During the Senate confirmation hearings earlier this year, it became clear that the man nominated by Donald Trump to become Secretary of Health and Human Services was completely unfit to run America’s leading public-health agency. Now that he has been confirmed, it is time to reckon with the likely consequences of that decision.

Robert F. Kennedy, Jr. insists he’s not anti-vaccine and that he just wants to ensure that vaccines are safe. But defending his a priori conviction that vaccines are unsafe requires him to ignore the results of large, rigorous studies indicating otherwise and to rely on bad evidence and debunked claims that support his preferred position. No medical intervention is entirely without risk, but any risk incurred by the administration of a licensed vaccine pales in comparison to the risk posed by the disease it addresses.

But Kennedy knows that his inflammatory statements about the dangers of vaccines will be more compelling to many people than dry recitations of rigorous studies demonstrating their efficacy and safety. And his pronouncements on health and disease display boundless hubris combined with an uncanny ability to be wrong. He routinely employs absolutist language as he dismisses well-established facts in favour of preposterous and unsupported claims:

• During a 2024 podcast, Kennedy said, “The polio vaccine contained a virus called simian virus 40, SV40. It’s one of the most carcinogenic materials that is known to man. In fact, it’s used now by scientists around the world to induce tumors in rats and guinea pigs in labs. But it was in that vaccine—98 million people who got that vaccine, and my generation got it, and now you’ve had this explosion of soft tissue cancers in our generation that killed many, many, many, many more people than polio ever did. So if you say to me, ‘The polio vaccine, was it effective against polio?’ I’m going to say, ‘Yes.’ And if you say to me, ‘Did it kill more people … did it cause more death than averted?’ I would say, ‘I don’t know, because we don’t have the data on that.’”
• During the same podcast, Kennedy said, “I think some of the live virus vaccines are probably averting more problems than they’re causing. There’s no vaccine that is, you know, safe and effective.” During an interview with PBS four months later, Kennedy was confronted with these words and flatly denied speaking them.
• During a 2020 debate with Alan Dershowitz, Kennedy said, “The proposition and the theology that smallpox and polio were abolished due to vaccination is controversial. That is not a proposition that is universally accepted.”
• During a press event at a New York City restaurant in 2023, Kennedy declared: “I know a lot now about bioweapons, because I’ve been doing a book on it for the past two and a half years. ... In fact, COVID-19—there is an argument that it is ethnically targeted. COVID-19 attacks certain races disproportionately. The races that are most immune to COVID-19 are—because of the genetic structure, the genetic differentials of different races of the ACE2 receptor, COVID-19 is targeted to attack Caucasians and black people. The people who are most immune are Ashkenazi Jews and Chinese. Now we don’t know if it was deliberately targeted or not, but there are papers out there that show, y’know, the racial and ethnic differential impact for that. We do know that the Chinese are spending hundreds of millions of dollars developing ethnic bioweapons. And we are developing ethnic bioweapons. That’s what all those labs in the Ukraine are about—they’re collecting Russian DNA, they’re collecting Chinese DNA so we can target people by race.”
• During a meeting with Louisiana lawmakers on 6 December 2021, Kennedy called the COVID-19 vaccine “the deadliest vaccine ever made.”

When confronted with statements like these, Kennedy either denies saying what he said, or he misrepresents scientific papers confident that his target audience is unlikely to check the source for themselves. “No matter how much data you show him,” the vaccinologist Paul Offit has said, “he refuses to believe it. He’s an anti-vaccine zealot.” Reviewing Kennedy’s Senate testimony and the public statements he’s made over the past six months, I was unable to find a single instance in which he acknowledged that he was wrong about an issue.

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Offit has recently identified a central tenet of Kennedy’s thinking that sheds light on his otherwise nonsensical claims. Kennedy simply doesn’t believe in the germ theory of disease established by Robert Koch and Louis Pasteur in the 1870s. He believes in “miasma”—the vague idea that substances in the air, water, and food (toxins, chemicals, contaminants) are the main cause of disease. This helps to explain many aspects of his thinking that would otherwise be unintelligible—his emphasis on healthy nutrition, exercise, strengthening the immune system, and avoiding ultra-processed foods in lieu of vaccination, not to mention his declared intention to impose an eight-year moratorium on research into infectious diseases at NIH. The centrality of his belief in miasma at least makes his crankery internally consistent.

Of course, Kennedy’s tortured responses to questions about vaccines have to be understood in light of his long involvement in bringing tort ligation cases against vaccine manufacturers. While publicising bogus ideas about vaccination through his non-profit Children’s Health Defense, he has been recruiting new plaintiffs for these cases, for which he receives a referral fee. Although he has stepped down from leadership of Children’s Health Defense, he will continue to profit from successful litigation against vaccine manufacturers.

More worrisome are the manifold ways in which Kennedy could use his position to erode current standards for vaccines. These include:

• Undermining school vaccine mandates.
• Instructing the CDC to no longer recommend certain vaccines.
• Adding warning labels to vaccine packaging.
• Making it easier for people to sue vaccine manufacturers based on the results of poor-quality studies.
• Attaching strings to federal funding of vaccines.
• Promoting distrust of vaccines.

Before the confirmation hearings, Offit said he had “little doubt” that Kennedy would take steps to weaken vaccination programs were he to be confirmed.

The only effective antidote to Kennedy’s anti-vaccine propaganda is exposing his grotesque distortions and conflicts-of-interest, while countering them with the less titillating but nonetheless correct information obtained through careful research and study. Rather than falling for RFK’s portrayal of vaccines as an ominous threat, we should consider them a public good that has helped extend life expectancy in America by eleven years since 1950.

When mRNA vaccines became available just a year into the COVID-19 pandemic, Kennedy tried to undermine trust in them by alleging that they had been “hastily” developed. In fact, the Moderna and Pfizer vaccines were tested in tens of thousands of subjects (30,420 in the Moderna trial and 44,165 in the Pfizer trial) and found to be safe and effective. Although the vaccines were developed in record time, the underlying mRNA technology was developed over decades of research. Their swift introduction has been credited with saving 1.2 million lives in the US.

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But Kennedy has been questioning the safety of vaccines for over twenty years. Before the pandemic, the two vaccines he focused on most were the MMR (measles, mumps, rubella) vaccine and the HPV (human papillomavirus) vaccine. A look at his arguments reveals his longstanding drive to perpetuate debunked risks, while ignoring the painstakingly amassed evidence demonstrating the safety and effectiveness of these vaccines.

The MMR Vaccine

During an interview on Fox News in March, Kennedy said, “There are adverse events from the [MMR] vaccine. It does cause deaths every year. It causes—it causes all the illnesses that measles itself causes, encephalitis and blindness, et cetera.” This is not true. The MMR vaccine does not cause death in healthy people. Measles, on the other hand, used to kill between 400 and 500 children a year.

Kennedy implies that “natural immunity” acquired by infection is superior to immunity derived from the vaccine, which is typical of his contorted style of reasoning. He has to come up with a way to discredit vaccines so he alleges adverse effects in order to detract from the main point, which is the demonstrably powerful positive effects of the vaccine. Before the measles vaccine was introduced in 1963, there were hundreds of thousands of measles cases each year. A precipitous drop in infections occurred immediately after the vaccine was made available and the number of infections remained at zero until recent outbreaks caused by falling vaccination rates in certain subgroups of the population.

The combined MMR vaccine was uncontroversially introduced in the US in 1971. The sudden explosion of distrust about MMR in 1998 was not sparked by any problem with the vaccine itself but by an unfortunate paper published in the Lancet. Based on a tiny sample of twelve cases studied in the absence of a control group, the paper claimed to show an association between the MMR vaccine and autism. But the data from the patients was later shown to be fraudulent, and the paper was subsequently retracted by the journal. Its lead author, Dr Andrew Wakefield, had his medical licence revoked. You would never know these facts by listening to Kennedy, who began speaking about the alleged harms caused by vaccines shortly after Wakefield’s fraudulent findings were published.

Many carefully performed studies have since been conducted to test the association between the MMR vaccine and autism, and not one of them has found a link. In 2004, the Institute of Medicine (IOM) issued a report that concluded there is no link between the MMR vaccine and autism. Many other studies (here, here, and here) have also examined the association and found no evidence of a link. In his official capacity as heath secretary, Kennedy has just hired a discredited researcher and vaccine conspiracy promoter to conduct a new study under the auspices of the CDC to reinvestigate the question of vaccinations and autism.

This plan may sound reasonable to people unfamiliar with the subject, but in undertaking this cynical ploy, the HHS Secretary has tipped his hand. It’s not as if we have any shortage of credible studies on the question of vaccines and autism. The only reason to commission a new one is because he doesn’t like the answer that the Institute of Medicine report and numerous other respected studies have already provided. Furthermore, nobody interested in obtaining an objective assessment would select someone with a preexisting bias to carry it out.

In response to Kennedy’s campaign to erode trust in vaccines, the FDA’s top vaccine official Dr Peter Marks has just resigned. In his letter of resignation, he wrote, “It has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies.”

Because measles is one of the world’s most contagious diseases, protection of the population requires a high level of vaccination (>95 percent). In recent years, as vaccination rates have declined, there have been new outbreaks in communities with low vaccination rates. In West Texas, an outbreak this year has reached 400 cases and is continuing to grow. Forty cases have been hospitalised, and one child has died—the first measles death in the United States in a decade. Additional cases have been reported in New Mexico, Oklahoma, and Kansas. The outbreak is expected to persist for a year according to Texas health officials.

Contrary to Kennedy’s irresponsible public statements, the MMR vaccine has saved tens of millions of lives over the past thirty years with an extremely low level of serious side effects.

The HPV (Human Papillomavirus) Vaccine

The human papillomavirus (HPV) is the sexually transmitted causal agent in more than ninety percent of cancers of the cervix and seventy percent of cancers of the oropharynx (the middle part of the throat). It also causes a number of less common cancers (of the vagina, vulva, penis, and anus). The CDC estimates that the virus is responsible for close to 38,000 cancers per year in the US.

The first HPV vaccine (Gardasil) was approved in 2006. Three randomised clinical trials of successive HPV vaccines—each including tens of thousands of subjects—have been carried out. According to the CDC: “More than 15 years of monitoring and research have accumulated reassuring evidence that HPV vaccination provides safe, effective, and long-lasting protection against cancer caused by HPV infections.”

Kennedy never refers to this solid body of evidence. Instead, he zeros in on possible adverse effects (autoimmunity) that are extremely rare. He cites a study from Denmark that suggests a potential link between HPV vaccines and autoimmune disorders; however, extensive studies and meta-analyses generally show no increased occurrence of autoimmune disorders following HPV vaccination. Regardless, Kennedy’s claims of insidious effects lodge in people’s minds and divert attention from the strength of the data demonstrating the benefits and the safety of the vaccine.

As the medical writer Lisa Doggett explains in a powerful article, disinformation of the kind Kennedy spreads undermines confidence in vaccines at the expense of publicising their vast real-world benefits. As a result, there are people who will needlessly contract a serious disease and in some cases die as a result. Vaccination against HPV is nothing less than a medical triumph that has the potential to virtually eradicate cervical cancer, which kills around 4,000 women every year in the US and 350,000 women worldwide.

The Next Pandemic

It feels almost quaint to point to major public-health accomplishments of the last eighty years when medical-research agencies and programs are being slashed in the name of efficiency and cost-cutting. Last week, the Trump administration announced that it was laying off 10,000 employees at the Department of Health and Human Services to reflect the priorities of its new health secretary.

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These cuts will fall on the NIH, the CDC, and the FDA. A quarter of the federal health workforce has already been cut. Grants are being cut in many fields, including for research into infectious diseases like HIV-AIDS and Long COVID. “The FDA as we’ve known it is finished,” the agency’s former commissioner Robert Califf wrote in a LinkedIn post on 1 April, “with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed. I believe that history will see this as a big mistake.”

The Trump administration has withdrawn from the World Health Organisation, and from GAVI, the alliance that promotes the distribution of vaccines to low-income countries. One of the administration’s first acts was to shut down the US Agency for International Development (USAID), which promotes public health and nutrition in underdeveloped countries. Domestically, these drastic reductions will have deleterious effects on the public-health system, the weaknesses of which were exposed by the COVID-19 pandemic. In a recent poll, 75 percent of American scientists say they are considering leaving the US and moving abroad.

All of this is taking place while the H5N1 virus is spreading through wild birds, poultry, and cattle and infecting farm workers, and the measles epidemic in Texas and other states is growing.

The system we have relied upon to identify and respond to the emergence of deadly pathogens is being dismantled. As the infectious-disease physician Craig Spenser wrote recently in the Atlantic, “In little more than a month, America has transformed itself from a preeminent global-health leader into an untrustworthy has-been. Undermining even one of these institutions would have posed a serious threat; gutting them all at once is an invitation for future outbreaks.” We can’t say we weren’t warned.