Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. On Monday, US Health and Human Services Secretary Robert F. Kennedy, Jr. announced that he is dismissing the entire Centers for Disease Control Advisory Committee on immunization practices. That is the expert panel that for decades has helped guide US vaccine policy. RFK Jr. says this is part of his broader effort to, "Restore trust in public health," but the vast majority of public health experts argue it's more about dismantling the scientific infrastructure that has helped steer the country through everything from polio to COVID. We're going to talk about what this move might actually mean in practice. How are vaccines recommended in the US Now? What does it mean to fire the people who've been evaluating safety data for years, all 17 people who are doing that? How are scientists and health professionals preparing for this next phase of public health under a deeply skeptical administration?

Joining us now is Dr. Katelyn Jetelina, epidemiologist, data scientist, and author of the newsletter called Your Local Epidemiologist. She's been following the story closely and breaking it down for readers. As some of you know, she was on with us multiple times during the height of COVID and since. Dr. Jetelina, always good to have you. Welcome back to WNYC.

Katelyn Jetelina: Yes, thank you for having me. Good morning.

Brian Lehrer: Give our listeners a little more background. What exactly is the CDC's Advisory Committee on Immunization Practices?

Katelyn Jetelina: Yes. For a vaccine or medical device or medication to make it from clinical trials to public access to your arms, for example, it goes through a really rigorous process, which includes FDA. It also includes ACIP, which is a external committee made up of pediatricians, immunologists, epidemiologists, physicians, who review the evidence and recommend who should receive which vaccines and when. It's a really critical step to ensuring vaccines, for example, are safe and effective, and that consumers, people in the community can feel confident in their decisions to get vaccinated.

What happened earlier this week was an unprecedented and really deeply alarming move that RFK removed every single member of that nation of our nation's vaccine policy committee. He announced that he plans to hand-pick their replacements. What is concerning is not just how fast this is happening, not just how sweeping this move is, but the justification is grounded in RFK Jr.'s decades worth of anti-vax ideology. It's very concerning, but they have a lot of questions of how this is going to play out in the next couple of weeks.

Brian Lehrer: Well, we also all saw this coming, I guess. You even began your Substack article about the news with, "Well, he did it," but I want to know if you think he lied to Congress in his confirmation hearings, because listeners may remember, and we played this clip at the time, Senator Bill Cassidy, the Republican senator from Louisiana who chaired the committee that confirmed Kennedy's appointment, and Cassidy is a physician, and then gave a speech on the Senate floor in support of Kennedy when he was considered such a decisive vote. I think other Republicans might have followed his lead if he decided to oppose Kennedy. He framed his support as conditional, and then, of course, he voted yes, so he dropped the conditions. Here he is back in February saying why he supported RFK.

Senator Bill Cassidy: He has also committed that he had worked within current vaccine approval and safety monitoring systems and not established parallel systems. It confirmed he will maintain the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommendations without changes. CDC will not remove statements on their website pointing out that vaccines do not cause autism.

Brian Lehrer: So, oops, Senator Cassidy said, if confirmed, he will maintain the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices without changes. That's what he just fired all 17 members of. Has Bill Cassidy, Senator Cassidy, Dr. Cassidy, reacted to this, to your knowledge?

Katelyn Jetelina: You're right. Your first question, did he lie to Senator Cassidy? He absolutely did. I think that us in epidemiology and those that have been following RFK Jr. for a very long time are not surprised. He's not a trustworthy person, and so you're right. All eyes are really on Senator Cassidy right now. He's a physician, he's a Republican. He's also, like you said, the deciding vote to confirm Kennedy. He's also the chair of the HELP Committee, which oversees FDA as well as CDC.

Now, this promise is broken from RFK to him and a lot of pressure is, and a lot of eyes are now on Cassidy and what his next move is. Cassidy, as of yesterday, I haven't looked this morning, did put out a tweet that he's in close conversation with RFK Jr., but at this point, I don't know what that really means because RFK has already made his decision and is already putting the processes in place.

Now, how and if Cassidy and the HELP Committee are going to respond, this is a big question. If this starts becoming a political liability for the Trump administration, I think is a really big question. I don't know if this is worth the fight for from Trump's perspective, but it's really obvious to me that Kennedy has overplayed his hands and what happens next lies a lot on congressional courage.

Brian Lehrer: Interesting that when I asked the question, did RFK lie to Congress, he didn't make that promise under oath. Cassidy reported to the rest of the Senate and the rest of the world that RFK made that promise to him. There isn't a perjury charge there, but there may be an act of bad faith, and interestingly, that he did only say it behind closed doors. I see some calls are coming in. Listeners, if you want to weigh in on this in any way, if you trust the CDC's vaccine recommendations as they have been, or if you have anything else question or comment on RFK Jr.'s decision to dismiss the whole committee, 212-433-WNYC, 212-433-9692, call or text.

With our guest, Dr. Katelyn Jetelina, data scientist, epidemiologist, an epidemiologist is someone who studies the spread of disease in populations, and author of the newsletter called Your Local Epidemiologist. What do you think the most-- what's the word? Tangible, actual health risks from this are, in your point of view?

Katelyn Jetelina: It's really hard to tell, and I'll tell you why, is because we don't know a lot right now. There's no new committee yet, there's no timeline, there's no public process. All we have is this Wall Street Journal op-ed and a really long tweet from Kennedy last night. How this affects us, our families, our communities just isn't clear yet. There's really a spectrum of scenarios that could play out. One, best-case scenario, RFK appoints really qualified independent experts and committee resumes its work. Guidance remains credible in act and all is good in the world.

Now, there's also this worst-case scenario, that he fills ACIP with anti-vaccine ideologues like himself, recommendations are completely removed and everyone's access to vaccines goes completely away. I think that where we will land, this is my hypothesis, is somewhere in between, maybe even it tilts more towards worst-case scenario. What that means is, if ACIP remains dismantled, if it starts losing credibility, if these recommendations are changed, there's a cascade of consequences.

One is insurance coverage. Insurance relies on ACIP recommendations on what to cover. If they stop covering it, people may not get and pay for a vaccine out of their pocket. There's going to be a whole lot of confusion on what is true, what is false, and overall, I think it, in the end, could really profoundly impact Americans ability to make informed decisions and have access to vaccines. There's a lot of questions right now. I think that the next few weeks will tell us a lot more about on-the-ground implications, but worst-case scenario, it could cost lives.

Brian Lehrer: You mentioned RFK's Wall Street Journal op-ed on this from yesterday. He wrote, "A clean sweep is needed to reestablish public confidence in vaccine science. In the 1960s, the world sought guidance from America's health regulators who had a reputation for integrity, scientific impartiality, and zealous defense of patient welfare. Public trust has since collapsed, but we will earn it back," from RFK Jr.'s Wall Street op-ed.

You're an epidemiologist, you're a data scientist. I don't know if you watch global public health policy and where the US stands in relation to that, but do you think it's even an accurate statement from Kennedy that in the 1960s the world sought guidance from America's health regulators who had a reputation for integrity... Public trust has since collapsed. Has it collapsed?

Katelyn Jetelina: I think that we need to step back and really ground us in facts right now that 90% of Americans get their kids vaccinated by routine vaccinations. When was the last time 90% of Americans agreed on something? It's a while. This is a shared value of Americans that vaccines are important. I don't buy that people are not getting vaccinated all of a sudden. That's just not the trend. What we do see is a decline in trust. I do agree with him there, and I think that it's impossible to untangle this story on the heels of the COVID-19 pandemic, where a lot of decisions were made and a lot of communities didn't feel heard, and even felt hurt from some policy decisions.

I do still think that the world does rely on our gold standard science because that is what we've led over the past decades. Just during the COVID-19 emergency a few years ago, we saw a ton of countries looking to our FDA processes, the science, the clinical trials and to determine their recommendations and what they perceive as needed. Yes, I think one of the most dangerous things that RFK Jr. does is he says very reasonable statements that are then just packed around it with right-out falsehoods, and that blurring between truth and false is what is, I think, the most dangerous at this time, and is now coming from the highest office and health in the United States, which has major, major implications.

Brian Lehrer: One of the implications that you already mentioned is, when there aren't official government recommendations for vaccines for certain populations, then the insurance companies don't cover them because they feel they don't have to, I guess, but a listener asked this question in a text, "If insurance doesn't cover vaccines, the insurers then pay for hospital stays. Why wouldn't they cover vaccines?"

Katelyn Jetelina: Yes, I think this is a really interesting point, and I agree. What we haven't seen come out yet are the other big players at the table. We've heard from RFK Jr., and apparently the federal policy, but we haven't heard from insurers or pharmaceutical companies. The listener is correct in that even if ACIP recommendations go away or become a whole lot less clear, coverage could be withdrawn without this structure and confidence.

I do think insurers think about their bottom line and may continue to pay out out of pragmatism, is that MMR vaccine is way cheaper than a child hospitalized with measles. How all these balances between these big powers play out is going to be, from my policy hat, a fascinating perspective to see unfold.

Brian Lehrer: Let's take a phone call in support of RFK's decision. Michael in Chicago, you're on WNYC. Hi, Michael.

Michael: Hi. Thank you. A long time listener. I support RFK and its policies. There's been a slow, decades-long takeover of the pharmaceutical companies of the CDC and the NIH, and there's a lot to learn that's easy to access online about it. Two points. The 90% parents going along with the vaccine schedule, they go into a doctor's office and they feel they have very little choice. The doctors are in position of power. They don't investigate the vaccines. They don't know what the side effects are anyway. It's not true. A lot of people are harmed by the vaccines, the mRNA vaccines in particular. They're not vaccines, they're gene therapies.

Brian Lehrer: Michael, I'm going to stop you, because an opinion is one thing, but stating something that's so false, it's not a vaccine, it's gene therapy, I just can't. I just can't, but thank you for your call.

Michael: It's not a vaccine. It does not fit, so it's something else. Vaccines were used. Look at that. [unintelligible 00:15:40] got to speak to.

Brian Lehrer: Say that again. Say that last line again and then I'm going to go.

Michael: The traditional definition of vaccines do not include what the mRNA gene therapy injections are. It's something else other than a vaccine.

Brian Lehrer: Michael, thank you for your call. Dr. Jetelina?

Katelyn Jetelina: Yes, this has been a falsehood that's been spread for the past five years. A vaccine, the definition is a substance, it's an injection that stimulates the body's immune system, and this is exactly what the mRNA vaccine does. It does it in a slightly different way than our traditional vaccines, but it certainly doesn't-- It's not gene therapy, it doesn't change our DNA. In fact, it lacks the necessary tools to even impact our DNA. It can't enter the cell nucleus. It doesn't have the tools called reverse transcriptase to change our DNA, and even if it had those two tools, it doesn't have another tool called integrase to do this. It doesn't even come close and couldn't, even if it wanted to, to changing our DNA.

I think what Michael brought up is an interesting point, is that how influenced our health care systems are by capitalism, I think is a really important point. I think, though, that it is very, very clear that pharma does not have influence on ACIP. One, ACIP has very public conflicts of interest that are disclosed. RFK Jr. even reaffirmed this process after he himself called for a full review of the current committee's or past committee's disclosure, and nothing was found, and ACIP isn't paid by big pharma.

There was an investigation in March this year that found no evidence of undue pharmaceutical company influence on its members. In fact, the vast majority of these members, one, didn't get paid by pharma at all. And those that did was about $3,000, which is about $4,000 less than your typical physician that you see. There's really no standing on that big pharma has influenced ACIP. In fact, I'm very proud that the system is so transparent and has a number of checks and balances, so we can feel confident in the vaccines that are available to us today.

Brian Lehrer: I'm glad the caller brought up that argument and that you responded to that argument explicitly, because I think we can hear that caller as an example of where the anti-big government right meets the anti-big pharma left. It might resonate with progressives to say, "Hey, the pharmaceutical companies are controlling the regulatory agencies that are supposed to monitor them." If the pharmaceutical companies control the approval process, then of course there are going to be more recommendations for vaccines and all kinds of other drugs and medications and substances, including vaccines. It taps into this progressive doubt as well as the anti-big government right wing doubt, and that's part of the power of RFK.

Katelyn Jetelina: Yes, and I think there's legitimate frustrations on the ground of how expensive our healthcare costs are, where all that money's going, who has influence, et cetera. I've been actually speaking with MAHA Grassroots on a regular basis for these past couple weeks, and this is a theme that I've learned from them specifically, is that MAHA members are incredibly skeptical of the entire medical industrial complex, which includes big pharma. I'm skeptical about their role too. I have to pay really expensive health care and I'm not happy with the state of the health in the United States.

What I have learned also is that there's this genuine misunderstanding of the separation between public health and big pharma. When scientists speak up for vaccines, like myself, it can sound like we're defending the industry, which erodes trust with this group, but the mission of public health is so fundamentally different, and I think us in public health need to do a whole better job educating on what we do and how we are, and honestly, voice our general frustrations with the systems as well.

Brian Lehrer: One more call. Laura in Warren, New Jersey. Primary care physician. Laura, you got to keep it really tight. We just have a few seconds for your call. Hi.

Laura: Okay. Hi. I'm a partially retired primary care physician and we rely very heavily on both the US Preventive Services Task Force and the ACIP regarding what's the appropriate medical care to give our patients every single day. It's terrible seeing these organizations as well as healthcare research being torn apart.

Brian Lehrer: Well, go ahead, Dr. Jetelina, and thank you, Dr. Laura.

Katelyn Jetelina: I was going to say, yes, Dr. Laura, I completely agree. It's a magnetic storm and it's really hard to find a North Star right now. I think what is going to happen with this ACIP guidance is a whole lot of confusion, not just for patients, but for physicians as well. This is where I'm really happy to see the big gaps starting to be filled outside of government, like the Vaccine Integrity Project. I also think that without a federal anchor, states could start creating, or are already starting to create their own advisory boards around vaccines. We'll see how this all plays out, but I agree with your frustration and your concern.

Brian Lehrer: Kennedy gets to appoint the 17 people, if it's the same number as the number of people he fired, to constitute a new vaccine advisory committee. Is this all on him? He has the authority to appoint the whole committee.

Katelyn Jetelina: He does. I will say that this has always been a political process. Public health is inherently political. What has changed is that this is being driven by ideology, not based in fact, and so we'll see who is on this new committee. I'm also curious of how quickly they'll appear. I think the faster it's announced, the more likely these appointments are ideological and not going through a rigorous process. I believe he already has a list of about nine people who's going to be included. That means the next up is this June 25th ACIP meeting and what's going to happen and what our recommendations are for fall respiratory season, which is quickly approaching. I'll be watching closely, and I know you will be too.

Brian Lehrer: Yes. Just this one retrospective thought, listener writes, "Didn't the pandemic management and COVID vaccine mandates cause the greatest spike in loss of trust in government health advice worldwide?" Any retrospective regrets or criticism about the way it was handled? Certainly, people didn't like being mandated, and also, maybe people expected the vaccines to be more effective at curbing the spread of COVID, not just the serious effects.

Katelyn Jetelina: Yes, I think if we look back at the COVID-19 storyline, it is. That is one space that was the mandates that people really, really didn't like and didn't understand. They had to make a decision between whether they get vaccinated or lose their job. There was legitimate questions, I think, about whether mandating vaccines really decrease transmission. Given what you said, over time they lost effectiveness because this virus mutated so quickly over time.

I do look at that, but I don't want us to lose the bigger picture that vaccines are mandated at a childhood level for a reason. We have very, very low measles, even this year where it's coming back and hot because of these vaccines, because we're protecting others, and healthcare workers. When I worked at a hospital, I was mandated to get the flu vaccine every year, so it wasn't that big of a difference.

Brian Lehrer: Yes, and it's very different to talk about the pandemic mass death immediate decisions in a crisis that government had to make compared to the decades of research on all the childhood vaccines, from polio to measles, mumps, rubella. Very, very different amount of science and very, very different conversations. Not to conflate the two. Katelyn Jetelina, epidemiologist, data science, and author of the newsletter called Your Local Epidemiologist. Thanks so much for joining us today.

Katelyn Jetelina: Yes, thank you for having me.

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