was originally reported by Barbara Rodriguez of .

Dr. Lara Jones still remembers her visceral reaction to the image of Liam Ramos. It wasn’t the most famous one, of with ICE officers behind him. It was one from days later, of Liam while both were in custody in Texas.

“He looked pale, he looked sickly. He looked like a completely different child,” she said. “When I saw that image, my doctor brain turned on. I was like, this kid is sick. He needs medical attention.”

Jones, who is double board-certified in pediatrics and pediatric critical care medicine, can quickly assess a lot based on a child’s appearance.

“I can tell in the first 10 seconds that I look at you from the door, before I even put my hands on you, before I put a stethoscope on your chest — I can look at you, and I can know right away, you are going to be fine, or you are really sick and you need attention,” she added. “He looked very sick.”

Jones couldn’t sleep that night. Liam’s well-being consumed her while at work the next day at a California hospital. After a round of patient visits, she went into a private room and “broke down and cried.” She needed to do something.

Since then, Jones has become part of — all pediatricians, all mothers — in immigration detention out of concern for their health. They warn that the detention of these children is causing severe and lasting harm to their mental and physical health, and say that of kids allegedly facing delayed and inadequate medical care under DHS demands urgency and transparency.

“We are traumatizing children, and we are putting them in dangerous environments,” Jones said.

These doctors are in detention, to help families in need of emergency assistance and to demand accountability so that children who remain in custody receive evidence-based standards of care.

“We are mothers of young children, and we are doing all of this in between shifts, after working night shifts, during nap time,” Jones said. “We are just doing as much as we can, in the time that we have, while we are working full time and being full-time moms.”

Just weeks ago, Jones and the other women — Dr. Ashley Marie Cozzo of Connecticut and Dr. Anita K. Patel of Washington, D.C. — did not know each other personally. Now they’re in contact daily through a group text that pings at all hours of the day. They use the chat to think through advocacy ideas, to troubleshoot potential challenges and to align their priorities.

“We’re trying to figure out every day in our brainstorming, ‘What’s next? What’s next?’” said Cozzo, who is double board-certified in pediatrics and neonatal-perinatal medicine. “I love a group project, and this is such a unique situation.”

Patel, who is double board-certified in pediatrics and pediatric critical care medicine, said the quick camaraderie among the women has “reinvigorated” her after years of online campaigns around unrelated advocacy issues.

“You have three critical care doctors for kids, and there are certain qualities inherent in pediatric critical care specialists — we will not stop until we have either saved a kid or we know that there is no chance of saving them,” she said. “We all have that personality, because literally that’s what we do in our jobs.”

Liam’s story propelled their cause. As the image of Liam seemingly in a lethargic state ricocheted across the internet, the women shared their outrage with medical peers. Jones and Cozzo circulated a small online petition calling for Liam to be returned home, and amid the national outcry, . (The Ecuadorian family has an active asylum case, and it’s unclear for now whether they will be able to permanently stay in the United States.)

The doctors then connected with Patel, and the three agreed to work together to bring more awareness to other children in detention. Patel said the power of imagery catapulted Liam’s story.

“If he was an older kid, or even if he was Liam without the bunny hat — the outcry may not have come,” Patel said. “And all I could think was Liam deserved that outcry, and every single kid in detention needs that outcry.”

The trio has fixated on the Dilley Immigration Processing Center, the facility near San Antonio that houses families, in part because they are in frequent communication with a journalist, Lidia Terrazas, on people impacted by detention.

When Terrazas highlighted in early February the story of a 2-month-old baby named Juan Nicolás, the case crystallized the doctors’ urgency. The boy had been in respiratory distress while at Dilley, but had allegedly received delayed care as his condition worsened. He was sent by ambulance to a hospital on February 16, according to Patel, after an unresponsive episode where detention officials could not wake him. DHS later deported the baby, his mother and other family members, including a 16-month-old, to Mexico.

Jones was able to connect by text with Mireya López Sánchez, Juan Nicolás’ mother. The postpartum mother said that her milk had dried up while at Dilley. Patel is still nursing her toddler; the parallels — the universal urge a mother has to feed her baby — linger for her.

When Patel nurses her own child, “I think of Mireya, whose milk dried up because she was so stressed and nutritionally deficient that she couldn’t breastfeed, and then when she couldn’t breastfeed, then she couldn’t afford clean water that wasn’t brown or smelled like chlorine to make formula.”

, which has partnered with the doctors to raise money for commissary funds, detainees at Dilley have to spend $40 to buy a four-pack of large water bottles and $35 for a 12-pack of small water bottles.

A spokesperson for DHS did not respond to a request for comment from The 19th, but the agency of malnourished or mistreated children and claims people in detention have access to medical care and adequate food. Emergency crews were called to the facility at least 11 times since September for children with symptoms including bronchitis, respiratory distress and fever, .

CoreCivic, a private company that runs the Dilley facility, deferred questions to DHS but that claims of inadequate medical care are inaccurate and “directly contradicted by the comprehensive, around-the-clock care delivered by our licensed physicians, dentists, advanced practice providers, nurses and mental health professionals.”

Jones doesn’t buy that when it comes to Juan Nicolás, whose mother reportedly told officials that her newborn was having difficulty breathing and was vomiting. Mireya said that instead of being seen by a medical professional, guards at the facility monitored the newborn for two days before he was sent to the hospital in distress.

“I don’t know what they were assessing, but they’re not assessing it through the lens of a pediatric expert,” Jones said. “They’re not doing the appropriate medical workup. So that case alone is proof of delayed care and denied appropriate care, because the appropriate care for a 2-month-old with difficulty breathing and vomiting is to go to the emergency department.”

Cozzo noted that several children died in 2018 and 2019 while in immigration , or . In 2023, — reportedly after her mother repeatedly sought medical care for her.

“We have a precedent of the highest degree of loss: children’s lives,” Cozzo said. “It has happened before, the things that these women are worried about — it’s only going to be a matter of time before we don’t learn from the mistakes of the past and another child dies.”

As the doctors circulated Juan Nicolás’ story online, they connected to help . They also helped secure a hotel room for Juan Nicolás’s family amid their deportation to Mexico. They are now raising money . As they hear of specific cases, including those of and , they try to spring into action by either raising public awareness or funds.

The medical community has long expressed alarm about how children’s health can deteriorate in immigration detention. concluded that children’s mental health suffers and there’s a cascade of ripple effects, including anxiety disorders, depression and developmental regression and delays. The issue has been examined , with similar outcomes.

There are also standards of care for immigrant children in detention, and states that children should not be detained for more than 20 days. But that some children are being held in detention for much longer — weeks or months. The publication estimated at the time that at least 3,800 children under 18 had been booked into ICE since President Donald Trump, who campaigned on mass deportation, returned to office. More than 1,300 children were held last year for longer than 20 days.

The American Academy of Pediatrics (AAP) has its call for limited exposure of children in DHS facilities. Dr. Sural Shah is chair of AAP’s Council on Immigrant Child and Family Health. She said the council, which was very responsive during the first Trump administration’s family separation policy, has been accelerating its work in recent months.

“We’re always active, always sharing information. But the era that we’re in now — it’s been a heightened sense of need, of urgency, of hey, this is happening, and we need to do something about it,” she said. “We need to figure out how to band together, how to lift up voices, how to gather health care professionals and folks that care about children’s health to stop these practices because they’re so harmful to children.”

Shah added that she’s not surprised that pediatricians are leading organic advocacy efforts.

“It is something that is deeply woven into the fabric of who pediatricians are,” she said. “We have a deep understanding of the range of factors that affect children and their families.”

Over the past few weeks, the trio of doctors began drafting and circulating a letter, which was later signed by thousands of medical professionals, to be sent to DHS officials and several key senators with roles in immigration enforcement oversight. , dated February 26, alleges unsanitary detention conditions and inadequate access to food and clean water. It also expresses concerns of a measles outbreak within the Dilley facility. Infants are typically too young to be vaccinated against measles.

Kristi Noem’s ouster as head of DHS last Wednesday doesn’t alter the demand for accountability, said Cozzo.

“I actually don’t necessarily think that changing the face changes anything, because it’s just a complete system that is broken,” she said.

All three agreed that the letter is a start.

“This letter is day one of a marathon,” said Patel, who was a guest of Democratic Rep. Joaquin Castro at the recent State of the Union address, with the goal of elevating the issue. “The point of the letter was to clearly and succinctly as possible, dictate what has been documented as known medical negligence or medical harm or human rights violations.”

They want to grow public pressure while helping as many children and their families as possible. Jones said their advocacy is about the health and well-being of children. She doesn’t see that as political.

“This is an issue about child welfare,” she said. “I feel like if we can continue to stand our ground about the fact that we are causing preventable, measurable, well-studied, predictable harm to children that is not justified. There’s no context in which that is justified, and so I think we just have to continue to get that message across — to the public, to lawmakers. There will be challenges at every step of the way, no doubt, but I think the truth and what’s right is on our side.”

It is up to individual states to determine if they want to adopt the newly announced Centers for Disease Control and Prevention recommendations that now advise universal vaccination against 11 diseases — down from 17.  

The new guidelines will lead to “more splintering of vaccine policies” and a patchwork system, warned vaccine law expert Richard Hughes, who also predicted legal challenges to the way the change was implemented.

Northe Saunders, president of the pro-vaccine advocacy organization American Families for Vaccines, said “there’s going to be a red-state, blue-state divide where blue states look to the science, and red states look to the ill-conceived recommendations of the federal government.”

“With differing vaccine schedules state by state,” he continued, “parents aren’t going to know what the right thing to do for their family is.”

The new guidelines continue to universally recommend vaccines against 11 diseases including measles, mumps, rubella, polio and tetanus. But, shots protecting against a number of other diseases will no longer be recommended and will only be available for certain high-risk groups or after a consultation with a medical professional, also known as shared clinical decision-making. 

These include meningococcal disease — which causes meningitis — hepatitis A, hepatitis B, rotavirus and respiratory syncytial virus, more commonly known as RSV, the

CDC officials said their decision will more closely align the United States with other peer nations, mirroring a policy objective voiced by President Donald Trump in December, but one that critics claim is a false equivalency meant to further the administration’s anti-vaccine agenda.

“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” Health Secretary Robert Kennedy Jr., a longtime vaccine skeptic, said Monday. “This decision protects children, respects families, and rebuilds trust in public health.”

Sean O’Leary, chair of the American Academy of Pediatrics Committee on Infectious Disease, said Monday “what was announced today is part of a decades-long effort on the part of the health secretary to spread fear and falsehoods about vaccines. This is another step in the secretary’s effort to dismantle the U.S. vaccination system.”

While shared clinical decision-making for these vaccines “may sound good on its surface, it’s actually really problematic,” said O’Leary. Pediatricians are already having these conversations with parents before vaccinating their kids. Shifting the recommendation won’t strengthen those exchanges, “it just makes things more confusing for parents and clinicians,” he said.

The American Academy of Pediatrics will continue to recommend kids get vaccinated against all 17 diseases, and multiple states have already banded together to form regional health alliances and establish their own vaccine recommendations. In September, the governors of California, Oregon and Washington created the to “ensure residents remain protected by science, not politics.”

Later that month, several others announced the . While neither alliance is solely focused on immunization policy, both have stated goals of science-based vaccine recommendations and equitable access to shots.

At the same time, Florida Gov. Ron DeSantis veered towards a vastly different approach, announcing the state’s intention to become the first to drop all vaccine mandates, including for schoolchildren. State officials have since taken steps towards making that goal a reality.

‘Children’s lives are at stake’

William Moss, director of the Johns Hopkins’ International Vaccine Access Center, told The 74 this week’s dramatic shift in the CDC’s recommendation “will lead to more disease and potentially some deaths in children in this country that could have been prevented.”

The process that led to the changes represents a sharp departure from past practices, which would have required extensive research, a forum for public comment, an opportunity for relevant stakeholders — such as vaccine manufacturers and pediatricians — to weigh in and a formal meeting of the CDC’s Advisory Committee on Immunization Practices, also known as ACIP. 

Significant changes such as the one announced Monday were historically “very deliberate by design,” said O’Leary because “literally children’s health and children’s lives are at stake.”

None of those steps were followed here, said Hughes, a George Washington University law professor.

“These are not rigorous analyses,” Hughes said. “These are not people who are qualified to be making these decisions. They’re not grounded in evidence. And for that reason they are unlawful.”

Kennedy last year fired all 17 ACIP members, replacing them with hastily hand-picked advisors who largely share his views on vaccines. It has since voted to overturn a recommendation that all newborns receive the hepatitis B vaccine; change policies surrounding the measles, mumps, rubella and varicella (chickenpox) combination vaccine; and roll back recommendations around 2025’s COVID 19 booster. 

The decision to change the childhood vaccine schedule in a much more far-reaching way did not go through ACIP, and the premise it was based on — to more closely match U.S. policy with those of other wealthy nations such as Denmark — is not a sound one, according to medical experts.

“You can’t just copy and paste public health,” said O’Leary, who argued there are fundamental differences between the counties that lead to very different needs.

Moss echoed this point: “Denmark has a universal health care system where we have this very fragmented, insurance-based health care system. Denmark’s the size of Wisconsin, so [the U.S. is] just a much bigger country, a more complex country.”

And, when it comes to diseases such as hepatitis B, Denmark has much stronger screening rates.

While HHS claimed all vaccines previously recommended will remain fully covered by insurance and available to parents who want to vaccinate their kids, others are less sure. According to O’Leary, HHS leaders appear to have misunderstood how insurance companies determine coverage: Historically vaccines recommended for high-risk groups are only covered for children included in that group.

At the very least, doctors and advocates argue, the shift will put up additional barriers in an environment that is already filled with vaccine hesitancy and confusion, inevitably leading to diminished uptake and, ultimately, more sick kids. Health care providers may also start stocking fewer vaccines, making it harder for families to access them. 

There also remains uncertainty around who can actually participate in the shared clinical decision-making; in some states, this may mean that pharmacists can no longer administer vaccines, such as RSV, independently. 

And even if the shots remain available, this week’s action by the CDC will likely further undermine confidence in vaccines, as immunization rates are already falling and diseases are on the uptick. 

In 2025, there were 2,065 confirmed measles cases — the most recorded since the U.S. deemed the virus eliminated a quarter-century ago. The vast majority of cases were in unvaccinated kids, died. 

Flu cases this season are also rising at a faster rate than in previous years, There have been 7.5 million cases so far, leading to 81,000 hospitalizations, and 3,100 deaths — including eight children. Despite this week’s updated guidance, the still recommends everyone 6 months and older receive a flu shot. 

If such a change goes into effect, “pediatric hospitals will be overwhelmed with [childhood] infections that have virtually been non-existent for the last 40 years,” said Florida-based infectious disease specialist Frederick Southwick. Southwick attended a Dec. 12 public comment workshop on the issue hosted by the Florida Department of Health. 

“We’re in trouble right now,” he added, pointing to and the likelihood that some diseases could become endemic. “We’re getting there, and this [ending the mandate] would just do-in little kids.”

The session delved into the proposed language the department has drafted for a rule change that would do away with vaccine mandates for four key immunizations: varicella, more commonly known as chickenpox; hepatitis B, pneumococcal bacteria and Haemophilus influenzae type B, or HiB. Currently, children cannot attend school in Florida without proof of these four immunizations, among others, including the measles, mumps and rubella vaccine. 

Although Florida is not considering removing the mandate for the MMR vaccine, health experts see the move it is contemplating as eroding childhood immunization generally. It comes when in South Carolina because of a burgeoning measles outbreak.

Rana Alissa, president of the Florida Chapter of the American Academy of Pediatrics, was also in attendance to express her concerns. She told The 74 this week that thanks to the success of vaccines, she’s never had to treat some of these “horrible diseases,” including HiB, which can lead to meningitis.

“Don’t make our kids — Florida’s kids — guinea pigs to teach me and my classmates and other pediatricians how to manage these diseases,” she implored.

Tallahassee parent Cathy Mayfield lost her 18-year-old daughter, Lawson, to meningitis in 2009, a few months before she was supposed to leave for college and just before she was due for a booster shot. (At the time, the booster was not recommended until college, according to Mayfield.)

“You just don’t realize until it happens to you,” she said.

She hopes others will learn the importance of vaccinating their own kids from her family’s story. 

“All the information I learned through our tragedy about vaccinations made me very supportive of the safeguards [they] offer,” she said.

“You’ve also got to realize,” Mayfield added, “that your decisions affect your community, and that’s something I think has gotten lost in … all this conversation and hesitancy about vaccinations.”

Equating vaccine mandates to slavery

The workshop, which was announced the day before Thanksgiving, was held in Panama City Beach, in the Florida Panhandle, far from the state’s main population centers. About 100 people showed up to the session, which was characterized by attendees as but civil. Northe Saunders, president of the pro-vaccine advocacy organization and who was there, estimated that about 30 people spoke in favor of keeping the current vaccine mandates, while approximately 20 spoke in opposition.

Some speakers opposed to vaccine mandates included conspiracy theories in their arguments, according to news reports and numerous people present at the workshop, echoing language heard from the federal government since Secretary Robert F. Kennedy Jr., a long-time vaccine skeptic, took over the Department of Health and Human Services.

One attendee argued that giving children multiple jabs in a 30-day period “accounts to attempted murder,” according to . A number of others questioned if this year’s reported measles outbreaks, which resulted in the in Texas, had actually occurred.

Florida leaders’ desire to become the first state to was announced in September by its surgeon general, Joseph A. Ladapo, standing beside Gov. Ron DeSantis in the gym of a private Christian high school. In sharing their plan, Ladapo claimed that “every last [mandate] is wrong and drips with disdain and slavery.” 

Only four vaccines are mandated through a Department of Health rule and are therefore under Lapado’s purview. The remaining nine, which in addition to the MMR shot include polio, are part of state law and can only be changed through legislative action. 

Experts told The 74 this is a much more difficult feat, one that state legislators — even conservative ones — don’t seem to have an appetite for. Richard Hughes, a George Washington University law professor and leading vaccine law expert, said such a legislative attempt would “warrant legal action.”

‘We really need to turn this around’ 

The debate in Florida and other states over mandatory childhood immunization comes as the country teeters on the edge of losing its measles elimination status. This year alone has seen nearly confirmed cases, the most since 2000, when measles was declared eliminated in the U.S. by the World Health Organization. Just over 10% of cases have led to hospitalization. The current South Carolina outbreak has infected at least , and among those forced to quarantine are students from nine schools. 

Significant educational implications from the outbreaks emerged in a by the Annenberg Institute at Brown University, which found that absences increased 41% in a school district at the center of the West Texas outbreak, with larger effects among younger students.

The spread of measles is also a warning of the ramifications of dropping vaccine rates, according to William Moss, executive director at Johns Hopkins’ International Vaccine Access Center.

“Measles often serves as what we [call] the canary in the coal mine,” he said. “It really identifies weaknesses in the immunization system and programs, because of its high contagiousness.”

“Unfortunately, I see a perfect storm brewing for the resurgence of vaccine preventable diseases,” he added, “… We really need to turn this around.”

Earlier this week, the Centers for Disease Control and Prevention , and in the preceding months changed policies surrounding the measles, mumps, rubella and varicella (chickenpox) combination vaccine and this year’s COVID 19 booster — all based on recommendations from an advisory committee hand-picked by Kennedy. The universal birth dose of the hepatitis B vaccine, in place for decades, was credited with nearly eliminating the highly contagious and dangerous virus in infants.

Lynn Nelson, the president of the National Association of School Nurses, fears that other, more conservative states will now look to Florida as an example.

“We already have seen outbreaks all over, and they’re only going to escalate if you have an area of the country whose herd immunity levels slip down further than they already are, which I think will happen if those [anti-mandate rules] come into effect,” she said. “That, in combination with some of the other misinformation that’s coming out, people will feel validated in decisions not to immunize their children.”

Florida’s Department of Health appears to be moving ahead to end requirements for the four vaccines it controls, despite indicating nearly two-thirds of Floridians oppose the action. Proposed draft language presented at the Dec. 12 workshop would also allow parents to opt their kids out of the state’s immunization registry, Florida SHOTS, and expand exemptions. 

Currently, all 50 states have vaccine requirements for children entering child care and schools. Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons and most states — including Florida — also have religious exemptions. Part of the proposed changes presented at the Dec. 12 meeting would add Florida to the 20 states that additionally have some form of , further widening parents’ ability to opt their kids out of routine vaccines. 

The public comment period remains open through Dec. 22, after which the department will decide whether or not to move forward with the rule change. In the interim, advocates are pushing state health officials to conduct epidemiological research around the impact of removing the vaccine mandates and studies on the potential economic costs. Florida is and out-of-state visitors. 

Without that information, pro-vaccine advocate Saunders said these critical public health care decisions will be made “at the whim of an appointed official.” 

“The nation,” he added, “is looking at Florida.”

The decision came in an 8-3 vote from the committee that has been handpicked by Health and Human Services Secretary Robert F. Kennedy Jr., a long-time vaccine skeptic. It followed three previous failed attempts to vote on the measure and two days of contentious, confused hearings that further undermined the group’s credibility.

Amy Middleman, a longtime committee liaison and a University of Oklahoma pediatrics professor, said it was the first time the committee “is voting on a policy that, based on all of the available and credible evidence … actually puts children in this country at higher risk — rather than lower risk — of disease and death.”

Susan J. Kressly, the president of the American Academy of Pediatrics, which the hepatitis B vaccine at birth, called the committee’s guidance “irresponsible and purposely misleading” and said that it will bring about more infections in infants and children.

“This is the result of a deliberate strategy to sow fear and distrust among families” she said.

The members of the Advisory Committee on Immunization Practices, known as ACIP, who voted in favor of the new guidance said the universal birth dose, first introduced in 1991, had likely played a small role in the reduction of acute cases and noted that the country’s policy was an outlier when compared to those of peer nations, which have more targeted approaches. They also raised concerns about the safety of the vaccine, arguing there were insufficient trials done, a claim that has been widely

The committee’s new recommendations still include a dose of the vaccine within the first 24 hours of life for infants born to hepatitis B-positive mothers. But for those born to mothers testing negative, they recommend “individual-based decision-making, in consultation with a health care provider” to decide “when or if” to give the vaccine. 

Removing the universal birth dose “has a great potential to cause harm,” dissenting committee member Joseph Hibbeln said, “and I simply hope that the committee will accept its responsibility when this harm is caused.”

The committee also voted to upend the rest of the schedule for the hepatitis B vaccine, which is required for school attendance in the vast majority of states and historically included three doses in an infant’s first year. Now, after the first dose, parents will be encouraged to ask their doctors to check infants for a sufficient immune response before proceeding with any future doses, a practice that currently lacks any scientific evidence, according to vaccine experts.

The recommendation now heads to Jim O’Neill, the acting head of the Centers for Disease Control and Prevention, newly installed after September’s of the previously confirmed director, who said she resisted Kennedy Jr.’s demands to pre-approve vaccine recommendations and fire career scientists. 

O’Neill’s decision could impact not only the vaccine’s availability, but also its accessibility, since both public and private health insurers look to these policies to determine coverage. 

“The American people have benefited from the committee’s well-informed, rigorous discussion about the appropriateness of a vaccination in the first few hours of life,” O’Neill said in a statement Friday.

Former CDC director Rochelle Walensky, now a Harvard University medical professor who recently co-authored on the importance of the hepatitis B birth dose, projected that eliminating it for infants whose mothers test negative will raise the number of newborn hepatitis B cases by 8% each year.

“We rely on an infrastructure of vaccines not only to protect ourselves and our children, but to protect our communities and one another,” Walensky said. “Today’s meeting was just another one of those chisels in the infrastructure.”

Paul Offit, the director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, referred to the committee as “a clown show” in an interview on CNN Friday morning.

“Honestly, it’s a parody of what this committee used to be,” he said. “It’s hard to watch, and for those of us who care about children, it’s especially hard to watch.”

Offit said he doubted that the committee understood how hepatitis B was transmitted in young children — half the time through the mother during childbirth but just as often through casual contact with someone who was chronically infected and didn’t know it. About infected with hepatitis B are unaware of it.

“By loosening the [immunization] reins, you are just putting children in harm’s way,” Offit said.

The hepatitis B vaccine was first recommended by ACIP in 1982. Before that point, an estimated 200,000 to 300,000 people, including about 20,000 children, were infected with the highly contagious virus each year. 

This was particularly dangerous for infants who have a 90% chance of developing liver cancer or chronic liver disease, if they contract the virus. For 4- and 5-year-olds, that chance remains high at 30-40%.

Committee members argued the guidance change reflected a return to pre-1990s policies that focused on a targeted approach, rather than a universal one. A number of them said that these earlier practices were successful and sufficient in cutting hepatitis B rates, a claim other experts — including those at the CDC — refuted. 

In a departure from typical practices, presentations on disease rates and safety concerns at the hearing were not given by CDC subject-matter experts, but instead were led by a climate researcher and a known anti-vaccine activist, who authored a paper on the impact of rising autism rates. 

When one CDC hepatitis B expert was invited to weigh in during a question-and-answer period, he expressed concern about the presented research and emphasized the lack of evidence to support the committee’s changes. Middleman jumped in at one point to correct the committee when it misinterpreted “the conclusions of my own study.”

Throughout the meeting, Kennedy Jr.’s appointees spoke about the importance of protecting parents’ rights, seemingly pitting this against public health policy. 

“My personal bias is to err on the side of enabling individual decision making and individual rights over the right [of] the collective,” said Robert Malone, the committee’s vice chair who led the meeting since chair Kirk Milhoan, a cardiologist and critic of the COVID vaccine for children, was unavailable to attend in person.

Earlier this year, the committee also voted to change policies surrounding the measles, mumps, rubella and varicella (chickenpox) combination vaccine and this year’s COVID 19 booster.

Historically, committee members were highly qualified medical professionals, vetted for months to years before serving. But, in an unprecedented upheaval in June, Kennedy Jr. fired all 17 existing advisory members via — after promising he would leave the committee’s recommendations intact — and hastily replaced them. 

Many of the new members have espoused anti-vaccine rhetoric and other scientific misinformation and a number of them do not have medical degrees or significant experience in the field. 

Cody Meissner, a professor at Dartmouth’s Geisel School of Medicine and the only committee member to have previously served, also opposed the guidance change.

 “We’ve heard ‘do no harm’ is a moral imperative,” he said. “We are doing harm by changing this wording, and I vote no.”

The committee vote was the latest in a wave of policy changes, firings and general chaos at the CDC and HHS that have alarmed experts since Kennedy Jr. took charge almost a year ago. 

Last week, the Food and Drug Administration’s chief medical and scientific officer released an unsupported memo claiming COVID-19 vaccinations had of at least 10 children. Last month, Kennedy Jr. ordered CDC staff to change information on their website to promote a link between vaccines and autism, an overwhelmingly discredited theory that he has promoted for years.

According to Offit, the negative impacts are already being seen: This year tallied the greatest number of measles cases (1,828) since it was declared eliminated in 2000. The majority of them were in unvaccinated children, two of whom died, marking the first pediatric measles deaths since 2003.

There have also been nearly 300 childhood flu deaths — among predominantly unvaccinated kids — the most seen since the country’s last flu pandemic and whooping cough cases are The highly contagious respiratory infection, prevented through the DTaP vaccine, has in Kentucky.

was originally reported by Barbara Rodriguez of . .

Although a majority of Americans are confident that childhood vaccines are highly effective against serious illness, Republicans’ trust in vaccine safety and support of school requirements is dropping, .

Sixty-three percent of Americans are extremely or very confident in the effectiveness of childhood vaccines, according to a survey published Tuesday. But Democrats and those who lean Democrat are much more likely than Republicans and Republican-leaners to hold that view — 80 percent versus 48 percent.

Get stories like this delivered straight to your inbox. Sign up for The 74 Newsletter

And while the majority of Americans believe in the safety of vaccines — 53 percent believe childhood vaccines have been tested enough for safety and 51 percent agree that the is safe — there is significantly more uncertainty among Republicans. For Democrats, 74 percent show high confidence in the safety testing of vaccines and 71 percent believe the childhood vaccine schedule is safe. For Republicans, those numbers are 35 percent and 32 percent, respectively.

“Both things can be true, that people believe in vaccines’ effectiveness overall and the confidence is a little softer on safety,” said Eileen Yam, director of science and society research at Pew who was part of the primary research team. “But writ large, that’s been pretty stable to see confidence in vaccines. But at the same time, when it comes to things like school requirements, or ‘telling me what to do,’ or requiring me to do something — that’s where you see the bristling on the Republican side.”

Americans have become more skeptical of requiring that children get the measles-mumps-rubella (MMR) vaccine to attend public school. Sixty-nine percent support it, a decline from 82 percent in 2016. Most of the drop can be attributed to Republicans — with just 52 percent believing in the requirement, compared to 79 percent in 2016. For Democrats, that support was 83 percent in 2016 and actually climbed to 86 percent this year.

This all comes amid that started in Texas and . And while students are required in each state to get the MMR vaccine to attend public school, have indicated a willingness to drop that requirement.

Pew found broad and consistent support for the MMR vaccine: 84 percent believe its benefits outweigh its risks (). When Pew first started asking about this in 2016, support was at 88 percent. Yam said the findings show some agreement on the benefits of the MMR vaccine. While 92 percent of Democrats believe the benefits of the vaccine outweigh the risks, 78 percent of Republicans do, too.

Health and Human Services Secretary Robert F. Kennedy, an anti-vaccine activist who has that helps decide vaccine policy, . He has the backing of President Donald Trump, .

Pew surveyed parents and found a majority with minor children (57 percent) say they are extremely or very confident in childhood vaccines’ effectiveness. Republican parents are far less likely than Democratic parents to have that confidence (45 percent versus 71 percent), belief in safety testing (29 percent versus 63 percent) and the childhood vaccine schedule (27 percent versus 58 percent).

Democrats are more likely than Republicans to say medical scientists should have a major role in decisions about childhood vaccines (85 percent vs. 62 percent). There are more partisan fissures on the role of parents: 71 percent of Republicans say that parents of young children should have a major role in policy decisions about childhood vaccines. For Democrats, it’s 46 percent.

“That speaks to just a divergence in trust in science that we’ve been tracking since before the pandemic,” Yam said. “Just Republicans since the pandemic, their confidence in scientists, the way they look at the CDC has just dropped off much more than on the Democrat side. Democrats have had fairly stable views on scientists and on the CDC, in contrast to Republicans.”

Pew also examined how have influenced Americans’ decisions around getting a COVID-19 shot. The agency recently agreed with Kennedy’s new vaccine panel to stop recommending the shot to everyone and to instead leave the choice up to people. Forty-four percent say they have heard nothing at all about the CDC’s changes to recommendations. Among those who have heard at least a little, 63 percent say it has had no influence on whether they got an updated vaccine.

“The one big takeaway there is that policies really can’t influence behaviors if people haven’t heard about the policies or the recommendations,” Yam said. “And in this case, a lot of people haven’t heard about it, and some when they have, their minds were made up. They’ve already kind of decided, and it really didn’t influence their behavior one way or the other.”

This was originally published on .

The 12 members, who were recently handpicked by controversial Health and Human Services Secretary Robert F. Kennedy Jr., also debated overturning decades of established practice around hepatitis B shots for newborns, though they ultimately tabled that vote.

The other two shots in play were the measles, mumps, rubella and varicella (chickenpox) combination vaccine, also known as MMRV, and this year’s COVID 19 booster. 

By the end of the week, the Advisory Committee on Immunization Practices, also known as ACIP, voted to no longer recommend the MMRV combination vaccine for kids under 4 years old, rendering it largely inaccessible for that age group. 

The committee also voted to shift the COVID 19 booster recommendation to “shared clinical decision making” for all people over 6 months old — regardless of age or risk level — meaning that before getting the shot, individuals will need to talk through the pros and cons with a health care provider, which includes pharmacists. 

Through this departure, the committee largely preserved access and insurance coverage, while also raising doubts about the effectiveness and safety of the vaccine, at times citing debunked theories.

“There is just widespread confusion about, ‘What should I do as a parent? Who should I listen to?’” said Northe Saunders, executive director of the pro-vaccine advocacy organization , formerly called SAFE Communities Coalition. 

“American parents and American providers don’t actually know what the best recommendations are anymore,” he added, “and so that is going to lead to more hesitancy, because there’s uncertainty about what the right thing to do is, and that’s going to lead to declining immunization rates.”

Before the ACIP meeting, MMRV and hepatitis B vaccine recommendations were based on decades of established practices supported by science, which experts described as “settled,” so it was unclear why they were being relitigated, according to numerous medical professionals, including those who spoke during the meetings as well as those interviewed by The 74.

The point of these conversations is, “to raise doubt, to confuse people,” said Paul Offit, the director of the and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. Offit was instrumental in the creation of the rotavirus vaccine and previously served as an ACIP member. 

“The degree to which the public is confused about vaccines is the degree to which they will be less likely to get them,” he said, “and that is RFK Jr’s goal: to make vaccines less available, less affordable and more feared.”

The meetings themselves appeared to be marked by moments of pronounced confusion for the new committee members, some of whom asked for clarification around what they were voting on multiple times.

At least some of this was likely due to their unusual level of inexperience, which committee Chair Martin Kulldorff even noted as he opened day two on Friday.

“We are rookies,” Kulldorff “With one exception, this was either our first ACIP meeting or our second.”

Typically, committee members are highly qualified medical professionals who are vetted for months to years before serving. In an unprecedented upheaval earlier in June, Kennedy Jr. fired all 17 existing advisory members via a Wall Street Journal — after promising he would leave the committee’s recommendations intact. 

Almost immediately he brought on eight new members, a number of whom have espoused anti-vaccine rhetoric and other scientific misinformation. One of them eventually stepped down and Kennedy then added an additional five members leading up to last week’s sessions.

Measles, mumps, rubella and varicella

The MMR vaccine was in the United States in 1971, followed by the MMRV vaccine in 2005. Two doses of the combined shot were preferred until 2008, when monitoring studies showed an increased risk of febrile seizures — convulsions in a young child caused by a fever — following the first dose. 

While these seizures are short-lived, resolve themselves and are not associated with any long-term negative outcomes, “they’re hard to watch,” said Offit.

So by 2009, the CDC released updated recommendations, in place up until Thursday’s vote, which advocate for separating MMR and varicella for the first dose at age 12-47 months and administrating the combined shot for the second dose at age 4-6 years old. These vaccines are among those required for school entry in all 50 states, though numerous states have recently introduced legislation to loosen mandates, and exemptions are on the rise.

The vast majority of parents (85%) opted to follow that recommendation for separating the shots, with 15% still choosing the combination vaccine for the first dose, often to avoid multiple jabs of an infant.

The committee’s recent update to the recommendations will mean that choice no longer exists.

While this change itself is “not a huge deal,” Offit said, the arguments brought up by committee members were “intellectually disingenuous” and will only continue to “raise doubt.”

Stacy Buchanan is a pediatric nurse practitioner and a clinical professor who is the National Association of Pediatric Nurse Practitioners’ liaison to ACIP

“I really feel like this was brought up to just further confuse caregivers that are already questioning whether or not they want to have their child vaccinated,” said Buchanan. “And in a time where we’re seeing unprecedented numbers of measles in communities, I think that we need to be really clear that the MMR vaccine — whether you’re getting the combined or two separate injections — is really key and needs to be administered routinely based on the schedule.”

In past years, the liaisons like Buchanan, who have on-the-ground clinical experience, would weigh in during the committee’s working group meetings to help evaluate the evidence. That precedent was unexpectedly overturned in late July when the liaisons received an email accusing them of being and no longer permitted to serve. Now they can only be heard during the public comment portion of the meetings.

In a statement released Thursday, the American Academy of Pediatrics wrote, “Today’s meeting of the federal Advisory Committee on Immunization Practices (ACIP) promoted false claims and misguided information about vaccines as part of an unprecedented effort to limit access to routine childhood immunizations and sow fear and mistrust in vaccines. Following today’s meeting, instead of emerging with clear guidance about vaccines that we know protect against serious illnesses, families are left with confusion, chaos and false information.”

The AAP also emphasized that they had released their own , which includes unchanged MMRV vaccination recommendations.

Committee members elected for the combination shot for those under 4 to remain covered by Vaccines for Children, which provides vaccines to millions of kids who otherwise wouldn’t be able to afford them, despite their recommendation against its use. Some members apparently misunderstood what they had voted on Thursday and reversed their stance the next morning. 

COVID 19 booster

On Friday, the committee voted on four measures surrounding the COVID 19 booster shot. Three passed, and the fourth, which was the most controversial and would have recommended required prescriptions for anyone seeking to get the shot, ended in a tie vote that ultimately failed.

During his presentation, Retsef Levi, put in charge of the working group on COVID, raised a number of concerns around mRNA vaccines that have been widely disputed, including the assertion that they could change the way the body reacts to its own genetic material. Levi is a professor of operations management at MIT’s Sloan School of Management and has no formal medical training.

The three provisions that did pass will mean that while the vaccine is not actively recommended for anyone — including those at high risk of infection — those over the age of 6 months can access it as long as they make the decision in conjunction with a health care provider.

Richard Hughes, a George Washington University law professor and leading vaccine law expert, said the committee appears to be using the practice known as “shared clinical decision making,” because it “gets at that medical freedom rhetoric — and provides an option other than ‘no recommendation’ — but is not a good option.”

While this sort of policy sounds like it’s creating greater choice, ultimately evidence shows it leads to struggles for health care providers who haven’t been given clear risk factors, Hughes said. This can be cumbersome, time consuming and lead to patient distrust.

“When you know that it’s an automatic ‘you should get it’ that’s different than ‘I don’t know, it’s kind of murky,’” he added.

The new policy is particularly confusing, said Offit, since last month the Food and Drug Administration only licensed the boosters for those . 

“The good news is, anybody can use it,” Offit said, “even though, according to the FDA, they’d be using it off label. But we don’t recommend it for anybody. Basically, that’s what they’re saying.”

He described this as a “bad choice” which will lead to fewer people being vaccinated and fragmented state-by-state policies.

Earlier this month, the governors of Washington, California and Oregon announced they’d be forming to establish their own vaccine recommendations, which Hawaii quickly joined. A few weeks later, seven northeastern states, including New York and Pennsylvania, formed with a similar goal.

Hepatitis B

The hepatitis B vaccine was first recommended by ACIP in Before that point, an estimated 200,000 to 300,000 people, including about 20,000 children, were infected with the highly contagious virus each year. 

This was particularly dangerous for infants who have a 90% chance of developing liver cancer or chronic liver disease, if they contract the virus. For 4- and 5-year-olds, that chance remains high at 30-40%.

At one point, the vaccine was only recommended for infants whose mothers tested positive for the virus, since it can be transmitted during birth, but for a number of reasons — including inaccurate test results — this was found to be ineffective. So by 1991, ACIP’s recommendation was expanded to include universal birth doses. Since then, infant infections have dropped by 95%.

According to Offit, the birth dose “has always been a target of anti-vaccine activists,” since the hepatitis B virus can be transmitted sexually. But it can also be transmitted in many other ways, including through surfaces. 

On Thursday, ACIP members were meant to vote on an updated recommendation which would have delayed the initial dose until an infant is one month, a move that would likely lead to a serious reduction in uptake, according to doctors.

Ultimately, after hours of arguments, which included research Offit called “bogus,” the committee ran out of time to vote on the measure Thursday. Friday morning they chose to table it indefinitely. 

Buchanan, the nurse practitioner, expressed concern that the safety of the well-established vaccine was even being reargued in the first place: “The ‘why’ was never there, and that’s so important, because we should not be bringing things to a formal ACIP committee vote without having a science-based rationale for bringing the question forward.”

While Hughes was relieved the vote was punted, Offit was more pessimistic, expressing fears that the committee will eventually try to push the first dose even later than one month.

“And that would be a tragic decision,” he said. “That would mean that there will be children in this country who will get hepatitis B in the first year of life, or in childhood … which will limit their life for no reason.”

Eleven of 12 Democratic Senate Finance Committee members called on Robert F. Kennedy Jr. to resign Thursday just before a charged — and at times explosive — committee hearing with the embattled health secretary.

Committee Democrats and two Republicans, both of them physicians, accused Kennedy of peddling misinformation, pressuring officials to rubber stamp policies not based on science and making it harder for Americans to access COVID vaccines. Sen. Maria Cantwell, D-Washington, called Kennedy a charlatan.

Sen. Michael Bennet, D-Colorado, said he was questioning Kennedy on behalf of “parents and schools and teachers all over the United States of America who deserve so much better than your leadership.”

Sen. Maggie Hassan, D-New Hampshire, accused the secretary of denying parents the right to vaccinate their children against COVID.

“You’re making things up to scare people,” Kennedy loudly interrupted. “And it’s a lie.”

Kennedy defended his running of HHS, which was thrust into turmoil after his decision last week to fire the Senate-confirmed Centers for Disease Control and Prevention director, issue confusing new COVID vaccine guidelines and cut funding for mRNA vaccine research, among other contentious moves. A number of committee Republicans applauded Kennedy for his work, noting he had reduced spending and shifted the agency’s focus to “promoting prevention first.”

During a moment that appeared to confuse senators, Kennedy said he had fired former CDC head Susan Monarez because he asked her, “Are you a trustworthy person?” and she replied, “No.” Several in response cited Monarez’s claim that that she’d sign off on forthcoming recommendations from a newly installed vaccine committee. Kennedy refuted these claims and repeatedly accused Monarez of lying.

He also appeared to double down on his assertions that childhood vaccines and autism are linked, citing

Sen. Tina Smith, D-Minnesota, attempted to push the secretary on his past statements: “When were you lying, sir? When you told this committee that you were not anti-vax, or when you told Americans that there’s no safe and effective vaccine?”

“Both things are true,” he replied.

Kids are heading back to school this fall as the country experiences some of the lowest childhood vaccine rates and highest levels of public health uncertainty in known memory.

Amid the swirling currents: the defunding of vaccine research and competing messaging around COVID shots for children; a rare federal attempt to influence a West Virginia legal battle over childhood vaccine exemptions; and a dramatic leadership struggle within the Centers for Disease Control and Prevention that could solidify more power in the hands of Health and Human Services Secretary Robert F. Kennedy Jr. 

Kennedy is seen by many as the destabilizing figure at the center of the chaos, and 2025-26 will be the first full school year that the longtime vaccine skeptic is in charge of childhood public health. The controversial secretary, who earned a this week from every one of his predecessors going back to the Carter administration, is scheduled to testify before the Senate Finance Committee later today.

Sen. Bill Cassidy, R-Louisiana, who heads the Senate health committee and played a pivotal role in Kennedy’s confirmation, has of the CDC amid the turmoil, citing children’s health as his major concern.

On Wednesday, three West Coast governors announced they’d be forming to establish their own vaccine recommendations, protesting those of the CDC, which, they said in a statement, “has become a political tool that increasingly peddles ideology instead of science, ideology that will lead to severe health consequences.”

The governors of California, Oregon and Washington said the alliance will “ensure residents remain protected by science, not politics.” Meanwhile, Florida Gov. Ron DeSantis and his surgeon general announced their intention Wednesday to become , including for schoolchildren.

As the states splintered on vaccines, 1,000 current and former HHS staff released formally calling for Kennedy’s resignation, writing that he “continues to endanger the nation’s health.” The group condemned a series of actions including the of the Senate-confirmed CDC director, Kennedy’s refusal to be briefed by CDC experts on vaccine-preventable diseases and his “misleading claims” about physician and hospital liability for following vaccine guidance that he opposes.

They also denounced the Food and Drug Administration’s recent of emergency use authorization for COVID vaccines, which — alongside the the CDC’s newest recommendations — will likely make it significantly harder for children, especially those under 5 years old, to access the shots. Recently released FDA memos show its vaccine chief overruled staff scientists who, citing high hospitalization rates among young children with COVID, recommended a wide range of age groups continue to get the vaccine, according to .

All of this, partnered with Kennedy’s long history of disseminating scientific misinformation, including the debunked claim that vaccines can cause autism, has led to great confusion for parents just as their kids are returning to school. Kennedy has promised to later this month, which he said would expose “what the environmental toxins are that are causing” autism.

“There is a lot of inaccurate information right now coming from the highest levels of HHS,” said Kawsar Talaat, physician and associate professor at the Johns Hopkins Bloomberg School of Public Health, whose research focuses on vaccines. “I would think that for family members, who don’t necessarily have expertise, it would be hard to know who to trust, and it will certainly contribute to a decline in vaccination rates.”

Indeed, during the 2024-25 school year, immunization rates among kindergarteners across the country decreased for all reported vaccines, according to the latest available . Rates for the measles, mumps, and rubella vaccine fell to 92.5% from approximately 95% pre-pandemic. And of states had MMR vaccination rates below the 95% needed for herd immunity, with some, like Idaho at 78.5%, well below it. 

As these numbers were falling, exemptions to mandatory vaccines for school-aged kids were on the rise, increasing to 3.6% nationally, driven by non-medical exemptions and up from in the 2019-20 school  year. Seventeen states — spiking from pre-pandemic — reported exemptions exceeding 5%, threatening herd immunity.

Lynn Nelson is the president of and has seen this uncertainty and hesitancy firsthand.

“We get a lot of families who are confused,” she said, “who may have immunized children until this point and now are having second thoughts about it.”

Increasingly, conflicted parents are bringing messages they’ve heard from HHS or Kennedy himself to their school nurses, wondering why they contradict what they’ve historically been told by their pediatricians.

“It tends to be things like, “Well, it sounds like maybe autism is caused by [vaccines]. We want to wait and see,’” Nelson said. 

But as these parents hold off on immunizing their kids, communities remain at heightened risk for infection and outbreak, she added.

And even if medical providers are able to fight the misinformation and have conversations with parents that ultimately lead them to want to vaccinate, some kids might not be able to access the shots, amid funding cuts to public health vaccination clinics in rural areas. 

Vaccine hesitancy also plays out at the district level, since school system leaders are “just as susceptible to misinformation as anyone else” and they often make the decision on whether or not to enforce the policies requiring most children be vaccinated in order to attend school, Nelson said. 

“It’s a question for most of us probably of when — not if — there’s going to be an outbreak.”

Chaos and pushback at the CDC

An already anxious back-to-school season for mandatory immunizations was intensified by the firing of CDC head Susan Monarez on Aug. 27, and her subsequent refusal to leave the post, following a clash over vaccine policy, according to reporting by  

Monarez’s lawyers her removal was “legally deficient,” and said, “the attack on Dr. Monarez is a warning to every American: Our evidence-based systems are being undermined from within.”

She has since been replaced by who has no medical training and, during the pandemic, posted conspiracy theories on social media and voiced support for unproven treatments — such as ivermectin, according to reporting by Before being appointed as acting head of the CDC, O’Neill served as a HHS deputy to Kennedy.

At least four other powerful agency leaders some with claiming they were asked to participate in an unscientific vaccine recommendation process. 

My resignation letter from CDC.

Dear Dr. Houry,

I am writing to formally resign from my position as Director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), effective August 28, 2025, close of business.…

— DrDemetre (@dr_demetre)

In response, CDC employees — a “clap out” protest to show support for their departing colleagues. An August investigation by revealed how badly the department has been depleted under Kennedy, with at least 20,500 total HHS workers gone since January, including at least 15% of all CDC staff.

Last week’s high-profile exodus comes after a tumultuous month: On Aug. 20, over 750 employees of the CDC and other health agencies signed a rare , imploring Kennedy to stop spreading misinformation. The authors argued his rhetoric contributed to an attack earlier that month on their headquarters by a gunman who fired more than onto the agency’s main campus and appeared to be, at least in part, motivated by COVID

“Health and Human Services Secretary Robert F. Kennedy, Jr., is complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information,” the letter reads. The authors accused Kennedy of sowing public mistrust in the CDC’s workforce; firing critical workers; making false and dangerous claims about mRNA and measles vaccines; and misusing data to falsely claim childhood vaccines are the cause of autism.

HHS did not respond to requests for comment on the confusion surrounding vaccine policies nor on the allegations that inaccurate information is coming out of the agency, eroding faith in its work.

In response to mounting criticism, Kennedy published an op-ed in this week, arguing he was, “restoring public trust in the CDC,” which had been destroyed by “bureaucratic inertia, politicized science and mission creep.”

“We have shown what a focused CDC can achieve,” he wrote, citing and defending his response to the measles outbreak, which he said, “was neither ‘pro-vax’ nor ‘antivax.’”

He identified six areas of focus, including investing in the workforce, that he wrote will “restore the CDC’s focus on infectious disease, invest in innovation, and rebuild trust through integrity and transparency.”

The American Academy of Pediatrics recently signaled its lack of confidence by filing a alongside a number of other health care organizations, arguing Kennedy had violated federal law and made “ unscientific changes to federal vaccine policy” by moving to curb COVID vaccines for young children. The plaintiffs include an immunocompromised mother to two teenage boys who were denied COVID vaccines. 

They’ve also issued their own guidance, the COVID vaccines for all young children. Kennedy responded to this move on X, calling it a “list of corporate-friendly vaccine recommendations” and “perhaps, just a pay-to-play scheme.”

Last week, the Food and Drug Administration approved updated COVID vaccines, but with new restrictions: they’ll only be available to people 65 and older or younger people with at least one underlying medical condition that increases their risk for severe disease. In a post on Kennedy said the Moderna vaccine had been approved for use in those older than 6 months, Pfizer in those older than 5 years and Novavax in those older than 12 years.

“These vaccines are available for all patients who choose them after consulting with their doctors,” he wrote, though it’s still not clear who will have the shots

While healthy children and adults without underlying conditions were eligible to receive the vaccine historically, HHS claimed, “Today’s decision does not affect access to these vaccines for healthy individuals.” 

“HHS is not limiting access,” a department spokesperson wrote to The 74. “The COVID vaccine remains available for anyone who chooses it in consultation with their healthcare provider.”

In response to a request for clarification to determine if this means children and healthy adults under 65 can access the vaccine with permission from a doctor, the agency spokesperson just repeated the same language.

All of this back and forth has contributed to confusion for parents, as increase in many areas of the country. Recent by KFF, a nonpartisan, nonprofit health policy organization, found that half (48%) of parents are not sure if federal health agencies are currently recommending that healthy children receive a COVID vaccine this fall or not.

A federal push for vaccine exemptions

While many eyes are on the debate surrounding COVID vaccines, researchers and physicians also remain laser focused on measles, following this year’s outbreak, which infected over across 41 states and killed two unvaccinated children. 

Case numbers this year are already the they’ve been since the disease was declared eradicated in the U.S. in 2000. Some 92% of reported infections have involved a person who was unvaccinated or whose status was unknown and 13% have resulted in hospitalization.

Throughout the outbreaks, Kennedy has the severity and has been in his support of the MMR vaccine.

In a recent and highly unusual move for the federal government, Kennedy expressed his support for a philosophical and religious exemption to mandatory vaccines for school-aged kids in West Virginia. 

Up until a recent opened the door for broader exemptions, the state had some of the nation’s strictest childhood vaccination policies and was one of only five that exclusively allowed for medical exemptions. Already around 500 requests for religious and philosophical exemptions have been submitted — and approved — for the 2025-26 school year, according to records obtained by The 74, though those numbers are not yet reflected in the CDC’s data.

According to that data, Georgia and Michigan saw exemptions rise faster than any other state — by 1.2 percentage points year-over-year — driven almost exclusively by non-medical exemptions. They were closely followed by Idaho, Pennsylvania, South Dakota and Utah.

In West Virginia, conflict between the governor’s order and current state law has and over how officials should proceed. Beginning on Aug. 21, the federal government publicly weighed in, apparently attempting to tip the scales. 

First, HHS’s Office for Civil Rights sent to all West Virginia health departments participating in the federal which provides vaccines to millions of kids who otherwise wouldn’t be able to afford them. The communication stated that if they did not comply with the governor’s executive order, they would no longer be eligible to participate in the program. 

Richard Hughes, a George Washington University law professor and leading vaccine law expert, called this move an unheard-of “implied threat.”

“I just think that’s got to be unprecedented for a federal agency — the Office for Civil Rights — to go and pick out a state law and say, ‘You need to comply with that.’ That just boggles my mind,” Hughes said.

“What I worry about is that we’re about to see a push at the federal and the state level encouraging religious exemptions,” he added.

Hours after Kennedy testified before the Finance Committee, the Office for Civil Rights announced they had issued similar letters to all states participating in the Vaccines for Children program stating they “must respect state religious and conscience exemptions from vaccine mandates.”

Earlier, the health secretary had posted on , voicing his support for the West Virginia governor and urging state legislators to comply.

Del Bigtree, CEO of the, an anti-vaccine advocacy group, told The 74, “We’re happy that Robert Kennedy Jr. and HHS are supporting Gov. Morrissey. I think this is a pivotal moment for this conversation in this nation.”

Other states have joined West Virginia in pursuit of such bills, according to Caitlin Gilmet, the communications director for , a pro-vaccine advocacy organization formerly called SAFE Communities Coalition.

“We’re seeing medical freedom bills in a number of states. Idaho, Montana, Tennessee, Texas, Florida are all kind of national bellwethers where those parental rights bills are being tested,” she said. 

Kids in those states are particularly vulnerable to “new exemption policies, weak enforcement and then the conditions to create exemption clusters,” she added, which can then lead to outbreaks.

A number of these types of bills contain language or policies that are unclear, leading to more confusion and conflicting guidance. 

Further complicating the issue is Kennedy’s recent firing of all members of the group responsible for making recommendations on the safety, efficacy and clinical need for vaccines to the CDC as well as the cancellation of $500 million in federal grants to mRNA vaccines, the technology used to develop the COVID vaccination. 

In a post on , he claimed the vaccines are ineffective and cause “more risks than benefits,” while “paradoxically… prolong[ing] pandemics as the virus constantly mutates to escape the protective effects of the vaccines” — assertions that are echoed by activists like Bigtree, yet have been widely debunked by researchers and medical professionals.

“It is incredibly misleading, not to mention just false, to say that the vaccines are more harmful than they are beneficial,” said Talaat, the Johns Hopkins professor. “They are incredibly beneficial. They’ve saved millions of lives.”

While COVID vaccines were the first on the market to use mRNA technology, others were in development before the funding cancellation, including ones to fight cancer and bird flu.

“[Bird flu] could be the next pandemic,” Talaat said, “and they canceled the contracts to create mRNA vaccines against this virus.”

“It’s really important,” she added, “that people understand that, unfortunately, this is not a time where we can trust those in the highest positions of power at HHS.”

But after this weekend, when President Donald Trump Bowen, who specializes in primary care pediatrics, fears a new obstacle: her patients might lose access to the publicly funded health insurance that makes her work possible.

“Before they had insurance, but then they couldn’t get to the provider,” Bowen said. “Now you’ll have providers coming out — but they won’t have the insurance.”

Experts say Bowen’s concerns are not unfounded. The sweeping, which Republicans pushed through Congress last week without any Democratic votes, will cut federal spending on Medicaid and Children’s Health Insurance Program benefits by $1.02 trillion and increase the number of uninsured Americans by 7.8 million people over the next decade, according to estimates by the nonpartisan

Cuts to the Medicaid budget will have “just tremendous impacts,” Bowen added. Schools receive about $7.5 billion annually from , a popular joint federal and state health program that insures nearly 70 million Americans, most of whom are low income. For more than 30 years, it’s paid for services in schools for students with disabilities as well as low-income students.

If all provisions in the bill are enacted, it will lead to enrollment drops in the , which provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid, and a $125.2 billion reduction in Medicaid by 2034, the Budget Office predicted, though it’s not clear just how many kids would be impacted. 

The cuts will come through a variety of mechanisms over the next decade, ranging from immediately enacted provisions that curb states’ ability to raise their share of Medicaid funding to new federal limits on eligibility — including work requirements for parents of kids 14 years or older — which will go into effect in 2027. These, in particular, could harm children, who are less likely to be covered themselves if their parents lose access, according to Anne Dwyer, an associate research professor at Georgetown University’s Center for Children and Families.

“Like many, we’re still unpacking exactly what this will mean for states and for individuals covered by Medicaid and for students in schools,” Dwyer said. “Some of these cuts are immediate and some go into effect over time.” 

Republican lawmakers, though, argue they’re actually Medicaid recipients by removing undocumented immigrants and others they say never should have had access in the first place.

While there weren’t any provisions in the bill that directly slash school-based Medicaid services, the 20-plus Medicaid provisions it does include will ultimately place immense financial pressure on states to make up for the lost funds, which will have trickle-down impacts on schools, according to Dwyer.

In response, states will either have to raise taxes, or make further cuts within their Medicaid programs — the more likely option, Dwyer said. They could also look to backfill budget shortfalls by slashing other school-based programs.

“It’s just hard to imagine a scenario where states are faced with these levels of cuts, and individuals across the program aren’t impacted,” she said. 

School-based Medicaid makes up less than 1% of the overall program’s budget, but is still the fourth-largest federal funding stream for districts and allows them to pay for a swath of resources, including therapies for students with disabilities, school nurses, mental health care and specialized equipment, such as wheelchairs. 

The loss of funds will significantly impact how schools are able to cover mandatory services under the Individuals with Disabilities Education Act, according to Mia Ives-Rublee, the senior director for the at the Center for American Progress, a left-of-center think tank.

Kids who are eligible for Medicaid through expansions or waivers — state-based mechanisms that widen access to some people who wouldn’t normally qualify — are particularly at risk of losing services, since their eligibility isn’t required by federal law, said Ives-Rublee. 

But, she added, children will largely remain more protected than adults since a number of pediatric services are mandated at the federal level, including preventative screenings, check-ups and vision and hearing services. 

Still, if fewer children are enrolled in Medicaid overall, it will reduce the pool of money that goes towards school-based services leading to fewer resources and providers.

“What we will start seeing, and what we’ve seen in previous states, is that there will be a chunk of people who will just lose eligibility … because they either don’t get the information about the new paperwork requirements, they don’t understand that they now have to do check-ins twice a year [to determine eligibility vs. once a year] … and they might miss a recertification process,” Ives-Rublee added.

The changes could also result in fewer social workers or school-based psychologists and decreased access to health care — especially in rural and urban communities, according to a opposing any proposed cuts that was spearheaded by the Medicaid in Schools Coalition and signed by 65 organizations.

of districts use Medicaid funding to pay for the salaries of health professionals, according to 2017 data. And — 40 million — are now insured through Medicaid or the Children’s Health Insurance Program.

In Alabama, where Bower sees patients, over are enrolled in these programs.

“If you put all the kids in the country together, they’re the largest group of impoverished people,” said Bowen, who also serves as the president of the National Association of Pediatric Nurse Practitioners, “and they have no political voice … They rely on adults to hopefully do the right thing so that they can grow up and be healthy and contribute to this country …. but if they’re sick, they’re hungry, they can’t be educated. It’s an all-around impact.”

These impacts will be challenging to track, though, as they play out over the next decade, experts warn — especially less tangible ones like the amount of time states will spend trying to untangle how to implement the bill’s complex provisions.

“We’re in for a long haul here,” said Dwyer. “A lot of these changes aren’t going to be overnight. They’re going to be over the next months and years to come. And so I think just documenting what’s happening, what’s working [and] where pressures are coming up will be really important.”

A trained doctor, he spent 26 years working in pediatric infectious disease and studying the rotaviruses before ultimately creating the strain that became the RotaTeq vaccine. That breakthrough saves 165,000 lives globally each year, he said, and has essentially eliminated the 70,000 annual U.S. hospitalizations caused by the contagious diarrhoeal virus common in young kids.

Now the director of the and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, Offit also serves as a member of the Food and Drug Administration’s . And about 20 years ago, he spent half a decade on the committee responsible for making recommendations on the safety, efficacy and clinical need for vaccines to the Centers for Disease Control and Prevention.

That committee, also known as the , or ACIP, experienced an unprecedented upheaval earlier this month when Robert F. Kennedy Jr. fired all 17 advisory members via a Wall Street Journal — after promising he would leave the committee’s recommendations intact.

“The committee has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine,” wrote Kennedy, the head of the U.S. Department of Health & Human Services and a longtime vaccine skeptic.

In a statement released by HHS, Kennedy said he was “prioritizing the restoration of public trust above any specific pro- or anti-vaccine agenda,” and later promised via that none of the replacement members would be “ideological anti-vaxxers.” Public health experts are now disputing that claim in light of his eight recent appointments.

“This is a slate that lacks a balanced viewpoint,” said Richard Hughes, a George Washington University law professor and leading vaccine law expert. “And it’s deeply concerning that many of them are outright anti-vaccine and have their own very concerning conflicts of interest, despite the fact that the secretary claims that he’s trying to avoid conflicts of interest on the committee.”

This could be particularly dangerous for children, some warn, as the committee’s recommendations often dictate which vaccines are covered by insurance and which are mandated for school-aged kids. Programs that provide free vaccines for kids could also see their funding cut.

The 74’s Amanda Geduld recently spoke with Offit to better understand the implications of the mass firing, what kids and their families can expect moving forward and how future administrations might work to rebuild trust in the public health vaccine system. 

This interview has been edited for length and clarity. 

The 74: Are you in touch with any of the folks who were fired from ACIP? If so, how did they receive that news and what was the mood among the members?

Offit: Well, they found out about it, typically, from reading the newspaper and learning that they had been fired from that position. The mood was one of sadness, because obviously there was no good reason to do it. 

The reason given by Robert F Kennedy Jr. was that all the members were horribly conflicted with pharmaceutical companies [and] that their financial ties to pharmaceutical companies made it such that they couldn’t give advice that would be beneficial to the American public, and that wasn’t true.

I mean, they have very strict conflict of interest rules at the ACIP whereby you have to make it very clear that you have no association with the pharmaceutical industry and no association with the government, which then allows you to be an independent advisor. And should there be a conflict … then you can’t vote on that company’s product, and you can’t vote on any product that that company makes. That’s very clear. That’s been clear ever since I was on the committee back 25 years ago.

So it sounds like there was confusion, disappointment and a feeling that the reasons given for the firing weren’t based in reality? 

They were angry. They were angry that they felt that they’d been dismissed for no good reason and that their willingness to serve the American public had been set aside. I mean, it’s not like you’re paid to do this. It’s just a voluntary position for the most part.

In your knowledge, has anything like this ever happened before?

No, but we’ve never had a secretary of Health and Human Services that was an anti-vaccine activist, science denialist and conspiracy theorist before.

Zooming out a little bit, what’s the significance of these firings? And what impacts can we anticipate?

I think we can anticipate that Robert F. Kennedy Jr. will put people on that committee who are like minded to him. We’re already seeing evidence of that with the first eight people that he picked. 

So I think what’s going to happen is that there are going to be groups that look elsewhere from the ACIP to try and get information that they think is reliable and up to date and informative. 

What I imagine is that, for example, the American Academy of Pediatrics has its so-called Red Book committee, or . I would imagine that that committee will start to speak with insurance companies to make sure that their recommendations would then have kind of the force of law … Because I can’t imagine the insurance companies are going to be looking to ACIP, given its current members.

My understanding is, up until this point, insurance companies and states — when they’re trying to determine school vaccination policies — have looked to ACIP for guidance. You’re saying that maybe insurance companies will look elsewhere for that information, but is there any concern that this will just mean vaccines are no longer covered by insurance, or that school-age vaccine policies are undermined altogether?

Yes, there’s concern, but it is to the financial advantage of insurance companies to pay for vaccines. I mean, you’d much rather pay for an HPV vaccine than to pay for the care of a woman who has cervical cancer. You’d much rather pay for a measles-containing vaccine than to pay for measles hospitalization.

So there isn’t necessarily concern here that suddenly these vaccines won’t be accessible to families from lower-income backgrounds?

I don’t know. I mean, I think it’s a frantic, chaotic time, and it’s really hard to know. Everything that you sort of counted on to make sense doesn’t make sense anymore. 

It used to be that solid, good science was how we made decisions, and that’s not true anymore with the ACIP. You can tell when Robert F Kennedy Jr. says we want gold standard science, that’s not what he means. What he really means is he wants quote, unquote scientific studies that support his fixed, immutable belief that vaccines cause more harm than good.

In a post on recently Kennedy wrote, “The most outrageous example of ACIP’s malevolent malpractice has been its stubborn unwillingness to demand adequate safety trials before recommending new vaccines for our children.” Has there been an unwillingness to demand adequate safety trials for new vaccines for children in America?

The opposite is true. I had the fortune of working with a team that created the rotavirus vaccine. Before that vaccine was put on the infant immunization schedule, it was tested in a prospective, placebo-controlled trial of more than 70,000 infants. It was done over four years in 11 countries to prove that that vaccine was safe and effective. That was a 70,000- person prospective, placebo-controlled trial that probably cost $350 million. 

I don’t know what he’s talking about. Name the vaccine. Name a new vaccine that hasn’t been tested in a large, prospective, placebo-controlled trial. They all are. 

The problem is that when they’re shown to work and they’re safe, he doesn’t believe it, because he’s a science denialist. That’s what he really means.

Are there any other ways this could impact school-aged kids in particular?

Now what worries me is, I think if RFK Jr. really wants to bring down vaccines, he can do it through the What he could do is he could hold up a paper and say, “Look, aluminum adjuvants cause autism or multiple sclerosis or diabetes or asthma, and now I’m going to add that to the list of compensable injuries.”

So anybody with asthma who’s gotten a vaccine that contains an — and there are seven different vaccines that contain aluminum adjuvants [an ingredient that helps create a stronger immune response] — is now on the list of compensable injuries. 

Or [he could say] “I’m going to take these vaccines out of the Vaccine Injury Compensation Program and then just subject them to civil litigation.” That would really disrupt vaccines in this country. I think companies would then do what they did in the 1980s … They’d leave the market. We had 18 companies that made vaccines in 1980. By the end of the decade, we only had four. 

So does that mean that while this ACIP move might introduce anger and distrust there are no real trickle-down effects that you think we’ll see yet in terms of what vaccines are available or what vaccines are covered?

I think you’ll know a lot when you watch the June [advisory committee] meeting, to hear that discussion, and to hear how pharmaceutical companies react to that discussion and how insurers react to that discussion. I think you’ll learn a lot in the next couple of weeks.

Can you tell me a little bit about the folks who replaced the 17 members? Eight people have been announced so far.

They’re who you would most fear. 

You have people like Robert Malone, in front of Marjorie Taylor Green’s committees … that the mRNA vaccines cause cancer and heart disease and autoimmune disease. Robert Malone has been an expert witness on behalf of Robert F. Kennedy Jr. in a lawsuit against the mumps component of the MMR vaccine. 

You have somebody like Martin Kulldorff who has represented — for — Robert F. Kennedy Jr. in a lawsuit against Merck’s Gardasil [HPV] vaccine. 

You have people who have published papers claiming that the mRNA vaccines caused heart attacks and sudden death in healthy, young people. You have Vicky Pebsworth, who is a member of the , which is an anti-vaccine group that has lobbied against state vaccine mandates for years. 

This is exactly the cavalcade of stars that you would expect RFK Jr. to feel comfortable with: people who are — like him — anti-vaccine activists, who are science denialists. 

It’s the worst of all worlds. It’s like a bad Saturday Night Live skit.

During Kennedy’s HHS confirmation hearings back in January, Republican Sen. Bill Cassidy — a former physician — expressed a lot of trepidation around the nomination, but ultimately voted to confirm, citing various commitments he had received from the administration. One of those promises, Cassidy was that “if confirmed [Kennedy] will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommendations without changes.”’

Critics have since argued that Kennedy’s move to fire all members amounts to a broken promise, a claim Cassidy himself has since disputed. Is this a broken promise?

He’s been breaking promises right from the beginning. I think Cassidy put out a list of 10 or so things [Kennedy] promised he wouldn’t do. And he proceeded to do it.

I’m reading: He has committed that he would work within current vaccine approval on safety monitoring systems. That he hasn’t done. 

He’ll maintain the CDC Advisory Committee Immunization Practices recommendation without changes, and he hasn’t done that either. 

He’s already, for example, changed the recommendation on pregnancy, changed the routine recommendation for young children to get COVID vaccines. And now Cassidy also put out saying that for those of you who think [Kennedy] may just put vaccine skeptics on [the committee], he’s not gonna do that. Then he proceeds to do that. 

What Cassidy does is he draws a line. He says, “Don’t cross this line.” Then Kennedy crosses the line, and he doesn’t do anything — just draws another line. I think he is weak and ineffectual. And I think his legacy will be the harm that’s caused to children and adults in this country because of this massive disruption of the public health vaccine system. I think that will be Sen. Cassidy’s legacy.

Have you spoken to Sen. Cassidy? If you could speak to him today, what would you say to him?

I spoke to him four times before that second confirmation hearing, and once afterwards. I said to him exactly what you would think I would say to him, which is, “Don’t hire this guy. She knows. She told you exactly who he is.”

It’s really frustrating. I was sure [Cassidy] was a “no” vote. He clearly had problems with him. But in the end, politics trump science. I think when you mix politics and science, you always get politics.

My last question is around this idea of trust. Kennedy has said that he removed all these members and is replacing them in response to a “crisis of public trust.” On the other side, there are folks who do not at all trust Kennedy. Looking forward, what will it take to rebuild trust in these systems?

I think there was a tremendous loss of trust in the first two years of the pandemic … I think people saw [many COVID-era policies as] a real impingement on their freedom, and that’s what you’re seeing now. 

I think that RFK Jr. represents the disdain that people ended up having for the CDC and for Dr. Fauci, unfortunately. I think that’s what happened …To the point that there were states that were trying to ban mRNA vaccines. The term “mRNA vaccines” has become a dirty word, even though it probably saved 3 million lives and probably cost more than 250,000 people their lives when they chose not to get the vaccine. But somehow that all got linked with sort of stepping on our medical freedom, and that’s what you’re seeing now. 

So what’s it going to take to get that back? I think slowly, we’re just going to have to make sure that we — as scientists and clinicians and academicians and public health people — explain in careful detail why we do everything.

But public health is also about the public. I mean, you have to care about your neighbor in order to have public health. I think right now, we’re sort of at a point where people go, “Don’t tell me what to do. If I want to catch and transmit a potentially fatal infection, that’s my right.” And I don’t think we used to be like that.

Is there anything else I haven’t asked you that you want readers to understand, specifically through an education- and child-centered lens?

What’s that line from Bette Davis in All About Eve? “Buckle up. It’s going to be a bumpy night” — although everybody says bumpy ride.  …

I think it is going to be a bumpy ride for a while, and then we’ll just see. I believe that the forces of good will prevail. I do. 

I think that there’s a basic feeling among virtually everyone that vaccines are a good thing, and that as people see them erode or maybe become less available or less affordable or more feared that people will rally on behalf of children. I do.

Childhood vaccination rates have markedly declined across the U.S. since the start of COVID, according to new Johns Hopkins University showing 78% of more than 2,000 counties reported drops and the average immunization rate had fallen to 91% — further below the 95% threshold needed for herd immunity.

While existing Centers for Disease Control and Prevention data has historically shown broadly declining measles-mumps-rubella vaccination rates at the state and national levels, the county-level analysis published this week in JAMA is far more granular.

It provides a “better understanding of these pockets where you have more exceptionally high risk,” said senior author Lauren Gardner, the director of Johns Hopkins University’s Center for Systems Science and Engineering.

“Knowing where there are problem areas,” she added, “gives policymakers and public health professionals locations to target their limited resources to try and improve vaccination coverage and therefore minimize the potential risk of measles outbreaks.”

The country is currently experiencing a deadly measles outbreak that has infected over people across 30 states and killed two unvaccinated children. Case numbers this year have already surpassed 2024’s total and mark the second-highest number of confirmed cases in a year since the disease was declared eradicated in the U.S. in 2000. Some 96% of reported infections have involved a person who was unvaccinated or whose status was unknown and 13% have resulted in hospitalization.

Gardner, who also led the data collection efforts behind , and her team collected county-level, two-dose MMR vaccine rates for kindergarteners from each state’s department of health website from 2017 to 2024, where available. Ultimately, they were able to analyze trends in 2,066 counties across 33 states and made all their data available to download.

While state level average rates may decline by a few percentage points, the researchers found 130 counties where they dropped by at least 10 percentage points, and in 15 of those counties, they plummeted more than 20.

Only four of the states studied — California, Connecticut, Maine and New York — reported an increase in the median county-level vaccination rate. They are currently the only four states that exclusively allow medical — and not philosophical or religious — exemptions to mandatory vaccines for school-aged children.

Gardner said she pursued the county-level data after observing growing vaccine hesitancy and misinformation. Based on her years of work in the field, she said she was “100% expecting to see [these current outbreaks].” 

If vaccination rates continue to drop “measles is likely to return to endemic levels in the US,” according to the Johns Hopkins’ report — a concern other experts see as heightened by Robert F. Kennedy Jr. now heading the U.S. Department of Health & Human Services. A well-known vaccine skeptic, Kennedy initially the measles spread in late February and has been in his support of the MMR vaccine.

Under Kennedy’s leadership, the Trump administration released the controversial “Make America Healthy Again” on May 22, which misinterpreted studies, and is suspected of being generated in part . The report, which involved , questions the safety and importance of some childhood vaccines.

“Despite the growth of the childhood vaccine schedule,” the report reads, “there has been limited scientific inquiry into the links between vaccines and chronic disease, the impacts of vaccine injury, and conflicts of interest in the development of the vaccine schedule.” 

Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a professor of pediatrics at the University of Pennsylvania Perelman School of Medicine, pushed back on these assertions.

The issue has been well studied, and there is no evidence of links between childhood vaccines and chronic diseases — including diabetes and autism — said Offit, who is also member of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee.

He referenced 24 studies across seven countries and three continents involving thousands of children that show they’re at no greater risk of developing autism if they receive the MMR vaccine.

Current skepticism is not isolated to the measles vaccine: The Food and Drug Administration, which falls under HHS, recently released which no longer recommends the COVID vaccine for healthy children or pregnant women. In response, a top COVID vaccine adviser at the CDC resigned this week, according to reporting from  

And across the country, numerous states have introduced legislation to loosen vaccine requirements for school-aged children, opening the door for more parents to opt their kids out.

“I think this is only going to get worse,” Offit said. “I think vaccines are under attack. You have a secretary of Health and Human Services who will do everything he can during the years that he is in that position to make vaccines less available, less affordable and more feared. … So I think this is a dangerous time to be a child in the United States of America.”

Correction: In a previous version of this story, we incorrectly characterized Dr. Paul Offit’s status on the CDC’s Advisory Committee on Immunization Practices. He is a former voting member of the CDC’s advisory committee and a current member of the FDA’s vaccine advisory committee.

Two groups filed a lawsuit against West Virginia’s state Department of Health, its Bureau for Public Health and agency leaders on Friday, challenging Gov. Patrick Morrisey’s January executive order, which opened the door for religious and philosophical exemptions to mandatory school vaccination policies. The American Civil Liberties Union’s West Virginia chapter and Mountain State Justice filed the suit in Kanawha County Circuit Court on behalf of two parents with immunocompromised children, according to reporting by

Just over 330 requests for religious and philosophical exemptions to West Virginia’s school vaccine policy have been submitted — and approved — for this school year and 35 have been granted for the coming year, according to records obtained by The 74.

The newly approved religious and philosophical exemptions already outpace the 203 permanent medical exemptions granted in the state over the past decade, at one time the only exemptions allowed in West Virginia.

Before January, when Gov. Patrick Morrisey signed an opening the door for broader exemptions, the state had some of the nation’s strictest childhood vaccination policies. 

The loosening of those policies is occurring amid a deadly measles outbreak that has infected over  across 30 states and despite state legislators rejecting a bill in March which would have codified religious exemptions into state law. The conflict between the governor’s order and the legislature’s action has over how West Virginia officials should proceed and could ultimately lead to legal action between the two branches of government. 

In the meantime, the West Virginia Department of Health is granting religious and philosophical exemptions based on the governor’s order and shared those numbers in response to a Freedom of Information Act request by The 74.

No requests for the newer category of exemptions has been denied, the department said. In contrast, 125 requests for medical exemptions to mandatory school vaccines have been rejected since 2015. Temporary medical exemptions have been granted to 288 West Virginia children in the past decade.

Richard Hughes, a George Washington University law professor and leading vaccine law expert, said the 331 religious and philosophical exemptions sought in just five months represent a “drastic, dramatic increase in the request for exemptions, and that’s going to potentially have public health consequences.”

He added the state appears to be approving them liberally and without real scrutiny.

“Clearly, when you open the door to these types of exemptions, people use them,” he said. “There has been evidence before that when only religious exemption is available, people request them without any really sincerely held belief. This just opens the floodgates.”

While the 331 students who have received exemptions represent a very small percentage of the approximately enrolled in public schools across the state, experts fear the number will continue to rapidly climb, especially at the start of the coming school year.

“You see how fast we approved those? Hundred percent approved … So if we keep allowing an executive order that goes against West Virginia code, it’s going to change the vaccination rate …” said Sissy Price, a registered nurse who serves as co-director of West Virginia Families for Immunization. “And it’s not a matter of if it’s going to happen, it’s a matter of when.”

Experts also emphasized the importance of knowing which regions or schools in West Virginia the exempted students come from to better understand the impact on herd immunity and to allow parents — especially those of immunocompromised students — to make informed decisions about where to send their kids to school.

Despite the governor’s insistence that the state collect that information, an official at the Health Department wrote in an email to The 74, “Nobody in the Department of Health or the Bureau for Public [Health] tracks that.”

“There’s a failure of government there,” said Northe Saunders, executive director of the pro-vaccine . “There’s a failure of making sure that parents can make the best informed decision that they can if we don’t know what immunization rates are like at the school level.”

The governor’s office and the Department of Health did not respond to requests for comment.

So far, West Virginia has no reported measles cases. Two children, both of whom were unvaccinated, have died during the current outbreak, whose case numbers have already surpassed 2024’s total and mark the second-highest number of confirmed cases in a year since the disease was declared eradicated in the U.S. in 2000. Some 96% of reported infections have involved a person who was unvaccinated or whose status was unknown and 13% have resulted in hospitalization. 

In issuing his Jan. 14 executive order, Morrisey relied on an interpretation of the state’s 2023 Equal Protection for Religion Act.

He argued that the law as it stood “forces” some West Virginians “to choose between their religious belief and their children’s fundamental right to public education,” and directed the commissioner of the Bureau for Public Health and the state health officer to establish a process for parents to object. The executive order noted that a “written, signed objection” was sufficient.

Based on the legislature voting down the measure to codify the broader exemption category, state schools Superintendent Michele Blatt issued a memo earlier this month to county superintendents recommending that students not be allowed to attend school next year without required immunizations, regardless of requests for religious exemptions. 

“We are faced with the fact that state law has not been changed by the Legislature and there is no religious exemption provided for in West Virginia law,” Blatt wrote, according to reporting by

But, by the end of the day she rescinded the memo, she had done so “at the Governor’s request.” 

Morrisey then issued May 9 saying that despite the legislative hurdle, the executive order “still stands, and I have no intention of rescinding it.” He further clarified the process to receive an exemption: Each year, parents or guardians must send a signed letter with basic information including their child’s name, date of birth and mailing address. Notably, the letter does not need to include the reason for the requested exemption.

In the wake of this confusion, some school districts have begun seeking about how to respond. 

West Virginia is not an outlier in its quest to allow parents to opt their children out of the measles, mumps and rubella vaccine that is a requirement in all 50 states for children entering child care and schools. 

“It goes towards the general erosion of vaccine policy,” said Saunders. “We’ve seen these kinds of small, incremental changes that are eroding vaccine policy in states across the country. There are still school entry requirements in West Virginia — just like there are in every single state — but this is one other chink in the armor of strong vaccine policy driving strong immunization rates.”

Childhood vaccination since COVID, and there’s fear that decline will accelerate now that Robert F. Kennedy Jr., a well-known vaccine skeptic, is heading the U.S. Department of Health & Human Services. He initially in late February, and on May 14, at his in Congress since his confirmation, he waffled on the importance of vaccines.

When asked if he would vaccinate a child of his own against measles today “Probably for measles. What I would say is my opinions about vaccines are irrelevant.”

He continued, “I don’t want to make it seem like I’m being evasive, but I don’t think people should be taking medical advice from me.”

Last week, the Food and Drug Administration, which falls under HHS, released guidance for COVID vaccines, saying they may require additional studies before approving the shots for healthy Americans younger than 65.

Candice Lefeber, executive director of West Virginia’s chapter of the American Academy of Pediatrics, said this move played into one of her fears: “I think the administration is going to make it harder for vaccines to be available.”

“Not only are we not going to require it, but then access to vaccines would be compromised,” she continued. “It’s just really disheartening for science and for our country — and we’re in big trouble.”

The West Virginia House Monday rejected its version of a Senate bill that would have loosened school vaccine requirements and expanded exemptions, voting it down

The bill’s defeat came after the House twice amended the Senate’s version of the legislation, first to remove both the philosophical and religious exemptions approved by the Senate and then to and to allow private and parochial schools to set their own mandatory vaccine requirements.

“The pro-vaccine messaging won out,” Northe Saunders, executive director of the pro-vaccine , told The 74 Monday.

West Virginia now has among the country’s strictest regulations governing the immunizations required for children entering child care and schools, allowing for medical exemptions only. It’s unclear what might come next.

While the House’s vote effectively killed the current legislation, over a dozen other vaccine-related bills have been introduced in the West Virginia legislature and the governor signed an executive order in January establishing the religious and philosophical exemptions that House members rejected.

Saunders said time may be running out for the other vaccine-related bills to move forward during this legislative session.

An amendment that would give West Virginia parents much greater leeway to exempt their children from mandated school vaccinations was deleted from a House bill at the last minute this week, but the prospect of far fewer students in the state getting immunized remains strong.

As written, the would still expand and loosen requirements for medical exemptions for students, making them “the broadest … in the country,” one advocate said. The religious and philosophical exemptions that were struck from the House version of the legislation could also be reintroduced and, while it doesn’t carry the same force of law, Gov. Patrick Morrisey’s January order establishing similarly far-reaching exemptions is also hanging in the balance.

Historically, West Virginia has had some of the nation’s strictest childhood vaccination policies and the current move to soften them is occurring against a deadly measles outbreak that has infected in 15 states and taken the life of one school-age child in Texas. 

“It’s hard to wrap your head around why we would do this right now — or anytime,” said Candice Lefeber, executive director of West Virginia’s chapter of the . “But at such heightened alertness with measles spreading in our country, it should be a wake-up call. And unfortunately, I don’t think that’s happening,”

West Virginia is not an outlier in its quest to allow parents to opt their children out of the measles, mumps and rubella vaccine that is a requirement in all 50 states for children entering child care and schools. 

On Wednesday, Idaho lawmakers passed a that would significantly broaden an existing law banning COVID vaccine mandates to include mandates on any “medical treatment.” If the governor signs it, the bill would apply to public and private schools as well, making Idaho the first state in the country to remove all mandatory school vaccination requirements.

Childhood vaccination since COVID, and there’s fear that decline will accelerate now that Robert F. Kennedy Jr., a well-known vaccine skeptic, is heading the U.S. Department of Health & Human Services. He initially in late February, and in a March 4 seemed to link the ongoing outbreak and child fatality to malnutrition and poor health while pointing to unproven treatments, such as cod oil.

“The best thing Americans can do is to keep themselves healthy,” Kennedy said in the interview. “It is very, very difficult for measles to kill a healthy, well-nourished person.”

Three months in, the number of measles cases has already surpassed 2024’s total and in the 15 states where it’s spread, 95% of infections have involved a person who was unvaccinated or whose status was unknown. Three of those states border West Virginia, although, so far, the Mountain State has no reported cases. 

‘We just want the policy left alone’

The latest House bill still has a more wide-ranging medical exemption that also protects health care providers who grant them “in good faith” from civil liability, except in cases of “gross negligence or willful misconduct.” 

It also includes no enforcement mechanism from a government oversight body nor is there guidance as to what qualifies someone for a medical exemption. 

Northe Saunders, executive director of the pro-vaccine , fears this might lead to bad actors writing “bogus” exemptions. Saunders’ group, which is based in Portland, Maine, opened a West Virginia chapter in February after local advocates asked for their help amid the exemptions push.

“We’re glad that the religious and philosophical exemptions were not part of the bill that came out of committee,” said Saunders, who believes the measles outbreak was a factor in their being cut, “but we expect [attempts to modify the bill] going forward.” 

Saunders said his organization is tracking an additional 20 vaccine-related bills in the West Virginia legislature. And, across 20 states, 47 bills have been introduced which would add or broaden vaccine exemptions.

Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons. Most states also have religious exemptions, and 20 have some form of leaving a varied landscape. 

West Virginia is currently one of only five states that don’t allow any exemptions, beyond medical ones. Last school year, they had the for four of the major mandated vaccines, significantly outperforming national averages. Almost all kindergarteners there — 98.3% — had received both doses of the measles, mumps and rubella vaccine. 

The state also had the lowest rate of exemption, with less than 0.1% of kindergarteners being exempt from one or more vaccines. And it was the only state that supported Donald Trump for president in November that did not see an average rise in official exemptions. 

That could change, depending on the fate of the pending legislation and the governor’s executive order.

“The current policy as is, is something that is highly favored among myself and my colleagues,” said Andrea Lauffer, an internal medicine doctor and pediatrician at WVU Medicine – Thomas Memorial Hospital in South Charleston. “We just want the policy left alone.”

Michael Ramey, president of the , noted the role the pandemic has played in the current vaccine skepticism. He said that while his organization does not hold a position on the safety or efficacy of vaccines, it stands in support of bills like the one in West Virginia.

“We welcome a move to give parents greater authority to make the decision that’s best for their individual child,” he said. 

The vast majority of Americans — 88% — believe the benefits of the childhood vaccine for measles, mumps and rubella outweighs the risks, compared with just 10% who say the risks outweigh the benefits, according to a 2023 Seventy percent of Americans say healthy children should have to be vaccinated to attend school, down from 82% in 2019. And the share of parents who think they should be able to decide against vaccination is up 12 percentage points from four years ago, to 28%.

This shift is being driven by Republicans, 57% of whom now support vaccination requirements — down from 79% in 2019.

‘The heat is on’

The debate over vaccine mandates in West Virginia is not new, but “this year, definitely, the heat is on, for sure, at a higher temperature,” said Sissy Price, a registered nurse who serves as co-director of .

Last year, former Gov. Jim Justice vetoed a bill which would have allowed private and parochial schools to set their own vaccination policies. Meanwhile, Morrisey signed his executive order creating religious and philosophical exemptions on his first full day in office.

The governor wrote that current mandatory vaccine laws force West Virginians who have objections “to choose between their religious belief and their children’s fundamental right to public education.” The order, he said, was based on his interpretation of the Equal Protection for Religion Act, signed by Justice in 2023. 

The pending legislation was meant to clarify and codify his order. Even if the bill’s final version does not include religious and philosophical exemptions, the governor’s executive order would still stand, said Richard Hughes, a George Washington University law professor and leading vaccine law expert. 

While the ability to set new laws lies only with the legislature, the governor does have the ability to interpret those laws, which is what his executive order does, Hughes said.

If the executive order is not in line with what the legislature passes, however, it would remain vulnerable to court challenges.

“The governor could be checked by the courts on this interpretation,” he said.

Introduced Feb. 13, would have allowed parents to simply provide a written statement to exempt their child from vaccines for religious or philosophical reasons and applied to public, private and parochial schools.

In addition to loosening the medical exemption process and protecting medical professionals from disciplinary actions, it would also eliminate the position of state immunization officer and no longer require schools to report a violation if an unvaccinated child without an exemption attempted to enroll.  

At a Feb. 21 committee meeting, both Democratic and Republican senators spoke out in opposition to the bill. Many cited the measles outbreak that began in West Texas in late January as core to their concerns.

GOP Sen. Mike Oliverio read aloud from a letter written by one of his constituents, a retired physician.

“Loosening these requirements will eventually lead to outbreaks of these diseases, including in our children, as the number of vaccinated individuals fall,” he read. “I urge you to vote against this bill for the sake of West Virginia’s children.”

A number of Republican lawmakers also spoke in favor of the bill, which ultimately passed by a 20-12 vote, with two senators absent, before going to the House. 

The House bill that came out of committee this week is now expected to move to the floor, where it will be debated and potentially amended again. If the final House bill that passes still differs from the initial Senate bill, senators will need to either accept the House’s version or head to a conference committee to reconcile the two before sending it on for Morrisey’s signature. 

of those infected so far are vaccinated. The remaining patients are either unvaccinated or their vaccine status is unknown. 

Robert F. Kennedy Jr., the newly confirmed head of the U.S. Department of Health and Human Services, has a long history of around vaccines, including the one for measles. He recently put vaccine advisory meetings — where a panel of experts establish a vaccine schedule used to inform state policies — on indefinite and wields power over how organizations within HHS, such as the Centers for Disease Control and Prevention, respond to such crises. 

Earlier this month, his anti-vaccine organization, Children’s Health Defense, put out a blaming the Texas outbreak on the vaccines themselves, arguing, “The real issue is not a failure to vaccinate but a failing vaccine.”

“As measles outbreaks continue to surface, the mainstream media is now using them as a political weapon, attempting to blame … Secretary Robert F. Kennedy Jr. for so-called ‘anti-vaccine rhetoric,’” the statement read. “His warnings about vaccine-induced injuries and failures are validated by the very outbreaks being reported today.”

Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, a Texas-based education advocacy organization that promotes childhood and adult immunization, said she is “just absolutely flabbergasted that there is intentionality to put blame on the vaccine when that is not where anybody should be spending their time or their effort. Our effort should be supporting families, making sure they’ve got the right information and supporting helping our public sector partners so we can try to get to the end of this crisis sooner rather than later.”

“CDC is aware of the death of one child in Texas from measles, and our thoughts are with the family,” Andrew Nixon, director of communications at HHS, wrote in a statement to The 74. “CDC continues to provide technical assistance, laboratory support, and vaccines as needed to the Texas Department of State Health Services and New Mexico Department of Health, which are leading the response to this outbreak.”

There are now also at least nine reported cases in neighboring  

Kennedy that he’s following updates on the outbreak, which he noted was mainly in the Mennonite community. Despite the confirmed death of a child, Kennedy appeared to downplay the spread, saying, “It’s not unusual. We have measles outbreaks every year.”

Measles were declared eliminated in the United States in but there’s been a resurgence of cases as vaccination rates have dropped.

Mary Koslap-Petraco, a pediatric nurse practitioner who treats underserved children in New York state, said that when she heard about the child’s death Wednesday morning, “Quite frankly, I broke down in tears. This was [99%] preventable.”  

She placed much of the onus on the anti-vaccination movement, saying they planted “seeds of distrust” that ultimately scared parents.

“I know this family only wanted the best for this child,” she said, “and I’m really sorry that they weren’t able to encounter someone who could help them through this misinformation that they’re hearing to feel comfortable enough to vaccinate their child.”

‘Primed for something like this to happen’ 

Measles is a highly contagious which can be serious and sometimes fatal in children. If one person has it, up to 9 out of 10 people nearby will become infected if they , though spread is preventable through the measles, mumps and rubella vaccine, which is safe and about . The infection is often marked by a high fever, sore throat and rash; more severe complications can include pneumonia and swelling of the brain.

In a statement Wednesday, the Texas Department of State Health Services said the best way to prevent measles is through the vaccine. The department  it was “working with local health departments to investigate cases, provide immunizations where needed, and keep the public informed.”

Texas is one of 18 states that allow school-aged children to of vaccine requirements for medical, religious or “personal belief” reasons.

The majority of measles cases so far are in Gaines County, a small, rural county in West Texas, with one of the state’s highest vaccine exemptions rates: up from just over 4% a decade ago. And the actual number of unvaccinated kids in the county is likely significantly higher, because there’s no data for the many children who are homeschooled, according to reporting from the

Some of the initial cases appeared to be connected to . 

To be exempted for “reasons of conscience,” a parent or legal guardian has to submit a form to the school. Under certain circumstances — like an official emergency or epidemic — these students might not be allowed to go to school.

None of the four public school districts serving Gaines County immediately responded to a request for comment. The county’s small Loop Independent School District of K-12 students had a conscientious exemption for immunizations in 2023-24. The statewide vaccine exemption rate is 2%.

“We know based on a ton of research that these kinds of exemptions cluster,” Lakshmanan said. “They cluster geographically, they cluster in schools, they cluster in neighborhoods, they cluster in faith-based communities. Sadly we are seeing the practical reality of this type of loophole … when we start to see high exemption rates, we are bound and we are primed for something like this to happen.”

Kindergarten measles vaccination rates in Texas generally have fallen to below 95% since the pandemic, though they still remain just above national averages, according to a recent data analysis from  

A number of Texas parents who previously had not vaccinated their children are now changing course. “We’ve vaccinated multiple kids that have never been vaccinated before, some from families that didn’t believe in vaccines,” Katherine Wells, director of public health for Lubbock’s health department, told

Yet, as the outbreak spreads, Texas lawmakers are preparing to consider bills that would further loosen exemption requirements.

“Now is not the time to be playing a game of roulette with children’s lives or Texans’ lives and even contemplate making the exemption process easier,” Lakshmanan said.

The , signed by 65 organizations, was spearheaded by the Medicaid in the Schools Coalition, which advocates to protect and improve school-based Medicaid programs, which primarily serve students with disabilities and those living in poverty.

“Any cuts to Medicaid would reduce care for children with disabilities, undermine efforts to address the mental health crisis and exacerbate workforce shortages of school health providers,” said Jessie Mandle, the national program director at the and coalition co-chair. “Strong school-based Medicaid programs … rely on a strong Medicaid program overall, and so cutting Medicaid is equivalent to cutting school district budgets.”

Schools receive about $7.5 billion annually from , a popular joint federal and state health program that insures nearly 70 million Americans, most of whom are low-income. For more than 30 years, it’s paid for services in schools for students with disabilities as well as low-income students.

While President Trump said this week that Medicare, Medicaid and Social Security would in the GOP’s quest to deliver $4.5 trillion in tax cuts and beefed-up border security, in Medicaid funding decreases are being eyed in the House.

School-based Medicaid makes up less than 1% of the overall program’s budget, but is still the fourth-largest funding stream for districts and allows them to pay for a swath of resources, including therapies for students with disabilities, school nurses, mental health care and specialized equipment, such as wheelchairs. 

of districts use Medicaid funding to pay for the salaries of health professionals, according to 2017 data. New data forthcoming from The Healthy Schools Campaign suggests that the number is now even higher, Mandle told The 74. 

And — 40 million — are now insured through Medicaid or the , which provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. Previous that improving children’s health improves their classroom performance.

Meanwhile, the political confusion over whether Medicaid will be protected has done little to quell anxiety that the funding might be in jeopardy. 

A Feb. 19 statement to from White House spokesperson Kush Desai attempted to reconcile Trump’s comments shielding Medicaid with his support for the proposed House budget that targets it: “The Trump administration is committed to protecting Medicare and Medicaid while slashing the waste, fraud, and abuse within those programs — reforms that will increase efficiency and improve care for beneficiaries.”

Any spending caps or reductions to the federal match would shift the bulk of the mandated costs of providing health care coverage to states, according to the coalition’s letter. This could have “devastating” effects, leading to a cut in services for all students — not just those with disabilities — or increased local taxes. 

On the ground, this could result in fewer social workers or school-based psychologists, decreased access to health care — especially in rural and urban communities, a loss of critical supplies that allow children with disabilities to access the same curricular as their peers and noncompliance with the Individuals with Disabilities Education Act, the coalition states.

“We have a very underfunded special education system,” said Sasha Pudelski, director of advocacy at and coalition co-chair, “and this Medicaid reimbursement is a critical source of funding.”

“Trying to find the money within our local education budget to fill in gaps where Medicaid currently reimburses districts would be — in this funding environment in particular — an enormous challenge,” she continued.

Silvia Yee, policy director at the , which co-signed the letter, said it’s particularly important that many of these health-related services are available in schools because they are widely trusted community hubs and family touchpoints. 

The burden of cuts would be felt particularly by vulnerable families, she added: “The more you reduce the available resources to a lower-income family, the more you’re potentially digging a pit for that family, and it’s very hard to dig out of.”

Yee also noted that a rollback in federal funding could make it more challenging for students with disabilities to learn in an integrated setting with their peers, setting them up for “segregation for the rest of their lives.”

“All of these services can and should work together to help us achieve integration that’s not a burden on teachers [and] not a burden on schools,” she said. “Helping take care of children’s medical needs in school is a step forward. Taking that away is such a step backward.”

Mary Koslap-Petraco, a pediatric nurse practitioner who exclusively treats underserved children, said when she heard the news Thursday morning she was immediately filled with “absolute dread.”

“I have been following him for years,” she told The 74. “I’ve read what he has written. I’ve heard what he has said. I know he has made a fortune with his anti-vax stance.”

She is primarily concerned that his rhetoric might “scare the daylights out of people so that they don’t want to vaccinate their children.” She also fears he could move to defund a program under the Centers for Disease Control and Prevention that provides vaccines to kids who lack health insurance or otherwise wouldn’t be able to afford them. While the program is federally mandated by Congress, moves to drain its funding could essentially render it useless.

Koslap-Petraco’s practice in Massapequa Park, New York relies heavily on the program to vaccinate pediatric patients, she said. If it were to disappear, she asked, “How am I supposed to take care of poor children? Are they supposed to just die or get sick because their parents don’t have the funds to get the vaccines for them?” 

And, if the government-run program were to stop paying for vaccines, she said she’s terrified private insurance companies might follow suit. 

Vaccines for Children is “the backbone of pediatric vaccine infrastructure in the country,” said Richard Hughes IV, former vice president of public policy at Moderna and a George Washington University law professor who teaches a course on vaccine law.

Kennedy will also have immense power over Medicaid, which covers low-income populations and provides billions of dollars to schools annually for physical, mental and behavioral health services for eligible students.

If Kennedy moves to weaken programs at HHS, which experts expect him to do, through across-the-board cuts in public health funding that trickle down to immunization programs or more targeted attacks, low-income and minority school-aged kids will be disproportionately impacted, Hughes said. 

“I just absolutely, fundamentally, confidently believe that we will see deaths,” he added.

Anticipating chaos and instability

Following a contentious seven hours of grilling across two confirmation hearings, Democratic senators Kennedy’s confirmation on the floor late into the night Wednesday. The following morning, all 45 Democrats and both Independents voted in opposition and all but one Republican — childhood polio survivor Mitch McConnell of Kentucky — lined up behind President Donald Trump’s pick.

James Hodge, a public health law expert at Arizona State University’s Sandra Day O’Connor College of Law, said that while it was good to see senators across the political spectrum asking tough questions and Kennedy offering up some concessions on vaccine-related policies and initiatives, he’s skeptical these will stick.

“Whatever you’ve seen him do for the last 25 to 30 years is a much, much greater predictor than what you saw him do during two or three days of Senate confirmation proceedings,” Hodge said. “Ergo, be concerned significantly about the future of vaccines, vaccine exemptions, [and] how we’re going to fund these things.”

Hodge also said he doesn’t trust how Kennedy will respond to the consequences of a dropoff in childhood vaccines, pointing to the current in West Texas schools.

“The simple reality is he may plant misinformation or mis-messaging,” he said.

During his confirmation hearings, Kennedy tried to distance himself from his past anti-vaccination sentiments stating, “News reports have claimed that I am anti-vaccine or anti-industry. I am neither. I am pro-safety … I believe that vaccines played a critical role in health care. All of my kids are vaccinated.”

He was confirmed as Linda McMahon, Trump’s nominee to head the Department of Education, was sitting down for her first day of hearings. At one point that morning, McMahon signaled to possibly shifting enforcement to HHS of the — a federal law dating back to 1975 that mandates a free, appropriate public education for the with disabilities — if Trump were to succeed in shutting down the education department.

This would effectively put IDEA’s under Kennedy’s purview, further linking the education and public health care systems.

In a post on the social media site BlueSky, Randi Weingarten, president of the American Federation of Teachers, she is “concerned that anyone is willing to move IDEA services for kids with disabilities into HHS, under a secretary who questions science.”

Keri Rodrigues, president of the National Parents Union and a parent of a child with ADHD and autism, told The 74 the idea was “absolutely absurd” and would cause chaos and instability. 

Kennedy’s history of falsely asserting a link between childhood vaccines and autism — a disability included under IDEA coverage — is particularly concerning to experts in this light.

“You obviously have a contingent of kids who are beneficiaries of IDEA that are navigating autism spectrum disorder,” said Hughes, “Could [we] potentially see some sort of policy activity and rhetoric around that? Potentially.”

Vaccines — and therefore HHS — are inextricably linked to schools. Currently, all 50 states have vaccine requirements for children entering child care and schools. But Kennedy, who now has control of an agency with a $1.7 trillion budget and 90,000 employees spread across 13 agencies, could pull multiple levers to roll back requirements, enforcements and funding, according to The 74’s previous reporting. And Trump has signaled an interest in that mandate vaccines.

“There’s a certain percentage of the population that is focused on removing school entry requirements,” said Northe Saunders, executive director of the pro-vaccine SAFE Communities Coalition. “They are loud, and they are organized and they are well funded by groups just like RFK Jr.’s .”

Kennedy will also have the ability to influence the makeup of the committees that approve vaccines and add them to the federal vaccine schedule, which state legislators rely on to determine their school policies. Hodge said one of these committees is already being “re-organized and re-thought as we speak.”

“With him now in place, just expect that committee to start really changing its members, its tone, the demeanor, the forcefulness of which it’s suggesting vaccines,” he added.

Hughes, the law professor, said he is preparing for mass staffing changes throughout the agency, mirroring what’s already happened across in Trump’s first weeks in office. He predicts this will include Kennedy possibly asking for the resignations “of all scientific leaders with HHS.” 

Kennedy appeared to confirm that he was eyeing staffing cuts Thursday night during on Fox News’s “The Ingraham Angle.”

“I have a list in my head … if you’ve been involved in good science, you have got nothing to worry about,” Kennedy said.

The Finance Committee vote, which could have ended Kennedy’s bid, appeared to hinge on Republican Sen. Bill Cassidy, a former physician who was outspoken about his trepidation during last week’s heated hearings. Moments before Tuesday’s session he on X indicating his final position: “With the serious commitments I’ve received from the administration and the opportunity to make progress on the issues we agree on like healthy foods and a pro-American agenda, I will vote yes.”

On the second day of Robert F. Kennedy Jr.’s contentious confirmation hearings, GOP senator and health and education committee chair Bill Cassidy appeared to be balancing his support for President Trump against his serious misgivings about Kennedy heading the Department of Health and Human Services — and how one could harm the other.

“If there’s someone that is not vaccinated because of policies or attitudes you bring to the department, and there’s another 18-year-old who dies of a vaccine-preventable disease … it’ll be blown up in the press,” said Cassidy, referring to a young woman he treated who experienced liver failure as a complication of vaccine-preventable Hepatitis B. “The greatest tragedy will be her death. But I can also tell you an associated tragedy: that it will cast an absolute shadow over President Trump’s legacy.”

Kennedy, whose first day of testimony Tuesday before the Senate Finance Committee , can afford to lose the votes of only three Republican senators if all Senate Democrats vote against him. Cassidy holds particular sway because of his Health, Education, Labor, and Pensions Committee chairmanship and his previous career as a physician. The Senate is expected to vote on Kennedy’s next week. 

Like many of his Republican peers, Cassidy noted his areas of agreement with Kennedy — such as the importance of removing ultra-processed food from American diets — but in a break from his party, he vehemently fought Kennedy on his anti-vaccination rhetoric. 

“You’ve got a megaphone … with that influence comes a great responsibility,” Cassidy said. “Now my responsibility is to determine if you can be trusted to support the best public health.”

“That’s why I’m struggling with your nomination,” he added.

At both hearings this week, Kennedy tried to distance himself from his past anti-vaccination sentiments stating, “News reports have claimed that I am anti-vaccine or anti-industry. I am neither. I am pro-safety … I believe that vaccines played a critical role in health care. All of my kids are vaccinated.”

If confirmed, Kennedy would take control of an agency with a budget and 90,000 employees spread across 13 agencies, including the and the . 

Historically, Kennedy has falsely linked the Centers for Disease Control and Prevention’s vaccine schedule to a rise in chronic disease, saying at a town hall last year, “What I’m focused on is the bigger issue of chronic disease, and that is linked to the vaccine schedule in some cases, the explosion of chronic disease.”

When questioned this week, though, he pivoted, arguing that he supported the childhood vaccine schedule, which many state legislatures rely on to determine their school vaccine policies. Currently, all 50 states have vaccine requirements for children entering child care and schools. 

In one particularly tense exchange, Democratic Sen. Angela Deneece Alsobrooks of Maryland asked Kennedy to clarify previous remarks he had made about Black people requiring a different vaccine schedule than those of other races. 

Alsobrooks, who is Black, asked, “What different vaccine schedule should I have received?”

When Kennedy began to respond, saying, “Blacks need fewer antigens,” she cut him off.

“With all due respect,” she said, “that is so dangerous. I will be voting against your nomination.”

Vaccines and autism

At one point, Cassidy pulled up a National Institutes of Health study titled and began to share the data with Kennedy. In response, Kennedy doubled down, despite his earlier claims that if he were shown the data and research he would correct his record of and publicly apologize. 

“There are other studies as well,” Kennedy instead responded, pointing to one, which he said “shows the opposite.” 

“I’d love to show those to you,” he said.

Multiple senators, including Democrats Bernie Sanders and Tammy Baldwin, pointed to the decades of research disproving the connection and expressed concern that Kennedy wasn’t already familiar with or convinced by the body of peer-reviewed research.

“That is a really troubling response,” Sanders said, when Kennedy noted he was open to looking at studies disproving his previous claims. “Those studies are there … it’s your job to have looked at them.”

Republican Sens. Rand Paul of Kentucky, also a medical doctor, and Markwayne Mullin of Oklahoma, though, applauded Kennedy’s willingness to question science and keep an “open mind.”

“My God, if we didn’t question science, where would we be today?” asked Mullin.

“These are the nuances you’re unwilling to talk about,” said Paul, “because there’s such a belief in submission. Submit to the government.” 

He then implied schizophrenia might also be linked to childhood vaccines or food.

School shootings and mental health

In 2024, Kennedy appeared to link school shootings with Prozac and other drugs used to treat mental illness. “There’s no time in American history or human history that kids were going to schools and shooting their classmates,” Kennedy told the comedian Bill Maher “It really started happening conterminous with the introduction of these drugs, with Prozac and the other drugs.”

On Wednesday, Sen. Tina Smith, Democrat from Minnesota, pushed him on this issue, asking if he still stands by that claim.

“I don’t think anybody can answer that question,” he responded, noting that it should be “studied along with other potential culprits.” He subsequently dodged a question about whether or not SSRIs, a class of drugs used to treat depression, anxiety, and other mental health conditions, are dangerous, noting he knows people who have had a harder time getting off of these commonly prescribed drugs than heroin. Kennedy is a former heroin addict.

“These statements you’ve made linking antidepressants to school shootings reinforce stigmas” Smith responded. 

In a heated exchange, Michael Bennet, Democratic senator for Colorado and the former Denver Public Schools superintendent, accused Kennedy of giving disingenuous answers that did not mirror decades of public statements. 

“Unlike other jobs we are confirming around this place,” he said, “this is a job where it is life-and-death for the kids that I used to work with in the Denver Public Schools and for families all over this country … It is too important for the games that you are playing, Mr. Kennedy.”

Medicaid and Medicare missteps

During both hearings, Kennedy flubbed basic questions related to Medicare and Medicaid. On Thursday, Democratic Sen. Maggie Hassan of New Hampshire grilled him about basic elements of Medicare, which provides coverage to older and disabled Americans. He responded to all questions either incompletely or incorrectly. 

“You want us to confirm you to be in charge of Medicare, but it appears that you don’t know the basics of this program,” said 

At the first hearing on Wednesday, he appeared to mix up Medicare and Medicaid, which covers low-income populations and provides to schools annually for physical, mental and behavioral health services for eligible students. 

A focus on the “MAHA moms,” and ultra-processed foods

Kennedy repeatedly spoke about pediatric chronic health issues — ranging from obesity to allergies — linking them to environmental toxins and ultra-processed foods, issues that serve as the backbone of his “Make America Healthy Again” movement.

“Something is poisoning the American people,” Kennedy said when asked what his recipe to fulfill the MAHA tagline would be. The food supply, he said, is the “primary culprit.”

He said the movement has been led largely by “MAHA moms, from every state, many of them who have traveled to be here yesterday and today. This is one of the most powerful and transcendent movements I’ve ever seen.”

Multiple Republican senators also referred to the MAHA moms, with one noting he would vote to confirm Kennedy in part to honor that group’s views.

Kate Gould said the classroom became a dangerous place for her son after took over the Douglas County school board and the district removed masking requirements.

After a prolonged back-and-forth, involving a pulmonologist and a special education attorney, district leaders finally agreed to an accommodation for his classroom, mandating masks. But mere weeks later, the superintendent was fired and, under new leadership, the district again removed the masking accommodation without consulting doctors or Gould, she told The 74 in a recent interview. 

Now, almost four years later, Gould and her family live in Southern California — where they moved during the pandemic for its masking and eventual COVID vaccine requirements — and they and other parents, advocates and health experts are gearing up for what could be the next front of the school culture wars: a broader attack on school vaccine mandates by the incoming Trump administration.

Currently, all 50 states have vaccine requirements for children entering child care and schools. But with Robert F. Kennedy Jr. — who has peddled baseless conspiracy theories and “There’s no vaccine that is safe and effective” — potentially at the helm of the Department of Health and Human Services, advocates and parents are right to fear a rollback of requirements, enforcements and funding, according to interviews with about a dozen experts. 

“The anti-vax warriors have made it inside the castle walls,” said Richard Hughes, a George Washington University law professor who teaches a course on vaccine law.

Kennedy’s legitimization and the different levers he could pull, experts told The 74, could have an immense impact on vaccination rates and the spread of preventable, contagious diseases in school-aged kids.

If confirmed by the Senate, Kennedy would take control of an agency with a budget and 90,000 employees spread across 13 agencies, including the and the . Dave Weldon, nominated by President-elect Donald Trump to head the CDC, has also endorsed debunked theories, and some chronic diseases.

Kennedy, whose nomination faces from health professionals and scientists and questioning by , did not respond to requests for comment. He has said he would not take away vaccines but look to make more of their safety and efficacy data available. 

“We don’t know what he’s going to do,” John Swartzberg, a professor at the University of California Berkeley’s School of Public Health told The 74. “But if he tries to carry out the things that he’s publicly stated — not just recently but over a long, long time — then the implications for our children in school are dire.”

While most school vaccine requirements come from states, the recommendations they’re based on begin with federal agencies, such as the CDC, and enforcement is often left up to local districts. This leaves room for both federal influence and “a hodgepodge of enforcement,” said Northe Saunders, executive director of the pro-vaccine , who sees battles around school vaccination mandates playing out at the federal, state and school board levels.

Experts agreed the federal government is highly unlikely to attempt to take vaccines off the market or categorically ban mandates, and most don’t anticipate individual states will do away with their long-standing requirements.

But James Hodge, a public health law expert at Arizona State University’s Sandra Day O’Connor College of Law, pointed out, “You don’t actually have to pull the vaccine for people to stop using it. You have to raise doubts about it.”

That can happen by planting seeds of misinformation, he said, or by starting to require that vaccines be assessed differently for approval or federal funding. Any slight dropoff in parents vaccinating their kids entering schools or day care can result in disease outbreaks, an outcome Hodge said he expects to see over the next year or so. Such declines are

As secretary, Kennedy could delay FDA vaccine development and influence the selection of CDC advisory committee members who make the vaccine recommendations that states then use to determine their requirements. Programs that provide free vaccines for kids could also see their funding cut.

“There’s short-term threats in terms of funding and what’s going to be available for state immunization programs,” Saunders said, “[and then] there’s long-term threats about immunization policy and what the future of the immunization landscape in the country can hold.”

Even in Democratically controlled California, Gould, the mom whose son has cystic fibrosis, said she’s concerned about shifts in vaccine rhetoric, particularly at the school board level. 

“I think what I have learned from my experience in Douglas County, Colorado, is that when these individuals take over majorities on school boards, it really affects everyone … Despite the fact that we are a highly educated, very liberal, coastal section of Southern California, you definitely have people that are trying to make inroads — and these are people who are anti-science.”

Are vaccines the new critical race theory?

Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons. Most states also have religious exemptions, and 20 have some form of personal , leaving a varied landscape. 

School vaccine mandates have been around for , and while some pushback has always existed, it wasn’t until COVID that there was a real spike in vaccine hesitancy, according to Kate King, president of the and a school nurse in Ohio.

The source of the skepticism has shifted, too: “Rarely have we seen the federal government behind those debates in a way that this next administration could be,” said ASU’s Hodge.

Randi Weingarten, president of the American Federation of Teachers, sees the potential “unraveling of decades and generations of protective vaccines.”

“RFK believes he knows more than the totality of any science that has come before him,” she said. 

For a vaccine to get approved, it must first go through an advisory committee at the FDA. Another committee at the CDC then develops recommendations for vaccine schedules, which state legislators rely on to determine their school policies. Kennedy would have an enormous impact on who serves on these committees, and he could stack them with anti-vaccine advocates.

Kennedy could also request a review of all vaccines that have been previously approved by the FDA and subject them to new requirements. 

Many vaccines are paid for by the federal government. If Congress — under HHS’s direction or on their own — were to begin pulling that money, some of the most vulnerable children across the country could lose access to immunization. Trump has threatened to requiring vaccines for students. 

“The moment you start tacking on any price tag to a vaccination — any price tag whatsoever, even fairly minimal — you do see vaccination rates go down,” said Hodge.

Beyond policy actions, experts warned of the power of rhetoric. “We still rely — even under legal mandates that exist at the state level — on public acceptance of vaccines,” Hodge added, so for vaccine rates to remain high, so too must the public trust. The mere presence of a federal official who is skeptical and — at times outright hostile — towards vaccines gives the opposition more credibility.

Since the enforcement of these policies is typically left up to the district level, some advocates are anticipating increased pressure on school board members to take anti-vaccine positions. 

“The real tension is if a school board decides that they don’t want to support these [vaccine mandate] policies,” said Hughes, the GW law professor. “They can’t change the policies, but they might say, ‘We don’t support these policies. Not in our school district. No way, no how.’”

He said he’s already seen some groups use vaccines as a wedge issue, much like the debate over critical race theory — an academic framework used to examine systematic racism — that convulsed school boards a few years ago.

In , public health workers were recently forbidden from promoting COVID, flu and mpox — previously known as monkeypox — shots, according to a recent NPR investigation. And a regional public health department in Idaho is no longer providing COVID vaccines to residents in six counties after a by its board. 

There’s money in anti-vax anxiety

The anti-vaccination movement is not new. It can be traced back as far as the 18th century with Edward Jenner’s discovery of the smallpox vaccine. Because it was made from cowpox, people at the time were afraid that if they got the vaccine, they’d turn into a cow, said Swartzberg, the public health professor who has taught a course on the anti-vax movement for over a decade. 

“There’s always been opposition to vaccination because it’s the idea of the word inoculate, — meaning putting into you something foreign — and that scares people,” Swartzberg said. “I understand that. That’s where emotion has to be countered with data.” 

The group of people so stringently anti-vaccination that they refuse them is small but vocal, he said. Over the past few years, though, “something has dramatically changed in our society,” and the voices behind the movement have shifted from expressing personal fears to looking to monetize the fears of others. 

For example, Joseph Mercola, deemed one of the — the 12 people responsible for sharing the majority of anti-vax messaging on social media — made substantial sums of money by peddling far-fetched health claims and then as alternative treatments. Kennedy also appeared on the “Disinformation Dozen” list.

Others sell merchandise, books and tickets to events, offer exclusive paid content on platforms like Patreon, have sponsored content and display affiliate marketing links to anti-vaccine products.

“It’s turned into an incredibly lucrative field for anti-vaxxers, and what’s really facilitated this has been the internet and the lack of any monitoring of the internet for misinformation and disinformation,” Swartzberg said.

Just last week, Meta, the owner of Facebook, Instagram and WhatsApp, d that it will end its fact-checking program on social media posts. 

Using social media and other mechanisms, the anti-vax movement has targeted fairly insular groups around the United States with misinformation, he added. These include New York’s and the y in Minnesota, both of which have seen recent measles outbreaks. 

While the image of vaccine skeptical parents is often one of young, white “,” Keri Rodrigues, president of the National Parents Union, also pointed to “well-earned” trepidation among Black and Latino parents. 

Historically, she noted, significant harm has been done to Black communities through the weaponization of medical trials, and families of color have had particularly negative experiences with the health care system —

During the pandemic, Children’s Health Defense, Kennedy’s anti-vaccine advocacy organization, seemed to tap into this distrust when it put out targeting Black Americans with disproven vaccine claims. 

Gould, the California mom, said if she were still living in more conservative Douglas County she’d fear that people would “believe the disinformation [and] stop vaccinating their children. For kids with chronic illnesses — or like my son, a life-limiting illness — that has massive consequences. It has life-or-death consequences.”

According to the (CDC), nearly 13% of preschool children in the U.S. and 21% of 6- to 11-year-olds are classified as overweight or obese. Note: The CDC defines children’s weight status differently from adult Body Mass Index (BMI) categories. Because children’s body composition varies as they age and varies between boys and girls, the BMI levels in children and teens are expressed relative to other children of the same age and sex.  place underweight as less than the 5^th percentile of children of the same age and sex; healthy weight from the 5^th to less than the 85^th percentile; overweight as 85^th to less than the 95^th percentile; and obese as 95^th percentile or greater.

The (NIH) describes childhood obesity as the most challenging public health issue in the 21^st century, and is associated with increased morbidity and premature death. Children who are obese in childhood tend to stay obese into adulthood and face increased risk for diabetes, asthma, cardiac problems and issues such as low self-esteem and anxiety. The NIH paper, “” by James A. Levine, states that obesity-associated chronic disease accounts for 70% of U.S. health costs. The paper further states that halting the U.S. obesity epidemic and lessening its health costs “may require that the U.S. addresses poverty itself.”

Multiple environmental factors influence childhood obesity, but living in a low-income family and in environments and communities that don’t support healthful diets or physical exercise are two of the most substantial risk factors, according to the . Though the CDC recommends children eat healthy food and stay physically active, many children — especially those living in very low-income homes — don’t have ready access to either nutritious food or a place to play freely. According to the NIH, roughly 6% of the people in the U.S. live in a food desert, defined as a geographic area that lacks sufficient access to grocery stores. Economic and racial disparities persist across the U.S., with about 30% more non-white residents facing limited access to retail food outlets than their white counterparts.

Dahlin says early childhood programs can provide an important pathway to launch children on healthier trajectories. Program standards for most early childhood programs require that the children receive some information on nutrition and physical education, though how this information translates into daily interactions can vary from one program to another. Information alone won’t make much of a dent in the complex issue of childhood obesity; Dahlin says a web of approaches is required.

“You can’t just tell families, ‘Eat healthier things,’ if you aren’t addressing the systemic components that affect their health,” she says. “How accessible is food? Can families get there? Is it affordable? Do the children have access to play areas where they can run around, play and be children?”

“Food deserts are in low-economic status neighborhoods without grocery stores or even transportation. Sometimes families are working multiple jobs, so their work schedules make it extremely difficult to get to any type of store with fresh fruits and vegetables. They might have one child in child care and another in school, and they have to take a bus to get each of them. These people are incredibly busy and just trying to access food is challenging and time intensive.”

To solve these challenges, it may not be necessary to reinvent the wheel.

Enter Head Start. Authorized in 1965, Head Start is the longest running publicly funded early learning program in the U.S. It not only provides child care, but it also connects low-income families with the services they need to support their child’s development. Guided by the that was introduced in 2011, Head Start has fostered positive parent-child relationships, community connections and viewed parents as leaders and advocates.

“Head Start provides food when children are attending, and they connect families to resources to support food security outside program hours,” Dahlin says. “That’s essential for learning. Look at — if a child is hungry, they aren’t learning. The program also connects children with primary care providers, dental care and immunizations — all these things that promote good health.”

Head Start collects BMI () information on children in the program within 45 days of entry and uses the information to monitor the well-being of children whose BMI percentiles are in the underweight, overweight or obese range. The NIH considers BMI an economical method to assess body fat indirectly, though the measure has come under scrutiny in recent years because it was developed in the 1800s as part of a quest to determine an average weight for “the average (white, European) man.” The tool is often inaccurate in determining health in women and people of color and has been the source of medical discrimination and weight stigma.

“There has been a lot of understandable push back on using BMI as the metric for health, but we felt that BMI, collected by the programs, could serve as a useful proxy for understanding the effects of Head Start’s contribution to children’s nutrition and physical activity,” Dahlin says. “In the program, children develop food vocabulary and a knowledge base to understand the impact of nutrition and different foods on health. They learn where food comes from. They have consistent access to food, which is a really important takeaway. So, moving away from that one-size-fits-all BMI metric, it’s important that future research take more of a look at what it would mean for children to develop healthy behaviors and to look at that behavior change over time.”

For their study, Dahlin and Reich looked at administrative data from a large urban Head Start program in the Southwest that comprised 26 Head Start centers. Their sample was restricted to 1,120 children with at least two reports of BMI at the 85^th percentile or higher, at points at least 90 days apart. All the children identified as Latine (the researchers prefer the term Latine), their parents spoke Spanish as their primary language and nearly all families reported incomes that fell under the federal poverty level.

What the researchers found was that children in the sample saw a reduction in their BMI over the program year and children with a BMI in the severely obese range experienced a greater, statistically significant, reduction than children who entered the program as overweight or obese. Entry to Head Start at 3 years old predicted a greater reduction in BMI for each month the child was in the program than for children who started later. Having a sibling in the program and receiving a child care subsidy also predicted lower BMI per month.

As is often the case with research, the study created questions that beg more research.

“I think as we transition away from BMI as the measure, we want to consider other ways to measure these health outcomes,” Dahlin says. “We need a lot more qualitative work to understand folks’ experiences and how they interact with food. What are their experiences with some of these food security programs? How do we foster behaviors like positive relationships with food and what systems do we need to set up to make sure folks have access to and an ability to get affordable, healthy food regardless of where they live or how much money they make?

“The bottom line is that the Head Start program is an existing, comprehensive program that is already well set up and well-suited to make a difference in our country’s child health and overweight and obesity issues.”