U.S. Health and Human Services Secretary Robert F. Kennedy Jr. has transformed the department over the past year. From the firing of several top health officials to the selection of a new CDC vaccine panel.
He says these changes are part of his “Make America Healthy Again” initiative, also known as MAHA, even though much of it appears to defy best-known public health practices. I spoke with Dan Vergano, editor-in-chief of Scientific American, to understand the consequences of this radical overhaul of the country’s public health system on public health.
Thank you for being with us today.
Dan Vergano: Great to be with you.
Pierre-Louis: I think for most people we grew up in a system where we take a lot of things for granted, whether it’s access to medicine or food safety, and I think for many of us we may have a hard time understanding what that kind of upheaval would actually mean in practice. And so, can you talk a little bit about the consequences of this kind of massive change?
Vergano: RFK Jr. is now at the head, essentially, of the MAHA movement, Make America Healthy Again, which is this sort of agglomeration of people concerned about food additives, vaccines, the pharmaceutical industry in general. So basically your federal government will do less for you when it comes to your health, that’s the whole point of the MAHA movement and RFK Jr.’s influence on HHS.
HAS [the Centers for Disease Control and Prevention]in the event of food poisoning or an outbreak in your state, you will no longer have federal assistance. When [the Food and Drug Administration] evaluates a new drug, there will be questions about whether the right number of reviews have been done or whether the right scientific voices have been listened to in order to assess its safety. Whereas before we were quite confident in this, we now have to wonder what was going on there. Likewise, we see it particularly with vaccines at the CDC: the committee that oversees their safety has been replaced by a bunch of vaccine deniers who have their own agenda that isn’t exactly pro-vaccine.
Among other areas the Trump administration has focused on, transgender health care is one example. Children will no longer benefit from medical standards – this simply will not be the case because [lawmakers have] decided to make it a political issue.
So there’s this alignment of the sort of Make America Healthy Again movement, which is concerned about food additives and things like that in the food industry, but also about vaccines, seeing them as dangerous, which fits in with the Trump administration’s sort of disregard for health equity and minority health, which is coming together to sort of throw a spanner in the works of a lot of things that have been the focus of HHS agencies over the last four decades.
Pierre-Louis: One of the things you brought up is gender-affirming care, and can we talk a little bit about that, particularly for young people?
Vergano: So the first thing we need to say is: why are we talking about gender-affirming care? And the reason is, of course, that political activists in the Republican Party decided about five or ten years ago that this would be the way to go. And they found a winning issue in the idea of boys participating in girls’ sports in high school. And this divisive issue, created solely to generate votes, has now morphed into this attack on gender-affirming health care for children. And you saw that because it’s a political movement – it started in 2022, 2021 in the state legislature: all of a sudden there were all these identical bills banning it.
Now it’s coming to a crescendo with RFK Jr. in charge of HHS, pushing this plan to deny medical funding from Medicaid, Children’s Health Insurance. [Program] funding for hospitals that treat children with gender-affirming health care. And all this means is that children receive counseling and possibly puberty-blocking hormones; if they want, things like testosterone; and it’s only very rarely – I mean, so extremely rare that it’s almost never – that it advances to the point of some sort of surgical intervention. And this, of course, after much advice. But they decided to cut that funding, basically to attract the voters they created by making this a political issue.
All this activity crescendoed last month during a big announcement at Hubert [H.] Humphrey Building with RFK Jr. and a whole bunch of politicians, basically, announcing these funding cuts to hospitals that provide this care to children. And they based it on a [roughly] A 300-page report — as if that was somehow important; you know the number of pages in the field of medicine – which, you know, was sort of disputed by other medical authorities, saying that there wasn’t really any solid evidence for what he was finding. But their assertion was that “there is not enough evidence that gender-affirming care helps children, so we are not going to pay for it.”
Instead, what they seem to be advocating is simply advice, which we know doesn’t work. And children placed in this type of care tend to be suicidal. And so they move kids away from what makes them less suicidal and toward something that makes them more suicidal.
Pierre-Louis: My understanding is that, at least in New York State, [Attorney General] Letitia James [has sued] against these changes. And it seems, in general, that some states are really stepping up to fight the administration, like the Northeast Medical Compact and I believe there’s a similar one in the West where they’re putting out their own vaccine guidelines and things like that. To what extent do you see reluctance more generally?
Vergano: That’s right, we’re going to see the classic blue-red divide in this country; you know, that East what we see. These… there will be trials; legal proceedings, like the ones you mentioned, are underway. And what we’re going to end up with is a patchwork country, where kids in some states can get this type of health care and kids in others can’t or, you know, won’t.
And how it will come out, we do not know. The Supreme Court made this curious ruling that states could ban it, but also seemed to say that states could defend it if they wanted to. I’m not a lawyer, so I can’t tell you where they will draw the line. The Supreme Court does have this tendency to support the government’s policy outcomes – the majority we have on the Supreme Court. So, you know, it could be that states end up having to make up the shortfall in federal funding themselves, but that’s going to have to wait for some court cases.
Pierre-Louis: And then the other thing that’s really been targeted under this administration is vaccines in children. And that highlights the fact that, to me, one of the things that stands out when we look at, you know, Make America Healthy Again and what RFK Jr. is doing with it [HHS] It’s that we’re not all equally vulnerable, are we? Like, I’m an adult. I am fully vaccinated. I have all my vaccinations except for shingles because I’m not old enough. [Laughs.] But young people in particular are particularly vulnerable to some of these changes, aren’t they?
Vergano: Well, yeah, I mean, the clearest example of vulnerability is the hepatitis B back and forth that we’ve seen, where it seems clear that RFK’s HHS wants to take away vaccination of newborns against hepatitis B, which is a terrible disease that’s going to kill people. And, you know, the medical evidence going back to 1991, when this system was first implemented, is that if you do this, some children will get this terrible disease, which will hurt them, even kill them, for no reason – it’s a preventable disease. There’s just this fear, this reluctance to require vaccination behind it. And so you’ll see this in all kinds of cases.
You know, in a broad sense, they’re discouraging people from getting their kids flu shots. It was never complete coverage; that’s like 60 percent is a good year for flu shots for kids. And, you know, fewer children will suffer if more people hear the news that they may not be well. And that’s a mistake. The flu vaccine, you know, no one ever pretended…
Pierre-Louis: Mm-hmm.
Vergano: What is it [fully] has prevented the flu, but it certainly seems, overall, to make the illness less severe, which is a good thing if you don’t want kids to get hurt. So, they’re hurt, and, you know, more generally, even people who, you know, have immune deficiencies or are otherwise vulnerable, older people. You know, it’s: the grandchildren give the grandfather the flu, and he dies. And, you know, other people have, you know, vulnerabilities like that, so vaccines aren’t just about you. “Vaccines help protect society as a whole” is a message that simply fails to find traction within RFK’s HHS.
Pierre-Louis: For example, it was reported last year that RFK Jr. was considering aligning the US vaccination schedule with Denmark’s for children. And in the end, the American recommendations published this week are quite close to those of Denmark, with a few differences. The new recommendations maintain the chickenpox vaccine, which is not on the Danish schedule.
And my understanding is that many vaccine advocates are saying it’s a bad idea. Some people in Denmark said, “Hey, actually, that’s a bad idea.” » Why wouldn’t we necessarily want to align with another country’s vaccination schedule?
Vergano: So Denmark and the USA are of course completely different countries, and that’s why you wouldn’t use someone else’s vaccination schedule. I mean, you know, why not Japan or Greenland? Because they don’t mix well. And for the same reason you wouldn’t use the Danish one.
Denmark has a universal healthcare system. We don’t have that. It offers universal treatment for these vaccine-preventable diseases. We don’t have any, that’s why We need vaccines. Denmark has a homogeneous population that can, you know, receive health care in the same way and get it reliably. We certainly don’t have that; we have a mosaic of 50 states and all sorts of different communities that are getting their health care in all sorts of different ways – and not getting it in all sorts of different ways.
Hence the idea that the American system could be grafted onto that of Denmark, where the attraction seems to be simply that they receive fewer vaccines, and that because they have better health care. This just doesn’t fit the American medical situation, so why would you do this? We have built this extensive system of vaccination protocols for the country over the last 40 years. Why should we suddenly plug in a group of Danes?
Pierre-Louis: That’s a very good question. [What] What seems particularly obvious to me is that these decisions are being made now, but we’re not necessarily feeling them now, right? So what is the long-term concern of these changes?
Vergano: That’s right, the long-term concern is that we’re going to destroy the whole vaccination project in this country, which has been built over a century, you know, in terms of people getting vaccinated, getting vaccinated as something that you do to protect your health. If the situation becomes a kind of Russian situation, where no one believes in anything and no one trusts anyone, then why get vaccinated, you know, then we will just have a lot of diseases in our society. or no reason.
And that’s sort of the fear of vaccine experts, is—we’ve seen with the pandemic, right, this hesitancy about vaccines…
Pierre-Louis: Mm-hmm.
Vergano: That’s the whole game, isn’t it? You can make the best vaccine in the world, and if people don’t believe in it and don’t take it, it’s no good. And so what you see is that the vaccine hesitancy that emerged during the pandemic has sort of spread throughout the entire vaccination industry and, you know, that kind of distrust has become the norm in this country and, you know, that’s led to a whole bunch of public health problems, which, you know, nutraceuticals and airport pull-ups like RFK Jr. wants you to do are not going to help at all.
Pierre-Louis: It’s interesting because I feel like since COVID and the rise of sort of vaccine hesitancy, it’s almost had the opposite effect on me, where I’m like, “I have to catch them all.” [Laughs.] Like, I joke that I play Pokémon with vaccines…
Vergano: RIGHT.
Pierre-Louis: And I’m trying to see which ones I don’t have and which ones I should potentially get because, I guess, in my case, I’m—I’m a little afraid that some of them will disappear.
Vergano: These people are particularly unlucky, aren’t they, if people who actually fear getting sick in this atmosphere feel a lot of stigma. I mean, people will give you a hard time for wearing a mask in certain places, you know, where you don’t know what that person might be facing – you know, they might have a sick grandparent or an immunocompromised child at home, and they’re trying not to give them the flu.
Pierre-Louis: Is there any hope – or is there something we can do to somehow slow down the trajectory we’re on?
Vergano: Yes, of course, and we see it. We need public health officials to continue to speak out. We need your doctor to continue to speak out; people trust their doctor…
Pierre-Louis: Mm-hmm.
Vergano: And so that will have to happen when people go to their doctor, the doctor says, “Yeah, I know RFK Jr. is saying all this nonsense, but you really need to get vaccinated. And that’s where the battle front really is, it’s in the doctor’s office.
So I think if your local provider is saying to people, “Geez, you should really do this”; if when you go to the 24-hour drug clinic and they tell you, “Yes, this is all nonsense, you have to do it,” and people accept it; if your pastor does not denounce from the pulpit that vaccines are bad but says: “You know, you really should do it”; then you can reverse it.
I think people are going to have to be wise, one conversation with a nurse, one conversation with a doctor at a time – people who aren’t already convinced that, you know, vaccines are a good deal. I really think that each of us will have to be frank about the fact that the decision to be vaccinated is the right one to reverse the trend.
Pierre-Louis: This seems like a good place to end this conversation. Thank you very much for taking the time to speak with us today.
Vergano: You bet.
Pierre-Louis: That’s all for today! Tune in Friday to find out how GLP-1 is evolving into more powerful drugs, and not just for weight loss.
Science quickly is produced by me, Kendra Pierre-Louis, with Fonda Mwangi, Sushmita Pathak and Jeff DelViscio. This episode was edited by Alex Sugiura. Shayna Posses and Aaron Shattuck check in on our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more recent and in-depth scientific news.
For Scientific American, This is Kendra Pierre-Louis. See you next time!
