How Robert F. Kennedy Jr.’s vaccine program risks a resurgence of deadly scourges among children

Dr. Adam Ratner hovered over a critically ill infant in a New York City intensive care unit on a bleak day in 2022. The 3-month-old had a fever spike two days earlier and had become lethargic. Soon she was having convulsions and had difficulty breathing.

She didn’t notice Ratner’s imposing figure or the bright lights of the hospital. His eyes were fixed to the right, strangely frozen.

He ran his hand over the soft spot on his head, which should have been flat. Instead, it swelled, a sign that too much fluid was building up inside his skull.

The baby’s life was in danger and Ratner had to understand why. He feared the culprit was bacterial meningitis, an infection of the membranes that protect the brain.

What came out of his lab tests was something out of the history books.

Infant meningitis was caused by Haemophilus influenzae type b, or Hib, a type of invasive bacteria that kill nearly 1,000 children a year in the United States An injection introduced in the late 1980s proved so effective that Ratner, a pediatric infectious disease specialist, was among the generation of doctors who had never seen a case. But the baby’s parents, Ratner learned, had chosen not to vaccinate her.

Discouraged, he told his colleagues: “This should never happen. »

This was not the case. The following year, Ratner treated another infant with Hib, and then another, each of them unvaccinated. Two of them returned home, but one had to be sent back to a rehabilitation center. This 5-month-old boy had huge black pupils that didn’t respond to light and he needed a ventilator to breathe. Ratner and colleagues noted a “absence of brainstem reflexes”, indicating serious damage.

It took the U.S. government half a century to establish a vaccination system that protected children from such a fate. Its success depends on two fundamental pillars: parental confidence in vaccines and children’s access to them. Both are now in peril, thanks in large part to the man who runs American health policy.

Health and Human Services Secretary Robert F. Kennedy Jr., who founded an anti-vaccine group and once compared childhood vaccination to a holocausttransforms a government that has long defended the life-saving benefits of vaccines into one that sows doubt about their safety here and abroad.

Kennedy is also considering changes that could prompt the few companies that make vaccines for American children to abandon the U.S. market, leaving parents who want shots unable to get them.

The threat to vaccine access is growing across the world after Kennedy withdrew the government’s $1.6 billion commitment to the aid group that provides vaccines to the world’s poorest children. For decades, the United States has funded this work not only as a humanitarian mission, but also as a way to protect Americans from uncontrolled contagions.

Kennedy’s efforts to reshape vaccine policies have been well documented, but ProPublica wanted to take a broader look at how the changes could affect Americans’ health in the years to come.

We discovered that long-forgotten scourges have returned with a vengeance, killing and maiming children in parts of the world where access to or confidence in vaccines has been undermined. What seemed like subtle changes in a country’s vaccine policy had disastrous consequences years later.

Even in places with very advanced health care, doctors feel powerless to try to repair the damage when these horrors return. Modern medicine cannot reverse the paralysis caused by polio. Surgeons can intervene when a baby is born blind, deaf and with heart defects after being exposed to rubella in the womb, but the child is still likely to face a life shaped by disability.

ProPublica reviewed hundreds of studies on vaccines and the disease outbreaks they prevent and interviewed more than three dozen people who have worked on U.S. vaccination programs here and abroad, dating back to the days of smallpox. Some had never spoken publicly about their experiences.

They shared a deep fear that America’s children would end up fighting for their lives against infections that have long been preventable.

“I think there’s always been a worst-case scenario,” said Dr. Melinda Wharton, who retired last September after more than three decades leading the Centers for Disease Control and Prevention’s vaccination programs. “I don’t think I imagined it could or would be this bad.”

This week, the Kennedy agency indicated he plans to appeal a Federal Court decision that halted, at least temporarily, some of its changes. Among these was the decision to remove six diseases from the routine childhood immunization schedule.

HHS declined to make Kennedy available for an interview. In an emailed response to detailed questions, HHS spokesperson Andrew Nixon said the agency has not limited access or insurance coverage for vaccines. During the previous administration, federal health agencies “told the public that it was illegal to question vaccine policy,” Nixon said. “This posture has contributed to a collapse of confidence in American health care. »

“Secretary Kennedy believes that trust is restored through an open review of security data, a willingness to ask the tough questions, and ensuring that the American people have all emerging information as soon as we know it,” he said.

Vaccination rates have fallen in large areas of the country. Angered by the way government institutions have responded to the COVID-19 pandemic, many Americans loss of confidence in public health leaders. Anti-vaccine activists are spreading misinformation and turning the once-fringe practice of refusing shots into an exercise in “medical freedom.”

Today, the United States is experiencing a surge in measles unprecedented in three decades. There have been more than 3,600 cases in 46 states and three deaths since January of last year. The virus has spread so quickly in South Carolina this year that some medical teams have had to examine infected patients in their cars to protect vulnerable people in their waiting rooms, as they did during the worst days of COVID-19.

Measles, one of the most contagious diseases, is usually the first to infect undervaccinated communities and serves as a warning that other scourges will follow.

This is what happened in New York, where Anti-vaccine forces distributed illustrated materials that sowed fear in Orthodox Jewish communities. Ratner saw a direct line between a loss of confidence and sick children in his intensive care unit – first with measles in 2018 and 2019then with Hib a few years later.

Now, vaccine vilification doesn’t come from pamphlets handed out on a Brooklyn street corner. This comes from the highest health offices in the US government.

“I fear,” Ratner said, “that we are returning to a time when people died in childhood.”

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The United States has been a leader in vaccination since the country’s founding.

During the Revolutionary War, George Washington ordered that troops be vaccinated against smallpox, which had ravaged the Continental Army and was ongoing. scare away the recruits. Washington knew the dangers of the disease: his face was riddled with scars from his own infection as a teenager.

Inoculation, the nation’s first vaccination mandate, took a primitive form. A wound of a smallpox patient was incised, and then the pus was inserted under the skin of a healthy person. Although some people died, the resulting infection was, for the vast majority, milder than that acquired in a dormitory or on a battlefield.

Washington issued the order in February 1777: “keep the matter as secret as possible” so that the British would not attack his bedridden troops during their month-long convalescence. Had he not carried out the inoculation, many historians have concluded, the The British may have won.

Nearly two centuries later, in the midst of the Cold War, CDC scientists teamed up with their counterparts in America’s archenemy, the Soviet Union, to eliminate smallpox from the planet. They worked through the World Health Organization to track the virus in cities, rainforests and war zones, vaccinating those at risk. Four American presidents, Democrats and Republicans, supported this work until the disease that had haunted humans since the days of the pharaohs disappeared.

For decades, vaccines were not politically divisive. They were so uncontroversial that McDonald’s restaurants in the 1990s included the children’s vaccination schedule on their trays.

When the national vaccination program was in trouble in the 1980s, Republicans and Democrats stepped in to save it.

Vaccine manufacturers were abandon the American market after a flood of lawsuits, it was claimed that the vaccine used at the time to protect children from diphtheria, tetanus and whooping cough had caused profoundly disabling seizures. Scientists later discovered the genetic causes of some of the most devastating forms of epilepsy, but parents who then sued won important verdicts and regulations.

At one time, pediatricians could only purchase this vaccine at one companyand there were shortages. The United States also had only one manufacturer left for the measles, mumps, and rubella vaccine and one for the polio vaccine.

“If there was a fire tomorrow at the factory where the polio vaccine is made, what would happen? Rep. Henry Waxman asked the CDC director during a 1984 House subcommittee hearing.

“We would have a shortage,” the director replied.

An exasperated Waxman retorted: “Are we then going to start putting money into iron lungs for polio victims?”

A liberal Democrat from California, Waxman worked for years with Sen. Paula Hawkins, a conservative Republican from Florida, on legislation that stopped the exodus vaccine manufacturers by limiting their liability. Launched in 1988, the federal Vaccine Injury Compensation Program pays people suffering from rare but serious side effects with money from a special tax on certain injections. The program maintains a injury table who are eligible for faster payments, and a dedicated vaccine court rules on cases involving health issues not listed on the table.

Those who don’t like what’s being offered can still sue vaccine makers in traditional civil courts, but a Supreme Court ruling has significantly limited the types of cases that can be won there.

As the compensation program began to take off, measles exposed another weakness in the vaccination system. The disease has ravaged America’s cities, hitting black and Hispanic preschoolers particularly hard. Between 1989 and 1991, there were more than 55,000 cases and 123 deaths.

In June 1991, President George HW Bush, a Republican, entered the White House Rose Garden with a message: “all parents all over America»: “Please make sure your child is vaccinated. »

He announced that a special team of health officials was investigating why so many children had not received their vaccine.

“While some say every generation repeats the mistakes of the last, no generation in America should suffer from the evils of the past,” Bush said.

The problem was access. Parents I couldn’t afford the vaccines given in pediatricians’ offices. Bush’s successor, President Bill Clinton, a Democrat, inaugurated a program that to date provides free injections through local doctors to more than half of America’s children.

Vaccination rates have increased and measles cases have fallen precipitously. By 2000, the United States had stopped the local spread of the virus so well that global health authorities declared it eliminated here.

After making progress at home, the US government has defended the use of vaccines abroad. Dr. Susan Reef, who trained in the CDC’s disease detection program made famous by Kate Winslet’s character in the movie “Contagion,” traveled the world showing health officials how they could save babies from birth defects and premature death by introducing the rubella vaccine.

Also known as German measles, rubella is usually mild in children and adults. However, when women are infected very early in their pregnancy, they face a 90% chance to give birth to a baby with congenital rubella syndrome. About a third of these infants die before their first birthday. Most survivors suffer from deafness, blindness, heart defects or intellectual disabilities. Before the vaccine, an epidemic in the United States in the mid-1960s resulted in 20,000 babies being born with the syndrome.

Reef and his colleagues at the CDC helped foreign health authorities set up surveillance systems to identify newborns with congenital rubella syndrome.

During a rubella outbreak in Vietnam in 2011, Reef spotted a group of tiny cradles in an intensive care unit in Ho Chi Minh City. The babies’ eyes had cataracts, a sign of vision loss. She knew most would have difficulty hearing, if at all. A WHO staffer told Reef that at least one of the infants had been abandoned by his family.

Doctors had isolated contagious newborns to prevent the spread of rubella, a sign that the country’s surveillance system was working. But the scene of this avoidable suffering, Reef said, “broke my heart.”

Vietnam launched a national rubella vaccination program a few years later.

When Reef’s work began, less than half of the world’s countries had introduced the rubella vaccine. When she retired in 2022 after a 30-year career at the CDC, all but 19 had done so.

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For half a century, one idea was at the heart of all American vaccination programs: Let your guard down and diseases will return.

Dr. Chuck Vitek witnessed this phenomenon while walking the worn linoleum floors of Russian infectious disease hospitals in the mid-1990s.

Throughout this decade, a massive epidemic of diphtheria raged in the countries of the former Soviet Union. The CDC has deployed Vitek several times to help health officials contain this ancient contagion, once known as the “child strangling angel.”

The name diphtheria is taken from the Greek word for leather, because tissue destroyed by diphtheria toxin accumulates at the back of the throat like a piece of skin, blocking the swollen airways. Many parents had to watch their children suffocate. For those who escape asphyxiation, the toxin can damage the heart and nerves. Patients who appear to be getting better may die weeks later.

At a hospital, Vitek looked into the mouth of a sick Russian teenager and saw the thick, grayish-white membrane covering a third of his throat. Doctors gave him antitoxin quickly, so his windpipe was not blocked. But, pale and weak, the boy had to face a terrible wait. Had diphtheria destroyed his heart?

Vitek had to leave before knowing if the child would survive. But one detail of his medical history stood out above all: the teenager had not been vaccinated.

“It was sad because it was something that could have easily been prevented through vaccination,” Vitek recalls.

Vitek was another graduate of the CDC’s disease detection program. A large part of his mission was to investigate the reasons for the resurgence of diphtheria. An obvious problem was access; the collapse of the Soviet Union in 1991 disrupted vaccine supplies. But that wasn’t the whole answer.

The unvaccinated Russian boy gave the others a clue.

The Soviets strongly believed in vaccination. Diphtheria vaccines for children have been free – and required – since the 1950s.

When diphtheria appeared to be a problem of the past, the Soviet Union relaxed its efforts. Concerns about fever and other possible side effects from the vaccine used at the time overshadowed fears about illness. In the 1980s, Soviet health authorities created alternative vaccination schedules with lower-dose diphtheria vaccines and fewer total injections, and they asked pediatricians to postpone vaccination if a child had one of the a long list health problems. “If a child had a runny nose, an upset stomach, almost anything,” Vitek said, doctors would skip the injection that day. “They wouldn’t make any effort to catch up.”

Anti-vaccine activists exploited deep distrust of government institutions in the years before the collapse of the Soviet Union. A 1988 column in a Moscow newspaper suggested that Soviet officials knew the shot could be harmful, even fatal, but kept it a secret. (In focus groups held years later, parents accurately recalled how news reports made them afraid of vaccinationsVitek and a colleague found.)

In 1990, only 60% of infants in Soviet Russia had received all three full diphtheria vaccinations before their first birthday.

The disease has found its way. Before the end of the epidemic, more than 157,000 people were infected and 5,000 diedmainly in Russia.

Health officials in Russia ended policies that left their population vulnerable and held mandatory mass vaccination campaigns.

“It was an additional dose for the entire population,” Vitek recalls.

It took years to end the epidemic.

Japan experienced a similar struggle with rubella.

When health officials introduced the rubella vaccine in the 1970s, they took an approach that considered those most at risk, targeting expectant mothers by only administering the vaccine to middle school girls. Boys of this era were left out and remained sensitive as they grew up. Rubella researchers call them “the lost generation.”

In 1989, Japan changed course and began vaccinating young boys and girls with a vaccine that combined protection against rubella, measles and mumps. But doctors quickly discovered that the mumps component – ​​different from the American version – sometimes caused a type of meningitis. Distrust has spread as health officials initially downplayed the risk, then withdrew combination vaccines in favor of stand-alone vaccines.

In 1994, Japan abandoned its strict vaccination requirements. Health authorities continued to recommend the shots, but vaccination became a matter of personal choiceand a lack of trust has clouded the vaccination program for years. Study showed Japan’s confidence in vaccines was among the lowest in the world.

Time and again, rubella circulated among men who had never been offered a vaccine as boys, then spread to pregnant women who had not been fully vaccinated. The babies were born with the type of devastating birth defects that Reef saw in the intensive care unit in Vietnam. The outbreak in Japan from 2012 to 2014 was so severe that researchers discovered a temporary decline in the country’s fertility rates this coincided with an increase in Google searches for the Japanese word for rubella.

Serious concerns about vaccination in one part of the world can have far-reaching consequences. Twenty countries that thought the days of paralytic polio were behind them saw the dreaded disease re-emerge in the 2000s. The origin of the virus can be traced to Nigeria, where religious and political leaders in some regions boycotted polio vaccination campaigns, amid false rumors that the vaccines had been contaminated to make Muslim girls sterile.

The boycott organizers feared the vaccine more than the disease.

The governor of a northern Nigerian state told the Associated Press in 2004: “It is a lesser evil to sacrifice two, three, four, five, even ten children.” [to polio] rather than leaving hundreds, thousands, even millions of little girls at risk of becoming sterile. »

Polio has returned to Nigeria, leaving more than 2,500 children disabled. It spread around the world for years, paralyzing children as far away as Indonesia.

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When Kennedy became the top U.S. health official last year, no other CDC leader had more experience preventing death and disability with vaccines than Dr. Melinda Wharton.

It was Wharton who sent Vitek to Russia to understand why diphtheria returned. And it was Wharton who launched Reef in its quest to overcome congenital rubella syndrome. Like them, she had trained as a disease detective.

During his 39 years at the CDC, Wharton saw activists try to persuade Americans that the shots they gave their babies were scarier than the diseases they prevented. In 2021, Kennedy wrote in a book about measles – a virus according to the CDC kills nearly 1 to 3 children in 1,000 who contract it – was not the threat proclaimed by the government.

“Measles outbreaks have been fabricated to create fear which, in turn, compels government officials to ‘do something,’” he wrote. “They then inflict unnecessary and risky vaccines on millions of children for the sole purpose of increasing the industry’s profits. »

During his confirmation hearings, Kennedy told senators he was not anti-vaccine. “I’m all for safety,” he said. “I have worked for years to raise awareness about mercury and toxic chemicals found in fish, and no one called me anti-fish.”

In its early days as the nation’s primary health leader, HHS fired thousands of Wharton colleaguesended vaccine promotions during a particularly deadly flu season and buried a measles forecast from the CDC who stressed the need for vaccination.

Wharton placed five empty cardboard boxes on top of her filing cabinet in case she needed to pack quickly.

In recent years, she has led the committee of outside experts that recommends which shots Americans should receive and when. Few people had heard of his dark side of the federal health bureaucracy.

But Kennedy knew that well. He understood that Congress had given these advisers the power to determine which vaccines were free for more than half of American children and which had to be paid for by insurers. Many states have used the committee’s recommendations to set vaccination mandates for children attending school.

Kennedy complained for years that the panel had been captured by Big Pharma. On June 9, his chief of staff at the CDC removed Wharton from his role leading the committee. As the news broke, Wharton’s phone lit up with messages from committee members. Kennedy announced in a Wall Street Journal column that he replaced them all. “A clean slate is needed to restore public confidence in vaccine science,” he wrote.

Kennedy filled the new committee with numerous vaccine skeptics who quickly delved into his long-standing grievances about the U.S. vaccination system. Webcasts of meetings have become a mouthpiece of mistrust. Some turned into arguments as doctors from medical societies pushed back against the misinformation.

One of Kennedy’s new appointees, Retsef Levi, a professor of operations management at the MIT Sloan School of Management, suggested that vaccinating a baby was like flying an airplane that hadn’t been rigorously tested. “I suggest parents be very, very suspicious when people tell them something is safe, especially a vaccine,” he said.

In an email response to questions from ProPublica, Levi said vaccines have benefits and risks “often personalized based on the individual’s health status, risk factors and preferences.” Being transparent about these benefits and risks, including being honest about what is known and unknown, increases public confidence in vaccination programs, he said.

Committee Chair Dr. Kirk Milhoan said “Why should I trust you?” ” podcast he was not afraid to reconsider whether or not the polio vaccine was necessary. In an email to ProPublica, Milhoan, a pediatric cardiologist, said the committee is required to review vaccines every seven years “to optimize effectiveness and reevaluate possible long-term risks.”

Like Kennedy, Milhoan doesn’t believe the vaccines’ safety has been properly tested. In the podcast, he said American parents deserve to know the risks so they can decide whether they are more concerned about illness or potential side effects from the vaccine.

“What we are doing is putting individual autonomy back at the forefront, not public health,” he added.

Since retiring last year, Wharton has followed the meetings she held, but sometimes they were too painful to watch. The new committee at one point sought advice from a former chair of the anti-vaccination group Kennedy founded, while a compilation of CDC evidence countering its presentation was quietly removed from the committee’s website. To get a glimpse of the children’s timeline, the panel listened to a 90-minute speech from a Kennedy ally, a vaccine injury lawyer who once called on the government to withdraw its approval of the polio vaccine for infants and toddlers.

In January, the acting CDC director narrowed the childhood vaccination schedule to recommend routine protection against 11 diseases instead of 17. Six shots that were universal would now fall into a category that essentially means “talk to your doctor and decide for yourself,” with guidance for certain shots based on risk.

“The idea that it’s increasingly acceptable to put children in harm’s way for these kinds of things is just terrible,” Wharton said. “It’s very frightening that this is the official position of the federal government.”

Nixon, the HHS spokesperson, defended the slimmed-down schedule, saying it would “maintain strong protection against diseases that cause serious morbidity or mortality in children while aligning the United States with peer countries.”

As for the committee, Nixon said Kennedy appointees are “committed to rigorous review and independent thinking.”

“Rebuilding trust requires advisory bodies willing to ask tough questions, not just reaffirm previous consensus and rubber-stamp recommendations,” he said. “Disagreements at public meetings constitute healthy scientific debate and are a way to overcome groupthink. »

The American Academy of Pediatrics, which had collaborated for decades with the committee on the childhood immunization schedule, boycotted committee meetings and sued to block many of Kennedy’s initiatives.

Monday, a federal judge sided with the academyfinding that for an advisory committee dedicated to using vaccines to control preventable diseases, more than half of the new members “appear clearly unqualified.” While he reviews the case, the judge has, for now, suspended Kennedy’s appointments to the panel as well as the CDC’s changes to the childhood immunization schedule.

The decision is a setback for Kennedy, but the Trump administration has planned other changes that could affect Americans’ access to vaccines.

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In September, President Donald Trump took the microphone in the Roosevelt Room of the White House with a major announcement on his administration’s efforts to counter the rise in autism. Flanked by Kennedy and other top health officials, the president urged pregnant women not to take acetaminophen, a painkiller often sold under the name Tylenol. This news ricocheted around the world.

But less attention was paid to the other vaccine bombs dropped that day. The president complained that pediatricians were giving so many shots that they were treating America’s children like horses.

“They’re putting so much stuff into these beautiful little babies, it’s a shame,” he said.

Without explaining how, Trump said his administration would remove aluminum from vaccines. “Who the hell wants that pumped into a body?” » he said .

Aluminum has been used in shots since the 1930s to boost the immune response. It is an essential ingredient in vaccines against nine diseases, including diphtheria, tetanus, whooping cough, human papillomavirus (a cause of cervical cancer), a version of the Hib vaccine, and many combination shots that babies receive. Kennedy has long questioned his security.

A study sponsored by the CDC found an association between the aluminum present in shots and asthma in young children. But the researchers, citing limitations in their analysis, wrote that “these results do not constitute strong evidence to call into question the safety of aluminum in vaccines.” A larger study by Danish government researchers later discovered aluminum in the shot. did not increase the risk autism, asthma, autoimmune diseases or dozens of other conditions. Kennedy criticized the methodology And tried without success for the Danish study to be withdrawn.

If the federal government banned aluminum in vaccines, companies would have to reformulate them and possibly launch expensive clinical trials. Almost all of the injections American children receive are made by a handful of pharmaceutical giants. The market is fragile enough that if someone hesitated and stopped making these vaccines, families could face shortages or no longer have access to them.

The fate of the measles, mumps and rubella vaccine, which does not contain aluminum, is also uncertain. At the White House autism press conference, Trump, without providing evidence, said he had heard bad things about the injection, which has been used here since 1971. Researchers around the world have repeatedly found that it does not cause autism.

Still, the president implored parents to insist on separate shots for measles, mumps and rubella — “separate, separate, separate,” he repeated.

But there is no standalone FDA-approved vaccine for measles, mumps or rubella. Facing a year with the highest number of measles cases in the United States in a generation, the president suggested there was a problem with the only foolproof prevention available and asked parents to demand vaccines that don’t exist here.

In an X post, the acting director of the CDC at the time appealed to the manufacturers to develop them.

A White House spokesperson did not respond to questions about the president’s plans.

“The Trump Administration is committed to a nuanced, agile, and multifaceted approach to reestablishing gold standard science as the guiding principle of our health policy without compromising access to or coverage of any life-saving treatment, including vaccines,” Kush Desai wrote in an email. “Until revealed by the administration, discussions of potential new policies or their second-order effects are idle speculation. »

The Federal Court ruling that suspended revisions to the childhood vaccination schedule in January does not prevent Kennedy from making similar changes in the future, provided he follows proper procedures. While moving photos to the Talk to Your Doctor category may seem harmless, it could affect access down the line.

The injury compensation program created by Congress in the 1980s to prevent manufacturers from fleeing the U.S. market. covers only vaccinations that the CDC recommends for “routine administration” to children or pregnant women. That leaves shots in other categories open to legal challenges from vaccine injury lawyers, renewing the specter of major legal verdicts that previously prompted vaccine makers to flee.

Kennedy has long denounced the vaccine injury compensation program, arguing that it is a giveaway to the pharmaceutical industry that removes any incentive to make safe products. Before becoming HHS secretary, Kennedy referred plaintiffs to a law firm suing a vaccine maker in exchange for a reduction in its fees if they won, according to federal financial disclosures.

Last year he hired a vaccine injury lawyer to help revise the compensation program and expand the number of people who can receive payments. In September, that lawyer said he and Kennedy were considering ways add symptoms of autism to the program’s injury table for prompt payments.

So many studies – carried out in different parts of the world and involving more than a million people – have found no link between vaccines and autism that it has become a reality. scientific consensus. (Scientists have discovered serious methodological flaws in newspapers that claimed such a link.) The compensation program’s vaccine court spent years in the 2000s trying cases that alleged shots caused autism and they discovered that no. ProPublica asked HHS if Kennedy planned to add autism symptoms to the program’s injury table, but the agency did not respond.

Given the prevalence of autism, such a change could deplete the compensation fund. If the program collapses and legal protections disappear, manufacturers could stop selling vaccines here as they did in the 1980s.

At the time, even Americans who still trusted vaccines couldn’t get them.

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Diseases that have been eradicated in the United States are still found in other parts of the world.

Polio is endemic in Pakistan and Afghanistan, and this month the CDC warned American travelers that the virus was circulating in the country. 28 additional countriesincluding Israel and the United Kingdom. In 2022, a unvaccinated young man in New York was paralyzed by the virus.

The same year, a diphtheria epidemic broke out in Western Europe. the biggest increase in cases in 70 years. Health authorities investigating the infection of an unvaccinated German boy in 2024 have discovered that the a toxic strain of diphtheria bacteria spread over two years from newly arrived migrants to homeless Germans, then to the child and his mother, who had no known contact with either group.

THE A 10-year-old child was admitted to hospital in the historic city of Potsdam. Just like Ratner meeting his first Hib patient, German doctors had never seen diphtheria before.

“It was taught like history,” said Dr. Bernhard Kosak, head of pediatric emergency medicine and critical care.

Treated with antitoxins and antibiotics, the child was transferred to the large university hospital in Berlin where a ventilator helped him breathe. But the wonders of modern critical care medicine have not been able to undo the damage caused by this ancient toxin. The boy died in January last year.

Illnesses can follow the contours of global travel. During the first months of last year, the CDC foundpeople infected with measles arrived in the United States from Canada, Vietnam, Mexico, Pakistan, the Philippines, Saudi Arabia, Afghanistan, Australia, Guinea, the Netherlands, Somalia, Spain and Uganda.

The Trump administration has abandoned longstanding international alliances that have helped the United States fend off scourges in other countries. The president withdrew the United States from the WHO. And Kennedy walked back the government’s promise to give $1.6 billion to Gavi, the global vaccine aid group that the United States has funded for decades. He accused the organization of neglecting vaccine safety.

“Secretary Kennedy has made clear that U.S. public health funds intended overseas must be spent wisely,” said Nixon, the HHS spokesperson. “That means reviewing funding commitments and ensuring programs meet standards for safety and effectiveness. Protecting Americans at home remains our first obligation.”

Reef, the former CDC doctor who saw newborns suffer from congenital rubella syndrome in Vietnam, is devastated by the withdrawal.

“It makes me very, very sad,” she said, then paused for a long time. “Very very sad. I can’t explain to you what it feels like to see all your hard work left behind.”

In retirement, she is still part of the expert panel that helps governments decide when to introduce the rubella vaccine and also serves on four WHO committees that determine whether countries have eliminated rubella or measles.

When countries first launch rubella vaccination campaigns, they cannot just target babies, otherwise the virus spreads to older groups and can infect those who are pregnant. To prevent this, Gavi has for many years supported the vaccination of all children aged 9 months to 15 years, when countries first introduced the vaccine, which provides protection not only against rubella but also against measles.

But facing a huge hole in its budget, Gavi’s board decided in December to save money by guaranteeing this vaccine only until age 10 when a country first launches it. Modeling predicts that this change could lead to 72,000 additional deaths from congenital measles-rubella syndrome, according to Gavi board records.

A Gavi spokesperson acknowledged the change created a higher risk of congenital rubella, but said the organization needed to find a way to protect as many people as possible with far less money. Countries that want to offer the vaccine to older children, she noted, can dip into another pot of Gavi money, but that will leave those countries with less funding for other vaccines.

The consequences of budget cuts go far beyond rubella. “Ultimately, over the next five years, we hope to be able to prevent 600,000 fewer future deaths than if we were fully funded,” the spokesperson said.

Responding to Kennedy’s criticism, the spokesperson added: “Gavi’s greatest concern is the health and safety of children. Our approach to child safety Vaccine policy is entirely guided by global scientific consensus.

The spread of measles in the United States warns of future rubella outbreaks. Since the rubella vaccine is given here in combination with the measles and mumps vaccine, parents who refuse the measles vaccine also leave their children vulnerable to rubella. It could take 20 years before birth defects from rubella become common again. Unvaccinated children must be old enough to become pregnant. The long lag can give a false sense of security.

But, Reef warned, “when it comes back, it will come back with a vengeance. We will see babies born blind, deaf and with heart disease.”

The world is poorly prepared for a major resurgence of diphtheria. Antitoxin, made from horse bloodmust be given immediately. However, stocks are scarce and few companies sell them. Dozens of children died in Pakistan in 2024 because doctors couldn’t get it in time.

Vitek, the CDC doctor who fought diphtheria in Russia, helped the CDC win permission to keep an emergency supply of the antitoxin for Americans after the only FDA-approved manufacturer stopped making it. The American medical system still depends on emergency supply controlled by the CDC.

ProPublica asked the CDC and HHS how many diphtheria patients the government’s current supply could treat, but neither agency would say. (“CDC vigilantly monitors disease trends, maintains emergency stocks, and supports outbreak response at home and abroad,” Nixon said.)

Vitek retired in July after 33 years at the CDC, but he still worries about how diseases that seem defeated can resurface if people can’t or won’t get vaccinated.

Unvaccinated parts of America could find themselves, like Germany, one unwitting traveler away from an explosion of horror worthy of the history books.

“Once reintroduced, your child could get sick or die, even with modern medicine,” Vitek warned. And diphtheria, he noted, “is a terrible way to die.”