RFK Jr. is an anti-vaxxer. He will protest that, but it’s a dodge. He basically lied (and it was quite transparent) to the senate confirmation committee, and I think Cassidy and others knew full well what they were getting when they approved him as HHS secretary. Those of us who have been following RFK’s career as an anti-vaxxer have not been surprised (although we are certainly horrified) as he got to work systematically undermining vaccines in every way within his reach. You can read the saga in great detail at SBM, where we anticipated his moves. Let’s quickly review.

Of course, RFK is not going to say, “I will destroy America’s vaccine infrastructure because I hate all vaccines.” He is doing what he always does, using a pretext. Now he is claiming that he is just supporting “gold standard science”. But this is exactly like science deniers saying that they are just applying healthy skepticism. When it comes to safety data, for example, you can set the bar as arbitrarily high as you want. There is no such thing as 100% certitude in science or medicine, and so you can nit pick the evidence-base and declare that any medical intervention you don’t like needs more safety data. You can claim that any connection to industry is a fatal conflict of interest, even if it isn’t. You can claim data is too old and needs review, or that public funds are better spent elsewhere. Finding a pretext to undermine vaccines is easy. The pattern, however, is undeniable and was predicted – in every case, RFK’s judgement will come down against vaccines.

He has pulled funding for mRNA research into viruses with pandemic potential, including the bird flu. He clawed back funding that was already given to fund testing, claiming the vaccine needs more testing. he also claimed that other interventions are more promising. This, of course, is also the guy who thinks that vitamin A is more effective than vaccines at preventing measles, something which is patently not true. It’s hard to imagine a better health investment than developing a vaccine to prevent the next pandemic, but here we are.

RFK fired the entire ACIP panel at the CDC claiming lack of faith and conflicts of interest. This is all absurd. He then replaced them with antivaxxers, most of whom are not qualified to sit on such a panel. This is the panel that makes all vaccine recommendations for the CDC, which affects how resources are allocated and insurance coverage. He claims this was to restore Americans confidence in vaccines, something he has spent his career undermining. The panel not only can hamper the approval of new vaccines, after their first meeting they agreed to go back and review long approved vaccines.

He has watered down CDCs messaging on vaccines, emphasizing “personal choice”. Lack of compliance and vaccine hesitancy are the main limiting factors in the US in terms of getting as many people vaccinated as possible. So undermining public communication on vaccines is an effective way to further undermine them.

In the developing world the main limiting factor is being able to afford the vaccines themselves. So recently RFK has withdrawn promised funding to Gavi, and international group that provides vaccines to poor children. It is estimated that this program has saved 17 million lives in the last two decades, and will likely save 8 million lives between now and 2030, which is the current funding cycle. The US had pledged $1 billion (out of the needed $9 billion for this funding cycle), and RFK has now withdrawn that pledge. His pretext was that Gavi does not listen to “science”, because they don’t agree with antivaxxer conspiracy theories and other nonsense.

RFK is pursuing a study to find the real cause of autism, and promises results by this fall. Autism has been studied for decades, and we already know a great deal about its causes and nature. Yet he thinks he will find “the cause” within a year. This is because he already thinks he knows what the cause is, he thinks it’s environmental (even though the data points to the fact that it is a complex genetic entity). And for “environmental” read “vaccines”. He also promises specifically a vaccine-autism study, just to reassure the public of the safety of vaccines (right). He put in charge of this study someone who is not a doctor or trained scientist but who is an antivaxxer with a long history of terrible antivaccine research, David Geier. I think we can guess the outcome of this study.

The bottom line is that RFK Jr. is a crank and a conspiracy theorist. He does not understand science or medicine, does not understand the idea of risk vs benefit, and has no business being HHS secretary. He is a self-styled environmental advocate and health guru who has no idea what he is talking about. But he is dangerous. The only real question is how many millions of deaths will he be responsible for. It depends on how much others pick up the slack, replace lost funding, independently provide messaging on vaccines, and try to undermine his undermining.

Perhaps if there is enough public outcry Trump might cave and fire RFK. I don’t think that will happen, but the public outcry should happen anyway.