Robert Kennedy Jr. and Robert De Niro convened a news conference on Wednesday at the National Press Club to announce a $100,000 cash reward for anyone who identifies a peer-reviewed scientific study demonstrating that the mercury in vaccines is safe. Though the challenge was perhaps something of a stunt, the significance of the appearance was underscored by Kennedy’s confirming that President Trump may ask him to lead a commission on autism. The consequences of such a commission could extend beyond the narrow vaccine/autism debate. More significantly, the commission could expose the incentives driving vaccination policy, which, in the current political climate, could move mainstream opinion against vaccines and also bolster doubts about the integrity of the health-care system.

Since at least 2007, Trump has suggested that the recent “epidemic” of autism might be related to current immunization practices. He is not categorically against immunization—in fact, he is “totally in favor of vaccines,” as he says—but he suggests that the rate and quantity of injections given to infants, per the recommended immunization schedule, may contribute to incidents of autism. In Trump’s words, “massive combined inoculations” and “simultaneous vaccinations” may be producing a wave of “doctor-inflicted autism.”

Trump’s central point that diagnoses of autism have skyrocketed alongside an increase in childhood vaccination is not in dispute. The term “early infantile autism” was first introduced in 1943 based on clinical observations of eleven children. When Austrian pediatrician Hans Asperger published a groundbreaking paper on autism a year later, it drew little attention, and, indeed, was only translated and annotated into a widely-available English version in 1991. Possible links between immunization and autism did not draw much comment in subsequent years because mass vaccination itself was not yet a common practice. It wasn’t until 1949 that the combined diphtheria, pertussis, and tetanus (DPT) vaccine was licensed in the United States for pediatric use, and it was only around this time that large-scale vaccine production for public health became feasible.

The more salient question is whether vaccines are contributing to the wave of autism diagnoses since the 1980s, when major policy changes related to immunization were enacted. By 1981, under the Childhood Immunization Initiative, all 50 states instituted laws linking school eligibility to immunization—an effective mandate far more stringent than what is instituted in Canada and most European countries. A surge of lawsuits followed and, in a series of high-profile settlements, manufacturers of the whooping cough and polio vaccines were held liable for injuries in children. In response to warnings from pharmaceutical companies that they would cease producing vaccines amid such a precarious legal environment, President Reagan, in 1986, signed into law the National Childhood Vaccine Injury Act. The mandatory no-fault compensation system established under the new legal regime shields vaccine makers from civil product liability, as it forces victims to file initial claims under a federal vaccine compensation program in which awarded damages are paid by taxpayers.

The law was a boon to vaccine manufacturers. The vaccine business, as the Wall Street Journal reports, was “transformed from a risky, low-profit venture in the 1970s, to one of the pharmaceutical industry’s most attractive product lines.” From $500 million in 1990, vaccine-industry revenues have grown to $24 billion today, expanding the pharmaceutical industry’s ability to enter into public-private partnerships, lobby for lower licensing standards for vaccines, and advocate against vaccine exemption laws.

Both the rate of vaccination and the rate of autism have spiked over the past three decades. From 23 doses of seven vaccines in 1983, the recommended immunization schedule has tripled to 69 doses of 16 vaccines, and Americans are now “required by law to use more vaccines than any other nation in the world.” What fuels vaccine hesitancy is the fact that, for several decades through the 1970s, childhood autism remained at a steady rate of about four in ten thousand children. After three decades of steady increases since the 1980s, however, the childhood autism rate, according to the CDC, has climbed to 1 in 68 or 1.5 percent.

Although the American Academy of Pediatrics issued a rebuttal to Trump’s critique, Trump has said that he “couldn’t care less” about the “shills” of conventional medical wisdom, the pharmaceutical companies, and their “fudged up reports.” In typical fashion, he declares that “the doctors lied” and that he is “being proven right about massive vaccinations.”

More influential to Trump than the medical establishment, it seems, is a dissident group of health practitioners, experts, and advocates. Trump has praised the efforts of Bob Wright, the founder and former chairman of Autism Speaks. And as a candidate, he met with a group of vaccine skeptics including:

• Mark Blaxill, editor-at-large of the web newspaper Age of Autism and author of three books on the subject as well as numerous articles in academic journals;
• Gary Kompothecras, a chiropractor who served on the Florida governor’s Autism Task Force;
• Jennifer Larson, CEO of the Holland Autism Center and Clinic and a board member on numerous autism and vaccine safety organizations; and
• Andrew Wakefield, an academic gastroenterologist whose controversial research on the MMR vaccine sparked a worldwide debate on possible links between immunization and autism.

All of these experts either have children with autism or were drawn to the field after personal encounters with parents who are certain that their children suffered from vaccine damage. This, as Kennedy remarked today, has made an impact on Trump. Asked to explain his persistence on the issue, Trump has consistently cited the testimony of parents who attribute the onset of autism in their children to vaccines—parents, he suspects, who “know far better” than the experts who assert instead that autism is genetic or starts in utero. If Trump ultimately establishes a commission led by Kennedy, and the commission provides a platform for vaccine skeptics, millions of Americans would be exposed for the first time to counter-narratives in the vaccine/autism debate.

They would see that the very term “anti-vaxxer” is misleading. The voluminous writings of the “anti-vaxxers” in fact reveal little in the way of unified opposition to vaccines. Their views, to the contrary, are quite diverse in terms of which vaccines they endorse, the schedules they recommend, and their assessments of vaccine risk in relation to more natural alternatives. Kennedy himself is explicitly “pro vaccine,” had all six of his children vaccinated, and believes that “vaccines save millions of lives.’’ But he questions the safety of neurotoxins in vaccines, particularly the mercury-based preservative thimerosal, given its causative link to brain disorders.

The American people would also learn that the activists with whom Trump has associated are not all that different from vaccine skeptics generally. Numerous investigations suggest that “anti-vaxxers” hardly conform to the caricature of fringe, anti-science zealots. They are, for the most part, highly-educated, wealthy, and, in the assessment of pediatric infectious disease specialist Mark Sawyer, “mainstream upper class people who don’t reject modern medicine.” Steve Silberman observes in his award-winning NeuroTribes: The Legacy of Autism and the Future of Neurodiversity, that they are “generally better acquainted with the state of autism research than the outsiders presuming to judge them.”

Why then are vaccine skeptics treated with such contempt in establishment institutions? There are, it is true, growing numbers of writers such as the science journalist Maggie Koerth-Baker, who, after advancing the conventional narrative on vaccines, decided to study media reporting on the issue. She ultimately criticized her colleagues in Aeon for their failure to acknowledge that vaccine rejection can be a “rational choice.” Yet standard accounts, insofar as they even mention the genuine debate among experts on vaccine safety, often ignore the science informing these objections. Nor do they grapple with personalized approaches to vaccine decisions that, as Prof. Maya Goldenberg argues, are not ignorant per se but can produce cost-benefit analyses that depart, in individual cases, from public health orthodoxy.

In addressing this question, it’s important to consider what vaccine skeptics, including those in Trump’s orbit, do have in common. Rather than a doctrinaire view on vaccines, what unites vaccine skeptics is a suspicion that a corrupt regulatory system, driven by the “seamless marriage” between the health establishment and government agencies, is succumbing to the temptations of “bureaucratic preservation.” The consequence, they fear, is routine data manipulation and stifling of dissent. A legal paradigm—upheld by the Supreme Court’s 2011 decision in Breusewitz v. Wyeth—that does not permit class-action lawsuits or the checks and balances that prevail in almost every other industry, they argue, only exacerbates the risk.

Herein lies the problem. In a recent paper in the journal Science and Engineering Ethics, Prof. Brian Martin found evidence not of a conspiracy, but rather of a pattern of “suppression of vaccination dissent”—one that made Andrew Wakefield “subject to a degradation ceremony, a ritualistic denunciation casting him out of the company of honest researchers.” Martin argues that challenges to free inquiry, while prevalent throughout mainstream science, are particularly serious in the case of immunization. Because “vaccination is a signifier for the benefits of modern medicine,” questions about vaccination are treated as “a potential threat to the public perception that credentialed experts unanimously endorse vaccination.”

While Trump can be faulted for his simplistic rhetoric on the issue, his objections appear to stem from legitimate questions. At a moment when doubts about vaccines are growing and when the federal government, the big pharmaceutical combine, and health-care industries are the three least trusted institutions in America, a presidential commission would seem sensible.

Pratik Chougule is an executive editor at The American Conservative. Follow him on twitter @pjchougule. He can be reached via email at pchougule@theamericanconservative.com. Sign up for his email list here.