This is a tiny ray of light in what has been a gloomy year for science-based federal health policy. Recently U.S. District Court Judge Brian Murphy in Boston ruled that the actions of RFK Jr. as HHS Secretary to fire the entire Advisory Committee on Immunization Practices (ACIP) did not follow procedure and is therefore not valid. Further, he concluded that the new ACIP, packed with anti-vaxxers, made capricious and arbitrary decisions that did not follow established science-based procedure. His ruling is a preliminary injunction that has delayed meetings of the ACIP and stays the revised vaccine schedule. The ruling is in a case brought by a coalition of medical professional societies, including the American Academy of Pediatrics. They are celebrating the ruling as “a momentous step toward restoring science-based vaccine policymaking.”
There are a few layers to this story. The first is RFK Jr. himself and what he has been doing as HHS secretary. I have not written much about him here, because posts about him and other Trump health appointees have dominated the SBM blog over the last year. This has been an “extinction level event” for rational federal health policy, and we have documented it and analyzed it every step of the way. David Gorski has done a great job specifically documenting what RFK Jr. has done to vaccines in the US in his series – “RFK Jr. is definitely coming for your vaccines”, in which he just published part 8. He did a great job not only documenting all of RFK Jr’s harmful actions but actually predicting them. Essentially, RFK is systematically using every lever at his disposal to dismantle the vaccine infrastructure in the US to reduce vaccines as much as possible. Given his actions he clearly straight-up lied to the confirmation committee when he said he was not anti-vaccine and would not take away American’s vaccines.
We, of course, recognized exactly what RFK Jr was doing during the hearings, because we have been following his nonsense for 30 years. He said, for example, “If we want uptake of vaccines, we need a trustworthy government,” Kennedy said. “That’s what I want to restore to the American people and the vaccine program. I want people to know that if the government says something, it’s true.” He then promised “gold standard science”. I would argue he has done the exact opposite. But what this statement is is classic denialism. Just claim you want to review the science, that everything is open to examination, and you just want the highest standards of science. These principles are great, but they can be used as a weapon, not just a tool. You can deny well-established scientific conclusions by arbitrarily claiming we need yet higher standards. Also, claiming you want to “restore” faith in the vaccine program assumes there is currently a lack of faith, which is rich coming from the person who has done the most to undermine that faith with pseudoscience and false claims. That is another denialist strategy – make a well-established science seem controversial, then argue that because it’s controversial we need to reexamine it and call it into question.
This point requires further discussion. It may seem ironic that at SBM we are constantly calling for higher standards of medical science, but now we are complaining about calling for higher standards of science. But again, this gets to using such calls as a weapon vs a tool. No conclusion in medical science is bullet-proof. All science is simply inference to the best current conclusion based on existing evidence. Medical science, because we are dealing with variable biological units (and not things like electrons), is especially complex. We are always making decisions with imperfect information, making our best extrapolation from what is known, and ultimately making a risk vs benefit decision. This requires constant review of the evidence by recognized experts to help establish and maintain a standard of care. But you can attack any medical practice as lacking sufficient evidence, if that is your agenda. This is why expert reviews need to be as free from bias as possible, and as transparent as possible. And the reviews need reviews. It’s a constant process.
The problem with what RFK Jr is doing is not that he is reviewing the science, it’s that he is putting a massive anti-scientific, conspiracy-addled, and biased thumb on the scale. He arbitrarily fired the entire ACIP, then packed it with known anti-vaxxers. Packing a review panel is one way to get the outcome you want.
David lays out what RFK Jr has already done and will likely do going forward to undermine vaccines. The most recent outrage – his MAHA institute is sponsoring a MEVI conference, which stands for Massive Epidemic of Vaccine Injury. Gee – I wonder what they will conclude. He’s not even pretending anymore.
The other big layer to this story, however, is how effective will a court injunction be in stopping the RFK Jr anti-vaccine wrecking ball? The court is correct – we have a process for a reason, to ensure that judgements about what the evidence say are objective and transparent. Bypassing that process and arbitrarily replacing it with one that is blatantly agenda-driven is not a valid process. But this gets into a tricky area – the “checks and balances” of the three equal branches of our federal government. How much oversight and veto power does and should the judicial branch have against overreach by the executive branch? Legal scholars can debate this – again I just hope we have an objective and transparent process to make such decisions.
But executives can put their fat thumb on the scale of this process too – by packing the federal courts with ideologues that will follow their wishes rather than following the law. They can also do it by judge-shopping, keep raising cases until you get a friendly judge. Our rights and freedoms should not so heavily depend on “federal judge roulette”. It should also not depend so much on the randomness of which executive gets to appoint the most Supreme Court judges. If the system gets too biased in one direction, then the public starts to lose confidence in the objectivity of the court, and the overall problem deepens. We seem to be digging ourselves deeper and deeper into a hole of affective polarization, lack of faith in the system, and justifying extremism.
What saves us from bias, arbitrary decisions, extremism, and corruption are institutions that have a process to maximize transparency, average out and minimize bias and conflicts of interest, and elevate genuine expertise. This is partly built on codified procedure, but also on democratic and professional culture and standards. RFK Jr is a blatant example of what happens when you ignore that culture of professionalism and let lose an ideologue to “go wild”.
