RFK’s New Vaccination Rules
It has not been a good time for public stewardship in Washington, DC. In just the last few weeks, we have seen our leadership fail us in so many unforgivable ways. We’ve had an unjustified and expensive war in Iraq. Rising prices for everyone. A national debt now past the $40 trillion mark, and exploding. AI breaking out of lab boundaries and hacking into a business site on its own, without anyone noticing, and the White House resolute in doing nothing. A summer of record heat and drought, and no effort to combat the carbon emissions that are behind it.
And ff all that were not enough, the President and the Secretary of HHS have issued a coup de grace: They have decided to break the vaccine system. While there is a measles epidemic, and only a few years after a major pandemic. Instead of a standard vaccination schedule, the White House, without any experts in agreement, has decided to break up the childhood vaccine schedule that has been in place for more than 50 years, replacing it with a “Gold Standard” mix-and-match system where parents decide what vaccines they want their children to get, if they want any at all, and when to get them.
In other words, they decided to erase all the white lines on the highway system, remove the signs, and just let the drivers figure it out.
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Many years have passed since I was in medical school, but I still remember the day I sat in an immunology lecture and learned the science behind vaccinations. Through all the charts and data analyses, one thing leaped out: How overwhelming the science behind vaccination truly is. While all fields in medicine are research-based, and all medical treatments are backed to some degree by scientific data and clinical studies, vaccination science exceeded them all, and it wasn’t even close. Vaccination science isn’t simply convincing. It is overwhelming.
Vaccines have a worldwide monitoring system in which every side effect is reported back and assessed by the FDA. In fact, one of the reasons vaccines have been vulnerable to criticism over side effects is precisely because the reporting system is so good — and so public. It is a system that has detected problems in the past, in several cases resulting in the withdrawal of harmful vaccinations. The swine flu vaccine in the 70s and a rotavirus vaccine in the 90s are two examples of vaccines that were promptly withdrawn when problems were detected.
What I want from a medication surveillance system isn’t perfection, because that’s not possible. I want rapid error correction. Here, vaccines leave traditional medications in the dust. Vioxx, a pain medication, was on the market for 5 years before it was withdrawn for causing strokes and heart attacks in 2004. The phen-fen treatment for obesity was prescribed for up to 7 years before the FDA banned it 1997 for damage to heart valves. Compare that to the swine flu vaccine, which was pulled after only 10 weeks for neurological effects in 1976, and the Rotoshield vaccine, which was taken off the market after 12 months when patients began developing GI complications.
The vaccine monitoring system is vastly superior to the monitoring of non-vaccines. There are various reasons for this, but much of the advantage comes from a superior reporting system that relies on government surveillance rather than self-reporting from private companies that stand to lose billions if their drug is taken off the market. This system doesn’t make vaccines perfect. But it means that those that have been administered for decades have been carefully vetted, and are the safest drugs on the market by far.
The childhood vaccinations that the Trump administration has called into question have been given tens of billions of times, with only rare complications. Few medications, prescription or over-the-counter, have a comparable track record. Even acetaminophen (Tylenol), aspirin, and ibuprofen, which can be found everywhere, are statistically more dangerous than vaccinations. At least 100,000 people a year are hospitalized in the U.S. from GI bleeding related to over-the-counter pain medications For vaccines the number of adverse events is complicated, given that many vaccines frequently cause minor side effects like fever and fatigue, without serious long-term effects. But severe reactions requiring hospitalization are very rare, about 0.1%, with the most common serious reaction being syncope (passing out).
Your typical vaccine is safer than the headache pill sitting on your shelf.
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The science of vaccination is straightforward. To protect patients from diseases that cause widespread harm, doctors introduce a very small amount of the infectious agent, in a weakened form, a killed form, or in the form of an easily recognizable protein. The immune system recognizes this agent and mounts a defense against it. Since the vaccination is unable to cause a full-blown infection, the patient develops immunity without suffering the effects of the disease itself.
The beauty of vaccination is that it is, in fact, completely natural. The protection comes not from the vaccination itself, which is a very small quantity of medicine, but from the body’s response to it. The argument that immunity from actual infection is somehow better than vaccine immunity is nonsense. The mechanism of immunity is the same.
Some anti-vaxxers argue that natural infections like measles and mumps create a stronger immune system than vaccinations do. (Secretary Robert Kennedy, Jr. is one proponent of this.) The argument is that full-blown infections force the immune system to fight in a way vaccinations don’t. Like the no pain, no gain mantra, the theory is that if the body is pushed further by more extreme infections, the result is a healthier child. A child who is vaccinated has an immune system that is weak, because it never had a workout.
This is laughable and has no basis in medical research. Besides the absence of proof for it, the argument makes no sense. Vaccines only protect against a dozen or so infections. The average child will get hundreds of other infections, including innumerable colds, GI infections, skin infections, ear infections, pharyngeal infections, and viral pneumonias. The human immune system has plenty to do without having to endure measles or rubella. It’s like arguing that a person who walks five miles to work each day isn’t getting enough exercise because he takes the elevator to the office.
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I really don’t have the desire to explain why the MMR vaccine doesn’t cause autism. The claim is false. Multiple, statistically powerful medical studies have shown no link. People who want to doubt these studies are entitled to that opinion. What they are not entitled to do is claim they have valid studies that show otherwise, because they don’t.
Anti-vaxxers have one thing in common. They have looked at scientific studies and dismissed them based on vague, general criticisms about the medical system. Nothing about the research itself, just general paranoia — drug companies make vaccines just for profit, doctors are brainwashed into pushing them, vaccines are some kind of a government/big pharma plot to push parents out of the job of parenting. Just a laundry list of anti-government, anti-corporate, anti-technological complaints.
Karl Marx made similar criticisms of capitalism. That should be enough to give anyone who thinks anti-vaxxers have a point a moment of pause.
If it doesn’t, consider this. How do antivaxxers know that measles, mumps, rubella, hepatitis B, and Heamophylus B are infections that exist? They know because medicine told them. But they doubt that the same medical establishment that discovered rubella and Hib knows anything about the vaccinations that prevent them. This always struck me as bizarre, like someone watching a documentary on TV that argues that television doesn’t exist.
How can anyone doubt the medical establishment about vaccines when medicine has made all the discoveries that make the understanding of infections possible?
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I practice hospital medicine and don’t have an outpatient office. So I don’t know what pediatricians will do now that the White House has decided it knows more than doctors about vaccine schedules. But I can tell you what I would do.
I would kick anyone who wants to follow RFK’s “mix and match” method of vaccination out of my office.
This is not out of spite. It is because breaking up the vaccine schedule is completely unworkable in a clinic. Imagine a pediatrician with a busy practice of about 3,000 patients. She has a refrigerator in the office full of vaccines of every kind — at least, all those recommended by the American Academy of Pediatrics: Hepatitis B, rotavirus, DTaP, HiB, pneumococcus, polio, MMR, varicella, and Hepatitis A. To coordinate this set of vaccines, she has a computerized database that lists every patient, what vaccines they have received, and when.
I concede the current schedule is a lot of shots. But every one of these infections is known to kill, paralyze, or cause significant complications like liver failure, deafness, and meningitis. The target diseases were not chosen for fun. They were chosen because they were diseases harm the thousands of children, or, in the case of rubella, cause very serious birth defects. And the order of the vaccinations is no accident, either. Some vaccines are timed to protect children from infections at ages when they are most devastating. Others are timed to be given when the immune system is mature enough to react to the vaccine in a way that will result in lifelong immunity. Everything is carefully planned.
Now imagine a Trump MAHA office. There will be more than twice as many vaccines, since all the combination vaccinations will be separated into their individual components, allowing parents to pick and choose according to their own schedule. Parents may choose to follow the AAP schedule. They may use the Danish schedule. They may use a schedule recommended by Parents Magazine, Sports Illustrated, or the American Chicken Farmers’ Bulletin. Or perhaps their church pastor, who has “heard” that some of the vaccines used harvested embryos for testing, told them to reject vaccinations on moral grounds. Or maybe the parents want them in alphabetical order.
How would you track all that? How would you know if a three-year-old is on schedule or not, if schedules are nothing more than “whatever you want, whenever you want it”? It wiil be much more expensive to stock the extra vaccines, much more complicated to track who got what and when, and much more exhausting to explain each vaccine combination and why the order of administration matters so much. (Please understand: I’m not against parents asking questions. But it’s one thing to ask, “what are the side effects of this medication,” and quite another to say “I don’t believe polio is a real threat to my child.” One is a clarification. The other is accusing the medical establishment of fraud.)
Imagine you run a clothing store. You have all the standard sizes. Then the government tells you you have to survey all your customers and stock a clothing item in exactly that person’s size and favorite color for as long as they live in the area. Before the new law you just bought clothes by a standard order, a few in every size. Now you have to buy and stock many, many more clothing combinations tailored for specific individuals who shopped with you once and may never return.
In other words, you have been put out of business.
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Doctors and medical professionals have to put up with a lot. Most of it is not the fault of the patients. We understand that people are different and that some patients have more medical needs than others. Patients have different means of payment and are in different health networks. They have different drug allergies and different personal concerns. That isn’t what makes a doctor in his thirties start counting the number of days he has to work before he can retire.
No, what hollows doctors out is a system that makes delivering proper medical care impossible. A system where the doctor knows what has to be done but can’t do it because the process won’t allow it. Doctors deserve better than this idiocy. Children deserve better.
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In medical school, students are taught the concept of medical justice. This is the idea that, to the best of our abilities, we should approach patients the same regardless of sex, race, or age. Two different patients with appendicitis, pneumonia, or high blood pressure should receive the same treatment.
But when everyone is on a separate track, doing their own thing, this is unworkable.
The amount of medical information a doctor is expected to know is staggering, and its volume increases every year. It is hard enough to provide patients with up-to-date medical care when we apply the same standards to everyone.
If everyone gets to make up his or her own standard, the entire enterprise is hopeless.
