With RFK's Attacks on the COVID Vaccine It's Official: We Don't Have the Tools

RFK's moves to limit access to the COVID vaccine are the latest in a long line of moves that shrank- rather than expanded- the size of the so-called anti-COVID "toolbox"

RFK Jr’s ongoing attacks on COVID vaccine access are getting widespread media and political attention.

Recently, his HHS announced that the FDA was authorizing the fall COVID vaccines only for “high risk groups”. His announcement, posted to X (formerly twitter), claims that vaccines will be available to all patients who want them “after consulting with their doctors.”

What was once an easy trip to the pharmacy will now become a multi-step process for millions of Americans, discouraging vaccination for those who do want the shots. Access to medical care itself can be a challenge in the US, with around 25 million Americans estimated to be uninsured. Even the insured may have difficulty finding the time or money to visit a doctor.

In general, it is considered good public health practice to make public health tools as accessible as possible.

However, this is hardly the first pandemic mitigation tool to be made less accessible over time; it might more accurately be said to be the latest and last.

A successful and healthy response to COVID would have seen our public toolkit expand over the last five years. Most critically, we would’ve seen a comprehensive plan for upgrading indoor air quality in all public buildings. Such a plan would’ve minimally comprised new ventilation standards, new air filtration standards, indoor CO2 monitoring, as well as public education in order to communicate the function and necessity of these measures. Hospitals, schools and congregate settings like nursing homes and prisons could have- should have- been prioritized.

We also could’ve begun to adopt Far UVC, one of the most promising new technologies that rapidly inactivates pathogens in the air. Distinct from Far UV, Far UVC emits radiation in a narrow, skin-safe range. We’ve had years to build and adapt our infrastructure, making clean indoor air a collective goal rather than an individual burden.

An article published in Photochemistry and Photobiology titled “Far-UVC Light at 222 nm is Showing Significant Potential to Safely and Efficiently Inactivate Airborne Pathogens in Occupied Indoor Locations” spoke to the efficacy of the technology back in November of 2022. Yet in the nearly three years since, no federal government official has ever broached the topic.

Indeed, no institutional anti-COVID measures were ever adopted. Contrast this with waterborne disease prevention, foodborne disease prevention, bloodborne disease prevention, and sexually transmitted disease prevention, all of which the state invests significant resources in mitigating and eliminating. Instead, the process of unwinding the COVID response at the institutional level- and bury the memory of COVID at the individual level- was begun.

This process was incremental, but thorough.

“We have the tools,” was the famous refrain of the Biden White House when speaking of COVID. Yet what became of them? Let’s take a look.

Mask mandates, of course, were unwound, and beyond that, masks were stigmatized by those in power. Leaders took their own masks off, publicly mocked them, and Biden, an elderly man with a host of pre-existing conditions, even failed to mask while actively infected with COVID. Privatization also moved masks, vaccines, and tests out of reach for many, as COVID centers were closed across the country. Masking, testing, and vaccination all declined precipitously - even before RFK Jr. got his paws on policy. Only 23% of American adults got a COVID booster last season.

As the technology behind home testing improved, the home tests offered by our government never did. They continued to offer RAT tests, which have a notoriously high false negative rate. In 2022, CIDRAP published a piece titled “High false-negative rate limits value of rapid COVID tests for kids,” which cited data showing sensitivity of RATs as 64.2% in symptomatic children and 56.2% in asymptomatic children. The piece went on to observe, “For reference, WHO and FDA performance standards for rapid antigen tests specify a minimum sensitivity of 80%”.

Meanwhile, brands like Lucira and Metrix raced ahead, producing home tests with PCR-level accuracy. The government never distributed these or any accurate home tests, likely due to cost. Today, Altruan, a German company, offers a small, costly little testing device (several hundred dollars) which, once purchased, accepts $5 tests that can test up to four individuals simultaneously with PCR-level accuracy. The US government not only hasn’t looked into offering home devices like these- the FDA under Trump also banned the importation of the cheap and accurate Altruan tests into the country.

I don’t know if I have to point out that it is of limited usefulness to distribute tests that fail to meet the FDA threshold for performance standards. Even worse, there was never any awareness campaign aimed at educating the public about the high false negative rates of these tests. In a certain light, the distribution of a small number of tests that do not meet minimum performance standards may look more like a PR move than a legitimate effort to limit viral spread.

For all the outrage surrounding RFK’s announcement, it’s not even the first move to limit vaccine access we’ve seen. In May 2023, President Biden the pandemic emergency declaration came to an end; this declaration was what provided for, among many other measures, free vaccines for all. The Bridge Access Program was intended to ensure that vaccines remained available for the uninsured and underinsured, but this too ended by August 2024. In a country with tens of millions of uninsured people, out-of-pocket price for a COVID shot can cost $200 or more.

It is never good public health policy to take a free disease mitigation tool and begin charging money for it. This is a bad idea whether that tool is a condom, a vaccine, a mask, or a test for any illness. The decision to do so can only ever discourage disease mitigation, contribute to disease spread, and- if your issue is spending- ultimately cost the economy money.

By the same token, rather than encouraging sick people to stay home, the CDC bowed to industry pressure, continually shortening the COVID isolation period until it became essentially nothing at all. From 14, to 10, to 5 days, down to “24 hours if your case is mild”, which was broadly interpreted to mean “24 hours” or “nothing”, workers were thrown to the wolves for the sake of employers.

Thinking rationally about this decision exposes the irrationality at the heart of every “let it rip” policy; force a sick worker into an office, school, or restaurant, and what follows? More sick workers, more sick days, more chronic illness, more disability; a predicted outcome which is borne out by data.

As COVID centers closed, vaccines were privatized, masks were stigmatized, and even the measly free four rapid tests per household per holiday season were shut down, individuals became increasingly responsible for their own safety.

Many disabled and immunocompromised people were (and are) forced into increasingly difficult and untenable situations at work and at home, attempting to protect themselves from encroaching infection on all sides. Those who can afford to- and many who can’t- are forced to spend money on masks, tests, air purifiers, filters and more.

Vaccines are an important tool in the COVID mitigation toolbox. They ensure that if you are infected with COVID-19, your infection will not be as severe as it would otherwise be. They reduce your risk of Long COVID, and they reduce your risk of hospitalization and death.

It’s also critical to get boosted each year, because the virus mutates rapidly, and protection from each booster fades with time. The peak of vaccine protection happens between the two-week to three-month mark, but does wane quickly. The vaccines are updated each year because new variants are constantly evolving, which is in large part a result of unmitigated spread of the virus.

The vaccine is a critical tool. It’s also an imperfect tool, and one that works to blunt the impact of a COVID infection once you are already infected. It is a tool that is most effective once an infection occurs; in other words, a tool that should be used when other tools in the COVID toolkit have failed.

Right now, our government has cast aside, stigmatized and privatized the insufficient prevention tools we once had- masks, tests, isolation periods, and paid sick leave- while entirely failing to expand our prevention tools into the systemic realm: ventilation, filtration, Far UVC, CO2 monitoring, and more expansive social policies like a new OSHA standard to protect workers from on-site infections.

We would have fewer variants and fewer surges- protecting the efficacy of the vaccines for longer- if we took mitigation of the virus more seriously, and relied on other tools in a robust toolkit, rather than abusing the vaccine as if it were the only tool available to fight COVID.

Over the past several years, the Biden administration narrowed the focus of the COVID response to a “vaccine only” strategy. Because our current vaccines are non-sterilizing, because protection fades rapidly, because the virus mutates quickly, we now know that this strategy does not meaningfully limit the spread of COVID. That’s why we are currently in a summer surge of the virus- with an estimated 1 in 55 Americans infected yet again, according to wastewater data.

Limiting the spread of a virus that is causing a great deal of illness, a great deal of social disruption, of sick days, of lost wages, of disability, of chronic disease, of post-acute complications- and yes, it still leads to deaths too- is the fundamental goal of public health.

We work to limit the spread of things like lice, bedbugs, pink eye, and chlamydia without having to have long, circular debates about how many people die of them each year. That’s because the primary purpose of public health is to reduce disease burden on the population level- because, even failing death, even failing disability, disease is unpleasant, an economic loss, and a quality-of-life issue.

RFK Jr. is attacking the final weapon our government offers us in the battle against COVID. Everything else we arm ourselves with- our masks, our air purifiers- is done out of our own pockets, and seemingly against our leaders’ express wishes and sometimes against their advice. But as we watch politicians turn on this final tool in the toolbox, can we not at last agree that our government has no plan to control COVID-19?

Our government has no plan to mitigate this wildly contagious virus.

Our government has no plan but infect you repeatedly, in biannual nationwide surges, with a highly disabling virus, as research continues to show that repeated infections carry myriad long-term risks.

Our government has no plan but to offload the costs of this virus - the costs of mitigation, the costs of infection, the costs of long-term damage to your health, the costs of lost wages- onto you.

We must face up to this. We must approach this problem anew, with renewed vigor. We must fight for our right to vaccines just as we fight for a comprehensive mitigation strategy, complete with clean air in all public buildings, CO2 monitoring, Far UVC, free masks and tests, public education, and universal paid sick leave.

We don’t have the tools. And we deserve more than one.