The willful blindness of RFK Jr’s supporters

Recent blog posts by contrarian physicians have tried to defend Robert F. Kennedy Jr. (RFK Jr) as someone who will improve public health if confirmed as Health and Human Services Secretary. They claim United States COVID19 policies and the mainstream media created the poor public health situation in the US, including vaccine hesitancy. These authors seem to think antivaccine sentiment did not exist before 2020, and that vaccine hesitancy has nothing to do with RFK Jr’s antivaccine nonprofit, which grew significantly during the pandemic.

On Sensible Medicine Dr. Frederik Schaltz-Buchholzer, a Danish vaccine researcher, states that the high US mortality compared to other wealthy countries is possibly explained by “the higher use of pesticides such as glyphosate, additives in processed foods…ultra processed foods, seed oils, unequal access to health care, and overconsumption of medicines and vaccines.” He cites zero evidence to support this speculation but goes on to elaborate about vaccines as a possible explanation for poor health outcomes in the US.

Intentional deception

The crux of the piece centers on vaccines with Dr. Schaltz-Buchholzer claiming Danish children only receive 11 shots whereas American children receive 72 injections. This is a classic antivaccine trope and borders on intentionally deceptive. He is counting the Danish combination vaccines such as DTaP/IPV/Hib as one shot but counting the same US vaccines that are almost always given as a combination shot as individual shots — DTaP/IPV/Hib = 3 shots. He is counting oral rotavirus as an injection which it isn’t.

But best of all, he criticizes the inclusion of yearly COVID & flu vaccines for children in the US schedule, which are not required by schools and generally have less uptake. He makes a point to say the flu vaccine is completely unnecessary for children, which is not an accurate reflection of what studies show. Meanwhile he neglects to include that the Danish Pediatric Society and Danish Health Authority now recommend a yearly flu shot for children aged 2-6. He has such high praise for the Danish vaccine schedule but ignores many of the recommendations as we will find out later.

Hep B History Lesson

In fairness, he’s correct that Denmark does not give hepatitis A, varicella, rotavirus, or meningococcal vaccines. Hepatitis B is only given to at risk children. He goes a step further and claims hep B vaccination in the US is “massive overtreatment.” This suggests a lack of understanding of the history of hepatitis B vaccination and hep B epidemiology. Since 1991, the hep B vaccine has been recommended for all newborns in the US. Prior to 1991, the US followed Denmark’s approach of focusing on at risk individuals. In these targeted programs, maternal testing is critical to determine if a pregnant woman was infected with hep B and then the newborn would be vaccinated if testing was positive. Why did the US change strategies? Why do we give a vaccine for a supposed STD at birth?

First off, we have to deconstruct the myth that hep B is just an STD that can be spread only by sexual activity, injection drug use, or from mother to child transmission at birth. A single mL of blood from someone infected with hep B can contain billions of infectious viruses. Often people do not know they are infected until years later. We know that 30-40% of adults can have none of the above risk factors and still contract this virus.

Why vaccinate babies against hep B?

Before starting universal hep B vaccination in the US nearly half of the 18,000 children <10 years of age who acquired hep B each year were not infected by mother to child transmission. So how did they get it? We don’t know the exact route of transmission but sharing a toothbrush, a bite on the playground, etc. could potentially spread the virus. This cryptogenic spread can happen just from living with someone that has chronic hep B which is why you are asked this question before you donate blood.

Another reason there are limitations to this targeted approach is that maternal testing for hep B is not as universal as we would like and the test can be reported or interpreted incorrectly. The stakes are high if an infant becomes infected with hep B. We know that 95% of infants who get infected will develop chronic hep B which requires lifelong treatment and can lead to severe complications like cirrhosis of the liver & liver cancer. Prior to the development of the HPV vaccine, the hep B vaccine was the first vaccine that prevented cancer.

Worldwide Hep B vaccination: Denmark an outlier

The US is far from the only country that takes the approach of universal neonatal vaccination. In fact the WHO reports that universal hep B vaccination to infants has about 84% coverage around the world with 45% of countries giving the first dose on the first day of life. The WHO explicitly recommends neonatal vaccination as a way of eliminating hep B. Some European countries give hep B at birth but almost all have a universal infantile immunization program.

Denmark and a few other Scandinavian countries are the outlier here. Dr Schaltz-Buchholzer later claimed on X that Sweden does not vaccinate infants against hep B. This is incorrect. Starting in 2016, Sweden began offering hep B vaccination to all infants and as of 2022, 92% of children less than 2 are protected. Norway added infantile vaccination in 2017, with 96% coverage in 2022. Is this massive overtreatment? Why would Sweden & Norway make this change?

2015 was the highest year of chronic hep B cases in the last decade with a steady trend of increasing cases year by year from 2010-2015 and, despite their targeted program, Sweden had also seen cases increase. In 2016 the WHO announced the plan to eliminate hepatitis as a global health threat. Sweden & Norway joined the 83% of other EU member states to recommend universal vaccination of infants.

Logically fallacious

If universal hep B vaccination is massive overtreatment that results in poor health outcomes then how do we explain that countries with better health outcomes also recommend it? Taiwan was the first country to implement universal neonatal vaccination in 1986 and is ranked as one of the healthiest countries in the world. For me to claim that this proves the hep B vaccine is the cause of their world-leading health outcomes is as illogical as this blog post claiming the US giving hep B at birth explains our poor health outcomes.

America’s healthcare system is highly complex and involves many social factors such as access to care which can directly affect maternal and infant health. I would not expect Schaltz-Buchholzer to understand these problems but I also don’t understand why he has an opinion on American health policies or our HHS secretary candidate. Put another way, I have zero opinion on Denmark’s hep B vaccination strategy or their department of health director as I do not have an in-depth understanding of the burden of disease in their country or how their healthcare system works.

What I do know is that targeted hep B vaccination was unsuccessful in the US but universal neonatal hep B vaccination has led to an 88% reduction in cases overall and the near elimination of pediatric hep B cases. I have never seen a case of pediatric hep B in 4 years of medical school or 10 years of being a pediatric physician, thanks to our vaccine program.

Autism waffling and nonspecific effects

To his credit, Schaltz-Buchholzer criticizes RFK Jr for claiming that MMR causes autism and that the HPV vaccine causes cancer. Neither of RFK Jr’s claims are correct though he has repeatedly doubled down despite the overwhelming evidence that refutes them. Shockingly Schaltz-Buchholzer claims we don’t know if other vaccines could cause autism, which means he did not read the work of his Danish colleagues. Hviid et al showed that in addition to MMR not causing autism, there was no association between childhood vaccines DTaP/IPV/Hib exposure and autism. This question has also been reviewed in this meta-analysis involving 1.2 million children that found no association between vaccines and autism.

Schaltz-Buchholzer then goes on to talk about how vaccines can have nonspecific effects. It is worth noting that this is the area his group focuses on and some of their findings have not been replicated in other studies. It’s interesting that he explains which vaccines he gave his daughters. He says he “delayed and/or skipped” (which is it?) DTaP-IPV-Hib & PCV while adding BCG, measles and varicella.

What is he thinking?

This frankly baffles me for several reasons. First off, he praises the Danish vaccine schedule as superior to the US and then does not even follow it. He decries the overtreatment of the US schedule but adds some vaccines and refuses others. By delaying and/or skipping those vaccines, he is risking inadequate protection against tetanus, pertussis, Hib & pneumococcus all of which are present in just about every country and are potentially deadly infections.

As a pediatric neurologist I have thankfully never seen tetanus because of the effectiveness of vaccines but I have rarely seen pertussis and bacterial meningitis from both pneumococcus and Hib. The latter was once the scourge of pediatrics, causing an estimated one thousand deaths in young kids each year and leaving a third with permanent disability prior to the vaccines. Tetanus, Hib & PCV are vaccines I would stand in line for hours to receive. This to me indicates he is not a clinician or if he is, he has not seen the effects of these terrible diseases because vaccines have made them rare. Meanwhile he opts for BCG which we don’t give in the US because it has variable effectiveness at its primary purpose of preventing tuberculosis but may have some nonspecific effects. That seems like overtreatment to use a vaccine not on your country’s schedule in the hope of nonspecifc effects.

I do agree with him about protecting against varicella. Chickenpox used to kill 200 children a year every year in the US and causes a 4-fold increased risk of stroke in children who were recently infected. The vaccine has decreased pediatric mortality from varicella by 99%. Not to mention protecting against shingles — without varicella vaccination, individuals who live to 85 years old have an approximately 50% lifetime risk of developing shingles.

RFK Jr’s Greatest Hits

The blog post ends with an amusing disclaimer of sorts: “While I have not read all of RFK’s statements closely, my general impression is that he focuses on topics that are potentially important/relevant, and then unfortunately often exaggerates or distorts the facts.” Every supporter of RFK loves this cop out, claiming they are unfamiliar with all of his views. Let’s review the greatest hits of his many false claims so they cannot pretend to be ignorant any longer.

• He has said that no vaccine is safe or effective.
• He has repeatedly claimed that MMR and vaccines cause autism.
• He still believes thimerosal causes autism even though it was removed from vaccines over 20 years ago.
• He has repeatedly claimed vaccines cause chronic childhood diseases apparently citing a paper which describes childhood obesity as the most common chronic disease of childhood. Does he think vaccines cause obesity?
• He believes COVID was engineered to spare certain ethnic groups, particularly Jews and Chinese.
• He repeatedly compared vaccines to the Holocaust.
• He claimed that 5G is a government plot for surveillance and that Anne Frank had it better because at least she could hide from the Nazis. Try to really let these 2 awful Holocaust statements sink in as I write most of this post on International Holocaust Remembrance Day.
• Blames his spasmodic dysphonia on the flu vaccine.
• Blames school shootings on psychiatry medications.
• Argued that COVID vaccines killed more lives than they saved. RFK Jr believes Fauci intentionally created the virus.
• Continues to believe ivermectin and hydroxychloroquine are cures for COVID and would recommend them in the next pandemic.
• He wants to criminally investigate journal editors and publishers for lying to the public.
• He says vaccines are classified as biologics rather than drugs to exempt them from safety testing. This is utter nonsense. Because they are biologics they undergo more safety testing than regular medications.
• He has stated that “poppers” cause AIDS rather than HIV. This is a long debunked homophobic theory that should be criticized by every physician.
• He repeats word for word the same misinformation as the blog poster about children receiving 72 vaccines.
• He wants to return to the 1986 vaccine schedule which would mean denying children protection against all 3 forms of vaccine preventable meningitis (Hib, PCV, MCV) and two cancer preventing vaccines (hep B and HPV). On a personal note, I was born in 1985 and I have had almost every vaccine on the modern schedule (hep A, hep B, Hib, MCV, PCV, HPV and COVID). I did not get varicella or rotavirus vaccines.
• He wants to repeat already performed placebo studies for childhood vaccines which would mean putting kids at risk of meningitis, tetanus, and other terrible diseases.
• Claimed the polio vaccine paralyzed almost half a million children in India when in reality there were 17 vaccine related cases in over 18 years.
• After being nominated for HHS secretary, he skipped a meeting about preparedness for a potential H5N1 pandemic as cases continue to spread amongst the bird population in the US, denied the H5N1 vaccine would be effective based on no evidence (it literally cannot be tested yet), and claimed someone could bioengineer a more dangerous version of H5N1 just to sell vaccines.

Samoa

Saving the worst for last, he visited Samoa at the peak of the country’s MMR vaccine crisis in 2019, prompted by the deaths of two infants who died after receiving vaccinations against measles, mumps and rubella, raising local fears over the vaccine itself and contributing to antivaccine hesitancy. It was later determined that the deaths had been due to the nurses mixing the vaccine with an expired muscle relaxant, instead of water, but the damage was done.

RFK saw this crisis as an opportunity to experiment with children’s health and recommended studying unvaccinated children. Months later a measles outbreak left 83 dead, mostly children. After the virus had killed 16 mostly unvaccinated children, RFK Jr wrote to the prime minister claiming the government’s MMR vaccine campaign was the cause of the measles deaths. Fortunately the government ignored RFK Jr and did not stop the vaccine campaign. The outbreak ended less than a month later when 95% of the population was vaccinated. RFK has never admitted he was wrong to try to blame the vaccine for those preventable measles deaths.

Untruths and no consequences

In short, RFK Jr will believe just about anything, including conspiracy theories, as long as vaccines are to blame. What concerns me the most however, is his inability to respond to new evidence. He has been doing this for nearly 20 years without admitting he was wrong about any of the above claims. This is not a man we want in a position of power, let alone a health policy position. He is not capable of restoring public trust but he is capable of damaging people’s understanding in the safety and efficacy of vaccines to a much larger audience if confirmed as HHS Secretary.

Furthermore, if children get hurt by RFK Jr’s amplified vaccine misinformation, it will not be the adult oncologist or the vaccine researcher who will care for them–it will be up to pediatric healthcare workers in our primary care clinics, emergency departments, and ICUs to treat this preventable suffering. Physicians supporting RFK Jr are eager to cheer from the sidelines and repeat his antivaccine talking points without learning why they are wrong or taking any responsibility for the harm they may cause.

They have learned their response to new data directly from RFK Jr: Shrug, move on and never admit you were wrong.