Title: Public Health Under RFK Jr.

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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning, everyone. Thank you, Michael and Bridget. Folks, keep those sustaining memberships coming. One of the things we're doing on this show during Trump's first 100 days is a Health and Climate Tuesdays section of the show. This builds on and expands what many of you know we've been doing over the last couple of years; the climate story of the week that we had been doing on Tuesdays the last two years.

Our thinking right now is that there are so many headlines coming from the new administration that are pretty monumental on a daily basis, that health and climate ones risk getting lost in the shuffle. We're always interested in these, so we're creating a lane. Today, for example, the big headlines are about the tariffs that suddenly went into effect today, right? Trump suddenly pausing all military aid to Ukraine. Big consequential things that are new and rightly grab top line attention.

May be lost as a result are the things we'll talk about to start the show today, RFK Jr.'s new endorsement. Some people are calling it a mixed message, but to my eye, in a way that matters, it is mostly an endorsement of the measles vaccine for kids amid the expanding outbreak. Two cases have been reported in New York City now, a long way from the West Texas Epicenter. Parents need to hear what RFK wrote, so we're bumping it up to our lead.

Also, the cancellation of the usual meeting that would be taking place around now to plan for next year's flu vaccine. Also, a high-ranking deputy to Kennedy, I bet you haven't heard this one yet. A Trump appointee, Trump loyalist who quit yesterday after just two weeks on the job over objections to how RFK is running the department. On the climate track, we'll discuss one big specific assault on climate policy that is being considered and not getting top line attention, going all the way back to an official finding from 2009 that climate change threatens human health.

They may cancel that finding to make it easier to undo many pollution regulations, including on automobile tailpipes. The Environmental Defense Fund yesterday filed a lawsuit seeking access to any records the Trump administration is producing. I imagine that would include any actual science that they might be citing or planning to cite to claim climate change does not threaten human health, or other records they're generating. We'll explain the politics and implications of that.

Vaccines and measles, first. Robert F. Kennedy Jr., now the United States Health and Human Services Secretary, wrote an op-ed on Fox News on their website over the weekend that did label the measles outbreak "a call to action for all of us," in its headline. Then the subhead did say the MMR vaccine is crucial to avoiding potentially deadly disease. Now, he does get a little more equivocal further down in the piece, hinting at attacks on the vaccine that may be yet to come from him. We'll explain.

With us to talk about these three relevant stories from the last few days is Jessica Malaty Rivera, infectious disease epidemiologist, science communicator, and PhD candidate at the Johns Hopkins School of Public Health. Some of you know she's been on with us multiple times since the start of COVID to explain the epidemiology of that as it has evolved now on this. Jessica, we always appreciate when you come on with us and the clarity of your explanations. Welcome back to WNYC.

Jessica Malaty Rivera: Hi Brian, thanks for having me back.

Brian Lehrer: Let's not downplay what might be actual good news for containing the measles outbreak. Kennedy's language in the Fox News op-ed that starts with "a call to action for all of us," and then says right away after that, "the MMR vaccine, measles mumps rubella vaccine is crucial to avoiding potentially deadly disease." Is it a clear message to Fox News consuming families who might be the most vaccine-hesitant American parents?

Jessica Malaty Rivera: It's clear-ish. I think that the "giant pull" is probably the greatest win that we have in the article in which he says that vaccines not only protect individuals from measles, but they contribute to community immunity. That is the TLDR, as we call it, the quick version of why vaccination is important. As you mentioned earlier, later in the article he does misrepresent the indication for vitamin A, as well as overemphasizing diet as a way to prevent chronic illnesses and diseases, including infectious diseases, which is simply not true.

I want to be very clear that his messaging on vitamin A can be misunderstood and could be harmful. Vitamin A administration is a clear indication and clear instruction from the WHO after a child is infected with measles, what it can do is deplete vitamin A levels. The WHO recommends two doses of vitamin A 24 hours apart to restore those depleted levels. It is neither a prophylactic or a cure for measles. It is just simply to respond to what can happen from a measles infection.

Yes, he mentions vaccination as the main thing to do, but then it seems like he gets a little bit back into his RFK-ness later in the article.

Brian Lehrer: On the community immunity, I'm glad you singled that out, because I was going to also. He wrote that, "vaccines not only protect individual children from measles, but contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons." That's a quote. Honestly, Jessica, I wasn't sure he had it in him to acknowledge community immunity rather than just personal choice, but he did. Can you explain as an infectious disease epidemiologist what community immunity means in this context?

Jessica Malaty Rivera: Yes. It's a really great question. I'm really glad he mentioned it in Article 2. Brian, it's not lost on me that he mentioned that, but I think folks will probably remember the term "herd immunity." It's a term that felt like this elusive threshold that we were trying to reach with COVID vaccination. Herd immunity is a very real established thing for the measles, and mumps and rubella vaccination, MMR.

Herd immunity means when a population is at least 95% covered with vaccination. Once those percentages dip under 95%, we fall out of that herd immunity threshold and that's when we start to see measles outbreaks emerge. We usually get this metric from kindergarten vaccination rates because if you look at the cadence of vaccination, the first dose is given between 12 to 15 months, and the second dose is given between 4 to 6 years old, ideally for kids to be fully immunized by the time they enter kindergarten.

We've seen this trend of dipping below 95% in the last 10 years in certain jurisdictions. As soon as that happens, measles jumps right back in. It is a very effective vaccine at preventing transmission and infection. I think a lot of folks misunderstand that some vaccines are really good at preventing infection and some vaccines are really good at preventing severe illness and death. Measles is one of those infections. The MMR vaccination is one of those vaccines that really prevents infection, primarily.

Brian Lehrer: It was just last week. Maybe we should remind our listeners when asked by a reporter about the first death from measles in this country in a decade, the death of an unvaccinated child in West Texas, Kennedy's response was to say measles outbreaks are not unusual. What happened between that public comment and the Fox News op-ed by Kennedy over the weekend? Was this a hostage video? Someone higher up got to him.

I don't know if there's any way for us to know at this point, but maybe someone higher up got to him and said, "You better start promoting that vaccine because Donald does not want a rash of kids dying from measles on his watch, which could discredit his whole shrink the government project. " Any idea about that?

Jessica Malaty Rivera: I mean, I wish I knew too. Right. I think it's speculation at this point. I think my first gut instinct was I think the liability was catching up to him. Because it's one thing to dismiss a measles outbreak, which he has done many times in the past. I think many folks who are antagonistic to the vaccine call it just a rash or just a regular childhood disease. In fact, the Children's Health Defense, the organization that he founded just last week in the middle of the outbreak, published an article saying that measles infection was beneficial, that it helped kids immune systems to prevent cancer. It was bizarre.

There's no evidence of that. In fact, if you look at some of the severe outcomes that can happen from measles, it can cause the opposite of that. It can cause something called immune amnesia, which basically wipes out your body's memory of all previous infections, making you very naive to any infectious disease. I think at the end of the day, once a child died, which is completely tragic, and actually not only the first death in 15 years, it's the first pediatric death in 20. The last time a kid died of measles in the US was 2003.

I think you're right. I think the liability of potentially more pediatric deaths was too great. I think there was pressure to put out this message that was in line with the science, and in line with the precedence of HHS in the past.

Brian Lehrer: If you're just joining us, our guest is infectious disease epidemiologist, Jessica Malaty Rivera, as we talk about the latest developments having to do with RFK Jr. and US vaccine policy.

Reading down into the op-ed, another place where it gets a little more creaky or equivocal is that some critics have said ultimately in the piece, Kennedy does not advise parents to actually get their kids vaccinated, just to see their pediatricians for advice. Even though he acknowledged community immunity, as we've discussed, he lands on vaccination as a personal decision. Is that a problem for you?

Jessica Malaty Rivera: It's a problem because of how it's worded and who it's coming from, right? Yes, all vaccination is a personal decision. Nobody is compelled to be vaccinated as far as far as kids are. That is always a choice. Informed consent is a hallmark of healthcare in this country, and parents must be given opportunity to consent to vaccination. The way he words it is there are options to get the MMR vaccine. I think there is this false understanding of a larger than reality group of kids who might not be eligible for vaccination. In fact, most kids are.

There are some who might be fragile, and like you mentioned before, some who cannot be vaccinated, those who are on chemotherapy and immunosuppression. Those are real variables in this discussion, but it still equates it as optional. When it comes to the social contracts that we have in public health, it is critical for everybody to participate, everybody who can, to participate in these things, because it protects not just yourself, but it protects your community.

Brian Lehrer: Yes. To my eye, where he starts to also set up a future attack, is by citing the old pre-vaccine stats. From 1953 to 1962, there were an average of about half a million measles cases in the US a year, including an average of 440 deaths. You would think people would read that and go, "Wow, 440 people died from measles every year. I'm sure glad we wiped this out." Which it had been wiped out due to the vaccine. The then cites the death rate as 1 in 1,200 cases, which sounds, "Well, that's not such a big risk."

I wonder if he's setting up to argue that while that's bad, it's not nearly as bad as all the ill effects from the vaccine. Something we know not to be true, but that he seems to believe despite the actual science. That section of his piece look like he's setting something up to you?

Jessica Malaty Rivera: Yes. I mean, it is a lot of downplaying. To be honest, I think it's quite concerning that anybody would even suggest that any pediatric death is okay, especially when we have the tools to completely prevent it. Children shouldn't be dying of infectious disease outbreaks that we have tools to prevent. If you look back at the data, he's largely misrepresenting the global incidence and the mortality, and the morbidity of this disease.

In the '80s, measles killed millions of children worldwide. It wasn't until GAVI, the Global Alliance for Vaccine that works with WHO and UNICEF, was able to bring the MMR vaccine globally and reduce that to 100,000 globally, from millions. That's still too many kids dying. That is a big vaccine equity issue, and hopefully, we get better distribution of vaccines. I do question our ability to do that, considering some of the policies that are coming out of the White House right now, but measles is not a joke.

I shared yesterday on my Substack about an article about a letter that Roald Dahl wrote about the tragic death of his seven-year-old from measles. This was his child was born before the measles vaccine was available. In the '80s, looking back at his child's death two decades prior, was saying, "I can't imagine making a decision to withhold something that could have prevented her from dying.".

Brian Lehrer: Let's go on to the cancellation of this annual FDA meeting to plan for next winter's flu vaccine. This is something most listeners have probably never heard about before because it just went on routinely, now under Trump and RFK, it's been canceled. Can you explain what that annual meeting is?

Jessica Malaty Rivera: Yes. The VRBPACmeeting happens every single March. It is a meeting that is hosted by the FDA, the Food and Drug Administration. It happens with the intention of sharing data about flu incidents so that they can make recommendations of what strains should be included, excluded, modified for the upcoming influenza season. They're looking at Northern Hemisphere data and Southern Hemisphere data. It's a very collaborative process that involves multiple entities in multiple countries swapping data to say, "How can we be best prepared for the next flu season?"

It happens in March because that process takes about six months to develop the next vaccine. I can't think of a time in which we did not participate in this. It is concerning. The United States has been a partner of the groups that do this work for a long, long time. I will say it seems that the flu vaccines will still be happening. I mean, there's enough data to continue despite this meeting's cancellation. It just sets a bad precedent that it could be optional.

Brian Lehrer: I read that this is the worst flu season in 15 years. Do you have those stats?

Jessica Malaty Rivera: It is. It's the worst flu season in 15 years. It is. We reached the thresholds of 2009, H1N1, which was a pandemic, the swine flu pandemic. The flu that is causing a lot of havoc, this flu includes H1N1, the same flu that happened years ago. Another strain that's H3N2. According to CDC data, we had hit high levels of transmission consistently for a few weeks. Recent data from this week says it might be tapering off. Perhaps the peak has happened and we might be seeing it starting to slow.

We have been encouraging folks that it's not too late to get a flu vaccine. I know we always say you want to boo before flu and get it before Halloween, but we are still well into flu season. It's. Honestly, really, it's respiratory virus season because there's a lot of things circulating. Again, I'll use a similar term that we used in COVID, but we want to flatten the curve. Right? There's lots of hospitals, ICUs, including pediatric hospitals and ICUs that are at their capacity right now.

COVID is not behind us. RSV is still circulating. We want to make sure that our hospitals do not get overwhelmed with too many patients requiring care. We know that the flu vaccine reduces that risk.

Brian Lehrer: What's your best information on the meaning of the cancellation of this meeting? Is it a precursor to not developing a 2025 flu vaccine? I think you have already said it's not that bad or not recommending it for widespread use, as government traditionally has in years like this?

Jessica Malaty Rivera: It's hard to speculate what it actually means, but I do know that it's not going to just completely get rid of the process of developing the flu vaccine. Now, again, we have to look back at what RFK Jr. said during the confirmation hearings and the deal that he made with Cassidy, which was that he would not touch the vaccination schedule, he would not question the safety of that.

Shortly after he was confirmed, he went straight after the vaccination schedule, he went straight after the ACIPH, the advisory board within CDC, and then VRBPAC. It's not setting a good precedent or tone for us, our confidence in what's going to happen. Again, I don't think that this is going to mean that flu vaccines will not be available.

Brian Lehrer: That's why I called Senator Cassidy last week, the Susan Collins of vaccines, because just like she said, she had a promise from Brett Kavanaugh that he wouldn't overturn Roe vs. Wade, and then he did after her crucial vote to confirm him. Senator, Dr. Cassidy, not a vaccine skeptic. He was an RFK skeptic. Said he got this promise from him, and then Kennedy turned right around and did what you just described after he got Cassidy's vote.

All right, this one more RFK story from yesterday. Easy to miss this one. I'll read from the Politico version. The headline is Top HHS Spokesperson Quits After Clashing with RFK Jr. His name is Thomas Corey. The article says, describing him, obviously, I have a printed version of this political article. It says, "A Trump administration veteran, Corey had previously done a stint during President Donald Trump's first term as senior advisor and communications director at the Centers for Medicare and Medicaid Services.

After he was sworn in last month, Corey wrote on LinkedIn that he was, "Thankful that I'll be part of a team that's going to work to make America healthy again, and on making health care more affordable and accessible." Now, Jessica, he resigned. Do you know much about Thomas Corey or if even someone that deep in Trump's MAGA camp, just reappointed and expressing enthusiasm with the quote that I just read, indicates any red lines for health policy that we should keep our eyes on?

Jessica Malaty Rivera: I think that the measles outbreak is a red line. I think that Corey, as the article mentions, had grown uneasy with this kind of muted response. I think the way that Kennedy represented the measles outbreak last week during that meeting was terrible. I mean, he misrepresented the deaths. He said two kids died, only one kid had died. He also misrepresented how hospitals do standard of care. He suggested that that the hospitals were using quarantine for hospitalization, and that is not standard of care. We don't do that.

I think that is a way to downplay the disease, downplay the outbreak. When you have an outbreak that is the worst in 30 years in a jurisdiction like Texas, the only response is to encourage vaccination and to downplay the severity. To say it's not unusual when looking at all of the epidemiological data suggests otherwise. I think that is a red line for folks, including people like Corey.

Brian Lehrer: Jessica Malaty Rivera, infectious disease epidemiologist, science communicator, and PhD student at Johns Hopkins School of Public Health. Sounds to me like you could be teaching PhD students. Thanks for teaching our listeners again today. Thanks for coming back on with us.

Jessica Malaty Rivera: Thanks so much, Brian.

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