Robert F. Kennedy Jr., the nominee to lead the Department of Health and Human Services, has been in a marathon of meetings to shore up his confirmation votes come the new year. As his “Make America Healthy Again” movement gets closer to a seat of power in the federal government, onlookers are wondering how Kennedy’s sweeping critiques of food, pharma and health care will translate into actual policy.
Some general areas of agreement — ripe for policymaking — have emerged, including on limiting corporate influence in government and improving the food supply so healthy foods are accessible for more Americans. There also seems to be bipartisan agreement that federal health officials should respond to the public’s suspiciousness with transparency and clear communication. That, in turn, may rebuild trust that has degraded over time and especially during the Covid pandemic.
STAT called Michael Osterholm, an epidemiologist, influenza expert and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, to discuss the sketches Kennedy has made on vaccine policy and public health, what could actually improve, and what might backfire.
This interview has been edited for brevity and clarity.
Are there places where you agree with Kennedy or some of these “Make America Healthy Again” concepts?
While these appointments are obviously very important, when you’re dealing with an agency of almost $2 trillion budget, with 13 different directorates or agencies involved, the senior leadership often are not in a position on a day-to-day basis to really have direct impact on what these agencies do. This is all going to come down to: How do they manage the current expertises within the federal government? And namely, that’s the Title 42 employees. These are the senior scientists and policymakers who are among the very best in the world at what they do.
There could be mass dismissals early into the administration, as least they have stated that. And that would be like cutting someone’s head off and then telling the body to go run a marathon. If, in fact, that happens, we will be so unprepared for almost anything that comes down the pike that, I mean, there’s been no time in modern public health history where we would be that vulnerable. A policy won’t matter if there is nobody there with expertise to move it forward.
Are there legitimate reasons to push for greater transparency or better public health messaging at the federal level?
There are two buckets of issues around vaccination. One is how well did the vaccines work? But the second thing is that the public is also really focused on the safety of the vaccines. To them, that’s the immediate issue right now: Will my son or daughter have a reaction to these vaccines? It seems remote for them to think about, you know, 550 deaths a year from measles back in the late 1950s or early 60s. That just doesn’t connect. And I think we need to do a much better job as a public health community laying out in detail the safety issues and the fact that nothing in this world is absolutely guaranteed to be perfectly safe.
We know that young adolescent boys who were vaccinated with the Covid vaccine had a very rare but real occurrence of acute myocarditis, inflammation of the heart. These cases were across-the-board mild. On the other hand, getting Covid itself posed a much, much higher risk of developing myocarditis which was life-threatening, in which there were cases of deaths.
When I hear [Kennedy] talk about the need to “get the data” so he can look at it — as if somehow he alone can understand data that no one else can — my first reaction is, “What data are you talking about?” The safety data on vaccines for licensure is public. The data on vaccines for post-licensure use are public. We have not tried to cover this up. I’m an example of this. In 1976, I was one of the people at the Minnesota Department of Health that first flagged Guillain-Barré syndrome in swine flu vaccine recipients. We brought that issue forward, which resulted in the stopping of the campaign.
Given how these ideas and vaccine-skeptical sentiment have caught on, do you think it is worth just opening this all up again?
We owe it to the public to share with them, in detail, not just how well the vaccines work and what they’ve done to prevent many, many, many thousands and thousands of deaths, particularly in younger children, but also, it’s not abstract — “my child is due for their first dose of measles vaccine, should they get it or not?” I don’t think we’re doing enough to share with them the system that’s in place to assess safety, how that safety is interpreted and how that’s shared back with the public. Trust in public health action is, at least in my lifetime, at an all-time low. We just dismiss people like RFK Jr. or Andrew Wakefield or people like that. And we don’t do enough to say what is being done and what does that look like.
Do you think any part of that has to do with corporate influence, as some people allege?
I have never seen anything with corporate influence. In fact, my big concern is that we’re going to see more and more companies rethink making vaccines. Look at the future sales in oncology drugs, neurologic drugs. Today, vaccines are very, very, very low on the return-on-investment scale. We take for granted that these companies will always be there and they will always do this. I worry that we will find a day ahead — and we’ve seen this on the international market, look at cholera vaccines and mpox vaccines, I can go through a laundry list of vaccines we are really short on. Are we going to chase these companies out of making vaccines?
What would happen in that case?
I don’t know. That’s what really concerns me. In the early 2000s, we had one company one season that was responsible for a large share of the influenza vaccine and they ran into a major manufacturing challenge. We had major shortages of flu vaccine that year. In high-income countries, we just take for granted that these vaccines will be there. It’s like every morning when you wake up, you assume you’re going to have electricity and water. It’s a crisis when it doesn’t happen.
And if I’m hearing correctly, the supply from companies in the U.S. would also have global effects, right, if they were to cut back?
Absolutely. Yeah, the whole world is dependent. And that is such an important point. It’s easy to talk about how bad vaccines are when you still have very few people getting that infectious disease. But we’re at a tipping point, where the rate at which parents are no longer vaccinating their children by basically opting out of a vaccine mandate, that is going to catch up with us and it’s going to accelerate.
It sounds like you don’t agree with the idea of repealing vaccine mandates or loosening them.
No, no, no. I came out against Covid vaccine mandates because, to me, a mandate should be reserved for a vaccine that is highly effective, with long-term duration, and actually has impacts on transmission within the community. Measles, mumps and rubella are good examples of those vaccines. They meet all those criteria.
Right, so I should have separated that out. You’re not against repealing vaccine mandates for the long-time childhood vaccinations?
How well do they work? Do they actually stop transmission in the community? Then I can make the case this is a community good. There’s going to be some child in one of these schools who’s going to have an underlying immune deficiency that, even though they’re vaccinated, they’re still at risk of potentially developing an infection and dying. It helps buffer that risk by having everyone vaccinated. For those kinds of vaccines, I strongly support that.
I hear people say to me, “I thought you’d be for all these vaccines.” Well, I surely encourage them. Even though the influenza vaccine may only [offer] 30 to 40% reduction in [the risk of] hospitalization, that’s a hell of a lot better than not being vaccinated at all. But at the same time, it doesn’t stop transmission in the community. That’s a very different vaccine than a childhood vaccine.
What about the liability protections for vaccine manufacturers? Do you think that those should be removed?
Before the injury compensation legislation, companies were quickly exiting the vaccine market. Individuals who have had legitimate adverse events related to a vaccine should be fully compensated — no ands, ifs or buts about it. At the same time, we need a process that helps, in a sense, buffer the industry so they’re not taking the suits. Otherwise they’re gone. That’s why the $0.75-a-dose tax on vaccine production is meant to actually provide that.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.