How vulnerable is our vaccine programme to a potential vaccine sceptic Health Secretary?

We've witnessed the way that RFK Jr and Trump administration have weakened US access to vaccines. Could it happen in the UK?

We've been seeing how RFK Jr and the anti-vax lobby has been steadily and effectively reducing access to vaccines in the US. But it could happen in UK too. It's a threat worth considering given Malhotra's speech at Reform conference earlier this month, linking Covid vaccines to cancer, and a growing overlap between anti-vax movements and right-wing populism, which was exacerbated by Covid.

Quick US summary: RFK Jr sacked all members of US independent vaccine committee in June. He replaced them with his own picks including known vaccine-sceptics. He sacked CDC chair after she refused to rubber-stamp his new committee's recommendations before they had been released. His new hand-picked committee is already making changes to the childhood vaccine schedule, drawing criticism from the American Academy of Pediatrics. You can read more about the way the Trump administration is undermining access to vaccines in this piece.

SO what is the UK system for decising on vaccines? The Medicines and Healthcare products Regulation Agency (MHRA) regulates vaccines. They decide whether a vaccine is safe and effective enough to be legally available in UK. The Joint Committee on Vaccination and Immunisation (JCVI) is a committee of independent vaccine experts who recommend whether the NHS should offer vaccinations and to which populations (including the childhood vaccination schedule, and annual flu and Covid vaccines). The Department of Health (DHSC) then decides whether to offer them, but they almost always do.

This is all fine as long as MHRA and JCVI are indpendent experts, and government doesn't try to intefere. BUT if the government did want to.... say an anti-vaxxer became Health Sec... then there are certainly ways to undermine their independence.

MHRA leadership is appointed directly by DHSC. The Health Secretary could appoint an anti-vaxxer.

The Department of Health also sets priorities for MHRA, so it could, for instance, ask MHRA to prioritise non-vaccine medicines. At the more extreme end, MHRA is an executive agency of DHSC with no statutory basis and could be abolished without legislation and minimal oversight (like Public Health England was during Covid).

JCVI does have status as an advisory body that is underpinned in law. It must respond to questions asked by the Secretary of Health - so e.g. should they ask about links between MMR and autism, or links between covid vaccines and cancer... Now, those questions woudn't matter as long as JCVI remains a committee of independent experts whose advice was based in scientific evidence. BUT the Secretary of Health has power to decide on the number of members and to the power to appoint them.

That said, unlike RFK Jr in the USA, our Secretary of Health could not arbitrarily sack members of JCVI - there must be due cause. But they could wait for current 3 year terms to lapse and reappoint their own preferences. They could even shorten term-limits to e.g. 1 year and speed up the process of replacement.

Why what is happening in the United States shows the need for the United Kingdom to repair its own constitution

This would be within letter, if not spirit, of the various codes of conduct around scientific advisory committee appointments. If a secretary of state did behave that way, their actions might be subject to judicial review with a strong enough opposition. But the Tories started to explore reducing the power of judicial review during their last term, and Reform floated undermining independence of our judiciary at their conference last week.

So - UK vaccine policy is more protected than the US has been, but there are certainly many ways it could be subverted over time without any changes to legislation. Of course, Reform could follow the US and simply ignore rules on appointments and effect changes much faster. Or, with the enormous power of a strong parliamentary majority, simply pass new laws.

The UK much less vaccine-hesitant than the US and Reform is much less anti-vaccine than the Trump administration. BUT it could easily tilt more anti-vax, especially with Republican-aligned US anti-vaccine movements like the Children’s Health Defense expanding to Europe.

Forewarned is forearmed. Can strengthen the weak points before they are tested?

PS This was a quick post based on a BlueSky thread I wrote today.