Health Secretary Robert F. Kennedy Jr.’s focus on vitamin A use to combat a growing measles outbreak in Texas is raising concerns among public health experts, who fear he is sending the wrong message about preventing the highly contagious disease and distracting from the critical importance of vaccination.
Kennedy, who in his years as an anti-vaccine activist criticized measles shots and boosted vitamin A as a treatment, is now using his government position to tout the vitamin’s accepted benefits. The Department of Health and Human Services has directed the nation’s top public health agency to add similar language to its guidance for caring for measles patients.
“It is also our responsibility to provide up-to-date guidance on available therapeutic medications. While there is no approved antiviral for those who may be infected, CDC has recently updated their recommendation supporting administration of vitamin A under the supervision of a physician for those with mild, moderate, and severe infection,” he wrote in an opinion piece that appeared on foxnews.com on Sunday night. “Studies have found that vitamin A can dramatically reduce measles mortality.”
His op-ed does not mention vitamin A’s risks.
Experts acknowledge that vitamin A can be beneficial after someone has gotten sick, but they say it is not a replacement for vaccination to prevent measles. Vitamin A is considered supportive care and typically used in countries where children are malnourished and have vitamin A deficiency. Vitamin A deficiency in the United States affects less than 1 percent of the population, according to a nutrition report from the Centers for Disease Control and Prevention.
Anti-vaccine activists have long touted vitamin A as an alternative to immunization, concerning public health experts and doctors, who worry that Kennedy’s public statements will legitimize that view.
“In fact, relying on vitamin A instead of the vaccine is not only dangerous and ineffective, but it puts children at serious risk,” Sue Kressly, president of the American Academy of Pediatrics, said in a statement Monday. “Taking too much vitamin A can cause serious health problems, including liver damage.”
In the op-ed Sunday addressing the outbreak, Kennedy said vaccines protect children and contribute to broader immunity in the community. The op-ed also states that before the measles vaccine, nearly every child in the United States contracted the infection, and that there was an average of one death for every 1,205 cases from 1953 to 1962.
“We must engage with communities to understand their concerns, provide culturally competent education, and make vaccines readily accessible for all those who want them,” the op-ed said.
While Kennedy won praise from some public health experts for mentioning the benefits of vaccines, some said he should have explicitly recommended vaccination as the safest and most effective way to prevent measles.
A 6-year-old unvaccinated child died in Texas last week, the first U.S. measles death since 2015. At least 159 people have been infected in the West Texas outbreak. Of the cases for which vaccination status is known, 80 were unvaccinated and five were vaccinated, according to state data. Kennedy recommended that parents consult with health-care providers about the shot, saying, “The decision to vaccinate is a personal one.”
Kennedy outlined the use of vitamin A as supportive management under the supervision of a physician for people with mild, moderate and severe infections. But public health experts and medical studies warn that excessive use of the supplement can lead to liver failure and death, which the op-ed does not mention.
“You can have excess amounts of vitamin A,” said Patsy Stinchfield, a past president of the National Foundation for Infectious Diseases. “It can be dangerous for you. Giving high doses can give you everything from dizziness, nausea, headache, even to coma, if you took too much vitamin A.”
Experts say limited studies have shown a potential beneficial effect when vitamin A is given as part of physician-led supportive care. The World Health Organization recommends the vitamin to help protect against measles complications such as pneumonia, vision loss and death, largely based on studies in countries where the virus is endemic and malnourishment is more common.
Summer Davies, a pediatric hospitalist in Lubbock, Texas, who has cared for nearly a dozen measles patients, said vitamin A is not offered as a front-line treatment because much of the data supporting it is based on malnourished children.
“There’s not enough information there to say, ‘Yeah, this is great, this will cure you.’ And it’s not a wonder drug and miracle drug,” Davies said. “So it’s not going to make measles go away. And it may prevent some complications, but we’re not giving it to every child in the hospital because the evidence just isn’t there.”
On Friday, the CDC added a section on vitamin A to its measles webpage saying that the supplement may be given to infants and children under the supervision of a health-care provider as part of supportive management. The language states that children with severe measles, such as those who are hospitalized, should “be managed with vitamin A” and provides dosing recommendations.
The one mention of risk states: “Inappropriate dosing may lead to hypervitaminosis A” – referring to high levels of the vitamin that can be toxic and lead to liver failure and death. Yet the guidance has no warnings about such risks.
While vitamin A has its place as a treatment for hospitalized children, it should not be deployed as a public health strategy to contain measles, said Peter Hotez, co-director of the Center for Vaccine Development at the Texas Children’s Hospital.
“It could lead to the impression of a false equivalency: To make the best decision for your children, you can either vaccinate or give vitamin A,” said Hotez, who has written about the anti-vaccine movement. “And that would be highly misleading.”
In a statement, an HHS spokeswoman said the measles outbreak is a “top priority” for Kennedy and referred to the Sunday op-ed.
“The CDC is actively supporting Texas state health officials and will be on the ground Tuesday working with the frontline health care providers,” said senior counselor and principal deputy chief of staff Stefanie Spear.
HHS has directed that 2,000 doses of the measles vaccine be sent to Texas and has provided lab support to better track the virus, Kennedy said Friday. HHS is also “working on sending a shipment of vitamin A” to Texas, Lara Anton, a spokeswoman for the Texas Department of State Health Services, said Monday.
During a hearing Monday before state lawmakers, Texas’s top health official said that global data backs including vitamin A in patient care, but more research is needed to understand whether its use is as effective in the United States.
“It’s not preventing it,” said Jennifer Shuford, commissioner of the Texas Department of State Health Services. “It’s after you’re already ill.”
In Gaines County, Texas, the center of the measles outbreak where 107 out of 159 confirmed cases have been reported, residents, including in the Mennonite community – a group that has been disproportionately affected – have embraced vitamin A and cod liver oil, which is rich in the nutrient, as a crucial way of getting through the surge.
At a recent breakfast hour in a Mennonite-owned pizzeria in Seminole, the county seat of Gaines, a waitress touted the vitamin as a great way to help children stricken by the disease as she casually talked to diners. A mile away at Health 2 U, a Mennonite-owned health food and supplement store, the supply of vitamin A products has been running low as demand has soared since the outbreak’s start.
“They’ll do cod liver oil because it’s high in vitamin A and D naturally, food-based,” said Nancy Ginter, the store’s owner. “Some people come in before they break out because they’re trying to just get their kids’ immune system to go up so they don’t get a secondary infection.”
Ben Edwards, a doctor in Lubbock who treats patients skeptical of modern medicine, said on a recent podcast episode that people will weather measles if they are good stewards of their immune system with nutrient-rich produce. He has expressed concerns about the side effects of measles vaccinations and said natural immunity is preferable, a view being cited by vaccine skeptics that is considered fringe by medical organizations. In an interview with The Washington Post, Edwards highlighted the studies showing a significant drop in measles deaths in malnourished children who take vitamin A.
“That’s the kind of thing I want to educate my patients: ‘Hey, you’re not severely malnourished. You’ve got an immune system,’” Edwards said. “Now you need to be feeding it real food. You need to nourish it, steward it, get some sunshine, get some good oxygen.”
