The measles outbreak is a “call to action for all of us,” health secretary and longtime anti-vaccine activist Robert F. Kennedy Jr. wrote in an opinion essay for Fox News on Monday. “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”
A total of 159 measles cases have been identified in the ongoing measles outbreak in Texas, along with nine measles cases in New Mexico. Twenty-two patients have been hospitalized, and one child has died. And fellow anti-vaxxers were furious with RFK Jr. for daring to suggest vaccines might be a good idea.
Kennedy has long blamed vaccines, especially the measles, mumps, and rubella, or MMR, vaccine, for a host of issues, including autism and chronic health conditions. As the chairman of Children’s Health Defense, the leading anti-vaccine organization in the world, and the author of several anti-vaccine books, Kennedy positioned himself as the voice for anti-vaxxers.
That’s why after his apparently pro-vaccine statements on Monday, consternation roiled the anti-vax world. “It has upset lots of supporters of RFK,” Jason Schwartz, associate professor of health policy at the Yale School of Public Health, told me.
But on closer review, and particularly in the context of an interview he then gave to Fox News, which aired Tuesday, it’s not so clear that Kennedy has actually changed his tune. “I think he’s playing the long game,” said Dorit Reiss, professor of law at U.C. Law San Francisco. And some anti-vaxxers engaging in a close reading of Kennedy’s piece agreed—even seeing the piece as an encouraging sign that the anti-vax agenda is proceeding in this administration.
Kennedy does not seem to be changing his stance on vaccines so much as cloaking it in code words. Sleights of hand like this are a good indicator of how he intends to transform health agencies, the recommendations they make, and the availability of—and trust in—vaccines in the United States.
“The piece begins by sending all the signals we would expect to hear regarding a vaccine-preventable disease outbreak and the important role that vaccines can play in the response,” Schwartz said. But then it goes off the rails. “Where we would expect to hear the unambiguous call for vaccination,” he explained, instead “we hear talk about providing information to the public, about discussing with one’s health care provider options, including vaccines.”
Rather than urging everyone to get measles vaccines, Kennedy called vaccination a “personal” decision and said officials will “make vaccines readily accessible for all those who want them,” with the Department of Health and Human Services “offering technical assistance, laboratory support, vaccines, and therapeutic medications as needed.” Parents should “consult with their healthcare providers to understand their options.” The piece then proceeded to extol the virtues of vitamin A. “While there is no approved antiviral for those who may be infected, the Centers for Disease Control and Prevention has recently updated its recommendation supporting administration of vitamin A under the supervision of a physician for those with mild, moderate, and severe infection,” he wrote, pointing to scientific research finding that vitamin A—alongside two doses of the vaccine—can help treat measles patients who are vitamin-A deficient.
This stance is a classic from the playbook of opponents to vaccination policy, Schwartz said. “To talk about vaccination in that way is absolutely coded language to signal a stance in which the government is declining to provide recommendations for what folks should do, and instead is taking a more hands-off approach to encouraging folks to learn and decide for themselves.” It signifies a troubling departure from decades of public health wisdom, he said. “It should be loud and clear and focused on vaccines.”
As for the “technical assistance” and “laboratory support” that Kennedy promised, “what does that mean?” asked Thomas Nguyen, a pediatrician and associate professor of pediatrics for Ohio University. “They don’t really need technical assistance. Laboratory support is not the bottleneck here.” This kind of statement is “designed to make it sound like you’re doing something, when in fact you’re probably not doing anything,” he said. The true challenge is getting vaccines into arms, he said. Kennedy, Nguyen added, is “making our jobs harder on the ground.” Given how contagious measles is, Nguyen already plans to go out to patients’ cars in the parking lot in suspected measles cases, rather than risk exposing other patients and staff. And “now I’m just even more nervous, more anxious, more on edge about identifying the potential cases that may pop up,” he said.
Kennedy’s statements about vitamin A may mislead people, as well. Vitamin A is a treatment for severe measles, not a preventative, and it’s unclear whether vitamin A helps people who get enough of it in their diets already, which is the vast majority of people in the United States. Only about 0.3 percent of Americans are deficient in vitamin A, mostly older adults. In fact, vitamin A toxicity—where you take too much—is more common. Taking too much, especially over a long period of time, can lead to significant organ damage, especially of the liver, bones, and nervous system.
In some ways, though, it’s the less obvious part of the op-ed—the material that sounds like mere pablum—that’s the most telling, giving away the game. Kennedy performed a few sleights of hand familiar to anti-vaccine watchers. He noted that in the nineteenth century, many thousands of people “died with, or of, measles” each year—casting doubt on the lethality of measles. He credited advances in sanitation and nutrition “before the vaccine’s introduction” for preventing the lion’s share of measles deaths. (Immediate death is not the only serious outcome from measles infection, which can produce “immune amnesia,” wiping out people’s previous immune responses, and fatal brain swelling that can set in years after the infection subsides.) “Good nutrition remains a best defense against most chronic and infectious illnesses,” Kennedy wrote, recommending vitamins A, C, D, B12, and E—advice reminiscent of anti-vax home remedies during Samoa’s tragic measles outbreak in 2019.
“To suggest that vaccines haven’t been uniquely responsible for the gains that we’ve seen in measles prevention over the last 60 years is just flat-out wrong,” Schwartz said. The effect is “to muddy the waters for what people need to know regarding how best to protect themselves and their children.”
Reiss called these parts of the piece “dog whistles” for Kennedy’s supporters. “Sanitation does not prevent an airborne disease, nutrition can reduce mortality but would not eliminate it, and vitamin A is not a substitute to vaccines.”
The message “feels like something that someone would say to satisfy the bare minimum of what their job requires, while throwing a few coded messages to their hardcore followers,” Nguyen agreed. “We know why measles is in southwest Texas right now. It’s because that particular community has too low of a vaccination rate, and it’s not because their nutrition is substandard,” Nguyen continued. “He should come straight out and say, ‘The best preventive measure to protect yourself and your family is to get vaccinated with the MMR vaccine.’”
But that’s not what he said. And some of his supporters read the “coded messages” loud and clear.
Melissa Floyd, a prominent anti-vaccine activist and podcaster, wrote in a long message on Facebook that those in the “medical freedom community” who were angry at Kennedy’s seeming endorsement of vaccines should be patient. “You want progress, and he’s already giving Americans progress—you’re just too distracted by the wrong things to even notice it,” she wrote. She listed Kennedy’s points on vaccines as a “choice” and his focus on sanitation, nutrition, and vitamins as indicators that he “didn’t betray the medical freedom movement, he isn’t ‘selling out.’” Moreover, “he did NOT point fingers and blame this outbreak on ‘vaccine hesitant parents’ or ‘antivaxxers.’”
Kennedy’s interview with Fox News on Tuesday supported this interpretation: Instead of urging worried parents to get their kids vaccinated, he recommended cod liver oil.
The confusion alone, experts say, is dangerous. “We have measles circulating in our communities, and the way to stop it from further spreading and causing more harm is through making sure that everyone who isn’t vaccinated gets vaccinated,” Schwartz said. “The story should be as simple as that.”
