Infamous vaccine critic and environmental activist Robert Kennedy Jr. has accepted a position in Donald Trump's administration as chair of a panel on vaccine safety and scientific integrity after a meeting with the president-elect.

This is the clearest sign of the president-elect's stand about vaccines and is worrying the medical community who bashed last week's commentary written by Dr. Daniel Nedies from Cleveland Clinic in Ohio - that was filled with anti-vaccine rhetoric- calling it "vile" and "false".

Immediately, scientists, paediatricians and public health experts were outraged at the decision as they fear that this move could provide legitimacy to sceptics of childhood immunisations - despite a huge body of scientific evidence stating that vaccines are safe. Many sceptics believe a widely discredited theory by Andrew Wakefield, a then gastroenterologist, that linked vaccines to autism.

Commission to study vaccines and autism not confirmed yet

However, hours later, a Trump spokeswoman issued a statement that the president-elect was "exploring the possibility of forming a commission on autism," but "no decisions have been made at this time."

Kennedy - the son of former US Senator Bobby Kennedy from the famous Democratic family - was unequivocal about an offer but also said Trump has doubts and questions about current vaccine policies. He said there would be approximately a dozen people on the panel, a "mix between science people and prominent Americans" and Trump was urgent with setting up the panel, within "a one-year commitment".

"His opinion doesn't matter but the science does matter and we ought to be reading the science and we ought to be debating the science," Kennedy said. "And that everybody ought to be able to be assured that the vaccines that we have - he's very pro-vaccine, as am I - but they're as safe as they possibly can be."

Putting Kennedy as chair could jeopardise national health

Kennedy has constantly doubted the safety of vaccines and advocated for arguments believing that there is a link between immunisations and autism, a rare stance among most Democrats. He has also suggested that thimerosal, a mercury-based preservative used in vaccines, can be harmful to children, a notion that has been widely debunked.

“That he [Trump] meets with people doesn’t surprise me,” said Paul A. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “That he would take this next step, which is to take a man who has no expertise about science or vaccines and make him the head of a vaccine safety … committee is truly amazing to me.”

“The science is clear: Massive evidence showing no link between vaccines and autism, and as both a scientist who develops vaccines for poverty-related neglected diseases and the father of an adult daughter with autism, there’s not even any plausibility for a link,” Peter Hotez, president of the Sabin Vaccine Institute, a nonprofit that works to control, treat and eliminate vaccine-preventable and neglected tropical diseases.

“Our nation’s public health will suffer if this nascent neo-antivaxxer movement is not stopped immediately,” he added.

Can Trump actually change the vaccine policy?

Trump's casual remarks on vaccines have constantly alarmed public health advocates, but it has also energised the anti-vaccination movement. He also met with Wakefield over the summer and during his presidential campaign, Trump said he wanted "smaller doses over a longer period of time" and tweeted: “Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!”

Fortunately, he does not have direct authority over vaccine schedules as the recommendations and timelines are developed by an advisory panel of scientists, which is governed by the Centre for Disease Control and Prevention (CDC). It will be different from the panel that Kennedy will chair, rendering Trump powerless over making recommendations that are not evidence-based.

He also does not have direct authority over vaccine requirements as that is under the domain of the states, such as the new law passed last year in California, making it harder for parents to get out of vaccinating their children before registering them for school.

But Trump has other ways.

He has the power to spread doubt about vaccines by planting uncertainty among wavering parents, and in the long-term turn it into abstention from vaccines. This is extremely dangerous as it would increase the risk of outbreaks of communicable diseases, such as measles.

He can also fill his administration with like-minded individuals to steer health-related agencies in a new direction. But pro-vaccine advocates can have some hope as members of the ACIP are chosen through a rigorous nomination process, so it will not be filled with anti-vaccine individuals. The makeup of the scientific advisory committee on vaccines also does not turn over with the start of a new administration as vacancies are staggered. MIMS

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