I was prompted to write this article after the last decision by CDC about newborns and the  Hepatitis B vaccine.

When incompetent, uncredentialed people in government make health decisions: the consequences

Public health thrives on a simple principle: decisions must be guided by evidence, expertise and an understanding of how diseases spread, how treatments work and how populations behave. When those responsible for making these decisions lack the necessary competence, training or scientific grounding, the consequences can ripple through every layer of society. History—modern and ancient—provides repeated examples of how misguided health directives can amplify disease, diminish trust and ultimately cost lives. The danger is not merely theoretical; it is practical, measurable and deeply human. These decision-makers are vulnerable to misunderstanding basic concepts or misinterpreting evidence.

When untrained officials make health decisions, they often rely on assumptions, simplistic explanations or political convenience. Science rarely cooperates with any of those. Expertise exists because managing health is difficult, nuanced work. Without that foundation, even well-meaning leaders can cause harm.

The consequences of downplaying risk

One of the first mistakes incompetent leadership makes in health crises is minimizing potential danger. Whether from fear of economic consequences, political pressure or simple misunderstanding, downplaying risk delays action. Delayed action during an emerging health crisis is among the costliest errors a government can make.

An epidemic grows exponentially. A few days of denial can mean thousands more cases. When leaders dismiss scientists or silence experts, a population loses precious time—time that should have been used for preparedness, medical stockpiling, vaccination or public education. Once a virus establishes itself widely, the cost of containment multiplies hospital system strain, emergency resources dwindle and public panic rises.

Downplaying also has psychological consequences. When the truth eventually becomes unavoidable, citizens feel misled. Trust in government erodes quickly, and trust is one of the most critical tools in public health. A community that trusts its leaders follows guidelines. A community that does not will ignore them.

Misinformation and mixed messaging

Incompetent or uncredentialed leaders often deliver inconsistent messages. They may announce health policies without understanding them, contradict scientific advisers or shift positions based on political winds. Mixed messaging confuses the public, and confusion breeds noncompliance.

One day masks are unnecessary; the next day they are essential. One day a disease is “nothing to worry about”; the next day, hospitals are overflowing. When guidance shifts without a clear explanation grounded in science, people stop listening altogether. Miscommunication can also empower fringe theories, pseudoscience and dangerous home remedies, filling the information vacuum created by weak leadership.

Once misinformation spreads, it is nearly impossible to fully retract. Even years later, false beliefs about diseases, vaccines and treatments can persist, rooted in statements made by officials who lacked proper expertise.

Politicizing science

Health decisions must be based on evidence, but uncredentialed leadership often treats science as negotiable, something to be shaped, pressured or reframed to suit political objectives. When science becomes politicized, several dangerous consequences follow. experts may become sidelined. Public health agencies risk being overridden or manipulated, and qualified professionals may resign rather than participate in unsafe decision-making. Second, scientific data can be selectively highlighted or suppressed, leading to half-truths rather than full transparency.  Laws or regulations may be crafted not for public safety but for political gains.

In the long run, politicizing health undermines not only the current response but also future ones. Once the public begins to associate scientific guidance with political motivations, compliance with future safety measures declines, even during legitimate emergencies.

Erosion of public trust

Public trust is the backbone of any effective health strategy. When officials demonstrate incompetence, offer unscientific directives or appear to prioritize politics over safety, the public loses confidence—not only in those officials, but in the entire health system.

This erosion has lasting effects:

• People skip recommended vaccinations.
• They ignore public advisories.
• They question scientific institutions.
• They turn to unverified sources for medical guidance.
• They view future emergency measures with suspicion.

Rebuilding trust is far more difficult than maintaining it. It requires consistent honesty, clear explanations and visible competence—qualities absent when uncredentialed individuals drive policy.

Economic and social consequences

Bad health decisions do not just harm bodies; they harm economies. A poorly handled outbreak can lead to:

• prolonged business closures
• job losses
• supply-chain disruptions
• overwhelmed hospitals unable to treat non-emergency cases
• increased long-term disability among survivors
• reduced workforce stability

A community’s economic health is inseparable from its physical health. Governments that ignore science ultimately pay more, not just in lives, but in dollars.

The effect on vulnerable populations

Incompetent decision-making disproportionately harms those least able to protect themselves: the elderly, individuals with chronic illnesses, low-income families, essential workers and communities with limited access to care. When health policy is misguided or delayed, these groups experience higher exposure, worse outcomes and lower survival rates.

Public health is not merely a technical field; it is a moral responsibility. Protecting the vulnerable requires competence, compassion and evidence-based action. When leaders lack those qualities, the most fragile members of society bear the greatest burden.

Why credentialed expertise matters

Having credentialed individuals in positions of health authority ensures:

• decisions grounded in medical knowledge
• recognition of early threats
• accurate interpretation of scientific data
• effective communication with the public
• accountability through established professional ethics
• the ability to coordinate with international health organizations

Credentials do not guarantee perfection, but they provide a strong foundation for sound judgments.

The consequences of ignoring science are steep. The benefits of embracing it are profound. In matters of public health, competence is not optional; it is lifesaving.

Understanding risk, reward and long-term impact

Every medical intervention carries some degree of risk. From routine medications like aspirin to complex surgeries, no health-related decision is entirely free of potential complications. Vaccines are no exception. They can cause side effects—some minor, a few extremely rare but serious. Yet when we step back and look at the full picture, one truth emerges clearly: the long-term benefits of vaccination overwhelmingly outweigh the risks.

Consider polio, a disease that paralyzed or killed hundreds of thousands of children annually before the Salk and Sabin vaccines. The vaccine carries a minuscule risk of adverse events, yet polio itself could cripple a child for life, require years in an iron lung, or lead to lifelong complications like post-polio syndrome. Smallpox was once one of the deadliest scourges in human history, killing an estimated 300 million people in the 20th century alone. The smallpox vaccine had known risks, but the risk of not vaccinating was catastrophic. Thanks to widespread vaccination, smallpox has been eradicated and polio is nearly gone.

Measles is another striking example. Many people think of measles as a rash and fever, but before routine vaccination in 1963, it hospitalized tens of thousands of Americans every year and killed hundreds. Globally, measles continues to cause brain inflammation (encephalitis), permanent hearing loss and death in unvaccinated populations. The MMR vaccine has a vastly safer profile than the measles virus itself.

Today’s vaccines undergo some of the most rigorous safety testing in the world, often over a decade of research, multiple phases of clinical trials, and continuous post-approval monitoring. No vaccine is ever considered “risk-free”—but no credible scientific review has found that the risks approach those posed by the diseases themselves.

In the end, vaccination is a long-term investment in individual and public health. While acknowledging small risks honestly and transparently, we must also maintain perspective: the far greater danger lies in leaving populations susceptible to infectious diseases that vaccines have made rare or invisible. The long-term outcome, lives saved, disabilities prevented, families spared grief, vastly outweighs the small risks that come with every dose.

The birth of vaccination: Jenner, cowpox and the origin of the word ‘vaccine’

In the late 18th century, smallpox was a merciless force. It killed about 30 percent of its victims and left many survivors scarred or blind. Periodic epidemics ravaged cities, villages, and royal courts alike. Yet even amid this devastation, a folk belief persisted: Milkmaids who contracted cowpox, a mild disease passed from cows, seemed to be immune to smallpox.

Dr. Edward Jenner, intrigued by this observation, decided to test it scientifically. In 1796, he took material from a cowpox sore on a milkmaid named Sarah Nelmes and inoculated an eight-year-old boy, James Phipps. After Phipps recovered from the mild infection, Jenner exposed him to smallpox. The boy did not get sick. This experiment marked the birth of vaccination.

Jenner coined the term “vaccine” from the Latin word vacca, meaning “cow.” He distinguished his method—using a benign virus to prevent a deadly one.  By the early 1800s, the medical world adopted the term “vaccination,” and it has endured to this day, long after vaccines expanded far beyond cowpox.

Jenner’s discovery ignited a global movement toward disease prevention. Smallpox vaccination spread across Europe, then to the rest of the world. By 1980—nearly 200 years after Jenner’s first experiment, the World Health Organization declared smallpox eradicated, the only human disease ever wiped from the planet. It was the ultimate proof that vaccines could not only save lives but eliminate a deadly pathogen entirely.

A century of devastation: Life before vaccines

To appreciate the importance of immunizations, one must understand what life was like before they existed. Infectious diseases were woven into daily life in ways modern society barely remembers.

Polio

Before the Salk vaccine in 1955 and the Sabin oral vaccine in 1961, polio outbreaks terrorized families each summer. The 1952 U.S. epidemic was the worst, with 58,000 reported cases and thousands of children paralyzed or placed in iron lungs. Pools closed. Parents kept children indoors. Fear permeated American life.

Measles

Measles was once nearly universal. Before 1963, almost every child caught the disease by age 15. The U.S. saw 500,000 reported cases annually, with many more unreported. Measles caused encephalitis, pneumonia, blindness and thousands of deaths each decade.

Diphtheria

Known as “the strangler,” diphtheria suffocated children as a thick membrane formed in their throats. In 1921, the U.S. recorded over 200,000 cases. Entire communities feared this disease, which often killed quickly and painfully.

Whooping cough (Pertussis)

Pertussis was another childhood killer. In 1934, the U.S. reported over 260,000 cases, many among infants too young to cough strongly enough to clear their airways.

Haemophilus influenzae type b (Hib)

Hib, before its vaccine in the 1980s, was the leading cause of bacterial meningitis in children, often leaving survivors deaf or neurologically impaired.

Hepatitis B

Unlike measles or polio, hepatitis B (HBV) killed slowly. Newborns infected at birth had a BBBBBB 90 percent chance of developing chronic infection, and a 15 to 25 percent lifetime risk of death from cirrhosis or liver cancer. Before newborn vaccination began in 1991, about 18,000 U.S. children each year contracted hepatitis B—half of them infected during birth.

There is no well-documented figure for the number of babies (infants/neonates) who died from HBV before the vaccine, because most deaths from HBV occur decades later (after chronic infection: cirrhosis or liver cancer). 

What we do know about pre-vaccine hepatitis B burden among children

• Prior to universal childhood vaccination, in the U.S. it was estimated that roughly 200,000 to 300,000 new HBV infections occurred each year. PubMed 
• A 2025 summary reports that before routine newborn vaccination (which began in 1991), about 18,000 children per year (under age 10) contracted HBV. Medical Xpress, PubMed
• About half of those infections were in babies at birth (perinatal transmission). Medical Xpress, Down To Earth
• Among infants infected at birth (or early childhood), ≈ 90% risk becoming chronically infected. CDC
• People who become chronically infected in infancy or early childhood have a 15 to 25 percent lifetime risk of premature death (from cirrhosis or liver cancer) due to HBV. CDC
• A global modeling study estimated that, without vaccination, a given birth cohort would yield a very large number of HBV-related deaths over a lifetime; many of those deaths stemmed from infections acquired in infancy or early childhood. PubMed, CDC

While not “baby deaths from Hep B immediately after birth, many of the pre-vaccine infant (or early-childhood) infections eventually resulted in death decades later via chronic liver disease.

Why we don’t have a solid number for 'deaths of babies' pre-vaccine

• Hepatitis B rarely kills babies or infants immediately; the major health burden arises from chronic infection years or decades later (cirrhosis, liver cancer).
• Death statistics for HBV are aggregated for all age groups, making it effectively impossible to isolate which deaths trace back to perinatal or infant infections. For example, recent U.S. HBV-related deaths are typically among adults (often in older age groups). Hepatitis B Online       
• Because the latency from infant infection → chronic HBV → liver disease can be 20–40 years or more, historical records rarely link back to the original infant infection.

What can be said—a rough ‘worst-case-style’ estimate

Using the available data:

• Suppose, before infant vaccination, ~ 9,000 infants per year (half of the ~18,000 annual childhood infections) were infected at birth.
• ~ 90% of those (≈ 8,100) would likely become chronically infected.
• If 15 to 25 percent of those chronically infected in infancy eventually die prematurely, then over their lifetimes, ≈ 1,200-2,000 deaths per birth-years’ worth of infected infants could be expected (from chronic HBV complications).

That does not mean 1,200-2,000 babies died each year. Rather,  those are the future deaths linked to that year’s infant infections.

Why the Hep B vaccine matters in infants

The preventive value of the Hepatitis B vaccine is not measured just in preventing acute infant illness, but in preventing chronic infection and the long-term mortality (cirrhosis, liver cancer) that follows.

A modeling study in 2000 estimated that, globally, routine infant vaccination could prevent ~84 percent of future HBV-related deaths in a birth cohort. PubMed
And in the U.S., once universal newborn vaccination was adopted, rates of HBV infection in children dropped dramatically. Pub Med,  Med Express

Major vaccine-preventable diseases and the last epidemic before vaccination

Why people forget the importance of vaccines

Ironically, vaccines are victims of their own success. Because most vaccine-preventable diseases have been pushed into the past, people often underestimate their severity.

This phenomenon is known as complacency drift:

• When people no longer witness disease, they forget its danger.
• When danger is forgotten, the perceived value of vaccines decreases.
• When vaccination rates fall, diseases return.

Measles outbreaks in communities with low vaccination rates are a modern reminder. The disease is extraordinarily contagious, and even small pockets of unvaccinated individuals can fuel rapid spread. We saw that in the Midwest this year.

History is clear: diseases return when vaccination rates drop.

Around the world, vaccines have had a monumental impact:

• Millions of deaths prevented annually
• Lifespans extended
• Child mortality drastically reduced
• Economic stability strengthened

No other medical intervention has done more to transform human health.

Vaccines protect not just individuals, but societies. They enable safe childbirth, stable communities, and the healthy development of children. They create a world where parents do not fear a simple rash becoming deadly or a summer breeze carrying paralysis.

Why immunizations remain essential today

Even with modern hygiene, antibiotics and medical technology, vaccines are irreplaceable. Here’s why:

1. Many infectious diseases have no cure.

Polio, measles, and hepatitis B cannot be cured—only prevented.

2. Antibiotic resistance does not affect vaccines.

Vaccines prevent bacterial infections without contributing to resistance.

3. Global travel spreads disease quickly.

A virus can cross continents in hours. Vaccination stops it at the source.

4. Vulnerable populations depend on community immunity.

Newborns, the elderly, and people on chemotherapy need protection from those around them.

5. Outbreaks cost lives and money.

Measles outbreaks can cost millions in containment efforts.

6. Vaccines protect future generations.

Hepatitis B newborn vaccination is a prime example of multigenerational protection.

From Jenner’s cowpox experiment to modern mRNA vaccines, the story of immunization is the story of humanity’s triumph over disease. Vaccines represent a simple idea with profound consequences: Prevent sickness before it begins. They do not just cure; they protect. They do not just treat; they prevent suffering across decades.

Without vaccines, our world would be unrecognizable. Smallpox would still exist. Polio would still paralyze children every summer. Measles, diphtheria, pertussis, and Hib would continue claiming young lives. Hepatitis B would silently inflict chronic infection and future liver cancer on newborns.

Every healthy child who grows up free of these diseases is a testament to the quiet, powerful effectiveness of immunization. Vaccines are not just important; they are essential to the foundation of modern life. And as new diseases emerge, as global populations shift, and as science advances, immunizations will remain one of our most vital tools for protection.

Michael Kossove is professor emeritus and adjunct professor of microbiology at Touro University’s School of Health Sciences.  "For Everyone's Health" is an occasional opinion column that explains the importance of public health and  looks at the impact of disease in the past.