Two senior FDA officials, including Dr. Robert Califf, the agency head, recently published a journal article entitled "Is Vaccination Approaching a Dangerous Tipping Point?" They make a compelling case that we are facing a crisis:
Despite the care taken in the development and deployment of vaccines and their clear and compelling benefit of saving individual lives and improving population health outcomes, an increasing number of people in the US are now declining vaccination for a variety of reasons, ranging from safety concerns to religious beliefs.
Vaccination is a pillar of disease prevention. The CDC estimates that, worldwide, between 2021 and 2030, more than 50 million deaths will have been prevented through immunization.
The U.S. cannot afford widespread rejection of vaccines, but Dr. Califf's proposed remedy is weak, essentially shifting the responsibility for educating the public "to all those directly interacting with individuals in a health care setting, ranging from front office staff to retail pharmacists to primary care physicians."
Healthcare providers cannot do it alone. Government officials, especially at the top of the food chain, must be part of the solution.
For a start, Dr. Califf should meet with White House Chief of Staff Jeff Zients, whose previous job was White House coronavirus response coordinator, grab him by the lapels, and give him a proper tongue-lashing. The White House has been letting senior healthcare officials get away with murder. Literally.
The CDC Director, NIH Director, U.S. Surgeon General, HHS Secretary and Assistant Secretary for Health – and Califf, himself, for that matter – have been invisible. For all the public knows, they could all have entered the Federal Witness Protection Program and, with new identities, be flipping burgers in Wyoming.
How bad is the current situation?
Measles, the most infectious vaccine-preventable disease caused by viruses, shows what happens when the public becomes blasé about vaccination. Before vaccines were available, every year in the United States there were 3 to 4 million cases of measles, around 48,000 hospitalizations, and 400 to 500 deaths. It was declared eliminated in the United States in 2000, after there were no measles cases for more than a year, due to an aggressive vaccination campaign. Nearly a dozen cases of measles virus have been reported in Pennsylvania, Virginia, and Georgia in recent weeks, according to local health departments. There were 56 cases in the U.S. last year.
Currently, about 92% of U.S. children have been vaccinated against measles, mumps and rubella (by the MMR vaccine) before age 2, according to a 2023 report from the CDC – below the federal target of 95%, which would restore herd immunity.
COVID is another case in point. During the week from January 14-20, COVID Emergency Department visits, hospitalizations, and deaths appeared to have peaked and were heading down. However, there were still more than 26,000 hospitalizations that week; 3.7% of all deaths in the U.S. were due to COVID; and as the result of new infections, it is probable that tens of thousands of Americans are likely en route to long COVID -- the persistence of signs and symptoms following the acute infection -- every day.
Yet, only 19% of eligible Americans have gotten the most recent COVID vaccine booster, and masking is almost non-existent even in high-risk situations such as airports, airplanes, trains, buses, theaters, and other places where people congregate indoors in large numbers. An opportunity lost was President Biden's January 8 campaign speech at a Charleston, SC, church. The pews were completely full, but there was not a mask in sight. Had Biden's staff required the attendees to wear masks, that would have sent an important message.
There is even what veterinarians have dubbed "canine vaccine hesitancy." An article published last year in the journal Vaccine found that "a large minority of dog owners consider vaccines administered to dogs to be unsafe (37%), ineffective (22%), and/or unnecessary (30%)" and that a majority of dog owners (53%) hold one or more of those opinions.
What can be done?
We need a multi-pronged public education campaign with participation from politicians and celebrities of all stripes. Think of a widely distributed Public Service Announcement video (including during the Super Bowl) that shows President Biden and Donald Trump getting Shingles vaccinations and Taylor Swift and Oprah Winfrey getting a COVID booster.
We can and must do better.
An earlier version of this article was previously published by the South Florida Sun-Sentinel.
Henry I. Miller, MS, MD
Henry I. Miller, MS, MD, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. His research focuses on public policy toward science, technology, and medicine, encompassing a number of areas, including pharmaceutical development, genetic engineering, models for regulatory reform, precision medicine, and the emergence of new viral diseases. Dr. Miller served for fifteen years at the US Food and Drug Administration (FDA) in a number of posts, including as the founding director of the Office of Biotechnology.
