In discussing Trump, the subject of his HHS appointee, Robert Kennedy Jr, came up. Kennedy is widely regarded as ‘antivax’ – a term regarded as pejorative by Bill Cole, although I argue that it is not inherently so. I use it to describe a person or organisation that campaigns against some or all vaccines. It’s descriptive, not pejorative. Of course, since many people have rather a low opinion of such campaigners, it becomes a pejorative. In similar fashion, “flat-earther” is both descriptive and pejorative. I would be happy to be advised of a non-pejorative synonym.

So, does RFK oppose some or all vaccines? Quite clearly, yes. So by my definition, he’s antivax. My usage here does not apply to someone who makes a personal choice not to get a particular or any vaccine. I am in favour of free choice, and someone choosing to reject a vaccine for themselves or their children is not (necessarily) opposing vaccination. The key point lies in the persuasion of others. I also would exclude people who oppose mandates. In the UK, no vaccines are mandated; it is different in the US, and there is considerable variation globally. So it is possible (though rare) for people to campaign against mandates without necessarily being ‘antivax’ as defined. The recent push by Florida Surgeon-General Joseph A. Ladapo to remove mandates is an interesting case study. It would essentially just make Florida equivalent to the UK, hardly something I should find inherently objectionable – and yet, because of Ladapo’s clear opposition to vaccination, earning a rebuke from the CDC and FDA, he isn’t the exception to the rule that mandate opponents are usually antivax. For my part, though I’m inclined to oppose mandates, I live in a country that does not have them, so it’s not a fight I can be bothered pursuing!

Supporters of RFK argue that “he’s not antivax, he just wants better studies” (as if there are those who want worse ones!). This is somewhat deceptive. Does RFK want

a) More people to be vaccinated

b) The same number to be vaccinated

c) fewer to be vaccinated.

?

Clearly, the answer is c. Kennedy’s campaigning deliberately sows mistrust of vaccines, and the guise of ‘pro-choice’ clearly contains the cryptic desire that the choice will be made in the negative. It goes beyond mere concern about specific additives: campaigning does not stop when formulations change; there’s always something else. He founded Children’s Health Defense, nominally a ‘nonprofit’ (from which Grok reports he has pocketed over $2 million). In the shop one can buy these nice baby onesies. Nothing says “not antivax” quite like parading “Unvaxxed. Unafraid” on your kid’s chest, eh? In a weirdly meta move, the same page lists adult t-shirts expressing support for the onesie – it even terms it ‘onesiegate’, as if there has been some furore.

He says his initial inspiration was from so-called ‘mercury moms’, convinced that their children’s autism was linked to mercury in vaccines. This keyed into his environmental activism; a less controversial topic. The autism-vaccine story dates back to Andrew Wakefield. Despite subsequent retraction and the striking-off of Wakefield from the medical register, this link has lodged firmly and unshakeably in the minds of activists. This hits close to home: influenced by some vegan friends (nothing wrong with veganism, but it seems to provide some correlation with ‘holistic’ approaches) my wife refused to have our 3rd child vaccinated by MMR, causing some argument. She relented, and in any case as a nurse my daughter was obliged to be up to date on all vaccines.

Extensive study has failed to find a link. But still it won’t lie. Kennedy announced that he would have an answer ‘by September’, appointing David Geier, a non-medic with no apparent grounding in evaluation of scientific studies who has long believed in the vaccine-autism link, to investigate autism. “Gosh, I wonder what he’ll find?”, the cynic in me mused. Well, apparently it’s Tylenol (Paracetamol in the UK) use in pregnancy. I haven’t seen the data, but this seems bizarre. Can we now expect a statement from CHD that they were wrong all along? I doubt it. Thimerosal (or thiomersal) stopped being used in most cases in 1999. Did autism cease or decline? It did not.

Kennedy has long campaigned against Gardasil. This is a vaccine against Human Papilloma Virus, a significant cause of cancers in girls and young women, Gardasil is nearly 100% effective in eliminating these cancers. Yet it would appear that Kennedy does not want girls to get it. The reason being the possibility of side effects. This is classically antivax, where relatively minor side effects are amplified over the devastation of the disease itself. Personally, I’d rather my girls avoided cancer. That’s just me.

Kennedy has ceased funding for mRNA vaccine technology, based upon what appears to be simply an opinion that traditional vaccines (eg inactivated whole-virus) have a better safety and efficacy profile. Yet during the evaluation of multiple platforms dusing 2020, mRNA and DNA vaccines consistently outperformed inactivated candidates. mRNA may have been over-hyped in some quarters. Many respiratory viruses tend to evolve faster than (say) measles, whose formulation has remained unchanged for years. This means that they can evade the immunity provided against the variant they were developed against. Antibodies can also wane with time. Note that this immune evasion and waning apply to infection-acquired immunity as much as vaccination: the same epitopes are involved. This is why we get colds most years, and flu.

The effectiveness of the vaccines has also declined due to a rise in the population of infection immunity. A vaccine 95% effective compared to an immune-naive population will seem much less effective when measured against a population that has had widespread infection, even if there is no viral evolution or waning of antibodies in the vaccinated. People are misinterpreting these findings to assert that mRNA vaccines are ‘useless’. They are not. Don’t let the perfect be the enemy of the good, as the saying goes.

Additional fuel is given by lurid amplification of the safety profile. mRNA vaccines are supposed to be responsible for a mechanistically implausible array of conditions – cancers, heart disease, fertility, neural issues. Yet there is virtually no mechanism of harm that can be exploited by mRNA that does not also apply to infection. Plus, there are many avenues of harm that only infection can account for. No-one ever needed a lung transplant after vaccination, but they sure did after infection. Likewise a friend of mine had his pancreas destroyed by Covid, and became diabetic almost overnight. Amateur analyses of VAERS and Yellow Card abound. People imagine that, if something has been reported to VAERS, vaccine is definitely causal. It really isn’t that simple. You need to know background rates in the unvaccinated to make any kind of comparison. VAERS is highly reported because the vaccine is widespread, and VAERS widely publicised. We want VAERS reports. But we can do without ill-informed amateur analysis. Imagine there were an equivalent CAERS system that was as well-used to report Covid adverse effects. People are inclined to discount Covid when looking for cause, but hyper-primed to blame vaccine.

In reality, the safety profile of mRNA vaccines appears to be excellent. In the UK, we started with the AstraZeneca vaccine, a viral vector DNA vaccine (like Johnson&Johmson). The vector sends the DNA into the nucleus where it is transcribed to RNA to be translated to Spike protein in the cytoplasm. This contrasts with mRNA which is brought directly into the cytoplasm by the lipid nanoparticle (LNP). Sadly, some 50 deaths have been registered as due to this vaccine, and it has been associated with clotting issues, particularly in women. So we switched to mRNA vaccines from Pfizer and Moderna; very few deaths have since been reported. This is not to say there are no issues with mRNA. Stimulating the immune system (by vaccine or by infection) can have adverse consequences. A friend of mine suffered a debilitating fever for months. But this is not the norm. People often try and blame the LNP or the pseudouridine that is used in the RNA, but since these are absent in DNA vaccines with worse safety, it seems unlikely that these are involved.

The main issue with mRNA appears to be myo-and pericarditis in young men. From the vaccine, this occurs at a rate of about 1 in 10,000 – but from infection, the rate is about 20 times higher. Additionally, vaccine myocarditis tends more to be milder and self-resolving. Critics say the vaccine was ‘rushed’ – if we’d taken more time, we’d have found these issues. But we wouldn’t. A trial of 45,000 people (a very large trial) is insufficient to find an event less frequent than about 1 in 7,500 with 95% confidence, however long you look. This is the ”rule of 3″ with 22,500 in the treatment arm. Additionally, the longer a trial goes on, the less of a control the control group becomes. If a vaccine has any effectiveness at all, you get more infection in the control group, introducing a growing confounder.

The big advantage of mRNA is in fact its speed. You can design an antigen in a few hours, once you have the genetic sequence (again, takes a couple of hours). You can scale up to produce that RNA very quickly. Even Robert Malone, whose bitterness appears to cloud his judgement, was once an advocate of the rapid scaling of nucleic acid technology. By contrast, it takes about a year to develop an updated flu vaccine, not because people spend hours stroking their beards waiting for people in trials to die, but because it takes about 6 months to inject the new variant into chicken eggs and scale up production.

The pandemic response was a triumph; the mRNA vaccine has saved many lives – but Kennedy, with as straight a face as he can muster, told Congress that “no-one knows” if it saved any lives. This is at odds with the facts. Additionally, his vaccine-skeptic appointees Makary and Prasad have indicated that they want placebo-controlled trials before any updated formulation is marketed. This is in contrast to flu, and indeed placebo trials are considered unethical when a safe and effective treatment is already available. Who is even going to volunteer for such a trial? A vaccine skeptic wouln’t touch it with a bargepole; a pro-vaccine individual would just get the current candidate (if they can) rather than risk placebo. There are not 45,000 public-spirited individuals available any more, nor the money to pay them, nor a sufficiently widespread disease to reach endpoints quickly.

The whole Covid minimisation/vaccine skepticism movement seems to skew quite far to the Right. Trump is actually a notable exception, though God knows what he was thinking when he appointed Kennedy. But it seems as if there is a straight line from libertarian resentment of Covid measures to regarding the whole thing – including that which helped end those measures – as a bit overblown, or even a massive hoax. Many have decided that the ‘Covid hoax’ is part of a bigger hoax to persuade us that viruses are real! Beyond that, some even deny molecular biology – DNA is a hoax, and as for ribosomes…. Well, my daughter was on the front line, a doctor on Respiratory when the pandemic hit. She watched people die, “drowning in their own body fluids”. She lost a colleague to Covid, a respected and loved consultant, who caught it working on the wards. She is in no doubt that the vaccines were an absolute game-changer in keeping people out of hospital.

How can we improve the safety profile, or the efficacy, if we don’t research? How can we prepare for the next pandemic? Certainly, we cannot look to the US for leadership right now.

Next pandemic – inevitably, there will be one – we can be assured that a bunch of people will try and blind themselves to the reality; will picket hospitals, even call for people like my daughter to be hanged as part of a fantasised “Nuremberg 2.0” as being directly responsible for the deaths. That’s the arse-end of antivax, of course. It’s a spectrum. I don’t mean to tar every antivaxxer with the same brush when I use the term. But the reasoning is the same, the confirmation bias, the authority arguments, the teeth-grinding ineptness with statistics, the conspiracism, the talking points, the misunderstandings… it all gets depressingly samey after a while.