CLEVELAND, Ohio — Imagine a country in which kids attend school unvaccinated, flu clinics are rare and measles is a common cause of death.
That could describe the United States under vaccine critic Robert F. Kennedy Jr. as head of the Department of Health and Human Services. Kennedy is President-elect Donald Trump’s pick for the role.
Time-tested vaccines – approved after extensive research and approval by two federal agencies – have been a staple of American healthcare for generations. They’ve been credited with ending significant public health threats from polio to smallpox. Research shows they significantly reduced COVID-19 deaths.
A list of common vaccines and why each is recommended by federal health officials is at the end of this story. But widespread acceptance, and their success in the future if vaccination rates decline, could be in jeopardy.
Kennedy has promoted the disproven claim that vaccines cause autism. He founded the nonprofit Children’s Health Defense to investigate whether certain health problems are caused by vaccines.
Kennedy also has criticized laws protecting companies that make vaccines from lawsuits, and urged the federal government to release more data about harms caused by vaccines.
The National Vaccine Injury Compensation Program provides financial compensation if a vaccine is found to have caused a serious problem, such as a severe allergic reaction. The program was created in the 1980s, after lawsuits against vaccine companies threatened to cause vaccine shortages, according to federal information.
It’s unlikely Kennedy could stop all vaccines from being distributed. However, if confirmed, he could exert influence over the Food and Drug Administration, the Centers for Disease Control and Prevention and CDC’s Advisory Committee on Immunization Practices, which makes vaccine recommendations for all Americans.
Kennedy also could influence public perception about immunizations, appoint fellow vaccine skeptics to advisory boards and ask federal health agencies to slow down approvals, health officials say.
These moves, if they happen, could face pushback from the pharmaceutical industry, legislators and the public, according to news reports.
Decreasing vaccination coverage and allowing more vaccination exemptions increase the risk for outbreaks of preventable illnesses, such as measles, pertussis and polio, according to health agencies. The very young and elderly can be vulnerable to severe illness if not vaccinated.
Kennedy’s opposition to routine childhood vaccinations threatens public health, the Academy of Medicine of Cleveland & Northern Ohio said in a statement criticizing Kennedy’s nomination.
“Vaccines not only protect the immunized but can also reduce disease among unimmunized individuals in the community through ‘indirect effects’ or ‘herd protection,’” said Dr. Kristin Englund, an infectious disease physician and president of the Medicine Education Foundation of the Academy of Medicine of Cleveland & Northern Ohio.
“Mr. Kennedy’s known opposition to routine childhood vaccinations is a threat to the public’s health and opens the door for these illnesses to recur in our children.”
But some Americans may approve of Kennedy’s approach.
Fewer Americans today consider childhood vaccines important, with 40% saying it is extremely important for parents to have their children vaccinated, down from 58% in 2019 and 64% in 2001, according to a 2024 Gallup poll.
And nationally, more school districts are granting exemptions to vaccination requirements for students. From the 2019–20 to the 2022–23 school year, the number of kindergarten students with state-required vaccinations declined from 95% to approximately 93%, according to a recent report from the U.S. Centers for Disease Control and Prevention.
“It is normal and healthy to be skeptical of any pharmaceutical intervention,” said Dr. David Margolius, director of the Cleveland Department of Public Health. “We should all work together to advocate for well-funded agencies to test and report on vaccine efficacy so that our families can live long, healthy lives.”
If Kennedy uses his new position to sow doubt about vaccines, the Cleveland health department will ask Cleveland residents about any new concerns regarding vaccine safety, Margolius said.
“It is important that we work with our residents before developing a public campaign based on any potential changes in Washington, D.C.,” Margolius said.
Lorain County Public Health said it will continue to prioritize clear, science-based communication and give the public accurate, accessible health information.
“Understanding people’s diverse perspectives helps us to provide better education to people about the actual risks of diseases preventable with vaccines,” Lorain County health officials said in a statement. “Our strategy will likely focus on people who are considering vaccines and who may have questions about them.”
The case for vaccines
Since the 1700s when the first vaccine was developed — it was against smallpox — immunizations have saved millions of lives worldwide.
Before the advent of vaccines in the 19th and 20th centuries, illnesses such as measles, mumps, diphtheria and respiratory viruses caused thousands of deaths each year in the United States, according to Immunize.org, a Minnesota-based nonprofit that works to increase immunization rates.
Disease rates will remain low only if the United States maintains high levels of vaccination, health agencies warn.
“The United States has a strong and transparent vaccine infrastructure to protect the public’s health, based soundly in objective science,” according to the nonprofit Immunize.org.
Below is an overview of how vaccine safety is monitored, the benefits of immunization, which shots your physician wants to have, and more. The online medical publication STAT, the Washington Post, the CDC, the World Health Organization, Ohio Department of Health and Immunize.org contributed information.
Influenza vaccination rates have dipped in most age categories since 2021, according to CDC data.Centers for Disease Control and Prevention
Q: What lessons can we learn from the worldwide rise in measles cases?
Cases of measles worldwide increased last year, up 20% from 2022, primarily due to low immunization rates, the World Health Organization and the CDC said earlier this month.
Measles resulted in 107,500 deaths worldwide last year, mostly killing children under 5, the two agencies reported.
Ohio has had 10 or fewer cases of measles so far this year, according to the CDC. The state saw one measles case in 2023, and 90 in 2022, when an outbreak centered in central Ohio totaled 85 cases.
In 2019, Ohio was part of a national measles outbreak involving nearly 1,300 cases across 31 U.S. states, the nonprofit Immunize.org said. The 2019 outbreak started when international travelers brought measles into the country, and it spread through unvaccinated communities.
Measles infections can lead to serious complications, including death. In addition, measles infection can also impair the body’s ability to battle other non-measles infections by erasing the immune system’s memory, health experts have warned.
Q: How are proposed vaccines tested to prove they are safe and effective?
Vaccines are tested in randomized, double-blind and placebo-controlled trial. This means that participants are randomly assigned to receive either the experimental vaccine or a placebo, such as injected salt water.
It’s called a double-blind trial because neither the study participant nor the care provider know who is getting the experimental vaccine or the placebo.
This type of trial helps minimize bias and makes the results more accurate, health experts said. Data from the two groups are compared to see if the vaccine is better than a placebo.
Q: Do vaccines cause autism?
A 1998 British journal article claiming of a connection between the measles vaccine and the development of autism was retracted by the journal’s editors, according to the nonprofit Immunize.org. The author had his license to practice medicine revoked.
Other studies involving more than 1.2 million children established no links between vaccines and autism or autism spectrum disorder.
Q: How is vaccine safety monitored?
The federal government has several agencies that collect information on vaccine safety and tracks possible health problems caused by vaccines.
The Vaccine Adverse Event Reporting System enables the FDA and CDC to detect possible vaccine safety problems early. Forms for reporting vaccine issues are available vaers.hhs.gov.
The Vaccine Safety Datalink, operated by the CDC, enables comparisons of large numbers of vaccine recipients and non-recipients.
CDC’s Clinical Immunization Safety Assessment Project links physicians who have vaccine safety questions with clinical safety experts at leading academic medical centers for consultations.
The FDA’s Post-licensure Rapid Immunization Safety Monitoring system monitors health insurance claims data for potential vaccine safety issues.
Q: What are the CDC’s recommendations on common vaccines and who should get them?
Flu: Everyone 6 months and older should get a flu vaccine every season. The updated flu shot for the 2024-25 flu season is now available.
COVID-19: Everyone ages 6 months and older should get the updated, one-shot 2024–2025 COVID-19 vaccine. Those 65 years and older, or immunocompromised, should get a second shot six months after their first dose.
Human Papillomavirus: The vaccine is a routine vaccination for youth 11 or 12 years old. Some adults ages 27 to 45 might decide to get the vaccine, if they weren’t adequately immunized when they were younger.
Pneumonia: Pneumococcal vaccination is part of the routine childhood immunization schedule. The pneumonia shot also is recommended for adults 50 and older, and those 19 through 49 with certain chronic medical conditions such as heart, liver and lung disease, diabetes or a weakened immune system.
Respiratory Syncytial Virus: Adults ages 75 and older — and adults ages 60-74 who are at increased risk for severe RSV — should be immunized. There are two immunizations to protect infants from severe respiratory syncytial virus: a maternal vaccine given during pregnancy or an antibody given to infants after birth.
Shingles: People 50 and up— and adults 19 and up who have weakened immune systems — should have two doses of recombinant zoster vaccine.
Q: Which vaccines are necessary for Ohio school students?
DTap (Diphtheria, tetanus and pertussis): four or more doses, grades K-12.
Hepatitis B: three or more doses, grades K-12.
MMR (measles, mumps, rubella): two doses, grades K-12.
Polio: three or more doses, grades K-12.
Chickenpox: two doses, grades K-12.
Tdap (tetanus, diphtheria, pertussis): one dose, grades 7-12.
MCV4 Meningococcal ACWY: one dose, grades 7-12, second dose in grade 12.
Julie Washington covers healthcare for cleveland.com. Read previous stories at this link.
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