Editors’ Note: An earlier version of this article was published in error. It has been replaced with the correct version.
“Some people believe that the term anti-vaxxer is a pejorative,” the physician Robert Malone wrote on June 9. “I do not — I view it as high praise.”
During in the pandemic, Malone campaigned for treatment with ivermectin and hydroxychloroquine and against mRNA vaccines, which he described as “causing a form of” AIDS, though he has also admitted he received the Moderna vaccine to treat his own long Covid. In 2021, Malone circulated a 2013 video of a high school athlete collapsing on the football field, blaming coronavirus vaccination for the death before he was served with a cease-and-desist letter from the family. More recently, he dismissed as “misinformation” news reports attributing the deaths of two girls in Texas to measles, blaming not vaccine refusal but “medical errors,” and last fall published a book, “PsyWar,” claiming that between the C.I.A. and Department of Defense, the United States maintains “reality-bending information control capabilities” and that much of federal government’s business is conducted via sexual favor. “The term ‘anti-vaxxer,’” he continued on June 9, “it is not a slur, but a compliment.”
Two days later, he was appointed to the advisory board that steers America’s vaccine policy.
Richard Nixon conducted his “Saturday night massacre,” back in 1973, when one after another federal prosecutor refused to fire Archibald Cox, the Watergate prosecutor. Robert F. Kennedy Jr., the health and human services secretary, staged his night of the long knives a week ago Monday, firing all 17 members of the vaccine advisory board, the Advisory Committee on Immunization Practices, in one fell swoop — a historically unprecedented action and one that broke an explicit promise he made to Senator Bill Cassidy, Republican of Louisiana and a physician, as a condition of his confirmation as secretary. The epidemiologist and immunologist Michael Mina called Kennedy’s move a “code red” for vaccines in America.
Reportedly, none of the A.C.I.P. advisers were warned or had their firings explained; they had to read the news in a Wall Street Journal opinion essay. The next day, Kennedy accused them of “malevolent malpractice.” Cassidy, who dodged questions from reporters on the subject, was left sputtering on X: “Of course, now the fear is that the A.C.I.P. will be filled up with people who know nothing about vaccines except suspicion.” Malone, whose appointment to the board hadn’t yet been announced, posted proudly, “Promises made, promises kept.”
The new appointees are not all fully committed skeptics — though, beyond Malone, they include people who have served as expert witnesses in lawsuits against vaccine manufacturers, as well as a board member for an anti-vaccine nonprofit and an M.I.T. business-school professor who has described coronavirus mRNA vaccines as causing “an unprecedented level of harm.” (The choices also include a nutritional neuroscientist focused on fatty acids and aa “serial C.E.O.” who has served on the boards of several private health care companies.)
When the names were announced, Mina tried to take a glass-half-full view of the appointments but had to acknowledge that the group didn’t include any actual experts in vaccines. “We’ve taken people who had expertise and fired them for a bogus reason,” says the University of Pennsylvania vaccinologist Paul Offit, a former member of the A.C.I.P. and a co-creator of the rotavirus vaccine. In their place have been installed what the bioethicist Ezekiel Emanuel, also of the University of Pennsylvania, described to me as “vaccine skeptics.” Offit calls them, more pointedly, “purveyors of disinformation.”
“The consequence will be people will lose trust in the panel and its advice,” Offit went on. “In fact, I think it’s already happened.” Emanuel agreed: “I don’t think we’ll be able to trust the A.C.I.P. operation anymore,” he told me. “It begins to make people distrust the U.S. government as a whole. Or distrust it even more.” One result, he suggested, was that Americans would start to treat vaccine recommendations like the State Department’s travel advisories — mostly ignoring them.
The immediate fallout from what Jess Steier of Unbiased Science called the “A.C.I.P. purge” may prove relatively limited. Removing vaccine recommendations would probably take time, most likely requiring some fig leaf of research cover, and would kick an awful lot of responsibility to insurance companies, which are required to cover the cost of shots recommended by the A.C.I.P. Today uninsured children can get them thanks to the federal Vaccines for Children program, which covers nearly half of American children. But that program is administered by the C.D.C., which has no director at the moment. (Trump’s initial nominee was torpedoed, presumably for being too outspoken an anti-vaxxer.)
In the coming months, alternate advisory bodies will most likely spring up — Emanuel tells me there are several groups already organizing themselves — so that parents and providers won’t find themselves shut off from vaccines or information about them. Instead, they’ll be served with contradictory guidance, forcing them to navigate the new landscape somewhat as individual consumers and make their own risk-benefit assessments, rather than as constituent parts of a social whole. And in the medium term, they may have to pay out of pocket for shots, which aren’t as expensive as, say, cancer treatment but aren’t exactly cheap either (about $100 each for many of the vaccines, like M.M.R. or DTaP/hepatitis B/I.P.V.).
So far, so grimly familiar: bad players weaponizing post-pandemic distrust to blowtorch institutions of public health in the name of restoring trust, but winning in the short term only small victories that leave Americans not exactly barred from health care but simply much more on their own.
This is “Make America Healthy Again” as public-health libertarianism. But while you may think the country has turned against vaccines in the aftermath of the Covid emergency, vaccine refusal, while seemingly growing, is far from a mass phenomenon. Routine childhood vaccinations have fallen from 95 percent just before the pandemic to just under 93 percent — an epidemiologically worrisome drop but not a screaming signal of social outrage. Families in states that voted for Donald Trump in 2024 are more likely to forgo vaccination for their children, Jeremy Faust and Benjamin Renton recently showed in a preprint analysis, but even there, barely one in 20 families decided to skip vaccination.
Perhaps one should want to carefully recalibrate the public-health approach to vaccination in the face of these declines, which are echoed elsewhere in the world.But this is not that. It is a war from above on public health — and public trust.
Over the last few weeks, the Trump administration has withdrawn hundreds of vaccine-related research grants, canceled a Moderna contract to produce an mRNA bird-flu vaccine and disavowed C.D.C. recommendations about coronavirus vaccines for “healthy children” and “healthy pregnant women,” an announcement that Offit calls “testing the fence, like the velociraptors did in ‘Jurassic Park.’” It was only in April, he points out, that Fiona Havers of the C.D.C. presented data showing that of the children who were hospitalized by Covid last year, half were otherwise healthy. Even among children who required I.C.U. care, 41 percent had no underlying conditions. Overall, 152 children died of Covid last year. Havers quit the agency this week, writing, “I no longer have confidence that these data will be used objectively or evaluated with appropriate scientific rigor to make evidence-based vaccine policy decisions.” She was starker to The Times: “A lot of Americans are going to die.”
MAHA figures will often invoke what they call “shared clinical decision making,” Offit goes on — doctors and patients empowered to make health care choices independently. “But that’s not what they really mean,” he says. “What they really mean is that we want to make this more like what they’re asking for in Project 2025, which is that the C.D.C. is no longer a recommending body.”
There is also a bigger risk, Offit says — one that might sound like a worst-case scenario but is, to him, the most likely one. That is that Kennedy finds an excuse to add autism to the list of compensable vaccine injuries. This would be a kind of rerun of the D.P.T. vaccine scare of the early 1980s, when a flood of litigation drove the number of vaccine manufacturers from 18 to four and forced the government to step in and establish the Vaccine Injury Compensation Program to minimize the exposure of manufacturers. Adding autism, Offit says, would break the program, making it immediately untenable for manufacturers to continue producing or delivering shots in the United States. The liability would be simply too much for drugs that offer the companies almost no profit. Suddenly, we would be faced not with problems of guidance or coverage but of simple accessibility — all those shots that brought such miraculous ends to centuries of infectious diseases in the second half of the last century no longer available in this one.
“I think we are on the verge of losing vaccines for this country, from this country,” Offit says. “And the reason is that Robert F. Kennedy Jr. will hold up a paper, in the next four or five months, that says it’s aluminum in vaccines that are causing a whole swath of problems, including autism,” he goes on. “I think he is about to destroy vaccines in this country. I do.”
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