Whopper of the Week: RFK Jr. Denies Role of Vaccines in History of Child Mortality

THIS WEEK'S WHOPPER:

rfk Jr. DENIES ROLE OF VACCINES IN History of Child Mortality

SUMMARY:

Throughout the 20th century, life expectancy increased dramatically, from 47.3 years in 1900 to 76.8 years in 2000. Much of this was driven by a decline in the infant mortality rate, which was 100 deaths per 1000 live births in 1915 for white infants and double that for Black infants. This declined to 7.2 per 1000 overall by 1998, a 93% reduction. The percentage of deaths in children attributable to infectious diseases also fell from 62% in 1900 to 2% in 1998. Secretary of Health and Human Services (HHS) Kennedy has claimed that almost none of this is due to vaccines, but he makes that claim by distorting the evidence.

In an exchange with Senator Bernie Sanders during the recent Senate Health, Education, Labor and Pensions committee hearing (HELP), Kennedy stuck to his guns, reaffirming the claim made in his 2021 book “The Real Anthony Fauci” that the idea that vaccines reduce infant mortality is incorrect. “Almost none of it was attributable to vaccination. It was attributable to hygiene, to sewer plants,” Kennedy asserted, emphasizing "If you want to talk about why disease mortality disappeared in the 20th Century it was not vaccines."

WHY IS THIS A WHOPPER?

There were important advances in vaccination throughout the 20th century. Smallpox cases hit a high of just over 110,000 in 1920, but no U.S. cases were reported after 1950. The virus was declared eradicated due to vaccination in 1980 thanks to worldwide surveillance and vaccination campaign. Vaccines for diphtheria and tetanus (1920s) and pertussis (whooping cough, 1930s) were combined in the 1940s into a single vaccine. Prior to vaccination, diphtheria killed 13,000-15,000 children annually and pertussis up to 9,000 per year. Polio cases collapsed following the polio vaccine in 1955. Measles deaths in the U.S. dropped by 99% after vaccine introduction in 1963. Infections were major killers of children in the pre-vaccine era.

Statista Vaccine and Disease Eradication — Figure from Statista based on CDC data

The 20th Century also experienced improvements to sanitation, with cities across the country modernizing their sewage systems. This led to decreases in key fecal-oral infections, including cholera and typhoid. Handwashing also reduced these infections, and pasteurized milk reduced infections from tuberculosis, streptococcus, brucella, and salmonella. Starting in early in the 20th Century, multiple changes to pre- and postnatal care significantly reduced infant mortality. Improved nutritional status led to a reduction in deaths from infectious disease, as did the invention of antibiotics in the early part of the century and their widespread distribution by the 1940s, because antibiotics could treat the secondary infections caused by measles, chickenpox, influenza, and other viruses. Medical interventions that allowed individuals to survive polio (e.g., the iron lung) also reduced mortality from that disease, even prior to the introduction of the polio vaccine.

It is challenging to disentangle these interventions from each other, as they occurred during the same broad time period. Kennedy cited one analysis which he claimed supports his view that “almost none” of the reduction in infant mortality during the 20th century was due to vaccines. The publication, from 2000, makes no such claim, and instead notes, “Vaccines against diphtheria, tetanus, and pertussis became available during the late 1920s but only widely used in routine pediatric practice after World War II. Thus vaccination does not account for the impressive declines in mortality seen in the first half of the century. The reductions in vaccine-preventable diseases, however, are impressive.” This role of vaccination in dramatically reducing vaccine preventable disease deaths was echoed by a WHO modeling study cited by Senator Sanders, and disputed by Kennedy, which concluded that “Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10.2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region.”

Vaccines alone did not cause the decline in infant mortality and infectious disease morbidity and mortality overall, but they played a key role in that decrease; and they continue to do so. Few would allege that the 1980s or 1990s were a period of poor health and sanitation, akin to 1900. But introduction of the Haemophilus influenzae type b vaccine in 1987 reduced deaths from that disease from 1,000 per year down to almost zero. Similarly, the chickenpox vaccine, released in 1995, cut deaths from 100-150 per year to nil. Vaccines continue to reduce infectious disease illness and deaths.

WHY IT MATTERS?

Kennedy, a longtime anti-vaccine crusader, continues to exaggerate the risks of vaccines while minimizing their enormous benefits and the many millions of lives that vaccines have saved. And he continues to distort scientific data and misread scientific papers in order to bolster his otherwise nonexistent case.

By suggesting that every other intervention except vaccines cut child and infant mortality rates during the 20th century, Kennedy is promoting a version of terrain theory which rejects the role of infectious agents, like viruses and bacteria, as a cause of disease. Kennedy is trying to convince his followers that vaccines are unnecessary and that other MAHA priorities –primarily healthy eating and exercise– are sufficient to "fortify the immune system" and maintain health. It also allows him to cut a variety of public health programs for communicable diseases he deems unnecessary.

Decades of real-world evidence show that vaccines improved infant and child mortality. As the Centers for Disease Control itself notes, over the last thirty years vaccines have prevent hundreds of millions of illnesses in the US, millions of deaths, saved trillions of dollars and vastly improved the quality of our lives.