Robert F. Kennedy Jr. will likely have a tremendous impact on public health in America for the next four years, given his nomination to serve as the Secretary of Health and Human Services under president-elect Donald Trump. The president-elect has said he would let Kennedy "go wild on health."
Of particular concern are his views on vaccines, which could lead to enormous health disparities across the United States.
RFK is a known vaccine skeptic and has repeatedly claimed childhood vaccines can lead to autism. This association has not been proved to be true based on evidence-based studies. Childhood vaccination rates,which have already declined in the last several years due to misinformation, vaccine hesitancy and access issues will likely get worse if RFK continues to cast doubt on their efficacy.
The decline in childhood vaccination rates threaten herd immunity and will ultimately allow diseases that were thought to be eradicated to reappear. This is already happening in some cases, such as with measles. The disease was declared to be eradicated by the United States in 2000, but because of falling vaccination rates among children, 283 cases of Measles have already been documented throughout the country, and the majority within unvaccinated children according to the CDC.
Many if not all of these cases could be prevented with childhood vaccinations and with herd immunity. Herd immunity refers to the protection conferred upon a population against contagious diseases when a certain percentage of a population is protected against a disease through vaccination or prior exposure. For measles, this requires a vaccination rate of 95%.
RFK's rhetoric on vaccines will undoubtedly lead to more vaccine hesitancy among Americans, which will invariably threaten herd immunity. Americans that will suffer most from a lack of herd immunity are those that are less likely to receive vaccines or those who do not benefit optimally from vaccines because of compromised immune functions. These people include underserved populations such as those living in rural areas where access to vaccines can be challenging, Black and Hispanic Americans who already have disproportionately lower rates of vaccination compared to White Americans and those who are uninsured and cannot afford vaccines. CDC data shows that these groups already have lower vaccination rates compared to many other Americans.
In addition, patients with compromised immune function like those with HIV or cancer patients will also be affected by decreasing herd immunity, because their bodies may not mount an appropriate immune response to vaccines even if they are vaccinated. This means that as vaccination rates for certain diseases fall in America, these patients will suffer most because they are more likely to get infected and even hospitalized as diseases spread.
Declining vaccination rates and herd immunity will invariably affect vulnerable populations, which will worsen health disparities and inequities that already exist for those that cannot get vaccinated or mount an appropriate response to vaccination. This means they will get sicker and potentially suffer complications from various diseases. In the case of measles, this could include getting pneumonia, swelling of the brain and even death.
Even beyond vaccines, RFK's views and potential policies on fluoride in public water will also worsen health inequities. On his social media X account, Kennedy wrote, "On January 20, the Trump White House will advise all U.S. water systems to remove fluoride from public water." Fluoride is known to prevent and protect individuals from dental caries and tooth decay. Fluoride reduces tooth decay by 25% in children and adults according to the American Dental Association.
Removing fluoride from public water supplies could result in a large increase in oral cavities across America. Furthermore, those that are likely to suffer most are those who cannot afford going to a dentist, those that live in rural areas that may not be able to access dental offices easily as well as underserved communities that do not have the luxury to purchase fluoridated water. Research has shown that water fluoridation not only decreases cavities, but also decreases socioeconomic health inequalities on oral health.
In the modern era where medical misinformation runs rampant, public health officials that rely and lead by evidence-based practices are necessary to safeguard the health for all Americans. To make America healthy again, we must never forget about the millions of Americans that are underserved and have limited access to health resources.