When children visiting Disneyland in 2015 contracted and then transmitted measles across the country, President Barack Obama lent his voice to the containment campaign. “You should get your kids vaccinated. It’s good for them,” he told an interviewer. “There is every reason to get vaccinated. There aren’t reasons not to get vaccinated.”
A few years earlier Obama was photographed getting immunized against H1N1, the flu virus that triggered the 2009 pandemic. Gerald Ford famously got vaccinated in the 1976 “swine flu” pandemic scare. Jimmy Carter and Bill Clinton created and expanded programs to immunize children against childhood diseases. White House photographers recorded Ronald Reagan getting multiple flu shots.
But as health departments in multiple states battle some of the largest measles outbreaks in decades, there has been radio silence from the current commander in chief.
President Trump’s absence in the national conversation about the measles outbreaks has prompted some debate in the public health community about whether he should be playing a more active role. For some observers, though, the question is not whether public officials should be supporting vaccinations, but rather whether a president who has previously spread false information linking vaccines and autism is the right messenger.
“I don’t know if he does have the moral authority or the scientific authority. And he’s certainly done a lot to erode that authority,” said Dr. Howard Markel, a pediatrician and a professor of the history of medicine at the University of Michigan.
On balance, though, Markel said he believes Trump should use his platform to promote measles vaccination. “If he said something very clear, concise, and accurate, I think it would help. I hope it would help,” he said.
Jonathan Zimmerman, a professor of the history of education at the University of Pennsylvania, has called out Trump publicly on his silence.
In an op-ed published in the Philadelphia Inquirer, Zimmerman noted that since Franklin Delano Roosevelt, presidents on both sides of the aisle have lent their support to the cause of vaccination. (FDR was paralyzed by polio and started the March of Dimes, which helped finance the successful quest for polio vaccines.)
“Every president since FDR has thrown themselves full bore behind this,” Zimmerman told STAT. That Trump has remained silent in the face of a large measles outbreak is “a radical departure from all of our precedents,” he said.
In reality, Trump’s silence may come as a relief to some vaccine proponents. Before becoming president, Trump publicly questioned vaccination strategies, insisting that the number of vaccines infants are given in the first couple of years of life were contributing to rising autism rates. Multiple studies have found no link between vaccines and autism.
Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn't feel good and changes – AUTISM. Many such cases!
— Donald J. Trump (@realDonaldTrump) March 28, 2014
During his presidential campaign, Trump met with prominent anti-vaccination figures, including Andrew Wakefield, whose discredited 1998 study purporting to find a link between autism and the measles, mumps, and rubella vaccine has since been expunged from the scientific record. Wakefield later attended one of Trump’s inaugural balls.
Between his election and inauguration, Trump also met with Robert Kennedy Jr., who announced he’d been asked to head a vaccine safety board by the incoming president, generating significant concern that attacks on vaccines might soon be given the backing of the White House.
But since taking office Trump has said nothing publicly about the issue of vaccines; he has also not established the body Kennedy said he had been asked to lead.
It’s unclear how much Trump has been pressed on the issue by others in his administration. Several top aides, notably Robert Redfield, the director of the Centers for Disease Control and Prevention, Jerome Adams, the surgeon general, and Scott Gottlieb, until recently the commissioner of the Food and Drug Administration, have used their offices to publicly promote the importance of vaccines.
Billionaire philanthropist Bill Gates has indicated he has taken the opportunity of several meetings with the president to privately stress that vaccines have delivered enormous gains for public health.
Zimmerman, however, isn’t convinced that silencing the anti-vaccine talk is a big enough contribution to the cause.
“The fact that he is silent about this is not good. But it is much better than tweeting out that vaccines cause autism and ‘I’m having a great meeting with Andy Wakefield,’” Zimmerman said. “This is better. It’s just not good enough.”
Zimmerman and Markel said they believe there are people among Trump’s loyal base — either fervently opposed or concerned about the safety of vaccines — who might be swayed were the president to publicly endorse vaccination.
“I think it’s entirely reasonable to imagine that there would be an uptick in vaccinations,” Zimmerman said. “And anyone who cares about the public health should want that.”
Saad Omer, a vaccine expert at Emory University, said having the president publicly support vaccination would be a good thing. But Trump’s silence is “not the end of the world,” said Omer, noting that if there are enough prominent voices taking up the task it enforces the social norm of vaccination.
And given how divided the country has become, he said, experts should be wary of calling on a polarizing president to speaking out on vaccination; the result might not be the one they desired.
“If this kind of thing becomes part of political identity,” he said, “that’s going to be a problem.”
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