US Health Secretary Robert F Kennedy Jr has regularly told Americans they should not take medical advice from him.
"My opinions about vaccines are irrelevant," he told Congress in May.
But under his watch a vaccine-preventable disease has continued to spread, with more than 1,300 cases in 40 states.
The measles outbreak that began amongst a rural West Texas Mennonite community with a low vaccine uptake has so far resulted in three confirmed deaths across the country.
"We're fully on track for losing our elimination status," Dr Noel Brewer told 7.30.
"We're having a meltdown around measles in the United States right now, it is a full crisis."
Dr Brewer is one of seven experts who determine whether the United States has maintained elimination over a 12-month period.
The status means there is no spread of the disease within the country and new cases are only found when someone contracts it abroad and returns it to the US.
"It may be that we haven't quite hit the technical mark, but we have so many cases right now that it seems almost impossible that we have not lost elimination," Dr Brewer said.
"It's a complete and utter failure of public health for us to lose our elimination status for a vaccine-preventable disease."
According to the US Centers for Disease Control and Prevention (CDC) "one to three out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications".
"There definitely has been issues with under-reporting and a lot of the measles outbreaks have been in communities that may have hesitation about seeking medical care and so that leads to under-reporting," epidemiologist Dr Zack Moore said.
"Measles is generally considered to be the most infectious virus out there … globally it's a major killer of children."
Ninety-two per cent of those who have been infected in the US are unvaccinated or their vaccination status is unknown.
"When you get introduction into a community that has lower vaccination rates, it's kind of dry kindling and the spark can really take off and start a fire," Dr Moore said.
Mixed messages on vaccination
The rapid spread of the disease has led to questions around RFK Jr's response to the outbreak as he has publicly recommended a mix of treatments.
Secretary Kennedy has publicly endorsed the measles, mumps and rubella (MMR) vaccine but has also called it a "leaky vaccine" that wanes and falsely stated it hasn't been "safety tested".
"We are recommending that [MMR vaccine] at this point but we're also doing studies on it," he told Dr Phil Primetime in April.
He has stated health officials are delivering Vitamin A to communities and "getting very good results from it" as well as promoting the use of the steroid Budesonide and antibiotic Clarithromycin.
The 71-year-old, who has a long history of disparaging a range of vaccines, has also said cod liver oil is a potential remedy for the disease.
"There's always some half-truths sometimes to this," infectious disease expert Dr Cameron Wolfe told 7.30.
"There is good data that supports supplementing Vitamin A in outbreaks of measles for kids in developing countries where Vitamin A deficiency is much more rife than it is in the United States.
"The extrapolation however to put that on a level conversation with vaccines as a way of curbing an outbreak that's already happening is where the problem occurs.
"It's the way that we have conversations that put those on a level playing field, which I think is actually even more dangerous because it undermines vaccines indirectly, which is a little more insidious."
Too much Vitamin A can be toxic and can lead to various health conditions.
"We've heard ho-hum endorsements but not really full-throated endorsements, and those questioning approaches that sort of slyly suggest there might be something wrong have a big effect on regular Americans," Dr Brewer said.
Vaccine panel overhauled
Dr Brewer was also a member of the Advisory Committee on Immunization Practices (ACIP) until he and 16 others were abruptly fired by RFK Jr.
"All of us heard about it through an editorial in the Wall Street Journal," Dr Brewer said.
"It was shocking to receive a notification from the government that I've been fired from a position that is a non-political position."
The ACIP comprises medical and public health experts who develop recommendations on the use of vaccines such as the dosage, demographic and age.
RFK Jr has effectively halved the size of the board and hand-picked new appointees — some of whom have a history of vaccine scepticism.
"We're going to bring people onto the ACIP panel, not anti-vaxxers, we're bringing people on who are credentialed scientists," he said in June.
In his WSJ editorial, the health secretary claimed that the ACIP members had too many conflicts of interest and had become "little more than a rubber stamp for any vaccine".
Dr Yvonne Maldonado, a professor of global health and infectious diseases at Stanford University, was also fired from the ACIP and disputes these claims.
"We don't rubber stamp," she said.
"The secretary doesn't seem to understand the process because it actually takes hundreds and hundreds of hours of many people's time to review vaccines well before they come up for a vote.
"To say that it's a rubber stamp really demonstrates a lack of understanding of what the process is."
Dr Maldonado said she was shocked by the pace at which Secretary Kennedy overhauled the board.
"When you remove an entire committee, you've left no institutional memory, no institutional history and so there's really nobody there to carry on the agenda … that had existed before that time."
Dr Brewer believes that may have been RFK Jr's objective.
"There was an interest in changing the direction of the ACIP to be more vaccine sceptical and they've been successful in accomplishing that," he said.
The overhauled vaccine advisory panel is already moving in a different direction and intends to review the impacts of the entire childhood vaccination schedule in the US.
The newly appointed chair has also said the group intends to look into possible changes to access for the Hepatitis B vaccine and a chickenpox vaccine that combines protection with the MMR vaccine.
RFK Jr Vs thimerosal
It's also recently recommended the removal of a mercury-based preservative, thimerosal, from flu vaccines. The Health Secretary has adopted this recommendation.
For two decades RFK Jr has made misleading and inaccurate claims about thimerosal. In 2014 he wrote a book alleging it likely caused autism and should be banned.
The health agencies he now controls have found these claims to be unfounded.
"This action fulfils a long-overdue promise to protect our most vulnerable populations from unnecessary mercury exposure," Secretary Kennedy said.
"Injecting any amount of mercury into children when safe, mercury-free alternatives exist defies common sense and public health responsibility."
Thimerosal has been used since the 1930s to prevent microbial growth and "there is no evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site", according to the CDC website.
The US Food & Drug Administration (FDA) also states "a robust body of peer-reviewed scientific studies conducted in the US and other countries support the safety of thimerosal-containing vaccines".
The FDA website states that the amount of elemental mercury contained in vaccines with thimerosal is roughly the same as "a 3 ounce [85 grams] can of tuna fish".
"I believe in a healthy scientific debate, I think that's good, and we want people to ask questions about vaccines … but the problem here is that these debates have already been settled with a great deal of evidence and expense," Dr Brewer said.
"We've already established that [thimerosal is] safe … and yet there's this whole long meeting about it that was not evidence-based and not productive so the US now will not include thimerosal in vaccines and there's no good reason for it.
"We need to not be rehashing all this old stuff and replacing it with misinformation and lies."
'Factually incorrect'
RFK Jr says he is "pro-safety and pro-good science" and rejects the label of "anti-vax" but has for years promoted the debunked claim that vaccines could cause autism and reiterated that theory as recently as June in a podcast interview with former Fox News host Tucker Carlson.
"The fact that someone in that position would continue to roll out that information is abhorrent," Dr Wolfe said.
"It builds this negative image of vaccines which is factually incorrect.
"Ever since a guy called [Andrew] Wakefield published a paper now 25 years ago to suggest that that link existed … countless large multi-million person studies have then looked to say, let's prove that and have proven that wrong."
Mr Wakefield's 1998 paper was retracted by the publishing journal in 2010 citing the claims in his paper were "proven to be false".
He was struck off the British medical register the same year for serious professional misconduct.
Dr Wolfe says this disproven claim is a "scare tactic" that takes people away from having important data-driven conversations about balancing risk and safety with getting vaccinated.
In April Secretary Kennedy pledged a "massive testing and research effort" to determine the cause of autism by September.
"I feel like we're stealing from that community by trying to put money into research on what causes autism with respect to vaccines when we know that vaccines don't cause autism," Dr Brewer said.
"Let's put research into either care for folks who have autism to help them function well in society and to live healthy, productive lives or let's do research on whatever causes it and find real causes, not these fake causes."
Health department's major changes
RFK Jr promised to overhaul the American health system, promoting the slogan "Make America Healthy Again".
"Trusting the experts is not a feature of science, it's not a feature of democracy, it's a feature of religion and totalitarianism," he told CNN in May.
"What we should do is trust the science. We are going to do the science and the science is going to be replicable and its going to be gold standard."
In that same interview he explained the value of the experts on the ACIP which he fired the very next month.
The health secretary has said he wants to ensure that there is information and treatment options available for all Americans, including those who don't want to get vaccinated.
He has described himself as a "freedom-of-choice person".
Under his leadership there have been radical changes to the Department of Health and Human Services (HHS).
It's reduced its workforce by 20,000 people through lay-offs, early retirements and buyouts.
He frequently questions the efficacy and safety of vaccines, in particular mRNA technology, which helped develop coronavirus vaccines during the pandemic.
"We need to know what the risk profile is of these products and the benefits and allow parents and physicians to make good choices for public health," he told NBC News.
In June he personally directed COVID-19 vaccines no longer be recommended for healthy children and pregnant women.
In May he revoked a nearly $US600 million contract to develop an mRNA bird flu vaccine, and last week he cancelled nearly $US500 million worth of mRNA vaccine contracts.
Secretary Kennedy defended the move, stating the funding would instead go toward "safer, broader vaccine platforms".
"HHS supports safe, effective vaccines for every American who wants them. That's why we're moving beyond the limitations of mRNA and investing in better solutions," he said.
President Donald Trump's former surgeon-general Jerome Adams slammed the decision, claiming some of the health secretary's rhetoric "ignores science and risks lives".
"Cutting half a billion in mRNA funding as HHS Sec Kennedy proposes, isn't just bad policy — it's dangerous," Mr Adams said.
"We should be doubling down on what works — not defunding it."
"What's happening in public health, what's happening in medicine, what is happening in our department of public health is really disturbing and depressing," Dr Brewer said.
"They're tearing the entire edifice down."
Make vaccines boring again
Secretary Kennedy also promised there would be "radical transparency" while he is at the helm.
"We have had very little [of that] since the start of this current administration and especially under this new secretary," Dr Maldonado said.
"It feels like there are a lot of these policies and philosophies and our procedures have gone by the wayside now and I am worried about how we physicians, as public health officials, as policymakers are going to be able to continue to protect our public's health."
Dr Wolfe, who is an Australian that has worked in the United States for the past two decades, says it's now more difficult to find public health information.
"It's less clear that the data and where it's sourced from on public websites is as accurate and complete as it once was. It's less clear about future policy decisions … it's less clear about how the FDA is judging vaccine decisions," he said.
"It's a nice sort of political appeal to say that you're going to be absolutely transparent and yet I would say that there's been very little of that."
Vaccine misinformation and some of these changes within the department are making the job of clinicians harder.
"I don't think any blame should be on one person although clearly someone has to be a leader — but there's a lot of people who went along willingly with the creation of the current administration in the way that it is structured," Dr Wolfe said.
The US Health Department did not respond to a list of questions but referred 7.30 to a recent press release.
"We need vaccines to be boring again … we need it to not be part of the political process however inevitably with this precedent it will be for at least a period of time," Dr Brewer said.
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