RFK Jr. Just Replaced the Experts Guiding U.S. Vaccines. Now What?

Dan Gorenstein (DG): Hey, it’s Dan. 

Earlier this year we looked at the power Robert F. Kennedy Jr. would have over vaccine policy as the nation’s health secretary. 

This week, Kennedy wielded that power dramatically. He dismissed every member of the important Advisory Committee on Immunization Practices, which makes vaccine recommendations to the CDC. 

Wednesday evening, Kennedy named eight of his own experts to the panel.

The move is unprecedented in the committee’s 61-year history. 

Kennedy called it a “clean sweep.”

A new ACIP could make big changes with far-reaching effects on vaccine cost and access.

In January, we profiled this obscure panel and its powerful role. Given this week’s news, we wanted to revisit that show. Stick around to the end. We will bring you an update about where we’re headed.

***

DG: Robert F. Kennedy Jr. is back in Washington this week. 

He’s meeting with the Senate, hoping to convince members he should become the nation’s next health secretary. 

Robert F. Kennedy Jr: I’m humbled to be sitting here today as President Trump’s nominee to oversee the U.S. Department of Health and Human Services. 

DG: During his hearing with the Senate Finance Committee yesterday, Kennedy’s views on vaccines came under sharp questioning and criticism from Democrats. 

Sen. Ron Wyden: He has made it his life’s work to sow doubt…

Sen. Michael Bennet: …pedalling in half truths, pedaling in false statements…

Sen. Bernie Sanders: Are you supportive of these onesies?

RFK JR.: I’m supportive of vaccines.

Sen. Elizabeth Warren: …Mr. Kennedy it’s just a really simple question…

DG: Kennedy testified he supports vaccines and good science.   

RFK JR: I support the measles vaccine. I support the polio vaccine. I will do nothing as HHS Secretary that makes it difficult or discourages people from taking either of those vaccines. 

DG: Kennedy’s pledge — to not make it difficult or discourage people from taking the measles or polio vaccine did little to assure his critics. 

Sen. Maggie Hassan: I am extremely concerned that, as secretary, you would be able to halt critical vaccine research and to exploit parents’ natural worries by advising them not to vaccinate their children. This will lead to more children getting sick and some will even die.

DG: What worries some senators and many public health officials is how much power Kennedy would have to shape vaccine policy as the nation’s health secretary. 

It turns out one of the most important levers he would have is control of an obscure committee whose influence shapes how doctors treat their patients, public health practices and even has the power to move markets. 

Today, the most powerful committee you’ve never heard of and the control Kennedy would wield as HHS Secretary. 

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, this is Tradeoffs.

DG: Joining us to talk about this committee and its influence over vaccines is Tradeoffs reporter and producer Melanie Evans. 

Hi Melanie 

Melanie Evans (ME): Hey Dan. 

DG: OK. So before we talk about Kennedy, let’s first focus on this committee.

It’s called the Advisory Committee on Immunization Practices. In a sentence, Melanie, what does it do?

ME: Well, Dan, this is a group that, for the most part, makes recommendations about who should get vaccines to the Centers for Disease Control and Prevention.

DG: OK, and to be clear this committee, which goes by the acronym ACIP, is made up of clinicians and scientists who advise the CDC.

I mean the CDC ultimately has to sign off on those recommendations, right? 

So, how much power does the committee actually have?  

ME: Fair point. I talked to lawyers, public health officials and vaccine developers about this, Dan. Robert Hughes IV, an attorney who represents drug makers, summed up what I heard. 

Robert Hughes IV: “It is the most important policy making body with respect to vaccines in the United States.” 

ME: ACIP’s influence, Dan, is pretty broad.

Doctors follow its recommendations. Their decisions guide school vaccine mandates [and] health insurance coverage. People told me ACIP even sways drug development.

DG: Why do so many people put so much faith into this obscure little committee?  

ME: Sure. I can answer your question in a few ways. 

First, this committee is influential because — over the last sixty years — many doctors and public health experts have developed a high level of confidence in its decisions. 

Dorit Reiss (DR): The ACIP is one of the most important points in the vaccine world because it’s such a trusted body.

ME: That’s University of California, San Francisco professor Dorit Reiss.

Dorit ticked off a whole list of why this body is so trusted.

And it starts with that the members have a lot of expertise

DR: Second, the recommendations are very detailed, very fact heavy. So the content of the recommendations is heavily science based. And third, transparency ACIP meets in public. Their recommendations are also public. They’re published. But the meetings themselves are also recorded and heard. So there’s no — it’s not a behind closed doors organization.

ME: But more than transparency, Dan, what the committee is doing is hard work. 

You’ve got these 19 scientists and doctors whose job is to basically keep tabs on all the research and data about diseases and vaccines, which of course, keeps changing. 

And for the people who do it, it’s basically a second job. 

Take Sarah Long. She served on the committee for about three years. 

Sarah says she squeezed in roughly 40 hours of meetings over several months to consider a single vaccine. Her day job, by the way, is pediatric infectious disease doctor and professor. 

Dr. Sarah Long: “Having grown up in Alaska was probably helpful. You know, you just did a lot of things. If you wanted to go skating, you went and swept off a glacier (laugh).”

DG: That’s intense.

ME: Skating on a glacier? Or the workload? 

DG: Both. One definitely sounds harder. 

ME: Sarah was one of 94 people who worked on this one recommendation. 

A thing I learned, Dan, interviewing people like Sarah is that their commitment to the work is real.

They are so devoted to it because they understand the stakes. Dr. Paul Offit from the Children’s Hospital of Philadelphia has also been on the committee. 

Dr. Paul Offit: You’re taking the responsibility for this country’s children often, and your heart is in your throat all the time because you’re so worried that you might miss something because these products are given to healthy people, including healthy young children.

DG: Alright. So, you’re really starting to paint a picture for me, Melanie, why this committee is so influential. 

You’ve got a bunch of vaccine experts who get together combing through evidence and data — trying to figure out the best vaccine recommendations.

They’ve been doing this work since the 1960’s and all their work is out in the open. 

ME: That’s why there’s so much trust in the committee, Dan. And the CDC almost always approves their recommendations which touch many of us. 

DG: How’s that?

ME: Well, a few things. 

One, their policies are followed by lots of doctors when they give vaccines to patients. 

States look to ACIP to know which vaccines students need for school. 

And finally, federal law requires most health insurers to make ACIP- recommended vaccines free. They pick up the entire bill. 

DG: Wow. This committee really has a wide reach, Melanie. 

ME: Yeah, Dan, its influence touches lots of us in ways either directly or indirectly. I definitely didn’t realize that when I started my reporting.  

But I’ve saved perhaps ACIP’s most direct power for last: It makes critical decisions for the Vaccines for Children program. And before you ask me what the Vaccines for Children program is, Dan, it’s basically a blank check from the feds to states and doctors to buy vaccines for vulnerable children. 

DG: How many kids does it serve, Melanie? How big is this?

ME: Right. About half the nation’s children are eligible for these free vaccines. And Congress gave ACIP the power to choose which vaccines will be included. If ACIP approves a vaccine, federal funding is guaranteed. If not, no money. 

DG: This is why lots of public health folks are nervous if RFK Jr. is confirmed. 

Given his anti-vaccine comments — many that have been totally debunked — through ACIP he could end up with a lot of power over vaccine policy. 

When we come back, how Kennedy could change the committee and public health officials begin drawing up plan B’s.

MIDROLL 

DG: Welcome back. 

Melanie, before the break you walked us through the broad reach these vaccine advisors to the CDC have.

Let’s talk now about what power the HHS Secretary has — whoever that is — over this advisory committee. 

ME: Sure. It’s pretty straightforward. The ACIP is what is known as a discretionary committee. That just means it exists because HHS says so. 

DG: So, does that mean the HHS Secretary can shut it down? 

ME: Yes, and in fact, the agency has to agree every two years to let the ACIP continue. 

Now, Kennedy has questioned the committee’s integrity. He alleges its members are in the pocket of drugmakers.

To be clear, the ACIP has ethics rules that say members must disclose any financial conflicts and sit out votes where they have personal financial interests. 

Kennedy may distrust the committee, but people I spoke to said he probably won’t go so far as to end it. 

DG: What did they think was more likely to happen? 

ME: So, the Secretary can appoint people. The folks I talked to said Kennedy could fill those seats with people who share what has been called his vaccine cynicism. 

Right now, there are four open seats. Another four members have terms that end in June. Adding eight new members to a committee of 19, who are vaccine skeptics, could be disruptive. 

DG: Doing some quick math, here, eight seats on a board of 19 falls short of a majority.  

ME: Good work, Dan. But, here’s the thing. The Secretary also has the power to remove existing members. I spoke to public health and legal experts who think this is possible.

DG: OK, so, and I know this is entering the world of speculation, but if Kennedy stacked the committee, what could happen?

Or, at least, what are the people you interviewed afraid could happen?

ME: Ok, so ACIP recommendations fall into two broad categories: vaccines you should get and vaccines you might want to get, based on your health. And, the committee has the power to roll back strong recommendations – vaccines you should get — in favor of softer ones — vaccines you might want to get. 

DG: Got it. 

ME: These softer recommendations can be time consuming in practice, right, doctors and patients talking it out. It can be confusing for physicians: ‘Should I give my patient the vaccine, or not?’ A CDC study found, no surprise, softer recommendations are a challenge to follow. 

DG: Makes sense. 

ME: And quick anecdote, Dan. In 2019, the committee switched to a soft recommendation for older adults for a vaccine that treats a serious bacterial infection called pneumococcal disease.

Fewer older adults got the vaccine, which was the point. And the drug maker, Pfizer, said sales dropped. 

Now, people told me they fear Kennedy could name members who would switch more vaccines to softer recommendations, even when a strong recommendation is warranted. 

That, obviously, could lead to fewer people getting vaccinated.

This is how Kennedy could make good when he says people should have a choice to get vaccinated and information to make that choice. 

DG: Right because Kennedy has been saying he wants people to have access to vaccines if they want them. 

And the softer “you might want to get this” recommendation doesn’t take anything away, but it does make it less likely people will get their shots.

ME: Yes, people worry we could see more preventable diseases in the United States as vaccine use drops off. 

DG: How realistic is this concern, Melanie? 

ME: Obviously, we won’t know unless Kennedy becomes secretary. I did contact staff for Kennedy and President Trump, but didn’t hear back.

But people are taking this risk seriously. 

Credit analysts warned investors the market for vaccines could shrink. 

And if that happens, we are likely going to see fewer new vaccines or, at least, they will take longer to reach the market. 

Here’s a great example. The Danish company, MinervaX, is developing a vaccine that’s been on the public health wish list for a long time. It’s to treat an infection that causes an estimated 90,000 infant deaths globally each year. 

CEO Per Fischer says his company needs more money to fund the third phase of clinical trials; but if Kennedy is confirmed, he believes it will be harder to raise that money. 

Per Fischer: I think people are sort of applying this wait and see kind of approach and then hoping it’s not going to be as bad.

DG: Can you explain a bit more, Melanie, why are people in the industry anxious?

ME: Sure. Private investors play a huge role in paying for the upfront costs.

DG: Like the third phase of clinical trials. 

ME: Exactly. And they do that in hopes there’s a hefty return at the end. 

But the market for vaccines is already limited. In most cases, we take vaccines once, maybe once a year. The money comes from the fact that many people who can get vaccinated actually do. With weaker vaccine recommendations from ACIP that pool gets smaller.

DG: And so the concern is a smaller payday means it’s harder for drugs like MinervaX’s to raise money.

ME: Yes, and, arguably worse than investors and the company losing out, we all lose out on the public health upside — in this instance the chance to reduce infant mortality. 

Per Fischer told me he’s concerned about what could happen in the short-term, but is grimly confident in the long-term demand for vaccines. 

PF: Ultimately I believe that if you start killing childhood vaccinations broadly, and, and parents start noticing that their infants become sick with measles and other, you know, serious childhood diseases then ultimately, I believe that, that science will prevail and that people will actually ultimately understand that vaccines are good.

DG: So, Melanie, investors and drug makers are bracing for what might be coming. I know you’ve also talked to public health officials who are relying on funding through the Vaccines for Children program. What are they saying? 

ME: Right. I talked to Ron Balajadia from the Hawaii Department of Health.

About 56% of the state’s children are eligible for free vaccines. He said that’s not cheap. Hawaii gets around $19 million from the feds.

He says the Health Department is in early talks with Hawaii lawmakers about coming up with a backup plan, in case ACIP cuts funding.  

Ron Balajadia: And how can the state government afford that? It would be one question and can it afford it? We’re still looking through that, we’re still trying to understand better what that looks like, because it’s going to be a lot of money. 

DG: I’m really curious, what’s the mood right now? 

ME: Ron says he’s been talking to counterparts around the country and lots of people are worried, kind of on pins and needles.

For Ron in particular, he’s seen firsthand what happens when there are outbreaks that impact kids and it’s scary. 

About 20 years ago the CDC sent him to the Federated States of Micronesia to help stop the spread of whooping cough, also known as pertussis. 

RB: I went to a very small island in, in the Pacific, and I got off a boat.

ME: He was met by a distressed mother and local healthcare worker holding a baby.

RB: I would say maybe seven, eight months old, that was blue and trying to cough, but was throwing up and was coughing at the same time with spasms of pertussis.

ME: The healthcare worker asked him to help. Ron tried to make sure the child didn’t choke as it vomited. 

RB: And there really isn’t anything we could have done. We didn’t have any medical equipment at the time.

ME: He still remembers that moment, Dan, about two decades later. 

RB: It haunted me in the way that I wanted to help, but I couldn’t.

ME: The child ultimately survived, but Ron said illness could have been avoided if the baby had had access to the vaccine. 

After my reporting for this story, Dan, this is a vivid example of what public health officials see is at stake. 

DG: That — if Kennedy is confirmed — we could end up in a situation where there’s a lot of suffering needlessly?

ME: That’s right. 

You remember we were talking about the pneumococcal vaccine?

DG: Yeah, the one ACIP gave a soft recommendation to — that led to the downturn in people who took it.  

ME: Right. Well, that was a decision the committee made after carefully reviewing the evidence. 

The people I talked to said they’re worried Kennedy will appoint people who will make decisions, regardless of evidence. 

DG: And if he does that, not only does he undermine the trust ACIP has built up over the last five decades — he’s also undermining basic science, which could lead to the kind of suffering Ron saw with the whooping cough. 

ME: Yep. That’s the real worry here, Dan. 

***

DG: So. Kennedy is now using his power as HHS secretary in ways some of his critics feared. 

This week, he fired the entire committee. Tradeoffs producer Melanie Evans has been reporting on vaccine policy under Kennedy. She’s been talking to policy and public health experts this week to make sense of what happened and what’s next. 

Hi Melanie.

ME: Hi Dan. 

DG: Let’s start with why Kennedy took the action he did. What justification did he give for kicking out all 17 members of the committee? 

ME: Kennedy made this announcement in a Wall Street Journal op-ed. What he said was the committee was a quote “rubber stamp” for vaccines. 

DG: I mean you have been reporting this for months, Melanie. He alleges members are in the pocket of drugmakers.

But — as you said in our original story — the ACIP has ethics rules that say members must disclose any financial conflicts and sit out votes where they have personal financial interests. 

ME: That’s right, Dan. And there’s another safeguard: The CDC reviews each member’s finances for conflicts of interest, real or perceived. I have read the guidelines and they cover a lot of ground: Consulting. Legal work. Clinical trials. Stocks. It’s pretty detailed. 

DG: The thoroughness seems to suggest the committee takes conflict of interest fairly seriously.  

So Melanie, on X this week Kennedy went on to defend his decision. His biggest critique of the committee is a lack of “adequate” safety trials for vaccines. The key word there is adequate, because there are safety trials. 

ME: Yes, Dan. To understand how safety trials are currently conducted, I talked with Dr. Paul Offit, who has served on the ACIP and advises the FDA on vaccines.

Paul walked me through some pretty technical steps and cited specific examples of where safety systems caught really rare risks associated with vaccines. 

He trusts the safety of the results and completely disagrees with Kennedy’s decision to push out ACIP experts. 

Paul Offit: The 17 people that he fired had a published expertise in areas like virology, vaccinology, immunology, statistics, epidemiology. And they served us well. The advice that they have given us, frankly, since the ACIP was founded in 1964, has been excellent.

ME: Paul said the new panel includes vaccine critics and generally lacked expertise in the field representing a giant step backwards. 

DG: Kennedy said earlier this week on social media of his replacements: “None of these individuals will be ideological anti-vaxxers.” 

He went on to say they would be highly credentialed physicians and scientists who will apply evidenced-based decision making with objectivity and common sense. 

Melanie, he’s appointed eight people. And at least some of them are considered vaccine skeptics. 

ME: Here’s what we know. 

Kennedy has a lot of latitude to choose who’s on the committee. You’ve got to have a knowledge of public health or some medical or research expertise with vaccines.

In terms of the vaccine skeptics, one new member, Dr. Robert Malone, said in a 2022 speech in Washington that COVID-19 vaccines weren’t working, The Washington Post reported. “The science is settled,” he told the crowd. 

Another of Kennedy’s picks, nurse and Ph.D. Vicky Pebsworth, is on the board of the anti-vaccine group National Vaccine Information Center.

DG: So, Melanie, ACIP is scheduled to meet later this month on June 25th. 

As of right now, we have eight new members. What’s on the agenda? Like is anything hanging in the balance?

ME: Dan, there is no agenda for the June meeting on the committee’s website. But the federal register says ACIP is scheduled to vote on COVID-19 and flu vaccines. 

This will be the first clear test of how Kennedy’s new ACIP will handle recommendations.

DG: And I know that public health agencies and clinicians rely on the ACIP for vaccine recommendations. Where does this leave them?

ME: So I think pretty soon, we will get a sense of the new members and we will see their first meeting.

And we’ll start to be able to answer the biggest question I heard this week: Will people be able to trust the committee under Kennedy?

DG: Right. Doctors need a place to turn to know who needs which vaccine. So if not ACIP, where do they look? 

ME: One option: major medical societies. They already participate in the ACIP’s work. So they have the familiarity and credibility that makes them a plausible alternative. Think of the American Academy of Pediatrics or American Academy of Family Physicians.

DG: Sure. These are groups with the expertise you’d want. They’re the doctors who are taking care of you and your parents or your kids. 

ME: But… 

DG: Yes? 

ME: It’s more complicated. ACIP relies on the CDC for a lot of support, scientific and technical work.

And ACIP is this public body, right. All of its evidence is public. How might that change if all of a sudden you have private societies doing this work?

Put that all together, Dan, and it would be tough for another organization to fill ACIP’s shoes. 

DG: There is, I think, at least one attempt at the University of Minnesota. Is that right? 

ME: Right. This is the Vaccine Integrity Project. It is early on, but the project’s goal is creating an alternative to the federal government as a source of vaccine recommendations. 

DG: Melanie, what’s your sense of where we are headed next? 

ME: Dan, all eyes are on who Kennedy is sitting on this committee and what they’ll actually do. 

Amanda Jezek, a policy expert with Infectious Diseases Society of America, sums up what I heard. 

Amanda Jezek: We all need to be watching really, really closely to make sure that, the critical decisions that ACIP makes, which impact what vaccines all of us have access to in this country, that those decisions continue to be made by the best experts using the best available data.

ME: When it comes to the “best experts” and the “best available data,” what everybody is really waiting to see, Dan, is where Kennedy draws that line.

DG: And based on at least some of these picks, he appears to be comfortable with people who share his deep skepticism of vaccines.

I know you’ll continue to follow this closely. Thanks for your reporting on this. 

ME: I will, Dan. You’re welcome. 

DG: I’m Dan Gorenstein, this is Tradeoffs.