On January 22, 2026, Dr. Kirk Milhoan appeared on a podcast called Why Should I Trust You? Milhoan, a pediatric cardiologist, is now the chairman of the CDC’s Advisory Committee on Immunization Practices (ACIP). During this interview, Milhoan offered a series of false beliefs that, in a normal world, would disqualify him from the committee. Here’s what he said:

Interviewer: “Do you think that vaccines are appropriately studied for safety?”

Milhoan: “No. They haven’t been. They’ve only been studied for efficacy.”

What is Dr. Milhoan talking about?

Prior to licensure, vaccines are tested in prospective placebo-controlled trials involving tens of thousands of subjects to determine safety and efficacy. These studies are designed to find relatively uncommon, but not rare, safety problems. The Covid-19 vaccines are a perfect example of how this works.

In February 2021, Johnson & Johnson’s Covid-19 vaccine was submitted to the FDA for authorization. At that point, the vaccine had been tested in a prospective, placebo-controlled trial of 40,000 adults. It appeared to be free of serious safety problems. Once authorized, however, and given to about 19 million people, the vaccine was found to cause clotting, including clotting in the brain. The problem was extremely rare, affecting about 1 in 250,00 people, but it was real and quickly picked up in post-authorization surveillance programs like the Vaccine Safety DataLink, which are designed to find safety problems as rare as one in 1 million.

Post-marketing surveillance safety systems are in place for all licensed and authorized vaccines.

Milhoan: “I think also, as you look at polio, we need to not be afraid to consider that we are in a different time now than we were then. Our sanitation is different. Our risk of disease is different.”

The incidence of polio in the United States skyrocketed in the U.S. in the 1950s when as many as 20,000 children were paralyzed by the virus. Why then? Why in the 1950s? In the 1920s and 1930s, when sanitation in the U.S. was poor, polio was a common disease, typically infecting babies in the first year of life at the same time they were receiving passively transferred antibodies from their mother through the placenta. Those passively transferred antibodies were often, but not always, protective against paralytic polio. (Hence the term “infantile paralysis”.) When sanitation improved, children were exposed to polio when they were older, after maternal antibodies had worn off. Polio became a more common disease of the 5- to 9-year-old, not a rarer disease in infancy. In other words, better sanitation increased the incidence of polio, the opposite of what Milhoan had claimed.

According to Milhoan, the individual has a right to make poorly informed decisions that put not only their child, but other children, at risk.

Also, if polio immunization rates decline, as happened in 2022 when a 27-year-old man in Rockland County, NY, was paralyzed by polio, the disease will come back. The incidence of paralysis caused by the strain that infected the Rockland County man is one in 2000. In other words, he was the tip of a much bigger iceberg of people who were infected, but not paralyzed, by the virus. Indeed, the poliovirus strain that caused this man’s infection was found in the wastewater of Rockland County as well as surrounding counties. And it might also be found in the wastewater in Philadelphia, Chicago, and Los Angeles. This virus, which is a derivative of the oral polio vaccine, is the most common cause of polio worldwide. Why would you ever take the risk of not vaccinating against a virus that is still around? Polio is not a disease you want to see come back.

Milhoan: “Many of [the] risks of measles without having a vaccine, was in the 1960s. We take care of children much differently now. Our ability to have pediatric hospitals, children’s hospitals, pediatric ICU’s. What we’re going to have [now] is a real-world experience of when unvaccinated people get measles. What is the new incidence of hospitalization? What’s the incidence of death?”

The first measles vaccine was available in 1963. Before that, every year about 48,000 children would be hospitalized with measles and 500 would die. Hospitalization was caused by severe measles pneumonia or severe dehydration. Our ability to take care of pneumonia with oxygen or ventilation, or dehydration with intravenous fluids, has not changed substantially since that time. The death rate from measles in 1963 was one to three per 1,000 cases. This past year in the U.S., three people have died among the roughly 2,000 reported cases — no different than mortality rates 60 years ago. Again, what is Milhoan talking about?

Interviewer: “So where do you see the line for individual autonomy versus infringing on my child’s safety by the choice you are making?”

Milhoan: “What if the child gets a measles vaccine to protect your immunocompromised child and gets a negative consequence from that? Wasn’t that your child causing that child to be harmed?”

Milhoan is arguing that any parent could reasonably decide not to get a measles vaccine because they believe that the risks of the vaccine outweigh the benefits. Measles virus causes pneumonia, dehydration, and encephalitis that can result in blindness and deafness. Measles vaccine doesn’t cause any of those problems. So, why would any parent reasonably choose not to get the vaccine? Then Milhoan takes his argument one step further, saying that if a parent’s choice not to get a vaccine puts another child at risk, even a child who is immune compromised, that’s a reasonable, even laudable, decision.

Milhoan: “It’s been very important to us, the members of the committee, that what we were doing is returning individual autonomy to the first order, not public health, but individual autonomy to the first order.”

And there it is. Individual freedom trumps public health. That’s why, according to Milhoan, the individual has a right to make poorly informed decisions that put not only their child, but other children, at risk. Public health means caring about your neighbor, individual freedom means not caring. “The likely increases in childhood illness and death appear to be worth the price of freedom to choose whether to vaccinate,” writes bioethicist Art Caplan. It’s not just bad policy, it’s “bad ethics.”

Interviewer: “You’re probably going to be getting a lot of reports and a lot of files and a lot of data that’s been established. Things that we’ve looked at and pursued and investigated.

Milhoan: “That’s not science. That’s not necessarily science. Science is what I observe.”

I have no idea what this means.

Milhoan: “If you allow flexibility on certain vaccines, you actually then enhance uptake in other ones that are really crucial like MMR and polio and things like that.”

Vaccine rates in the U.S. are eroding. During the past year, we’ve seen an outbreak of measles greater than anything we have seen in more than three decades, child deaths from influenza greater than anything seen since the last influenza pandemic, cases of tetanus greater than anything we have seen in the past 10 years, and children dying from whooping cough in states that hadn’t experienced deaths from whooping cough in years.

Milhoan is arguing that if we loosen vaccine recommendations, making vaccines more optional, then vaccine rates will increase. On what planet does he imagine this happening? Loosening vaccine recommendations — by making vaccines appear to be less necessary — will only decrease vaccine rates.

Milhoan: “I’ve never seen a case of congenital rubella affecting a child in my career.”

Milhoan is implying that congenital rubella syndrome is rare in the U.S. Which is true. If rubella infections are rare in the U.S., then, at least according to Milhoan, it is reasonable not to get a rubella vaccine. But the disease is rare in the U.S. because of the rubella vaccine. Before the rubella vaccine, about 20,000 children in the United States whose mothers were infected with rubella virus in the first trimester delivered children who were blind or deaf or had heart defects. The vaccine virtually eliminated rubella virus from the United States by 2005.

But rubella is common in the world. Every year, about 32,000 babies suffer congenital rubella syndrome. And international travel is common. So, it is likely that people who are infected with rubella enter this country all the time. This is also true for measles virus. The measles vaccine eliminated measles from this country in 2000. But people infected with measles still entered the country every year. Fortunately, in 2000, enough people were vaccinated against measles so that the virus didn’t spread. The same is now true for rubella. But lower immunization rates and rubella will be back.

“The likely increases in childhood illness and death appear to be worth the price of freedom to choose whether to vaccinate.” — Art Caplan, bioethicist

We stopped giving the smallpox vaccine routinely in 1972 because smallpox had been eliminated from the face of the earth. Smallpox was no longer a threat. But measles and rubella and polio viruses are still circulating. If we let our guard down, then they will come roaring back, which is exactly what happened with measles this past year.

At the end of the podcast, the host, Brinda Adhikari, made a final plea.

Adhikari: “I also ask that you hold space for those moms who are really worried about infectious disease and are really worried about them making a comeback should uptake of these vaccines go crashing down. To hold space for all of that because I think that is what I am entrusting in my government [to] not hurt me and look out for me in some way. So, I just ask you hold space for all those types of voices. Will you do that for me?”

More than 90 percent of children in the U.S. are immunized. Most parents, independent of political affiliation, support vaccines and school entry requirements. Adhikari recognizes that the CDC vaccine advisory committee, now headed by Dr. Milhoan, is heavily weighted toward anti-vaccine advisors. She is asking that the vast majority of people in this country who support vaccines can also have a voice on that committee. The most amazing aspect of Adhikari’s plea is that she felt the need to make it.

Paul A. Offit, MD, is director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. This piece originally ran on his Substack, Beyond the Noise!

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