When Joseph Ladapo was appointed the surgeon general in Florida in September 2021, the vaccination rate for routine injections for kindergartners was 93.3 percent. Now, it’s at 90.6 percent — the lowest it's been in over a decade. Some point to Lapado’s actions as a contributor to the decline.
For example, amid a measles outbreak in Florida, Lapado contradicted widespread medical guidance, failing to direct parents of unvaccinated children to get them their shots or keep them home. He advised not to vaccinate children against COVID-19 in 2022 and called for a halt to using mRNA vaccines for both adults and children.
Pediatricians now fear that national vaccination rates, which are already on the decline, will follow a similar trend as Florida if Robert F. Kennedy Jr. is confirmed as the head of the Department of Health and Human Services. But it’s not just how a reduction in vaccination rates could affect kids, but an overall decline in trust in science and medicine that could be devastating to children’s health.
“Positions on vaccines represent a discounting of medicine and science, and that discounting of medicine and science goes beyond vaccines, to include, as an example, his support for hydroxychloroquine as a treatment for COVID,” Jeffrey Goldhagen, a professor of pediatrics at the University of Florida College of Medicine in Jacksonville, Florida, told Salon in a phone interview. “The issue with RFK goes far beyond vaccines, vaccines are the tip of the iceberg — an iceberg that represents a nihilism or denial of medicine and public health.”
In other words, Kennedy represents a “dismantling” of the public health system. In a way, this is what Trump has instructed Kennedy to do. As Trump recently said, Kennedy will “restore” public health “agencies” to the “traditions of Gold Standard Scientific Research” to “Make America Great and Healthy Again.” But such a restoration could lead to the loss of key programs that are vital to children’s health.
Kennedy is infamous for pushing health-related conspiracy theories. He opposes drinking water fluoridation and has been a vocal skeptic of vaccines for decades. If confirmed, he would steer the massive public health agency that includes the Centers for Disease Control and Prevention and the National Institute of Health. Goldhagen said he fears for the future of the Vaccines for Children program that provides vaccines to kids whose parents might not be able to afford routine vaccinations.
“His vaccine stance represents a denial of medicine and science and public health,” Goldhagen said. “And we saw the impact of that with the situation in Samoa.”
Many point to what happened in Samoa in 2018 and Kennedy’s involvement in the crisis. Two infants died when nurses accidentally prepared the MMR (measles, mumps and rubella) vaccine with an expired muscle relaxant. This caused the local government to suspend its vaccine program briefly. At the same time, Kennedy and his anti-vaccine nonprofit Children’s Health Defense spread falsehoods about vaccinations across the island, which led to a decline in vaccination rates. One year later, a measles outbreak infected 57,000 Samoans and killed 83 of them, including children.
In a way, it's a return to the first two decades of the 20th century when measles deaths occurred by the thousands in the United States. But by 2000, measles was declared eliminated from the United States, and no deaths were reported until 2015 when a woman in Washington was the first to die in 12 years due to complications from the disease. Measles cases rise rapidly because the virus is so contagious. It can be easily spread by coughing, talking or simply being in the same room. It is estimated to infect 90 percent of unvaccinated people who are exposed.
But it doesn't have to be this way. The MMR vaccine is extremely effective and safe. After two doses, nearly 99 percent of people will be shielded against infection. While the vaccine was first developed in 1963, it wasn’t until 1980 that all 50 states had laws that required measles immunization for school enrollment.
But since then, the so-called “Wakefield effect” has unraveled this progress. This effect refers to a thoroughly discredited British doctor, who claimed to document changes in behavior in children given the MMR vaccine, suggesting it could cause autism. This has seemingly contributed to the decline in vaccination rates. Kennedy has said he believes “autism comes from vaccines.” Salon reached out to Kennedy and did not receive a response. The problem with a decline in MMR vaccines is that for a population to have herd immunity, in which when a sufficient number of the population are immunized, about 94 percent people needs to have the shot.
“Even a small drop in immunization rates for MMR vaccine can increase the risk of community transmission of measles, which is very risky for those who are not immunized, but also increases risk of infection for those who are immunized,” Dr. Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California, Davis, told Salon. “Vaccines decrease the risk of infection, but are not 100 percent effective.”
Notably, childhood vaccination rates nationwide are declining — not only for measles.
“I and a number of colleagues are very concerned that there could be the potential spread of polio to the U.S.,” Goldhagen said. “If in fact, we don't maintain our levels of vaccine coverage that provide herd immunity.”
In response to the possibility of Kennedy’s nomination, Benjamin Hoffman, president of the American Academy of Pediatrics, emphasized in a statement that “vaccines are the safest and most cost-effective way to protect children, families and communities from disease, disability and death.”
“Vaccinations prepare children’s immune systems to recognize and respond to serious diseases, helping them stay healthy so they can learn, grow and thrive,” Hoffman said. “Immunization prepares children for long-term health, well-being and development into adulthood.”
Hoffman also said that a national investment in vaccines “is absolutely essential to support healthy communities.”
But as Goldhagen said, the concern about vaccines is just the beginning. Blumberg elaborated that he fears that vaccine misinformation can snowball into a distrust for other routine care in early childhood, too.
“The more vaccine misinformation is spread, parents then question other routine care, such as the newborn vitamin K [shot], which is not an immunization,” Blumberg said. “And this can lead to a more contentious relationship with their child’s health care provider as they question mainstream care; this risks physician burnout, and then less access to care for children.”
Blumberg added a distrust in public health and science will ultimately lead to more children being hospitalized, and dying and add pressure to an already-strained healthcare system.
“And then more public health resources trying to contain outbreaks, less safe environments for everyone in the community. It’s sad, everyone loses,” Blumberg said. “It’s frustrating to see a decline in the health of children because people with fringe beliefs are promoted to high-profile platforms where they can spread their conspiracy theories.”
When asked if there were reasons why many people resonated with Kennedy, Goldhagen said it’s important to remember that a majority of parents are pro-vaccine.
“The problem is that the science behind vaccines requires a vaccine rate to ensure herd immunity,” Goldhagen said. “If 10 percent of parents choose not to vaccinate their children, it places 100 percent of children and people to whom children are exposed, at risk.”
