In polite conversation, a muted cough can signify disagreement. It is tragically ironic, therefore, that whooping cough, or pertussis, is fast becoming the poster child disease for preventable infections.
Despite the U.S. government recommending a vaccine series that prevents the disease, immunizations are down and whooping cough has exploded, with more than six times as many infections in 2024 than in the previous year.
Vaccine skepticism has been around for more than two centuries, as long as there have been vaccines, and is a primary culprit in this public health debacle. Skepticism has continued to transform as the diseases the vaccines target appear to have been controlled — like the elimination of polio in the U.S.
Ironically, these vaccine victories have helped to fuel vaccine skepticism. Anti-vaccine individuals posit that vaccines are now unnecessary since the diseases they prevent are seemingly gone and forgotten. But they are still a threat all over the world when not enough children are given lifesaving vaccines.
If there was a recent “gateway drug” equivalent for vaccine skepticism, it would have to be the vaccine against human papillomavirus, or HPV. This series of shots, which prevents around 90 percent of cervical cancers caused by HPV, was approved in the U.S. in 2006 despite objections that, somehow, getting a jab that prevents a common cancer in women would lead to promiscuity.
Thanks to this vaccine, though, infections with HPV types that cause most related cancers have dropped dramatically among young women in the U.S., making the elimination of cervical cancer a real possibility.
Yet Robert F. Kennedy Jr.’s descent into vaccine skepticism began before the HPV vaccine was approved, and, if at all possible, his public skepticism was even more insidious than objecting to preventing cancer.
His target was the measles shot, which, in the U.S. and many other countries, eliminated what had been a common childhood killer. Although more than 100,000 children still die of measles each year around the world, the measles vaccine averted more than 60 million deaths globally from 2000 to 2023.
We could list study after study disproving the skeptics and showing how vaccines are safe, but it doesn’t matter.
The federal agency that Kennedy has been nominated to lead, the U.S. Department of Health and Human Services, keeps track of how effectively vaccines prevent deaths from measles, cervical cancer and other vaccine-preventable illnesses. But that also doesn’t matter.
Kennedy and his allies are somehow immune to science. As more than 15,000 doctors have pointed out, Kennedy’s agenda threatens the health of children and the generations to come.
Consider measles, one of the most contagious infectious diseases. When immunization rates with two doses of a measles-containing vaccine exceed 95 percent in a community, epidemiologists have seen that this highly contagious disease cannot gain traction — a concept known as herd immunity. But when immunization rates dip below 95 percent, we worry about infections popping up — as they have in Louisiana and South Dakota in 2024.
Or consider whooping cough. South Dakota has seen some of the highest increases in incidence rates over the last few years. When schools opened this fall in Alaska, whooping cough cases surged. Immunization rates in both states are significantly below where they should be.
Outbreaks of vaccine-preventable diseases anywhere pose a threat here in the U.S. Globally, childhood immunization rates are still recovering from setbacks during the COVID-19 pandemic. In 2023, more than 14.5 million infants did not receive basic childhood vaccines, placing these children at risk of disease and death.
Stateside immunization rates are much higher than in many countries, but coverage for state-required vaccinations decreased to below 93 percent among kindergarteners during the 2023–2024 school year, marking the fourth year in a row that we are below the Healthy People 2030 target of 95 percent.
We have a choice to make: whether these trends should be reversed so that immunization rates can start climbing again, or whether the bottom will fall out with federal officials who refuse to acknowledge the importance of vaccines and, worse, promote vaccine avoidance.
In addition to decreasing childhood vaccination rates, Alaska, Louisiana and South Dakota have one more thing in common — U.S. senators who will play a key role in whether the Senate confirms RFK Jr. A fourth senator hails from Maine, where immunization rates are above the U.S. average and vaccine-preventable diseases are not as common, in part because of advocacy by groups such as the Maine Immunization Coalition and Maine Families for Vaccines.
It would be helpful if there was a vaccine that could immunize someone as prominent as Kennedy so that they would reject vaccine skepticism and embrace science. But in the absence of such a cure, we hope for some political backbone, fortified by the evidence of what is happening in the states of four key senators.
William Moss is the executive director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health.
