Vaccine Expert and Former CDC Advisory Committee Member on RFK Jr.’s Firings

Get stories like this delivered straight to your inbox. Sign up for The 74 Newsletter

Paul Offit knows vaccines. 

A trained doctor, he spent 26 years working in pediatric infectious disease and studying the rotaviruses before ultimately creating the strain that became the RotaTeq vaccine. That breakthrough saves 165,000 lives globally each year, he said, and has essentially eliminated the 70,000 annual U.S. hospitalizations caused by the contagious diarrhoeal virus common in young kids.

Now the director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, Offit also serves as a member of the Food and Drug Administration’s vaccine advisory committee. And about 20 years ago, he spent half a decade on the committee responsible for making recommendations on the safety, efficacy and clinical need for vaccines to the Centers for Disease Control and Prevention.

That committee, also known as the Advisory Committee on Immunization Practices, or ACIP, experienced an unprecedented upheaval earlier this month when Robert F. Kennedy Jr. fired all 17 advisory members via a Wall Street Journal op-ed — after promising he would leave the committee’s recommendations intact.

“The committee has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine,” wrote Kennedy, the head of the U.S. Department of Health & Human Services and a longtime vaccine skeptic.

In a statement released by HHS, Kennedy said he was “prioritizing the restoration of public trust above any specific pro- or anti-vaccine agenda,” and later promised via X that none of the replacement members would be “ideological anti-vaxxers.” Public health experts are now disputing that claim in light of his eight recent appointments.

“This is a slate that lacks a balanced viewpoint,” said Richard Hughes, a George Washington University law professor and leading vaccine law expert. “And it’s deeply concerning that many of them are outright anti-vaccine and have their own very concerning conflicts of interest, despite the fact that the secretary claims that he’s trying to avoid conflicts of interest on the committee.”

This could be particularly dangerous for children, some warn, as the committee’s recommendations often dictate which vaccines are covered by insurance and which are mandated for school-aged kids. Programs that provide free vaccines for kids could also see their funding cut.

The 74’s Amanda Geduld recently spoke with Offit to better understand the implications of the mass firing, what kids and their families can expect moving forward and how future administrations might work to rebuild trust in the public health vaccine system. 

This interview has been edited for length and clarity. 

The 74: Are you in touch with any of the folks who were fired from ACIP? If so, how did they receive that news and what was the mood among the members?

Offit: Well, they found out about it, typically, from reading the newspaper and learning that they had been fired from that position. The mood was one of sadness, because obviously there was no good reason to do it. 

The reason given by Robert F Kennedy Jr. was that all the members were horribly conflicted with pharmaceutical companies [and] that their financial ties to pharmaceutical companies made it such that they couldn’t give advice that would be beneficial to the American public, and that wasn’t true.

I mean, they have very strict conflict of interest rules at the ACIP whereby you have to make it very clear that you have no association with the pharmaceutical industry and no association with the government, which then allows you to be an independent advisor. And should there be a conflict … then you can’t vote on that company’s product, and you can’t vote on any product that that company makes. That’s very clear. That’s been clear ever since I was on the committee back 25 years ago.

So it sounds like there was confusion, disappointment and a feeling that the reasons given for the firing weren’t based in reality? 

They were angry. They were angry that they felt that they’d been dismissed for no good reason and that their willingness to serve the American public had been set aside. I mean, it’s not like you’re paid to do this. It’s just a voluntary position for the most part.

In your knowledge, has anything like this ever happened before?

No, but we’ve never had a secretary of Health and Human Services that was an anti-vaccine activist, science denialist and conspiracy theorist before.

Zooming out a little bit, what’s the significance of these firings? And what impacts can we anticipate?

I think we can anticipate that Robert F. Kennedy Jr. will put people on that committee who are like minded to him. We’re already seeing evidence of that with the first eight people that he picked. 

So I think what’s going to happen is that there are going to be groups that look elsewhere from the ACIP to try and get information that they think is reliable and up to date and informative. 

What I imagine is that, for example, the American Academy of Pediatrics has its so-called Red Book committee, or Committee of Infectious Diseases. I would imagine that that committee will start to speak with insurance companies to make sure that their recommendations would then have kind of the force of law … Because I can’t imagine the insurance companies are going to be looking to ACIP, given its current members.

My understanding is, up until this point, insurance companies and states — when they’re trying to determine school vaccination policies — have looked to ACIP for guidance. You’re saying that maybe insurance companies will look elsewhere for that information, but is there any concern that this will just mean vaccines are no longer covered by insurance, or that school-age vaccine policies are undermined altogether?

Yes, there’s concern, but it is to the financial advantage of insurance companies to pay for vaccines. I mean, you’d much rather pay for an HPV vaccine than to pay for the care of a woman who has cervical cancer. You’d much rather pay for a measles-containing vaccine than to pay for measles hospitalization.

It used to be that solid, good science was how we made decisions, and that's not true anymore.

Dr. Paul Offit

So there isn’t necessarily concern here that suddenly these vaccines won’t be accessible to families from lower-income backgrounds?

I don’t know. I mean, I think it’s a frantic, chaotic time, and it’s really hard to know. Everything that you sort of counted on to make sense doesn’t make sense anymore. 

It used to be that solid, good science was how we made decisions, and that’s not true anymore with the ACIP. You can tell when Robert F Kennedy Jr. says we want gold standard science, that’s not what he means. What he really means is he wants quote, unquote scientific studies that support his fixed, immutable belief that vaccines cause more harm than good.

In a post on X recently Kennedy wrote, “The most outrageous example of ACIP’s malevolent malpractice has been its stubborn unwillingness to demand adequate safety trials before recommending new vaccines for our children.” Has there been an unwillingness to demand adequate safety trials for new vaccines for children in America?

The opposite is true. I had the fortune of working with a team that created the rotavirus vaccine. Before that vaccine was put on the infant immunization schedule, it was tested in a prospective, placebo-controlled trial of more than 70,000 infants. It was done over four years in 11 countries to prove that that vaccine was safe and effective. That was a 70,000- person prospective, placebo-controlled trial that probably cost $350 million. 

I don’t know what he’s talking about. Name the vaccine. Name a new vaccine that hasn’t been tested in a large, prospective, placebo-controlled trial. They all are. 

The problem is that when they’re shown to work and they’re safe, he doesn’t believe it, because he’s a science denialist. That’s what he really means.

Are there any other ways this could impact school-aged kids in particular?

Now what worries me is, I think if RFK Jr. really wants to bring down vaccines, he can do it through the Vaccine Injury Compensation Program. What he could do is he could hold up a paper and say, “Look, aluminum adjuvants cause autism or multiple sclerosis or diabetes or asthma, and now I’m going to add that to the list of compensable injuries.”

So anybody with asthma who’s gotten a vaccine that contains an aluminum adjuvant — and there are seven different vaccines that contain aluminum adjuvants [an ingredient that helps create a stronger immune response] — is now on the list of compensable injuries. 

Or [he could say] “I’m going to take these vaccines out of the Vaccine Injury Compensation Program and then just subject them to civil litigation.” That would really disrupt vaccines in this country. I think companies would then do what they did in the 1980s … They’d leave the market. We had 18 companies that made vaccines in 1980. By the end of the decade, we only had four. 

So does that mean that while this ACIP move might introduce anger and distrust there are no real trickle-down effects that you think we’ll see yet in terms of what vaccines are available or what vaccines are covered?

I think you’ll know a lot when you watch the June [advisory committee] meeting, to hear that discussion, and to hear how pharmaceutical companies react to that discussion and how insurers react to that discussion. I think you’ll learn a lot in the next couple of weeks.

Can you tell me a little bit about the folks who replaced the 17 members? Eight people have been announced so far.

They’re who you would most fear. 

You have people like Robert Malone, who’s testified in front of Marjorie Taylor Green’s committees … that the mRNA vaccines cause cancer and heart disease and autoimmune disease. Robert Malone has been an expert witness on behalf of Robert F. Kennedy Jr. in a lawsuit against the mumps component of the MMR vaccine. 

You have somebody like Martin Kulldorff who has represented — been an expert witness for — Robert F. Kennedy Jr. in a lawsuit against Merck’s Gardasil [HPV] vaccine. 

You have people who have published papers claiming that the mRNA vaccines caused heart attacks and sudden death in healthy, young people. You have Vicky Pebsworth, who is a member of the National Vaccine Information Center, which is an anti-vaccine group that has lobbied against state vaccine mandates for years. 

This is exactly the cavalcade of stars that you would expect RFK Jr. to feel comfortable with: people who are — like him — anti-vaccine activists, who are science denialists. 

It’s the worst of all worlds. It’s like a bad Saturday Night Live skit.

During Kennedy’s HHS confirmation hearings back in January, Republican Sen. Bill Cassidy — a former physician — expressed a lot of trepidation around the nomination, but ultimately voted to confirm, citing various commitments he had received from the administration. One of those promises, Cassidy shared, was that “if confirmed [Kennedy] will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommendations without changes.”’

Critics have since argued that Kennedy’s move to fire all members amounts to a broken promise, a claim Cassidy himself has since disputed. Is this a broken promise?

He’s been breaking promises right from the beginning. I think Cassidy put out a list of 10 or so things [Kennedy] promised he wouldn’t do. And he proceeded to do it.

I’m reading: He has committed that he would work within current vaccine approval on safety monitoring systems. That he hasn’t done. 

He’ll maintain the CDC Advisory Committee Immunization Practices recommendation without changes, and he hasn’t done that either. 

He’s already, for example, changed the recommendation on pregnancy, changed the routine recommendation for young children to get COVID vaccines. And now Cassidy also put out a tweet saying that for those of you who think [Kennedy] may just put vaccine skeptics on [the committee], he’s not gonna do that. Then he proceeds to do that. 

What Cassidy does is he draws a line. He says, “Don’t cross this line.” Then Kennedy crosses the line, and he doesn’t do anything — just draws another line. I think he is weak and ineffectual. And I think his legacy will be the harm that’s caused to children and adults in this country because of this massive disruption of the public health vaccine system. I think that will be Sen. Cassidy’s legacy.

Have you spoken to Sen. Cassidy? If you could speak to him today, what would you say to him?

I spoke to him four times before that second confirmation hearing, and once afterwards. I said to him exactly what you would think I would say to him, which is, “Don’t hire this guy. Listen to Caroline Kennedy. She knows. She told you exactly who he is.”

It’s really frustrating. I was sure [Cassidy] was a “no” vote. He clearly had problems with him. But in the end, politics trump science. I think when you mix politics and science, you always get politics.

[Cassidy did not immediately respond to The 74’s request for comment.]

My last question is around this idea of trust. Kennedy has said that he removed all these members and is replacing them in response to a “crisis of public trust.” On the other side, there are folks who do not at all trust Kennedy. Looking forward, what will it take to rebuild trust in these systems?

I think there was a tremendous loss of trust in the first two years of the pandemic … I think people saw [many COVID-era policies as] a real impingement on their freedom, and that’s what you’re seeing now. 

I think that RFK Jr. represents the disdain that people ended up having for the CDC and for Dr. Fauci, unfortunately. I think that’s what happened …To the point that there were states that were trying to ban mRNA vaccines. The term “mRNA vaccines” has become a dirty word, even though it probably saved 3 million lives and probably cost more than 250,000 people their lives when they chose not to get the vaccine. But somehow that all got linked with sort of stepping on our medical freedom, and that’s what you’re seeing now. 

So what’s it going to take to get that back? I think slowly, we’re just going to have to make sure that we — as scientists and clinicians and academicians and public health people — explain in careful detail why we do everything.

But public health is also about the public. I mean, you have to care about your neighbor in order to have public health. I think right now, we’re sort of at a point where people go, “Don’t tell me what to do. If I want to catch and transmit a potentially fatal infection, that’s my right.” And I don’t think we used to be like that.

Is there anything else I haven’t asked you that you want readers to understand, specifically through an education- and child-centered lens?

What’s that line from Bette Davis in All About Eve? “Buckle up. It’s going to be a bumpy night” — although everybody says bumpy ride.  …

I think it is going to be a bumpy ride for a while, and then we’ll just see. I believe that the forces of good will prevail. I do. 

I think that there’s a basic feeling among virtually everyone that vaccines are a good thing, and that as people see them erode or maybe become less available or less affordable or more feared that people will rally on behalf of children. I do.

Get stories like these delivered straight to your inbox. Sign up for The 74 Newsletter