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Nirenberg is a vaccination advocate and science communicator focusing on vaccines and COVID-19.
Yamey is a physician and professor of global health and public policy at Duke University, where he directs the Center for Policy Impact in Global Health.

Joe Rogan, America’s most popular podcaster, recently called for Professor Peter Hotez, an internationally recognized pediatric infectious disease doctor and vaccine scientist, to come on his podcast to debate Robert F. Kennedy Jr. (RFK Jr.), a prolific spreader of medical disinformation. Rogan even offered to donate $100,000 to a charity of Hotez’s choice if he agreed to the debate. Hotez declined—instead offering to be a guest on Rogan’s show to discuss vaccine science.

Hotez is right not to take the bait. Rogan is unqualified to moderate such a debate, and has himself peddled disinformation about vaccines. Debating anti-vaccine conspiracy theorists like RFK Jr. is a fool’s errand, which always backfires, as history has demonstrated repeatedly. These debates give the false impression that there are “two equivalent sides,” and therefore can cause real public health damage.

Historian Andrew Wehrman, an expert on the history of smallpox vaccination in the United States, gives a telling example of the harm that is done when an expert debates an anti-vaxxer. In Minnesota in 1902, the local anti-vaccination league hoped to overturn a law requiring vaccination of schoolchildren against smallpox, managing to organize a debate. Dr. Justus Ohage, a giant of medicine, engaged anti-vaccine advocate W.B. Clarke. Ohage discussed the evidence around the importance of smallpox vaccination. Clarke raised multiple false claims which Ohage was unprepared for (as these could not be fact-checked in real time), and in 1903, the law was repealed. Two decades later, in 1924, Minnesota experienced its deadliest-ever smallpox epidemic, with 500 deaths. “Repealing the childhood vaccination law,” says Wehrman, “cost lives.”

Like Clarke, RFK Jr. is, certainly chomping at the bit to debate Hotez. For Kennedy, there are only upsides to such a debate. The event would turn into a media circus akin to the 1902 Minnesota affair, giving Kennedy air time and creating the impression that Kennedy’s views on vaccines should be taken seriously and are reasonable—which is certainly not the case.

Read More: Inside the Very Online Campaign of RFK Jr.

Much of Kennedy’s opposition to vaccination seems to center on his false claim that vaccines cause autism. But there have now been studies that have included millions of children and these studies have found no relationship between vaccination and autism. One remarkable study looked at every child born in Denmark over a twelve-year period and could not identify an increased risk of autism in the children who were vaccinated relative to those who were not.

Indeed, the evidence is very clear: there is no link between vaccination and autism. The best available research evidence suggests that autism is likely to be genetic in nature. The rise in the incidence of autism is attributable largely to evolving diagnostic criteria that are intended to capture more cases and begin earlier intervention. All of this evidence has not stopped anti-vaccine activists like Kennedy from holding steadfast to their false claims, with each successive refutation being met with an excuse.

Kennedy also made the false claim that COVID vaccines are the deadliest vaccines ever made. Let’s take a look at this claim.

Deaths from vaccines are exceptionally rare for two main reasons. The first is that precautions are taken in who gets vaccinated—for example, the MMR vaccine is a live vaccine, so it is not given to people who are severely immunocompromised. The second is the stringent safety standards that must be met for any vaccine to ever reach the public.

Kennedy’s false claim is based on reports of deaths after receipt of COVID-19 vaccines in the Vaccine Adverse Event Reporting System (VAERS). His claim does not hold up to scrutiny, and shows his misunderstanding of VAERS. Anyone can report any event to VAERS. A report of an event is not proof that the vaccine was the cause. Indeed, VAERS’s own disclaimer states: “VAERS reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable.” Deaths reported in VAERS have included car crashes and even the death of a girl who fell into a well—these events were clearly not caused by a vaccine. The main purpose of VAERS is as an early warning system: If there’s a dramatic rise in a particular event, this signal can be investigated with more robust surveillance systems, like the Vaccine Safety Datalink (VSD), which has access to medical records and can make detailed comparisons between vaccinated and unvaccinated individuals. Evidence from these more robust systems has shown that COVID-19 vaccines are remarkably safe and that deaths from the vaccines are extremely rare, which has also been confirmed by studies outside the U.S.

In Kennedy’s conspiracy-laden fantasy world, a shadowy cabal conspires to hide the risks of vaccination. In the real world, U.S. public health agencies take vaccine safety extremely seriously and approach it with great transparency. After millions of the Janssen COVID-19 vaccine were given, just 6 cases of an unusual pattern of blood clots were enough to trigger a pause on vaccine—eventually a preferential recommendation for mRNA vaccines was issued because of the seriousness of this very rare condition, one that does not occur from mRNA vaccines. A safety signal for the bivalent Pfizer COVID-19 vaccine for strokes in older adults was immediately communicated when it was identified even though subsequent data suggests that this finding is a statistical artefact.

Unfortunately, Kennedy has also argued that COVID-19 vaccines are especially inappropriate in pregnancy. While it is true that the initial studies of the COVID-19 vaccines did not include pregnant individuals, data showing the safety and effectiveness of COVID-19 vaccines in pregnancy quickly emerged. Pregnant people are at dramatically heightened risk of severe illness and death if they get COVID-19, and vaccination plays a critical role in preventing these awful outcomes. Kennedy’s organization, Children’s Health Defense, has published posts dated as recently as August 2022 arguing that COVID vaccines should be banned in pregnancy, after extensive evidence for their safety and benefits has been available.

Kennedy’s brand of extreme anti-vaccine activism can have deadly consequences. In June 2019, he visited Samoa, appearing alongside local anti-vaccine activists. Later that year, a measles outbreak resulted in 83 preventable deaths, most of which were in children under 5, because of poor uptake of the MMR vaccine. Despite the deadly outbreak, Kennedy wrote a letter to Samoa’s Prime Minister Malielegaoi to deflect blame from the anti-vaccine movement and instead suggest that the outbreak was due to a defective MMR vaccine. Physician-scientist David Gorski has provided a thorough dissection of the “deceptive pseudoscientific talking points” in Kennedy’s letter.

RFK Jr’s own family say that he is “tragically wrong about vaccines.” They state that he is “part of a misinformation campaign that’s having heartbreaking—and deadly—consequences.” We agree. Kennedy’s views on vaccination are as fringe and detached from reality as it is possible to be, and their dissemination among the public in any format directly harms us all.

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