He received advanced training at Brown University and was an attending physician at Tufts Medical Center. While there, he witnessed a young patient die of liver cancer that stemmed from a hepatitis B infection, a death that could have been prevented had the man received a common vaccine for the disease as a baby.<\/p>\n
That experience moved Chow to urge<\/a> members of a federal vaccine advisory committee to affirm that all babies should continue to <\/b>receive a hepatitis B shot shortly after birth. His plea, submitted in a public comment along with scores of others by physicians, medical societies and state health directors, went unheeded: On Friday, members of that panel did the opposite<\/a>, voting to undo more than three-decades of vaccination policy that demonstrably reduced<\/a> cases of hepatitis B in the United States.<\/p>\n The recommendation now awaits approval from Jim O\u2019Neill, deputy secretary of the Centers for Disease Control and Prevention, to become official. <\/p>\n \u201cWe will see more cases of chronic hepatitis B,\u201d said Chow, who now practices at Harbor-UCLA Medical Center in Los Angeles, in an interview this week. \u201cCirrhosis or cancer, we\u2019ll see more of those cases.\u201d<\/p>\n The change to the hepatitis B schedule is the most dramatic step yet in what senior figures in American medicine fear will be a wholesale undoing of not just vaccines, but health policies grounded in evidence-based science, under US Health Secretary Robert F. Kennedy Jr. <\/p>\n Leading figures in the medical establishment, many of whom are based in New England, see two ways forward:: decades spent regrouping from the changes wrought by the Trump administration, or using this moment of strife to embrace big changes in health care and forge better connections with the people they seek to help.<\/p>\n \u201cThere\u2019s a lot of things the community has recognized that are problematic,\u201d said Dr. Craig Spencer, an emergency medicine doctor and public health expert at Brown University, referring to some of the major complaints of the Make America Healthy Again movement.<\/p>\n He described this week\u2019s ACIP meetings as \u201cbuffoonery,\u201d but cited the cost of health care, the influence of pharmaceutical companies, and the quality of food as MAHA issues that deserve attention. <\/p>\n \u201cI see a lot of my community almost unwilling to cede any ground,\u201d he said. <\/p>\n The panel, the Advisory Committee for Immunization Practices, is manned by people hand-picked by Kennedy, many of whom embrace discredited theories that vaccines can cause harm in children. Science denialism and alternative medicine have been part of the United States since the country\u2019s beginning, historians said, but this moment is unique. <\/p>\n \u201cThey\u2019ve now been able to completely infiltrate existing federal agencies,\u201d said Dr. Peter Hotez, a virologist and vaccine expert <\/b>at Houston\u2019s Baylor College of Medicine. \u201cThat to me is unprecedented.\u201d<\/p>\n Skepticism of established medicine has recently been driven by legitimate concerns over the influence of the pharmaceutical industry in health care, the prominence of ultraprocessed foods in our diets, and frustration with insurance denials. COVID supercharged that discontent. Social distancing orders and masking may have been reasonable precautions, and the COVID vaccine saved lives, but mandates, business closures, and remote schooling fed anger toward public health and medical professionals that the anti-science crowd is still exploiting.<\/p>\n To Kennedy\u2019s supporters, his approach is a needed shakeup to a calcified, insular establishment. <\/p>\n \u201cThe American people voted for a change in the status quo,\u201d said Emily Hilliard, a spokesperson for the Department of Health and Human Services. \u201cIn less than a year, the Secretary has advanced reforms in public health institutions, strengthened safety monitoring, improved communication with the public, and renewed the focus on informed decision-making.\u201d<\/p>\n That resonates with Elizabeth Frost, a MAHA activist who led Kennedy\u2019s Ohio presidential campaign operation. She isn\u2019t opposed to vaccination, she said, but is deeply skeptical of the medical establishment after seeing the opioid epidemic ravage her Ohio River Valley home. Legal pain killers<\/a> made by established pharmaceutical companies played a huge role in driving that plague of addiction. <\/p>\n \u201cThere was a lot of group think that happens in any industry, any group of people when it hasn\u2019t been shaken up in a while,\u201d said Frost <\/b>of the national public health agencies.<\/p>\n The members of the panel themselves deny they\u2019re ignoring science. Rather, they are bringing new skepticism to old policies, and considering evidence that contradicts the narratives of established medicine. <\/p>\n \u201cThe primary mission of the ACIP committee is to provide independent advice \u2014 and I emphasize independent \u2014 to the CDC director,\u201d Dr. Robert Malone, the committee\u2019s vice chair, said during Thursday\u2019s meeting. <\/p>\n But other voices in American medicine point out <\/b>that the people whom Kennedy picked to lead federal health agencies and committees have spread misinformation, cherry picked studies, distorted evidence, and spoke out publicly on topics about which they do not have expertise. <\/p>\n Dr. Rochelle Walensky, a former head of the Centers for Disease Control and Prevention, said the agency has dramatically changed since she left. <\/p>\n \u201cThe voice of the CDC is not of those subject matter experts, and that\u2019s deeply concerning,\u201d she said during a media availability Thursday. Walensky was a Harvard professor and chief of the division of infectious diseases at Massachusetts General Hospital<\/a> before joining the CDC. She is now back at MGH as a research scholar.<\/p>\n By contrast, the committee\u2019s meetings this week were marked by a lack of discussion and a lack of interest in data that showed the existing hepatitis B vaccination recommendation was effective and safe, she said. <\/p>\n This week\u2019s meeting resulted in the most dramatic change in vaccine policy since Kennedy took office, but it\u2019s not the administration\u2019s first departure from mainstream science. During this year\u2019s measles outbreaks, Kennedy endorsed vaccination, but also suggested Vitamin A is an effective treatment, which is not meaningfully helpful for patients who do not have a vitamin A deficiency<\/a>, and can in fact cause harm. Also, the federal vaccine advisory panel gave credence to a debunked theory that an additive used in vaccines, thimerosal, was harmful, and added restrictions<\/a> to chickenpox, measles, mumps, and rubella vaccines that experts called unnecessary. <\/p>\n Much about MAHA echoes other movements in history that opposed mainstream medical science, Hotez said. In the 19th century, Samuel Thomson<\/a> gained a passionate following selling a system of botanical treatments. The early 20th century\u2019s National League for Medical Freedom opposed government regulation of medical care to make space for \u201cHomeopaths, the Eclectics, the Osteopaths, the Christian Scientists and other schools of Healing,\u201d Hotez wrote<\/a>. <\/p>\n Opposition to government regulation is common in these movements, Hotez said, as is framing their anti-scientific ideologies as expressions of freedom or independence. Often, the real motive is more base, he said, citing wellness influencers who feed doubt about established science while peddling alternative treatments.<\/p>\n While there\u2019s little precedent for people so far outside mainstream science leading America\u2019s health agencies, there are parallels in other nations. In the 2000s, South African President Thabo Mbeki<\/a> questioned whether HIV caused AIDS amid an outbreak in that nation. He blocked antiretroviral treatments<\/a> for the virus, and about 330,000 people died as a result of his policies.<\/p>\n At the time, South Africa had only recently emerged from apartheid<\/a>, said Benjamin Siegel, a Boston University history professor with expertise in the history of medicine, and the legacy of colonialism was still an open wound on the nation\u2019s psyche. <\/p>\n \u201cIt was reasonable people would be distrustful of international authority when it had failed them for so long,\u201d Siegel said.<\/p>\n What comes next is uncertain. Hotez isn\u2019t optimistic. He said the country <\/b>is just beginning to be inundated by the science deniers, who are amplified by television, podcasts, and social media and empowered by the nation\u2019s health agencies.<\/p>\n \u201cWe\u2019ve started the freefall,\u201d he said.<\/p>\n Without action from Congress or the President, he doesn\u2019t anticipate a change of course. <\/p>\n Spencer, the Brown public health expert, doesn\u2019t believe the American medical establishment can go back to the way it was before Kennedy.<\/p>\n \u201cThere\u2019s not a world where I see, three years from now, there\u2019s a different administration and we put all these things back in place,\u201d he said. <\/p>\n But, to Spencer, that\u2019s not a bad thing. <\/p>\n In November, he attended a meeting of the Children\u2019s Health Defense, a nonprofit Kennedy founded with a mission to end toxic exposure in children and that has led the anti-vaccine movement. <\/b>The concerns he heard, that the American health system is expensive and doesn\u2019t get great results for too many people, is compelling, he said. Fixing that, he said, may help deflate anti-vaccine activism.<\/p>\n \u201cI want us to say, \u2018we\u2019re willing to engage in how to do things differently,\u2019\u201d Spencer said. <\/p>\n Meanwhile, Frost, the Kennedy campaigner in Ohio, expressed some disillusionment with Trump\u2019s health priorities. She hasn\u2019t seen much action on the issues she cares about, and cuts to funding for local health programs are taking a toll on her community.<\/p>\n \u201cIt really woke people up to how much of our daily lives are supported by these programs,\u201d she said. <\/p>\n In his letter to the vaccine advisory panel, Chow, the former Tufts physician, described his terminally ill patient. The man was 30 years old, a scientist and a husband, Chow wrote. <\/p>\n He declined to say where his patient was from, but in his letter to the committee he said, \u201cHis only risk factor was being born in a time and place where hepatitis B infections were high [and] use of hepatitis B vaccine was low.\u201d<\/p>\n Chow knew his patient\u2019s story wasn\u2019t likely to change the minds of committee members. But such personal experiences, he believes, can be more persuasive than data alone. <\/p>\n \u201cI still think it\u2019s incredibly important to tell our patients\u2019 stories, to tell the lived experience,\u201d he said. \u201cThere will be someone who will read that and will learn the truth, and will make the decision to vaccinate their child or themselves.\u201d <\/p>\n Jason Laughlin can be reached at jason.laughlin@globe.com<\/a>. Follow him @jasmlaughlin<\/a>. Sarah Rahal can be reached at sarah.rahal@globe.com<\/a>. Follow her on X @SarahRahal_<\/a> or Instagram @sarah.rahal<\/a>.<\/p>\n