The Kennedy Effect
We are living in a topsy-turvy world.
The capture of government agencies by the corporations over which they have formal oversight was once a core concern on the American left. If I didn’t know the source of the following remarks, I might have guessed that they came from the lips of Bernie Sanders or someone closely allied with him:
All of the institutions of our government have been captured by the industries that they're supposed to regulate. The NIH, CDC, and FDA have been captured by the pharmaceutical industry and the medical cartel. People are making money on sick children and on keeping us sick. The insurance companies, the pharmaceutical companies, the healthcare companies, the hospitals, even the medical schools are all bought off and tied in by this kind of money. And they've turned our public health agencies predatory against the American public. The FCC… they've been captured by the big telecom companies. The EPA has been captured by the big polluters. The USDA has been captured by Big Ag. USDA was created to protect the small farmers and to ensure that we would have a wholesome food supply. But it does just the opposite. It's making war against small farmers. And it's ensuring that Monsanto and Cargill and the big chemical companies, Argenta, etc., control our food supply and are able, without any kind of impediment, to poison the American public.
As it happens, the remarks were made by Robert F. Kennedy Jr., who has been nominated to lead the Department of Health and Human Services in the incoming Republican administration. The Democratic governor of Colorado is supportive, and the senior senator from New Jersey may well vote in favor of confirmation.
The Kennedy nomination has raised alarm among many members of the public health community. The greatest concern is that there will be significant declines in vaccination rates for highly contagious diseases such as measles, giving rise to deadly outbreaks. In 2019, for example, immunization rates fell precipitously in the wake of two infant deaths wrongly attributed to the vaccine in Samoa, leading to 83 fatalities, most of them children. Even those who are open to many of Kennedy’s ideas have warned that if he “uses his perch as HHS secretary to discourage parents from getting their children inoculated with the MMR vaccine, severe negative repercussions could result, including measles outbreaks and childhood deaths.”
It is certainly possible that Kennedy’s presence at the top of our federal health bureaucracy could result in disaster. But it is not inevitable. There is a different possibility that is worth thinking through.
The argument, in a nutshell, is this. Since the early days of the pandemic, confidence in scientists to act in the interests of the public has fallen sharply. This is due, in part, to policy choices and public statements that even some of their architects and champions have come to reconsider. If the scientists who will be placed in leadership positions in the new administration break with Kennedy on the issue of certain essential vaccines—while endorsing his views on a number of other issues—they may have enough credibility to prevent catastrophic declines in immunization. In fact, they may be able to sway people and local authorities who would otherwise be tempted by vaccine hesitancy.
Consider the evidence for each of these points.
Public confidence in scientists has fallen sharply since the early days of the pandemic, especially among Republicans:1
There has also been a shift among Democrats, but of a slightly different kind—the proportion with “a great deal” of trust in scientists to act in our best interests rose during the first few months of the pandemic but has since fallen back.
These declines can be attributed to a number of policy choices—including lockdowns, school closures, mask mandates, and vaccine requirements—that were implemented and defended without adequate attention to their broad repercussions. Among the architects of these policies was Francis Collins, who was director of the National Institutes of Health at the time. Looking back on this experience, Collins made the following startling remarks on a podcast last year:
If you’re a public-health person and you’re trying to make a decision, you have this very narrow view of what the right decision is, and that is something that will save a life… You attach a zero value to whether this actually totally disrupts people’s lives, ruins the economy, and has many kids kept out of school in a way that they never quite recovered… This is a public-health mindset, and I think a lot of us involved in trying to make those recommendations had that mindset, and that was really unfortunate.
Polices that are disruptive and ruinous have downstream effects on morbidity and mortality, so it’s not clear that even by the standard of saving lives these choices were wise. For example, resistance to a particular vaccine can spill over into resistance to other, more vital vaccines. Paul Offit was a fervent supporter of vaccine mandates during the pandemic, but has since reconsidered his position for precisely this reason:
In May 2021, after about 70 percent of the United States population had been vaccinated, we hit a wall… In response, we mandated COVID vaccines. We mandated them for travel, schools, restaurants, businesses, and federal employees. We mandated them for entry into churches and synagogues. We mandated them for sporting events; athletes who refused to be vaccinated weren’t allowed to compete… Early in the pandemic, mandates appeared to be the way to go. But there was, as it turned out, an unanticipated price to pay… In 2023 alone, 48 states introduced 377 bills many of which addressed the legality of vaccine mandates and argued for more non-medical exemptions… About 35 percent of parents now question the value of school vaccine mandates for all vaccines. Consequently, vaccine exemptions among school children have increased dramatically. It is not a coincidence that measles cases are how sweeping across the country; 15 states are reporting cases.
It seems to me that restoring faith in the scientists leading our public health institutions—especially among those whose trust has fallen precipitously—is a very high priority.
How might this be done?
It has been reported that Jay Bhattacharya is a leading contender to head the NIH. He is popular among conservatives as a prominent and early critic of pandemic policies, and as someone whose views were suppressed on social media.2 If Bhattacharya (or someone with his standing among those currently most skeptical) were to make a strong case for the safety and efficacy of the most critical vaccines, it could stem the tide of exemptions and the incidence of outbreaks.
This argument would be especially persuasive if the NIH director were to endorse some positions held by Kennedy. The most obvious candidate for this is water fluoridation, the value of which is genuinely up for debate. The evidence for its oral health benefits is weak and uncertain, while the risks of excessive exposure on the cognitive development of children are real. Many jurisdictions avoid artificial fluoridation entirely, including the city of Portland and several European countries.
There is no doubt that we will see dramatic changes in policy guidance from our agencies with Kennedy at the helm of the federal health bureaucracy. But the catastrophe that some are predicting need not come to pass.
There has been a lot of second-guessing and finger-pointing in Democratic circles since the election, with little agreement on the direction the party should take. However, there seems to be a broad consensus that if the sitting President had decided not to seek reelection in the first place, allowing for a competitive primary on the usual calendar, the resulting nominee (even if it turned out to be Harris) would have been battle-tested and in a stronger position to win.
That may be true. But it’s important to remember that Kennedy was already running for the Democratic nomination a year and a half ago. Many others would have entered the race had Biden stepped aside, but Kennedy would have been right there on the debate stage with them. He would have had the opportunity to communicate his views to an attentive primary electorate, and to challenge the positions of others on live television. It seems unlikely to me that he would have secured the nomination, but I do think that he would have remained in the party and endorsed the eventual nominee, just as Tulsi Gabbard did in 2020.
Back in July of last year, when Kennedy was still running as a Democrat, I wrote the following:3
Kennedy’s bid remains unlikely to succeed, but if his party adopts a dismissive and contemptuous stance towards him and towards those whom he has mobilized, it will sink its own prospects. The proper and prudent response is to identify and absorb his legitimate concerns, while pushing back firmly but respectfully on the claims that lack merit.
Later that year, running as an independent, Kennedy reached as high as 22 percent in a three-way poll. This support declined over time as he struggled to get on the ballot nationwide, and the viability of his campaign came into question. Even so, as late as June of this year, he was polling in double-digits overall with exceptionally strong support among Latinos.
But the mockery never stopped and the ad hominem attacks kept coming. By the time he was ready to make a Faustian bargain, he was embraced by one candidate and couldn’t even get an audience with the other. There are many lessons to be drawn from the recent election results, but one of them is surely this—Kennedy Democrats vastly outnumber Cheney Republicans. And in an election decided by just 230,000 votes across three states, this difference proved decisive.
I’m grateful to Alice Evans for bringing this survey to my attention.
The blacklisting of Bhattacharya was a mistake, one among many made by media companies during the pandemic. But such errors of judgement have been leveraged to malign researchers such as Renee DiResta, who were examining and exposing what they perceived to be misinformation online. Those who read this newsletter regularly will know that my commitment to free expression is longstanding and deep. I have urged people to form independent judgements of Kennedy, and would make the same case for DiResta. Her recent book is worth reading, as is a thoughtful post on censorship alarmism by Dan Williams.
For reasons that I still don’t understand, my post on Kennedy was flagged by Google for having allegedly violated its policies.
RFK is a very difficult case. Not when it comes to what to do about his speech, I'm of the same mindset as you and I don't support the misinformation panic. But free expression people do need to be clear in recognizing that there are lots of people out there with poor critical-thinking faculties and a conspiracy-theorizing mindset. RFK is obviously such a person.
The complicating factor, of course, is that a critical mass of voters is equally bad or worse in these respects. (An important habit of mind for free speech absolutists is to work hard not to overestimate the electorate's critical thinking capabilities, which the "marketplace of ideas" metaphor encourages us to do.)
I think there is value in holding the line that says 5G conspiracy theories, vaccine/autism and GMO fearmongering and the like has no place in the halls of power. If the opponent were Nikki Haley, I'd be inclined to say that it's worth running a greater risk of losing in order to repudiate RFK. Given that the opponent was Trump, I think you're right that it was worth it to try to reach an understanding with him.
Bhattacharya, on the other hand, is a very serious person and I actually agree with many of his unorthodox views. I think it would be great to have him in a high position. But here there is a problem as well. If he works for Trump, that could end up further polarizing the response to his views--lots of folks will assume that he's a bad guy because he's willing to work with Trump (and RFK). It would be nice if the response was the one you hope for, but I'm not sure that's realistic.
I continue to find perspectives like this perplexing. RFK Jr. is a known quantity, defined historically by his being profoundly wrong about most topics on which he advocates and his unwillingness to change his position despite definitive critique. Yes, what happens with him as HHS secretary remains to be seen. It is theoretically possible that power will have a moderating effect on him and that he would somehow see his way to endorsing routine childhood vaccination, but his own protestations that he is not "anti-vaccine" are utterly unconvincing given his history. He has a long track record of opposing childhood vaccination based on dubious naturalistic fallacies.
The cases of Prasad and Bhattacharya are a little tougher to adjuducate. They both at least appear to be competent in some domains but have demonstrated precisely the opposite in their advocacy around Covid. Prasad may have correctly identified instances where the risk-benefit calculation for vaccination (e.g., in young people) or masking (e.g., in toddlers) was not clear, but elsewhere he demonstrated, repeatedly, that he has a poor grasp of infectious disease dynamics and interpreted the statistical results of many studies in risible ways. I can only conclude that he is in fact more susceptible to motivated reasoning than the targets of his ire, not to mention being high on his own gas.
I was led back here by a Bluesky post where you said it would be better for him to post without being trolled. He should extend the same professional courtesy to people he disagrees with rather than slandering them with accusations of lying and deceipt [in some cases, he points to real cases of bad behavior and messaging on the part of public health officials, but also unjustly smears swathes of people]. I cannot see why you do not hold him to the same standard, much less why you appear to be such a fan of his. I think he's precisely the wrong kind of contrarian, i.e., one whose protestations do less to illumnate and more to inflame knee-jerk emotional reactions. Paraphrasing a colleague of mine, contrarianism is a technology that we use to inprove our understanding. I would add that once contrarianism becomes one's identity, that person now resides in perilous environs. (As an aside, Glenn Loury has fallen victim to this in the past and admitted to it, to his credit. Despite the fact that he obviously relishes his own contrarianism, he is a serious thinker with a great deal of self-awareness.)
I know less about Bhattacharya, though I will say I believe the Great Barrington Declaration to be an embarrassing document for all involved, and not just in hindsight. Without relitigating the entire thing, the fatal core of that document was this: they *assumed* the truth of herd immunity, ignored unique aspects of population risk under contagion, and then proposed solutions based on those assumptions. That document is an object lesson in poor reasoning under uncertainty.
None of this is to say there aren't serious discussions to be had about trade-offs, mandates, tensions between systemic risk and individual liberty, etc. It's crucial we have those discussions, and I do believe ideological and political homogeneity in my field is a problem.