By Rebecca Robins
The discredited researcher who launched the anti-vaccine movement met with Donald Trump this summer -- and found him sympathetic to the cause. Now, with Trump preparing to move into the White House, leaders of the movement are newly energized, hopeful they can undermine decades of public policy promoting childhood vaccinations.
At the most basic level, they're hoping Trump will use his bully pulpit to advance his oft-stated concern -- debunked by an extensive body of scientific evidence -- that there's a link between vaccines and autism.
"For the first time in a long time, I feel very positive about this, because Donald Trump is not beholden to the pharmaceutical industry," movement leader Andrew Wakefield told STAT in a phone interview.
"He didn't rely upon [drug makers] to get him elected. And he's a man who seems to speak his mind and act accordingly. So we shall see," said Wakefield. A former doctor whose medical license was revoked, Wakefield launched the movement to question the safety of vaccines nearly two decades ago with a fraudulent study (which has since been retracted) suggesting that a widely administered vaccine against measles, mumps, and rubella can cause autism.
Wakefield and a small group of like-minded activists spent nearly an hour with Trump in the closing months of the presidential campaign. "I found him to be extremely interested, genuinely interested, and open-minded on this issue, so that was enormously refreshing," Wakefield said.
Though he would be a powerful ally, there are limits to what Trump can do to undercut evidence-based vaccination policies.
Public health experts said it's unlikely Trump will pack federal agencies with activists who would change the recommended childhood vaccine schedule or otherwise steer shifts in federal vaccination policy. The evidence that vaccines are safe and effective is so overwhelming, they said, that such a move would prompt a huge outcry from scientists and many politicians on both sides of the aisle.
But experts said there could be a cultural impact of having a doubter in the Oval Office.
Those who seek to undercut trust in vaccines "see in Donald Trump a fellow traveler -- someone who, like them, is willing to basically ignore scientific studies and say, 'This is true. Vaccines cause autism because I believe it's true,'" said Dr. Paul Offit, the head of the infectious diseases department at Children's Hospital of Philadelphia.
"Even if he doesn't change federal policy," Offit said, "he still is no doubt strengthening the belief some parents have that vaccines have done harm and therefore they should choose not to vaccinate their children."
Trump's plans to dismantle the Affordable Care Act could also have an indirect effect on childhood vaccination rates, if families lose insurance and become disconnected from primary care, including visits to pediatricians. If that happens, "they're less likely to engage regular opportunities for their children to get vaccinated. Simple as that," said Dr. Sandro Galea, dean of the School of Public Health at Boston University.
Trump's transition team did not respond to requests for comment on the meeting with Wakefield or the administration's vaccine policies.
Demands for the new administration
The president-elect's new nominee to head up the Department of Health and Human Services, Georgia Congressman Dr. Tom Price, has not been vocal on the vaccine issue.
But Price, a former orthopedic surgeon, is a member of the Association of American Physicians and Surgeons, a conservative group that publishes a journal that has promoted discredited views -- including the supposed link between vaccines and autism. The group's executive director, Dr. Jane Orient, confirmed Price's current membership in an email to STAT.
Trump's biggest appointment with respect to vaccination policy will be the director of the Centers for Disease Control and Prevention. The director sets priorities for the National Center for Immunization and Respiratory Diseases and oversees the staff that helps select an advisory committee to recommend tweaks to the childhood vaccination schedule. Trump's choice of a surgeon general could also shape the national conversation on vaccines, but that appointment is more symbolic.
Wakefield said he and fellow advocates are focused on two main goals at the federal level.
The first is to convince Congress to repeal a Reagan-era law that effectively moved vaccine injury lawsuits out of the civil courts by setting up a separate compensation system. That system awards compensation to people who can meet strict requirements for showing their injury was caused by a vaccine. Autism is not on the list of recognized injuries that can sometimes stem from vaccines-- so activists have long wanted to do away with the system.
A second goal: to get the administration to appoint an independent board to oversee vaccine safety. Many anti-vaccine activists see the CDC, which currently oversees safety, as a corrupt agency in league with drug makers, though they have not produced evidence to back up that allegation.
Other activists have their own wish lists. Kent Heckenlively, a writer active in the movement to undercut vaccines, laid out several goals for the Trump administration in an email to STAT. Among them: give parents the option to get the vaccine against measles, mumps, and rubella administered as three separate shots. And hold a congressional hearing about alleged fraud at the CDC. (That's an unsubstantiated conspiracy theory that been circulating online for several years.)
Another blogger, who writes under a pseudonym, laid out 10 demands for Trump. One used the vernacular of the president-elect's campaign: "Drain the swamp we call the CDC." Another called for federal intervention in the vaccination schedule: "Don't allow children to receive more than one vaccine at a doctor appointment."
A resurgence of deadly diseases
Even as they lay plans to press for federal action, anti-vaccine advocates continue to bolster their lobbying efforts at the state level.
All 50 states allow certain children, such as those who are on chemotherapy or were born with an immune deficiency, to opt out of required vaccinations to protect their health. All but three states also allow exemptions for religious reasons.
Fewer than 20 states allow parents to opt their children out of vaccines due to philosophical objections; activists have been pressing hard to block legislation that would make it harder to get such exemptions. (They've even launched political action committees in some states, including Texas and Michigan.)
As the anti-vaccine movement has gained traction, there's been a resurgence of potentially deadly diseases like measles and whooping cough. Low vaccination rates in some communities helped fuel nearly 700 measles cases in the US in 2014, the most in any year since the disease was declared eliminated in North America back in 2000.
Over the past decade, Trump has repeatedly fanned parents' unfounded fears of vaccines. During a Republican primary debate last year, Trump said he wants "smaller doses over a longer period of time." He also told a story about a toddler who was diagnosed with autism after being vaccinated.
Trump used similar language during his meeting with about 10 activists in August, before a rally at a sports arena in Central Florida, Wakefield said. He recalled Trump sharing that he'd seen children of his employees exhibit symptoms of autism after being vaccinated.
Among those attending the meeting: people who have written for an anti-vaccine website and a chiropractor who has donated to Trump. They gave the candidate a copy of "Vaxxed," an anti-vaccine documentary directed by Wakefield that premiered last spring, and Trump said he'd watch it, Wakefield said.
Wakefield and Trump even posed for a photo that has circulated online in recent weeks.
Wakefield said he didn't talk to Trump or his team in the final months of the campaign. He declined to comment on whether they've communicated since the election.
Correction: A prior version of this story incompletely described the Reagan-era system for awarding compensation to people injured by vaccines.