On March 8, in “The Coming RFK Jr Health Recession Part 3,” we took a hard look at the US measles epidemic, which has been enabled by falling measles vaccination rates. (Since that time, as of April 9, confirmed measles cases in the US have risen to 1714 across 33 states.)
We also noted the accumulating damage imposed by RFK Jr’s flawed leadership at the helm of Health and Human Services. That damage encompasses significant economic impacts, impacting GDP and exerting recessionary pressures.
In a tweet at X on October 5, former Surgeon General Jerome Adams pointed to research noting the cost of a measles outbreak:
A measles outbreak in South Carolina (993 cases, 20 hospitalizations, 5 months) cost an estimated $35.5M – about 6.7% of the state public health budget!
(https://x.com/JeromeAdamsMD/status/2040882930508009564?s=20)
A day later, to those who remained skeptical about the astronomical costs an outbreak might present, he offered this explanation:
The total cost of an outbreak goes far beyond hospitalizations alone. The majority of the expense actually comes from public health response efforts and not just downstream medical care for those that get really sick.
For every confirmed measles case, public health teams have to conduct detailed case investigations, identify and notify contacts, and monitor those individuals for symptoms. Anyone who is unvaccinated and exposed often has to be quarantined or excluded from work or school for a period of time. That requires significant staffing, coordination, and resources.
There are also broader economic impacts. People who are quarantined may miss work, parents may have to stay home with children who are excluded from school, and workplaces and schools can be disrupted. All of that adds indirect costs on top of the direct public health spending.
So while only a small number of people may be hospitalized, every single case triggers a cascade of response activities and economic consequences. That’s why outbreaks can become so expensive so quickly — and why preventing even a single case through vaccination saves both public health resources and taxpayer money.
Signed: someone who used to run a state health department, and actually investigated infectious disease outbreaks…
(https://x.com/JeromeAdamsMD/status/2041266453022699623?s=20)
Whatever figures readers might arrive at themselves, the essential takeaway remains: Infectious disease outbreaks are costly, and prevention or mitigation of resulting harms, wherever possible, is far less so.
Today, we continue our discussion on the RFK Jr. Health Recession, with a focus broader than measles. On March 8, we observed:
Specifically, under RFK Jr.’s leadership we are seeing and will see
- Resurgences of infectious diseases once controlled by vaccination
- Rising costs that will run into the billions
- Rising cases, hospitalizations, long-term health impacts, and deaths into the future
- A growing burden on a weakened healthcare system, compromising medical care for all
- Selective suppression of data, particularly data that documents the consequences of policy changes
- A vacuum of expert leadership, pared staffing, pared and redirected research, and public health guidance compromised by misinformation and vaccine skepticism
- The gutting of preparedness for pandemics, whether new pathogens emerge from nature or from labs, ensuring peak national vulnerability to disease-related demographic and economic shocks
We pick up today with a deeper examination (though hardly a comprehensive one), of the impact of falling vaccination rates, which are being impacted by an erosion of trust in the efficacy of vaccines, orchestrated by RFK Jr. and his appointees.
Along with measles, other vaccine-preventable infectious diseases, including pertussis (discussed separately below), meningitis, polio, rotovirus, RSV, tetanus, rubella, hepatis B, diphtheria, will rise as vaccination rates fall.
“As measles cases climb, these 9 diseases threaten comebacks” | Washington Post,
https://www.washingtonpost.com/wellness/2026/02/24/measles-vaccine-preventable-diseases/
We can add mumps (Maryland) to the list:
“Measles is not the only disease on the rise. Mumps also may be making a comeback” | KTBS (CNN),
https://www.ktbs.com/health/measles-is-not-the-only-disease-on-the-rise-mumps-also-may-be-making-a/article_fee50cab-a707-5ca6-b2bf-163c4bd8b5e2.html
And a difficult flu season, especially for children, has highlighted the continuing relevance of annual flu vaccines. As Bloomberg reported in January,
Last year was the deadliest flu season for kids in 15 years, with more than 280 deaths recorded. Emergency department visits for flu-like symptoms this season are the highest among children and nine deaths have been recorded.
(“US Flu Cases Show No Signs of Letting Up” | Bloomberg, https://www.bloomberg.com/news/newsletters/2026-01-06/why-this-year-s-flu-season-is-so-severe-thanks-to-subclade-k)
COVID, too, makes the list, as the march of variants continues. On the rise now is BA 3.2, nicknamed “Cicada” because it reemerged after largely disappearing for a while. BA 3.2 infects children at higher rate, relative to the rest of the population, than previous variants did.
Let’s get specific about some projections. What clues do we have about what the future will look like, given RFK Jr’s vaccine skepticism writ into public health communication and policy?
Cases, Hospitalizations, Deaths — What We Can Expect if Vaccination Rates Drop
The authors of a study published in JAMA in April 2025, “Modeling Reemergence of Vaccine-Eliminated Infectious Diseases Under Declining Vaccination in the US,” modeled expected cases, hospitalizations, complications, and deaths for four vaccine-preventable childhood illnesses (measles, rubella, polio, and diphtheria) over 25 years, based on vaccination rates. If current vaccination rates rise, cases, hospitalizations, complications, and deaths fall. But if current vaccination rates continue to fall, say by 10% or 25% or 50%, the numbers state by state and in total change dramatically, with many more children suffering needlessly, many more exorbitantly costly hospitalizations, and many more deaths.
Below, we used data reported in the study to create a table. Remember that the numbers of cases and deaths are projected for a 25-year period. (Cells are grayed out where no numbers were mentioned.)
Consider the cost of millions of extra hospitalizations. Consider the number of days caregivers will have to take off from work. Consider the productivity costs and the school closures and quarantines during outbreaks and their long-term impacts on children’s educations. Consider the lifelong consequences of polio paralysis or of congenital rubella syndrome, which may cause deafness, blindness, and heart defects among many other possible impacts. Consider the tragedy of children’s lives lost and the economic impacts of their absence.
The authors write:
Based on estimates from this modeling study, declining childhood vaccination rates will increase the frequency and size of outbreaks of previously eliminated vaccine-preventable infections, eventually leading to their return to endemic levels.
Measles will get there first. For reference, the study provides a number of maps and charts, including US maps showing state-by-state expected cumulative cases under a given scenario. Here’s the link to the full study, which we recommend as a tool for thought:
“Modeling Reemergence of Vaccine-Eliminated Infectious Diseases Under Declining Vaccination in the US” | JAMA,
https://jamanetwork.com/journals/jama/fullarticle/2833361
What will actually happen may well be somewhat different from the projections. Many policy and individual choices lie between the present and future outcomes. But however outcomes may vary from the model, the thought experiment it entails is a vital one to conduct right now.
On this theme, see also ProPublica’s compelling March 27 article based on the same research:
“THE HORRORS THAT COULD LIE AHEAD IF VACCINES VANISH” | ProPublica,
https://projects.propublica.org/childhood-vaccines-deaths-modeling/
Pertussis (Whooping Cough) Also Making a Comeback
The study discussed above deals with just four vaccine-preventable infectious diseases that have long harmed children. The same work could be done with all the others. We discussed the implications for delaying the hepatitis B vaccine in Part 1. There’s another discussion to be had around the pertussis vaccine (for whooping cough). According to NBC News, “About 70% of the counties and jurisdictions in [the] 31 states [that provided data for kindergartners] were below the 95% target rate recommended for community protection” against pertussis.
The introduction of the pertussis vaccine in the US reduced annual deaths per million cases from the thousands to the tens. To the extent that vaccination rates drop, that trajectory will reverse. Though most people recover, symptoms last three to six months with treatment. Some people have coughed hard enough to fracture a rib. Infants are most vulnerable, but older adults are vulnerable, too. According to the Mayo Clinic, people who contract the illness are contagious for up to three weeks, and the protection vaccination offers wanes after about 10 years.
Recommended readings on this subject follow.
“Whooping cough cases soar as vaccination rates drop” | NBC News,
https://www.nbcnews.com/health/kids-health/whooping-cough-vaccines-cases-us-pertussis-rcna248746“Global Childhood Deaths From Pertussis: A Historical Review” | Clinical Infectious Diseases via Oxford Academic,
https://academic.oup.com/cid/article/63/suppl_4/S134/2526410?login=false
A Study Delayed
Blowing vaccine risks far out of proportion relative to vaccine benefits is one way that RFK Jr. and other vaccine skeptics erode trust in vaccines and whittle vaccination rates. The flip side of that coin is being less than forthright about the relative benefits of vaccines vs. their risks. Recently, RFK Jr’s Acting CDC Director Jay Bhattacharya postponed the release of a study documenting the 2025–2026 COVID vaccine’s effectiveness in reducing serious the likelihood of serious illness among adults by about half. Bhattacharya called into question long-trusted methodology used in the study. Was the problem methodology or simply a message RFK Jr. did not want to promote?
Gutting Testing
Remarkably, as of April 6, RFK Jr’s CDC is no longer offering testing for rabies, toxic shock syndrome, fungal infections, measles, chicken pox, Epstein Barre, and other infectious diseases, for a total of 31 tests paused. In most cases, viewers of the “Test Directory” page are advised that “commercial diagnostic testing is available.” The pause is characterized as “temporary” as processes are reviewed. Apparently, the thought that processes might be reviewed even as critical testing continues has not occurred to leadership at RFK Jr.’s CDC. Parallel efforts, after all, should not be difficult to undertake at an adequately staffed CDC, if the nation still had one.
Sarah Boden, writing for CIDRAP, explains how fundamental such tests are to CDC’s mission:
Testing is a vital aspect of disease surveillance. It allows public health officials to identify outbreaks early or track how a disease is spreading through a region. State and local public health labs, particularly those in smaller jurisdictions, rely on the CDC for testing, because they lack the staff and resources to handle every possible test that might be required.
(“State public health labs step up as CDC pauses testing for various pathogens, including rabies, mpox” | CIDRAP,
https://www.cidrap.umn.edu/rabies/state-public-health-labs-step-cdc-pauses-testing-various-pathogens-including-rabies-mpox)
New Republic doesn’t mince words in its headline: “CDC Forced to Pause Rabies Testing Thanks to RFK Jr.,” noting that CDC has offered these tests for decades and the qualified staff available to advise state and local officials regarding rabies outbreaks — the rabies team — now consists of one person (who might occasionally get sick or go on vacation).
The CDC’s capacity for surveillance has been sharply reduced under RFK Jr.’s leadership. Now that erosion extends to testing for a broad range of infectious diseases. May the “pause” be short.
Gutting Expert Leadership and Preparedness
In the February 26 edition of the Osterholm Update (Episode 203: “Somebody to Lean On”), Dr. Michael Osterholm, Director of CIDRAP, surveyed the damage to public health leadership under RFK Jr. He noted that
- CDC has had four different leaders in a little more than a year, with 11,000 staff members working at various centers and offices. Jay Bhattacharya, a co-author of the Great Barrington Declaration, now heads both CDC and NIH; neither position is a part-time job.
- More than 80% of the CDC’s center directors, representing “midlevel expertise,” have left CDC since January 2025, most “replaced by temporary or interim leaders.” Experienced, expert leadership across CDC has been largely gutted.
- NIH has 20,000 employees working at 27 institutes and centers. As of a February 15 NBC News Report, only 11 of the 27 institutes and centers had permanent directors in place.
- Part of the NIH, the National Institute of Allergy and Infectious Diseases (NIAID) has seen its workforce reduced by 4000 (20% of agency), experts replaced by political appointees, and research grants clawed back, including $500 million in mRNA research. mRNA is the best technology we have for developing a new vaccine in a hurry in the case of a pandemic, among other applications.
Of course, March 6 brought the news that the FDA will soon navigate another change in leadership as Vinay Prasad, the FDA’s controversial vaccine chief, is slated to leave that agency at the end of April.
Slashed personnel reflect only part of the damage. Vital research is another aspect. The New York Times offers a thoroughgoing report regarding the changes in play:
“The U.S. Is Funding Fewer Grants in Every Area of Science and Medicine” | New York Times (gift article),
https://www.nytimes.com/interactive/2025/12/02/upshot/trump-science-funding-cuts.html?unlocked_article_code=1.aFA.DYLa.OnVOgXSwZnbn&smid=url-share
Abandoning Preparedness for New Infectious Diseases
In his February 26 podcast, Dr. Osterholm also pointed out that NIAID has been ordered by the Trump administration to remove the words biodefense and pandemic preparedness from the institute’s web pages. Biodefense, pandemic preparedness, and future diseases in general are no longer a focus. What is the predictable and inevitable result? The US will not be prepared for any future naturally occurring pandemic or AI-generated viral bioweapon. (This is a good a spot as any to note that the risk of a deadly H5N1 influenza pandemic continues to edge higher: One strain that infects cattle can now replicate in human lungs and is better able to bind to our upper respiratory tissues than avian-adapted strains are.)
With that assessment in mind, we recall some of our concluding points in the closing pages of The Fed and the Flu: Parsing Pandemic Economic Shocks:
In the war against microbes that cause disease, human beings look for first opportunities to lay down their arms, while certain viruses continually and industriously better their opportunities to infect and reproduce, ever on the offensive…. We speed economic recoveries following pandemic shocks by being ever prepared to mitigate the worst harms that pandemics can do, protecting people (including essential workers) from disease transmission even as we protect continuity of essential economic activity, and cultivating sources of economic resilience….
How long we have before the next pandemic is unpredictable, and the next one may prove more devastating than the last. In the meantime, our preparations, surveillance, research, and vaccine development have yet to be scaled and paced to adequately prepare us for the threat of a new pandemic…. It behooves us to act on the realization that the epilogue to one pandemic story is always the prologue to the next.
(The Fed and the Flu, 510–512)
Medical Experts Organize to Provide Reliable Information and Counter Misinformation
Trust in the CDC, FDA, and NIH has fallen since RFK Jr. was appointed to lead federal public health institutions in the US, though it had also eroded prior to Trump 2.0. More Americans now look to professional medical groups such as the American Academy of Pediatrics (AAP), the American Heart Association, and the American Medical Association rather than to CDC, etc., for reliable information.
Vaccines
Beyond individual medical authorities who speak out to counter medical misinformation, medical organizations are stepping up. The American Academy of Pediatrics released its own childhood vaccination schedule, parting ways with RFK Jr’s CDC. CIDRAP’s Vaccine Integrity Project, dedicated to providing accurate information about vaccines, is producing its own independent reviews of the Tdap vaccine in pregnancy and the HPV vaccine.
After a federal judge blocked RFK Jr.’s handpicked ACIP Committee because its appointees were not the vaccine experts that the committee’s charter required, RFK Jr. has crafted a new charter to replace the old one.
“RFK Jr. moves to broaden CDC vaccine panel eligibility after federal judge found new members unqualified” | The Hill,
https://thehill.com/policy/healthcare/5819958-kennedy-revamps-vaccine-advisory/
The new charter specifies that the committee must have “necessary expertise” and “geographical balance” and a “balance of specialty areas (e.g., biostatistics, toxicology, immunology, epidemiology, pediatrics, internal medicine, family medicine, nursing, consumer issues, state and local health department perspective, academic perspective, public health perspective, etc.)”
Gone is language that insisted under the previous charter that all members have actual “expertise in the use of vaccines and other immunobiologic agents in clinical practice or preventive medicine, have expertise with clinical or laboratory vaccine research, or have expertise in assessment of vaccine efficacy and safety.”
Further, in the new charter, “ACIP members “shall be selected and appointed by the HHS Secretary.”
For these specifics and more, see
“Federal Register / Vol. 91, No. 65 / Monday, April 6, 2026 / Notices” | Govinfo.gov,
https://www.govinfo.gov/content/pkg/FR-2026-04-06/pdf/2026-06577.pdf
In the face of RFK Jr’s foolhardy rejection of genuine expertise, the AAP and the AMA and other experts and panels of experts with deep and relevant medical expertise have a critical role to play.
Autism
In March, MedPage Today reported that a new, independent committee — the Independent Autism Coordinating Committee (Independent ACC) — will guide nongovernment autism research funders with accurate information. That 12-member committee includes “former National Institute of Mental Health (NIMH) Directors Joshua Gordon, MD, PhD, and Tom Insel, MD…. Former U.S. Congressman James Greenwood (R-Pa.), a sponsor of the act that created the IACC, also joined the group, as did Alison Singer, the president of the Autism Science Foundation and a former IACC member.” The Independent ACC affords an alternative to the federal Interagency Autism Coordinating Committee (IACC), which is now comprised entirely of RFK Jr’s handpicked appointees.
Paul Offit, professor of pediatrics at Children’s Hospital of Philadelphia, wrote this past week about all the ways that RFK Jr’s pursuit of various erroneous theories about autism’s causes, prevention, and treatment are hurting those with autism. Overhyping leucovorin as a broadly applicable treatment for autism is the latest example, Offit writes.
“RFK Jr.’s Latest Disservice to Children with Autism” | Beyond the Noise,
https://open.substack.com/pub/pauloffit/p/rfk-jrs-latest-disservice-to-children?utm_campaign=post-expanded-share&utm_medium=web
In contrast, the Independent ACC “will fulfill the [2006] Autism CARES Act’s objective of developing a coordinated autism research agenda” and, in the words of Alison Singer, the president of the Autism Science Foundation, “will ensure science, not misinformation, guides autism research.” (https://www.medpagetoday.com/neurology/autism/120149)
Possible Pushback from the Trump Administration
There are some signs that RFK Jr’s health leadership is now perceived by the administration as a liability, especially as measles spreads. Speaking as acting CDC Director, Jay Bhattacharya, on March 2, released a video on X detailing the CDC’s response to the outbreak in South Carolina and strongly endorsed vaccination for measles, saying:
The MMR vaccine remains the most reliable and effective way to prevent it. Two doses are 97% effective at providing lifelong protection against measles and its complications. Vaccination protects not only individuals but entire communities.
(“Acting CDC director Bhattacharya urges measles vaccines” | The Hill, https://thehill.com/policy/healthcare/5763366-cdc-urges-measles-vaccination/)
Political pressure may be having an impact. As an example, the FDA reversed its decision to cancel mRNA research, which is vital to the optimally timely development of vaccines and to innovative treatments.
“RFK Jr.’s Anti-Vaccine Stance Infiltrated FDA. Trump Is Reining It In.” | MedPage Today,
https://www.medpagetoday.com/opinion/second-opinions/120041
That research offers significant new hope for the treatment of a number of conditions, including cancer. See
“How mRNA Vaccines Could Help Treat Cancer” | JAMA,
https://jamanetwork.com/journals/jama/fullarticle/2847793
Political pressure is a vital tool for countering RFK Jr’s misguided and inexpert leadership and curbing the recessionary forces that damage unleashes. Politics put RFK Jr. in charge. Politics keeps him there even though the Senator who chairs the oversight committee now knows he made a mistake by allowing RFK Jr. to be confirmed. Politics includes the angry voters who supported RFK Jr. and now realize that he hurts them and sickens their families and their neighbors. Politics may cause a sea change as citizens realize that they have been duped and that they have the power to change things. RFK Jr. and his miscreant appointees remain in place only because of political decisions that are fully reversible.
We will see the results of the RFK Jr. recession in November unless he gets “fired” sooner. While dead people don’t vote, those who see rising policy-driven risk to health and wellbeing certainly do. My hunch is that the firings of cabinet-level appointees and others is just beginning. One large epidemic of any type may be required as a catalyst for RFK Jr. & Co. to be shown the exit. We’ll see.
The Kotok Report will continue “The Coming RFK Jr Health Recession” series. Part 5 is coming.
Previous Commentaries in This Series:
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