The news from Monday is that Robert F. Kennedy Jr. (RFK Jr.), the Secretary of U.S. Department of Health and Human Services (HHS), just “retired” all 17 members of the Advisory Committee on Immunization Practices (ACIP). He published an editorial in the Wall Street Journal to explain this. I’m not sure which is worse, his firing of the entire committee, or his editorial. The editorial is at best disinformation – at its worst, it is made up of lies. But his editorial wasn’t written by some fringe character on an arcane website – it was written by the sitting Secretary of the US Department of Human Services, stating the current policy of the government of the United States.
RFK Jr. claims he is acting to avoid conflicts of interest, acting to restore public trust in public health agencies, pharmaceutical companies, and in vaccines themselves.
Here are my biases: I’m a physician who practiced family medicine and public health. I got duped into helping with a drug trial when I first started practice, in 1987, but have not taken a dime from the industry since. I went to a couple of drug company lunches and dinners in the eighties and nineties, including one thrown by the then Purdue Frederick about OxyContin and another by whatever company was then pushing estrogen replacement.
When I then began to understand the dangers of drug and industry influence on health care, I threw the drug reps out of my office. I stopped going to drug company dinners. I took a vow to never invest in any stock or bond of a medical industry company, and I believe that all physicians and health care workers should take a similar vow. I wrote three books on health care, each calling out in detail the risks of the medical industrial complex. And I’m working to build a social movement to create a health care system for the US that is for people, not for profit, because it is clear to me that the profit motive has destroyed health care in the US as it has eroded the public’s trust in health care. So I am about as critical of conflicts of interest with the health care industry as you can get.
Even more, I have been critical of both the CDC and the ACIP for many years. There is no scientifically trained public health person in the US more likely to be open to reform of the ACIP and the whole vaccination approval process, which has flaws.
But I’m still completely freaked out by RFK’s actions and his editorial.
Here’s why. The Advisory Committee on Immunization Practices advises the CDC on who should get which vaccine once a vaccine has been tested, proven safe (in a step I’m quite critical of), and licensed by the FDA. ACIP makes recommendations. Virtually everyone in health care follows those recommendations. They can be overruled by the Director of the CDC, and I suspect, by the Secretary of HHS, something that rarely happens.
The committee today is made up of very well-trained physician scientists – pediatric and adult infectious disease specialists and epidemiologists — practicing physicians and a few others. One of the people who was just “retired” is a Rhode Islander I don’t know.
In his editorial, RFK Jr. claims that “the committee has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine.” In support of that claim, he cites investigations of committee members from the 1990s. I just looked up the members of the committee, none of whom I know. These appear to be mostly great public servants, public health folks, and physician scientists who work in the public interest. RFK Jr. doesn’t identify any conflicts of interest among the current members of the committee. He says that ACIP members are influenced by groups that meet behind closed doors, but doesn’t identify any of these groups, and ACIP’s meetings are themselves completely open. Every member identifies any potential conflicts of interest before each meeting and recuses themselves from voting if there are any. I looked at those identified conflicts, and they are scathingly few and very peripheral ( ‘my university takes research support from a non-profit company that’s thinking about vaccine development’, for example), and those people recuse themselves out of an abundance of caution, in a process that is both honorable and transparent.
RFK Jr. says that ACIP has never recommended against any vaccine, which is a lie. It recommended against Rotashield in 1999, nasal influenza vaccines in 2016-2017, and the Johnson and Johnson Covid-19 vaccine in 2021. (Thanks to Your Local Epidemiologist for information about those rejections.)
But what RFK Jr. just did and said isn’t about reform. It’s to open up seats on the ACIP so he can appoint hand-picked supporters, people who agree with him and support his positions. It is thereby a frontal attack on the integrity of science in medicine, integrity that depends on non-biased and non-partisan measurement, analysis, and conclusions based on evidence, not opinion or belief, or knowing a guy. This attack is based on lies and on innuendo – the worst kind of sophistry and manipulation that has no place in a democracy or in a government by and for the people.
Worse, RFK Jr. claims that his actions will help restore the public trust in vaccine science.
Medical and public health science has already been weakened by the for-profit nature of health care in the US today.
But lies and distortions from our government destroy both trust in vaccines and trust in government.
I’m ashamed about what RFK Jr. did with ACIP. But I’m also aghast about what he said about it.
The Declaration of Independence reminds us that government depends on the consent of the governed. Now is the time for all good people to come to the aid of their country.
