Robert F. Kennedy Jr. is incompetent and he must resign. He shows zero leadership while the measles outbreak grows

Echo report published in Medscape from JAMA, by Kathryn M. Edwards, M.D.

Texas measles outbreak tops 500 cases, including multiple at a day care in Lubbock

A day care facility in a Texas county that’s part of the measles outbreak has multiple cases, including children too young to be fully vaccinated, public health officials say.  West Texas is in the middle of a still-growing measles outbreak with 505 cases reported on Tuesday. (Associated Press)

In late January 2025, there were 2 cases of measles reported in a religious community in Texas. The outbreak spread rapidly, with 422 cases reported by April 1, 2025 (no April Fools 😓). The Secretary of Health and Human Services (HHS), Robert F. Kennedy Jr, commented on the outbreak in February 2025, stating that “There have been four measles outbreaks this year and last year there were 16. So, it is not unusual.”

What RFKjr did not acknowledge was that the rapidly spreading Texas outbreak has affected unvaccinated children, and that a child died. The last pediatric measles death in the US was in 2003 and the last adult death was in 2015. 

In 2024, there were 285 measles cases in the US; as of March 27, 2025, the Centers for Disease Control and Prevention (CDC) reported that there have been a total of 483 confirmed measles cases in 20 states and the outbreak continues to spread widely. The HHS secretary stated that children were being hospitalized for quarantine, but this was refuted by hospital officials who confirmed that the children were admitted for respiratory difficulties, with several receiving ventilator support. The trivialization of this outbreak by the HHS secretary was medically inappropriate and delayed issuing strong recommendations for widespread measles immunization of the previously unimmunized. It was also a major setback because measles had been declared eliminated from the US in 2000 by the World Health Organization.2

On March 3, 2025, the HHS aka RFKjr, secretary posted a commentary on Fox (Fake❗News) that outlined several facts about measles and recommended that “All parents should consult with their healthcare providers to understand their options to get the MMR vaccine. The decision to vaccinate is a personal one.” He should have strongly advocated for MMR vaccination because it is one of the most effective vaccines. It is given in 2 doses: the first at 12 to 15 months of age and the second at 4 to 6 years of age. One dose has a projected efficacy of 93% and 2 doses has projected efficacy of 97%. Data clearly show that a strong presumptive recommendation by a health care professional significantly increases vaccine uptake compared with simply outlining vaccine options, as was done by the HHS secretary.

In addition, RFKjr should have stated that high community measles immunization levels are needed to stop the outbreak. As higher proportions of children are immunized, other children in the community who are too young or too immunocompromised to be immunized will be protected. 

Also, he commented in an interview with Fox (Fake❗) News on March 7, 2025, that Texas clinicians were giving steroids, antibiotics, and cod liver oil to their measles patients and “getting very, very, good results.” 

These anecdotal reports are misleading and should not serve as the source for patient treatment❗ 

Reports of children with vitamin A toxicity from Texas have also appeared. Treatment of measles is supportive, although oral vitamin A at appropriate doses is recommended by the World Health Organization and the American Academy of Pediatrics for all children with measles, regardless of their preexisting nutrition status- because of the risk of eye involvement. The HHS secretary also linked measles severity to poor sanitation and nutrition, and stated that improvements in those areas eliminated more than 98% of deaths from measles before the availability of measles vaccine. However, just prior to the licensure of measles vaccine in 1963, there were approximately 500 yearly measles deaths in the US among a total US population of 150 million less individuals than today.

During evolving outbreaks, it has been standard practice of the CDC to promptly issue Health Alert Network advisory notices to provide emergency guidance for health care professionals. It was not until March 7, 2025, that the CDC issued a health advisory that “MMR vaccination remains the most important tool for preventing measles.”6 This statement should have been issued in January when the outbreak began. The advisory also indicated that young children aged 6 months to 1 year in communities with an outbreak should be immunized. An article by Rader et al published in JAMA on March 14, 2025, also strongly supported immunization of young children in the outbreak setting.7 It also highlighted that the risk of subacute sclerosing panencephalitis, a progressive usually fatal neurodegenerative brain disorder that is a complication of measles infection, is most common in children infected within the first year of life.8 Given the delayed issuance of the advisory, the controversial comments of the HHS secretary, and the knowledge that health-related information had been previously removed from the CDC website by executive order, the article by Rader et al was a timely and welcome publication. 

Also, it caused the reader to question whether we could continue to rely on the CDC to provide timely medical guidance or whether peer-reviewed articles in medical journals would replace the CDC as the go-to source of information. 

This query was furthered reinforced by the recent comments of Kevin Griffis, who resigned last week as the director of communications at the CDC. He stated that “My first-hand experience over the recent troubling weeks convinced me that Kennedy and his team are working to bend science to fit their own narratives, rather than allowing facts to guide policy.”

To provide proper care for individuals with infectious diseases, evidence-based approaches must be used. When CDC guidance is slow or incomplete, infectious disease specialists should provide updated educational materials to inform clinicians about the signs and symptoms of measles and appropriate infection control measures for office and clinic settings. Specialty organizations such as the American Academy of Pediatrics, the American Academy of Family Practitioners, the Infectious Diseases Society of America, and other professional societies must step forward to strongly support vaccination and provide medical guidance. Efforts should also be extended to support our CDC colleagues who have toiled for decades in the interest of public health to ensure their expertise is heard. Additionally, rapid review and dissemination of peer-reviewed medical journal articles, such as the article by Rader et al,7 can serve as alternative sources of evidence-based approaches.

Further concerns about vaccine policy exist. The CDC Advisory Committee on Immunization Practices (ACIP) meeting scheduled for February 25-27, 2025, was abruptly canceled. 

ACIP meetings are pivotal to the provision of vaccine recommendations for the entire public sector, encompassing half of vaccine delivery in the US, and are usually implemented in the private sector as well. The ACIP meetings offer an open forum where experts in public health, epidemiology, pediatrics, internal medicine, and other medical specialties meet at regular intervals to discuss new vaccines, debate their implementation, discuss outbreaks, and make vaccine recommendations. These recommendations, once approved by the CDC director, are then implemented. Recommendations for new meningococcal and chikungunya vaccines and modifications to influenza and respiratory syncytial virus vaccine recommendations were topics of discussion for the canceled February ACIP meeting. It also could have been a productive format to discuss the measles outbreak and affirm the importance of measles immunization in halting the outbreak. It was announced that the ACIP meeting has been rescheduled for April 15-16, 2025, imposing a 2-month delay in these recommendations and outbreak guidance.

Several other concerning events regarding vaccines have occurred over the past few weeks. The CDC was ordered to abandon vaccine promotions developed for measles and other vaccines. 

The National Institutes of Health was instructed to terminate funding for approved, merit-based grants designed to conduct studies on vaccine hesitancy and to promote vaccine uptake because it “does not prioritize research activities that focus on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.” 

Public health officials from West Texas have warned that recent federal funding cuts to the local health department will impede their response to the measles outbreak. 

Plus, earlier this week, Dr Peter Marks, the director of the Center for Biologics Evaluation and Research at the US Food and Drug Administration, resigned. In his resignation letter he stated that “It has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies.”

The measles outbreak must be approached with scientifically based recommendations for immunization and infection control. If the usual government sources of information cannot be relied on, medical journals and specialty societies must fill that gap. If our usual approaches are not effective, other strategies must be used.

Corresponding Author: Kathryn M. Edwards MD, 1300 Falkirk Ct, Nashville, TN 37221: "Approaches for MMR Vaccination During a Measles Outbreak and Evolving Domestic Attitudes"