For sending the public health establishment into chaos, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. this week fielded often-angry questions from US senators.
At his confirmation hearings, Kennedy promised, “I will support the [Centers for Disease Control and Prevention’s vaccination recommendations]…if I’m fortunate enough to be confirmed.” Once in office, Kennedy removed the CDC’s recommendation that healthy children and healthy pregnant women receive a COVID-19 vaccine. He removed all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP). His replacement appointees announced ACIP may revisit vaccination recommendations (for COVID-19, hepatitis B, measles, mumps, rubella, varicella, and respiratory syncytial virus) at a meeting on September 18–19. Former CDC Director Susan Monarez alleges Kennedy fired her when she refused to rubber-stamp those recommendations. Three senior CDC officials resigned in protest.
Drastic change is not necessarily bad. The public health establishment vastly overplayed its hand during COVID-19. Reform is in order—and reform is disruptive.
Yet Kennedy is committing the same mistakes as the establishment. While claiming to be a champion of gold-standard science, he is sharing neither the scientific evidence and analyses (or lack thereof) on which he bases his policies nor the value judgments that those policies reflect. Kennedy changed the COVID-19 vaccine recommendations without notifying the CDC. One CDC official wrote, “The data analyses that supported this decision have never been shared with CDC despite my respectful requests to HHS and other leadership.” ACIP has published neither an agenda for its upcoming meeting nor the recommendations it plans to consider, nor the data on which it bases those recommendations.
The result? Kennedy is taking heat even from Trump allies. Senate Health, Education, Labor, and Pensions Committee Chair Dr. Bill Cassidy (R‑LA), who voted to confirm Kennedy and Monarez, has demanded that ACIP postpone its September 18–19 meeting “indefinitely”:
Serious allegations have been made about the meeting agenda, membership, and lack of scientific process being followed for the now announced September ACIP meeting. These decisions directly impact children’s health and the meeting should not occur until significant oversight has been conducted. If the meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership.
If Kennedy wants his reforms to succeed and endure, he must practice the “radical transparency” he promised during his confirmation hearings. For starters, HHS must:
Postpone all ACIP meetings indefinitely, per Senator Cassidy’s request.
Cooperate fully with all congressional requests and investigations, as Kennedy promised during his confirmation hearings.
Pledge that ACIP will consider, and base any decisions solely on, peer-reviewed, consensus-based, and widely accepted scientific studies.
Pledge that ACIP will not vote on any recommendations that have not been public for at least two weeks prior to the meeting. (If you’re not ready to publish a proposal on September 4, you’re not ready to adopt it on September 18.)
Disclose all studies that ACIP will discuss at the meeting, highlighting those that will serve as the basis for any new recommendations, at least two weeks prior to the meeting.
Disclose all cost-benefit analyses on which ACIP members base any new recommendations, again at least two weeks prior to the meeting.
Kennedy should have zero problem making and adhering to these pledges. During his confirmation hearing, senators asked, “Do you commit that you’ll revise any CDC recommendations only based on peer-reviewed, consensus-based, widely accepted science?” Kennedy answered, “Absolutely, senator.” He should issue these pledges immediately and hold his subordinates to them on threat of termination.
Public health requires public trust. Only radical transparency can build the popular support necessary for reasonable, sustainable public health policy. If Kennedy doesn’t build a case that even a sizeable share of his critics view as reasonable, his successors are likely to ride the backlash into power and undo whatever wins he achieves.
