With health secretary Robert F. Kennedy Jr. unable to prove his specious claims about the dangers of vaccines, he has pivoted. In a Sept. 29 Instagram post, Kennedy claims vaccines are ineffective, that is they are not the reason deaths from infectious diseases have dropped in the U.S. over the 20th century.
Kennedy claims communicable disease mortality decreased long before vaccines and pharmaceuticals were developed. He argues that sanitation and nutrition are the real reasons Americans are living longer and no longer suffering from infectious diseases.
His video is slick and persuasive, but incomplete and deceptive.
Kennedy deserves credit for stressing the importance of sanitation and nutrition in reducing infectious diseases and death. In 1900, the average life expectancy in the U.S. was 47 years, and by 1953 — when the polio vaccine was first developed — it was nearly 69 years. Epidemiologists and demographers agree that most of that improvement is from the installation of sewage systems, availability of clean water, clean air, and better nutrition.
However, today, the average life expectancy is nearly 80 years. That additional life expectancy improvement is not from sanitation, which has stayed roughly the same since 1953, nor from nutrition, which deteriorated after the 1980s largely due to the proliferation of ultra-processed foods.
Vaccines — as well as smoking cessation, safer cars, antibiotics, blood pressure pills, and many other medical advances — are responsible for the dramatic improvement in Americans’ life expectancy since 1953. Vaccines have not only reduced mortality but also morbidity, and in many cases, they have even saved money.
Contrary to Kennedy’s charts, sanitation and nutrition did not end deaths from infectious diseases. For instance, in 1950, long after Kennedy’s cited sanitation and nutrition improvements, influenza/pneumonia was the sixth leading cause of death. Today, influenza/pneumonia is not in the top 10 causes of death. Nor is any other vaccine preventable disease. Indeed, influenza/pneumonia deaths per capita have declined threefold since 1950. This dramatic change is due primarily to vaccines and antibiotics.
Vaccines may not have saved quite as many lives as sanitation and nutrition, but they still have saved millions of Americans. Kennedy’s own department has determined that childhood vaccines have prevented or will prevent 1.1 million deaths and 32 million hospitalizations just among Americans born between 1994 and 2023.
Furthermore, despite Kennedy’s focus on mortality, health is about more than preventing death. Vaccines have immensely improved Americans’ quality of life. The polio vaccine on its own has saved hundreds of thousands of people from paralysis and other complications. In 1952, there were 58,000 polio cases with 21,000 people paralyzed annually for a population of about 155 million Americans. If we didn’t have a vaccine and the disease occurred at the same rate, today there would be over 150,000 polio cases and 45,000 cases of paralysis annually. By 1979, the polio vaccine brought the number of polio paralysis patients down to eight per year. As every mother from the 1950s would tell you, that is nothing short of a miracle.
Similarly, before the Haemophilus influenzae vaccine, also known as Hib, was approved in 1985, Hib caused 10,000 cases of meningitis per year in children predominantly under 5 years of age, leading to lifelong neurological effects, including 3,000 cases of hearing loss, decrease in IQ, and sepsis. Today, the vaccine has almost completely eliminated Hib’s tragic consequences.
And we cannot forget measles, Kennedy’s favorite bugaboo. Even after sanitation improvements, measles spread wildly, causing 1,000 U.S. cases per year of lifelong acute measles encephalitis and producing permanent brain damage. Introduced in 1963, the measles vaccine led to zero U.S. measles deaths in 1993 and elimination of the disease (including acute measles encephalitis) by 2000. Vaccination of all children, not sanitation, was what finally eliminated measles and the horrid brain damage it causes. Both measles deaths and cases have returned as vaccine hesitancy has grown, with more than 1,500 confirmed cases and three deaths occurring so far in 2025.
Finally, Kennedy pretends that there is no economic cost when rates of vaccine-preventable infectious diseases rise. But without vaccines, health care spending would balloon, imposing costs not just on anti-vaxxers but on all of us. For instance, for every dollar spent on the MMR vaccine, the health care system saves over $13. Why? The direct medical cost of a measles case in the U.S. today is $1,793. In 1962, the year before the measles vaccine, there were 549,000 recorded measles cases. Since then, the U.S. population has grown by a factor of 1.82. If doctors stop administering the MMR vaccine, as some in Kennedy’s circle urge, and transmission returns to previous levels, measles alone will cost the U.S. $1.79 billion annually. Before the chickenpox (varicella) vaccine there were 10,500 chickenpox hospitalizations per year. Today each chickenpox hospitalization costs $1,308-$38,268. That’s $13.7 million at best, and $401 million at worst.
Kennedy claims he is giving people information to make individual choices. But individuals’ choices to refuse vaccination have huge consequences for the rest of our society.
The only way to justify forgoing vaccines would be if they caused harm greater than their benefit. That is not the case. Evidence from randomized clinical trials (RCTs) definitively demonstrate that vaccines have been: 80%-90% effective against paralytic polio, 98% effective against HPV-induced precancer, 97% effective against measles, 90%-95% effective against Hib, 100% effective against severe chickenpox, and 85%-98% effective against the rotavirus that causes diarrhea in young children. These numbers do not even account for herd immunity and elimination, which magnify vaccines’ positive impact when there is high uptake.
While Kennedy is right about the virtues of sanitation and nutrition in the early part of the 20th century, he is dead wrong about the ineffectiveness of vaccines in the later part of the 20th century. Vaccines have saved lives and reduced severe impairments like paralysis, brain damage, and hearing loss. And they have saved us billions of dollars, too. Enough of the dangerous deceptions on vaccines.
Ezekiel J. Emanuel is vice provost for global initiatives and co-director of the Healthcare Transformation Institute at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. Abe G. Baker-Butler is a research fellow in the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Michael T. Osterholm is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
