Part 3: The Looming Crisis of Access to Care – Attacks on Research and Vaccines

by Kim Bergner

The first post in this series explored why an autocratic ruler would make his populace unhealthier and distrustful of science and experts. We showed how the Trump regime is increasing our risk of disease.

The second post delved into the access to care crisis caused by profound cuts to Medicaid and Medicare and the rising cost of insurance for all. The downstream effects of defunding health care are hospital closures, loss of critical services, and overcrowding in remaining hospitals. Such policies decrease government spending on health care in the short term and help pay for President Donald Trump’s tax cuts for the wealthy and to fund the Iran war. They also imperil and impoverish large numbers of Americans and drive up the national debt.

We further examine the access to care debacle in this post and the next.

Decreased access to care intersects with increased risk of disease. Both effects are factors in the attacks on women’s health and the increased exposure to environmental hazards that will be the subjects of future blogs.

Defunding research and development: A devastating setback

On the first day of his second term, Trump withdrew the United States from the World Health Organization. Without international data collection and analysis, we lose our ability to understand what’s happening in the world around us. A WHO statement warns that it was “a decision that makes both the United States and the world less safe.”

Citing false claims about efficacy and safety, Health and Human Services Secretary Robert F. Kennedy Jr. has cut $500 million from mRNA research, thereby destroying our preparedness for the next inevitable pandemic. Pandemic preparedness is a matter of national security.

By defunding medical research and development, Republicans are blocking access to lifesaving vaccines and treatments for emerging infections, cancer, autoimmune diseases and many other conditions.

“(RFK Jr.) would be less hazardous if he decided to do cardiac surgery. Then he would kill people only one at a time rather than his current ability to kill by the thousands.”

Former CDC Director William Foege, quoted by Stat

mRNA vaccines have huge potential beyond controlling emerging infections that will be lost to Americans. Critical research will be stalled for mRNA technology to treat infectious diseases such as HIV, cancers and autoimmune diseases such as type 1 diabetes and multiple sclerosis.

A Johns Hopkins Bloomberg School of Public Health publication states, “This undermining of public confidence in and federal funding for mRNA research is really going to set us back….” An editorial in Nature titled “The Cancelling of mRNA Studies Is the Highest Irresponsibility” states that slashing funding for this cutting-edge technology will slow global progress, although the rest of the world is not following the U.S. government’s dangerous path.

Last month, the administration announced its intention to withhold $600 million in research funding in four Democratic-led states. Much of that funding was for research on HIV prevention and health issues affecting minority populations. The administration stated that the grants were “inconsistent with agency priorities” (paywalled). This purely political move harms people.

Backsliding on America’s public health successes

Before RFK Jr. gutted it, the Centers for Disease Control’s Advisory Committee on Immunization Practices was composed of experts who followed a deliberative, evidence-based process for determining vaccine schedules. Kennedy replaced the experts with handpicked appointees who eschewed ACIP’s previous evidence-based process and changed the child vaccine schedule to conform to their political interests and ideological beliefs.

“We’ve seen policy changes by federal officials based on evidence that has been shown as flawed, analytically fraught, or flat-out wrong,” said Dr. Michael Osterholm, a nationally renowned epidemiologist and author of books on biosecurity.

When universal vaccination is the default policy, children have automatic access to vaccines. Previously established standards saw tremendous success in preventing millions of cases of serious infectious diseases. Children lose access to safe vaccines when the government creates barriers such as eliminating the recommendation for universal vaccination, disseminating disinformation about safety, requiring people to talk to their physician first, imposing legal and economic jeopardy for doctors and manufacturers, and causing vaccine shortages.

Policy and propaganda limit access to vaccines

There are several ways these changes will limit Americans’ access to lifesaving vaccines. In some states, insurance coverage requirements will be withdrawn; fearmongering influences parents to decline vaccines; pharmaceutical companies will face economic pressure to stop manufacturing vaccines.

“I fear we are going to be right back to where we were in the 1980s, when the making of these vaccines became more and more onerous for the companies who make them,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “Vaccines are going to be less available, less affordable, and there is going to be more fear.”

America has a resurgence of measles, and the United States is on the verge of losing its Measles Elimination Status. Yet in Florida, the surgeon general has moved to eliminate vaccine mandates for school entry. The New York Times (paywalled) reported that Kennedy allies are targeting more states to overturn vaccine mandates. Where they succeed, children will be deprived of the safety and health equity conferred by vaccine mandates. Entire communities, including vulnerable people, will be deprived of herd immunity, and outbreaks will spread beyond state borders.

What we stand to lose

A study published in the CDC journal Morbidity and Mortality Weekly Report estimated, “Among children born during 1994–2023, routine childhood vaccinations will have prevented approximately 508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths, resulting in direct savings of $540 billion and societal savings of $2.7 trillion.”

One egregious example of regressive policies is ACIP’s recent termination of the universal birth dose of hepatitis B vaccine. Since the CDC and the AAP recommended this vaccine, hepatitis B infections in children decreased by 99%. Newborns, infants and young children are particularly susceptible to hepatitis and are more likely than adults to develop chronic infection that leads to life-threatening complications, including cirrhosis and liver cancer. Of those who develop chronic hepatitis B infection, 15 to 25% will die.

A serious but overlooked risk in today’s anti-vaccine climate is congenital rubella syndrome. Rubella, or German measles, is “a leading cause of vaccine-preventable birth defects,” according to another study published in MMWR. Because of universal vaccination, Americans of childbearing age have never seen this condition. However, as measles, mumps and rubella vaccination rates fall, unvaccinated pregnant women can catch rubella and pass it to their babies, leading to severe birth defects. Those newborns will have lost protection from a disease that was once nearly eliminated.

As a pediatric hospitalist, I witnessed a dramatic reduction in disease burden due to the advent of the rotavirus vaccine. During my training in the 1990s, children’s hospitals were inundated with rotavirus patients. The cost of health care for rotavirus patients was estimated to be $1 billion annually. Since universal rotavirus vaccination was established, this infection in American children is rare.

During my training in the 1990s, children’s hospitals were inundated with rotavirus patients. The cost of health care for rotavirus patients was estimated to be $1 billion annually. Since universal rotavirus vaccination was established, this infection in American children is rare.

Kim Bergner, M.D.

Attacking the people who would save America’s children

The political weaponization of the legal system against vaccine proponents and providers is chilling. Powerful Republican politicians and conspiracy-mongering organizations have taken legal action against physicians and medical associations that continue to protect their patients by following evidence-based standards. For example: 

• Texas Attorney General Ken Paxton launched a spurious investigation into whether pediatricians, pharmaceutical companies and insurance companies are incentivized to give children “unsafe” vaccines.
• Children’s Health Defense (the anti-vaxx organization formerly led by RFK Jr.) filed a racketeering suit against the American Academy of Pediatrics.
• Texas Gov. Greg Abbott signed a bill allowing lawsuits against vaccine makers that advertise in the state. Florida is in the process of doing the same. Doctors may feel pressured to capitulate against their better judgment.

Patients will suffer, some will die, and health care providers will suffer moral injury.

The combined effects of global disengagement, research cuts, and politicized vaccine policy hinder our access to some of the greatest advancements in medicine. The human and economic costs are profound.

What Indivisibles can do

Take advice on fighting tyranny from author Timothy Snyder:

“It is institutions that help us preserve democracy…. Institutions do not protect themselves. They fall one after the other unless each is defended from the beginning.”

— Timothy Snyder, “On Tyranny,” Lesson 2: Defend Institutions

The Northeast Public Health Collaborative did this when, in the face of poor guidance from the federal government, eight states came together to collect and share data to make evidence-based public health guidelines and policy. We can ensure that Massachusetts remains part of this trustworthy public health collaborative by voting only for state officials who support it. 

Other steps:

• Take medical advice only from medical associations and your trusted physicians, for example, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, Infectious Diseases Society of America, the Massachusetts Department of Public Health, and the Northeast Public Health Collaborative. 
• Remain skeptical of medical advice coming from the federal government under the Trump administration. Do not take medical advice from social media influencers and online support groups or from internet searches, except for links to medical societies, academic medical centers and peer-reviewed journal articles. 
• Read the Evidence Reviews at the Vaccine Integrity Project.
• Lobby at the State House with MA Families for Vaccines or or call your reps regarding MA bills to eliminate loopholes in vaccine mandates. 
• Lobby with doctors, scientists and academics who advocate for the restoration of research funding, including the restoration of clinical trials. 
• If you are affiliated with a university that does scientific and medical research, join groups, such as Crimson Courage at Harvard, that exert pressure on their overseers to fight for the restoration of federal research funding.
• Vote up and down the ballot, from your local health department and school board to the president of the United States, only for candidates who advocate for science, sound public health policies, research funding, and the integrity of higher education.
• Participate in public comment opportunities to advocate for research funding and evidence-based policies. This link explains how.

Kim Bergner, MD, is a pediatrician and co-founder of Indivisible Weston.

IndivisiBlog posts reflect the opinions of the authors and do not necessarily reflect the opinions or policy positions of Indivisible Mass Coalition.