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MAKE AMERICA DISEASED AGAIN?  
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Sarah Zhang
November 19, 2024
The Atlantic
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_ RFK, Jr.'s nomination normalizes and emboldens the anti-vaccine
movement. The danger now is that diseases confined to the past become
diseases of the future. _

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When I was taking German in college in the early years of this
millennium, I once stumbled upon a word that appeared foreign even
when translated into English: _Diphtherie_, or diphtheria.
“What’s diphtheria?” I wondered, having never encountered a
single soul afflicted by this disease.

Diphtheria, once known as the “strangling angel
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was a leading killer of children into the early 20th century. The
bacterial infection destroys the lining of the throat, forming a layer
of dead, leathery tissue
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by suffocation [[link removed]]. The
disease left no corner of society untouched: Diphtheria killed Queen
Victoria’s daughter
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of Presidents Lincoln, Garfield, and Cleveland
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Parents used to speak of their first and second families, an elderly
woman in Ottawa recalled
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because diphtheria had swept through and all their children died.

Today, diphtheria has been so thoroughly forgotten that someone like
me, born some 60 years
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the invention of a diphtheria vaccine, might have no inkling of the
fear it once inspired. If you have encountered diphtheria outside of
the historical context, it’s likely because you have scrutinized a
childhood immunization schedule: It is the “D” in the DTaP
vaccine.

Vaccine breakthroughs over the past two centuries have cumulatively
made the modern world a far more hospitable place to be born. For most
of human history, half of all children
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15; that number is down to just 4 percent worldwide, and far lower in
developed countries, with vaccines one of the major drivers of
improved life expectancy
[[link removed](24)00850-X/fulltext].
“As a child,” the vaccine scientist Stanley Plotkin, now 92, told
me, “I had several infectious diseases that almost killed me.” He
ticked them off: pertussis, influenza, pneumococcal pneumonia—all of
which children today are routinely vaccinated against.

But the success of vaccines has also allowed for a modern amnesia
about the level of past human suffering. In a world where the ravages
of polio or measles are remote, the risks of vaccines—whether
imagined, or real but minute—are able to loom much larger in the
minds of parents. This is the space exploited by Robert F. Kennedy
Jr., one of the nation’s foremost anti-vaccine activists
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now nominee for secretary of Health and Human Services. It is a
stunning reversal of fortune for a man relegated to the fringes of the
Democratic Party just last year. And it is also a reversal for Donald
Trump, who might have flirted with anti-vaccine rhetoric in the past
but also presided over a record-breaking race to create a COVID
vaccine. Kennedy has promised that he would not yank vaccines off the
market
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but his nomination normalizes and emboldens the anti-vaccine movement.
The danger now is that diseases confined to the past become diseases
of the future.

Walt Orenstein trained as a pediatrician in the 1970s, when he often
saw children with meningitis—a dangerous infection of membranes
around the brain—that can be caused by a bacterium
called _Haemophilus influenzae_ type b or Hib. (Despite the name, it
is not related to the influenza virus.) “I remember doing loads of
spinal taps,” he told me, to diagnose the disease. The advent of a
Hib vaccine in the 1980s virtually wiped these infections out; babies
are now routinely vaccinated in the first 15 months of life. “It’s
amazing there are people today calling themselves pediatricians who
have never seen a case of Hib,” he says. He remembers rotavirus,
too, back when it used to cause about half of all hospitalizations
for diarrhea [[link removed]] in
kids under 5. “People used to say, ‘Don’t get the infant ward
during diarrhea season,’” Orenstein told me. But in the 2000s
[[link removed]], the introduction
of rotavirus vaccines for babies six months and younger sharply
curtailed hospitalizations.

To Orenstein, it is important that the current rotavirus vaccine has
proved effective but also _safe_. An older rotavirus vaccine
was taken off the market
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1999 when regulators learned that it gave babies an up to
one-in-10,000 chance of developing a serious but usually treatable
bowel obstruction called intussusception. The benefits arguably still
outweighed the risks—about one in 50 babies infected with rotavirus
need hospitalization—but the United States has a high bar for
vaccine safety. Similarly, the U.S. switched from an oral polio
vaccine containing live, weakened virus—which had a one in 2.4
million chance
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causing paralysis—to a more expensive but safer shot made with
inactivated viruses that cannot cause disease. No vaccine is perfect,
says Gregory Poland, a vaccinologist and the president of the Atria
Academy of Science & Medicine, who himself developed severe tinnitus
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getting the COVID vaccine. “There will always be risks,” he told
me, and he acknowledges the need to speak candidly about them. But
vaccine recommendations are based on benefits that are
“overwhelming” compared with their risks, he said.

The success of childhood vaccination has a perverse effect of making
the benefits of these vaccines invisible. Let’s put it this way: If
everyone around me is vaccinated for diphtheria but I am not, I still
have virtually no chance of contracting it. There is simply no one to
give it to me. This protection is also known as “herd immunity” or
“community protection
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But that logic falls apart when vaccination rates slip, and the bubble
of protective immunity dissolves. The impact won’t be immediate.
“If we stopped vaccinating today, we wouldn’t get outbreaks
tomorrow,” Orenstein said. In time, though, all-but-forgotten
diseases could once again find a foothold, sickening those who chose
not to be vaccinated but also those who could not be vaccinated, such
as people with certain medical conditions
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too young for shots. In aggregate, individual decisions to refuse
vaccines end up having far-reaching consequences.

Evolutionary biologists have argued that plague and pestilence rose in
tandem with human civilization
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Before humans built cities, back when we still lived in small bands of
hunter-gatherers, a novel virus—say, from a bat—might tear through
a group only to reach a dead end once everyone was immune or deceased.
With no one else to infect, such a virus will burn itself out. Only
when humans started clustering in large cities
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certain viruses keep finding new susceptibles—babies or new migrants
with no immunity, people with waning immunity—and smolder on and on
and on. Infectious disease, you might then say, is a necessary
condition of living in a society.

But human ingenuity has handed us a cheat code: Vaccines now allow us
to enjoy the benefits of fellow humanity while preventing the constant
exchange of deadly pathogens. And vaccines can, through the power of
herd immunity, protect even those who are too young or too sick to be
effectively vaccinated themselves. When we get vaccinated, or don’t,
our decisions ricochet through the lives of others. Vaccines make us
responsible for more than ourselves. And is that not what it means to
live in a society?

Sarah Zhang [[link removed]] is a
staff writer at _The Atlantic._

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* Science
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* RFK jr.
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* vaccines
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* pandemics
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