Pediatricians fear RFK's vaccine skepticism will influence Trump's health policy: vaccinations

President-elect Trump says he will let Robert F. Kennedy Jr. “go wild” on health care. That makes many pediatricians nervous about RFK Jr.'s anti-vaccine rhetoric. When another vaccine skeptic, Joseph Ladapo, became surgeon general in Florida, some doctors there said vaccine skepticism got worse.

“That’s because people in power, like our surgeon general, are pushing this anti-vax message,” says Dr. Jeffrey Goldhagen, professor of pediatrics at the University of Florida College of Medicine and president of the International Society for Social Pediatrics and Child Health.

Vaccine skepticism is increasing in Florida. When Ladapo was appointed in September 2021, the routine vaccination rate among kindergarten children was 93.3%. It has now fallen to 90.6%. That's the lowest rate in more than a decade – and it's well below the threshold needed for herd immunity against highly contagious diseases like measles.

Dr. Lisa Gwynn, a pediatrician in Miami-Dade County, says she spends a lot of time combating misinformation about vaccines. “Probably 50% of our work in pediatrics right now is educating parents about the importance of vaccinating their children,” she says.

Earlier this year, Gwynn saw firsthand the consequences of not giving children routine vaccinations.

“We just had a measles outbreak right around the corner from the elementary school my daughter attended” in nearby Broward County, she says. “There were five children who contracted measles and were not vaccinated.”

If a measles outbreak occurs, the Centers for Disease Control and Prevention advises parents to keep unvaccinated children at home after infection to prevent the disease from spreading. But Florida Surgeon General Joseph Ladapo's advice was very different: He told parents of unvaccinated children that it would be up to them to decide whether to send their children to school or keep them at home.

These guidelines “violate every single premise about how measles should be handled,” Goldhagen says.

Vaccine hesitancy was increasing in Florida long before Ladapo became surgeon general. In the two years before he took office, the vaccination rate had fallen by a fraction of a percentage point each year. After his appointment, the decline accelerated – falling by almost 3% in just two years.

Goldhagen says the fight against vaccine skepticism has become more difficult. “It accelerated during the COVID-19 crisis. It accelerated after the COVID-19 crisis, particularly because of the anti-vaccine stance of this surgeon general,” he says.

In January 2022, Ladapo advised against vaccinating children against COVID, contradicting federal health officials who recommend that all children be vaccinated. The Florida chapter of the American Academy of Pediatrics called the move irresponsible.

That same year, he appeared on a podcast hosted by Dr. Sherri Tenpenny, a well-known anti-vaxxer in Ohio, moderated the event. When she made the false claim that vaccines cause autism, Ladapo neither corrected her nor corrected her claim that no vaccine has been proven safe or effective.

In January this year, Ladapo called for a halt to the use of mRNA COVID-19 vaccines for both adults and children, citing unproven health risks but these have been refuted.

Ladapo has become a frequent target of critics who say his stance on vaccines contradicts established science. Last year, the CDC and FDA sent Ladapo a letter reprimanding him for spreading misinformation about COVID vaccines and stoking vaccine skepticism. Now Ladapo has been mentioned as a possible candidate to lead the Department of Health and Human Services. This also applies to RFK Jr.

Pediatricians say anti-vaccination, which has increased during the pandemic, particularly around the COVID vaccines, is now affecting all childhood vaccinations.

And that doesn't just apply to Florida.

Routine childhood vaccination In most US states, vaccination rates have fallen while vaccine exemptions have increased.

Gwynn fears those rates will fall even further as those responsible for national health policy doubt the safety and effectiveness of vaccines. “I am very concerned, as are all pediatricians across the country,” she says. “One of our main tasks as pediatricians is to protect children. And the most effective way to protect children from preventable communicable diseases is through vaccination.”

Dr. Rana Alissa is president of the Florida Chapter of the American Academy of Pediatrics. She says vaccine hesitancy is complex and cannot be blamed on a single person. But she says the politicization of vaccines hasn't helped during the pandemic, when people's attitudes toward COVID vaccines became a kind of litmus test for their political leanings.

Vaccines are one of the most effective tools available to health care workers to prevent disease, she says. “The vaccines we have in the United States prevent 21 deadly diseases.”

The success of vaccinations means that many people no longer remember how serious some diseases can be. Alissa says this can lead to incorrect risk calculations for some people about the value of vaccination.

“People think it is easier or safer to catch the disease than to get vaccinated. I have no idea where that came from,” says Alissa.

The U.S. is already seeing an increase in some vaccine-preventable childhood diseases, says Dr. Adam Ratner, a pediatric infectious disease specialist in New York City and author of a forthcoming book about the resurgence of measles and the growing anti-vaccination movement.

Measles outbreaks and cases of chickenpox and pneumococcal disease are increasing in the United States, he notes.

“When we see children in the hospital with these types of complications that we can prevent or at least reduce their risk through the use of vaccines, it is very frustrating,” he says.

As vaccine hesitancy continues to spread, Alissa and other pediatricians fear that other devastating childhood diseases like polio could reemerge.

Alissa says many people have lost trust in public health science and the country needs leaders to help regain that trust.

This story was edited by Jane Greenhalgh