America's New Anti-Vaccine Foreign Policy

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This week, Robert F. Kennedy Jr. used his address to a global vaccine summit to disparage global vaccination. The conference was organized by Gavi, the world's leading immunization program, and in a recorded speech, Kennedy accused the organization of collaborating with social-media companies to stifle dissenting views on immunization during the coronavirus pandemic and said it had 'ignored the science' in its work. He criticized Gavi for recommending COVID-19 shots to pregnant women, and went deep on a discredited study that purported to find safety issues with a tetanus vaccine commonly used in the developing world. 'In its zeal to promote universal vaccination,' Kennedy claimed, Gavi 'has neglected the key issue of vaccine safety.'
Kennedy's remarks confirmed what The New York Times first reported in March: that the United States, Gavi's third-largest donor, would stop pledging money to the organization. (Congress, which has always had final say over Gavi funding, has not yet weighed in.) They are also the first indication that the U.S.'s rejection of global vaccine campaigns stems from the Trump administration's opposition not only to foreign aid, but to vaccination itself. For the first time, Kennedy has managed to use the anti-vaccine agenda to guide American foreign policy.
Gavi, at its most basic level, is Costco for immunizations, wielding its massive purchasing power to buy vaccines in bulk for cheap. National governments and private philanthropies pledge funding to it every five years. The United Kingdom and the Gates Foundation are its largest donors; the United Nations distributes the shots. The poorest countries pay 20 cents per vaccine, and prices rise along with national income. Since the partnership was launched, in January 2000, 19 countries—including Ukraine, Congo, and Guyana—have gone from relying on Gavi to paying for vaccinations entirely on their own. Indonesia, which accepted donations from Gavi as recently as 2017, pledged $30 million to the organization this funding cycle.
Gavi, by its own estimate, has saved about 19 million lives and vaccinated 1 billion children. At the conference this week, the director of the World Health Organization noted that since 2000, the number of children who die each year before they reach the age of 5 has fallen by more than half, largely due to the power of vaccines. By Gavi's estimates, the U.S. canceling its Biden-era pledge to provide $1.2 billion this donation cycle could lead to the deaths of more than 1 million children who otherwise would have lived. (The Department of Health and Human Services did not respond to a request for comment.) In his recorded remarks, Kennedy said America would not send the money until Gavi can 're-earn the public trust' by 'taking vaccine safety seriously.'
Cutting off millions of children's only access to routine vaccines is 'the most emphatic globalization of the anti-vaxxer agenda,' Lawrence Gostin, the faculty director of Georgetown's O'Neill Institute for National and Global Health Law, told me. Tom Frieden, the former director of the CDC, told me that after he heard Kennedy's remarks, 'I was literally sick to my stomach,' because 'unscientific, irresponsible statements like this will result in the deaths of children.' (The U.S. has run an international anti-vaccine campaign before: According to an investigation by Reuters, in 2020, the Pentagon unleashed bot accounts on multiple social-media platforms that impersonated Filipinos and discouraged uptake of China's Sinovac vaccine—the first COVID vaccine available in the Philippines—using a hashtag that read, in Tagalog, 'China is the virus.' The goal was not to combat vaccines, but to undermine China's influence.)
[Read: RFK Jr. is barely even pretending anymore]
Kennedy's prerecorded address held back his harshest critiques of Gavi. In his 2021 book, The Real Anthony Fauci, Kennedy paints 'Bill Gates's surrogate group Gavi' (the Gates Foundation co-founded Gavi) as nothing more than a profiteering 'cabal' and a facilitator of 'African Genocide.' To hear Kennedy tell it, 'virtually all of Gates's blockbuster African and Asian vaccines—polio, DTP, hepatitis B, malaria, meningitis, HPV, and Hib—cause far more injuries and deaths than they avert.'
Decades' worth of safety and efficacy studies have proved him wrong. In his remarks to Gavi this week, Kennedy focused on the DTP (diphtheria, tetanus, and pertussis) shot, describing at length a 'landmark' 2017 study that found the vaccine increased all-cause mortality among girls in Guinea-Bissau. But as Frieden pointed out, this was in fact a relatively small observational study. In 2022, a randomized, double-blind, placebo-controlled trial of more than 50,000 newborns found that the DTP vaccine significantly decreased infant mortality. Frieden compared the evidence: 'Hundreds of kids versus 50,000 kids. Poorly done; well done.'
Kennedy made efforts to take his anti-vaccine advocacy global before he became America's health secretary. In 2021, he delivered a webinar on the importance of expanding an 'international movement' for Children's Health Defense, the anti-vaccine organization he founded. In 2019, when Samoa was experiencing a major dip in measles immunization after an improperly prepared vaccine killed two children, Kennedy visited the prime minister and, on behalf of Children's Health Defense, reportedly offered to build an information system the country could use to track the health effects of vaccines and other medical interventions. When a deadly measles outbreak took hold later that year, Kennedy sent a letter to the prime minister suggesting that widespread vaccination might make unvaccinated Samoan children more likely to die of measles. (In an interview for a 2023 documentary, Kennedy said that 'I had nothing to do with people not vaccinating in Samoa' and that his conversations about vaccines with the prime minister had been 'limited.')
[Read: The U.S. is going backwards on vaccines, very fast]
Now, it seems, Kennedy has gained the power to realize his ambitions both domestically and abroad. Earlier this month, Kennedy dismissed all 17 members of the CDC's vaccine advisory committee, then replaced them with a group that includes several allies who have spread misinformation about the harms of vaccines. This week, as other countries pledged their support for Gavi, Kennedy's brand-new, handpicked panel convened for a discussion of the dangers of thimerosal, a vaccine ingredient that is a frequent target of anti-vaxxers despite having been found safe. The committee has formed a working group to review the 'cumulative effect' of childhood vaccination in the United States. As Kennedy said in his address to Gavi, 'Business as usual is over.'
Article originally published at The Atlantic