RFK Jr. Spewed Endless Lies and Smears in Senate Testimony. The Worst Concerned Vaccines.

Sad but true, the public health of U.S. citizens lies in the hands of a dangerous conspiracist and quack who's trying to eradicate science from government agencies set up to protect us.

By Jonathan Cohn/ The Breakdown

Robert F. Kennedy, Jr., the secretary of health and human services, made so many misleading or false statements during his testimony before the Senate Finance Committee last week that it was genuinely difficult to keep track—but here are some of the biggest:

• He once again endorsed discredited claims about the dangers of immunization, reaffirming his belief that there is no such thing as a “safe and effective” vaccine.

• He denied making statements tying school shootings to the use of antidepressants, just weeks after announcing that the department would be investigating the association.

• He said anybody can still get COVID-19 shots, amid widespread reports from sixteen states where pharmacies confused by HHS guidance aren’t dispensing them without a prescription.

• And he said the impetus for his forcing Susan Monarez out as head of the CDC in late August was her confession, in a meeting, that she was untrustworthy.

That last claim was so implausible that a few of the aides sitting behind senators on the committee dais laughed. Others just stared in bewilderment, which was my reaction too.

But the Kennedy claim that really stuck with me was an argument he made in his opening statement, as a preemptive response to questions about the firing of Monarez and the subsequent resignation of four senior CDC scientists:

CDC failed that responsibility miserably during COVID when its disastrous and nonsensical policies destroyed small businesses, violated civil liberties, closed our schools, caused generational damage in doing so, masked infants with no science and heightened economic inequality. And yet all those oppressive and unscientific interventions failed to do anything about the disease itself. America is home to 4.2 percent of the world’s population, yet we had nearly 20 percent of the COVID deaths. We literally did worse than any country in the world.

This argument, which echoed a Wall Street Journal opinion article under Kennedy’s byline that appeared on Tuesday, had more basis in reality than much of what he said on Thursday. Although the U.S. COVID death rate wasn’t literally the worst in the world, it was one of the worst among both economically advanced countries and those in which the disease was most widespread.

And while it was primarily federal, state, and local officials who gave the orders on the masks, business suspensions, and school closings that Kennedy decried, it’s certainly true that the CDC recommended many of these steps either directly or by implication—and that the agency’s overall record during the pandemic includes some decisions that look like bad calls in retrospect.

But Kennedy’s linking of the two—his suggesting that CDC actions increased the death toll—makes no sense whatsoever.

And it’s important to understand why, because Kennedy isn’t using this argument simply to justify the firings and other changes he’s making to the agency. He’s also using it to justify policy changes that will leave us more vulnerable—and more likely to die—the next time we face a threat like COVID.

Truth behind death toll. Lots of researchers have tried to figure out why so many Americans ultimately died from COVID. And while they’ve used different methods and put forward some different theories, the well-respected analysts have tended to converge on a few factors.

High on that list is the poor underlying health of the American public. People with chronic diseases like diabetes, heart disease, and chronic kidney disease are more likely to suffer the most severe COVID complications and to die from them. And there are a lot of such people in the United States.

Kennedy certainly knows this. Battling chronic disease is his rallying cry, the reason he cites for his crusades to improve diet and exercise—crusades that, at least in principle, pretty much everybody in public health supports.

But in his Senate testimony, Kennedy did more than call for more focus on fighting chronic disease.¹ He singled out the CDC for—evidently—not doing enough to reduce the chronic disease burden. “If we don’t end this chronic disease—we are the sickest country in the world. That’s why we have to fire people at CDC,” Kennedy said. “They did not do their job.”²

It’s a bit hard to understand exactly how a single, sub-cabinet agency like the CDC was supposed to make a big dent in the U.S. chronic-disease burden—which, as KFF executive vice president for health policy Larry Levitt noted in an interview with me the day after Kennedy’s Senate appearance, “has been many years in the making. It’s a product of many factors, including individual behavior, inequality and poverty, and lack of access to primary care.”

When it comes to individual behavior, it’s especially tough to see what the CDC could have done on its own. The individual behaviors that can lead to more chronic disease—whether tied to diet or activity, or to the use of tobacco or alcohol or drugs—are sometimes linked to inherited traits, and are sometimes rooted in habits that people pick up from their families or their communities or through American culture writ large. All of these can be notoriously difficult for the government to change, as my colleague Mona Charen observed a few weeks ago.

It’s a different story when it comes to the other factors in chronic disease.

Hypocrisy of RFK lies. Inequality and poverty, access to health care—these are places where the government can make a real difference. It can provide direct cash support or vouchers for necessities like housing and food.

Or it can make sure people have health insurance.

But this is not something the government does through the CDC. It’s something the government does through programs like Medicaid or the Supplemental Nutrition Assistance Program.

And it’s not like Kennedy is calling to strengthen those programs now.

On the contrary, he’s been a loyal soldier in the campaign by President Donald Trump and the Republicans to slash those programs—defending, as he did again during his testimony, the massive cuts to Medicaid and the Affordable Care Act, which are expected to leave 10 million people newly uninsured.

The story on health care in the years prior to Trump coming back into office has been more and more people getting coverage, putting them in a better position to manage the chronic conditions Kennedy says need so much attention.

“The [newly insured] report better access to primary care—and better use of preventive services seeking care for chronic medical conditions like high blood pressure, diabetes, depression, asthma,” John Ayanian, director of the University of Michigan’s Institute for Health Policy and Improvement, told me recently.

“Now we are on the cusp of reversing those gains,” added Ayanian, “and that could lead to worse health outcomes.”

Why vaccinations matter. The other big cause for higher COVID mortality in the United States was an obvious one that Kennedy would never concede: lower levels of vaccination.

It’s easy to forget, but initial distribution of the COVID vaccines in 2021 was remarkably quick, exceeding projections—thanks in part to actions by the Trump administration, which launched “Operation Warp Speed” to develop and distribute vaccines as quickly as possible, and thanks to in part to actions by the Biden administration, which took over distribution upon taking office.

In both instances, the CDC played a big role—by advising state and local health departments, for example, and managing a public-private partnership with the big pharmacy chains. The CDC also helped design plans to reach communities where vaccination distribution was likely to be more difficult—say, because of thin health care infrastructure or large numbers of people without health insurance.

But progress stalled, causing the United States to fall behind other peer countries on vaccine uptake.

The big reason for that was vaccine hesitancy. And while some responsibility for that lies with the CDC and other officials who oversold the vaccines’ capabilities, fueling skepticism, responsibility also lies with the influential figures who spread misinformation or turned vaccine resistance into a badge of political honor.

You know, people like Kennedy—who, during the pandemic, called the COVID vaccine the “deadliest” ever made.

“While COVID vaccines rolled out quickly in the U.S., we fell behind other countries as vaccines became politicized,” said Levitt, who collaborated on an international COVID mortality comparison that KFF produced. “The lack of vaccination led to more preventable deaths from COVID in the U.S.”

That was also the conclusion of Thomas Bollyky, who directs the global health program at the Council on Foreign Relations.

He’s been the lead author on two major sets of studies, one comparing COVID-related mortality across countries and one comparing mortality across U.S. states.

One particularly telling finding from the latter is that the states that performed best—the ones with the fewest deaths relative to the population—actually had rates relatively comparable to the best-performing countries abroad.

“There is a nearly fourfold difference between the rate of COVID deaths in the best-performing U.S. state and the worst-performing U.S. states,” Bollyky told me. “And the biggest difference was vaccination.”

“They’ve hung this on CDC or the public health community, that the advice we had given to the United States public served them poorly in the pandemic,” Bollyky added. “But in the states that followed it—and in the populations that followed that advice—they did fine by international standards.”

“A big, flashing warning sign.’ These sorts of findings don’t only undermine Kennedy’s narrative about why so many people in the United States died from COVID. They are also a big, flashing warning sign about the agenda Kennedy is currently carrying out—and that he was on Capitol Hill to defend.

That agenda includes steps cutting half a billion dollars of research funding into next-generation mRNA vaccines—something that many scientists believe, with good reason, could make development of a vaccine against a future outbreak (or bioweapon attack) both quicker and more effective.

And based on hints Kennedy has been dropping, his agenda is likely to include some kind of attack on the no-fault liability system widely credited with guaranteeing a secure vaccine supply.

These and other steps mean the death toll from the next pandemic could be even higher than it was in COVID-19—for reasons that have far more to do with Kennedy than with the CDC.

That doesn’t mean the CDC got everything right during the pandemic. Far from it.

There’s lots of reason to think the agency should have given more consistent, better-supported advice on measures like social distancing—and that it should have been more careful about recommending limits on schooling given the potential for learning loss.

The pandemic also exposed what even many of the agency’s strong supporters consider serious institutional flaws, like a heavy reliance on slow-moving academic research. The CDC struggled with tracking early in the pandemic, and famously botched the development of COVID testing during the pandemic’s first months back in 2020.

At the same time, any honest assessment of the CDC’s performance during COVID should take into account the magnitude of the challenge: It had been a century since anybody had seen anything like it.

That’s not to mention the other big challenge the CDC faced Trump.

How Trump and RFK undermine public health. For nearly a year, it was operating under a president—Donald Trump—who was constantly downplaying the crisis, touting unproven or potentially dangerous therapies, and actively undermining the state officials who were trying to manage the pandemic in its first, scariest months; to say nothing of people like Kennedy who spent those months stoking fears that COVID may have been a government plot.

And if there is still a case for major changes at the CDC, there’s also good reason to make those changes in a methodical, careful way that allows it to keep performing essential, lower-profile functions like data collection. The CDC has traditionally been the nation’s best source for information about all kinds of health problems, including the very chronic conditions that Kennedy says are a priority.³

Instead of fortifying the offices that produce that data, Kennedy has been downsizing them—and, in many cases, proposing to eliminate them altogether so he can fold them into a still-undefined health-promotion division.

“Without those systems, we won’t be in a position to tell whether we’re making progress—and where we still need to improve,” Ayanian told me. “That’s particularly true for parts of the nation that may be lagging behind—rural communities, tribal communities, inner-city communities—where health outcomes are most severely lagging.”

Kennedy’s refusal to acknowledge these sorts of contributions—or the parts of the CDC’s response to COVID that saved lives—is more than a dishonest argument about the agency’s ability to carry out its mission.

It’s also a smear of the people who have worked there.

Many of them have skills that could command much higher salaries—and, in some cases, entail less physical risk—in the private sector. They are at the CDC because they decided to serve the public.

Sometimes they’ve succeeded, sometimes they haven’t. But they have chosen to do what they can to make America healthy again. And they are doing so with more integrity than the man who wields that slogan as a weapon.

1-During his testimony on Thursday, Kennedy scolded Sen. Ron Wyden (D-Ore.) for purportedly ignoring the problem of chronic disease. But Wyden has been talking about chronic disease—and proposing major legislation to address it—for as long as I’ve been covering health care. (Which, to be clear, is quite a long time.) It’s just one instance of Kennedy acting like he discovered the significance of chronic disease, which has been a preoccupation in health policy for decades.

2-At a different point in his testimony, Kennedy criticized the CDC for “mission creep” away from its core purpose of fighting infectious disease. It’s hard to see how that could be compatible with his attack on the CDC for not addressing chronic disease—i.e., something besides infectious disease.

3-CDC’s data-gathering on chronic disease can play a critical role in helping other parts of the federal government to shape their actions. But, to reiterate, it’s not CDC itself that operates these programs.

Public policy journalist and author Jonathan Cohn writes “The Breakdown” newsletterr for The Bulwark. You can subscribe here.

Photo illustration by Fast Company.