How Trump's 'big discussion' around vaccines and autism could hurt children's health

President-elect Donald Trump promises he and Robert F. Kennedy Jr., his pick to run America's health agencies, will have a “big discussion” about childhood vaccines.

In a Time magazine interview for “Person of the Year," Trump wondered aloud if vaccinations administered in childhood contribute to rising autism rates ‒ an idea that has been repeatedly debunked by research.

“We're going to have a big discussion,” Trump said. "The autism rate is at a level that nobody ever believed possible. If you look at things that are happening, there's something causing it.”

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Trump, who oversaw development of the COVID-19 vaccine during his first administration, said he wants “to see the numbers.” Then, after the studies, “we’re going to know what’s good and what’s not good,” Trump said.

‘What diseases would he like to come back?’

Kennedy, a lawyer, has said he isn't against all vaccines. He has been vaccinated himself, he has said, and vaccinated his children. Instead, he generally supports parental "choice" around vaccines.

But Kennedy has peddled conspiracy theories against a number of vaccines, both in public and in lawsuits, including those for measles and COVID-19. As Health and Human Services Secretary, Kennedy would oversee the Centers for Disease Control and Prevention, which runs the federal children’s vaccine program.

On Monday, 77 Nobel laureates said Kennedy would "put the public’s health in jeopardy.”

Public health experts have also sounded alarms on his nomination.

His anti-vaccine stances are "dangerous," said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, which has looked at conspiracies around vaccines and autism. “What diseases would he like to come back?” 

For measles, for instance, if less than 95% of the population is vaccinated, an outbreak can take hold, infecting vulnerable people who are too young, old or otherwise unable to get vaccinated. Before vaccines were available in the U.S. in 1963, nearly every child contracted measles before age 15, according to the Infectious Diseases Society of America. About 48,000 were hospitalized and 500 died every year.

Discredited link between vaccines and autism

The myth that vaccines cause autism stems from a discredited and retracted 1998 study by Andrew Wakefield, a disbarred British physician. The study published in the science journal, The Lancet. 

Trump met with Wakefield before his first election win in 2016, and Wakefield attended one of Trump’s inaugural balls in 2017.

The Wakefield paper looked at just 12 children in the U.K. with developmental delays, and said eight children who received the common measles, mumps and rubella (MMR) vaccine developed behavioral symptoms consistent with autism within two weeks of vaccination.

But the study was deeply flawed, according to the standards of scientific research. Nearly all of Wakefield's dozen co-authors later removed their names from the paper.

Studies published in 1999, 2002 and 2019, among others ‒ including hundreds of thousands of children, some of whom received the MMR vaccine and some of whom didn't ‒ found no association between vaccination and the development of autism.

Although every medical intervention can have negative effects, vaccines undergo extensive safety testing precisely because they are given to healthy people.

“There’s probably no therapeutic medication that undergoes more safety testing than vaccines,” said Dr. Matthew Boulton, professor of epidemiology and internal medicine at the University of Michigan School of Public Health. 

If a person has a bad reaction to a vaccine, federal officials encourage reporting to the Vaccine Adverse Event Reporting System, which is part of the Department of Health and Human Services. 

This system was used, for instance, to identify blood clots linked to the Johnson & Johnson COVID-19 vaccine used early in the pandemic, according to the Yale School of Public Health. Six cases of blood clotting, out of 6.8 million total doses, occurred before regulators pulled it from the U.S. market.

What about rising autism rates?

Autism spectrum disorder is a neurological and developmental disorder affecting how people communicate, interact with others, learn and behave. Symptoms generally appear early in life. It's a spectrum, so some people may show milder symptoms autism, while others might not be able to communicate at all, devastating families and lives.

Autism rates have increased dramatically in recent decades. About 1 in 36 children born in 2012 is estimated to have an autism spectrum disorder, up from 1 in 150 born in 1992, according to the CDC.

The lack of an explanation for these skyrocketing increases has fed a variety of theories, including a possible link to childhood vaccines, though there has never been definitive research proving such a connection.

The many research-supported causes for the increase include diagnosing children with more mild disorders. About 100 genes have been associated with autism, and if one identical twin has autism, the other twin has an 80% chance of also having autism, suggesting a strong genetic link. A mother's infection during pregnancy is also believed to increase the risk of a child later developing autism.

Other research has found a connection between the environment and autism, though it's not clear exactly what in the environment might be the cause. Exposure to air pollution during pregnancy, which one study showed might increase autism risk, would happen before a baby is born and therefore before they receive childhood vaccines.

Vaccines for Children program might be at risk

Trump and Kennedy haven't explicitly said they would target the federal Vaccines for Children Program, but several health experts said they're worried the new administration has the program in its sights.

The Vaccines for Children Program provides immunizations to over half of U.S. children, regardless of family income or health insurance status. Private insurers draw from recommended vaccines in this program for their own coverage plans.

Congress established the program after a measles outbreak between 1989 and 1991 that left over 160 preschoolers dead and 11,000 hospitalized.

Cost was a key reason why children hadn’t received their measles vaccine, said Dr. Walter Orenstein, a professor emeritus at the Emory School of Medicine, who led the U.S. Immunization Program when Vaccines for Children launched.

A recent CDC study estimated the program will have saved 1.13 million lives and $2.9 trillion from not getting sick, missing school or parents missing work, and longer term health issues, such as deafness or blindness.

Ending Vaccines for Children, a congressional entitlement program, would likely require legislative action, said Jason Schwartz, an associate professor of health policy at Yale School of Public Health. But Trump and Kennedy can undercut the program even if they don't terminate it, Schwartz said.

The incoming administration could recalibrate or reduce CDC’s recommended vaccine schedule for children, he said. This could affect children covered by private insurance as well as those on Medicaid or in families that are under- or uninsured.

“Really, we will be creating a system whereby, if you can afford them, you get them,” Boulton, of Michigan, said. “If you can’t, you don’t.”

What about other vaccines?

Kennedy has targeted other vaccines besides MMR, including the COVID-19 vaccine. A Kennedy-affiliated lawyer petitioned the Food and Drug Administration in 2022 to revoke the polio vaccine's approval. If appointed HHS Secretary, Kennedy would also oversee the FDA.

On a Sunday interview with “Meet the Press,” Trump said he supported the polio vaccine, which was first licensed in the U.S in April 1955, a few months before his ninth birthday.

“The polio vaccine is the greatest thing,” he said.

Karen Weintraub of USA TODAY contributed to this report.