RFK Jr. Acknowledges the Measles Vaccine Amid a Worsening Outbreak

Robert F. Kennedy Jr., the new head of the U.S. Department of Health and Human Services (HHS), has long cast doubt on the safety of vaccines—particularly the one for measles, mumps, and rubella (MMR). But in his new opinion piece about the ongoing measles outbreak, published March 2 in Fox News, Kennedy wrote that vaccines “not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”

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Kennedy’s acknowledgement of the value of the measles vaccine comes as the outbreak that began in Texas continues to grow. So far, nearly 150 cases and one death—the first U.S. fatality from the disease in more than 10 years—have been confirmed. It’s the largest measles outbreak in the U.S. in decades.

When Kennedy previously discussed the outbreak at a cabinet meeting last week, he did not mention vaccination.

However, in the Fox piece, Kennedy also wrote about the importance of a good diet in protecting people from measles—a factor that experts say may not be very relevant for Americans. “Good nutrition remains a best defense against most chronic and infectious diseases,” he wrote. He also touted vitamin A for people with measles. On Feb. 27, the U.S. Centers for Disease Control and Prevention, which HHS oversees, updated their guidance to say that while there is no antiviral treatment for measles, “supportive care, including vitamin A administration under the direction of a physician, may be appropriate.”

Here’s what experts think about Kennedy’s first major public communication in his new role at the helm of the top U.S. health agency.

A (qualified) endorsement of vaccination

Kennedy acknowledges what public-health experts have long maintained: that the best way to control measles is to vaccinate the public and give them immunity to the virus. Of the 146 cases reported so far, state health officials say 79 people were not vaccinated against MMR.

But while he concedes the importance of population-level vaccination in order to achieve community-wide protection, he also maintains that “all parents should consult with their healthcare providers to understand their options to get the MMR vaccine. The decision to vaccinate is a personal one.”

Read More: A Study Retracted 15 Years Ago Continues to Threaten Childhood Vaccines

Unfortunately, herd immunity doesn’t work that way, public-health experts say. Community-level protection—otherwise known as herd immunity—isn’t possible unless upwards of 90% of people are immunized. Experts agree that balancing personal choice and the scientific reality of herd immunity is critical for keeping outbreaks under control.

“The problem with making health decisions like vaccination on an individual level is that viruses don’t see us as individuals,” says Ben Neuman, professor of biology at Texas A&M University. “[They] see humanity as a group. And once the virus gets into one of us, the chances are greater that it gets into another person.” Neuman describes vaccination against diseases like measles as “basically a moral responsibility of living in a modern democracy. Treating [the decision to get vaccinated] as an individual liberty is essentially irresponsible, in a public-health sense.”

“It’s important as public-health experts that we do our best to convey to the population at large why it’s so important that we continue to have this shared obligation for each other’s health,” says Dr. Daniel Kurtizkes, chief of the division of infectious diseases at Brigham and Women’s Hospital. “Yes, certainly, individual liberty is an important American value, but it needs to be put in context: we don’t have the right to do everything we might want to do. We have some obligation to do certain things we might not otherwise want to do because it protects other people.”

A troubling emphasis on vitamin A and diet

While infectious-disease experts are gratified that Kennedy is acknowledging the efficacy of vaccines and the importance of herd immunity, they are concerned about his emphasis on vitamin A. “Vitamin A is not a specific treatment for measles,” says Kuritzkes.

In parts of the world where children may not be getting enough vitamin A in their diet, the deficiency can increase their risk of more severe disease and complications from measles. But, says Dr. Tina Tan, professor of pediatrics at the Feinberg School of Medicine at Northwestern University and president of the Infectious Disease Society of America, that doesn’t mean that vitamin A is a backup for vaccination. “I don’t want people reading about this to think, ‘I don’t need to get vaccinated, I’ll just get vitamin A.’ It doesn’t work like that.”

Read More: What to Know About the Measles Vaccine

The studies supporting the benefits of vitamin A for people with measles come mostly from the developing world, where people typically do not get enough of the vitamin in their diet. The deficiency can lead to weaker immune responses, as well as other health issues such as blindness and delayed growth. Those studies show that supplementing with vitamin A in people who are deficient can lead to milder infections with diseases like measles.

But there is little evidence that it can make a significant difference in people who already have healthy levels of the vitamin, as is the case in the U.S. “In a country like the U.S. where vitamin A deficiency is extraordinarily rare, it would be surprising if supplementation produces any measurable clinical benefit,” says Kuritzkes. “It’s certainly not an alternative to measles vaccination.”

Supplementing with the vitamin can cause serious health problems if it’s not done properly, Kuritzkes says. Too much vitamin A can lead to the toxic effects of hypervitaminosis A, which causes nausea, joint pain, bone fractures, and liver damage, among other symptoms. The condition has been described in Indigenous people who consumed polar bear livers, which have high concentrations of vitamin A.

Tan says that some doctors in the U.S. do give measles patients the vitamin, but only if they believe the patient may be deficient. “We saw a number of kids during the measles outbreak in the immigrant centers here in Chicago, and there was no way of knowing upfront what the vitamin A levels were in these kids, so we just gave them supplements,” she says. But she and Kuritzkes say it’s a mistake to self-treat with off-the-shelf vitamins. Doing so is likely a waste of money and time, they say; it probably won’t do much to mitigate the infection and can be toxic if used in excessive amounts.

Kennedy’s message doesn’t clarify in which groups vitamin A supplementation might be most useful or appropriate: just that “studies have found that vitamin A can dramatically reduce measles mortality.” He goes on to discuss the importance of good nutrition as a “best defense against most chronic and infectious illnesses.”

While proper nutrition is critical for establishing a strong foundation to fight any disease, it won’t make you invincible to viruses and pathogens. “The only way to protect yourself against measles is to get vaccinated,” says Tan. “The best preventive method is to prevent somebody from getting the disease in the first place by vaccinating them.”

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