Message in an Outbreak

RFK Jr’s Op-Ed refers to the ongoing measles outbreak as a 'call to action'. But its coded messages say even more.

The Bottom-Line

On Sunday afternoon, Sec. of HHS Robert F. Kennedy Jr released an Op Ed: ‘Measles outbreak is call to action for all of us’ with the subtitle ‘MMR vaccine is crucial to avoiding potentially deadly disease.’ The Op-Ed is a break from his recent claims that measles outbreaks in the US are ‘not unusual’ (fact check: false). In that sense the Op-Ed is valuable – the title alone could help to signal a shift in priorities. But reading beyond the headline reveals a problem. The Op-Ed contains coded messages that undermine what should have been the central message:

Vaccines are the best defense against measles.

Vaccines work. They do. HHS should say that - clearly (bottle from NIH art).

Let’s face facts. The ongoing measles outbreak has intensified because too many parents decided not to vaccinate their children. What is needed are more vaccinations – now – in NW Texas and throughout the US where far too many “personal” decisions leave children and families vulnerable to a preventable and potentially lethal disease.

Unfortunately, the Op-Ed doesn’t make this point clear. Instead, the Op-Ed leaves wiggle room and ambiguity. It uses phrases that can resonate depending on one's prior beliefs. These phrases raise questions: perhaps this Op-Ed represents a reversal of perspectives. Or, perhaps this is business as usual from the same RFK Jr who suggested, falsely, that vaccines caused a devastating measles outbreak in Samoa.

Why leave ambiguity? In the face of a growing crisis why leave any of this to chance?

Coded Messages

To start, take the following turn of phrase:

"The decision to vaccinate is a personal one. Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons."

The second sentence is mostly in line with what should be standard, public health guidance, elevating the discussion of vaccines beyond personal protection to the protective benefits it offers to the community. However, the sentence leaves out a specific group of individuals who are unable to be vaccinated – infants, all of them. Perhaps hearing that infants cannot be vaccinated and are therefore at risk for infection would be too effective a motivation.

But, the first sentence reverberates – “The decision to vaccinate is a personal one”.

Parents do decide whether or not to vaccinate their children. But, no matter what RFK Jr might tell you: these are not strictly personal choices. The consequences of these choices extend beyond the safety of one’s own children and school entry requirements. An unvaccinated child or adult puts others at risk, including infants of parents who never had the chance to make a choice and anyone who has a legitimate medical exemption for the MMR(V) vaccination.

There are more examples:

• “As healthcare providers, community leaders, and policymakers, we have a shared responsibility to protect public health. This includes ensuring that accurate information about vaccine safety and efficacy is disseminated.”

Translation: the second sentence can be read as code for 'just asking questions' about safety and impact, the very same questions that have led to falling vaccine coverage nationally. And yes, the vaccines are in fact safe & effective.

• "Studies have found that vitamin A can dramatically reduce measles mortality."

Translation: don’t worry about vaccines, you can always take vitamin A, despite the reality that the measles vaccine is the most effective way to prevent measles infection (and all the associated bad outcomes from the very start).

Finally, RFK Jr writes what I view as the most counter-productive element of the Op-Ed:

"Good nutrition remains a best defense against most chronic and infectious illnesses. Vitamins A, C, and D, and foods rich in vitamins B12, C, and E should be part of a balanced diet."

Good nutrition is indeed a good thing (to a point - see addendum below). These are not either or-s. With no lack of irony, RFK Jr neglects to point out that the US has cut programs that provided vital food aid to communities worldwide which will also make these communities more vulnerable to severe outcomes of infectious disease. But an Op-Ed by the head of HHS should be unambiguous:

Vaccines are the best defense against measles.

Full stop.

If one attributes nutrition as the ‘best defense’ that implies, naturally, that other things are not the best defense against infectious diseases like measles. In fact, well-fed children who are unvaccinated can and will get infected and they can have severe, life-long impacts and may even die from a preventable disease that had not led to a single child’s death in the US in more than a decade.

Closing Thoughts from Gaines County, Texas

Measles is incredibly infectious and will spread to a dozen or more new individuals per infectious individual if given a foothold in an unvaccinated community. This matters because far too many are living in alternative worlds where what they read and amplify online spills over in many senses.

To understand the mindset, I strongly encourage folks to read the following Washington Post profile of an impacted community in Gaines County, Texas (a gift link is here). The article describes the reaction of a mother of an infected boy who “fed him organic food and cod liver oil, bathed him in magnesium salts and rubbed him in beef tallow cream infused with lavender.” Home remedies aside, she remains convinced that the vaccine causes more harm than the disease. The story continues:

"The family took precautions to protect others in the community, such as ordering groceries for pickup and keeping their older son out of school. He developed a measles rash Friday."

But measles can spread w/out a rash - so "personal" choices are simply not that. As the WHO describes: measles “can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts.”

Decisions not to vaccinate should not be viewed as 'opinions'. They are decisions with consequences, sometimes deadly ones, and they impact others. Exacerbated by misinformation and grift, it is time to realign HHS and permissive local decision making that has enabled more and more exemptions with biological reality – we cannot take a break from infectious diseases nor from infectious disease research.

It will only make things worse.

Monday addendum - I had been reviewing a few RCTs on Vitamin A treatment of severe infections and significant caution is warranted. An excellent rundown from today’s WaPo.