ACIP vote could put kids at risk.

If you just look at the numbers, the Centers for Disease Control and Prevention’s headquarters in Atlanta ought to be a ghost town right about now.

Over the past year, the agency has lost a third of its staff. During the government shutdown, the administration tried to fire hundreds more. Scroll around and you’ll find pictures of the notes employees have allegedly been leaving behind. Some simply present data supporting their work, like “1.4 million children are living with HIV.” In the women’s bathroom, though, the messages are reportedly more pointed. They include Post-its reminding workers that “It’s okay to not be okay.”

But despite all this, this agency is still going about its business. On Thursday, the Advisory Committee on Immunization Practices is set to issue recommendations about the kinds of immunizations infants get, for instance. And there’s nothing any of us can do to stop them.

“Anti-vaccine activists like Robert F. Kennedy Jr. have been around forever, arguably since the first vaccine, usually shouting from the sidelines, but now they’re not shouting from the sidelines anymore, they’re making policy,” says Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

Former CDC directors, like Rochelle Walensky and Tom Frieden, have said they don’t trust the agency anymore, he notes, “so you can’t look to them, other than with your heart in your throat waiting for the next dangerous, misguided thing they say.”

On a recent episode of What Next, host Mary Harris spoke to Offit about what we can do as Robert F. Kennedy’s Department of Health and Human Services leans into its anti-vaccine agenda. This transcript has been edited and condensed for clarity.

Mary Harris: I want to break down exactly what this panel’s going to be talking about. The first day of the meeting, they will talk about the hepatitis B vaccine, which is given at birth to babies. I wonder if you can lay out why this vaccine has been so important.

Paul Offit: If your mother has hepatitis B and you then go through a birth canal that is invariably bloody that contains hepatitis B, and you’re then infected by passing through that birth canal, you need to be vaccinated at birth. And the reason is that if you’re not, you have an 85 percent chance of getting hepatitis B, passing through a birth canal that has the virus in it. And if you get it, you have a 90 percent chance of going on to develop chronic liver disease, which is to say cirrhosis or liver cancer, and it shortens your life. And if you get hepatitis B in the first five years of life, you have a 25 percent chance of going on to develop cirrhosis or liver cancer, which will shorten your life.

Some people would say, “Well, then just test the mother. See if the mother has hepatitis B. If she does, then you vaccinate the baby.” What would you say to that?

Great, but it makes a few assumptions. There’s about a 5 percent false-negative rate, meaning falsely reassuring. Two, it assumes that you haven’t been infected in your second and third trimester. Three, it also assumes that when the child is between 1 and 5 years of age and goes to a day care center, everybody that person comes in contact with at that day care center is not chronically infected.

Most people who are chronically infected with hepatitis B in this country, and there are millions, don’t know they’re infected, and they are highly contagious—50 to 100 times more contagious than human immunodeficiency virus, the cause of AIDS.

The vaccine is as safe and as effective at birth as it is at two months of age. So why take that risk? Why would you ever take that risk? Because it’s a risk without benefit.

I noticed that in the past year or so, you’ve been making a point to meet with people you disagree with, people who are leaders in the Make America Healthy Again movement. I wonder what you’ve learned from those conversations. 

Generally, they don’t trust public health officials. They think that there’s a big conspiracy to hide the truth.

So you could say anything, and it wouldn’t matter?

I don’t think it matters. The conversations were collegial, but at the end of it, they don’t trust me, or they don’t trust people in public health, because they think that we’re lying to them. I don’t know how you get over that hump. There’s not a deep state. There are not forces working against you.

The people who are in public health want desperately to get it right. Know that we don’t know everything, and we have to be open-minded as we learn new things. But vaccines don’t cause autism. That’s not a thing to learn.

You’ve said that you think the only thing that will break through to everyday Americans who may be feeling very strongly about vaccines or may have misinformation about vaccines is for kids to get sick, and even to die. I hear you saying something like that, and as a patient and a person, I feel kind of abandoned. I just feel like, Hold it. Families I know are going to have to pay this horrible price? How would you respond to someone like me? 

This tears me apart. I think that everybody in public health who’s watching what’s going on is horrified by what’s happening. And we’re not the establishment anymore. Robert F. Kennedy Jr. is the establishment. Anti-vaccine activists are the establishment. They’re the ones that are making policy, and no one’s pushing back.

And so what can we do? Seventy-five Nobel Prize winners decried the appointment or confirmation of RFK Jr. for secretary of Health and Human Services. Thousands of doctors have written this. All the professional medical and scientific societies have decried this and written letters about this and had thousands and tens of thousands of signatures. A lot of people go on national television to decry how awful this is. I just feel like we’re screaming into the void.

And it is such a defeat to think that these children are dying unnecessarily. And so I understand you’re feeling abandoned. I do. I feel the same way.

I guess I wonder, given our whole conversation and what we’ve said, whether broader action is needed and how you feel about that. How do we mobilize together to create some kind of attentional event, whether it is a strike of health care workers or something else, that would make clear to the country exactly what’s on the line in this moment?

I think what would have the most impact is a parents’ march, where parents all get together—Republican, Democrat, independent—and say, “We are worried about what’s happening to our children. We are worried that vaccines are becoming more expensive, less available, more feared. We’re worried about the future.” This is a fragile market. I don’t think people quite realize how fragile the vaccine market is. It’s something you get once or a few times in your lifetime. It’s never going to compete with drugs you’re taking every day. This is a weak stepchild for these pharmaceutical companies. They can drop vaccines they have. They did. In many ways that is RFK Jr.’s goal. Parents need to stand up.

If a parent came to you right now and asked for advice in this moment, what would you tell them? 

I think there are a lot of different places one can look to get good advice. There’s our Vaccine Education Center at Children’s Hospital in Philadelphia, but there are other excellent sources. The Center for Infectious Disease Research and Policy in Minnesota has excellent information about this upcoming hepatitis B vaccine story.

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There are a number of places where you can educate yourself. And I do think that it’s still somewhat of a democracy here in this country, and you still can pretty much say what you want, although people seem to be more scared these days. But there’s still a lot of good information out there.

And a lot of people are standing up. You see academic and professional societies like the American Academy of Pediatrics coming up with their own recommendations based on their own expert advisory groups. Same thing for the American College of Obstetricians and Gynecologists and the Infectious Disease Society of America. You can look to those sites to find accurate evidence-based information. And states are standing up. There are coalitions being formed in the Northeast and Northwest about how to have your own expert advisers. In Pennsylvania, Gov. Josh Shapiro is looking into creating a vaccine for children program that can provide vaccines to uninsured or underinsured children, because they don’t trust the CDC. 

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