The Friday Biotech Perspective #41

A personal vaccine journey and … the Makary-Prasad-RFK Jr. guidance

When planning a trip to Southeast Asia many years ago I was advised to get a typhoid vaccine. Because I had received the usual mumps-measles-polio regimen as a child, I did not believe a typhoid vaccine was a big deal. How wrong I was. Think 24 to 36 hours of serious fever, shakes and chills, following the administration of a live, attenuated vaccine.

Two days following the vaccination, I was back to full, normal health. While I would not wish the experience on anyone, I later appreciated typhoid vax ensured I had the necessary antibodies should I contract the disease on my trip. Without developing the antibodies, the risk of serious illness and possibly, death, would have increased significantly. (NB: I also was more relaxed during my trip!)

My personal experience with the typhoid vax did not fully inform future decisions but I did reflect on it as I made choices about flu, pneumonia, shingles, RSV, and, of course, Covid19 vaccines. With each decision, I was open minded but leaning toward the Ben Franklin advice, “An ounce of prevention is worth a pound of cure.”

But then, life and your body happens. Flu shots became slightly miserable for me but much, much more miserable for my children. As adults, they now calculate contracting the flu for three days is not worth the lost time when the prevention capability is suspect. And unlike typhoid, they likely can survive a serious bout of flu.

After friends and family recommended I really did not want to suffer through shingles, I took the vaccine without complications. Ditto for flu after a few years. Then the RSV vaccines were approved in 2022-23 and I thought, well, that’s just a serious cold. I sat that one out.

Naturally, my wife got seriously sick in late 2023 and passed it on to me. Lovely. I attempted to grind through it until the coughing became too bad and I thought I had walking pneumonia. Turns out, I did have pneumonia and a surprise diagnosis of RSV. It took another 4 weeks after diagnosis for the RSV to clear my system. RSV for eight weeks was no fun at all.

Enter 2025. On May 27 via video, Health and Human Services (HHS) Robert F. Kennedy Jr. announced Covid vaccines no longer are on the list of immunizations recommended by the Centers for Disease Control and Prevention (CDC) for pregnant women and "healthy" children. Joining RFK Jr. in the video were National Institutes of Health (NIH) Director Jay Bhattacharya, and FDA Commissioner Marty Makary. No CDC representatives appeared in the video.

The new guidance extends the practice put into place in the recent full FDA approval of Novavax’s ( ) Covid vaccine, which was indicated for use only in people 65 years and older, or those between the ages of 12 and 64 who have at least one underlying health condition. The underlying condition must place 12- to 16-year-olds at a high risk for severe COVID outcomes.

The anti-vaxers thus won their case as soon as Trump came into office. In practice around the world and in the US, however, the yes vax versus no vax choice remains personal. The late 30s mother in St. Louis who kept postponing her Covid shot probably regrets not living to see her 4-year-old daughter grow up. Sweden famously turned its back on pandemic safety measures and its population did not appear to shrink significantly more than peer countries Scandinavia or Europe. Hong Kong commuters famously packed the subways wearing masks. And transmission was held in check.

Faced with an epidemic, medical and government officials reacted quickly with policies, potential vaccine options and treatment practices for infected patients. Some, or many ideas, were not necessarily on target, depending on your individual perspective. And the opposite sides dug in. Politicians to control the narrative. Medical professionals to preserve their status – by refusing to acknowledge a policy or approach they favored could be incorrect.

Perhaps the only mea culpa came last year from Francis Collins, former director of the NIH. In an interview he acknowledged, “As a guy living inside the Beltway, feeling the sense of crisis, trying to decide what to do in some situation room in the White House … we weren’t really considering the consequences in communities that were not New York City or some other big city.”

Policy within the Beltway will no longer dominate vaccine choices. As Makary and Prasad wrote in a New England Journal of Medicine (NEJM) article, “US vaccine policy has sometimes been justified by arguing that the American people are not sophisticated enough to understand age- and risk-based recommendations. We reject this view.”

I’d characterize my vaccine choices as practical at each decision point. Some worked well, others did not. I’m gearing up for a new level of sophistication.