US Health Secretary Robert F Kennedy Jr’s vaccine stance is completely at odds with the global public health community and reams of vaccine science, ignoring years of research that have found vaccines are safe and effective, and which have saved an estimated 154m lives – mostly under five – over the past 50 years.
Public health experts say what could be more dangerous than the American funding cuts is the misinformation campaign he is driving, which is fuelling a growing lack of trust in vaccines with global repercussions, including in this country – and which is why, write Ida Jooste and Tanya Pampalone for Bhekisisa, he has become South Africa’s problem too.
The threat of diphtheria
Before vaccines were widely available, diphtheria was a leading global killer. But after the WHO rolled out standard immunisation campaigns in 1974, new cases were reduced by more than 90%. Today, most people would be hard-pressed to tell you what diphtheria is, never mind what it does to a child’s body.
But one three-minute video released on social media at the end of June may change all of that.
That’s when Kennedy accused Gavi of distributing a version of DTP – the combined diphtheria, tetanus and pertussis vaccine – that does more harm than good.
Kennedy also halted all US funding to the group until it embraces what he defines as proper science.
It’s the latest in a long history of his anti-vaccination attacks, and the latest round of brutal losses for the global public health community, already battered by US Government funding cuts and reduced support from other donors.
South Africa has also been hit by debilitating US funding cuts but we won’t lose out on vaccines. The government pays for ours – as a middle-income country we are a contributor to the fund, pledging $20m in Gavi support over 20 years to ensure lower-income countries can vaccinate their populations.
But, said Heidi Larson, the director of the Vaccine Confidence Project, the main problem is not a lack of vaccines. It’s the growing lack of trust in them.
“US events have global repercussions,” she said. “They embolden others, especially those still undecided about vaccination, and that’s where the danger lies.”
The trouble with Kennedy
Since launching in 2000, Gavi has been credited for protecting an entire generation, or more than 1bn children, from deadly infectious diseases like diphtheria, helping cut child deaths in half across many lower-income countries, nearly 60% of these in Africa.
The US had been among the top three donors to Gavi alongside the UK, and the Gates Foundation. With WHO and Unicef, the organisation provides vaccine funding, helps plan for disease outbreaks and helps keep prices low and supplies steady.
It also maintains emergency stockpiles for diseases like Ebola and cholera, and co-ordinated Covax, the international effort to ensure fair access to Covid-19 vaccines.
To support his attack on Gavi and DTP, Kennedy points to a small 2017 study he’s cited before, an analysis from Guinea-Bissau that uses vaccine data from the 1980s. Experts say he has misinterpreted the study, and with his high profile and large social media following, is spreading misinformation about a well-established combination vaccine, shown to be safe with either form of the vaccine.
“He cherry-picks a poorly conducted study and ignores mountains of evidence to the contrary,” saids Salim Abdool Karim, leading epidemiologist and director of the Centre for the Aids Programme of Research in South Africa (Caprisa).
A recent study in The Lancet estimated that over the past 50 years, DTP vaccines have saved more than 40m lives.
South Africa, like many higher-income countries, uses a newer version of the vaccine than Gavi, called DTaP. It causes fewer mild side effects like fever or soreness but also requires more booster jabs.
Gavi supports an older version. Called DTwP, it tends to cause mild, short-lived side effects but offers longer-lasting protection – crucial in lower-income countries where the healthcare system is under strain and booster shots may be harder to deliver.
Recent diphtheria outbreaks show how quickly things can go wrong when vaccination rates slow down.
The WHO found that the Covid-19 pandemic disrupted vaccination campaigns, including DTP, causing an immunity gap. In South Africa, at least 60 confirmed cases of respiratory diphtheria, the most serious and life-threatening form of the disease, were recorded between January 2024 and June this year.
Because it is such a rare and deadly disease that spreads easily through coughing and sneezing, even one case is cause for concern.
Deepfakes, institutionalised disinformation
As Kennedy took to social media to spread more disinformation about vaccines, a video of an AI-generated Abdool Karim surfaced.
The video was a deepfake (a manipulated image created to misrepresent someone or something) and hijacked Abdool Karim’s credibility and likeness to falsely warn viewers that those vaccinated against Covid-19 vaccines may be facing deadly danger.
In reality, Abdool Karim has been a vocal advocate for vaccines, including during the pandemic, when he chaired the ministerial advisory committee which guided the government on vaccines.
In a lecture in May honouring his impact in public health, Abdool Karim spoke about “institutionalised disinformation”, where the very institutions once trusted to uphold science are now those spreading doubt.
He draws a straight line between former President Thabo Mbeki’s Aids denialism, leading to the deaths of more than 330 000 South Africans, and the coming fallout of Kennedy’s dangerous misinformation campaign.
He warned that when political leaders question well-established science or spread doubt, the erosion of trust in science weakens our ability to respond to pandemics effectively.
MMR, autism and RFK
In the US, measles vaccination rates have been slipping steadily for years, largely because of the anti-vax movement galvanised by Kennedy during the pandemic.
He has claimed countless times that the vaccine against MMR – measles, mumps and rubella – causes autism, pointing to a retracted study that has been refuted by reams of research.
Last week, the US Centres for Disease Control and Prevention reported around 1 300 confirmed measles cases across 35 states, 25 years after being declared eliminated.
“The chaos in the US … has a knock-on effect around the world. It’s critical for us to be proactive, rather than wait until the damage is done,” says Edina Amponsah-Dacosta, a virologist with the University of Cape Town-based Vaccines for Africa Initiative.
For Amponsah-Dacosta, the current measles flare-up in Gauteng is a stark warning. The Health department has flagged a dangerous immunity gap after Covid, reporting that immunisation coverage for the second dose of the measles vaccine is below 75% in Johannesburg and Tshwane, which she says aligns with global patterns of under-vaccination seen after the pandemic disrupted routine vaccination.
Because measles is one of the world’s most contagious diseases, experts like Michelle Groome, an infectious disease epidemiologist with Wits University’s Vaccines & Infectious Disease Analytics, say at least 90% of the population should be vaccinated. She said outbreaks of highly contagious diseases happen when pockets of unvaccinated people come into contact with someone who is infected, triggering a rapid spread.
Measles affects many organs and the impact of the disease on the body can linger, she said.
“It actually causes disease through all your systems, and can affect the brain. Some of the consequences can be delayed for many years, so that if you have measles now, you may develop problems much later.”
HPV wiped out cervical cancer
Just as some diseases take years to show problems, it can take years to see a vaccine’s benefits.
An infection with certain forms of the human papillomavirus (HPV) can cause genital warts, and certain cancers, most commonly cervical cancer – the leading cause of cancer related deaths in South Africa too.
In those not vaccinated, it can take up to 20 years for the cancer to emerge.
Kennedy has also featured the HPV vaccine in his misinformation parade, falsely claiming it caused cervical cancer, the very thing it protects against.
Vaccine economics
Despite the cost of vaccines, they save money for governments because there’s so much less illness and disability. A large 73-country study estimates that childhood vaccinations given over a decade (2001-2020) had a broader social and economic value of $ 820bn.
“There are not many things as amazing as vaccines for child health – a miracle intervention,” said Susan Cleary, director of the School of Public Health at the University of Cape Town.
Her research group recently published an impact study in PLOS ONE which shows how Covid-19 vaccines helped to slash hospital admissions in South Africa: a follow-up study, being published soon, shows these vaccines didn’t just save lives, they saved taxpayers money too.
But the knock-on effects of vaccination also help in the long term. By preventing diseases, vaccinations help to ensure people won’t become ill in the first place.
Immunising against misinformation
Despite overwhelming evidence that vaccines are safe and effective, analysis by Larson’s Global Listening Project shows rising global vaccine hesitancy. It’s about a breakdown in trust in health authorities and a complex information environment.
Even more confusing for the public, said Larson, is that that fringe has now gone mainstream in the US. For example, in June, Kennedy also dismissed all 17 members of the US Centres for Disease Control’s vaccine advisory panel. He replaced them with eight new members, some of whom are openly sceptical of vaccines.
“Vaccines have become kind of a victim of their own success,” said Amponsah-Dacosta. Because of vaccines, diseases like smallpox have been eradicated while deaths and disabilities from polio, tetanus, rubella have disappeared from view, lulling people into thinking vaccines aren’t needed.
“Eventually, people get to hear misinformation, so the best practice is to provide people with sound information. This way, once they’re faced with myths … they are already immunised against misinformation and can make the right decision.”
See more from MedicalBrief archives:
Waning immunity, low jab rate, trigger SA diphtheria cases
US physicians want investigation after Kennedy fires CDC vaccine panel
Kennedy, the Manto Tshabalala-Msimang of the United States
Kennedy’s conflicting advice leave US doctors frustrated