As Robert F. Kennedy Jr., who has a history of anti-vaccine activism, takes the helm at the Department of Health and Human Services, infectious disease specialist and pediatrician Adam Ratner is weighing in with serious concerns.
Speaking on behalf of himself and not the organizations he is affiliated with, Ratner says: "It's very disturbing that someone who has spent so much of his career trying to undermine confidence in vaccines, trying to tear down the infrastructure that approves and recommends vaccines, has the potential to be in a position of power over the infrastructure that has those goals."
Though Kennedy has declared that he's not "anti-vaccine," he has also repeatedly questioned the efficacy and safety of the vaccines against COVID-19, measles and other infectious diseases. Ratner says he's worried not only about vaccine availability going forward but also about the public's overall confidence in vaccines.
"As mentors of mine have said many times over the years, 'It is much easier to scare people than to unscare them,'" Ratner says. "And I think that just by elevating anti-vaccine views in the guise of RFK, I think that we risk a crisis in vaccine confidence in the U.S."
Ratner notes that measles, once considered a "solved problem" due to a widespread vaccination effort, has been making a comeback in recent years: "It was a thing that we had had a vaccine for since the mid-1960s and that we very, very rarely saw. ... And then in 2018 and 2019, we had a huge measles outbreak in New York City with about 650 cases and some kids who were very, very sick."
In his new book, Booster Shots, Ratner makes the case that our ability to control measles is a test of how strong our public health institutions are — which makes the resurgence of the disease especially troubling.
"When we start to see measles, it's evidence of the faltering of our public health systems and of fomenting of distrust of vaccines," he says. "I am worried that actions taken in the next year or two years may have long-lasting effects on the health of children, not just in the United States but, I think, worldwide."
Interview highlights
On why measles is so hard to control
Measles is the most contagious disease that we know of. It is more contagious than flu. It is more contagious than polio. It's more contagious than Ebola. It's more contagious than COVID. In a susceptible population, measles can infect, you know, 90% of the population easily. If someone with measles walks into a room of people who have not been vaccinated and haven't had measles before, 90% of those people will get infected with measles from that one person. And that is much more infectious than most things that we generally deal with. Measles is an indicator for whether there is vaccination going on, whether people are protected, because it is so very infectious.
On the lasting impact of anti-vaccine messaging
We live in a time when children, for the most part, grow up happy and healthy and where infectious diseases that used to kill large numbers of children have been brought under control through vaccines — and that has been through a tremendous amount of work. And some of that has been scientific work. But some of that has also been policy work in building an infrastructure that can withstand fluctuations in funding and can provide support for getting vaccines to children whose families may not be able to afford them, and all sorts of other things that have been built over time. The successes that we have, and the point that we are at in children's public health, is not guaranteed.
On being surprised by the divided public reaction to the COVID-19 vaccine
The pandemic we all experienced together, but we each experienced in kind of a different way. … I remembered the moment I got my first dose of the mRNA vaccine. I remember the day my wife got hers. I cried. I cried when my daughter got hers because I felt like we had won. Like, I felt like science had saved us — vaccine science had saved us. In the back of my mind, I thought, "This is the end of the anti-vaccine movement. Like, how do they possibly recover from everyone in the world seeing what we can do?" And of course, looking back now, five years after the start of the pandemic, I was naive and I was wrong at that time about how the anti-vaccine movement would respond to the COVID-19 vaccines and where we would be just a few years later. ...
COVID vaccines saved millions and millions of lives, and they are an incredible success story. And amazingly, that's not the story that is generally being told. And it's not the story that most people believe.
On the possible implications of the Trump administration's cuts to National Institutes of Health funding
The biomedical research enterprise in the United States is incredible. And there have been advances that have helped all Americans. And we would never have had the COVID-19 vaccines without NIH research. We would never have the chemotherapies that we have or the gene therapies that are emerging to cure diseases. All of those advances are built on the back of NIH-funded basic research. It is absolutely critical to people's health in both the short and the long term. I think that the executive order capping NIH indirect costs at 15% and making it effective immediately and applied to existing grants is going to be an enormous budgetary strain on universities and other research institutions. And it has the potential to have people lose their jobs, to drive scientists out of the field, to have universities shut down labs that they can't afford to run because they haven't budgeted for this abrupt change. And I think that the effects of this may be long lasting.
On fighting two wars — one against pathogens and another against disinformation
It is a different world than it was in the stories that I told about the measles vaccine development and vaccines for children and things like that, where there were limited news sources, there was often collaboration between public health entities and news outlets. And now we're in a very different situation, where there is unlimited information, much of it is bad, some of it is malicious. …
I think there certainly does need to be direct countering of misinformation and disinformation that are put out there by anti-vaccine groups. And that is something that CDC and public health departments should be doing. But there's also the direct outreach to individual families and to communities and bringing good information and being willing to sit and listen to what people have heard and try to help them disentangle the bad information that they may have gotten and to explain the science-based information that hopefully your pediatricians and your trusted community members are bringing.
Sam Briger and Anna Bauman produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the web.
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