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Hey, short wavers, Regina Barber here.
So if you've been listening to us, this past year we've done stories about all the big and small ways Robert F Kennedy Jr is changing how the United States approaches vaccines.
And this is all in his role as the Secretary of Health and Human Services.
But as Gabriela Emanuel will tell you in a sec, those changes aren't limited to the United States.
Definitely not.
So Gabriela, as a global health correspondent at NPR, you've been keeping tabs on how this new HHS approach is changing the conversation around the world.
That's right.
And right off the bat.
There are two clear examples I can give you where changes in the US are creating public health controversies elsewhere in the world.
Okay.
So the first one, RFK Jr. and his ultimatum to an international vaccine group called Gavi.
I've heard of Gavi.
They're a big player internationally.
And looking at their site, they say they vaccinated over 12 billion children and prevented over 20 million deaths.
The U.S. is historically one of their biggest funders, right?
Yeah.
But last year the Trump administration halted over a billion dollars the US had previously promised to Gavi.
And then earlier this year, HHS threatened to withhold future funding from Gavi too, unless the organization removes a specific ingredient from its vaccines.
Wow.
OK, so that's the first example, this ultimatum, which we'll talk about later.
But what's the second?
So that second example is a controversial vaccine research study that is partly funded by the U.S.
And it looks at hepatitis B and newborns in Guinea-Bissau, so a West African country.
Now I have to say right up front there are conflicting reports about the current status of the study.
But Africa CDC, which is part of the African Union, says it's currently paused for review.
And that is because some doctors like Paul Offit have called it unethical.
Paul was a member of the Advisory Committee on Immunization Practices for the CDC from 98 to 2003.
He also compared it to the notorious Tuskegee experiment that started in the 1930s in the U.S.
Wow.
This is where Black men who had syphilis were purposely not given treatment.
Yeah, exactly.
This was a very dark moment in American history.
All right.
This is a lot to dig into.
So today on the show, how changes in U.S. vaccine priorities are making global waves.
You're listening to Shortwave, the science podcast from NPR.
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OK, Gabriela, we started our conversation talking about the U.S.'
's ultimatum to Gavi, this international vaccine alliance.
And now Congress has allocated money to them.
But the Trump administration, specifically RFK Jr.'
's team has been trying to withhold money unless Gavi agrees to remove an ingredient from its vaccines.
What is this ingredient?
It is called thimerosal.
And it helps make sure vaccines don't get contaminated with bacteria or fungi.
Important.
Yes.
They want that.
This is key if a vaccine comes in a vial that has many doses in it.
So when you dip in that needle to fill it up, there's a risk of contamination.
And thimerosal does a really good job at avoiding the contamination.
Yeah.
So why do people want to remove it then?
Because it's partially made of a form of mercury, which on its face does sound scary.
But thimerosal has been very well studied and deemed safe in medications and vaccines since the 1930s.
Okay.
However, RFK Jr. is still skeptical.
And that might actually be an understatement.
He spent 20 years campaigning against thimerosal, including editing a book on the topic.
And he's made moves to ban this ingredient from U.S. vaccines.
He's urged Gavi to follow suit and to stop their programs of injecting mercury into more than 100 million black and brown babies in developing countries annually.
That is a big accusation.
And you said it was safe.
Well, here is Angela Rasmussen, a virologist at the University of Saskatchewan.
The amount of mercury that you get dangerous mercury that you get that could be toxic from a single thimerosal containing vaccine is like less than you would get from eating a tuna fish sandwich.
In reality, she says the main type of mercury in thimerosal leaves the body very quickly and it does not accumulate and it isn't known to cause damage.
And that's why the World Health Organization, the U.S.
Food and Drug Administration and the U.S.
Centers for Disease Control and Prevention have all deemed it safe.
OK, but now because of this ultimatum, can it happen?
Is there a replacement or can it be like easily removed from vaccines?
No, there's no obvious alternative.
And actually, in many lower income countries, it cannot be removed easily.
The single dose vials that are common in the US, where thimerosal isn't needed, are really too expensive.
Instead, these lower income countries tend to use those multi-dose vials during these mass immunization days where lots of kids get vaccinated.
But now that the US has given this ultimatum, do you think that Gavi will remove the Marisol from their vaccines?
Well.
In a statement to NPR, Gavi said it remains in contact with the US on the subject and that any changes would be guided by scientific consensus and their board.
But HHS... in a statement to NPR, put it more bluntly.
It said Gavi has refused to develop a phase-out plan and future funding will be withheld.
But Congress did allocate funding to Gavi, so we'll see how it all plays out.
I did speak with Paul Offit.
As we mentioned earlier, he's the director of the Vaccine Education Center at the Children's Hospital of Philadelphia.
He says, if Gavi agrees to the deal, the outcome is clear children will no doubt die because those vaccines are unavailable.
That's really heavy.
And I think it's time we turn to something else that seems just as heavy that controversial study on hepatitis B which, for anyone who doesn't know, it's a viral infection that attacks the liver.
It's spread through blood or other bodily fluids.
Newborns can get this infection from their moms during delivery and there's no cure, but it is preventable with vaccines.
Yes, exactly.
Okay.
If a vaccine is given right after birth, it is super effective at preventing infection, even if a kid is exposed through their mom during delivery.
And so for 30-some years newborns in the US have been given the hepatitis B vaccine, and that's also the recommendation globally by the WHO.
But here's a big but.
On December 5th last year, CDC advisors voted to stop vaccinating all newborns against hepatitis B in the US.
So these advisors who voted for the change were handpicked by RFK Jr.
And they say they're worried it might cause harm to babies and that the vaccine should be limited to high-risk babies after consulting with their doctors, not given kind of on a routine basis to every newborn.
So is this harm?
Is there research to back it up?
In a word, no.
And that's part of the pushback from doctors and vaccine experts about this change the lack of research to support a shift in policy.
And outside medical groups have pointed to studies showing the vaccine is very safe and that the rate of young kids getting hepatitis B has dropped by 99 since 1991 in the US, largely because of this birth dose.
Okay, so this is all good context for the US, but the study we've been talking about is in Guinea-Bissau.
So what's the status of hepatitis B there, Gabriella?
Yes.
So this is a very poor country that we're talking about, and it has a very high hepatitis B rate.
About one in five adults there have hepatitis B. So really high rates.
And that means the chance a newborn gets exposed by their mom during delivery is pretty high.
Yeah.
So having the vaccine immediately after basically helps the baby fight off hep B if they've been exposed to it during that delivery.
Exactly.
It's a post-exposure vaccine here.
But it's very effective at preventing that infection from taking hold.
The alternative is administering the vaccine a few weeks later.
But at that point, the infection could have taken hold.
Okay.
This is the current policy in Guinea-Bissau.
However, the country is planning to start vaccinating at birth in 2028.
But before then, researchers from Denmark want to do a study.
And it's paid for in part by the U.S. to the tune of $1.6 million.
Okay.
So the study was announced two weeks after the vote in the US to stop vaccinating every newborn and also after that pushback saying there wasn't evidence to back up this change in US vaccine policy.
The plan is for the researchers to study over 14,000 newborns.
Half would get the hepatitis B vaccine at birth.
The other half would get it later, as is the country's current policy.
And then the researchers would watch for side effects in the first few years, things like neurological problems or eczema.
So the Tuskegee experiment comparison comes in right here, because doing it this way you're leaving like 7000 newborns who would be unvaccinated and they could be exposed in those critical early weeks.
That's right.
But since the current policy in Guinea-Bissau is to wait several weeks, the researchers say oh no no, we're not taking away vaccines from any babies.
Who'd get them otherwise?
In fact they say half the time.
The babies will be getting treatment sooner, which is arguably better than the current policy.
So that's the heart of the debate.
Yes, and it has gotten heated.
The WHO even called it unethical, which is pretty extreme language for a very kind of subdued, careful group.
They say, exploiting scarcity, exploiting the country's lack of resources is not a justification for withholding proven medical solutions for families that enroll in a research study.
Some doctors, like Paul Offit, have been even more blunt.
The rebuttal is we're just doing what has been done, even though you could argue that what has been done has been woefully ineffective.
And to continue to do something that's woefully ineffective is highly unethical and cruel and frankly dishonest.
Other experts, like Christine Grady, point out that there might be an even more fundamental question about this research.
She's the former chief of the Department of Bioethics at the National Institutes of Health Clinical Center.
The first and important consideration in making a study ethical is that it's answering a valuable question.
The researchers behind this study say the goal is to see if newborns who do get the vaccine develop other illnesses and issues after vaccination.
Yeah, but to Christine's point, you said earlier that the hepatitis B vaccine has been proven to be safe and effective.
Exactly.
And one of the risks of doing a study that is not asking a valuable question is that you are then asking the community to help and to trust you when it's not actually necessary.
And later.
That can then create resistance and hesitancy and suspicion of healthcare workers if people realize that they were part of an unnecessary and possibly unethical study.
Ooh.
Okay, so what have the researchers said in response to all of this pushback?
So I did reach out to the researchers in Denmark, and I didn't get a response despite many attempts.
But it is worth noting.
The researchers are already controversial and RFK Jr is a fan of their work and their somewhat unorthodox vaccine arguments, and he has cited them in the past.
Many in the medical establishment say that after reviewing their published work, they've found big claims questioning vaccines where the data and the statistics often just don't back it up.
So in the meantime, has the CDC responded to any of this?
So, so far, they have defended the study.
In a statement to NPR, HHS called the study the gold standard and said it was based on the highest scientific and ethical standards.
So will the study go on despite all of this pushback and controversy?
Yeah, that is the question.
The authorities in Guinea-Bissau, where there's been years of instability.
They say it is currently suspended.
Yeah.
And it's kind of pending an ethics review.
The head of Africa CDC said he's sending experts to help with the review.
So that's where things seem to stand right now.
After reporting on these two sort of case studies, what's your takeaway for the global public health landscape?
Yeah.
So I think I've noticed over the past year that the US is getting more isolated when it comes to public health, being called out publicly as supporting things that are unethical or go against science.
So we may be at the beginning of a kind of shift in the balance of power of who leads the world, at least from a public health perspective.
Gabriela, thank you for sharing these stories with me.
It sounds like neither one is quite resolved, so we'll see how this plays out.
Absolutely.
Thank you so much, Gina.
If you like this show, share it with a friend.
It really helps our show out.
Also consider checking out our episodes on RFK Jr.'
's new vaccine advisors and how an innovative HIV vaccine trial is pivoting after losing USAID funding.
This episode was produced by Rachel Carlson and edited by Giselle Grayson and our showrunner, Rebecca Ramirez.
Gabriela Emanuel and Tyler Jones check the facts.
And the audio engineer was Kweisi Lee.
I'm Regina Barber.
Thank you for listening to Shorewave from NPR.
