“Just when I thought I was out… they pull me back in.”
Michael Corleone in The Godfather, Part 3
This is one of those weeks when I feel obligated once again to begin my post with this little clip from The Godfather, Part 3, in which Michael Corleone laments:
I totally felt this as I sat down to write this week’s post. After having just last week posted the sixth part of my series, RFK Jr. Is Definitely Coming for Your Vaccines, I had been hoping to go at least a few weeks—or even a couple of months!—without succumbing to feeling the horrible, irresistible need to write a seventh segment in the series, but, damn, the Trump administration and its Secretary of Health and Human Services, antivax activist Robert F. Kennedy Jr., just couldn’t let me go anywhere near that long. As much as I tried to force myself to write about the shitstorm that the NIH has become in light of a recent story in Nature (maybe next week or as an inaugural post to resurrect my not-so-secret other blog, as I’ve been hoping to do early in 2026), I kept coming back to this story in STAT News last week:
There is SO MUCH STUFF to dissect in this article.
Discuss.
www.statnews.com/2026/01/22/v…
[image or embed]
— Megan Ranney MD MPH (@meganranney.bsky.social) January 23, 2026 at 8:57 AM
And then there was this story published in the New York Times on Friday: Rejecting Decades of Science, Vaccine Panel Chair Says Polio and Other Shots Should Be Optional. Suffice to say, I succumbed and let the darkness flow over me and in me. I had to write about this again, and what better way to do it than as part seven of this series?
And, yes, I know that it is the Trump administration that is behind all this and that there would be an attack on public health and science no matter who was in charge of HHS. However, once again I will argue that, absent RFK Jr. as HHS Secretary, there would not be this monomaniacal focus on eliminating as many vaccines as rapidly as possible and reducing and destroying access to as many vaccines as possible as rapidly as possible. The reason? Anyone else appointed to be HHS Secretary would enthusiastically attack science and public health, but every candidate I’ve looked at who might plausibly have been appointed to helm HHS (or might be appointed to replace RFK Jr., should he finally flame out by annoying Trump too much) is not a fanatical antivaxxer who has been working to undermine confidence in vaccines and eliminate vaccines for over two decades. For any other HHS Secretary under Trump, the antivax would be just subsumed into the broader anti-science and anti-public health portfolio that the administration wants, just one part of many, rather than the primary focus.
Moving on, though, that’s not all there is to cover in RFK Jr.’s ongoing quest to eliminate vaccines. Over at The Defender, the “news” part of Children’s Health Defense, the antivax organization founded by RFK Jr. and whose leadership RFK Jr. only left after he had decided to run for President, which led to him eventually bending the knee to then-candidate Donald Trump in return for the power to destroy public health in this country as President Trump’s instrument, antivaxxers are exulting, Children’s Health Defense Hits AAP With RICO Suit Over Fraudulent Vaccine Safety Claims.
And that’s still not all! Over at her Substack, antivax “journalist” Maryanne Demasi is beside herself with excitement because, as I have long predicted (and the mention of polio aside), the next target for the newly antivax CDC after the birth dose of the hepatitis B vaccine is going to be the human papilloma virus (HPV) vaccine, primarily Gardasil in this country: ACIP puts HPV vaccine back under the microscope, 20 years after approval. Remember Retsef Levi, the utterly unqualified and incompetent operation management professor who thinks he knows vaccines, public health, and infectious disease? According to Demasi, “MIT professor Retsef Levi will lead a new workgroup to re-examine the HPV vaccine, including its effectiveness, dosing, safety, and long-term population outcomes.”
What’s wrong? Was Mark Blaxill not available?
Remember how I said last week that RFK Jr.’s edict that slices six vaccines off the US CDC-recommended vaccine schedule, using the excuse that he was aligning the US schedule with that of Denmark, if for no other reason than that Denmark vaccinates against the fewest diseases of any European Union country? (Really, that is the only reason, all the bloviating and pontificating about “best practices” notwithstanding.) And remember how I discussed how RFK Jr. was going to try to bankrupt the Vaccine Injury Compensation Program (VICP) in order to take the US back forty years, when a flood of pseudoscience-based lawsuits against vaccine manufacturers over the DPT vaccine legitimately endangered access to vaccines in the US, leading Congress and the Reagan administration to pass the National Childhood Vaccine Injury Act of 1986 to create the VICP? Well, here we go. The next steps are coming fast and furious.
Let’s start out with the RICO lawsuit, because it will be the quickest to deal with, and then I’ll proceed to discuss Levi’s impending attempt to engage in some policy-based evidence making in order to lay the groundwork for eliminating HPV vaccines, followed lastly by Dr. Milhoan’s, “What, me worry?” attitude about polio and other vaccine-preventable diseases?
RICO vs. the American Academy of Pediatrics
In discussing the RICO lawsuit that RFK Jr.’s CHD is bringing against the American Academy of Pediatrics (AAP), I’m not going to cite The Defender. Rather, I will cite Walker Bragman’s post in Important Context, RFK Jr.‘s Former Anti-Vax Org Launches RICO Suit Against Leading Pediatrics Group:
Children’s Health Defense, the anti-vaccine advocacy group founded by Health and Human Services Secretary Robert Kennedy Jr., has filed a racketeering lawsuit against the American Academy of Pediatrics.
The suit alleges that the 67,000-member AAP—the nation’s largest pediatric medical trade group—engaged in a conspiracy to mislead the public about the safety of the childhood and adolescent vaccine schedule while taking donations from vaccine manufacturers for its charitable efforts. The case comes as the AAP and other medical organizations are embroiled in their own federal court lawsuit against Kennedy and HHS over changing vaccine recommendations.
In an amended complaint filed Monday, the AAP alleges that the recent updates to the U.S. childhood and adolescent vaccine schedule were made “without following the evidentiary-driven, and legally required processes for issuing recommended vaccine schedules in the United States.”
RICO, you might recall, stands for the Racketeering Influenced and Corrupt Organizations Act, the law upon which RICO lawsuits are based. The RICO Act allows for extended criminal penalties and a civil cause of action for acts performed as part of an ongoing criminal organization. Now, you might ask: WTF? After all, the AAP is not a criminal organization under any sane interpretation of law. I realize that I said I wouldn’t quote from CHD, and I shouldn’t have to. The “reasoning” behind the lawsuit, such as it is, is accurately described above, namely that the AAP is supposedly involved in a “criminal conspiracy” to mislead the public. However, to see just how ridiculous this lawsuit is in a manner that even non-lawyers like me can understand it, I find it useful to cite this one passage:
The suit alleges that the AAP violated the Racketeer Influenced and Corrupt Organizations Act (RICO) by making “false and fraudulent” claims about the safety of the Centers for Disease Control and Prevention’s (CDC) childhood immunization schedule — while receiving funding from vaccine manufacturers and providing financial incentives to pediatricians who achieve high vaccination rates.
“For too long, the AAP has been held up on a pedestal, as if it were a font of science and integrity,” said CHD CEO Mary Holland. “Sadly, that’s not the case.”
Instead, Holland said, the AAP “is a front operation in a racketeering scheme involving Big Pharma, Big Medicine and Big Media, ready at every turn to put profits above children’s health. It’s time to face facts and see what the AAP is really about,” Holland said.
According to the complaint, the AAP has worked to conceal the findings of studies that the Institute of Medicine (IOM) — now known as the National Academy of Medicine — published in 2002 and 2013.
The IOM called for more research after concluding that no studies had ever been conducted to compare the health outcomes of vaccinated and unvaccinated children.
The AAP’s conduct constitutes a pattern of fraud under RICO, a statute often used to prosecute organized crime, said Rick Jaffe, attorney for the plaintiffs.
Jaffe told The Defender that while previous lawsuits “challenged individual vaccines or sought compensation for individual injuries,” this “is a fraud case following the playbook that took down Big Tobacco.”
“The AAP’s actions parallel those of Big Tobacco, which misled the public regarding the safety of its products,” Jaffe said. “Tobacco created false uncertainty to manufacture doubt. The AAP did the inverse — it created false certainty to foreclose questions. Both used the trappings of science to prevent actual science.”
You might recall from previous posts dating back years that Rick Jaffe is most notorious for having served as attorney for Houston cancer quack Stanislaw Burzynski, at least until Burzynski stiffed him for $250,000 in legal fees. Indeed, he is the one who came up with the idea of having Burzynski register dozens of useless clinical trials to bypass FDA action against his quackery in the 1990s. In addition, Jaffe has long been one of the go-to lawyers for the quacks, grifters, and charlatans in the “health freedom” movement.
Let me just say two things here. Although I can’t prove it, I do believe that there’s no way CHD would have filed a lawsuit like this without RFK Jr.’s approval—or even in response to his behind-the-scenes outright “suggestion” to do so. Given that CHD is RFK Jr.’s group, long led by him, I really have a hard time believing that it isn’t still under his control, for the most part. Having CHD sue the AAP at this time in such a ridiculous fashion serves RFK Jr. well, too, forcing the AAP to waste legal resources defending this suit instead of investing them in the legitimate lawsuit against HHS for “making the US Denmark” (in terms of vaccines) without evidence and without having followed the steps required by law to do so. As Bragman notes, through its lawsuit, the AAP is “seeking to block the schedule changes, invalidate ACIP on the grounds that its new members were unlawfully appointed, and overturn its previous recommendations,” while CHD’s lawsuit is trying to frame “these efforts as attempts by AAP to derail Kennedy’s ‘reform’ of the childhood immunization schedule.”
The CHD lawsuit alleges a lot of wrongdoing that is basically a litany of antivax tropes and talking points. I mean, seriously, the CHD lays down a truly stinky turd of a claim by trying to argue that the AAP’s claims about vaccine safety rest on a “foundational fraud,” which, according to antivaxxers, is a 2002 article by pediatrician Dr. Paul Offit, published in the journal Pediatrics, which is misrepresented as claiming that infants can “theoretically” receive up to 10,000 vaccines at once without posing a health risk. Longtime readers might recognize that claim for the BS that it is. In the article, Dr. Offit did some calculations and stated that theoretically a baby’s immune system can handle up to 10,000 vaccines at one time. Theoretically. In reality, the overall argument in the paper was that today’s vaccines contain many fewer antigens per vaccine and that, although infants receive more vaccines, their immune system deals with many fewer antigens as a result of vaccination than in years past, when vaccines tended to be whole organism-based, rather than carefully selected protein antigen-based. In addition, he pointed out how infant immune systems deal with thousands of antigens a day. A lay-friendly version of Dr. Offit’s actual argument can be found in a 2018 AAP post entitled Too many vaccines? What you should know. The CHD argument is bullshit, pure and simple, and that’s putting it mildly. (Regular readers know that I seldom use four-letter words here, but if any argument deserved it, this CHD argument does.)
The CHD then goes on to claim that AAP used Dr. Offit’s estimate from 24 years ago to block efforts to study the vaccine schedule. Really? Given the number of studies of the vaccine schedule that I’ve seen over the years—all of which, other than “studies” done by antivaxxers—have supported the conclusions that vaccines in the schedule as administered are safe and effective. More predictably, CHD cites “studies” by antivaxxers about whom I’ve written a number of times before, including supplement-hawking former cardiologist Dr. Peter McCullough, antivax “researcher” Anthony Mawson, CHD chief scientific officer Brian Hooker, and disgraced and delicensed antivax pediatrician Dr. Paul Thomas.
As Dorit Reiss, a frequent commenter and friend of SBM put it:
Dorit Reiss, a professor at UC Law San Francisco and leading expert in vaccine law, told Important Context that CHD “using RICO to target AAP’s vaccine policy is a pretty blatant misuse.”
“The lawsuit makes it clear that Children’s Health Defense complaint is that they do not agree with AAP’s position on vaccines,” Reiss explained. “But that’s not racketeering activity.”
Reiss said that the plaintiffs’ injury claims bore a “very weak connection to anything AAP does,” highlighting the cases of Dr. Thomas and Dr. Kenneth Stoller, a California physician who lost his license for writing unnecessary vaccine exemptions. She noted that the issue the doctors faced in their disciplinary actions was not AAP but rather “the schedule recommended at the time by ACIP.”
Sadly, though, even frivolous lawsuits like this one can force the defendant to waste time, effort, and precious money defending it, even if it’s dismissed fairly expeditiously. That’s the point. I also note that Bragman makes it very clear that, as I do, he strongly suspects that CHD is coordinating with RFK Jr.’s HHS, even if he can’t prove it. It is a very reasonable suspicion.
File this one under using the legal system to try to silence and intimidate critics.
After hepatitis B vaccines, HPV vaccines will be next on the chopping block
I’ve long noted that the two most hated vaccines among antivaxxers are the hepatitis birth dose and HPV vaccines. That’s why the hepatitis B birth dose was one of the first vaccines targeted. Although RFK Jr.’s reconstituted antivax ACIP failed to eliminate the birth dose of the hepatitis B vaccine on the first go-around, the next time around they managed to remove it and stick it into the gauzy area of “shared decision-making,” which is a total misuse of the concept from a clinical and ethical standpoint. (Why that is could be a good topic for a future post.) Of course, ethics means nothing to RFK Jr. and his cronies; after all, they’ve taken policy-based evidence-making to new levels of unethical abuse of vulnerable populations by funding a study in Africa to try to prove that the birth dose of hepatitis B vaccine is harmful.
Given that background, it makes perfect sense that, after the birth dose of hepatitis B vaccine is out and the US has without evidence hastily remade its vaccine recommendations into Denmark, HPV vaccines are next on the chopping block. Although Maryanne Demasi’s Substack post is behind a paywall, there’s enough there above the fold to tell us what is happening:
After nearly two decades on the childhood immunisation schedule, the HPV vaccine is undergoing a formal reassessment.
The CDC’s Advisory Committee on Immunisation Practices (ACIP) has convened a new workgroup to re-examine the vaccine from the ground up — its effectiveness, dosing, safety, and long-term population impact.
The workgroup will be led by MIT professor Retsef Levi, a current ACIP member who has consistently pressed for longer safety follow-up and greater transparency about uncertainty in vaccine science.
For much of the past 20 years, ACIP’s approach to HPV vaccination followed a trajectory of expanding eligibility, strengthening uptake, and adding new indications. Once licensed, the core assumptions underpinning the policy were rarely reopened.
That approach now appears to be shifting.
“Shifting”? That’s only because under the Trump administration a longtime antivax activist is now in charge of HHS.
Demasi has also published what appears to be a revised but mostly complete version of her post on the CHD website, which is not surprising, given her longtime association with the antivax group, and posted a video to LinkedIn. Naturally, the name of the game is sowing fear, uncertainty, and doubt with cherry-picked studies and handwaving about the genotypes used in Gardasil:
The original HPV vaccines targeted the most common cancer-associated strains, particularly HPV-16 and HPV-18, and subsequent population-level studies reported declines in those vaccine-targeted strains.
However, some studies have reported relative increases in other oncogenic HPV strains not covered by the original vaccines, raising the possibility that suppressing dominant strains may allow others to fill the ecological space.
A Finnish population study, for example, observed declines in HPV-16 and HPV-18 alongside increases in strains such as HPV-52 and HPV-66.
Concerns about incomplete strain coverage drove the development of Gardasil 9, which expanded protection from four to nine HPV types.
But broader coverage has not necessarily translated into better outcomes.
In a Merck-sponsored study of more than 14,000 women, Gardasil 9 did not reduce high-grade cervical lesions compared with the original quadrivalent vaccine — despite targeting five additional strains.
The links above both go to the same study in the International Journal of Cancer. Seriously think that Demasi screwed up, given that the two links go to the same study, and the Finnish study didn’t even report on reductions in high-grade cervical lesions by Gardasil-9 compared to the original Gardasil. All I can say is: Sloppy. As for the Merck-sponsored study, they are citing an 11-year-old study that I found myself based on recognizing the table that Demasi reproduced as being in the format of New England Journal of Medicine articles. You’ll notice that Demasi zeros in on the whole population, failing to note that if you look at the populations who were not HPV-infected on day one, the efficacy of the vaccine was actually quite good, with the rate plunging from 1.2 cases/1000 person-years to zero—and that’s in the part of the chart that Demasi pointed to. Of course, girls and women who have never been infected with HPV are the very population for which the vaccine was designed. The rest of the chart shows similar efficacy. If you take the chart in its totality, the results show that Gardasil-9 is very efficacious at preventing precancerous lesions associated with the HPV types included in the vaccine and not effective if the recipient was HPV-infected on day one.
In any event, the most recent Cochrane Review concludes that there is “high-certainty evidence that HPV vaccines protect against cervical precancer in adolescent girls and young women aged 15 to 26” and that there was no increased risk of serious adverse effects. More recent systematic reviews, modeling studies, and meta-analyses find that HPV vaccines are effective at reducing the risk of cervical cancer and very safe, with few adverse reactions.
As for the rest, Demasi trots out common old antivax tropes about HPV:
In my reporting, one longstanding concern that has emerged is that most pre-licensure trials used Merck’s proprietary aluminium adjuvant, AAHS, as the placebo, limiting the ability to generate clean comparative safety data.
Another unresolved issue I have examined is residual DNA contamination detected in the Gardasil HPV vaccine.
Regulators have repeatedly said the levels present pose no risk, but that conclusion rests largely on theoretical thresholds rather than direct human safety studies.
To date, no clinical trials have specifically tested the safety of residual DNA in these products — a gap that now falls squarely within the scope of the workgroup’s review.
Everything old is new again, or is it: Everything new is old again? As you might recall from my previous posts, fear-mongering based on exaggerated claims of DNA contamination in COVID-19 vaccines were not new. Antivaxxers had been making similar exaggerated claims for HPV vaccines over a decade before. Indeed, really old hands combating antivax disinformation knew this claim by a derisive nickname, ”homologous recombinaltion tiniker,” which, according to antivaxxers led to “molecular mimicry,” which in turn led to autism. Indeed, Demasi herself was among the antivaxxers trumpeting the “dangers” of supposedly high levels of “DNA contamination” in COVID-19 vaccines and even likening it to such “contamination” in the HPV vaccine. In brief, an antivax pathologist named Sin Hang Lee claimed to find HPV L1 gene DNA bound up in aluminum adjuvant, using a highly sensitive nested PCR prone to false positives to find HPV DNA in Gardasil, starting in 2011, producing a scandal that wasn’t and then resurrecting it 13 years later to bolster the false and intentionally deceptive narrative that DNA contamination in all vaccines is highly dangerous. Similarly, Demasi complains about the aluminum adjuvant in Gardasil, which has been another longstanding antivax talking point, as well as harping on the misleading “no saline placebo” claim.
Normally, there would be no problem with ACIP reevaluating every vaccine in the schedule if ACIP were any longer a credible scientific committee whose membership consisted of legitimate infectious disease, public health, and vaccine experts. Unfortunately, such is no longer the case. ACIP exists solely to engage in policy-based evidence-making to generate, no matter what it takes, evidence just plausible enough for RFK Jr. to use to eliminate each vaccine targeted in turn. Right now, it’s the HPV vaccine’s turn, and Retsef Levi will deliver the “evidence” that RFK Jr. wants in order to restrict and ultimately eliminate HPV vaccination.
What, me worry (about polio and measles)?
Once again, ACIP is no longer a credible scientific committee, all of its real scientific expertise having been purged in favor of RFK Jr. stacking the committee with a collection of antivax cranks and grifters, with a couple of less antivax members, just to give the appearance of expertise. Among the most recent new members is Dr. Kirk Milhoan, a pediatric cardiologist who was named ACIP chair in December. Last Thursday, the podcast Why Should I Trust You? featured an interview with Dr. Milhoan, and—boy howdy, as one of my favorite podcasters, Robert Evans, likes to preface facepalm-worthy revelations—did Milhoan let his “make America healthy again” (MAHA) antivax freak flag fly! This led to a series of articles in STAT News, the New York Times, The Hill, Reuters, and many others. The headlines were all about his questioning the need for the polio vaccine and MMR vaccine, but there was so much more antivax crazy in his interview than that, and Dr. Milhoan’s overall message was that the “right” to refuse vaccines was more important than public health, leading him to prioritize what I like to call “freedumb” über alles.
I went to the source, because I know how antivaxxers like to claim that they are taken out of context. Trust me, in context, the quotes are every bit as bad as they sound. For instance, there was one point where, as the NYT notes, he laid down false equivalences like, “I also am saddened when people die of alcoholic diseases,” adding, “Freedom of choice and bad health outcomes.” Of course, alcohol-related diseases aren’t contagious, something that Dr. Milhoan seems oblivious to or uncaring about, not to mention his not-so-subtle and very MAHA-like implication that those who suffer the complications of a substance use disorder deserve to suffer and die because of the complications of said substance. As I’ve been saying for a year now, MAHA is basically soft eugenics, with health being completely up to the individual, which means that if you are ill it must be your fault. To paraphrase what Dr. Milhoan seems to be saying, “It’s very sad if your habits lead you to suffer from chronic diseases, but it’s all personal choice. Don’t expect the government to help.” In other words, let nature, instead of humans, do the culling of the “unfit.”
Even worse was the first question the host of the podcast started out with:
A pleasure to be here. You’re the newly appointed chair of the ACIP committee, which of course helps set America’s vaccine policy. Given that and given the fact that you’re a physician, we just thought it might be useful for you to talk about your philosophy towards vaccines.
I mean, do you like them? Which are your favorite? Which ones don’t you like so much?
This is about as cringeworthy a question as I can imagine. It’s not a matter of whether you “like” or “don’t like” individual vaccines. It’s a matter of whether each vaccine under consideration has proven itself in scientific studies, clinical trials, and epidemiological surveillance to be safe and effective, a standard that all of the vaccines on the CDC-recommended vaccine schedule before RFK Jr. made the US Denmark have passed, Dr. Milhoan’s attempts to sow fear, uncertainty, and doubt notwithstanding.
Dr. Milhoan’s response was disingenuous at best:
I think trusting the actions of the individual are much more appropriate. I think that we live in a polarity, where you are not allowed to be in the middle. You’re either to be this or that.
You’re either to be pro or anti, for or against. So I think one of the reasons they chose me first to be on the committee and then to be given the chairmanship was the measure I bring to a discussion. When I was doing my PhD, it was very clear to me that in my own mind, I had a confirmation bias.
I had a hypothesis, and I really needed that hypothesis to be right. And if it weren’t right, I could have wasted years and years and years. But if you’re going to have character and have integrity, then you have to examine your confirmation bias and decide, why am I doing this?
So I come to this. I don’t have a favored vaccine. I don’t have a vaccine that I have any personal, emotional, necessarily, opinions about.
I call BS here, but this is a typical antivax rhetoric, falsely claiming to take the scientific high ground and to be logical, unemotional, and “unbiased” about them, in contrast to, I suppose, those of us who know on the basis of existing evidence that vaccines are safe and effective, who are portrayed by the likes of Milhoan as being “emotional” about vaccines. Sure, we’re sometimes emotional, but that’s because we are just so tired of countering the pseudoscience, misinformation, and lies about vaccines promoted by antivaxxers, not to mention the conspiracy theories and “pharma shill gambit” that portray us as all being either in the pay of big pharma or ideologically captured by big pharma. It’s exhausting.
In any event, when it comes to polio, Milhoan basically appeals to—you guessed it!—sanitation:
I think also, as you look at polio, we need to not be afraid to consider that we are in a different time now than we were then.
Our sanitation is different. Our risk of disease is different. And so those all play into the evaluation of whether this is worthwhile of taking a risk for a vaccine or not.
We have to take an account that are we enjoying herd immunity right now, that it may look like it’s better not to get a vaccine than to get a vaccine. But if we take away all of the herd immunity, does that switch? Does that teeter totter switch in a different direction?
So that’s how I would look at both or polio vaccine and the MMR vaccine.
Notice how, first, he seems to claim that sanitation will save us, to which I like to respond: Was sanitation in the US so much worse in the 1940s and 1950s, when polio outbreaks were infecting and paralyzing thousands and thousands of Americans? Dr. Milhoan then implies that now, somehow, the risk-benefit profile of polio vaccination might no longer be in favor of vaccination in this country. Consider this, though. It is true that polio has been eliminated in the US and in much of the world. Unfortunately, it is not totally eliminated. If we were to stop vaccinating against polio, what will happen is fairly predictable, although the timeline might not be. What would happen is that, sooner or later, someone infected with polio would travel to the US and infect someone living here. As vaccine coverage falls, herd immunity would likewise decline, and, eventually, someone bringing polio to the US would spark an outbreak. Would we get back to the bad old days before the Salk vaccine was introduced in the mid-1950s? Probably not, if only because nearly everyone living in the US has been vaccinated against polio. It will take years, or decades, for the percentage of vaccinated people to fall.
Indeed, now would be as good a time as any to remind you of a modeling study that I discussed last year that modeled what would happen if vaccination rates against various diseases were to fall by differing amounts. The study estimated that if polio vaccination rates fell by 50% there would be millions of cases of polio over the next 25 years and thousands of cases of paralytic polio. Indeed, here’s a graph from the study:
The study estimated that if polio vaccination rates were to fall by 50%, there would be 4.3 million cases of polio over 25 years, of which 5,400 would be paralytic polio. But, hey, what’s a few thousand paralyzed Americans over 25 years compared with freedumb, a hell of a lot more if vaccine rates fall below 50%? Let’s just say that I hate it when people like Milhoan say, “we just don’t know” what would happen if we stopped vaccinating against various diseases. We have a lot of evidence, this model included (which used conservative discussions) to have a pretty good idea what would happen. Milhoan is an ignoramus.
But what about MMR? Milhoan makes a similar appeal to ignorance:
The MMR vaccine, and you guys have probably seen this data, is that often the incidence of disease is going down even before the vaccine had been started. When we look at the risk and we talk about the risk of, let’s say, measles, many of those risks of not getting measles without having a vaccine, was in the 1960s.
We take care of children much differently now. Our ability to have pediatric hospitals, children’s hospitals, pediatric ICU’s, how we look at the whole gamut of how we can treat measles is different. That’s something that comes into play.
Dr. Milhoan can’t even get his antivax tropes correct, so I’ll help him. The incidence of measles was not going down before the measles vaccine was introduced in the early 1960s. It fluctuated wildly, but it was definitely not going down. The correct antivax trope is that mortality from measles had been declining before the vaccine was introduced, not the incidence, the false implication being that vaccination doesn’t save lives and is unnecessary. It’s what I like to call the “vaccines didn’t save us” gambit and intellectual dishonesty at its most naked. This trope is a favorite of RFK Jr.
The second trope that Dr. Milhoan is weaponizing is the common antivax claim that we don’t need vaccines for an infectious disease because, according to the first trope, it’s harmless (to the healthy) and, according to this trope, we can treat it medically if necessary, no problem. This particular trope is why we got hydroxychloroquine, ivermectin, and a veritable panoply of quackery to treat COVID-19 during the pandemic. The idea, of course, is that if an infectious disease is treatable with an inexpensive drug that causes no side effects (according to antivaxxers), then vaccines are unnecessary.
The implication of the final part is the false claim that we don’t know what the rate of serious complications from measles would be because all the pre-vaccine data on measles complications in the US is from over 60 years ago. Again, first, we actually do have a pretty damned good idea of what will happen if MMR vaccination rates fall. To cite the modeling study again, if measles vaccine coverage were to fall by 50%, over 25 years we could expect to see 51.2 million cases of measles and 51,200 cases of postmeasles neurological sequelae, such as encephalitis and, most dreaded of all, subacute sclerosing panencephalitis (SSPE), the latter being a complication that occurs years after infection and is 100% fatal. Again, what’s 50,000 children suffering severe neurological complications over 25 years, a hell of a lot more if vaccine rates fall below 50%? I would also point out that the study modeled smaller decreases in vaccine coverage, including 25% and 10%, and the increase in disease incidence and morbidity would still be frightening even with smaller declines in vaccine uptake. Read my post and the study if you want more details.
Truly, Dr. Milhoan seems unconcerned if ACIP were to make measles (and polio) great again. Worse, he seems to view the resurgence in measles, more than anything else, as a good research opportunity:
What we’re going to have is a real-world experience of when unvaccinated people get measles, what is the new incidence of hospitalization? What’s the incidence of death? I think to go back to a bigger question about what ACIP is doing, remember we’re just an advisory panel.
Don’t blame me! I’m just the chair of the panel that recommends the CDC vaccine schedule! Of course, the above observation is truly chilling. It’s another Tuskegee experiment on a far greater scale, but then, MAHA stans don’t seem to have a problem with unethical experiments and recommendations that harm the most vulnerable in society.
Running throughout Milhoan’s interview is the “informed consent” trope favored by antivaxxers:
I look at what the data are, and I’m not afraid to say, wow, that’s a really good vaccine, or that’s a really bad vaccine. I look at medicines the same way. There are medicines.
I try to use the least amount of things I do to make somebody better. The less I do, the less I have a chance of doing harm to somebody. I think that we’ve talked a lot about the efficacy of vaccines, but I think what has been neglected is really looking deeply at what the risks are.
Everything I do, especially if we inject something that bypasses first pass, elimination and detoxification, it’s a bigger deal than if we take something morally usually. There’s a risk for everything we do medically, from a simple antibiotic to heart surgery, there are risks and people act differently. I think this is what I desire to bring, is pulling back the curtain and telling people, what do we know, what don’t we know
When I give informed consent, I can be honest.
It is, quite simply, either a lie or evidence of Dr. Milhoan’s profound ignorance (take your pick) when he says that looking deeply at the risks of vaccines has been neglected. What he really means is what all antivaxxers mean when they use the dog whistle of the “neglect” of looking at adverse events due to vaccines is that science has not shown that vaccines cause the adverse events, diseases, and conditions that antivaxxers attribute to them, like autism, autoimmune disease, and a veritable panoply of other conditions and diseases. Indeed, science has failed to find any compelling evidence linking vaccines to the adverse outcomes attributed by antivaxxers to vaccines. Indeed, vaccine safety is one of the most studied topics in all of biomedical research, and there are mountains of studies supporting the safety and efficacy of vaccines.
As for “informed consent,” I call that a trope because what they really mean is not true informed consent, but rather what I used to call “misinformed consent” but now call “misinformed refusal.” The way I like to explain this antivax trope is simple. Antivaxxers like to attribute all sorts of horrible outcomes due to vaccines such that any reasonable person who believes (or thinks plausible) that vaccines might cause these problems, would be frightened or wary enough to refuse to be vaccinated—or to have their child vaccinated. What Dr. Milhoan thinks is being “honest” is, in reality, fear-mongering about vaccines. That much is evident from much of what he says, for example:
I guess that’s one way to look at it. I think that the concerns that are coming forward of what happens when you stimulate an immune system over and over again, concerns for increasing incidences of non-disease related hyperallergic responses in children is concerning asthma, eczema, other things have been concerned. This is a risk benefit that I believe needs to be discussed with everything.
There is no good evidence that vaccines are associated with increasing incidence of these conditions, but Milhoan is implying, as antivaxxers love to do, that vaccines cause these conditions, all while maintaining plausible deniability that that’s what he’s saying. All of this is wrapped up in a common antivax trope: “If there is no choice, then informed consent is an illusion. Without consent, it is medical battery.”
RFK Jr. or any other antivaxxer couldn’t have said it any better! Indeed, I was actually somewhat surprised that in the interview, Milhoan seemed somewhat annoyed that RFK Jr. had decided to make American Denmark with respect to vaccines without consulting ACIP but still toed the line and made up the excuse that one ACIP report falsely claiming that the US is an “outlier” with respect to vaccines was ACIP advising the HHS Secretary. Oh, well.
But back to “choice.” Contrary to Milhoan’s dichotomy about “informed consent” about vaccines, there is a choice. The vast majority of states with school vaccine mandates have religious and personal belief exemptions, the exemptions often being risibly easy to obtain. Moreover, there haven’t been any real COVID mandates for at least a couple of years anywhere in the US. Dr. Milhoan is tilting at antivax windmills, and not in a charming Don Quixote-like way, but rather in a dishonest, crank-like way.
He also doesn’t understand science:
Well, that’s what I’m saying. I’m looking at the observable science, and what I’m saying is that there is a motion that it is, when people use the word proven, this is scientifically proven, it’s a contradiction to the word science when you’re looking at observations, and when we look at something that’s statistically significant, you’re still saying it’s at a 95, let’s say it’s at a 95% confidence interval, what does that tell you? Well, 5% you’re wrong.
Spoken like someone who has never taken a basic biostatistics course. No, to put it simply (but hopefully not simplistically), according to frequentist statistics, a 95% confidence interval defines a numerical range that, upon repeated sampling, will contain the true value 95% of the time. It’s actually a measure of the method’s reliability, not a 95% chance for a single interval, and its width reflects precision, getting narrower with larger samples and wider with more confidence. (A result based on a sample of a population that is a larger percentage of the population being sampled will usually result in a lower confidence interval, for instance.) As far as a “statistically significant” difference between two means at the 95% confidence interval goes, all it means is that, using appropriate statistical tests for a comparison of two mean values, there is a 95% chance that the null hypothesis is not true; i.e., a 5% chance that there is no true difference between the means. Of course, the meaning gets more complicated the greater number of means being tested and if the data is not Gaussian, but we don’t need to get into that. The point is, Dr. Milhoan is appealing to 95% confidence intervals to imply that vaccine safety studies might be wrong. To that, I would mention that this is only even a semi-useful concept for one study. When there are a lot of studies, all with the same result, the chances that they are all wrong fall to a heck of a lot lower than 5%.
I could go on, but suffice to say, on this topic and his general bloviation about vaccines, Milhoan doesn’t know what he’s talking about, as experts quoted by the NYT say:
“He has no idea what he’s talking about,” said Dr. Sean O’Leary, chair of the infectious disease committee at the American Academy of Pediatrics.
“These vaccines protect children and save lives,” Dr. O’Leary said. “It’s very frustrating for those of us who spend our careers trying to do what we can to improve the health of children to see harm coming to children because of an ideological agenda not grounded in science.”
But, as I said before, it’s freedumb über alles:
In a series of text messages later on Thursday and Friday, he elaborated on his view that personal autonomy was paramount.
Because of course it is to him. To MAHA, health is strictly personal responsibility. The social determinants of health don’t matter, and individuals have no responsibility or obligation to their fellow citizens to assist with public health, with any vaccine mandate being “authoritarian” and the CDC having to “canonize” ACIP recommendations.
RFK Jr. is continuing to come for your vaccines
I’ll conclude by recapping my predictions of the strategies that RFK Jr. will be using to come for your vaccines:
- Change HHS policymaking from being science- and evidence-based, at least as much as possible, to being policy-based evidence making, where the evidence is generated solely to convince the rubes that the policies being implemented have science behind them. The consequences will be:
- Influence the Vaccine Court and the NVICP to compensate “vaccine injuries” that antivaxxers believe in but that are not supported by science.
- Failing #1 and #2, make changes by edict, as RFK Jr. did when he changed the US recommended vaccine schedule to be patterned on the Danish schedule.
- Use policy-based evidence-making to falsely claim that vaccines are dangerous and don’t work nearly as well as science shows to bolster their predetermined purely ideological and political argument that “personal rights” trump—word choice intentional—public health in order to justify eliminating all vaccine mandates.
a. FDA will use this “evidence” to weaponize EBM to make vaccines much more difficult and expensive to approve and allow it to attribute “injuries” to vaccines that vaccines don’t cause.
b. NIH will shift its funding away from new vaccines to studying “vaccine injury” and “nonspecific effects.”
c. CDC will use this “evidence,” through ACIP, to remove as many vaccines from the schedule as possible and use this technique to cherry pick evidence from vaccine safety monitoring systems to portray vaccines as dangerous.
d. CMS will use this “evidence” to justify ceasing to pay for specific vaccines through federal health insurance programs.
What we’ve seen since last week includes:
- More policy-based evidence-making, with Retsef Levi turning his fake evidence sights on the HPV vaccine
- A new wrinkle to abusing the legal system, with RFK Jr.’s proxies like CHD using the law to attack any organizations that try to combat his antivax crusade
- More evidence-based policy-making in the service of arguing that the “right” to refuse vaccines trumps everything else
What new horrors with respect to public health will 2026 bring? Stay tuned. (I suspect that there will be no new updated yearly influenza or COVID-19 vaccines approved by fall, for starters.)
I’m coming to think of RFK Jr. as the Terminator of vaccines. He’s out there, as head of HHS. He can’t be bargained with. He can’t be reasoned with. He doesn’t feel pity or remorse (for all the dead children) or fear (that he will cause many deaths). And he absolutely will not stop—EVER—until the US vaccine program is dead!
I’ll spare the addition of jokes based on the Monty Python Dead Parrot sketch. I’m too depressed right now.
