Health officials around the world are alarmed over the likely impact of Robert F. Kennedy Jr. -- a longtime vaccine skeptic who was tapped for the health secretary role this week -- on global health. Experts from Samoa have been particularly vocal in sounding the alarm, citing the destructive impact of Kennedy's rhetoric on the tiny Polynesian island nation.
Warning that Kennedy will empower the global anti-vaccine movement and may advocate for reduced funding for international agencies, Aiono Prof Alec Ekeroma, the director general of health for Samoa's health ministry told The Washington Post that Kennedy "will be directly responsible for killing thousands of children around the world by allowing preventable infectious diseases to run rampant."
"I don't think it's a legacy that should be associated with the Kennedy name," Ekeroma said in an email Friday.
Ekeroma recalled a disastrous epidemic in 2019, when measles spread rapidly across the small Pacific Ocean country. Of Samoa's population of 200,000, more than 5,700 were infected and 83 died, many of them young children. Hospitals were overrun, and the nation declared a state of emergency. To stop the outbreak, Samoa launched a massive vaccination campaign, and unvaccinated families were asked to hang red flags outside their homes.
The island nation already had a lagging measles vaccination rate of only about a third of infants, plummeting from 90 percent in 2013. Health experts attributed that drop in part to a public health scandal in which two nurses improperly mixed the measles vaccine with the wrong liquid, resulting in the deaths of two infants. Both nurses were sentenced to five years in prison, and the vaccination program was temporarily suspended -- but the accident also opened the door to a wave of vaccine misinformation, including from Kennedy and his anti-vaccine nonprofit.
Kennedy had visited Samoa only four months before the outbreak and met with anti-vaccine advocates. He later characterized the outbreak in Samoa as "mild."
A representative for Kennedy did not respond to a request for comment.
Among the lessons Samoa learned from the outbreak was that low vaccination rates for infectious diseases are "an invitation to disaster," the Health Ministry's Ekeroma said. "Vaccine confidence in the population is of utmost importance."
The short-term impact of influential anti-vaccine rhetoric is the loss of trust in public health authorities, said Helen Petousis-Harris, a New Zealand-based vaccinologist and co-director of the Global Vaccine Data Network, who worked on vaccine safety information and advocacy during the Samoa outbreak. The long-term effect is the "inevitable resurgence of diseases," she added. "It always happens."
Global health officials worry that Kennedy's nomination Thursday to lead the Department of Health and Human Services will have far-reaching effects, given the U.S. government's outsize role in setting the global health agenda.
Lawrence O. Gostin, a leading expert in public health law at Georgetown Law, said that he has "never seen a darker day for global health than after the election of President Trump."
Scientific recommendations and guidelines from U.S. government agencies including the Centers for Disease Control and Prevention and the Food and Drug Administration have long been seen globally as the gold standard.
The FDA for instance, said Petousis-Harris, is a "big and powerful regulatory agency, whose standards, because it's so big, can be relied on by smaller markets." She cited her home New Zealand as one such example: "No way could we go through the same process independently for the same medicine. I don't think people realize how vital that is."
If countries "can no longer trust that our scientists are experienced and wise, and that there's [not] politics intertwined with science, there'll be no gold standard to look toward," Gostin said.
If the U.S. health agencies that are looked to for reliable medical research and guidance are "headed by Trump loyalists who are not respected scientists, who have skepticism of evidence, and their funding will be hollowed out," Gostin said, "that's a very dim future for public and global health."
Kennedy has for years questioned federal agencies charged with vaccine production and safety, promoted debunked claims linking vaccines to autism, and challenged the CDC's recommended list of vaccines for children. He founded and chaired one of the nation's most prominent anti-vaccine groups, Children's Health Defense, a prolific and lucrative spreader of anti-vaccine misinformation online.
President-elect Donald Trump and Kennedy have "similar core values," Gostin said, citing a hostility to science as well as skepticism of "vitally important" public health interventions. Both have also embraced "America First" isolationism and an antipathy toward international public health agencies such as the World Health Organization, he said.
"That suggests to me that there's going to be a huge assault on international cooperation in global health," Gostin said.
Kennedy's spokeswoman previously told The Washington Post that Kennedy is not "anti-vaccine," and in early November, Kennedy told NPR that he would not take vaccines away from anybody. "The science on vaccine safety particularly has huge deficits, and we're going to make sure those scientific studies are done and that people can make informed choices," he said.
Globally, falling vaccination rates have already resulted in a rise in measles cases in recent years, spurred in part by rising vaccine hesitancy.
Global measles cases surged by more than 20 percent to an estimated 10.3 million last year, the WHO and the CDC said Thursday. About 107,500 people, mostly young children, died -- an "unacceptable" death toll from a disease that's preventable through two doses of the measles vaccine, the health groups said.
More than 22 million children missed their first dose of the measles vaccine in 2023, they said. Even when people survive measles, serious health effects can occur, some of which are lifelong.
"The idea that vaccination would be simply a matter of personal choice will put so many people at risk," said Richard Besser, president and CEO of the Robert Wood Johnson Foundation health nonprofit and a former CDC acting director.
"One of the things that RFK Jr. has been a leader in has been instilling mistrust in public health as a system and the people who do that work," Besser said. "I worry about the health of people in America and those around the globe who rely on a public health system for their health."