“RFK Jr. of course is somebody who has been undermining vaccines and vaccine confidence,” said Dr. Ashish Jha, President Biden’s White House coronavirus response coordinator and dean of Brown University’s School of Public Health. “A lot of what will happen as a result of this election will depend on what role he plays.” Trump has said that Kennedy could have a “big role” in his administration but since the election has not clarified what precisely that might be. While Massachusetts kindergartners have an overall vaccination rate of 95 percent or higher for illnesses such as polio, measles, and hepatitis B, undervaccinated pockets have formed in some school districts. According to data from the 2023-2024 school year, 180 kindergarten classes — or more than 10 percent statewide — reported their students had not reached herd immunity against measles, mumps, and rubella, which require a 95 percent vaccination rate. Fifteen classes failed to meet the 80 percent rate needed to ensure polio would not spread. Those troubling statistics stem from the state’s record rates of religious exemptions, which allow parents to forgo immunizations for their children with little or no questioning. In the most recent school year, the rate of medical and religious exemptions rose to a cq10-year high , with more than 800 kindergartners receiving them. While they account for only around 1 percent of all children in that grade, the number marks a huge expansion of religious exemptions, a type virtually unheard of 30 years ago. The increase in exemptions mirrors a national trend , which has caused a small but noticeable increase in preventable illnesses. As of the end of October, the Centers for Disease Control and Prevention had reported 272 measles cases nationally this year, more than have been reported in five years. Whooping cough, also known as pertussis, another vaccine-preventable illness, has increased over the same time period, the CDC reported . “The more people decide not to have childhood vaccinations,” said Dr. Wayne Altman, chair of family medicine at Tufts University Medical School, “the more likely that we will have epidemics of unvaccinated kids getting illnesses that were essentially forgotten.” Massachusetts’ high immunization rates offer significant protection, but Jha said the federal government could take steps to reshape state vaccination policy. A 1905 Supreme Court decision protects states’ rights to establish vaccine mandates, but Jha said the administration could reduce funding for the CDC‘s Vaccines for Children program, which provides free vaccines for children and in 2023 distributed more than 74 million pediatric doses. The program reported preventing more than a million deaths over the past 30 years. It could also potentially withhold federal education funding to states with vaccine requirements that the administration deems unfair, he said. “I think there are definitely tools the federal government has to make it harder for Massachusetts to do what it wants to do in that area,” Jha said. The state Department of Public Health released a statement Wednesday affirming its commitment to a robust public health system, including its vaccination policies. Candice Edwards, a representative from Health Action Massachusetts, which has opposed legislative efforts to bar religious exemptions, declined to comment on what Kennedy’s possible ascension could mean for vaccinations in Massachusetts. “We are committed to offering accurate, fact-based information and will not contribute to any potential misinformation, especially on such a sensitive topic,” she said. Immunization science is to a great extent a victim of its own success, Jha said. A generation ago, most parents would have witnessed firsthand the effects of polio or measles, and were terrified of their children suffering from them. The near eradication of those illnesses in the United States has had the effect of erasing the traumatic impact of seeing or experiencing their effects. “Once you’ve really eliminated or made pretty rare a disease, the next generation doesn’t really see it as a threat,” Jha said. Vaccinations can prevent more than just the single disease they were developed to protect against. A measles infection in a person not vaccinated can leave them vulnerable to multiple other infections, said Dr. Mary Beth Miotto, immediate past president of the Massachusetts chapter of the American Academy of Pediatrics and a pediatrician at the Mattapan Community Health Center. One study showed it can wipe out anywhere from 11 to 73 percent of the antibodies that protect against strains of various diseases the person was previously immune to. Kennedy’s history of spreading false information about vaccines dates back to 2005, when he published a story warning about thimerosal, a mercury-based preservative that had been removed from most childhood vaccines by 2001. The preservative has no connection with health problems in children, according to multiple studies, including an exhaustive one by the Institute of Medicine , but the campaign left lasting scars, said Dr. Lauren Smith, a pediatrician and former medical director at the Massachusetts Department of Public Health. “Once that thimerosal information was out there, people [could] use this as part of their disinformation efforts,” she said. “It gets to be more accepted because it’s out there more, but that does not make it true.” Trump and his surrogates have been vague about whether outright banning vaccines is a possibility. Last weekend, Trump told NBC News , “I’m going to talk to [Kennedy] and talk to other people, and I’ll make a decision,” when asked about vaccine bans. On Wednesday, Kennedy appeared to soften some of his positions when asked about his plans for vaccine regulation in a Trump administration. “I am not going to take away anyone’s vaccines,” Kennedy told MSNBC. “I’ve never been anti-vaccine.” He added, “I am going to make sure that scientific safety studies and efficacies are out there and people can make individual assessments about whether that product is going to be good for them.” Such language, officials said, obscures settled scientific consensus that vaccines are effective and overwhelmingly safe. It’s exceedingly rare for vaccines to pose a risk to children. Indeed, the number of children who receive medical exemptions from immunization is consistently small and has declined in Massachusetts over the past decade. Altman, the Tufts physician and a board member of the Massachusetts Academy of Family Physicians, said he’s observed vaccine hesitancy become more common among his patients over the last decade and a half, but he takes comfort that few are fully opposed to vaccinations. Some want to delay immunizing their children, or decide to do partial vaccinations. While he expressed confidence that Kennedy’s most outlandish ideas wouldn’t appeal even to many vaccine skeptics, he does worry the atmosphere of misinformation they feed could make illness more likely. “We know what a powerful influence social media is,” he said.
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