Robert F. Kennedy Jr.’s anti-vaccine activism is not what you’d call subtle. For decades, he has questioned the safety and effectiveness of various childhood vaccines, insisting that some of them cause autism, lying about their ingredients, and dismissing troves of evidence that counter his views. However much he might deny it, Kennedy is “an old-school anti-vaxxer,” Dorit Reiss, an expert in vaccine law at UC Law San Francisco, told me.
When he became the United States’ health secretary, Kennedy brought few of his staunchest and oldest allies in the anti-vaccine movement with him. Instead, the Department of Health and Human Services is filling with political appointees whose views of vaccines run less obviously counter to evidence than Kennedy’s. But these officials, too, question the safety and usefulness of at least some vaccines, and seek to slow or stop their use.
Among those officials are Marty Makary, the new FDA commissioner, and Tracy Beth Høeg, his new special assistant; Vinay Prasad, the new director of the FDA center that oversees the regulation of vaccines; and Jay Bhattacharya, the new director of the National Institutes of Health. Unlike Kennedy, they hold advanced degrees in science, medicine, or public health, and have published scientific papers—often in direct collaboration with one another. And they have each endorsed at least some vaccines for children, or even pushed back on some of Kennedy’s most flagrant vaccine misinformation—criticizing, for instance, his false claims that MMR shots cause autism. When reached for comment by email, Emily Hilliard, HHS’s deputy press secretary, described the cohort to me as “credentialed physicians and researchers with long-standing commitments to evidence-based medicine” who “were brought into HHS to restore scientific rigor, transparency, and public trust—not to blindly affirm the status quo.” (Emails to the FDA and the NIH requesting interviews with each of these four officials either went unanswered or redirected me to HHS.)
These new appointees can also be described, more succinctly, as a COVID contrarian who has questioned the worth of vaccines. Their approach to immunization policy is less extreme, more engaged with evidence, and more academic than Kennedy’s. And precisely because these officials’ perspectives carry a sheen of legitimacy that most of the secretary’s usual allies lack, they could be more effective than Kennedy at undermining America’s protections against disease.
In sharp contrast to Kennedy, this new cohort—you could call them the neo-anti-vaxxers—are generally established in their respective scientific fields. Makary, for instance, has been hailed for pioneering several surgical procedures; in the 2010s, Prasad, a hematologist-oncologist, gained recognition for his rigorous—albeit acerbic—takes on precision medicine and cancer drugs. And each has acknowledged, in at least some capacity, the lifesaving powers of immunization. When they’ve argued about vaccines, they’ve often done so in respected scientific venues, and performed their own analyses of the evidence.
No medical intervention is without risk, and on the broadest level, what these officials are asking for appears to fit the essential tenets of public health: thorough testing of vaccines before they’re debuted, and careful scrutiny of each immunization’s relative pros and cons. But these officials’ past actions show that they haven’t always weighed those scales fairly or objectively.
All four of these officials began to publicly coalesce in their view of vaccination in the early months of COVID. None of them had trained as infectious-disease specialists or vaccinologists. But in their public comments, and in several publications, they contended that the virus was far less dangerous than most public-health officials thought, and that the measures that the U.S. was taking against it were far too extreme. They argued against mandates and boosters, especially for children and for young and healthy adults; they exaggerated the side effects of the shots, extolled the benefits of acquiring immunity through infection, and dismissed the notion that people who’d already had COVID should still get shots later on. In October 2020, Bhattacharya and a group of colleagues advocated for reopening society before vaccines had debuted; Makary, although initially supportive of COVID vaccines, went on to praise the Omicron variant of the virus—which at one point killed an average of 2,200 Americans each day—as “nature’s vaccine.” Prasad, meanwhile, has said that COVID-vaccine makers should be sued for the rare side effects caught and disclosed with standard monitoring. And Høeg, who’d previously worked with Florida Surgeon General Joseph Ladapo, influenced his decision to recommend against the COVID vaccine for healthy children.
Plenty of Americans were reasonably nervous about taking a vaccine developed at record speed, with new technology, under conditions of crisis. But Bhattacharya, Makary, Prasad, and Høeg went further than simply recommending caution; they questioned the legitimacy of the data supporting repeat immunization and at times actively advised against it.
Their criticism of vaccination has transcended COVID. Prasad allows that some vaccines are important but has also questioned the value of RSV vaccines during pregnancy; he’s argued that the evidence for annual flu shots is “extremely poor,” and disparaged doctors who consider all vaccines lifesaving. He has suggested that Kennedy randomize different parts of the U.S. to different childhood vaccine schedules, to determine an optimal dosing strategy—an experiment that could keep kids from accessing safe and effective shots in a timely fashion. Høeg, too, has called for an overhaul of how vaccines are tested, approved, and regulated in this country. And she has sharply criticized the American pediatric immunization schedule for including more vaccines than the one in Denmark, where she holds citizenship. Makary, while more tempered in his public comments, has still declined at times to urge parents to vaccinate their children against measles, and downplayed the virus’s risks.
As a group, these officials have generally been more sanguine about Kennedy’s false claims about vaccines and autism than other researchers have. Bhattacharya, for example, said at his confirmation hearing that he is convinced that vaccines don’t cause autism, but added that he wouldn’t reject more studies on the issue.
Hilliard, at HHS, wrote that, by interrogating vaccines, these officials are doing only what science requires: “Questioning the quality of data, highlighting the limits of past decisions, or advocating for better trials is not anti-science—it is the gold standard of science.” But truly rigorous science also rests on the foundations of previous data—and a willingness to accept those data, even if they conflict with one’s priors. Many of the questions these officials are asking have already been repeatedly asked and answered—and the four of them have been criticized by public-health experts for their tendency to, like Kennedy, ignore reams of evidence that do not support their views. Some of their suggestions for revamping vaccines would also put Americans at unnecessary risk: Asking certain American jurisdictions to delay childhood vaccinations, or perhaps even skip certain shots, could leave entire communities more vulnerable to disease.
Fundamentally, they, like Kennedy, believe that vaccines should generally be more optional for more Americans—a perspective that elides the population-level benefits of widespread immunity against disease. And fundamentally, they, like Kennedy, have argued that vaccines that have passed rigorous tests of safety and efficacy, been successfully administered to hundreds of millions of people, and saved lives around the world are not safe or necessary. If those stances are further codified into policy, they could waste the country’s resources on unnecessary testing, produce misleading data, and erode confidence in public health as a whole.
Already, these officials have turned their new powers on COVID vaccines, some of which are still authorized only for emergency use. The FDA has delayed full approval of the Novavax COVID vaccine and is reportedly asking for a new—and very costly and laborious—randomized controlled trial on the shot’s effectiveness, even though the shot has already been through those sorts of studies and been safely administered to people for years. The agency could also require all COVID-vaccine makers to submit new effectiveness data for shots updated to include new variants of the virus—essentially treating them as brand-new vaccines and potentially making it nearly impossible, logistically, to produce new formulations of the COVID vaccine each fall. (Experts worry that the agency will apply the same logic to flu vaccines, with the same result.) The FDA could also go as far as revoking emergency-use authorizations, such as the one for pediatric COVID vaccines, which Prasad has said should be stricken from the childhood immunization schedule.
These officials’ powers have limits: The CDC (which still doesn’t have a permanent director), not the FDA, recommends the childhood immunization schedule. At a meeting last month of the CDC’s advisory council on immunization practices, though, Høeg came as the FDA’s liaison—an unconventional choice, Jason Schwartz, a vaccine-policy expert at Yale, told me, for a role historically filled by a career scientist from the Center for Biologics Evaluation and Research, the FDA center Prasad runs. (After deferring to HHS, the FDA responded to a request for comment by pointing out that Høeg holds the title of “senior clinical science adviser” at CBER—a title she was apparently given after the meeting.) Grace Lee, who previously chaired the committee, told me that the FDA liaison is “not usually an active participant.” And yet, Høeg pointedly questioned the safety and effectiveness of multiple vaccines, including COVID shots—the sort of contribution that could influence the discussion, the ultimate vote, and, potentially, the eventual CDC director’s decision to accept the panel’s advice, Lee and Schwartz said.
Bhattacharya’s sway, too, is likely to expand far past his own agency. Under this administration, the NIH has already canceled grants for hundreds of infectious-disease-focused studies, including dozens that look at vaccine uptake and hesitancy. Now, with Bhattacharya in charge, the agency is leading a $50 million study into the causes of autism, as directed by Kennedy—who already seems set on the answers to that question. When asked in a recent interview with Politico whether mRNA-focused science might be defunded, Bhattacharya said that “many, many people now think that mRNA is a bad platform.” If the U.S. ignores vaccine hesitancy—or if researchers have fewer resources to develop new vaccines—immunization in this country will stall, regardless of who runs the FDA or the CDC.
Modern American politics does still consider some positions to be too anti-vaccine: Trump’s original pick for CDC director, Dave Weldon, who has repeatedly promoted the debunked idea of a connection between vaccines and autism, had his nomination withdrawn by the White House in March. Kennedy’s own confirmation hearing was contentious, and heavily focused on vaccines; in official press statements and in interviews since then, he has softened some of his stances—acknowledging the protective powers of the MMR shot, for instance—to the point where he has angered his extremist base. Bhattacharya and Makary faced less resistance during their own hearings, during which they both praised the importance of vaccines. The vaccine distortions they’ve pushed are less blatant than Kennedy’s, but also more difficult to combat.
When Kennedy began his new position, some feared he would immediately take a sledgehammer to American vaccines. The moves he and his new team are making have stopped short of obliterating access to shots; they’re more about creating new roadblocks, Luciana Borio, a former acting chief scientist at the FDA, told me. But even seemingly minor hurdles can mark a substantial philosophical shift: Where HHS once treated the U.S.’s vaccines as well-vetted, lifesaving technologies, it’s now casting them as dubious tools with a murky track record, pushed onto the public by companies rife with corruption. By sowing doubt that vaccines can safely protect people, HHS’s lesser skeptics will help legitimize Kennedy—until all of their views, fringe as they may have begun, start to feel entirely reasonable.