RFK Jr.’s lukewarm endorsement of vaccines to end the Texas measles outbreak 

Last week, while answering questions about a measles outbreak in Texas that’s left one child dead, Robert F. Kennedy Jr. called the situation “not unusual.” This week, perhaps reacting to growing alarm over the increase in cases, the long-time anti-vaccine activist turned Department of Health and Human Services secretary changed his dismissive tune and in an op-ed urged parents to learn about the measles vaccine.

The Fox News piece represented a mild endorsement of vaccines that Kennedy once campaigned against, though it also contained points minimizing their significant benefits. To some, it was still a welcome change.

“The fact that he felt a need to speak up, and even this lukewarm embrace of vaccination, suggests it’s been brought to his attention that he has a responsibility here and cannot ignore the outbreak,” said UC Law San Francisco professor Dorit Reiss, who specializes in vaccine policy.

Still, Kennedy’s op-ed was far from a full-throated call for people to get vaccinated. “All parents should consult with their healthcare providers to understand their options to get the MMR vaccine,” Kennedy wrote. “The decision to vaccinate is a personal one. Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”

By way of comparison, after measles cases reached a 27-year-high in 2019 during outbreaks centered in and around New York City, Alex Azar, who was health secretary during Trump’s first term, offered forceful support of vaccines. “We cannot say this enough: Vaccines are a safe and highly effective public health tool that can prevent this disease and end the current outbreak,” Azar said then.

Despite writing about a responsibility to ensure “accurate information about vaccine safety and efficacy is disseminated,” Kennedy’s op-ed didn’t actually mention the efficacy of the MMR vaccine, which protects against measles, mumps, and rubella. The Centers for Disease Control and Prevention (CDC) puts the efficacy figure for measles at 97 percent after the standard two-shot regimen.

Kennedy provided details, though, when it came to downplaying the role that measles vaccines have played in taming the disease. “Tens of thousands died with, or of, measles annually in 19th Century America. By 1960—before the vaccine’s introduction–improvements in sanitation and nutrition had eliminated 98% of measles deaths,” he wrote. According to US government statistics compiled by Our World in Data, a partnership between the University of Oxford and the nonprofit Global Change Data Lab, the fatality rate dropped from 13 people per 100,000 in 1919 to less than one person per 100,000 in 1939 and has remained below that threshold ever since. In absolute numbers, measles in the pre-vaccine era would kill 4-500 people a year in the United States, according to the CDC. The death in the Texas outbreak was the first in the country since 2015.

Clean water and indoor plumbing—though touted as measles killers by the anti-vaccine organization Kennedy ran until recently—do not prevent the spread of the highly contagious airborne virus, which can linger in a room for hours after an infected person leaves. Measles cases dropped 97 percent between 1963, when the vaccine was introduced in the United States, and 1968, “despite the fact that hygiene practices and sanitation did not significantly change during that time,” according to the Infectious Diseases Society of America.

By highlighting vitamin A, which can treat a measles infection, and the pre-vaccine drop in measles death rates, Reiss said, Kennedy is ignoring the risks that an acute measles infection poses short of death. In that way, Kennedy’s Fox News piece is in keeping with his decades of work to undermine support for vaccination. “Focusing on deaths instead of harms in this context is a common anti-vaccine trope,” Reiss said.

According to the CDC, one out of five people with a measles infection will end up hospitalized. One in 1,000 children will have brain swelling (encephalitis), which can leave them deaf or intellectually disabled. And one in 20 children will get pneumonia, a common cause of death in measles cases.

Moreover, the worst effects of measles infection may come after someone recovers.

Research in recent years shows that measles decimates the immune system’s ability to recognize previously encountered pathogens. The effect can last years and leaves people more susceptible to diseases than they otherwise would be had they not survived measles. A 2015 study in Science found that “when measles was common, [measles virus] infections could have been implicated in as many as half of all childhood deaths from infectious disease.”

In 2019, another study in Science showed that while measles infection significantly reduced the “antibody repertoire” circulating in children, immunization did not. “By preserving immunity, measles vaccines may have reset overall baseline morbidity and mortality rates to lower levels,” the authors wrote.

“It really challenges this idea that measles is benign, or that it’s okay to get because everyone used to contract it,” Michael Mina, one of the authors of the measles studies, told the publication CIDRAP in 2019.

As anti-vaccine activists seek to weaken vaccine policy—for example, by removing official recommendations or creating loopholes for school children to avoid routine vaccinations— populations of unvaccinated people will grow, raising the specter of more outbreaks of measles and other diseases.

Kennedy is now in charge of federal public health efforts and no longer an agitator trafficking in false ideas about vaccines. And in West Texas, he now has a real problem on his hands. “However sloppy he was willing to be with facts as an anti-vaccine activist, as a secretary of Health and Human Services he has both the responsibility and the ability to get things right,” Reiss said. “He has access to people with actual expertise. He needs to do better. “