Restoring Trust in Public Health: Start with Vaccines

“The headwinds facing vaccination in the United States are unlikely to subside soon. New people will be appointed to federal health agencies overseeing vaccines and their expert advisory committees, HHS and the CDC will consider additional new recommendations, and new attention will be directed toward allegations about vaccine safety.”

Jason Schwartz, Ph.D., Department of Health Policy and Management, Yale School of Public Health

“Trust is the easiest thing in the world to lose, and the hardest thing in the world to get back.”

Reginald M. Williams, Australian bushman and entrepreneur

In last week’s post, I made the case that due in large part to the impact of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr.’s firing and hiring decisions, trust has been lost in the Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP)—American institutions that play a crucial role in vaccine monitoring. (See, “Autism: Playing Politics with Vaccines,” Germ Gems, July 2, 2025). Noting that physicians and public health officials would now need to look elsewhere for guidance of patients about vaccines, I questioned where they could look. In today’s Germ Gems post, I provide an answer and suggest all is not lost. In fact, there are reasons for cautious optimism.

Why prioritize vaccines? In my opinion, the development of vaccines is the single most consequential advancement in all of modern medicine. The most recent global estimate indicates that vaccines have saved approximately 154 million lives over the past 50 years with the vast majority of these being children under 5 years of age. Dr. William Foege, an American epidemiologist who played a pivotal role in the global vaccine campaign that eradicated smallpox, referred to vaccines as the “tugboats of preventive medicine.”  Indeed, vaccines are the cornerstone of public health.

In addition to saving lives, vaccines also prevent symptoms of many really terrible diseases. For a case in point, take shingles. New evidence indicates vaccines against varicella zoster virus (chickenpox) as well as against respiratory syncytial virus (RSV) prevent shingles, a painful affliction suffered by an estimated 1 million Americans per year.

Vaccine control in the U.S. The CDC and the Federal Drug Administration (FDA) are the two institutions that govern vaccine use in the U.S. The CDC is responsible for providing recommendations to the public about when and how to use approved (or authorized) vaccines. This includes issuing the U.S. adult and childhood immunization schedules, which gives guidance on the age(s) when vaccines should be given, the number of doses recommended, timing of doses, and other information. 

The FDA oversees review of the safety and efficacy of candidate vaccines. It is authorized to determine whether or not to approve vaccines for use. Only vaccines that have been FDA-approved can be legally administered in the U.S.

Kennedy’s appointments. HHS Secretary Kennedy has appointed several vaccine skeptics to positions in the FDA and CDC, specifically to the CDC’s ACIP. This is a giant step backwards for vaccines. (See, Wu, K, “The U.S. is Going Backward on Vaccines, Very Fast,” The Atlantic, June 25, 2025).

Recently, the newly reconfigured ACIP decided to withhold approval of influenza vaccines containing the preservative thimerosal because of a totally unsubstantiated link of thimerosal to autism.  The ACIP’s decision as well as its the discussion of other vaccine-related issues reveals the appalling level of inexperience and lack of understanding of vaccines by many (if not most) of the new ACIP members. Its decision sounded the death knell of trust in the ACIP—if not the entire CDC.

To the Rescue: the Vaccine Integrity Project. Just as the new ACIP’s thimerosal decision was taking the wind out of the sails of everyone who relies on the CDC, and for that matter the FDA, for trustworthy advice, hope appeared on the horizon. On July 3, 2025, the creation of The Vaccine Integrity Project (VIP), a non-governmental vaccine advisory group funded exclusively by an enlightened philanthropist, was announced. (See, “The U.S. government is failing on vaccine policy. The Vaccine Integrity Project is here to help,” STAT News, July 3, 2025).

According to the article in STAT News, “[The VIP’s] mission is simple and urgent: to ensure vaccine use in the United States remains grounded in the best available evidence and focused squarely on protecting the public.” It “is designed solely to give clinicians the evidence-backed guidance they need to help protect Americans this year from respiratory viruses that hospitalize and kill tens of thousands annually.” The group aims “ to lock arms with doctors, scientists, and public health experts and promote integrity, openness, and scientific rigor.”

Michael T. Osterholm, PhD, University of Minnesota Regents Professor of Public Health and Director of the University of Minnesota, Center for Infectious Diseases Research and Policy (CIDRAP), conceived of the project. All VIP members are highly regarded experts in various aspects of the field of vaccines. Their fully vetted recommendations will be turned over to medical and professional associations, whose physician members are on the frontline providing care to Americans.  

The VIP’s initial focus will be on vaccines against three respiratory tract viruses: influenza virus, RSV, and SARS-CoV-2, the cause of COVID-19. We can look forward to the VIP’s guidelines sometime this summer or fall.

The crucial role of trust in healthcare. In medicine, I’ve always advocated for the essential importance of trust. (“If you don’t trust your doctor, get another doctor.”) Although I’m not an expert in the field, I believe this is also true in public health.

I’ve had the good fortune of knowing Mike Osterholm for 50 years. (He embarked on his career in public health at the same time and institution I began mine as an infectious diseases specialist.) His leadership in the development of the VIP is indicative of his profound expertise and passion for public health. And, he is trustworthy.

What Osterholm and his VIP colleagues have in mind is highly innovative. And I believe if you can trust any group to pull off this hugely complicated and important project, it is the VIP.

In a June 4, 2025 commentary in Medscape, “Is It Too Late to Rebuild Trust in Public Health?,” Dr. George. Lundberg, former Editor of the Journal of the American Medical Association for 17 years, stated it well, “In medicine and health, we humans are a connected community—regardless of current politics. We must care for each other, thereby protecting the health of the public, which includes ourselves, our friends, our families, and our neighbors.” America’s trust in public health information (and vaccines) is at a low point. It needs to be restored. I am optimistic that the VIP will do just that. It is a very important project.