RFK Jr. guts ACIP to pack it with antivaxxers

I realize that nearly two weeks ago I said I’d try to get back into regular blogging and that I’ve thus far failed. I suppose I should thank Robert F. Kennedy Jr. for the constant stream of horrors that he’s inflicting on public health in his new role as Secretary of Health and Human Services. No, I’m not going to thank him, but he did just do something yesterday that roused me from all the distractions that had been keeping me from delivering the regular doses of Insolence, both Respectful and not-so-Respectful, lo these past few months. What did he do? Yesterday, he fired all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP). I will admit that I had been long predicting that RFK Jr. would tamper with ACIP somehow, perhaps appointing antivaxxers as the terms of current members ended. Clearly, I suffered a failure of crank imagination, as I had only briefly considered, only to quickly reject, the possibility that RFK Jr. might fire everybody at once. As I said at the time, I don’t think RFK Jr. would eliminate ACIP, even though he could. I was (probably) correct about that. I was also correct in predicting that RFK Jr. might try to subvert ACIP and bend it to his own antivax ends, but, again, mea culpa. I underestimated his audacity. You’d think I’d know better by now, having written about his antivax quackery, misinformation, and conspiracy theories for nearly 20 years now.

Even. worse, RFK Jr. got the compliant right wing lackeys running the editorial page of The Wall Street Journal to let him publish his announcement in an editorial, saying that he’s doing it all in the name of “restoring public trust in vaccines” and to “avoid conflicts of interest.” I suppose that it’s fitting that the editorial is behind a paywall. Fortunately, I have Apple News, which let me read the whole putrid wall of text for your edification. RFK Jr. being RFK Jr., naturally he tries to deflect the blame:

Vaccines have become a divisive issue in American politics, but there is one thing all parties can agree on: The U.S. faces a crisis of public trust. Whether toward health agencies, pharmaceutical companies or vaccines themselves, public confidence is waning.

Some would try to explain this away by blaming misinformation or antiscience attitudes. To do so, however, ignores a history of conflicts of interest, persecution of dissidents, a lack of curiosity, and skewed science that has plagued the vaccine regulatory apparatus for decades.

No, “to do so” is entirely right and proper. Who but RFK Jr. himself has had an outsized role in undermining public confidence in vaccines over the last 20 years in the US? Seriously, he’s a giant in the field of spreading misinformation and antiscience attitudes that undermine public confidence in vaccines. It’s what he does. It’s what he’s done for two decades. So are lying and breaking his promises, as RFK Jr. had had promised Sen. Bill Cassidy that he would not tamper with ACIP:

In early February, when there was still some question as to whether or not the Senate would confirm Robert F. Kennedy Jr. to lead the Department of Health and Human Services, Sen. Bill Cassidy delivered a closely watched speech on the Senate floor. The Louisiana Republican, a physician by trade, not only endorsed the anti-vaccine conspiracy theorist during his remarks, he offered assurances about the future.

“If confirmed, [Kennedy] will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices — without changes,” Cassidy declared with confidence, pointing to assurances he’d received directly from RFK Jr.

This cartoon comes to mind:

Or, to go a bit meme-crazy, when it comes to RFK Jr. and the decline in public confidence in vaccines, I’m reminded of this classic meme:

If I were better at Photoshop or using AI prompts, I’d have created a version of this meme with RFK Jr.’s face in the hot dog suit. In any event, having falsely claimed that it was “conflicts of interest,” rather than exaggerations and misinformation about “conflicts of interest” and vaccine science spread by the likes of RFK Jr. that were responsible for the decline in public confidence in vaccines, RFK Jr. proposes his “remedy”:

That is why, under my direction, the U.S. Department of Health and Human Services is putting the restoration of public trust above any pro- or antivaccine agenda. The public must know that unbiased science guides the recommendations from our health agencies. This will ensure the American people receive the safest vaccines possible.

Today, we are taking a bold step in restoring public trust by totally reconstituting the Advisory Committee for Immunization Practices (ACIP). We are retiring the 17 current members of the committee, some of whom were last-minute appointees of the Biden administration. Without removing the current members, the current Trump administration would not have been able to appoint a majority of new members until 2028.

That would have been so sad. Actually, ironically, I was very critical of the Biden administration for having let the membership of ACIP languish after the departure of some members and was actually happy that his HHS Secretary had appointed new members to bring it back up to a full contingent before President Biden left office.

Unsurprisingly, to bolster his false claim that ACIP is rife with COIs, RFK Jr. cites “investigations” dating back to 2000, the most recent of which was 2009:

In 2000 the House issued the results of an investigation of ACIP and another vaccine advisory committee under the U.S. Food and Drug Administration—the Vaccines and Related Biological Products Advisory Committee. It found that enforcement of its conflict-of-interest rules was weak to nonexistent. Committee members regularly participated in deliberations and advocated products in which they had a financial stake. The CDC issued conflict-of-interest waivers to every committee member. Four out of eight ACIP members who voted in 1997 on guidelines for the Rotashield vaccine, subsequently withdrawn because of severe adverse events, had financial ties to pharmaceutical companies developing other rotavirus vaccines. A 2009 HHS inspector-general report echoed these findings. Few committee members completed full conflict-of-interest forms—97% of them had omissions. The CDC took no significant action to remedy the omissions. 

These conflicts of interest persist. Most of ACIP’s members have received substantial funding from pharmaceutical companies, including those marketing vaccines. The problem isn’t necessarily that ACIP members are corrupt. Most likely aim to serve the public interest as they understand it. The problem is their immersion in a system of industry-aligned incentives and paradigms that enforce a narrow pro-industry

It’s an old antivax claim that RFK Jr. has been peddling for years and years. That “investigation,” such as it was, was carried out by Mark Benjamin at UPI. Truth be told, it was one that I hadn’t seen before, but then 2000 was four years before I started blogging regularly about antivaccine propaganda. I read his “investigation” with the perspective of my more than two decades of having dealt with antivax propaganda, and I found it…typical. Benjamin cited multiple antivax activists; e.g.,Rep. Dan Burton (R-Ind.) and Barbara Loe Fisher, founder of the Orwellian-named National Vaccine Information Center (NVIC), whom I like to refer to as the “grande dame of the American antivax movement.” He rehashed the Simpsonwood conspiracy theory that claimed that at a CDC meeting in suburban Atlanta in 2000 the CDC “covered up” data showing that vaccines containing thimerosal (a mercury-containing preservative) were associate with an elevated risk of autism. No such thing happened.

In fact, in my first post that ever went viral, I deconstructed all the misinformation and conspiracy mongering shortly after, as did others, who noted that the entire Simpsonwood transcript was not at all consistent with any effort to “cover up” a link between mercury and autism, but rather included a debate about how best to deal with confounders in a study by Verstraeten et al. (Of course, to antivaxxers, any adjustment for confounders that eliminates a link between vaccines and whatever bad health outcome that they attribute to vaccines is always a “coverup,” not science doing what science is supposed to do and being rigorous.) Years later, I referred to this as the Simpsonwood conspiracy theory and, sometimes, part of the central conspiracy theory of the antivaccine movement, in which They (the CDC, government, FDA, medical profession, big pharma, and who knows who else—aliens, possibly) “know” that vaccines cause autism but actively work to cover up any incriminating evidence.

Let’s just say that I’m not at all impressed by the Benjamin report. I will give RFK Jr. credit for one thing, though. Notice what he wrote about Rotashield: “Four out of eight ACIP members who voted in 1997 on guidelines for the Rotashield vaccine, subsequently withdrawn because of severe adverse events, had financial ties to pharmaceutical companies developing other rotavirus vaccines.” In the past, antivaxxers would claim that Dr. Paul Offit, for instance, had a direct financial COI and had developed Rotashield. Personally, if anything, hearing this story I’d wonder if those with financial ties to pharmaceutical companies developing other rotavirus vaccines might have been biased against Rotashield. After all, their companies were making competing vaccines, and the first to market usually has a huge advantage. Seriously, RFK Jr. can’t even make sense in his insinuations of financial COIs from 28 years ago. Nor, apparently, can he back up his claims that ACIP members today are hopelessly compromised by their financial ties with pharmaceutical companies manufacturing vaccines, because of course he can’t.

Also, ACIP, as I’ve discussed before, has strict rules about conflicts of interest, and potential members are rigorously screened for such conflicts, and stringent measures are taken not only to assure technical compliance with ethics statutes and regulations regarding financial conflicts but also to address more general concerns regarding any potential appearance of conflict of interest:

People with specific vaccine-related interests at the time of application are not considered for appointment by the committee. Examples of such interests include direct employment of the can- didate or an immediate family member by a vaccine manufacturer or someone holding a patent on a vaccine or related product. In addition, before their names are submitted for final consideration, potential members are asked to resign for their term of member- ship from any activities that are, or could be construed as, conflicts of interest. These activities include provision of advisory or consult- ing services to a vaccine manufacturer or acceptance of honoraria or travel reimbursement from a vaccine manufacturer.

Members are required to file confidential financial reports every year with the Office of Government Ethics and to disclose publicly all vaccine-related interests and work, including participation in clinical trials, at each meeting. They must also declare conflicts at each meeting of a WG. Any single conflict, real or apparent, may serve to disqualify a participant from participating in a WG. WG members may receive confidential and proprietary information from the FDA or others to assist them in their discussions. When appropriate, they are therefore required to fulfill confidentiality requirements and, when required, sign non-disclosure forms prior to receiving such information.

If, despite all these safeguards, a conflict exists, limited waivers allow members to participate in committee discussions on con- dition that they are prohibited from voting on matters involving the specific or competing vaccine manufacturers. A member who develops an important conflict of interest during the 4-year term is required to resign from the ACIP.

It’s basically an antivaccine myth that the ACIP is totally corrupt and controlled by the pharmaceutical industry. I do suspect, though, that that will soon change given how many potential members favored by RFK Jr. have very real COIs through their financial connections to antivax organizations and the sale of supplements and various “treatments” for “vaccine injury.”

Unfortunately, in the intervening two decades since RFK Jr. took the Simpsonwood conspiracy theory, which had previously only been seen in the deepest, darkest recesses of the antivax movement, and popularized it in mainstream press, RFK Jr. has evolved from not just an antivax conspiracy theorist but to an all-purpose conspiracy theorist, embracing (of course) lab leak conspiracy theories, including one claiming that Ashkenazi Jews were immune to COVID-19 and SARS-CoV-2, the coronavirus that causes the disease, because it was an “ethnically targeted bioweapon.” As for being “not antivaccine,” I like to point out how since at least 2014 he was likening vaccination to the Holocaust, trying to persuade Samoan officialsthat the MMR vaccine was dangerous (in the middle of a deadly measles outbreak!), and claiming that today’s generation of children is the “sickest generation” (due to vaccines, of course!). Indeed, a few years ago his own family even called him out for his antivaccine activism, while, predictably, RFK Jr. has, as so many antivaxxers have done, gone all-in on COVID-19 pseudoscience and conspiracy theories and become anti-mask, “anti-lockdown,” and pro-quack treatments for COVID-19.

And now he’s HHS Secretary and gets to pick the members of ACIP.

Sadly, I’ve begun a bit of a grim game. I’m trying to predict which antivax loons RFK Jr. will pick to be on the reconstituted ACIP. Note that the rules governing the membership of ACIP require that, other than the consumer representative member, that its medical professional members have real subject expertise, described as “technically qualified people trained in a clinical medical field and possessing in-depth knowledge of vaccines and immunization” plus:

• Advanced medical degree (e.g., MD, RN)
• Board certification in area(s) of specialization
• Scientific knowledge of vaccines, immunization, and/or immunization programs
• Ability to interact actively and respectfully with other ACIP voting members, as well as ACIP ex officio members and liaison representatives, all of whom attend each ACIP meeting
• Willingness to take part in three regularly scheduled meetings per year, and any additional meetings that may be called
• Individuals must demonstrate expertise, comfort, and facility with active participation in deliberations of the ACIP during public meetings
• Willingness to participate actively in at least two ACIP work groups
• Willingness to review and give input on ACIP recommendation statements.

That means that most of the “experts” that RFK Jr. will choose to reconstitute his ACIP in his antivax image will have to be antivax doctors and scientists. That’s why I came up with a list of possibilities, presented in alphabetical order:

• Del Bigtree (a candidate for the lay or consumer representative, perhaps)
• Byram Bridle, BSC, MSc, PhD
• Christopher Exley, PhD
• David Geier (he might not fly because he doesn’t have an advanced degree)
• Tracy Høeg, MD
• Brian Hooker, PhD (a good candidate given his ties to RFK Jr.)
• Pierre Kory, MD
• James Lyons-Weiler, PhD
• William Makis, MD
• Paul Marik, MD
• Anthony Mawson, PhD
• Peter McCullough, MD
• Joe Mercola, DO
• Harvey Risch, PhD
• Bob Sears, MD
• Christopher Shaw, PhD
• Aaron Siri (another candidate for lay or consumer representative?)
• Mark Skidmore, PhD
• Sherri Tenpenny, MD
• Paul Thomas, MD
• Andrew Wakefield, MB, BS

Of course, there are only 17 slots on ACIP, and there are more people listed above. Not everyone will get in, and there are likely possibilities whom I haven’t considered. Here’s your chance to get the comments active again by commenting on the list above and suggesting others that RFK Jr. might appoint, possibly even worse members. I also realize that some of these people might not make the cut because they have lost their medical licenses or board certifications. On the other hand, RFK Jr. can bend the rules or possibly even change them if he wants. Either way, I bet I can update and recycle posts about each new antivax member that RFK Jr. appoints. It might even jump start my blogging again.

In the meantime, I hope you all are up to date on your vaccines. I have an appointment with my primary care doctor later this week, and I plan on telling him to hit me up with every vaccine for which I’m eligible and/or behind on. Finally, I predict that, as soon as the new ACIP is up and running, the CDC schedule will be shedding vaccines faster than antivaxxers think people vaccinated with COVID-19 vaccines shed spike protein. I’ve said it again and again, and people still don’t believe me. Never underestimate RFK Jr.s’ determination to eliminate access to all vaccines. He’s been antivaccine to the core for at least two decades, and nothing, no amount of evidence, will change his mind. He is coming for your vaccines. By 2029, he might well succeed in, for all practical intents and purposes, eliminating access to vaccines in the US.