How Rfk Jr. Could Discourage Vaccination

Robert F. Kennedy Jr. has vowed not to take vaccines away from Americans, assuring senators that he just wants to cast more sunlight onto the science behind the public health interventions he’s spent years attacking.

His history of anti-vaccine advocacy has made those promises difficult to believe for some of the senators who will decide whether to confirm him to lead the Department of Health and Human Services.

Before President Donald Trump nominated him to lead HHS, Kennedy questioned vaccine safety as chair of Children’s Health Defense, an anti-vaccine nonprofit he founded.

There are a slew of policy decisions he could make, if senators confirm him, to limit the availability of some shots or prompt states to downplay the importance of others.

He could also try to shake up longstanding legal protections for vaccine makers, creating uncertainty in a market that decades ago was at risk of leaving the U.S. amid an onslaught of lawsuits.

Here are five vaccine policy moves Kennedy could make:

Revoking Covid vaccines’ liability shield

One of the most significant actions Kennedy could take is pulling back HHS’ declaration shielding manufacturers and providers of Covid vaccines from legal liability — a move that would likely spur a tidal wave of litigation over alleged injuries from the shots.

Former HHS Secretary Xavier Becerra most recently amended that policy on Dec. 11, extending the protections through 2029. That means anyone who believes they or a family member was injured or killed by any drug or vaccine for Covid must file a claim through a fund Congress set up to handle claims related to national emergencies, rather than petitioning the federal vaccine court that covers routine childhood immunizations under the Vaccine Injury Compensation Program.

But both programs are overburdened with claims, and attorneys and lawmakers have criticized the emergency fund handling Covid-related injuries — the Countermeasures Injury Compensation Program — for issuing few awards that are significantly smaller than those doled out by the vaccine court.

Leaving people injured by Covid vaccines in the pandemic program under those circumstances is a “disservice to public health,” said Renée Gentry, director of George Washington University’s Vaccine Injury Litigation Clinic. “They are becoming vaccine-hesitant.”

Pfizer, Moderna and Novavax — the makers of Covid vaccines used in the U.S. — would likely sue HHS if Kennedy were to revoke the declaration.

Children’s Health Defense suggested after Becerra’s last extension that a new secretary could rescind it.

“I hope and trust that the new administration will review this decision and make necessary changes,” CEO Mary Holland said in a post on the group’s website.

Adding or removing injuries to the vaccine table

The HHS secretary has the authority to amend the vaccine injury table — the list of conditions associated with vaccines for which the Vaccine Injury Compensation Program will provide payment.

The most consequential change Kennedy could make is changing or adding injuries to existing vaccines, Gentry said. That means he could propose making a diagnosis like autism a covered condition.

While the law requires the secretary to consult with the Advisory Commission on Childhood Vaccines before proposing a table change and taking public comment, Kennedy wouldn’t be required to follow the commissioners’ advice.

“The Secretary may place injuries or conditions on the Table based on scientific and/or policy reasons,” the Health Resources and Services Administration — the HHS arm that administers the compensation program — says on its website.

The last time a significant change was made to the injury table outside of adding a new vaccine was during the Clinton administration, Gentry said, when then-HHS Secretary Donna Shalala endorsed amendments that removed residual seizure disorder from the covered conditions for whooping cough and tetanus vaccines in 1995 and for the measles, mumps and rubella shot in 1997. Patients with those claims then had to pursue them in court with expert witnesses since their conditions were considered “off-table,” she said.

Pulling emergency use authorization of Covid vaccines for children

While the FDA has approved Covid vaccines for use in teenagers and adults, two of the shots are still authorized only for emergency use in children under 12.

While Kennedy said after Trump’s election that he won’t “take away anybody’s vaccines,” he petitioned the Food and Drug Administration in May 2021 on behalf of Children’s Health Defense to withdraw its Covid vaccine emergency authorizations and refrain from expanding them to younger age groups.

He also cited “the extremely low risk of severe COVID illness in children,” as reason for the FDA to “immediately refrain from allowing minors to participate in COVID vaccine trials.”

Changing membership of federal advisory committees

Four expert panels advise branches of HHS on vaccine policy. Some could see membership shakeups under Kennedy.

While members of the Advisory Committee on Immunization Practices historically make recommendations to the director of the Centers for Disease Control and Prevention, the HHS secretary delegates that authority. That means new leadership could step in and reimagine its functions, an idea Kennedy has discussed with allies ahead of his Senate confirmation hearings.

The Advisory Commission on Childhood Vaccines recommends changes to the vaccine injury table and proposes vaccine injury research ideas. Its charter requires at least two representatives of vaccine-injured children and at least one vaccine injury attorney to serve on the panel.

The National Vaccine Advisory Committee recommends strategies to the assistant secretary of health to ensure an adequate domestic vaccine supply and research priorities around vaccine safety and effectiveness.

Revising the CDC’s childhood immunization schedule

Kennedy could direct the CDC to revise its childhood immunization schedule, which could run the gamut from removing recommendations for certain vaccines to changing their suggested use from “routine” — when the default approach is to vaccinate — to “shared clinical decision-making,” an individual choice guided by discussions between a health care provider and the patient or their guardian.

Kennedy and his associates have opposed vaccine mandates — including those for children to attend schools — that states institute based on the CDC’s vaccine schedule.

This week, Dr. Casey Means, a former surgeon who’s now a wellness influencer close to Kennedy, questioned the “huge explosion of the vaccine schedule” after the 1986 law creating the injury compensation program passed.

While noting vaccine science isn’t her academic area of expertise, she suggested in a podcast interview released Tuesday that vaccinating infants within hours of birth against hepatitis B may be unnecessary if mothers test negative for the virus.

“To me, that’s just, like, dystopian,” Means told Kristin Cavallari, a reality TV star who has said she didn’t plan to vaccinate at least two of her children.

Public health experts recommend that vaccine for newborns because the virus is easily transmitted through casual contact with infected blood or saliva, and young children who catch it are at greater risk of cirrhosis and liver cancer in their adult years.