When Donald Trump vowed to let Robert F. Kennedy Jr. “go wild” on America’s health in October, he meant it. The Health and Human Services secretary has overseen a bloodbath at America’s public-health agencies during his brief tenure: More than 2,400 people were laid off at the Centers for Disease Control, which currently has no director, and 10,000 at HHS. Though some staffers have since been rehired, the widespread cuts, carried out in chaotic and indiscriminate-seeming fashion, have laid siege to some of the agencies’ core functions. The DOGE-ified federal government has also canceled or impeded billions of dollars in health grants and cynically frozen crucial funding to institutions like Harvard. RFK Jr. himself has used his powerful perch to cast doubt on the efficacy of vaccines amid a measles outbreak among other dubious claims. Recently, he fired all members of the esteemed Advisory Committee on Immunization Practices (ACIP), which sets recommendations for vaccines nationwide, and replaced them with eight handpicked members, multiple of whom have expressed anti-vaccine views.

Just how badly has the Trump administration damaged American health care over a mere five months? To get a sense, I spoke with Tom Frieden, who served as the CDC director for almost the entirety of Barack Obama’s presidency. Before that, he was New York City’s health commissioner (he oversaw the ban on smoking in bars and restaurants). Since 2017, Frieden has been the president and CEO of Resolve to Save Lives, a global organization that combats epidemics and cardiovascular disease and promotes healthy eating. He is also the author of a forthcoming book, The Formula for Better Health: How to Save Millions of Lives — Including Your Own.

RFK Jr. has unilaterally fired all the members of the ACIP and replaced them with eight new people, some of whom are pretty heavily involved in the anti-vax movement. I wanted to get your initial reaction to these new picks. Maybe I’m putting words in your mouth, but were they as bad as you feared?
I don’t want to speak about the individuals; I think the broader issue is what ACIP is and why it’s important. ACIP has been a model for evidence-based, transparent, fact-based decisions on whom to recommend vaccines to for decades — it’s been around for 60 years. When I was CDC director for nearly eight years, people came from all over the world to watch the ACIP meetings because the quality of evidence being presented, the clarity with which it was presented, the openness of discussions, and the involvement of pediatricians and parents and others in the process were truly models of effective policymaking. And that’s why essentially every doctor in America used the ACIP to decide whom to recommend vaccines to. That process has been completely upended, and it was upended based on at least two untrue assertions.

The first is that there were terrible conflicts of interest — Secretary Kennedy refers to a 2009 report. I was the recipient of that report when I was CDC director, so I remember it. Secretary Kennedy has portrayed that report as saying that 97 percent of ACIP had severe conflicts of interest. What the report actually showed was that 97 percent had some problem or other with a form they filled out, not that anyone had a conflict of interest. Before I became CDC director, I was on an advisory committee, and I had to fill out that form. It is an incredibly tedious form. It makes your income taxes look easy. If you forget to initial every page, it counts as a lapse, and that’s the kind of administrative problem that was found. It is true that there were problems with the process. For example, the person guiding people to fill out those forms was not as highly trained as they should have been. They were a lower-level staff member.

Not exactly a conflict of interest, though.
Right. So this was classic misinformation. There’s a kernel of truth — yes, there was a report and it said there were problems. But when it comes to conflict of interest, there are 17 slots on the ACIP. Sixteen of those 17 people reported no conflicts of interest. One reported a conflict of interest: a distinguished pediatric infectious-disease physician who also happened to do research on vaccines. And so she recused herself from the decisions on those vaccines.

Some federal committees, not at CDC, but at other agencies, take a different view on conflict of interest where they say it’s fine for you to be part of the decision or the discussion as long as you disclose your conflict of interest. That’s never the position the CDC has taken, or at least not in recent years, certainly not since I was there. You can’t be part of the discussion if you have even the appearance of a conflict of interest. And we’ve looked at the kind of conflicts that people disclosed, and there are things like they’re on what’s called the Data Safety Monitoring Board, DSMB, which is an independent unit that looks at whether a vaccine trial is being........

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