It’s one thing to find a country’s politics objectionable. It’s another to have to deal with its people – even when they’re well intentioned – being dangerous to meet in person. That’s a very real possibility should the US start doing away with vaccination programmes under the influence of populist pseudoscience. How might this affect international relations, trade and travel?
We’re already in a dangerous era with regard to infectious disease. Climate change means that micro-organisms and the insects that carry them are expanding beyond their usual ranges and encountering populations with little to no immunity – as we’ve seen with Lyme disease in England and Wales, and dengue fever in France. Bird flu has caused serious illness in humans and is spreading in dairy cattle, increasing the risk of human exposure. And existing levels of vaccine hesitancy have led to outbreaks of diseases like measles, not seen at this level for a century, around the world.
Robert F Kennedy Jr and the future of US healthcare
Into this situation comes new US Secretary of Health and Human Services Robert F Kennedy Jr, who will take up his post on 20 January, but whose influence is already being felt. Not only is he a passionate advocate of drinking unpasteurised milk, a dangerous choice in the best of circumstances and all the more so in light of the bird flu risk, but he has a long history of making questionable statements in relation to vaccination. He has been accused of contributing to public distrust of the MMR vaccine in the run-up to the 2019 measles outbreak in Samoa (which led to the deaths of 83 people) – something he denies on the basis that he never told anybody not to get vaccinated. He repeatedly criticised the Covid-19 vaccine at a stage when it was seen by experts as the only feasible alternative to lockdowns.
Concerns about Kennedy’s suitability for his new role erupted last week when it emerged that his lawyer and close advisor, Aaron Siri, is involved in efforts to have federal approval for the polio vaccine revoked. Kennedy has attempted to distance himself from this, asserting that the vaccine should be available, but also stating through a spokesperson, that it should be “thoroughly and properly studied” – the kind of ‘reasonable concerns’ language that has been used again and again on the right to undermine ideas which are actually very well evidenced. He has taken a similar approach in the past when questioning the link between HIV and AIDS.
Siri, who is also understood to be seeking the revocation of the Hepatitis B vaccine, along with 13 others, works for a law firm which specialises in making claims for vaccine damages. In 2015 he successfully campaigned to force New York City daycare centres to accept children who had not been vaccinated against flu (a ruling which was overturned on appeal earlier this year). Vaccine damages are a real phenomenon – occasional allergic reactions can occur, which is why doctors ask people to wait for 15 minutes before leaving the surgery after the administration of some vaccines – but no vaccine is approved unless it has been determined that these are very rare, and significantly, that the risk of severe illness, injury or death due to not being vaccinated is higher. There are 150,000 children in New York school districts, including hundreds with low immune systems, asthma and other complicating factors which make flu very dangerous to them.
The horrors of polio
Flu is difficult to wipe out because of its fast mutation rate, but polio was very nearly eliminated by worldwide vaccination programmes before making a comeback in the last few years due to disruption caused by war and loss of public confidence. The danger of successful vaccination is that it can lead people to forget how bad it was to live with the disease, but many older people still vividly remember polio. Not only does it have a dangerous acute phase, but years after infection, some survivors develop secondary symptoms which can lead to severe disability. Historically, many victims were left dependent on breathing machines for years.
“I had polio when I was nine,” said the actor Mia Farrow, speaking out in response to the Siri news. “I was taken from my parents and placed in a hospital for contagious diseases – the polio ward. I would see them once a week – through the glass window at the end of my ward. I could not walk. It was terrifying. Kids died. Iron lungs were awful. Don’t let RFK Jr ban the vaccine.”
Donald Trump has said that he plans to discuss vaccination with Kennedy so that he can assess the pros and cons for himself. The incoming president is well known for his phobia of germs but, like Kennedy, lacks medical training, so is not well equipped to analyse the evidence. His statement that Kennedy will investigate the “connection between vaccines and autism” has caused concern, as this has been investigated numerous times already, always with the same conclusion: that there is no connection. It suggests that he may already be falling prey to conspiracy theories on the topic.
The risk of dangerous policy errors goes beyond those vaccines currently available, with many US researchers afraid that government funding for their work on potential new vaccines, and other key areas of medical science, will be severely restricted or stopped altogether.
US healthcare policy and the international disease burden
It has often been said that “when America sneezes, Britain catches a cold,” and now we may see that unfold literally. The risk is not so much of the UK following in the US’ wake with potential vaccine bans, but of the US becoming an incubator for diseases largely beaten back in the rest of the world. This could give dangerous pathogens a chance to mutate, producing new strains that would not only present a risk to Trump’s own citizens, but could endanger people everywhere. The only solution to this would be to severely limit contact between the US and the rest of the world, which would require a tremendous amount of political will and, even if successful, would cause significant loss of life internationally due to its economic impact.
It is simply not possible, in our interconnected world, for any large country to take its approach to public health back to a primitive state without putting everyone’s healthcare progress at risk. The earliest forms of vaccination – variolation – were practised in China as long ago as the 11th Century, and modern vaccination has been around since 1796. The value of that legacy cannot be lightly set aside – even for the sake of political normality. At this level, healthcare is everybody’s business and everybody’s responsibility, and that will need to be made clear to the incoming US regime, one way or another.
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