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How Trump Could Change America's Vaccine Policies

Trump met with notorious anti-vaxxer Robert F. Kennedy Tuesday, but what can he actually do?

President-elect Donald Trump met with Robert F. Kennedy Jr., a notorious anti-vaxxer, on Tuesday. Kennedy said Trump asked him to "chair a commission on vaccine safety," which Kennedy accepted, a move that was nearly unanimously decried by the public health community.

A Trump spokesperson told Motherboard* "no decisions have been made at this time," but said the commission would specifically focus on autism. The fact that Kennedy described the commission as relating to vaccines, and Trump's team described it as related to autism, suggests a link that has been thoroughly debunked by science.

"The President-elect is exploring the possibility of forming a commission on autism, which affects so many families," Hope Hicks, a spokesperson for the Presidential Transition Team, wrote in an email. "The President-elect looks forward to continuing the discussion about all aspects of autism with many groups and individuals."

Allowing an anti-fact, anti-evidence individual to have any kind of advisory role in the government's health care decisions is disturbing on a philosophical level. It also has the potential to politicize a debate that has largely stayed on the fringes for both parties. But it's important to keep these moves in perspective. Here are the ways Trump could influence vaccine programs, and what the limitations are:

"Everybody ought to be able to be assured that the vaccines that we have — he's very pro-vaccine, as am I — but they're as safe as they possibly can be," Kennedy told reporters Tuesday after the meeting.

But the notion that Kennedy is "pro vaccine," is dubious at best. If you're unfamiliar, Kennedy was once best-known for his work in environmental conservation, but in recent years he gained notoriety for stubbornly clinging to the notion that vaccines can cause autism—even though scientific analysis has debunked any connection between the two. Kennedy's even gone so far as to claim a massive government cover-up hiding the link between vaccines and autism, so you can add conspiracy theorist to his resume.

The pairing isn't altogether surprising: Trump has repeated misleading claims about vaccines and autism for years, including throughout the presidential election. But the president-elect has also had a habit of reversing course on some campaign claims, so it's troubling to see him staying on this particular path. I reached out to Trump's transition team, but have not yet heard back.

But there's a limit to how much can really change. Vaccine mandates are determined at the state level, and all 50 states have some kind of vaccine mandate in place: in order for children to attend public school in the state, they have to be up-to-date on their shots.

There are exemptions, and some states are looser than others on what a parent needs to do to avoid shots. Some stricter states, like Mississippi and, as of last year, California, will only grant exceptions for medical reasons—if a child has a documented allergy to a specific vaccine ingredient, for instance. Others allow religious or "personal belief" exemptions, which lets anti-vaxx parents claim whatever they want to avoid getting a shot.

Still, the mandates do a lot to ensure a majority of kids are protected from vaccine-preventable diseases, and aren't going to infect vulnerable populations like newborn babies. And the federal government can't force states to change these laws. But there are a few things the feds could do that would be worrisome for vaccine proponents. Congress could incentivize loosening up vaccine mandates, for example, giving states a reason to keep or add personal belief exemptions.

Trump could also potentially appoint a vaccine-unfriendly head of the Centers for Disease Control to replace current director Dr. Thomas Frieden, who has said he will resign on inauguration day. The CDC sets recommendations for vaccines that many states choose to follow, and may make changes under the direction of an anti-vaxx head. But neither of these routes would likely dramatically shake up states that believe in strong vaccine mandates.

Another area that's maybe more likely to be influenced by the likes of Kennedy is the National Vaccine Injury Compensation (NVIC) Program. Rarely, vaccines can cause adverse events, like an allergic reaction that causes anaphylactic shock. In those events, the parents can seek compensation from the government through the NVIC program, paid for through a surcharge on vaccines.

I spoke with Dr. David Gorski, a surgeon and the managing editor of the blog Science-Based Medicine, last year about Representative Tom Price, Trump's pick to lead the Department of Health and Human Services (who is in a group that promotes anti-vaccine views, among other anti-evidence beliefs). Gorski explained that the compensation program would be a potential target for an anti-vaccine administration.

"Win or lose, parents get their legal costs taken care of and it has a certain set of table injuries where compensation is pretty much automatic," Gorski said. "The thing [anti-vaccinationists] don't like about it is that autism is not a table injury and they don't get compensated for autism, because the evidence is overwhelming that vaccines are not associated with autism."

Congress could conceivably amend the injury table to include autism, forcing the government to pay out compensation to anti-vaxxer parents that claim a shot gave their child autism, even without the support of science. Or it could get rid of the court altogether.

"That would actually be very bad for parents of children who really have been injured by vaccines because it's way more difficult to be compensated in regular, run-of-the-mill civil court," Gorski told me.

Tapping an anti-vaccine proponent to advise on medical policy legitimizes a viewpoint that's dangerous, and could send out waves that shift state-level thinking. When state mandates are softened, it opens the door for not only anti-vaxxers, but also to any parents who are under informed, or frankly just really busy, to skip vaccinations for their kids. And when too few kids are vaccinated, outbreaks can occur, and people die from diseases that should have been long defeated.

There are limits to how much Trump, or Kennedy, can actually alter vaccine policy. But there's no limit to how much this ideology can ripple out across the country, and that's a dangerous prospect.

*This story was updated after it was first published to include response from Trump's transition team.

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