The global fallout of RFK Jr.'s vaccine policies

In his role as secretary of Health and Human Services, Robert F. Kennedy Jr. is changing how the United States approaches vaccines. But those changes aren’t limited to the United States. NPR global health correspondent Gabrielle Emanuel https://www.npr.org/people/470414236/gabrielle-emanuel joins Short Wave to talk about two examples of how the global public health landscape may be shifting. First, the United States’ ultimatum to an international vaccine group. Second, the uncertain fate of a vaccine trial. Some researchers are calling the trial a “unique” opportunity, and others are calling it “unethical.” Read more of global health correspondent Gabrielle Emanuel’s work here https://www.npr.org/people/470414236/gabrielle-emanuel. Interested in more global health? Email us your question at [email protected] mailto:[email protected]. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Speaker 00

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• 0:22Regina Barber?

  Hey, Short Wavers. Regina Barber here. So if you've been listening to us this past year, we've done stories about all the big and small ways Robert F. Kennedy Jr. is changing how the United States approaches vaccines. And this is all in his role as the Secretary of Health and Human Services. But as Gabriella Emanuel will tell you in a sec, those changes aren't limited to the United States.

• 0:43Speaker 02

  Definitely not.

• 0:44Regina Barber?

  So Gabriella, as a global health correspondent at NPR, you've been keeping tabs on how this new HHS approach is changing the conversation around the world.

• 0:54Speaker 02

  That's right. And right off the bat, there are two clear examples I can give you where changes in the US are creating public health controversies elsewhere in the world.

• 1:05Regina Barber?

  OK.

• 1:06Speaker 02

  So the first one, RFK Jr. and his ultimatum to an international vaccine group called GAVI.

• 1:13Regina Barber?

  I've heard of GAVI. They're a big player internationally. And looking at their site, they say they vaccinated over 1.2 billion children and prevented over 20 million deaths. The US is historically one of their biggest funders, right?

• 1:27Speaker 02

  Yeah. But last year, the Trump administration halted over $1 billion the US had previously promised to GAVI. And then earlier this year, HHS threatened to withhold future funding from GAVI, too, unless the organization removes a specific ingredient from its vaccines.

• 1:47Regina Barber?

  Wow. OK, so that's the first example, this ultimatum, which we'll talk about later. But what's the second?

• 1:54Speaker 02

  So that second example is a controversial vaccine research study that is partly funded by the US, and it looks at hepatitis B and newborns in Guinea Bissau. So a West African country. Now, I have to say, right up front, there are conflicting reports about the current status of the study. But Africa CDC, which is part of the African Union, says it's currently paused for review. And that is because some doctors like Paul Offit have called it unethical. Paul was a member of the Advisory Committee on Immunization Practices for the CDC from 98 to 2003. He also compared it to the notorious Tuskegee

• 2:37Speaker 02

  experiment that started in the 1930s in the US.

• 2:40Regina Barber?

  Wow, this is where black men who had syphilis were purposely not given treatment.

• 2:45Speaker 02

  Yeah, exactly.

• 2:46Speaker 03

  This was a very dark moment in American history.

• 2:50Regina Barber?

  All right, this is a lot to dig into. So today on the show, how changes in US vaccine priorities are making global waves. You're listening to Short Wave, the science podcast from NPR.

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• 4:10Regina Barber?

  Okay, Gabriela, we started our conversation talking about the US's ultimatum to GAVI, this international vaccine alliance. And now Congress has allocated money to them, but the Trump administration, specifically RFK Jr.'s team, has been trying to withhold money unless GAVI agrees to remove an ingredient from its vaccines. What is this ingredient?

• 4:32Speaker 02

  It is called thimerosal. And it helps make sure vaccines don't get contaminated with bacteria or fungi.

• 4:40Regina Barber?

  Important.

• 4:41Speaker 02

  Yes. They want that. This is key if a vaccine comes in a vial that has many doses in it. So when you dip in that needle to fill it up, there's a risk of contamination. And thimerosal does a really good job at avoiding the contamination.

• 4:58Regina Barber?

  Yeah, so why do people want to remove it, then?

• 5:01Speaker 02

  Because it's partially made of a form of mercury, which on its face does sound scary. But thimerosal has been very well studied and deemed safe in medications and vaccines since the 1930s. However, RFK Jr. is still skeptical, and that might actually be an understatement. He spent 20 years campaigning against thimerosal, including editing a book on the topic. And he's made moves to ban this ingredient from US vaccines. He's urged GAVI to follow suit and...

• 5:36Speaker 05

  ...to stop their programs of injecting mercury into more than 100 million black and brown babies in developing countries annually.

• 5:44Regina Barber?

  That is a big accusation. And you said it was safe.

• 5:47Speaker 02

  Well, here is Angela Rasmussen, a virologist at the University of Saskatchewan.

• 5:52Speaker 06

  The amount of mercury that you get, dangerous mercury that you get that could be toxic from a single thimerosal-containing vaccine is like less than you would get from eating a tuna fish sandwich.

• 6:05Speaker 02

  In reality, she says, the main type of mercury in thimerosal leaves the body very quickly and it does not accumulate and it isn't known to cause damage. And that's why the World Health Organization, the U.S. Food and Drug Administration, and the U.S. Centers for Disease Control and Prevention have all deemed it safe.

• 6:25Regina Barber?

  Okay, but now because of this ultimatum, can it happen? Is there a replacement or can it be like easily removed from vaccines?

• 6:33Speaker 02

  No, there's no obvious alternative. And actually, in many lower-income countries, it cannot be removed easily. The single-dose vials that are common in the U.S. where thimerosal isn't needed are really too expensive. Instead, these lower-income countries tend to use those multi-dose vials during these mass immunization days where lots of kids get vaccinated.

• 6:56Regina Barber?

  But now that the U.S. has given this ultimatum, do you think that Gavi will remove the marisol from their vaccines?

• 7:02Speaker 02

  Well, in a statement to NPR, Gavi said it remains in contact with the U.S. on the subject and that any changes would be guided by scientific consensus and their board. But HHS, in a statement to NPR, put it more bluntly. It said, "Gavi has refused to develop a phase-out plan and future funding will be withheld." But Congress did allocate funding to Gavi, so we'll see how it all plays out. I did speak with Paul Offit, as we mentioned earlier. He's the director of the Vaccine Education Center at the Children's Hospital of Philadelphia. He says if Gavi agrees to the deal, the outcome is clear.

• 7:40Speaker 03

  Children will no doubt die because those vaccines are unavailable.

• 7:45Regina Barber?

  That's really heavy. And I think it's time we turn to something else that seems just as heavy, that controversial study on hepatitis B, which for anyone who doesn't know, it's a viral infection that attacks the liver. It's spread through blood or other bodily fluids. Newborns can get this infection from their moms during delivery and there's no cure, but it is preventable with vaccines.

• 8:08Speaker 02

  Yes, exactly.

• 8:10Regina Barber?

  Okay.

• 8:10Speaker 02

  If a vaccine is given right after birth, it is super effective at preventing infection, even if a kid is exposed through their mom during delivery. And so for 30-some years, newborns in the U.S. have been given the hepatitis B vaccine, and that's also the recommendation globally by the WHO. But, here's a big but, on December 5th last year, CDC advisers voted to stop vaccinating all newborns against hepatitis B in the US.

• 8:41Regina Barber?

  Okay.

• 8:41Speaker 02

  So these advisers who voted for the change were handpicked by RFK Jr. And they say they're worried it might cause harm to babies and that the vaccine should be limited to high-risk babies after consulting with their doctors, not given kind of on a routine basis to every newborn.

• 8:59Regina Barber?

  So i- is this, is this harm? Is there research to back it up?

• 9:05Speaker 02

  In a word, no. And that's part of the pushback from doctors and vaccine experts about this change. The lack of research to support a shift in policy. And outside medical groups have pointed to studies showing the vaccine is very safe and that the rate of young kids getting hepatitis B has dropped by 99% since 1991 in the US, largely because of this birth dose.

• 9:29Regina Barber?

  Okay, so this is, this is all good context for the US, but the study we've been talking about is in Guinea-Bissau. So what's the status of hepatitis B there, Gabriella?

• 9:40Speaker 02

  Yes, so this is a very poor country that we're talking about, and it has a very high hepatitis B rate. About one in five adults there have hepatitis B. So really high rates, and that means the chance a newborn gets exposed by their mom during delivery is pretty high.

• 9:58Regina Barber?

  Yeah, so having the vaccine immediately after basically helps the baby fight off Hep B if they've been exposed to it during that delivery?

• 10:07Speaker 02

  Exactly, it's a post-exposure vaccine here, but it's very effective at preventing that infection from taking hold. The alternative is administering the vaccine a few weeks later, but at that point, the infection could have taken hold.

• 10:22Regina Barber?

  Okay.

• 10:22Speaker 02

  This is the current policy in Guinea-Bissau. However, the country is planning to start vaccinating at birth in 2028.

• 10:31Regina Barber?

  Okay.

• 10:31Speaker 02

  But before then, researchers from Denmark want to do a study, and it's paid for in part by the US to the tune of $1.6 million.

• 10:40Regina Barber?

  Okay.

• 10:42Speaker 02

  So the study was announced two weeks after the vote in the US to stop vaccinating every newborn. And also after that pushback, saying there wasn't evidence to back up this change in US vaccine policy. The plan is for the researchers to study over 14,000 newborns. Half would get the hepatitis B vaccine at birth. The other half would get it later, as is the country's current policy. And then the researchers would watch for side effects in the first few years. Things like neurological problems or eczema.

• 11:17Regina Barber?

  So the Tuskegee experiment comparison comes in right here. Because doing it this way, you're leaving like 7,000 newborns who would be unvaccinated. And they could be exposed in those critical early weeks.

• 11:30Speaker 02

  That's right, but since the current policy in Guinea Bissau is to wait several weeks. The researchers say, oh, no, no, we're not taking away vaccines from any babies who get them otherwise. In fact, they say half the time, the babies will be getting treatment sooner, which is arguably better than the current policy.

• 11:49Regina Barber?

  So that's the heart of the debate.

• 11:51Speaker 02

  Yes, and it has gotten heated. The WHO even called it unethical, which is pretty extreme language for a very kind of subdued, careful group. They say exploiting scarcity, exploiting the country's lack of resources is not a justification for withholding proven medical solutions for families that enroll in a research study. Some doctors, like Paul Offit, have been even more blunt.

• 12:18Speaker 03

  Their rebuttal is we're just doing what has been done. Even though you could argue that what has been done has been woefully ineffective. And to continue to do something that's woefully ineffective is highly unethical and cruel. And frankly dishonest.

• 12:32Speaker 02

  Other experts like Christine Grady point out that there might be an even more fundamental question about this research. She's the former chief of the Department of Bioethics at the National Institutes of Health Clinical Center.

• 12:45Speaker 07

  The first and important consideration in making a study ethical is that it's answering a valuable question.

• 12:52Speaker 02

  The researchers behind this study say the goal is to see if newborns who do get the vaccine develop other illnesses and issues after vaccination.

• 13:01Regina Barber?

  Yeah, but to Christine's point, you said earlier that the hepatitis B vaccine has been proven to be safe and effective.

• 13:08Speaker 02

  Exactly. And one of the risks of doing a study that is not asking a valuable question is that you are then asking the community to help and to trust you when it's not actually necessary. And later, that can then create resistance and hesitancy and suspicion of healthcare workers if people realize that they were part of an unnecessary and possibly unethical study.

• 13:31Regina Barber?

  Oof, okay, so what have the researchers said in response to all of this pushback?

• 13:37Speaker 02

  So I did reach out to the researchers in Denmark, and I didn't get a response despite many attempts. But it is worth noting, the researchers are already controversial, and RFK Jr. is a fan of their work and their somewhat unorthodox vaccine arguments, and he has cited them in the past. Many in the medical establishment say that after reviewing their published work, they've found big claims questioning vaccines where the data and the statistics often just don't back it up.

• 14:08Regina Barber?

  So in the meantime, has the CDC responded to any of this?

• 14:13Speaker 02

  So so far, they have defended the study. In a statement to NPR, HHS called the study "the gold standard" and said it was based on the highest scientific and ethical standards.

• 14:26Regina Barber?

  So will the study go on despite all of this pushback and controversy?

• 14:30Speaker 02

  Yeah, that that is the question. The authorities in Guinea-Bissau, where there's been years of instability, they say it is currently suspended, and it's kind of pending an ethics review. The head of Africa CDC said he's sending experts to help with the review. So that's where things seem to stand right now.

• 14:52Regina Barber?

  After reporting on these two sort of case studies, what's your takeaway for the global public health landscape?

• 14:59Speaker 02

  Yeah. So I think I've noticed over the past year that the US is getting more isolated when it comes to public health, being called out publicly as supporting things that are unethical or go against science. So we may be at the beginning of a kind of shift in the balance of power of who leads the world, at least from a public health perspective.

• 15:28Regina Barber?

  Gabriela, thank you for sharing these stories with me. It sounds like neither one is quite resolved. So we'll see how this plays out.

• 15:37Speaker 02

  Absolutely. Thank you so much, Gina.

• 15:44Regina Barber?

  If you like this show, share it with a friend. It really helps our show out. Also, consider checking out our episodes on RFK Jr.'s New Vaccine Advisors and How an Innovative HIV Vaccine Trial Is Pivoting After Losing USAID Funding. This episode was produced by Rachel Carlson and edited by Gisele Grayson and our showrunner, Rebecca Ramirez. Gabriela Emanuel and Tyler Jones checked the facts. And the audio engineer was Kwasi Lee. I'm Regina Barber. Thank you for listening to Shorewave from NPR.

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  This message comes from Capella University. That spark you feel? That's your drive for more. Capella University's FlexPath learning format lets you earn your degree at your pace without putting life on pause. Learn more at capella.edu.