First, Do No Harm

by Ambassador Thomas Graham (Retired) and David Bernell

Robert F. Kennedy Jr. was installed by Donald Trump to lead the U.S. Department of Health and Human Services (HHS). Near the end of the 2024 election campaign, at an event at Madison Square Garden, Donald Trump announced that Kennedy would serve in his administration and said what his mandate would be. “I’m going to let him go wild on health,” Trump said. “I’m going to let him go wild on food. I’m going to let him go wild on medicine.” It is fair to say that Kennedy’s views about medicine and public health – which seem not to be based on medical science, research, epidemiology, or even common sense – can appropriately be categorized as “wild.”

Kennedy now runs HHS, the part of the American government that implements policy and directs programs involving medicine, health care services, health insurance, and public health. It has been an effective and resourceful department for many years, and it is very necessary. Protecting public health and seeking to keep citizens healthy is an important responsibility of government. Without good health, we cannot be a strong, productive country. Kennedy, however, seems to have come into the position with little intention of following in the better traditions of HHS. He has no medical, scientific, or government experience of any kind. He is best known for endorsing various conspiracy theories that have no relationship to science or sound medical practice. And his general view of government policy and industry practices in the medical field and food production is that they are causing “mass poisoning” of the American public.

The most notable examples of this view are Kennedy’s many false assertions regarding vaccines. Because of his family name, Kennedy has often been able to draw attention, giving his claims a big audience. He has frequently said that childhood vaccines are related to autism, an assertion that has been completely rejected by medical science. He falsely called the COVID vaccine – which saved the lives of people the world over – as “the deadliest vaccine ever made,” and compared COVID vaccine mandates to Nazism. A comment Kennedy offered in 2023 was broad enough to cover all ground, when he declared that, “There is no vaccine that is safe and effective.”

On June 9, Kennedy took his latest step in dismantling the institutional strengths of HHS by firing all 17 members of the Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention. He claimed he was doing this to “reestablish public confidence in vaccine science.” In doing so, he broke the explicit promise he made to Senator Bill Cassidy in his confirmation hearing to maintain this committee without changes. Cassidy, a Republican, and also a physician who is the chair of the Senate Health Committee, knows the value of vaccines and has expressed his concerns that RFK Jr. would undermine their use. In responding to Kennedy’s move, Cassidy said that, “now the fear is that the ACIP will be filled up with people who know nothing about vaccines except suspicion.” At the same time, to avoid forcefully challenging the administration, Cassidy said his response would involve only to “talk” to the Secretary to try and ensure his fears don’t come true. Considering Kennedy’s record, it stretches credulity to think that this move is anything other than an effort to stack the committee with Trump loyalists and vaccine skeptics. Once again, it seems that Congressional Republicans who have any differences with the administration have great capacity to be rolled, ignored, duped, and lied to, and then do little or nothing in response.

Vaccines for measles, polio, smallpox, diphtheria, mumps, the flu, COVID and many other deadly diseases represent some of the greatest scientific advancements ever achieved. The United States has been one of the world’s leaders in developing these vaccines. Kennedy, on the other hand, has lent his voice and now his authority as Secretary of HHS in favor of reducing the widespread acceptance and usage of these life-saving vaccines. Rather than promoting public health, Kennedy is leading the department he runs and the country in the opposite direction, significantly worsening the prospects for human health.

The First Vaccine: The Greatest Vaccination Success Story

The smallpox vaccine was the first successful vaccine ever developed, and it eventually led to the complete eradication of the disease worldwide by 1980, after an estimated 300 million deaths in the 20^th century alone. The dramatic success of inoculating people against this disease has been evident for so long that Americans can read in their own history books that General George Washington ordered soldiers in the Continental Army to be inoculated against smallpox in 1777. This even predated the development of a vaccine by the British doctor Edward Jenner in 1796. The practice of injecting a small amount of infected material under the skin of a healthy person was not completely safe and reliable, yet it had been in practice – in the American colonies and elsewhere – for several decades and was considered so useful that Washington ordered the inoculations to stop the disease from its rapid spread through the ranks of the army.

Smallpox has been a terrible scourge for humankind. The disease is highly contagious, with the most common variant causing fatal results in about 30 percent of its victims, and less prevalent variants causing death in over 90 percent of cases. The appearance of the disease goes far back in history, including evidence that has been found in Egyptian mummies more than 3,000 years old. While records of the prevalence of smallpox were relatively scarce before the 1700’s, there are many accounts of the impacts of the disease. Perhaps the best-known instance is the use of the disease by colonizing countries in the Americas, where it was used as a weapon of conquest. (There is not a clear consensus among historians whether the Spanish deliberately spread smallpox as a biological weapon, though there is one documented case of the British doing so in North America). As the disease was not native to the Western hemisphere, its introduction in blankets and other goods provided to native populations, along with personal contact, became a biological weapon that European invaders brought with them that had overpoweringly devastating results.

During the 1700’s, it is estimated that smallpox killed in the range of 400,000 in Europe every year. And as recently as 1967, the World Health Organization (WHO) estimated that 10-15 million people contracted the disease in that year, resulting in two million deaths. In that same year, the World Health Organization launched a smallpox eradication campaign. After a vigorous and successful vaccination program worldwide, the last recorded case was in 1977, and the disease was declared eliminated in 1980.

This success was no accident. It took two centuries of advances and concerted efforts to overcome doubts and resistance. One person in particular, Lady Mary Wortley Montagu, the wife of a British diplomat stationed in The Ottoman Empire (now Turkey) in the early 1700’s, is credited with being instrumental the path to this success. She found that smallpox, which was widespread in Britain, was hardly evident in Istanbul. She learned that every year there were efforts to inoculate people with a small injection under the skin, and saw that this caused only a small reaction, but then the recipient was made immune, though sometimes people did contract the disease. (The observation that piqued her curiosity was that people in Istanbul seemed to have such beautiful skin compared to people in Britain.) She is credited for bringing smallpox inoculation to England, though skepticism and resistance was widespread, and adoption of the practice was slow and uneven.

Edward Jenner – living in an era in which smallpox killed an estimated ten percent of the global population – later discovered that cowpox, a much milder disease, could protect people from the far more dangerous smallpox. This led to his development of a vaccine in 1796 that used cowpox as the inoculation agent. This was much safer and highly reliable. It was the first vaccine ever developed, and it changed medical practices and medical history. Still, even after Jenner’s vaccine, the practice remained controversial for a long time (the world has had vaccine skeptics as long as it’s had vaccines). Over time most resistance was overcome because the vaccine worked, but it took a concerted effort by individuals and governments around the world for almost two centuries.

In the 1960’s and 70’s, when the World Health Organization’s campaign to eradicate smallpox was carried out, the government of the United States of America played a critical role in its success and was a driver of the effort. The US Centers for Disease control provided technical expertise and personnel to coordinate with local communities in numerous countries. American funding was central to the project (some of it from the now-dismantled US Agency for International Development). Also, it was an American doctor and epidemiologist who led the WHO eradication campaign, and another American doctor and epidemiologist who figured out the strategy for isolating the disease so it would be far less likely to spread.

Remembering this history serves as a reminder of the massive toll taken by smallpox over the centuries, and it underscores the bitter realization that the American government led by Donald Trump has put Robert F. Kennedy Jr. in office as Secretary of HHS. Kennedy seem to be making it his mission to reject the successes achieved over the years, to spread the message of doubting vaccines, and to put policies in place that make it harder for people to get vaccines. Considering that Kennedy said there is no vaccine that is safe and effective, and that the smallpox vaccine has saved hundreds of millions of lives, it is difficult to imagine what level of success would be considered “effective” to Kennedy.

Amiss with the Measles

While Kennedy has not had an opportunity to offer his opinions on smallpox vaccines, due to the eradication of the disease, he has done so with regard to other vaccines, and the measles vaccine stands out. This is another highly contagious, deadly disease with a long history. One account from the American colonies comes from Cotton Mather, a Puritan clergyman who is perhaps best known for his defense of the Salem witch trials. His family suffered from a measles outbreak in Boston in 1713. Mather’s diary described how everyone in the family got sick with the disease, and how the disease took his wife and three of his children. All died within days of each other in the epidemic. (Mather was also a proponent of smallpox inoculation.)

The disease has not gone away, even with available vaccines, which are very effective at preventing illness. The problem lies in getting people vaccinated. In 2000, 800,000 people died of measles worldwide, but by 2023, with aggressive vaccination campaigns, that number declined to 107,000, a reduction of 87 percent. The number of deaths from measles averted in that time is estimated to be over 60 million.

Children are particularly vulnerable. In Adam Ratner’s book, Booster Shots: the Urgent Lessons of Measles and the Uncertain Future of Children’s Health (discussed by Jerome Groopman in “Measles Gone Wild” in The New York Review of Books), explains why measles remains so deadly. “If a school teacher notices a measles rash on Friday, it likely has been spreading within the classroom since Tuesday. And spreading is what measles does best. Unless the kids in that class are protected by vaccination or have already had the measles, it is likely that more than 90 percent of them will be infected.” The polio virus can spread to 5-7 people from one person, similar to smallpox, but for measles that number is 12-18. Thus, a single child can spread measles to a dozen or more children very rapidly.

For children who do get measles and survive, even if they recover, their immune systems are weakened by the measles virus. This condition can persist for several years, leaving the victim subject to many potentially life-threatening infections. This period of increased vulnerability is called the “measles shadow.” Vaccinated children not only avoid getting the disease, they don’t get the shadow either.

Before the measles vaccine became available in the 1960’s, the disease infected more than half a million people in the United States alone, and killed hundreds of children each year. In 1966, a national eradication campaign was launched to vaccinate young children and institute school mandates. While the attempt to completely eradicate measles did not succeed, the program was very successful. Only 15 years after the eradication effort began, there were three deaths in the United States from measles. In 2021, there were none.

But now the disease is back in the United States. As of early June there are over 1,100 cases of measles across 34 states, resulting from 17 outbreaks. Why? Because of growing vaccine skepticism, with Robert F. Kennedy a major voice for years in fostering doubts about a vaccine that has saved millions. In 2015, when there was an outbreak of measles in California, Kennedy spoke against a bill in the legislature to mandate vaccination in schools, saying that the effects of vaccines on children amounted to a “holocaust.” Now, in 2025, as Secretary of HHS, he has attributed the current outbreak to poor nutrition and lack of physical exercise. He has recommended cod-liver oil, vitamin A, antibiotics, and steroids as treatments, although there is no scientific data saying they are effective for measles. He later relented after the number of cases in the U.S. grew so quickly, and said publicly that the vaccine is the best way to stop the measles. Still, he tries to “appeal to both sides: the public, which largely supports vaccination, and the anti-vaccine hard-liners who helped propel his rise.” He will recommend vaccines, then also say the vaccine has “problems” while posting photos with anti-vaccine activists who he calls “extraordinary healers,” and saying that, “We don’t know the risks of many of these products because they’re not safety tested.”

Kennedy was harmful enough when he was only a well-known charlatan with no responsibility. Now as the Secretary of HHS, with an even bigger microphone and a position of authority and power, he will have even bigger impacts on diminishing vaccination rates. “Hey, hey, RFK. How many kids did you kill today?” has already made its way into social media. It may soon be a refrain that accompanies the Secretary at his public appearances.

Moving Forward Backwards at HHS

The role that vaccines played in the reduction of preventable disease has been remarkable. In Groopman’s article, he also reviews So Very Small, by Thomas Levenson, who writes that, “In the first half of the 20^th century, major microbial diseases saw vaccines emerge. From the 1930s forward, a growing tally of viral pathogens were similarly tamed. Yellow fever…pertussis…More shots brought more diseases under control with each succeeding decade—perhaps most famously polio…and then measles, mumps and rubella by the end of the 1960s…These last seventy or eighty years are the only time in history in which humans—at least those in reach of adequate healthcare systems—have not had to fear the most prolific childhood killers.” Vaccinations have stopped the progression of numerous diseases that used to be widespread. What’s more, much of American society has developed “herd immunity.” When enough people are vaccinated, the disease cannot spread in a community because it has little opportunity to thrive.

The irony is that the success of vaccines seems to have impaired society’s collective memory. As the case rates and total numbers of cases have gone down, there has been less reason to think about childhood diseases and the imperative of vaccination. The country has let its guard down.

In the midst of this forgetfulness, the concerted efforts to delegitimize vaccinations have also been on the rise, seeking to convince people that life-saving vaccines are far worse than the diseases that took so many lives. Now RFK Jr. is indeed going “wild,” just as Donald Trump told him to do. With people in power who reject the advances that have made life for people so much better, outbreaks of preventable diseases may also go wild, causing much unnecessary suffering and death.