Public health poster, Herbert Bayer, 1949.
There are certain irrefutable verities when, like me, you’re an infectious diseases specialist married to a pediatrician. Here are our top two, which are deeply interrelated:
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Infectious deaths in children, or severe illnesses that lead to lifelong disability, are more devastating than similar events in adults. Each such case in a baby or child is so very tragic. I’ll again quote Dr. Burton Grebin: “To lose a child is to lose a piece of yourself.”
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The success of vaccines in preventing those deaths and illnesses stands as one of the great accomplishments of modern medicine.
Seen a case of Haemophilus influenzae meningitis in a kid lately, one so severe they have permanent deafness or other neurologic sequelae? The same bug causing epiglottis, forcing a child to lean forward, afraid to talk and struggling to breathe? Bad rotavirus diarrhea in a baby, leading to that awful look of sunken eyes and the clinical descriptor, “floppy”? Whooping cough in an infant who can’t catch their breath? Or measles complicated by pneumonia or encephalitis that required hospitalization?
Thanks to vaccines, even busy clinicians rarely if ever see such cases today. As I’ve noted here before, if you combine the total number of cases of measles seen by my wife and me in our cumulative decades of practice, you’d fit that number on one hand, and have a couple of fingers left over. And we’ve witnessed first-hand the near disappearance of invasive disease from Haemophilus influenzae, severe varicella, and rotavirus disease.
It’s no wonder, then, that when the nomination of Robert F. Kennedy, Jr. to head the Department of Health and Human Services began circulating, my wife and I watched the proceedings with intense interest, and rising dread. I naïvely hoped that Sen. Bill Cassidy, a physician himself and ranking member of the Senate HELP Committee, would do the right thing and block the nomination, as he shared his concerns about Kennedy’s anti-vaccine views during the nomination process.
Alas, he did not block the appointment. In fact, he issued a statement explaining his support, citing Mr. Kennedy’s assurances that he would preserve the existing vaccine infrastructure:
He has also committed that he would work within the current vaccine approval and safety monitoring systems, and not establish parallel systems. If confirmed, he will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) without changes.
Emphasis mine — because earlier this week, Kennedy announced the removal of all current members of ACIP. So much for those assurances. Yesterday, he replaced them with eight new members of varied backgrounds, some of whom clearly share his skepticism about the benefits of childhood vaccines.
His stated motivations for the firings, rife with misstatements and oversimplifications, reveal a profound misunderstanding of how ACIP works. It also provides a glimpse into Kennedy’s longstanding distrust of vaccine safety and efficacy.
Let’s be absolutely clear: ACIP was a group of unpaid vaccine experts who based their recommendations on clinical data, safety monitoring, disease surveillance, and cost-effectiveness. They were not shills for the pharmaceutical industry. They were not political actors. Their deliberations were public and open to commentary. For years, their work has been critically important in shaping policy and ensuring insurance coverage for vaccines in our byzantine healthcare system.
What policies will we get from the new panel? More importantly, what will be the health implications for our society? Time will tell — an ACIP meeting is planned for later this month, and their actions should be watched closely by pediatricians, ID specialists, and indeed all clinicians. Already, alarmist headlines predict dire health outcomes ushered in by this regime change, and many of us worry it will further undermine confidence in vaccines that are of critical importance to childhood health. We’ll see.
But one thing is certain: For anyone who expected that Kennedy would “maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) without changes,” this week’s events are a clear reminder that actions speak louder than words.