By Daniel Dale, CNN
(CNN) — President Donald Trump’s Monday comments about autism and public health were filled with misinformation that left many doctors aghast – and not just about Tylenol.
Most of the media coverage of Trump’s press conference centered around his repeated advice to pregnant Americans to try to avoid taking Tylenol, which he based on a supposed link to autism that has not been proven. But the president also made a series of additional comments about autism, vaccines, and hepatitis B that ranged from unproven to misleading to false.
Trump said he has “been hearing” that the combination measles, mumps and rubella (MMR) vaccine is “bad” and called to split it up into separate shots. But the combination has proven safe and effective since it was approved in the 1970s, and it has no link to autism.
Trump said there is “no reason” to vaccinate a newborn for hepatitis B given that the virus is sexually transmitted, and he called to delay the first dose until age 12. But there is a very good reason to give the vaccine to babies: The virus can also be transmitted from mother to child at birth and through contact with small amounts of blood on common household items.
Trump greatly exaggerated how many shots babies receive – it’s nowhere near the “80” he claimed – and wrongly suggested numerous different vaccines are drawn from the same “vat.” He greatly exaggerated how rare autism was “18 years ago.”
He cited “the Amish” as a group “that don’t take vaccines and don’t take any pills,” though many Amish people do take vaccines and pills, and added that they “have essentially no autism,” though there are Amish people with autism. There is no known connection between any community’s autism prevalence and its use of vaccines or certain pills. And he similarly cited a “rumor” that Cuba has “no Tylenol,” though the generic version is widely available in Cuba, and that Cuba has “virtually no autism,” though Cuba does have autism and though lower-income countries’ low known autism levels are generally connected with a lack of resources to diagnose cases.
Below is a more detailed fact check of the president’s remarks.
The combination MMR vaccine has been safe and effective for decades
Trump said that, “based on what I feel,” children should get separate vaccinations for measles, mumps and rubella rather than the “MMR” combination shot that has been used in the US since the 1970s.
“Break up MMR, break it up. It’s practically a known fact that if you break it up, you’re not going to have a problem. But for years, we’ve been hearing how bad MMR is as a combination,” Trump said.
We have no idea what Trump has been “hearing,” but there’s no basis for claims that the combination MMR vaccine is generally “bad” or that there is “a problem” with it. The MMR combination has proven highly effective and very safe over its decades of US use, and it is used today in dozens of countries around the world. Some children experience side effects, but those are usually mild and temporary.
“Numerous studies and many decades of experience have showed us that they are safe and that they work well when given together,” said Dr. Adam Ratner, a pediatric infectious diseases physician in New York City and author of the book “Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health.”
Anti-MMR sentiment sometimes stems from a fraudulent, debunked 1990s study that wrongly suggested a connection between the MMR vaccine and autism. Subsequent studies have shown there is no connection.
“I’m not aware of any evidence that it’s dangerous to give MMR together,” said Dr. Ofer Levy, a professor of pediatrics at Harvard Medical School and director of the Precision Vaccines Program at Boston Children’s Hospital. “All my sources seem to say that the safest, most efficient, is to give that combination.”
In a social media post Friday, Trump directly addressed pregnant women and advised them to “BREAK UP THE MMR SHOT INTO THREE TOTALLY SEPARATE SHOTS.” But that is impossible for Americans because separate shots for measles, mumps and rubella aren’t currently available in the US, as FactCheck.org pointed out earlier this week.
There is a good reason to vaccinate newborns for hepatitis B
Trump said, “Hepatitis B is sexually transmitted. There’s no reason to give a baby that’s almost just born hepatitis B.” He also said, “So I would say, wait till the baby is 12 years old and formed and take hepatitis B.”
But there is a very good reason to give a newborn baby a dose of the hepatitis B vaccine within 24 hours of birth, as the US Centers for Disease Control and Prevention recommends today and the World Health Organization recommends internationally, and medical experts say it clearly does not make sense to wait until age 12. Trump didn’t mention that, while hepatitis B is indeed sexually transmitted, it can also be transmitted from a mother to child at birth or through a child making contact with common household items that have tiny amounts of blood on them, such as razors, nail trimmers or toothbrushes.
And that’s a major problem: Hepatitis B is much more dangerous to people who get infected as babies and young children than people who get infected as adults. CNN Health’s Brenda Goodman reported last week: “Nearly 90% of infants who are infected go on to develop chronic infections. People who have chronic hepatitis B infections are more likely to develop liver scarring or cancer, or need a liver transplant, later in life. Roughly 1 in 4 children who are infected will die prematurely from their infections.”
There is an ongoing debate within a CDC vaccine advisory panel appointed by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, about whether to recommend that the first hepatitis B shot be delayed until babies are at least one month old (unless their mother has tested positive for hepatitis B, in which case an immediate dose would still be recommended); the panel postponed a vote on the subject last week. And European countries generally give the first dose when babies are two months old, Levy noted, unless the mother has tested positive.
But not all hepatitis B cases are caught during pregnancy, and even the idea of a one-month or two-month delay in vaccinating babies is controversial given that it would leave them unprotected during those first weeks of life and that some may never return to get vaccinated at all. (Levy said that if vaccination no longer happens when the mother and child are already in contact with the medical system at birth, “the fear is some kids will fall between the cracks,” with with some proceeding to develop liver cancer.) There is no serious suggestion of waiting until children are 12 years old, as the president recommended.
“Even delaying until one month is a mistake because of the danger of perinatal transmission. There is certainly no reason to delay to age 12,” said Ratner.
Babies don’t get ‘80 different vaccines’ from a ‘vat’
Trump made a series of false or misleading comments about how many vaccines babies receive and the process of giving them the vaccines.
At one point, Trump said babies receive 80 different vaccines from a vat: “And they pump so much stuff into those beautiful little babies, it’s a disgrace … I think it’s very bad. They’re pumping – it looks like they’re pumping into a horse. You have a little child, a little fragile child, and you get a vat of 80 different vaccines, I guess, 80 different blends, and they pump it in.”
At another point, Trump suggested that babies get all of these vaccines at once: “And on the vaccines, it would be good – instead of one visit where they pump the baby, load it up with stuff – you’ll do it over a period of four times or five times.”
Trump’s assertions are comprehensively inaccurate.
Babies do not receive “80 different vaccines” or even 80 total shots, as the CDC’s recommended childhood vaccination schedule shows. The number of shots that a young child ends up getting can vary – based on factors like the different vaccine formulations available, state and local requirements for daycare and school, and whether or not the child gets regular shots for the flu or Covid-19 – but it’s clearly not 80 shots; Levy said US children generally get roughly 20 to 30 shots from birth to 15 months of age. (He said Trump is correct in his “general point” that infants receive many shots.) Even counting shots given to children well beyond baby age, such as up to age 10 as PolitiFact did this week, does not bring the total anywhere near 80.
The vaccines are not blended in a vat. “Needless to say, there is no ‘vat’ of vaccines,” Ratner said; “they are packaged in a sterile manner and given by people who are trained to do so safely.” And children already do receive their vaccinations over multiple visits to the doctor over the course of years, not during “one visit” as Trump suggested, though they may get multiple vaccines during some visits.
“We give multiple vaccines in a single visit because we try to get kids protection against important diseases as early as possible,” Ratner said. “The diseases that we vaccinate against cause serious disease or even death in young children. Delaying vaccines that we know are safe in childhood just gives kids additional time at risk without any benefit.”
He added: “Kids get more vaccines now than they did in the past because we are lucky enough to be able to protect them against more diseases now than we could in the past.”
Levy said Trump’s desire to reduce the number of shots children have to take is reasonable, and that “this could be achieved, for example, by developing better adjuvants – molecules that are added to vaccines to boost an immune response.” But he said that needlessly splitting up the MMR vaccine as Trump proposed would mean more shots rather than fewer shots, and he said any future reduction needs to be “science-driven” – adding that research shows the existing US vaccine schedule has prevented more than 1 million deaths and tens of millions of hospitalizations in the past 20 years alone.
Autism exists in Cuba
Trump said, “I mean, there’s a rumor, and I don’t know if it’s so or not, that Cuba, they don’t have Tylenol because they don’t have the money for Tylenol. And they have virtually no autism, okay. Tell me about that one.”
Cuba has paracetamol, the common international name for generic Tylenol; though it’s true that there are sometimes shortages in the country’s government-run pharmacies, paracetamol remains widely available on the black market. And Cuba has autism, as Havana-based CNN international correspondent Patrick Oppman reported in the wake of Trump’s remarks and the publication Autism Spectrum News reported in a lengthy article in June, though it’s true that the known prevalence of autism in Cuba is low.
The country has dedicated schools for children with autism and has health professionals who specialize in addressing autism. An August article in the state-run media said the country of roughly 11 million people has “approximately 3,500 people registered on the autism spectrum,” but that’s an obvious undercount of the true number of people with autism.
There are Amish people with autism
Trump said, “And by the way, I think I can say that there are certain groups of people that don’t take vaccines and don’t take any pills, that have no autism.” He cited “the Amish” as an example and added that they “have essentially no autism.”
Braxton Mitchell, a professor at the University of Maryland School of Medicine who has worked with Amish communities for more than 30 years, said it’s not true that the Amish categorically reject vaccines and pills, and not true that they have no autism at all.
Childhood vaccination rates in Amish communities have long been lower than in the country as a whole, but they are not nonexistent. And while Amish people sometimes prefer alternative treatments over modern medications, their communities do not completely shun pills like Tylenol.
“Regarding vaccines: some Amish choose to vaccinate their kids and some do not. So it is incorrect to say that Amish do not vaccinate,” said Mitchell, co-director of the Amish Research Clinic in Lancaster, Pennsylvania, which has a large Amish community. “A claim was also made about use of Tylenol. I can tell you that Tylenol is used by many Lancaster Amish.”
Mitchell noted it’s not clear what the prevalence of autism is in Amish communities, since there has been “very little systematic data” collected on the subject, but: “Bottom line: yes, autism does exist in the Amish. We do not know how its frequency compares to non-Amish.”
When Trump asked the chair of the Food and Drug Administration Commissioner Dr. Marty Makary if he wanted to comment on the subject, Makary said, “The Amish population are a very mixed group, so there’s a subset that take vaccines, a subset that does not, and we know they have very low rates of chronic disease all across the board.”
The prevalence of autism 20 years ago was much higher than Trump said
There’s no doubt that the known prevalence of autism has spiked in the last 20 years, which experts have attributed in large part to greater awareness of the symptoms and improvements in diagnostic practices. But Trump has repeatedly exaggerated the extent of the increase, and he did so again Monday.
“It used to be 1 in 20,000, then 1 in 10,000. And I would say that’s probably 18 years ago. And now it’s 1 in 31, but in some areas it’s much worse than that, if you can believe it; 1 in 31,” Trump said.
It’s true that the most recent known prevalence of autism in the US is 1 in 31 children age 8, according to 2022 data published by the CDC. But it was much higher than 1 in 10,000 “18 years ago.” The known prevalence of autism was 1 in 125 in 2004 and 1 in 110 in 2006; even in 2000, it was 1 in 150. While some of the earliest studies on the subject, from the 1960s and 1970s, estimated autism prevalence to be in the range of 2 to 4 per 10,000 children, that was much farther back than the “18 years ago” Trump claimed.
CNN’s Deidre McPhillips contributed to this item.