By Daniel Summers
Donald Trump just made my job harder. The work of every medical provider for children is likely to become more difficult, and our nation may well become sicker.
Yesterday, Robert F. Kennedy Jr. announced that Trump had asked him to head a commission to study the safety of vaccines. Saying "we ought to be debating the science," as he left Trump Tower, Kennedy caused grave concern for those of us who truly understand that science. A proponent of the thoroughly debunked theory that vaccines cause autism, Kennedy's implication that any real debate exists is genuinely troubling.
Hardly a day I spend in the office goes by when I don't give vaccines. I do so because I know there is no actual debate. I do so as a paediatrician because the welfare of my patients, welfare I took an oath to safeguard, depends on protecting them against diseases that could seriously sicken or kill them.
The idea of creating a commission to study one of the most settled subjects in medicine confirms a gnawing fear I've had since the earliest days of Trump's presidential campaign. Drowned out by the noise of his outrageous statements and intemperate tweets is the fact that Trump believes vaccines cause autism. He has loudly proclaimed that misinformed belief for years, long before he was ever considered a serious candidate for the White House.
He is unambiguously wrong about this. In the words of my colleagues at the American Academy of Paediatrics in a statement released shortly after Trump's meeting with Kennedy, "Vaccines are safe. Vaccines are effective. Vaccines save lives."
To believe otherwise requires a couple of different things. First, it requires the rejection of a huge amount of medical science. Not merely one study or two, but study after study after study confirms that vaccines are safe, and that there is no connection with autism. If that mass of evidence doesn't convince you, what can medical science produce that will? If you reject those data, which data can be found that will somehow prove trustworthy?
But the implications of a vaccine-autism connection go beyond that. If vaccines genuinely cause autism like their opponents claim, one of two things must be true of paediatricians like me who administer them. Either we are too incompetent to discern the relationship between the two, or we are too monstrous to care. One cannot believe that autism is related to vaccination without simultaneously indicting the overwhelming majority of physicians, nurses and other medical providers in this country. Even your local Rotary Club is in on it.
By saying that immunisations cause autism, Trump is training his sights on me and every other provider who delivers the same care I do.
I encounter the effects of the anti-vaccine movement on a regular basis. Mine is an office that asks parents to agree to protect their children by having them immunised according to the standard schedule for early childhood, but there are a few shots they can opt out of later. Despite ample evidence of its safety and efficacy, many parents choose not to give their children the vaccination against the carcinogenic human papillomavirus, leaving their sons and daughters at increased risk of several different cancers. When I ask why, they mention vague things they've heard about ill effects.
When I worked previously at a practice that had a more lenient policy regarding vaccines, the experience was even more stark. Several parents rejected them outright, and nothing I could say would change their minds. Every study I could reference was cooked, and there was some malign influence behind it all.
Preventing measles isn't a matter of avoiding some minor ailment. The disease killed over 100,000 people in 2015. Even in patients who recover there is a risk of severe brain damage years after getting over measles. Why on earth would parents opt for that risk when there's a safe way of protecting their children? Why allow your son or daughter to remain vulnerable to the potentially devastating effects of invasive Haemophilus influenzae or diphtheria?
If enough parents refuse to have their children vaccinated, the herd immunity that protects the nation as a whole will wane. There were a record number of measles cases in 2014, the majority in people who were unvaccinated. Does anyone want to share the experience of the Spanish parents whose unvaccinated son died of diphtheria in 2015, after that country had been free of the disease since 1986?
Of course not. But vaccine-preventable illnesses will only stay at bay if parents are appropriately reassured that the means of preventing them are safe and effective.
Will that be the conclusion of a Trump-created, Kennedy-led commission? I have absolutely no confidence that it will be. The mere creation of the commission, meant to investigate a question that has already been asked and answered many times over, is ominous, even aside from the anti-vaccine agenda both men unmistakably share. Given Trump's disdain for facts that inconveniently conflict with his opinions, to believe the commission will land on the side of vaccination requires an optimism bordering on the deranged.
Instead, what is likely to happen is that confidence in one of the greatest benefits to public health in human history will be further eroded. Its findings will certainly be as unfounded, perhaps fraudulent, as the anti-vaccine efforts that have come before it. But this time they will bear the seal of the President of the United States.
Daniel Summers is a paediatrician in New England.