Under the leadership of Robert F. Kennedy, Jr (RFKJr) as head of the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC) has steadily dialed back and begun to reverse its support of robust administration of childhood vaccines that have been proven efficacious and safe for decades.
Most Recent Reversals
In the past two weeks the acting director of the CDC, James O’Neill, announced the removal of six standard childhood immunizations (hepatitis A, hepatitis B, rotavirus, influenza, RSV, and meningococcal) from the routine, automatic schedule for children’s care. Instead, they could be obtained after “shared decision-making” with the parent, child and pediatrician.
Mr. O’Neill is a technology investor with a non-science background and no expertise in medicine or vaccines. The ACIP (Advisory Committee on Immunization Practices), which had been reconstituted in the past few months without any actual national known vaccine experts who used to serve on the committee, was also bypassed. No scientific rationale has been provided by CDC or HHS to support these changes.
Why Is Mandatory Shared Decision-Making a Concern?
During this quarter century, childhood immunizations have been essentially automatic. They are highly effective and exceedingly safe interventions that have been exhaustively studied. Recent generations have been free of many serious viral and bacterial illnesses that lead to disability and death because of protection from these vaccines.
“Shared decision making” is just a highfalutin way of saying the person and the doctor confer and discuss the particular item and come to a decision. This is of course appropriate in medically uncertain situations, and also anytime a patient has questions. But requiring conversations about safe and established preventive measures takes time and effort, often in short supply, even though the rational answer would almost always be to go forward with the vaccination.
This friction in the care process will inevitably substantially lower the administration of those vaccines, leaving many more children vulnerable to preventable diseases. And for many of those diseases (measles is the most prominent) achieving a high rate of immunization is central to protecting the population as a whole.
The Massachusetts Response
Fortunately, in Massachusetts, under Governor Maura Healy the Department of Public Health (led by Robbie Goldstein, MD, PhD) is setting our statewide vaccine guidance together with most other NE states and New York, New Jersey and Pennsylvania. This guidance basically adheres to the robust CDC schedules that existed before this Trump administration came into office and RFKJr began to upend science-based vaccine policy.
Massachusetts and Northeast and California children will be safe. But expect a needless resurgence of harmful childhood diseases in states that follow the RFKJr CDC recommendations.