Opinion | What R.F.K. Jr. Might Do on Vaccines

Vaccines save lives and reduce health care costs. Those are facts. They have been critical public health tools for more than 200 years. Their hallmark achievement was against smallpox, a frequently disfiguring and often fatal disease that killed over 300 million people in the 20th century before a worldwide vaccination campaign eradicated it in 1980.

Thanks to a vaccine, smallpox virus no longer exists outside the confines of a few secure laboratories. And there are many more success stories: polio, measles, mumps, rubella, chickenpox, diphtheria, yellow fever. Outbreaks of all of these diseases have been sharply reduced by vaccines.

Which is why it is both head-scratching and outrageous that Robert F. Kennedy Jr., a political figure with no medical or public health training, who has been accused of being an anti-vaxxer, or, more charitably, a vaccine skeptic, is Donald Trump’s choice to take the nation’s most powerful and important public health job.

Mr. Kennedy said the day after the election that “I’m not going to take away anybody’s vaccines.” But the potential to use the bully pulpit as secretary of health and human services to cast doubt on the efficacy of vaccines could mean that many people will skip their vaccinations, become sick from diseases we can prevent and die for no reason.

As The Times noted last year in an examination of “five noteworthy falsehoods” furthered by Mr. Kennedy, he “has promoted many false, specious or unproven claims that center on public health and the pharmaceutical industry — most notably, the scientifically discredited belief that childhood vaccines cause autism.”

Before vaccinations were available, parents worried constantly about their children contracting dangerous viruses. As recently as the 1950s, parents feared every summer, when polio epidemics were most common, that their children might contract the disease and become paralyzed. Today, vaccines are close to eliminating polio from the planet.

The story is similar for other diseases before vaccines became available. Measles killed an average of 440 people a year from 1953 to 1962, with a high of 552 deaths in 1958. By 2004, there were no deaths. Diphtheria claimed an average of 1,822 lives a year from 1936 to 1945. In 2004, there were no deaths, either. Invasive Haemophilus influenzae Type B killed an average of 1,000 a year in the 1980s. In 2005, there were fewer than five deaths.

Looking at vaccine accomplishments more broadly, a 2024 study showed that among children born from 1994 to 2023 in the United States, nine vaccines prevented an estimated 1.1 million deaths, 32 million hospitalizations and 508 million lifetime cases of illness. They also saved $540 billion in direct medical costs and $2.7 trillion in indirect costs over the same period.

Mr. Trump has promised to allow Mr. Kennedy to “go wild on health.” Mr. Kennedy has recently softened his position on vaccines, at least publicly, claiming he just wants Americans to have information on the safety of vaccines so they can make informed choices. “I’m going to make sure scientific safety studies and efficacy are out there, and people can make individual assessments,” he said.

Howard Lutnick, a chair of Mr. Trump’s transition team and his choice for commerce secretary, came away with a different impression after a conversation with Mr. Kennedy before the election. “He wants the data so he can say these things are unsafe,” Mr. Lutnick said. “He says if you give me the data, all I want is the data, and I’ll take on the data and show that it’s not safe.”

Our question is, what data is Mr. Kennedy talking about? Comprehensive national vaccine safety data are readily available to anyone. This includes the safety data used to license vaccines and data gathered after they have gone into use.

Every state requires students to have certain vaccines to attend school, for the most part based on recommendations from the Centers for Disease Control and Prevention and its Advisory Committee on Immunization Practices. Most states allow exemptions for religious or personal reasons. Vaccinations among children in kindergarten have remained below the federal target rate of 95 percent for four consecutive years. It was below 93 percent during the past school year.

Besides occupying a platform for public persuasion, Mr. Kennedy and the White House will have other levers at their disposal to reduce vaccine production and use. The Advisory Committee on Immunization Practices develops guidelines on vaccine use. Its recommendations have to be approved by the C.D.C. director to become policy. These recommendations help determine whether vaccines are covered at no cost for children and others. What’s worrisome is that Mr. Trump would nominate the next C.D.C. director, a decision Mr. Kennedy no doubt would have influence over. He would also select members of the immunizations committee.

It would be easy for Mr. Kennedy and his allies in the administration to discourage pharmaceutical companies from pursuing vaccine research and development. The Food and Drug Administration, which would be in Mr. Kennedy’s purview, can shape the types of clinical trials required to test a vaccine, slow the review of the results and determine who would be eligible to receive the vaccine. These costly roadblocks would discourage companies from continuing to research, develop and manufacture vaccines.

Project 2025, the conservative blueprint for the Trump administration to revamp the government, assembled by the Heritage Foundation with assistance from Trump allies (and from which Mr. Trump has distanced himself), has also offered advice in the wake of the Covid pandemic: “Never again,” said the report, “should C.D.C. officials be allowed to say in their official capacity that school children ‘should be’ masked or vaccinated (through a schedule or otherwise) or prohibited from learning in a school building.”

The United States could reverse decades of health gains if Mr. Kennedy is given the ability to shape health policy and perhaps muzzle the C.D.C. on children’s vaccinations. Any actions that reduce the trust in and access to vaccines will result in an increase in serious illnesses, hospitalization and deaths not just in the United States but around the world.

Michael T. Osterholm is a professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Ezekiel J. Emanuel is a physician and the vice provost for global initiatives and a professor of medical ethics and health policy at the University of Pennsylvania.

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