‘I'm Not Quite Sure How to Respond to This Presentation'

The Atlantic

11 hours ago

The past three weeks have been auspicious for the anti-vaxxers. On June 9, Health Secretary Robert F. Kennedy Jr. purged the nation's most important panel of vaccine experts: All 17 voting members of the CDC's Advisory Committee on Immunization Practices (ACIP), which sets recommendations for the use of vaccines and determines which ones must be covered through insurance and provided free of charge to children on Medicaid, were abruptly fired. The small, ragtag crew of replacements that Kennedy appointed two days later met this week for the first time, amid lots of empty chairs in a conference room in Atlanta. They had come to talk about the safety of vaccines: to raise concerns about the data, to float hypotheses of harm, to issue findings.
The resulting spectacle was set against a backdrop of accelerating action from the secretary. On Wednesday, Kennedy terminated more than $1 billion in U.S. funding for Gavi, a global-health initiative that supports the vaccination of more than 65 million children every year. Lyn Redwood, a nurse practitioner and the former president of Children's Health Defense, the anti-vaccine organization that Kennedy used to chair, was just hired as a special government employee. (She presented at the ACIP meeting yesterday.) A recently posted scientific document on the ACIP website that underscored the safety of thimerosal, an ingredient in a small proportion of the nation's flu vaccines, had been taken down, a committee member said, because the document 'was not authorized by the office of the secretary.' (A spokesperson for the Department of Health and Human Services told me in an email that this document was provided to the ACIP members in their meeting briefing packets.)
What's clear enough is that, 61 years after ACIP's founding, America's vaccination policy is about to be recooked. Now we've had a glimpse inside the kitchen.
The meeting started with complaints. 'Some media outlets have been very harsh on the new members of this committee,' said Martin Kulldorff, a rangy Swedish biostatistician and noted COVID contrarian who is now ACIP's chair. (Kuldorff was one of the lead authors of the Great Barrington Declaration, a controversial proposal from the fall of 2020 to isolate seniors and other vulnerable people while reopening the rest of society.) In suggesting that he and Kennedy's other appointees are opposed to vaccination, Kulldorff said, journalists were misleading the public, weakening trust in public health, and fanning 'the flames of vaccine hesitancy.'
This was, in fact, the most pugnacious comment of the two-day meeting, which otherwise unfolded in a tone of fearmongering gentility. Robert Malone, a doctor and an infectious-diseases researcher who has embraced the 'anti-vaccine' label and published a conspiracy-theory-laden book that details government psyops against the American people, was unfailingly polite in his frequent intimations about the safety of vaccines, often thanking CDC staff for their hard work and lucid presentations. With his thick white beard, calm affect, and soldierly diction—Malone ended many of his comments by saying, 'Over' into the microphone—he presented less as a firebrand than as, say, the commanding officer of a submarine.
When Malone alluded to the worry, for example, that spike proteins from the mRNA-based COVID vaccines linger in the body following injection, he did so in respectful, even deferential, language, suggesting that the public would benefit from greater study of possible 'delayed effects' of immune-system activation. The CDC's traditional approach—its 'world-leading, rigorous' one, he clarified—might be improved by examining this question. A subject-matter expert responded that the CDC has been keeping tabs on real-world safety data on those vaccines for nearly five years, and has not detected any signs of long-term harm.
Later, Malone implied that COVID or its treatments might have, through some unspecified, bank-shot mechanism, left the U.S. population more susceptible to other illnesses. There was a 'paradoxical, sudden decrease' in flu cases in 2020 and 2021, he noted, followed by a trend of worsening harm. A CDC staffer pointed out that the decrease in flu during those years was not, in fact, a paradox; well-documented shifts in people's health behavior had temporarily reduced the load of many respiratory illnesses during that same period. But Malone pressed on: 'Some members of the scientific community have concern that they're coming out of the COVID pandemic—exposure to the virus, exposure to various countermeasures—there may be a pattern of broad-based, uh, energy,' he said, his eyes darting up for a moment as he said the word, 'that might contribute to increased severity of influenza disease.' He encouraged the agency to 'be sensitive to that hypothesis.'
Throughout these and other questions from the committee members, the CDC's subject-matter experts did their best to explain their work and respond to scattershot technical and conceptual concerns. 'The CDC staff is still attempting to operate as an evidence-based organization,' Laura Morris, a professor at the University of Missouri School of Medicine, who has attended dozens of ACIP meetings in the past and attended this one as a nonvoting liaison to the committee from the American Academy of Family Physicians, told me. 'There was some tension in terms of the capacity of the committee to ask and understand the appropriate methodological questions. The CDC was trying to hold it down.'
That task became more difficult as the meeting progressed. 'The new ACIP is an independent body composed of experienced medical and public health experts who evaluate evidence, ask hard questions, and make decisions based on scientific integrity,' the HHS spokesperson told me. 'Bottom line: this process reflects open scientific inquiry and robust debate, not a pre-scripted narrative.' The most vocal questioner among the new recruits—and the one who seemed least beholden to a script—was the MIT business-school professor Retsef Levi, a lesser-known committee appointee who sat across the table from Malone. A scruffy former Israel Defense Forces intelligence officer with a ponytail that reached halfway down his back, Levi's academic background is in data modeling, risk management, and organizational logistics. He approached the proceedings with a swaggering incredulity, challenging the staffers' efforts and pointing out the risks of systematic errors in their thinking. (In a pinned post on his X profile, Levi writes that 'the evidence is mounting and indisputable that mRNA vaccines cause serious harm including death'—a position entirely at odds with copious data presented at the meeting.)
Shortly before the committee's vote to recommend a new, FDA-approved monoclonal antibody for preventing RSV in infants, Levi noted that he'd spent some time reviewing the relevant clinical-trial data for the drug and another like it, and found some worrying patterns in the statistics surrounding infant deaths. 'Should we not be concerned that maybe there are some potential safety signals?' he asked. But these very data had already been reviewed, at great length, in multiple settings: by the FDA, in the course of drug approval, and by the dozens of members of ACIP's relevant work group for RSV, which had, per the committee's standard practice, conducted its own staged analysis of the new treatment before the meeting and reached consensus that its benefits outweighed its risks. Levi was uncowed by any reference to this prior work. 'I'm a scientist, but I'm also a father of six kids,' he told the group; speaking as a father, he said, he personally would be concerned about the risk of harm from this new antibody for RSV.
In the end, Levi voted against recommending the antibody, as did Vicky Pebsworth, who is on the board of an anti-vaccine organization and holds a Ph.D. in public health and nursing. The five other members voted yes. That 5–2 vote aside, the most contentious issue on the meeting's schedule concerned the flu shots in America that contain thimerosal, which has been an obsession of the anti-vaccine movement for the past few decades. Despite extensive study, vaccines with thimerosal have not been found to be associated with any known harm in human patients, yet an unspecified vote regarding their use was slipped into the meeting's agenda in the absence of any work-group study or presentation from the CDC's staff scientists. What facts there were came almost exclusively from Redwood, the nurse who used to run Kennedy's anti-vaccine organization. Earlier this week, Reuters reported that at least one citation from her posted slides had been invented. That reference was removed before she spoke yesterday. (HHS did not address a request for comment on this issue in its response to me.)
The only one of Kennedy's appointees who had ever previously served on the committee—the pediatrician Cody Meissner—seemed perplexed, even pained, by the proceedings. 'I'm not quite sure how to respond to this presentation,' he said when Redwood finished. He went on to sum up his concerns: 'ACIP makes recommendations based on scientific evidence as much as possible. And there is no scientific evidence that thimerosal has caused a problem.' Alas, Meissner's warnings were for nought. Throughout the meeting, he came off as the committee's last remaining, classic 'expert'—a vaccine scientist clinging to ACIP's old ways—but his frequent protestations were often bulldozed over or ignored. In the end, his was the only vote against the resolutions on thimerosal.
Throughout the two-day meeting, Kuldorff kept returning to a favorite phrase: evidence-based medicine. 'Secretary Kennedy has given this committee a clear mandate to use evidence-based medicine,' he said on Wednesday morning; 'The purpose of this committee is to follow evidence-based medicine,' he said on Wednesday afternoon; 'What is important is using evidence-based medicine,' he said again when the meeting reached its end. All told, I heard him say evidence-based at least 10 times during the meeting. (To be fair, critics of Kuldorff and his colleagues also love this phrase.) But the committee was erratic in its posture toward the evidence from the very start; it cast doubt on CDC analyses and substituted lay advice and intuition for ACIP's normal methods of assessing and producing expert consensus. 'Decisons were made based on feelings and preferences rather than evidence,' Morris told me after the meeting. 'That's a dangerous way to make public-health policy.'