With RFK nomination, Washington state health leaders brace for local impacts

President-elect Donald Trump has named Robert F. Kennedy Jr. to lead the Department of Health and Human Services, a choice that worries some Washington state leaders, largely because of his position on vaccines. They anticipate funding cuts and increased vaccine skepticism under the next administration, and want to ensure local vaccination programs are safeguarded from a political shift.

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As HHS Secretary, Kennedy would be in charge of agencies that fund research and set vaccine recommendations. He’d also oversee the CDC, the FDA, and the Centers for Medicaid and Medicare Services. Kennedy has a long history of expressing skepticism about vaccines and spreading misinformation about their safety.

A top concern of officials in Washington state is that, as the country’s top health official, Kennedy would have a broad platform for broadcasting those views.

“That simple lack of confidence or confusion that he could sow … could result in fewer people becoming vaccinated, more cases of vaccine-preventable diseases, many of which are severe and life-threatening,” said Dr. Jeff Duchin, King County’s recently retired public health officer. “So more sick children. Some of those sick children will die.”

Dr. Helen Chu, an immunologist at UW Medicine, said one example is whooping cough, a vaccine-preventable disease that’s most dangerous to babies. She notes that cases of whooping cough have skyrocketed in 2024, both nationally and locally.

“We've now seen 1,500 cases of whooping cough here in Washington state, which is the highest ever [for a single year],” she said.

That’s in part because vaccination rates have declined since the pandemic.

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“The most worrying thing right now is that we're really at a turning point in how people are thinking about vaccine[s],” Chu said. “There was a lot of concern about [the Covid vaccines], and a lot of that concern has now bled over into childhood vaccinations. And because of that, what we've seen is that the number of parents who are choosing to delay their childhood vaccines, or are choosing to decline childhood vaccines, has really gone higher and higher and higher to the point that we're no longer at herd immunity thresholds for many vaccine-preventable diseases.”

Duchin said, beyond the human cost of illness and death, the other costs of disease outbreaks would also be felt locally, such as the cost of investigating outbreaks, the cost of people missing work because they or their children are sick, and the possibility that hospitals or emergency departments fill up.

Duchin said public health agencies can do their best to counter misinformation by working with communities and trusted community representatives to distribute accurate messages about vaccines, their safety, and their benefits.

When asked if King County’s public health agency is preparing to increase its efforts to promote vaccination, a department spokesperson said in an email, “It’s too early for us to be able to speak to impacts.”

The spokesperson also pointed to a blog post written by Faisal Khan, the county’s public health director, after the election.

“Although we don’t know everything that will happen in the coming months and years, we have the tools and critical experience to serve with our values,” Khan wrote. “All of us at Public Health Seattle and King County remain prepared to take important steps to support the health, well-being, and rights of you and everyone else in our communities, as needed in response to changes and initiatives at the federal level.”

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King County has the highest rate of fully-vaccinated two-year-olds in the state, based on the CDC-recommended schedule. Rural areas in southwest, southeast, and northeast Washington have much lower vaccination rates, which contributed to a measles outbreak in Clark County in late 2018 and early 2019.

That prompted Washington lawmakers to pass a law in 2019 removing parents’ ability to claim a personal or philosophical exemption to opt their children out of the measles vaccine. Hearings on the bill reflected the controversy surrounding vaccines and personal choice; hundreds of opponents turned out in Olympia to testify against it, including Robert F. Kennedy Jr., who questioned safety standards around vaccines.

Public health officials are worried that, as HHS secretary, Kennedy would have the power to appoint people who share his views on vaccination to the committees that evaluate new vaccines, decide whether they’re safe and effective, and make recommendations about who should get them and when — for example, when children or elderly people should get various boosters. He could also change the administrative requirements for vaccine approval, to make it harder for new vaccines to be approved or even to walk back existing approvals.

“And right now, insurance companies base their coverage of vaccines” on those recommendations, said Sen. Patty Murray, a Democrat representing Washington state. “If they eliminate that, then insurance companies — first thing they’re going to do is not pay for it.”

Duchin said a possible local response would be to re-establish a West Coast vaccine review committee. Washington, California, Oregon, and Nevada came together in late 2020 to establish such a committee to review the new Covid vaccines.

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“It would be a shame if our national recommendations were not reliable enough in the future to base local recommendations on,” Duchin said. “But if they're not, then I think local governments have the responsibility to try and provide better information for people to make health decisions.”

“Ideally, that would be done in collaboration with as many neighboring states as possible to make it more standardized,” he added.

When asked if Governor-elect Bob Ferguson would consider re-establishing a committee like that, a spokesperson said in an email that he “is considering multiple strategies to protect public health here in Washington from attacks at the federal level.”

Public health officials are also worried about funding — Kennedy could cut funding for research into new vaccines, or reduce the federal budget for vaccine purchases and distribution.

“He has said that he’s going to eliminate researchers … that he’s going to fire researchers,” Sen. Murray said. “This, to me, would set our country back, just in a way that I cannot fathom.”

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Asked what she might do to ensure continued funding for vaccine research, Murray said, “I will be using my voice as I always have to fight to make sure we are investing in the things that are important to our country. Investing in NIH is really important.”

“Everything I'[ve said about my concerns] is predicated on people in government making bad decisions, and doing things that are suggested by what RFK has done and said in the past,” Duchin said. “But they could surprise us. … Maybe people will step up and do the right thing.”