| This week, Robert F. Kennedy Jr. will face Washington lawmakers in hearings where the nominee for the nation's highest-ranking health post is sure to hear comments and questions about his criticism of vaccines. While many Republicans have supported President Trump's pick to lead the Health and Human Services Department, some health advocates worry RFK Jr. will promote policies that erode vaccine coverage. Already, one meeting of US vaccine advisers was canceled at the behest of the new administration. Gaps in immunization have led to sporadic outbreaks of preventable infections like whooping cough and measles. Further retreat from prevention policies threatens to allow clusters of those long-suppressed diseases to become epidemics. Debunking misleading information could come down to how we talk about vaccines. Preparing patients for side effects and refining our approach to who should get the immunizations — and when — could counter criticism, even from those in leadership roles. Vaccines have been so effective for so long that some people have forgotten the difference they've made in our health and lifespan, says Paul Sax, a Harvard infectious disease professor. "The difference between our childhoods and our kids' is dramatic,'' Sax says. "That's why it's so frustrating to have misinformation out there." Older people benefit, too. The shingles vaccine prevents a disease that, while seldom lethal, can transform a healthy adult into a chronic pain patient, Sax says. "You don't have the same impact on years of life saved," Sax says, "but there are enormous benefits that can't be denied." Still, there are some messages and practices that health officials could refine to bolster vaccine confidence and counteract misleading information that may even come from the highest levels of government. One is to make sure patients understand that vaccination does carry some risk. For example, some vaccines have been linked to cases of Guillain-Barre syndrome, a rare neurological disorder that's usually temporary. Because they're used in healthy people, vaccines should have minimal side effects. Minimal does not mean none, Sax points out. Side effects for regularly administered vaccines can include soreness, swelling and fever. "There are tradeoffs with any medical intervention," Sax says. "Statin drugs are sensationally good at reducing the risk of heart attacks, but in some people they cause side effects. We need to have the same realistic messaging about vaccination." And while vaccine mandates make sense for schoolchildren, they should be scrutinized more heavily for adults, he says. Covid vaccine workplace mandates may have made sense while the disease was especially threatening, he says, but they may be less crucial for certain people now that more people have acquired immunity. One way or the other, health officials are going to contend with a country in which the public view of vaccines is mixed, at best. "You don't want any negatives to pollute the benefits that are so profound," Sax says. — John Lauerman | 
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