The Current - RFK Jr. and rising vaccine hesitancy

Episode Date: December 2, 2024

Anti-vaccine activist Robert F. Kennedy Jr. has been nominated as Donald Trump’s health secretary, prompting concerns about rising vaccine hesitancy and misinformation — both in the U.S. and here in Canada. 

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway, and this is The Current Podcast. There's no vaccine that is, you know, safe and effective. One of the most outspoken vaccine skeptics is poised to take over the U.S. Department of Health. Robert F. Kennedy Jr. has, for years, questioned vaccines, even spread conspiracies about them, including the discredited claim that vaccines cause autism. In a moment, we will hear how the growing influence of figures like Kennedy is impacting Canadians. But starting in the U.S., Rupali Lima is an associate professor at George Mason University.

She specializes in vaccine behavior and decision-making, including vaccine hesitancy and acceptance. Rupali, good morning. Good morning. What was your reaction when you heard that RFK Jr. was Donald Trump's nominee to be the head of the Department of Health and Human Services? You know, as someone that has been studying vaccine hesitancy for a long time, I think there's a lot of concern. And that's simply because, unfortunately, RFK Jr. is really focusing on non-evidence-based information and is really spreading misinformation, which unfortunately is going to impact morbidity and mortality of vaccine-preventable disease. Kennedy himself has addressed those concerns in the wake of the election.

Have a listen to what he said to NBC on election night. I'm not going to take away anybody's vaccines. I've never been anti-vaccine. I'm going to make sure scientific safety studies and efficacies are out there and people can make individual assessments about whether that product is going to be good for them. So he says there that he's not anti-vaccine. He's not going to take away anybody's vaccines. He's going to allow people to make individual choice, individual assessments on whether,

as he says, the vaccine is good for them. What's your concern with that? My concern with that is that while I think it's important for individuals to have individual choice, the purpose of public health is to protect the health of the public. And so I think there are certain safeguards in place environmentally, for example, vaccines are another one, seatbelts are one, that we really try to think about from a public perspective. And that's to protect, again, the more broader population. That's to protect, again, the more broader population. And so by switching that and sort of saying that, you know what, we're going to let individuals have an individual choice, that unfortunately is going to really impact broadly the health of the public and in general will really overwhelm, I think, health systems as well.

And so that to me is really a big concern. I think the second piece of it is that while I am all about individuals being able to do their own research, I want to make sure that individuals are also being exposed to research that is evidence-based. And unfortunately, a lot of the information related to vaccines is not evidence-based. There's quite a bit of misinformation. So it can be really hard to figure out what is true and what is not true. I want to talk more about that in just a moment and how people go about assessing what is true and what's not true. Let me just play you, before I do that, something else that RFK Jr. told Reuters earlier this year about vaccines. When I was a kid, there were three vaccines, and I took all three. There were three that were mandatory, that were recommended,

which essentially means mandatory. And I was compliant. Today, there are 72, and we're going up to now, I think, 77 or 79 with the annual COVID vaccines. The Centers for Disease Control website recommends vaccines for 16 diseases for American children. Is his number accurate? Well, I think what he is trying to say, I mean, there are a number of vaccines. He's talking about doses, and I think that's how he perhaps is getting to that number of 77. I think one thing that's really important to note here is that when he was younger and he had the three vaccines that he refers to, I think that many, many, many children died of other vaccine preventable diseases. And

so while yes, the vaccine schedule has shifted and grown over time, to me, that's really a benefit and success of science, right? We've been able to identify different vaccines that protect and prevent morbidity and mortality. And I should say that given this increase in vaccines, we have seen huge, huge reductions in morbidity and mortality. And so while I do agree the schedule has shifted, it has grown, we've also been able to limit a lot of childhood disease, which I think is really critical and really important that, you know, I think he fails to mention in that speech. He has talked about revising the government's vaccine recommendations. What specific measures do you think he could implement that concern you? Well, I mean, I think, first of all, I will say that the schedule here in the United States has gone through extensive, extensive review through people

that are scientists, people that are parents, by the way, people that care about the health of the public. And so this isn't a schedule that was done sort of willy nilly, if you will, this was a schedule that has been thought through that has been tested. And so I think that by him coming in and sort of questioning that, that also questions a huge mountain of evidence that scientists have worked on for decades, literally decades to try to perfect to make sure that kiddos are getting the vaccines at the opportune time that they are getting them and when they're recommended. And so my concern with him saying, you know, I want to revise the schedule. Again, I know with a lot of the diseases that we're talking about, we need a pretty high proportion of the population vaccinated to

prevent an outbreak. And so I think we're going to start to see many more outbreaks. We're already starting to see them as we're seeing uptake drop in certain antigens, including measles, for example. And so that just means that we're going to have to be ready for a lot more infectious disease if the schedule is revised. He has had over the years considerable influence, but it's been, I don't think it's been mainstream. I think it's fair to say that it's existed kind of out on the sides and the left and the right. to say that it's existed kind of out on the sides on the left and the right. Why do you think increasingly some Americans or an increasing number of Americans are more receptive to this messaging in the mainstream? It's a really great question. I have to say that, you know, when I started studying vaccine hesitancy about 10 years ago, it was very fringe, right? There were a few

pockets of the population that really were concerned about vaccines, and they tended to cluster together. I think COVID really changed that. I think what happened with COVID is that those that were vaccine hesitant ended up really feeling as though the government was infringing on their rights when we asked people to wear a mask, for example, or to social distance. And as a result, I think that these groups sort of coalesce together, if you will, that really talk about you can't take my liberty away, or this is tyranny by the government. And as a result, vaccines really became a casualty of that kind of philosophy and that ideology. And

so I think COVID, there was so much uncertainty. Recommendations were changing. And from a scientific perspective, we saw that as progress. Recommendations should change as new data came in. But the public didn't see that as progress. And I can understand that. And as a result, I think many people saw COVID as an example of the government doesn't know what they're doing. The government shouldn't tell us what to do. And as a result, voices like him really were able to be elevated. And again, were brought together by other voices that were concerned about other mitigation measures that were put in place, again, to protect the health of the public while arguing that it's my individual choice. How do you think language, and again, hindsight is 20-20, but how do you think language

used during the pandemic influenced that? Where you have people now who are looking back, people who, epidemiologists and people in public health, who are looking back saying, you know what, going for the slam dunk and telling people that if they didn't get the vaccine, that they were misinformed, that they were subject to misinformation, that they were ignorant, that that didn't help in some ways. How do you think the language influenced what we're talking about? Yeah, it's a really great question. And I think, you know, as someone that works with folks that do have concerns, I do think that we've become polarized. We've become polarized politically.

But that has really, I think, come down and filtered down through social issues and health issues, including vaccines. And I do think that that is the wrong approach, right? To be able to sort of say to someone that, you know, you're not doing the right thing. I think it's important to understand concerns. People have concerns. We should be empathetic with people that have concerns and be able to think about how can we explain things in a way so that people feel more comfortable getting a vaccine. Because I do think by dismissing them, we're just further polarizing the debate and we're also politicizing vaccines, which is really what unfortunately has happened. And I'm really concerned it's going to become even more

entrenched in this sort of polarized polls, if you will, during this next administration. How do you turn that around? I mean, I've heard people in public health talk about the need for humility as they approach this issue. Yeah, I mean, it's such a great idea. I think it's being able to have this conversation with people that don't necessarily think the same way that you do. And that's sort of a little bit of a lost art, right? If we think about 20 years ago, we could have conversations with people, you know, whether it's about health issues, whether it's about gun control here in the United States, we could talk about it. And now I think it's become so polarized. So to me, it's to be able to really start every single conversation with empathy and being able to understand that people have fears and concerns,

and those fears and concerns are valid. It's important from a scientific perspective and public health perspective that we as public health practitioners, you know, including those that are in the medical profession, really spend time understanding the concern and being empathetic so that we can help work through the concern together to overcome the barrier that people might have towards accepting a vaccine. How do you get them toward the information that you believe is legitimate, given that you're going to have someone like RFK Jr., who could very well be a high-ranking member of the Trump administration, and his messaging is going to be amplified

and legitimized as well. So how do you make sure that people get accurate information when it comes to vaccines? You know, and part of the problem with that, as you can imagine, is that we also, you know, relying on social media, which so many people do, really forces you into these echo chambers, right, where you're essentially hearing beliefs that you already believe in. I think a critical thing of this is to be able to bring voices that are maybe

outside of health that people do trust, that are able to talk about these issues. But again, I mean, if you look at social networks on social media, they've also become much more polarized. And so the problem is you're not really hearing attitudes that are not supportive of what you already believe. And so that's why I think it's important to be much more reliant on these networks that are more local, if you will. numbers. Schools played a huge role, for example, during COVID, talking to parents as to how to protect their kiddos. I think it is thinking about some of these alternative messengers that people trust. We're going to speak about how this could impact, we're talking about how this could impact us here in Canada in just a moment. But just finally, I mean, the United States is a global leader in vaccines. You take a look at what happened during Operation Warp Speed, for example, in the middle of the pandemic and creating the vaccines that so many people around the world ended up taking.

What impact would changes in your country, when it comes to research and development, have on the rest of the world? The concern that I really have is, particularly during COVID, there were huge issues of inequity, not only here in the United States, but globally. So my concern is that if we go back, excuse me, to the drawing board, that that's also going to impact access, particularly among lower and middle income countries, which is really, really concerning, given that they are ripe because they have weaker healthcare systems, for example.

Rupalai, we'll leave it there. It's good to talk to you. Thank you very much. Thank you so much. Rupalai Lima is a specialist in vaccine behavior and decision-making, including vaccine hesitancy and acceptance. In 2017, it felt like drugs were everywhere in the news. So I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with season three of On Drugs. And this time, it's going to get personal.

I don't know who Sober Jeff is. I don't even know if I like that guy. On Drugs is available now wherever you get your podcasts. There are growing concerns here in Canada about the impact that vaccine hesitancy is having. There was an outbreak of measles earlier this year in Quebec, and you might remember this news out of Hamilton, Ontario, in May. A rare and shocking Canadian death from measles, prompting a response from the Prime Minister.

This is a tragedy that nobody wants to see. I can't imagine what that family is going through right now. The child who died was under five and public health officials say not vaccinated against the virus. That was in the spring. Now New Brunswick is going through its largest measles outbreak in decades with at least 44 confirmed cases. Dr. Cora Konstantinescu is a pediatric and infectious diseases specialist, pediatrician, pardon me, and infectious diseases specialist at the Vaccine Hesitancy Clinic at the Alberta Children's Hospital. She's also a clinical associate professor at the Cummings School of Medicine at the University of Calgary. Dr. Konstantinescu, good morning to you.

Good morning. How vulnerable, we'll start with the measles, how vulnerable are Canadians to measles right now? Yeah, well, man, measles is a big deal. It's a tough virus. And I just want to say that when we talk about measles, we're not talking about German measles that sometimes people get that confused with, which is rubella, which is a much more easier disease. But measles is a significant disease in terms of impact on severity, and about half the kids who get it end up in hospital. But measles really is a disease of the unvaccinated. So the vulnerable Canadians and people living in Canada are the ones who are not

immunized or partially immunized to measles. How worried are you about, I mean, for example, this story in New Brunswick, as I said, at least 44 confirmed cases. We know that measles, as they say, spreads like wildfire. Yeah, it is. It's probably one of the most infectious pathogens that we have. And I'm sure some of your listeners have heard that we talk about 90% attack rate, which means that if you have 10 non-immune or unimmunized children, nine of those would get the disease if exposed to measles. That's very powerful. And measles loves certain body parts. It loves the lungs. It can give you bad pneumonia and respiratory failure. And it loves the brain.

And it can lead to awful brain swelling, sometimes leading to death, as we saw in that child in Ontario, or long-term disability. So this is not one of those diseases you want to get immunity by having the disease. It has high impact on the infected children. And that's why we worry about it. And so if this is, as you've said, a disease of the unvaccinated in many ways, how big of a factor is fear or resistance to vaccines in terms of why somebody would not get the vaccine? Oh, I think a lot of it comes out of fear, for sure. But, you know, what I've also noticed in our vaccine hesitant patients is for sure there is this difference in balance in how they perceive the disease and how they perceive the vaccine. But I've also noticed that in addition to fear, people feel post-pandemic somewhat lonely and powerless. And I think when you have that sense

of loneliness and powerlessness and fear together, people have lost that common ground that they used to have with the healthcare community. And they don't feel the same support as they did before. And that leads to distrust in vaccines. And at the end of the day, it leads to children being left unprotected. I want to ask about the pandemic in a moment. vaccines, and at the end of the day, it leads to children being left unprotected. I want to ask about the pandemic in a moment, but as a pediatrician, what do you say to parents who, for the reasons that you've been talking about, perhaps don't want to get their kids immunized?

You know, we talk a lot about vaccine hesitancy. I do want to highlight that most patients are vaccine confident. But, you know, obviously, I deal with vaccine-hesitant patients in our clinic, but I'm I do want to highlight that most patients are vaccine confident. But, you know, obviously I deal with vaccine-tested patients in our clinic, but I'm also a clinician. I'm also an infectious disease specialist. So I see children with vaccine-preventable disease in hospital, and that's really hard. So I try, you know, I think the most important message when I talk to parents is to, first of all, build a sense of common ground. And, you know, parents are great because they're always on the right side of the equation. Both parents and healthcare providers want to protect the child. But I want them to think

about what this, whatever disease we're talking about may mean to their child and their family and the threat that that means. And, you know, people like to say, well, sure, children end up in hospital, but they may not die of these diseases, which is, of course, you know, fortunately, through, we are so much better at keeping children alive than before. But just think of what a hospitalization would mean to your child and to your family. So I like to always put into the perspective of their situation and help them realize that the threat of the disease is significant. And I think once parents see that, that does help open, you know, the opportunity to talk about the vaccine once they see their child as being vulnerable and under threat,

because most parents don't, because we don't put a lot of attention to the vaccine, once they see their child as being vulnerable and under threat, because most parents don't, because we don't put a lot of attention to the vaccine-preventable diseases out there. But when you think of the different outbreaks, measles, in the eastern part of Canada, we have whooping cough, pertussis in Alberta. These vaccine-preventable diseases are around us now. As you've said, COVID changed many things. And we don't see in this country political leaders who are criticizing vaccines. But there are elements of pushback by some politicians against vaccine mandates,

for example, that were put in place during the pandemic. Pierre Polyev, the leader of the Conservative Party, hammered that point during the pandemic. And in your province, in Alberta, the Premier Daniel Smith put forward changes to the Alberta Bill of Health and the Alberta Bill of Rights, pardon me, recently aimed at blocking mandates specifically around public health. Have a listen to what Daniel Smith said. No one should be pressured into accepting any medical treatment without their full consent, including a vaccine. Do you think, I mean, as I said to our previous guest, hindsight is 2020, and there's a

lot of people who are now thinking about what we did in the moment during the pandemic, understanding that people were trying to do the best at the time, but now have some opportunity to look back on it. Do you think mandates when it came to the COVID vaccine were a mistake? No. I think the mandates were needed at the time when people were dying and when the hospitals were overrun um i think the way things were probably communicated and then what we probably didn't understand or at least didn't take into account at the time was how this is going to impact people and lead to that sense of loneliness and powerlessness that it did lead to. But I think at the time they were needed. And, you know, that's the other thing we

don't often talk about, Matt, is how I think the vaccines changed the turn of COVID and how they saved so many lives and how they enabled so many people to actually go back to doing the things that they're supposed to be doing and children, you know, having normal lives and so on. So I think we've somehow lost that conversation and we are focused on how bad they were. And of course, nobody liked them. You know, I certainly didn't, nobody likes to be told what to do around these things and to feel forced into a decision. And I think a lot of people regret decisions they feel forced into because it's part of that sense of self. But I think they had a role when they did.

But now there is a lot of work to be done to help build that common ground and that support with patients because the vaccine mandates, without a doubt, did a lot of damage to vaccine confidence. That goes to the issue of language that I was talking to Rupali about. I mean, you have the former head of the National Institutes of Health in the United States saying that the vaccine mandates were important, that vaccines were important, but that he believes that in some ways people didn't take into consideration the impact that that would have

on people's lives, keeping kids out of school and what have you. So how do you go about changing that? And maybe it's in the language that you use, but if you're concerned now about vaccine hesitancy in the future, what do you do to address that in a meaningful way so that that doesn't just continue to build from what we all went through a few years ago? You know, I was just at the Canadian Immunization Conference last week,

so there was actually quite a lot of thought and discussion around this. I think what we need to do is we need to remind patients we do care because there has been a disconnect between the healthcare community and patients. And we also need to remember that patients still do trust their family physician, their pediatrician, their primary care providers. But I think we need to consider other aspects of people's health and functioning, such as mental health, such as, you know, socioeconomic health. And overall, and put immunization within that context as one aspect of maintaining people's health. And I hope that if we do that, as opposed to speaking about vaccine mandates, you know, instead of calling it, you know, we should speak about promoting health overall patients and look after these other aspects when we do talk about

vaccination, that I think that might help take vaccines out of this political sphere that right now they seem to occupy and put them back into the healthcare sphere, which is where they belong. So I think we need a supportive pro-vaccine movement in Canada that gets co-created with patients and communities and mental health practitioners and socianthropologists and psychologists for a much more holistic approach to communication, to empowering the vaccine confident, to supporting those who are, you know, vaccine hesitant. I think we need a much more, an approach from different angles as opposed to just saying it's all about the vaccination because I think then people can help frame that within their life and their health,

which is really what I try to do when I do a one-on-one conversation with a patient. We always try to put it the perspective of their life. I think we somehow need to do that at the public health and public level. And just, we just have a minute or so left. In the meantime, RFK Jr. could well be in charge of the health department in the United States, and that will have influence here in Canada. What are you most concerned about?

Well, I'm concerned about this idea, you know, people talk about health protection or community protection. I'm worried about this idea of community influence. Where's your community? With social media, communities span borders. So I do worry that the community influence is going to come from what is not your community and people will lose sight of their immediate communities because of that and will make decisions that will not protect themselves and their communities because of these kind of influences. So I do think that we need to be proactive because it will impact vaccine confidence in Canada. Dr. Konstantinescu, good to speak with you. Thank you very much. Thanks for having me. Dr. Cora Konstantinescu is a pediatrician and infectious disease specialist

at the Vaccine Hesitancy Clinic at the Alberta Children's Hospital, also clinical associate professor at the Cummings School of Medicine at the University of Calgary. For more CBC podcasts, go to cbc.ca slash podcasts.