As RFK Jr. delivers his message on measles, public health experts hear a familiar tune

The headlines on Robert Kennedy Jr.’s measles commentary published on Sunday excited proponents of vaccines who have worried about the Health and Human Services Secretary’s oft-aired skepticism about the value and safety of vaccines.  With a growing outbreak of measles in Texas, they’d been watching HHS and its new leader, waiting for the call to vaccinate children that the headlines implied the article would contain.

But as they read through the commentary looking for a full-throated appeal for parents of unvaccinated children to get their children immunized — the standard public health approach in a measles outbreak — what they saw instead was coded text from a different playbook, one written by opponents of vaccines. 

The stressing of parental choice. A recommendation that parents talk to a health care provider about the possibility of vaccination. An emphatic push for good nutrition and vitamin supplementation, factors that influence measles survival in developing countries if children are malnourished, but are no shield against infection anywhere, and not the threat facing children in Texas, New Mexico, and other states with active outbreaks. 

In an outbreak that has already claimed one life, that wasn’t the message that a number of public health officials STAT spoke to Monday were hoping to read. 

“You would expect the conversation to be saying: This is why vaccination is absolutely imperative, and [the Centers for Disease Control and Prevention] and HHS wholeheartedly recommend individuals who are not vaccinated receive the vaccine. And we just don’t get that here,” said Jason Schwartz, an associate professor of health policy at the Yale School of Public Health.

“‘Ask your doctor, understand your options.’ That’s a huge departure from the classic response to a measles outbreak for decades,” Schwartz said.

The Texas outbreak, which has already led to nearly 150 cases and at least 18 hospitalizations, has placed Kennedy in a situation where his statements or lack thereof are being viewed through the frame of his well-known distrust of the safety of vaccines — particularly the measles, mumps, and rubella vaccine, which has been falsely linked to autism. (Kennedy repeatedly refused to denounce that disproved allegation during his Senate confirmation process.) 

The beginning of the commentary, which was published on the Fox News website, read like a traditional pro-public health argument was about to unspool, with Kennedy expressing concern about the outbreak, revealing he had offered condolences to the family of the child who had died, and reminding readers that people who are vaccinated against measles help to protect those who cannot be vaccinated and are therefore vulnerable to the virus.

“It started strong,” said Paul Offit, an infectious diseases expert at the Children’s Hospital of Philadelphia, who has long been a leading voice for vaccination in this country. “Then it sort of fell apart.” 

Several of the people STAT interviewed for this article suggested the commentary seemed a bit disjointed, as if it had been written by multiple people. Schwartz likened it a bit to a “Frankenstein” creation.

“There were clearly a lot of hands and voices in this text,” he said. “Several minds being expressed here in this piece.”

It’s unclear if the headlines on the commentary would have been suggested by HHS, or if they were written by the editorial staff of Fox News. It would not be unusual for a senior government official to have advisers help craft a missive like this one. But, in this case, William Moss, a professor of epidemiology at Johns Hopkins University’s Bloomberg School of Public Health, said part of what was interesting was “how the messages are mixed here.”

“It wasn’t blatant vaccine skepticism expressed in this piece. It was more subtle,” said Moss, who is also executive director of the International Vaccine Access Center.

Heidi Larson, who has long worked in the field of vaccine confidence, said she was glad to see some of what Kennedy wrote in the article, particularly his comment about having called the grieving parents of the child who died. When first asked about the death last week, Kennedy offered no sympathies and appeared to try to downplay the severity of the Texas outbreak.

“Maybe it’s because my bar has dropped … so low in the past couple of weeks that I’m happy to see any quasi-positive thing,” said Larson, a professor of anthropology, risk, and decision science in the department of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine. She acknowledged, though, that Kennedy went off track at points.

Malia Jones, an assistant professor of community health in the University of Wisconsin-Madison’s department of community and environmental sociology, argued that the actual messaging in the commentary fell short of what the moment demands from the country’s leading health official. 

“I guess it’s more of an endorsement [of vaccines] than we’ve seen from RFK Jr. in the past, but it still is not him saying measles vaccines are safe, effective, and necessary,” Jones said.

The op-ed did address the need to make vaccines available to people who want them. But as much or more emphasis in it was placed on nutrition. The article called it “a best defence” against many chronic and infectious diseases, listing off a string of vitamins that should be part of a healthy diet.

No public health expert will argue against the benefits of a balanced diet. But the stress on diet as an answer to a measles outbreak in a highly developed country where malnutrition is not common seemed to miss the point, several suggested.

“He does seem to subscribe to the idea that is certainly one of the anti-vax movement talking points that public health prevention amounts to taking a multivitamin, or eating whole foods,” Jones argued. “We can have good nutrition … and also vaccines.”

In particular, Kennedy focused on vitamin A, which is recommended as part of the supportive care regimen for children who are hospitalized with measles. Studies have shown vitamin A improves the chances of survival, especially in children whose stores of vitamin A have been depleted by malnutrition. But Offit and others have questioned whether vitamin A has the same benefit in children who are not malnourished. And in any case, it cannot prevent infection. 

“Giving kids who are hospitalized vitamin A really doesn’t meet the bar for me for public health prevention,” Jones said.

A healthy immune system could certainly help a child weather the measles. But if the goal is to prevent measles infections — which it should be — that’s not enough, Offit said.

“You can have the best immune response in the world, but you’re not going to have specific immunity unless you’ve either been naturally infected or vaccinated,” he said. “Those are your only two options for specific immunity.”