罗伯特·肯尼迪的反疫苗观点会促使更多马萨诸塞州的父母拒绝为孩子接种疫苗吗？

【中美创新时报2024 年 11 月 9 日编译讯】（记者温友平编译）当选总统唐纳德·特朗普表示，美国最著名的疫苗怀疑论者之一罗伯特·肯尼迪 (Robert F. Kennedy Jr.) 将在他的新政府中发挥重要作用。对此，《波士顿环球报》记者Kay Lazar 和 Jason Laughlin 作了下述报道。

卫生从业者、专家和官员现在正在努力解决这对马萨诸塞州意味着什么，马萨诸塞州的疫苗接种率是全国最高的，但正在经历一场规模虽小但不断增长的疫苗犹豫运动。

肯尼迪是已故参议员、司法部长和总统候选人罗伯特·肯尼迪的儿子，他支持早已被揭穿的疫苗会导致自闭症的观点，并敦促人们在疫情最严重的时候反对新冠疫苗接种规则。特朗普表示，肯尼迪可能会负责解决公共卫生机构的腐败问题。

“罗伯特·肯尼迪二世当然是一个破坏疫苗和疫苗信心的人，”拜登总统的白宫冠状病毒应对协调员、布朗大学公共卫生学院院长阿希什·贾博士说。“这次选举的结果很大程度上取决于他扮演的角色。”

特朗普表示，肯尼迪可能会在他的政府中发挥“重要作用”，但自大选以来，他的具体作用尚未明确。

虽然马萨诸塞州幼儿园儿童对脊髓灰质炎、麻疹和乙肝等疾病的总体疫苗接种率为 95% 或更高，但一些学区已经出现了疫苗接种不足的情况。根据 2023-2024 学年的数据，180 个幼儿园班级（占全州的 10% 以上）报告称，他们的学生尚未达到针对麻疹、腮腺炎和风疹的群体免疫，而这需要 95% 的疫苗接种率。15 个班级未能达到确保脊髓灰质炎不会传播所需的 80% 的接种率。

这些令人不安的统计数据源于该州创纪录的宗教豁免率，这些豁免允许父母几乎不加质疑地放弃为孩子接种疫苗。在最近的学年，医疗和宗教豁免率上升到 10 年来的最高水平，有 800 多名幼儿园儿童获得了这些豁免。虽然他们只占该年级所有儿童的 1% 左右，但这个数字标志着宗教豁免的大幅扩展，这种豁免在 30 年前几乎闻所未闻。

豁免数量的增加反映了全国范围内的趋势，这种趋势导致可预防疾病的数量略有增加，但增长幅度却十分显著。截至 10 月底，美国疾病控制与预防中心今年已报告全国麻疹病例 272 例，超过五年来报告的病例数。美国疾病控制与预防中心报告称，百日咳（又称百日咳）是另一种可通过疫苗预防的疾病，在同一时期内发病率也有所增加。

塔夫茨大学医学院家庭医学系主任 Wayne Altman 博士表示：“决定不接种儿童疫苗的人越多，未接种疫苗的儿童患上基本上已被遗忘的疾病的可能性就越大。”

马萨诸塞州的高免疫率提供了显著的保护，但 Jha 表示联邦政府可以采取措施重塑州疫苗接种政策。

1905 年最高法院的一项裁决保护了各州建立疫苗强制令的权利，但 Jha 表示，政府可能会减少对 CDC 儿童疫苗计划的资助，该计划为儿童提供免费疫苗，并在 2023 年分发了超过 7400 万剂儿童疫苗。该计划报告称，在过去 30 年中，该计划防止了 100 多万人死亡。他说，政府还可能扣留联邦政府对疫苗要求不公平的州的教育资金。

“我认为联邦政府肯定有办法让马萨诸塞州更难在那个领域做它想做的事情，”Jha 说。

该州公共卫生部周三发表声明，重申其对建立强大的公共卫生系统的承诺，包括其疫苗接种政策。

马萨诸塞州健康行动的代表 Candice Edwards 一直反对立法禁止宗教豁免的努力，她拒绝就肯尼迪可能的上台对马萨诸塞州疫苗接种意味着什么发表评论。

“我们致力于提供准确、基于事实的信息，不会助长任何潜在的错误信息，尤其是在如此敏感的话题上，”她说。

Jha 说，免疫科学在很大程度上是其自身成功的牺牲品。一代人以前，大多数父母都会亲眼目睹脊髓灰质炎或麻疹的影响，并害怕自己的孩子患上这些疾病。美国近乎根除这些疾病，消除了看到或经历其影响所带来的创伤性影响。

“一旦你真正消除了某种疾病或使它变得非常罕见，下一代就不会真正把它视为威胁，”Jha 说。

疫苗可以预防的不仅仅是它们被开发来预防的单一疾病。美国儿科学会马萨诸塞州分会前任主席、马塔潘社区健康中心儿科医生 Mary Beth Miotto 博士说，未接种疫苗的人感染麻疹可能会使他们容易感染多种其他疾病。一项研究表明，它可以消灭 11% 到 73% 的抗体，而这些抗体可以抵抗人体之前免疫的各种疾病。

肯尼迪传播疫苗虚假信息的历史可以追溯到 2005 年，当时他发表了一篇报道，警告人们不要使用硫柳汞，硫柳汞是一种含汞防腐剂，到 2001 年，大多数儿童疫苗中都已不再使用硫柳汞。根据多项研究（包括美国医学研究所的一项详尽研究），这种防腐剂与儿童健康问题无关，但这场运动留下了永久的伤疤，儿科医生、前马萨诸塞州公共卫生部医疗主任劳伦·史密斯博士说。

“一旦硫柳汞信息被曝光，人们 [可以] 将其用作虚假信息宣传的一部分，”她说。“它被更多人接受，因为它被更多人知道，但这并不意味着它是真的。”

特朗普和他的代理人对是否有可能彻底禁止疫苗一直含糊其辞。上周末，当被问及疫苗禁令时，特朗普告诉 NBC 新闻：“我将与肯尼迪和其他人交谈，然后做出决定。”

周三，当被问及特朗普政府的疫苗监管计划时，肯尼迪似乎软化了一些立场。

“我不会取消任何人的疫苗，”肯尼迪告诉 MSNBC。“我从来没有反对过疫苗。”

他补充说：“我将确保科学的安全研究和功效得到公布，人们可以自行评估该产品是否对他们有益。”

官员们表示，这种语言掩盖了疫苗有效且绝对安全的既定科学共识。疫苗对儿童构成风险的情况极为罕见。事实上，获得免疫豁免的儿童数量一直很少，而且在过去十年中，马萨诸塞州的儿童数量一直在下降。

塔夫茨大学医生、马萨诸塞州家庭医生学会董事会成员奥特曼表示，在过去十五年里，他观察到患者对疫苗犹豫不决的情况越来越普遍，但他感到欣慰的是，很少有人完全反对接种疫苗。有些人想推迟给孩子接种疫苗，或者决定只接种部分疫苗。虽然他表示相信肯尼迪最古怪的想法甚至不会吸引许多疫苗怀疑论者，但他确实担心他们传播的错误信息氛围可能会使疾病更容易发生。

“我们知道社交媒体的影响力有多大，”他说。

题图：罗伯特·肯尼迪 (Robert F. Kennedy) 与前总统唐纳德·特朗普 (Donald Trump) 一起出现在佐治亚州的集会上。Jabin Botsford/华盛顿邮报

附原英文报道：

Will RFK Jr.’s anti-vax views drive more parents in Massachusetts to reject shots for their children?

Trump has said Kennedy could play a prominent role in his second term.

By Kay Lazar and Jason Laughlin Globe Staff,Updated November 8, 2024 

Robert F. Kennedy appeared with former president Donald Trump at a rally in Georgia.Jabin Botsford/The Washington Post

President-elect Donald Trump has said Robert F. Kennedy Jr., one of the nation’s most prominent vaccine skeptics, would have an important role in his new administration.

Health practitioners, experts, and officials are now wrestling with what that could mean for Massachusetts, which has one of the nation’s highest vaccination rates but is seeing a small but growing vaccine hesitancy movement.

Kennedy, son of the late senator, attorney general, and presidential candidate Robert F. Kennedy, has championed the long-debunked idea that vaccines cause autism and urged people to push back against COVID vaccination rules at the height of the pandemic. Trump has said Kennedy could be tasked with addressing corruption in public health agencies.

“RFK Jr. of course is somebody who has been undermining vaccines and vaccine confidence,” said Dr. Ashish Jha, President Biden’s White House coronavirus response coordinator and dean of Brown University’s School of Public Health. “A lot of what will happen as a result of this election will depend on what role he plays.”

Trump has said that Kennedy could have a “big role” in his administration but since the election has not clarified what precisely that might be.

While Massachusetts kindergartners have an overall vaccination rate of 95 percent or higher for illnesses such as polio, measles, and hepatitis B, undervaccinated pockets have formed in some school districts. According to data from the 2023-2024 school year, 180 kindergarten classes — or more than 10 percent statewide — reported their students had not reached herd immunity against measles, mumps, and rubella, which require a 95 percent vaccination rate. Fifteen classes failed to meet the 80 percent rate needed to ensure polio would not spread.

Those troubling statistics stem from the state’s record rates of religious exemptions, which allow parents to forgo immunizations for their children with little or no questioning. In the most recent school year, the rate of medical and religious exemptions rose to a 10-year high, with more than 800 kindergartners receiving them. While they account for only around 1 percent of all children in that grade, the number marks a huge expansion of religious exemptions, a type virtually unheard of 30 years ago.

The increase in exemptions mirrors a national trend, which has caused a small but noticeable increase in preventable illnesses. As of the end of October, the Centers for Disease Control and Prevention had reported 272 measles cases nationally this year, more than have been reported in five years. Whooping cough, also known as pertussis, another vaccine-preventable illness, has increased over the same time period, the CDC reported.

“The more people decide not to have childhood vaccinations,” said Dr. Wayne Altman, chair of family medicine at Tufts University Medical School, “the more likely that we will have epidemics of unvaccinated kids getting illnesses that were essentially forgotten.”

Massachusetts’ high immunization rates offer significant protection, but Jha said the federal government could take steps to reshape state vaccination policy.

A 1905 Supreme Court decision protects states’ rights to establish vaccine mandates, but Jha said the administration could reduce funding for the CDC‘s Vaccines for Children program, which provides free vaccines for children and in 2023 distributed more than 74 million pediatric doses. The program reported preventing more than a million deaths over the past 30 years. It could also potentially withhold federal education funding to states with vaccine requirements that the administration deems unfair, he said.

“I think there are definitely tools the federal government has to make it harder for Massachusetts to do what it wants to do in that area,” Jha said.

The state Department of Public Health released a statement Wednesday affirming its commitment to a robust public health system, including its vaccination policies.

Candice Edwards, a representative from Health Action Massachusetts, which has opposed legislative efforts to bar religious exemptions, declined to comment on what Kennedy’s possible ascension could mean for vaccinations in Massachusetts.

“We are committed to offering accurate, fact-based information and will not contribute to any potential misinformation, especially on such a sensitive topic,” she said.

Immunization science is to a great extent a victim of its own success, Jha said. A generation ago, most parents would have witnessed firsthand the effects of polio or measles, and were terrified of their children suffering from them. The near eradication of those illnesses in the United States has had the effect of erasing the traumatic impact of seeing or experiencing their effects.

“Once you’ve really eliminated or made pretty rare a disease, the next generation doesn’t really see it as a threat,” Jha said.

Vaccinations can prevent more than just the single disease they were developed to protect against. A measles infection in a person not vaccinated can leave them vulnerable to multiple other infections, said Dr. Mary Beth Miotto, immediate past president of the Massachusetts chapter of the American Academy of Pediatrics and a pediatrician at the Mattapan Community Health Center. One study showed it can wipe out anywhere from 11 to 73 percent of the antibodies that protect against strains of various diseases the person was previously immune to.

Kennedy’s history of spreading false information about vaccines dates back to 2005, when he published a story warning about thimerosal, a mercury-based preservative that had been removed from most childhood vaccines by 2001. The preservative has no connection with health problems in children, according to multiple studies, including an exhaustive one by the Institute of Medicine, but the campaign left lasting scars, said Dr. Lauren Smith, a pediatrician and former medical director at the Massachusetts Department of Public Health.

“Once that thimerosal information was out there, people [could] use this as part of their disinformation efforts,” she said. “It gets to be more accepted because it’s out there more, but that does not make it true.”

Trump and his surrogates have been vague about whether outright banning vaccines is a possibility. Last weekend, Trump told NBC News, “I’m going to talk to [Kennedy] and talk to other people, and I’ll make a decision,” when asked about vaccine bans.

On Wednesday, Kennedy appeared to soften some of his positions when asked about his plans for vaccine regulation in a Trump administration.

“I am not going to take away anyone’s vaccines,” Kennedy told MSNBC. “I’ve never been anti-vaccine.”

He added, “I am going to make sure that scientific safety studies and efficacies are out there and people can make individual assessments about whether that product is going to be good for them.”

Such language, officials said, obscures settled scientific consensus that vaccines are effective and overwhelmingly safe. It’s exceedingly rare for vaccines to pose a risk to children. Indeed, the number of children who receive medical exemptions from immunization is consistently small and has declined in Massachusetts over the past decade.

Altman, the Tufts physician and a board member of the Massachusetts Academy of Family Physicians, said he’s observed vaccine hesitancy become more common among his patients over the last decade and a half, but he takes comfort that few are fully opposed to vaccinations. Some want to delay immunizing their children, or decide to do partial vaccinations. While he expressed confidence that Kennedy’s most outlandish ideas wouldn’t appeal even to many vaccine skeptics, he does worry the atmosphere of misinformation they feed could make illness more likely.

“We know what a powerful influence social media is,” he said.