Offering a startlingly candid view into the philosophy guiding vaccine recommendations under the Trump administration, the leader of the federal panel that recommends vaccines for Americans said shots against polio and measles — and perhaps all diseases — should be optional, offered only in consultation with a clinician.
Dr. Kirk Milhoan, a pediatric cardiologist who is chair of the Advisory Committee on Immunization Practices, said that he did have “concerns” that some children might die of measles or become paralyzed with polio as a result of a choice not to vaccinate. But, he said, “I also am saddened when people die of alcoholic diseases,” adding, “Freedom of choice and bad health outcomes.”
In the case of an infectious disease, a personal choice to decline a vaccine may also affect others, including infants who are too young to be vaccinated or people who are immunocompromised. But a person’s right to reject a vaccine supersedes those risks, Dr. Milhoan said.
“If there is no choice, then informed consent is an illusion,” he said. “Without consent it is medical battery.”
The polio and measles vaccines are widely acknowledged as staggering successes in public health, credited with preventing disability and millions of deaths worldwide. The polio vaccine in particular has strong bipartisan support, including from President Trump and some Republican lawmakers, who have invoked the horrific time before the vaccine was available.
But Dr. Milhoan said that making the vaccines optional, rather than requiring them for entry into public schools nationwide, as is now the case, would ultimately restore trust in public health.
Outside experts had sharp words for Dr. Milhoan, saying the changes in vaccine policy he was suggesting would result in unnecessary deaths among children.
“He has no idea what he’s talking about,” said Dr. Sean O’Leary, chair of the infectious disease committee at the American Academy of Pediatrics.
“These vaccines protect children and save lives,” Dr. O’Leary said. “It’s very frustrating for those of us who spend our careers trying to do what we can to improve the health of children to see harm coming to children because of an ideological agenda not grounded in science.”
Dr. Milhoan outlined some of his views in an episode of the podcast “Why Should I Trust You?” that aired on Thursday. In the podcast, he said polio and measles were not the threat they once were in the United States because of improvements in medicine and sanitation, rather than the vaccines alone, echoing comments by Health Secretary Robert F. Kennedy Jr. He described himself as “pulling back the curtain” on the risks of vaccines.
In a series of text messages later on Thursday and Friday, he elaborated on his view that personal autonomy was paramount. The vaccine committee may “not necessarily” recommend that all vaccines be optional, he added, but it is charged with “re-evaluating all of the vaccine products including risks and benefits” and may make significant changes to the roster of childhood vaccines over the coming year.
Any changes the committee makes would add to a significant reshaping of the vaccination schedule announced this month by federal health officials. Bypassing the process that the committee has long followed for vaccine recommendations, Mr. Kennedy and his appointees debuted a schedule that reduces the number of recommended immunizations to 11 from 17, and advises that the six vaccines that were dropped should now be administered only under “shared clinical decision making” — that is, after consultation with a health care provider.
A spokesman for the Department of Health and Human Services declined to comment on Dr. Milhoan’s views.
So far, states and insurance companies are continuing to follow the previous vaccination schedule, which is still endorsed by the American Academy of Pediatrics and other medical organizations. All 50 states and the District of Columbia require children to be vaccinated against most of the 17 diseases to attend public schools.
Children can be exempted from the shots for medical or other reasons. Still, requiring routine shots for school entry is “heavy handed” and “authoritarian,” Dr. Milhoan said on the podcast. “What we are doing is returning individual autonomy to the first order — not public health but individual autonomy to the first order,” he added.
Dr. Helen Chu, a vaccine expert at the University of Washington in Seattle and a former A.C.I.P. member, said the entire premise of a conflict between individual choice and public health was false.
“It is true that vaccinated people are less likely to infect others, but the primary reason to receive a vaccine is to protect yourself,” she said.
Noel Brewer, a vaccine expert and previous member of the committee, said Dr. Milhoan seemed to misunderstand the purpose of the vaccine committee.
“A.C.I.P. makes recommendations for what is best for the whole population,” Dr. Brewer said. As for individual autonomy, all vaccines are already delivered with patient consent, he noted.
“For me, autonomy means being able to have my children go to the grocery store or go to preschool and not be stalked by a vaccine-preventable disease that will kill them,” he added. “Ensuring high uptake of vaccines through school-entry requirements protects my child and other children.”
Dr. Milhoan seemed to approach the committee’s work from his perspective as a medical doctor, rather than as a champion of public health, said Dr. Mark Abdelmalek, a surgeon and co-host of the podcast.
During the wide-ranging interview, Dr. Milhoan also claimed he had seen data that suggested “a very large death signal in children” from the Covid vaccine, referring to at least 10 deaths that the Food and Drug Administration is investigating but has not yet made public. He said there were emerging concerns that repeatedly stimulating the immune system with multiple vaccines might increase the risk of allergies, asthma and eczema.
Large studies have dismissed that claim, but Dr. Milhoan said he trusted his own observations over what “established science” might suggest about vaccines.
“He views the vaccines as the threat,” Dr. Abdelmalek said.
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
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