In the days before Christmas, as measles, whooping cough and influenza continued to spread and surge across the United States, the Department of Health and Human Services came perilously close to scrapping the nation’s long-standing list of recommended childhood vaccines.
The number of US children catching measles is rising. Credit: Sydney Morning Herald
As CNN reported, the agency’s plan was to go with a shorter list, along the lines of what Denmark recommends. As Politico reported soon after, that plan was jettisoned at the last minute over legal and political concerns.
Sources in and around the department have since suggested that something far worse may still be in the offing. “They could still move to align us with a country like Denmark,” said Dr Demetre Daskalakis, a former director of the Centres for Disease Control and Prevention’s respiratory disease division. He resigned in August in protest of the agency’s politicisation of vaccine policy. “But they could also just scrap the list altogether, so that there are no official recommendations, only vague suggestions.”
Either of those changes would be unconscionable. Among other things, the CDC list, also known as the childhood vaccine schedule, helps determine which vaccines are covered by insurance, which are included in the Vaccines for Children Program that supplies crucial shots to the un- and underinsured, and which are protected from certain liabilities that might otherwise drive vaccine makers from the US market. Altering those recommendations, or downgrading them to “shared clinical decision making,” would upend those protocols, and could make it nearly impossible for millions of families to receive certain lifesaving vaccines, even if they still want them.
However, neither move would be surprising.
In the 11 months since he was confirmed as health secretary, Robert F. Kennedy Jr has wreaked steady havoc on the nation’s vaccination policies and programs. He cancelled hundreds of millions of dollars in federal investment for mRNA vaccines, including ones that would have improved our ability to fight the next flu pandemic. He chased away doctors and scientists at the Food and Drug Administration and the CDC who oversaw federal vaccine policy for decades.
Perhaps worst of all, he fired the entire 17-member Advisory Committee on Immunisation Practices, known as ACIP. It is responsible for advising the CDC on which vaccines to recommend for whom. It now consists of a mix of ideologues and incompetents handpicked by Kennedy himself. Already, it has:
Rescinded recommendations for any flu shots containing thimerosal, a preservative that keeps multi-dose vaccine bottles free of bacteria and other contamination. It has been in use for nearly a century and has decades’ worth of data validating its safety.
Revoked a long-standing recommendation of the measles, mumps, rubella and chickenpox, or MMRV, combination vaccine for children younger than four. The policy change is not based on any valid medical or scientific concern.
Stopped recommending COVID-19 vaccines for healthy people younger than 65 unless they talk to a health care provider, a move that makes it harder for people who want or need those shots to get them.
Changed the recommendations for hepatitis B vaccination from saying all newborns should have this shot to one that might as well be a shrug emoji: new mothers who test negative should decide for themselves whether to have their babies vaccinated at birth, but might consider waiting.
None of these changes are evidence-based. All run counter to what the CDC’s own experts (and most of the nation’s leading medical groups) have advised. And all are likely to sow confusion, undermine public trust and ultimately drive the nation’s vaccination rates down. “We are already hearing about pregnant women who test positive for Hep B deciding not to get the shot,” said Dr Paul Offit, director of the Vaccine Education Centre at the Children’s Hospital of Philadelphia. “Because the message they’re getting from that recommendation is that the vaccine itself is dangerous.“
Proponents of the push to align US recommendations with those of so-called peer nations such as Denmark, Japan and Germany – all of which recommend fewer shots than the US – have billed it as a commonsense corrective. But, as innumerable doctors and scientists have explained, when it comes to public health, countries with fewer shots on their must-have list are not actually our peers.
In Denmark, to take the administration’s favourite example, prenatal care is free and universal. More than 95 per cent of pregnant women are screened for hepatitis B, and those who test positive are promptly treated and duly monitored. In Japan and in most European nations, primary care systems have the capacity to find and vaccinate children who face a higher risk for vaccine-preventable diseases – and in many of those countries, paid sick leave also helps minimise the spread of contagions through schools and offices.
None of this is true in the US, where nearly a quarter of pregnant women lack adequate prenatal care, and those who face the highest risk of contracting and spreading vaccine-preventable diseases are often the least likely to have access to doctors or pharmacies. When US health officials tried to stamp out hepatitis B through vaccination programs aimed at high-risk groups, they failed miserably. It was not until they carried out a universal, at-birth vaccination policy in 1991 that hepatitis B infections finally plummeted – by about 99 per cent.
In fact, if the US public health system has one thing going for it relative to other nations, it’s probably vaccines. As the CDC’s own data indicates, routine childhood vaccination has prevented hundreds of millions of illnesses and tens of millions of hospitalisations. It has also saved half a trillion dollars in medical costs, a figure that jumps into the multitrillions once you factor in indirect, societal costs like lost productivity and lost wages.
The US tends to have higher rates of measles vaccination than Europe, and fewer measles cases as a result. Compared with Denmark, we also tend to have lower hospitalisation rates for rotavirus (which causes diarrhoea and can be fatal in infants and children) and respiratory syncytial virus, or RSV (which is a leading cause of hospitalisation among children). The reason for those disparities is not in dispute: we vaccinate routinely against both viruses. Denmark does not.
Kennedy and his supporters have said repeatedly that parents should be able to decide for themselves whether to vaccinate their children. But the Trump administration’s actions have put the nation on course for a future where even those who want vaccines may not be able to get them.
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“Anytime you move away from a clear, universal recommendation, implementation becomes more difficult,” said Dr. Fiona Havers, a vaccine expert who resigned from the CDC in protest in June. Does insurance still have to cover a shot that falls under shared clinical decision-making? Maybe. Can you still get it at the pharmacy? Not necessarily.
For now, health insurers have promised to continue covering vaccines, regardless of what the CDC does or says, presumably because they understand that vaccinating people is far cheaper than letting them get sick. But consumers would have no obvious recourse if those insurers eventually changed their minds – and, in any case, that promise applies only to families that have commercial health insurance to begin with. About half of all American children rely instead on the federally funded Vaccines for Children Program – and that program falls squarely within the jurisdiction of Kennedy, our anti-vaxxer in chief.
If the CDC does change the childhood schedule to resemble Denmark’s, or scraps that schedule altogether, and if the health secretary decides to adjust the Vaccines for Children Program accordingly, about half of all American families could suddenly find themselves with no clear way to get essential vaccines – their best possible protection against a roster of devastating diseases., including rotavirus, RSV and hepatitis B.
In the meantime, the FDA is angling to make an even bigger and more enduring impact on Americans’ access to vaccines. After claiming, without presenting a shred of proof, that COVID vaccines played a role in the death of 10 children, top officials at the agency have proposed a roster of new requirements for the shots, including several that critics say would be logistically impossible and could leave us with no FDA-approved COVID or flu vaccines.
That loss of approval would be disastrous, Daskalakis, Havers and others say.
Changes to the federal Vaccine Injury Compensation Program could also seriously undermine vaccine access. The program, which compensates people who suffer rare side effects from certain vaccines, was established in 1988 after a tidal wave of lawsuits threatened to drive vaccine makers from the American market. If Kennedy decides to exempt any shot that falls under the fuzzy rubric of “shared clinical decision-making” from this program – and if nobody stops him – vaccine makers may once again threaten to leave the U.S. market.
Kennedy could also drive those companies away by adding autism to the list of conditions for which they are potentially liable. (Decades of research has debunked the assertion that vaccines cause autism. But Kennedy and his supporters have proved astoundingly impervious to that evidence.) “They will stop selling vaccines here,” Havers said. “And regardless of what ACIP says, regardless of what FDA says, regardless of what your doctor says, and regardless of what you actually want, if companies don’t sell them, people can’t get them.”
We don’t have to wonder what that future will look like. We can glimpse it already in communities across the country where measles and whooping cough are resurgent and where infants and young children have already died from both. We can also see it foretold in the current flu season: this year’s flu vaccine has proved an imperfect match to the currently circulating strains. New shots, based on mRNA technology, would have one day enabled us to avoid this kind of misfire. But the nation’s leaders have imperiled that future with the decisions they made this year.
It should not surprise anyone that 2025 – when the nation’s most prominent anti-vaxxer rose to the highest health office in the land – is ending with our vaccine policies in disarray and our access to vaccines increasingly imperiled.
Kennedy has brought us to this precipice by aggressively subverting nearly every process and protocol that previously governed our public health institutions. He has granted political appointees enormous sway over agency scientists. He has excluded people with meaningful expertise from his planning and deliberations. And he has fired dissenters all the way up to the CDC director and replaced them with lackeys, sycophants and wellness grifters.
The relentless norm-shattering is not just a byproduct of Kennedy’s larger plans; it is a central feature. Bureaucratic changes to arcane and acronym-laden programs are easy to overlook or forget after a brief flash of indignation, especially in a world saturated with bleak, worrisome headlines. But it’s through that overlooking that we may eventually lose vaccines altogether.
Vaccines are a triumph of human ingenuity, modern medicine and public health. With them, we have beaten back smallpox, chickenpox, yellow fever, polio, measles, mumps, rubella, hepatitis B, COVID, meningitis and more. If Kennedy continues to force the nation down the course he’s now set, we will be left to explain to future generations how we came to abandon them.
