The ruling came about nine months after the American Academy of Pediatrics and other groups filed a lawsuit against longtime vaccine skeptic, Health and Human Services Secretary Robert Kennedy Jr.,  and the department he leads, which includes the Centers for Disease Control and Prevention.  In it, the plaintiffs argued that Kennedy Jr.’s advisory committee appointments — and the panel’s subsequent votes to roll back childhood vaccine recommendations — were unlawful.

David Hill, a pediatrician who has been practicing for over 30 years, serves as a spokesperson for the AAP. He recently told The 74 that while he and his colleagues are “very happy” with this latest development, “we’re also all still holding our breaths.”

“This is one moment in a lengthy process,” he added. “It is an encouraging moment, but I don’t think any of us are under the impression that this is over yet.”

Most of Hill’s work centers around hospitalized children and newborn care, which means he is often the first pediatrician a family meets and the one parents talk to about vaccinating their kids. He recently started practicing in Seattle after spending years working in North Carolina, where he served a widely diverse group of patients.

The families he works with, he said, have “vastly different socioeconomic backgrounds and value systems and understandings of health,” which has given him a unique perspective into on-the-ground impacts of shifting vaccine policies.

While not new to public discourse, vaccine skepticism has significantly swelled and gained greater footing since Kennedy Jr. took the helm of the nation’s health care system last February. Following his appointment, he swiftly fired all 17 members of the Advisory Committee on Immunization Practices, also known as ACIP, replacing them with hastily hand-picked advisors who largely shared his views on vaccines. 

The committee 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. Then, this January, officials announced a plan to overhaul the U.S. childhood vaccine schedule, significantly reducing the number of shots routinely recommended for all kids — all amid already falling vaccine rates, measles outbreaks and The AAP and other groups were also cut off from their long-standing liaison roles. 

It was in response to all of these decisions that the AAP, a trusted source of information for pediatricians and families for nearly a century, began boycotting ACIP meetings, released a competing vaccination schedule, filed their lawsuit and effectively severed ties with the committee.

March’s preliminary injunction halts the changes to the pediatric immunization schedule, and stays Kennedy Jr. ‘s 13 appointments to the committee, essentially rendering it unable to meet. All votes made by the now-stayed ACIP appointments are also overturned — at least temporarily. 

When asked to comment, HHS spokesperson Andrew Nixon said this week that the department looked forward to the judge’s decision being overturned, but would not say whether it had filed an appeal.

The 74’s Amanda Geduld recently spoke with Hill about his organization’s lawsuit and how childhood vaccine sentiments have shifted over the past three decades. The impacts he’s seen in his own practice are particularly illuminating.

This interview has been edited for length and clarity. 

What is the most common question that parents ask you about vaccinating their newborns? Is there one vaccine they’re particularly concerned about?

I have the most experience in my current role with the first hepatitis B vaccine, but I think it is a fantastic model for the questions that we get about other vaccines. For example, I recently admitted a child at the hospital with an infection and breathing difficulty at age 2 who had not yet been vaccinated against Haemophilus influenza B (Hib) and pneumococcal pneumonia. 

And we had to think about this child very differently, because these are complications of viral illnesses that used to be absolutely horrendous — with meningitis, aggressive pneumonia, severe ear infections, infections of the bone around the ear or behind the ear. And really, because of the effectiveness of the vaccines against these illnesses, we have been lulled into not worrying about them very much anymore. And so we had to make sure that the team was aware that this was a possibility — these complications with this baby. 

But most often I’m talking about hepatitis B, and usually I’m the one who begins with the questions, and I say, “Hey, I noticed that your child has not had the hepatitis B vaccine we usually give. Do you mind sharing with me your thoughts about that?”

How have those conversations shifted, if at all, over the past three decades that you’ve been practicing medicine?

Well, they used to be vanishingly rare. And not a “never” event, but a rare enough event that if it occurred, it was remarkable. It might be the first thing I would tell my wife when I came home that evening, or something I would comment to my colleagues about when I went into the office. “You’ll never believe this, but we had a patient turn down [the] hepatitis B vaccine today.”

And that is because there was a widely shared understanding that this was an important intervention to keep children healthy for the rest of their lives, and that it was an extraordinarily low-risk intervention with a very high degree of reward. 

And it wasn’t a never event. It’s always been there, but it was remarkable. It was unusual, and the script has flipped to the extent now that when I’m first reviewing a newborn’s chart before I go into the room, I actually breathe a sigh of relief when I see that they have gotten their vaccine, because a really significant proportion of my patients — especially just in the last five or six months — have decided that they are going to delay it or maybe not get it at all.

How much of that do you attribute to this current administration and to Robert F. Kennedy Jr.’s leadership of HHS?

I think that there’s a very apropos chicken-and-egg question here. The wellness industry has put an enormous amount of money and effort into undermining confidence in traditional medicine, and that, of course, allows them to expand their market. It’s a market which is extraordinarily profitable. 

But if patients have trust in traditional medicine, then they’re less likely to purchase those products or to go to those providers. So there has been a decades-long effort — in terms of marketing, in terms of influence — that has been well funded and extraordinarily successful. 

It certainly did not start with the election of Donald J. Trump, either the first time or the second time. It definitely was accelerated by the success of a number of proponents of these efforts to achieve power within the United States government, to achieve federal power. 

And as much as people distrust the government, they really do listen to what the government says. So when the message coming from the Centers for Disease Control and Prevention or from the Department of Health and Human Services, are messages undermining confidence in traditional medicine — whether we like it or not — that really does have a bearing on the decisions that people make.

Last July, the AAP sued HHS and Kennedy Jr. over vaccine policies. Then, in March, a judge issued a stay, which essentially means that a lot of the votes that ACIP made are overturned — at least for now. One of those involves the Hep B vaccine birth dose. Can you talk a little bit about the initial decision that was made by ACIP to delay that birth dose, and how you saw that impacting patients on the ground?

I think the really good news for those of us in public health and those of us striving for child health is that the initial decisions made by the ACIP — the ones that were recently stayed by the court — had not yet come to affect what vaccines were available to children. And so the stay has also not changed that, because payers were still paying for the vaccines, suppliers were still supplying them, manufacturers were still making them, hospitals and offices were still stocking them. 

So I think it’s very good news that we had not yet seen our worst case scenario of some of these vaccines becoming unavailable or unaffordable. We, on the ground, are very happy to see a court agreeing with our professional opinion that there was no scientific basis for making these changes, and yet I think we’re also all still holding our breaths, because this is not done. There will be appeals. This is one moment in a lengthy process. It is an encouraging moment, but I don’t think any of us are under the impression that this is over yet.

You mentioned that the judge’s ruling luckily came before some of the worst case scenarios were able to play out. But are you aware of any pediatricians on the ground who had started shifting any of their practices based on ACIP votes?

I am not. I am quite involved in the American Academy of Pediatrics, and listen to a lot of lines of communication. And I think we were all trained to follow the best evidence. And the American Academy of Pediatrics, and scores of other medical organizations, endorsed an evidence-based vaccine schedule that was very similar to the prior vaccine schedule, and that is, as far as I know, what all of my colleagues were referring to.

If the judge had not issued this preliminary injunction, do you think providers on the ground ultimately would have shifted their practices to match the new ACIP guidelines? Or would they have stuck to the evidence-based practices regardless?

You know, I have great confidence that my colleagues would have continued to follow the evidence wherever it leads. I think the fear would have been that some other barriers to following that evidence might have arisen — in terms of reimbursement, manufacturing, liability — that would have made it more difficult for us to do what we know is right for children.

I would imagine that the majority of parents across the country are not keeping super close tabs on this lawsuit or tuning into ACIP meetings, but they are reading the headlines, and they’re seeing these rulings go back and forth and practices being implemented and then rolled back. I’m wondering what impact that back-and-forth messaging is having on parents. Is that leading to confusion?

Oh, I know that it is leading to massive confusion. When you look at a marketing campaign, as this has been, people don’t have to be convinced that a message like this is correct, they just have to have some doubt. And so the fact that these conflicting announcements or decisions are sowing doubt is really enough to dramatically change the landscape that we are looking at at this point in terms of communicating with parents, in terms of following the best practices for public health and in terms of protecting children.

So what is your big takeaway of the judge’s latest ruling then? What impact will this stay have for parents and providers on the ground?

I think the most important shift that I’ve seen — and as a professional medical communicator, it is a shift that I welcome — is that pediatricians and health care providers as a whole, and scientists and public health officials are coming to terms with a new understanding of how critical our communication is. And it is across the board revolutionizing the way that we communicate, both individually and in public.

Can you talk a little bit about how that communication is revolutionizing, specifically when you’re talking to patients and parents of patients?

Yeah, absolutely. My dad is still a practicing pediatrician at age 84, and throughout his career he could count on the fact that he was the doctor being enough for most people. He walks in the room in a white coat with years of experience and an absolutely spectacular education at the best institutions the country has to offer, and has a wall of diplomas behind him, and people will be like, “OK, you know a thing.” It’s just like when I walk onto my airplane and I see the pilot with all the gold bars on his epaulet. I’m like, “Oh, this guy probably knows how to fly an airplane. I’m going to take my seat.”

The relationship between doctors and patients and doctors and the public has changed in a way that I don’t think is going to change back. No matter what happens, we can’t just sit down in the chair and say, “Hey, I’m the doctor. Here’s what you need to do. Trust me, I studied, I know some stuff.” Patients are really demanding — and appropriately so — that we show first that we care and that we can listen and that their value system, their understanding, their goals for their child’s health are the most important thing in that room — that we are servants who can bring our knowledge to bear to further this family’s goals for their child. … 

My mentor for many years, Dr. Tom Blackstone in Wilmington, North Carolina, used to sit me down early in my career and say, “Davey, they don’t care how much you know until they know how much you care.” And those are the very wise words of someone who’s been doing this for a long time, and I think those are words we all have to live by.

I love that — that’s a beautiful sentiment. Well you talked about how there have been shifts in medicine you don’t necessarily foresee going back. I’m going to ask you to look into a crystal ball here, if you will, and tell me if you foresee this moment as a shift in policy moving forward. 

In other words, might this be a time the administration moves away from the attacks on vaccine policy and perhaps more towards other elements of the MAHA movement, like nutrition? Or is this stay merely a brief pause before the vaccine battle continues?

I would tend more toward the brief pause, and I would be thrilled if MAHA acted aggressively on some of their (other) priorities. There is more common ground between the stated priorities of the MAHA movement and the priorities of pediatricians. We would love to see kids get more fresh, healthy food in their diets. We would love to see aggressive measures taken to reduce pollutants in the water, in the air, in farming practices. We would love to see efforts toward increasing family activity and generating safe green spaces for exercise and play really put at the forefront of policy. 

I think, in a very sincere way, there are a ton of common goals that pediatricians and the MAHA movement share. I am disappointed that on many of these fronts, it appears that this administration is actually taking steps backwards rather than forwards. Taking steps to allow greater degrees of pollution that we know harm children; taking steps to allow greater use of chemicals in farming; taking steps to decrease the availability of fresh, healthy food in schools, for example. 

And people have done this — there are forums where pediatricians and MAHA advocates sit down and find that they agree on a lot. So I think we would love to see any of those priorities move to the forefront of the movement. … The attack on vaccines, unfortunately, is very much an attack on public health, and so I think we are still waiting to see what the next steps are going to be before we relax.

The AAP has always been a highly trusted organization and leading authority on children’s health, but I would imagine that role has been pretty seriously magnified over the past year or so with this shift in leadership. Can you talk a little bit about what that feels like from inside the organization and how that’s impacted some of your public-facing actions?

Past administrations have certainly cooperated in more concert with the American Academy of Pediatrics, regardless of whether the leadership was Republican or Democratic. We are a nonpartisan organization, and we have enjoyed close working relationships with pretty much every administration. I believe it is unprecedented since we began working with the ACIP to terminate that relationship. So that certainly would appear to be a flash point. 

However, as a pediatrician of a certain age, I also recall that this is very much in continuity with the American Academy of Pediatrics taking positions in favor of child health that were at times quite unpopular with the public. We were out there early talking about tobacco-free spaces and tobacco-free homes. Those of us who are old enough to remember when people smoked in restaurants and airports and pretty much anywhere they wanted to also recall that there was a tremendous backlash on that. 

When the American Academy of Pediatrics came out in favor of taking lead out of gasoline and paint that was dramatically unpopular. The fuel industry and the paint industry, the builders, really protested quite loudly against that. Even car seats, bike helmets, things that we all take for granted as public safety measures — like who would not have their baby in a car seat right now? — were incredibly controversial when they began, and the American Academy of Pediatrics always stood up for child health and safety first and understood that if children’s health was benefited, eventually the public would understand. …

So to some extent, we are just following in the footsteps of those who came before us, and I certainly hope that when I’m not working anymore, there will be another generation to continue in that path, because it’s the right path.

Is there anything I haven’t asked about — having to do with this current administration and vaccine policy — that you think is important for readers to understand, given the news of the past couple of weeks?

I think first of all, that the public is wise enough to see where these attacks on vaccines could lead, and to make good decisions regarding child health moving forward. I don’t think we’re going to be having the same conversation in 10 years, or even five years, because as we see measles sweep through certain states, we’re also seeing people in those states recognize what a danger it is. And part of what we’re seeing is parents asking if they can have their babies vaccinated against measles at six months of age, which they can, it just doesn’t keep them from needing the next two vaccines. 

I think that the public is really very intelligent, and that people are already waking up to what these changes mean for public health, and I think for the most part, they don’t like it. One truism that I’ve witnessed as a pediatrician throughout my career is that parents love their children. They want the best for their children. Everybody holds their baby, imagining what that little being is going to turn into, how they’re going to grow, what they’re going to accomplish, and knowing that, I know that societally, we are going to ultimately make good choices, because that’s what it means to love our children.

was originally reported by Barbara Rodriguez of . .

In mid-December, Dr. Annie Andrews turned on her camera to record. The pediatrician — among a growing cohort of medical professionals who use social media to break down health care news and misinformation — had a public service announcement.

“As the entire country is aware, we have a measles outbreak in the upstate of South Carolina,” Andrews said. At the time, there had been of the highly contagious disease in the state, where she and her three school-aged children reside.

Andrews noted that the vaccine available to prevent measles — known as the measles-mumps-rubella (MMR) vaccine — . She offered practical advice for adults who might want to check if their measles immunity had waned. And she cautioned people to be extra mindful amid holiday travel.

“Please stay home if you have a fever, stay home if you have obvious cold symptoms like a cough and a runny nose,” she said. “Certainly stay home if you have a rash along with that fever. Protect your loved ones and do what you can to stop the spread of measles here in South Carolina and in the other parts of the country where it is currently spreading.”

Her video ended with an image promoting her campaign for the U.S. Senate.

“I never in a million years, when I was in medical school, thought that I would be running for the U.S. Senate and also talking about measles nearly every single day,” Andrews told The 19th.

A growing measles outbreak — since start of the year, in the United States, with South Carolina being the epicenter — has become a cornerstone of Andrews’ messaging for her , which she balances while working at a children’s hospital and parenting.

And Andrews suspects that mothers are paying close attention to her campaign. She calls mothers of school-aged children her most loyal base of supporters. They leave positive messages on social media, stop her after campaign events and while she’s shopping at the grocery store.

“As we see our children under constant threats — whether it’s from or now sort of the politicization of HHS and vaccine recommendations — moms have had enough and they’re fighting back,” she said. “I think I’m tapping into something here in South Carolina and across the country. Moms who just get that ‘mama bear’ instinct — and now they understand that politics is a really important way to fight back and protect their kids.”

The Democrat faces an uphill battle as she challenges Sen. Lindsey Graham, a four-term Republican incumbent who’s held the seat for more than 20 years. While Andrews outraised Graham in the third and fourth quarters of 2025 , the senator has more cash-on-hand to spend. Both candidates are heavily favored to win their primaries in June.

Andrews first ran unsuccessfully for Congress against Republican Rep. Nancy Mace in the 2022 midterm election. in a race that centered . After her last congressional bid, Andrews did not plan to run again.

Then Robert F. Kennedy Jr. was confirmed as health secretary.

“The fact that it is 2026 and here I am in South Carolina, where we are in the midst of a measles outbreak because of disinformation and conspiracy theories spread by people like RFK Jr. — is just really mind-blowing to me as a health care professional, as a physician, as a clinical researcher,” she said. “And so it really was the reason I decided to get in this race.”

Andrews connects Kennedy’s actions on vaccines — his department has made , , to senators like Graham in part by noting their critical confirmation votes. A spokesperson for Graham did not respond to a request for comment about the senator’s stance on the measles outbreak in his home state. A review of recent public news releases on Graham’s Senate website does not appear to address the topic.

But Andrews’ campaign also focuses on health concerns more broadly: Andrews believes the political headwinds are shifting. Republicans, who control Congress, last year enacted massive budget cuts to programs like , and they allowed under the Affordable Care Act to lapse, sending premiums skyrocketing.

“South Carolina has a lot of health care deserts, folks who live in rural areas, who have to drive many, many miles and cross county lines to reach a hospital system and an emergency department and maternity care,” she said. “All of that is going to be made so much worse because of what we’ve seen from this Trump administration — of course, enabled and supported by Lindsey Graham.”

Andrews is tapping into a topic with massive implications on public health, said Shaughnessy Naughton, president of 314 Action, a political action committee that tries to elect Democrats with a STEM background to office and has endorsed Andrews. Before the record-setting cases in 2025, the United States had averaged 180 cases of measles annually since 2000, when the disease was declared eliminated. this year and the United States is on the brink of losing its elimination status.

“As a pediatrician in kind of ground zero of the measles outbreak in South Carolina, she is a voice of real credibility and authority,” Naughton said.

Doctors and health care professionals have increasingly declared candidacies ahead of the midterms, according to 314 Action. Last November, the group endorsed and supported 148 candidates in races that included seats in New Jersey and Virginia — 108 won.

314 Action launched a new last year aimed at electing more doctors, nurses and public health experts to state and federal offices. It has received 200 applications from doctors interested in running, according to Naughton.

“Americans overwhelmingly support childhood vaccines that have been shown to be effective and safe. Americans wanted the ACA subsidies to be extended so they could continue to purchase health insurance to keep their family safe and healthy,” she said. “You couple it with a cut to public health and research that provides future hope for people and cures — it’s just an administration that is not listening to what Americans want.”

Kayla Hancock is director of Public Health Watch, a health-focused communications initiative from the health care advocacy group Protect Our Care. She said the Trump administration’s health policies — led in part by Kennedy — have forced the electorate to pay attention. shows 75 percent of voters say the cost of health care will impact how they vote in the midterms.

“Every day, the consequences of the Trump administration’s policies around health and public health are mounting,” she said. “Between disruptive vaccine development and now deadly outbreaks of diseases that we had previously had under control, and then, of course, .”&�Բ�����;

Andrews is running for office while commuting between Charleston, where her children attend public school and she co-parents with her ex-spouse, and Washington, D.C, where she works at a children’s hospital. She said going back and forth between these two worlds — the campaign trail and her job as a doctor — has grounded her candidacy.

“I’m taking care of kids who are struggling with food insecurity. Kids who have asthma and live in a home with mold on the walls and can’t afford to move to a different apartment. Kids whose parents can’t afford their prescription drugs. Kids who can’t access mental health resources in their community, and kids who have a past medical history of gunshot wounds, which is really only something you see in America,” she said. “It reminds me of all the reasons I’ve sacrificed so much to run for office. Because these problems are so urgent.”&�Բ�����;

Andrews’ campaign platform extends beyond health care. Through her lens as a parent, she talks about addressing gun violence, making groceries more affordable for families and restoring federal abortion rights.

Still, disease prevention has been a central issue for her. Even before the outbreak in South Carolina, Andrews featured an X-ray of a kid with measles pneumonia and noted the condition could be prevented by vaccines. It’s a point she often brings up now both online and on the campaign trail, partially because the outbreak in her state has worsened since her December PSA: As of early February, cases in the state , mostly involving children 17 and under.

More than 240 cases involve children under the age of 5, some of the most vulnerable to infection since children under the age of 1 are typically too young to get the MMR vaccine. Most of the infections reported were among people not vaccinated.

The consequences to children only crystallize Andrews’ decision to run. She pointed out that while doctors have served in the Senate, a pediatrician has never been elected into the centuries-old chamber. (Rep. Kim Schrier of Washington state, a Democrat elected in 2018, .)

This week, Andrews focused on measles and related resources for parents.

“There’s never been a more important time for people who have an understanding of our health care system and basic medical principles to be in the room where decisions about our health care system — decisions about the public health guidance that is coming out of the federal government — are being made,” Andrews said.

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.

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.”&�Բ�����;

“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.”

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].”&�Բ�����;

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.”&�Բ�����;

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.”&�Բ�����;

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.”

Last week, National Institutes of Health Director Dr. Jay Bhattacharya announced that his office would draw on an unprecedented array of public and private records to establish a “disease registry” centralizing information on autistic people’s prescription drug use, insurance claims, Medicare and Medicaid records, genetic and lab tests and even data from smartwatches. 

In response to the strong pushback that followed, the department attempted to walk back the announcement — and blame the media for the furor.

“The original narrative incorrectly suggested that HHS was creating an autism registry to track individuals using personal data,” the department said in a statement to The 74. “This is not accurate. The NIH is developing a secure data repository that will allow researchers to analyze large-scale, de-identified data. The director did not misspeak; rather, the term ‘registry’ was misused by the media, implying an unethical method of data collection.”

However, using video of the NIH announcement, the fact-checking site Snopes that the original reporting was accurate. 

Bhattacharya’s initiative followed a promise by U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. that by September, new research sponsored by his department would responsible for what he called an autism epidemic. That theory contradicts mainstream science that links autism to genes and the increasing number of diagnoses to better testing — particularly in low-income households and among children of color. 

Though many autistic children are able to prepare for college and a career when given the proper supports, “These are kids who will never pay taxes,” Kennedy said. “They’ll never hold a job. They’ll never play baseball. They’ll never . They’ll never go out on a date. Many of them will never use a toilet unassisted.”

To head the study, Kennedy appointed a man cited by Maryland officials for practicing medicine without a license. David Geier was also found to have improperly prescribed puberty blockers for autistic children and administered a harmful drug used to treat lead poisoning that is not approved for use in the U.S. 

Given Kennedy’s public proclamations, advocates said they would take a wait-and-see stance to the announcement that the new database would not contain a registry.  

“This is positive news, but given this administration’s previous actions and comments, particularly those related to autism over the last several weeks, we are not assuming that there is no longer anything to worry about,” leaders of the Autistic Self Advocacy Network said in a statement. “Given everything this administration is saying and doing about autism,  and public health, we have every reason to distrust this initiative under current leadership at HHS.”

The word “registry” is particularly polarizing to disability advocates, who note that such lists — which still exist in some U.S. states — were used to identify autistic children who were killed in Nazi Germany’s experimental “euthanasia clinics,” as well as people to be sterilized and institutionalized in the United States.  

“ ‘Registry’ and ‘data collection’ can mean many things,” the network said, adding that if advocates had been included in discussions about the proposed research, they could have asked for clarity: “Under previous administrations led by both Democrats and Republicans, we and other organizations had direct lines of communication with autism policy experts inside HHS.”

Several days before the NIH announcement was reported, four dozen organizations that advocate for autistic people issued a rare collective statement criticizing Kennedy’s repeated, disproven claims about a condition many scientists agree is a naturally occurring neurotype. 

“We are deeply concerned by growing public rhetoric and policy decisions,” said . “Claims that autism is ‘preventable’ [are] not supported by scientific consensus and perpetuate stigma. Language framing autism as a ‘chronic disease,’ a ‘childhood disease’ or ‘epidemic’ distorts public understanding and undermines respect for autistic people.”

Unknown is whether the NIH plan will indeed merge records that contain sensitive personal details with datasets that don’t include people’s identifying information. “HHS will … spend tens of millions of dollars linking existing federal databases,” the trade publication , attributing the information to a department statement. “The National Institutes of Health (NIH) working to partner with the Centers for Medicare & Medicaid Services, the Centers for Disease Control & Prevention, the Department of Defense, the Department of Veterans Affairs and other agencies to create ‘a comprehensive real-world health dataset that maintains the highest standards of security and patient privacy.’ ”

In its statement to The 74, the department said the dataset being assembled “would be fully compliant with these laws and regulations to protect Americans’ sensitive health information.”&�Բ�����;

“Data science can advance our understanding of biomedical and behavioral phenomena and contribute to breakthroughs that improve health by mining large sources of data, such as databases and datasets, for information,” said the statement. “Researchers can use techniques like machine learning and AI in data science to help analyze data and make predictions about health outcomes and disease incidence.”

As of press time, more than 150 researchers belonging to the recently formed Coalition of Autism Scientists had signed a letter calling on HHS and NIH to observe rigorous standards. Kennedy’s controversial dismissal of mainstream beliefs that better diagnosis is a major factor behind the rise in autism rates, and his plans to find, within a few months, an environmental toxin that causes autism, have . 

“We were deeply troubled to hear [Kennedy] dismiss past research, downplay the causal role of genes and portray autistic people in ways that counter our experiences and demean their value to society,” the letter says.  

Among other measures, researchers urged Kennedy to pre-register the protocol for any planned study. This voluntary practice — creating a time-stamped, public document outlining what the study will attempt to determine — is what is sometimes referred to as “hypothesizing after results are known.” The scholars also want HHS’ researchers to share their data with independent analysts for verification. 

It all began when school officials mistook a blurry image of a Mike and Ike candy for pills. 

Pennsylvania teenager Blake Robbins found himself  that gave rise to student privacy debates amid schools’ growing reliance on ed tech. 

Spy High, a four-part documentary series streaming now on Amazon Prime, puts the focus on a lawsuit filed in 2010 after Robbins’ affluent Pennsylvania school district accused him of dealing drugs — a conclusion officials reached after they surreptitiously snapped a photo of him at home with the chewy candy in hand. 

The moment had been captured on the webcam of his school-issued laptop — one of some 66,000 covert student images collected by the district, including one of Robbins asleep in his bed. 

I caught up with Spy High Director Jody McVeigh-Schultz to discuss why the 15-year-old case offers cautionary lessons about student surveillance gone awry and how it informs contemporary student privacy debates. 

How student surveillance plays out today: Meet the gatekeepers of students’ private lives. | 

In the news

Courts block DEI directive: Three federal courts ordered temporary halts on Thursday to Trump’s efforts to cancel student diversity initiatives — and demands for states to pledge allegiance to the administration’s interpretation of civil rights laws. | 

President Donald Trump signed an executive order Wednesday that called for school discipline models “rooted in American values and traditional virtues,” taking aim at Obama- and Biden-era efforts to reduce racial disparities in suspensions and expulsions. | 

‘The history there is deeply, deeply disturbed’: Disability-rights advocates have decried plans at the National Institutes of Health to compile Amerians’ private medical records in a “disease registry” to track children and other people with autism. | 

• Health and Human Services Secretary Robert F. Kennedy Jr., faced criticism for recent comments that many kids “were fully functional and regressed because of some environmental exposure into autism when they’re 2 years old.” | 

A new lawsuit filed by students at military-run schools accuses the Defense Department of harming their learning opportunities by banning books related to “gender ideology” or “divisive equity ideology,” including texts that refer to slavery and sexual harassment prevention. | 

California lawmakers are demanding answers after Department of Homeland Security agents visited two Los Angeles elementary schools and asked to speak with five students who the federal agency said “arrived unaccompanied at the border.” | 

‘We all deserve reparations’: White House aide Stephen Miller said in an interview last week the country “used to have a functioning public school system” until it was destroyed by “open borders.” | 

The Justice Department seized thousands of photos and videos in an investigation of a former University of Michigan assistant football coach who was indicted on allegations he hacked into student athletes’ private accounts to steal intimate images. | 

A 48-year-old mother was arrested and accused of bringing a gun to her daughter’s Indiana elementary school and threatening the girl’s teacher over a classroom assignment about flags. While discussing flags, the teacher reportedly referred to a rainbow flag in the classroom with the words “be kind.” | 

Banning ‘frontal nudity’: A Texas school district has removed lessons on Virginia history from an online learning platform for elementary school students because the commonwealth’s flag depicts the Roman goddess Virtus with an exposed breast. | 

The Supreme Court will hear oral arguments next month to weigh Trump’s executive order eliminating birthright citizenship, bringing into question a 127-year-old court precedent. | 

A class-action lawsuit accuses tech giant Google of amassing “thousands of data points that span a child’s life” without the consent of students or their parents. | 

A Florida teacher is out of a job after she called a student by their preferred name, allegedly violating a 2023 Florida law that requires schools to receive parental permission to refer to students by anything other than their legal names. | 

The vice president of the Buffalo, New York, chapter of Bikers Against Child Abuse was arrested and accused of sex crimes against children. | 

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Don’t even think about touching Matilda’s cactus.

Until the 1970s, numerous U.S. states used registries to identify disabled people to be subjected to forced sterilization and institutionalization. A number of states still maintain lists of autists.

“The history there is deeply, deeply disturbed,” says Larkin Taylor-Parker, legal director of the Autistic Self Advocacy Network. “It doesn’t usually end well for us. It has ended in murder — industrial-scale incarceration and murder.”&�Բ�����;

In given to NIH leaders April 21, Bhattacharya said the registry will draw from an unprecedented compilation of public and private databases to be used for U.S. Secretary of Health and Human Services Robert F. Kennedy Jr.’s controversial new study of autism. In addition to information collected by the Centers for Medicare and Medicaid Services, the registry and research database will include pharmacy records, private insurer claims, lab and genetic testing information, treatment records from the Department of Veterans Affairs and Indian Health Service — even data from smartwatches.

Though the plan described is still too vague for advocates to know for sure, NIH might also tap state records that identify neurodivergent children who receive special education services. In the 2022-23 school year, almost 1 million autistic students attended U.S. schools.  

Bhattacharya promised “state of the art” protections to guard patient confidentiality, explaining that 10 to 20 groups of outside researchers would be allowed to use the data but not download it. It is unclear whether this meets any legal standard for privacy safeguards.  

As The 74 has reported, the man tapped to lead Kennedy’s study was found to have practiced medicine on autistic children without a license, prescribing a dangerous drug not approved for use in the U.S. and improperly giving them puberty blockers. 

Kennedy, a longtime anti-vaxxer, intends the study to find a link between autism and vaccines. More than two dozen studies have discredited the notion of any connection.

With few details released about how the NIH will compile data — some of which is subject to privacy restrictions at various federal agencies— it’s unclear how patient confidentiality will be maintained. 

NIH researchers are not bound by the Health Insurance Portability and Accountability Act, or HIPAA, the main law that restricts who can access private medical information, and under what circumstances. Instead, the institutes to the Privacy Act of 1974, which protects “records that can be retrieved by personal identifiers such as a name, Social Security number or other identifying number or symbol” and, with limited exceptions, “prohibits disclosure of personally identifiable records without the written consent of the individual(s) to whom the records pertain.”

The privacy law was enacted in large part to stop federal agencies from sharing damning information about people singled out by former President Richard Nixon and former FBI Director J. Edgar Hoover as political enemies. Since President Donald Trump’s second inauguration, privacy law experts have that Elon Musk’s Department of Government Efficiency has gone into sensitive government records systems without legal authority to do so. Some courts have ordered a stop to the practice.

“The thought of a federal registry of autistic people that includes incredibly personal data that makes us very easy to find deprives us of the privacy that other citizens enjoy,” says Taylor-Parker. “It taps some of my community’s deepest fears and the specters of some of the most horrifying episodes in our history.”

In the 1930s and ’40s, German and Austrian public health officials of “malformed children” to the Third Reich’s Ministry of the Interior for a list of those targeted for sterilization or death. Among those supplying names was early autism researcher and Nazi collaborator Dr. Hans Asperger. He identified nearly 2,700 children, most commonly citing “education problems” as the reason.

Until 2013, Asperger’s Syndrome was a diagnosis given to autistic children who were believed to be “higher functioning” — Asperger himself called the visibly intelligent children he experimented on “little professors.”&�Բ�����;

Most advocates now recognize efforts to distinguish higher- and lower-functioning autists as false and harmful. In his presentation to NIH staff, however, Bhattacharya said the new research will consider the perceived severity of subjects’ autism. 

“I recognize, of course, that autism, there’s a range of manifestations ranging from highly functioning children to children that are quite severely disabled,” he said, according to . “And of course, the research will account very carefully for that.” 

This, too, terrifies Taylor-Parker, who notes that autistic people who are nonverbal or also have a developmental disability have historically been involuntarily placed in asylums and other facilities and are still often excluded from general education classrooms. 

“We already have a societywide problem…with ignoring the support needs of people who can hold down a job, can drive a car and maybe score well on an IQ test,” she says. “On the other hand, we ignore the capacities, the capability, the humanity of people who don’t do those things.”

Further, she points out, compiling as much diagnostic and prescription information on autistic individuals as possible is likely to uncover other private information that people fear could end up on future “disease registries.”&�Բ�����;

“I’m very concerned about this becoming a slippery slope,” says Taylor-Parker. “There is very good research demonstrating that [autistic people] are trans and gender-nonconforming at above-average rates.”

In the interest of establishing the prevalence of autism and in some cases understanding which services are helpful, several states and two national philanthropies . With a goal of ensuring that as many children as possible are offered early intervention services, at least two contain identifying information. 

Good intentions notwithstanding, many autistic people oppose the existence of any registry, citing the historical danger they pose for disabled people in general. Indeed, recognizing this last year, New Hampshire lawmakers eliminated the state’s autism registry. 

Since Kennedy’s appointment, autistic people have repeatedly decried his plan to again attempt to link autism to vaccines, despite dozens of credible studies that have ruled out immunizations as a cause. His plan, they charge, would divert resources from research into therapies and services that can improve the lives of people with disabilities. 

Says Taylor-Parker, “That discussion sucks the oxygen out of the room when it comes to making life better for autistic people who are already here and who will be born in the near future.”

According to the NIH, will be posted in the coming days. 

was originally reported by Barbara Rodriguez of .

In mid-March, the parents of a 6-year-old girl in Texas who died of measles complications — the — decided to speak out about what happened to their daughter.

But it was not an interview with a news outlet. The parents had agreed to an exclusive on-camera interview with staff from the Children’s Health Defense (CHD), a nonprofit that promotes anti-vaccine sentiment and policies. Their daughter, Kayley, had been unvaccinated, a point the parents defended in the interview.

Kayley’s father, who spoke at times in a German dialect through a translator, said that measles is “not as bad as the media is making it out to be.”

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A few weeks later, the father of an 8-year-old who became the second measles-related death, according to public health officials, also spoke with CHD through video. Asked if he regrets not vaccinating his child, Daisy, or his other children, the father said: “Absolutely not. And from here on out, if I have any other kids in the future, they’re not going to be vaccinated at all.”

Health and Human Services Secretary Robert F. Kennedy Jr. met with these parents in April, he said , “to console the families and to be with the community in their moment of grief.” He advocated for the highly effective measles-mumps-rubella (MMR) vaccine in that same post. Hours later, in a separate post, .

As Kennedy tries to respond to the spread of measles cases in the United States — more than 700 cases have been reported in at least 25 states as of April 10, according to the Centers for Disease Control and Prevention (CDC) — medical experts say that messaging has been mixed. But any focus on vaccination is also being undermined by CHD, the anti-vaccine nonprofit Kennedy chaired from 2015 to 2023, the year he launched a presidential campaign.

As of , Kennedy has said he is no longer officially affiliated with the group, which has repeatedly questioned the safety of vaccines, . But CHD still prominently displays its former ties to Kennedy. The secretary has a standalone tab on the group’s “About” section, which credits him as its founder. Its video site features public appearances that Kennedy has made in his current role as secretary, including a recent trip to Indiana and his first major news conference in the role.

This year, CDH published a website that mimicked the design of a CDC site — with nearly identical layout, logos and typefaces — that laid out what it called research that vaccines cause autism () alongside some data debunking the theory. first reported on the existence of the mock site.

When asked about the site by The New York Times, the secretary would send a request to ask the group to take down the site.

An HHS spokesperson for Kennedy did not immediately respond to a request for comment. Representatives for CHD, contacted through a form on their website, did not immediately respond to a request for comment.

CHD boasts a media apparatus that includes a video-focused site and podcast that shares claims about vaccine safety, including about the MMR vaccine. On these platforms, commentators and an array of guests openly criticize news coverage on the growing measles cases and related deaths, which public health officials say includes an unvaccinated adult in New Mexico as well as the two children. (Many of the videos also note that the hosts’ and guests’ views are not necessarily the views of Children’s Health Defense.)

“This constant fear mongering by the media … to see them rampage like this on inaccuracies and peddling falsehoods and just distortions, it’s terrible,” said one guest identified as a doctor to discuss one of the girls’ medical histories.

Measles, a highly contagious airborne disease, can appear through fever and a rash. It : 1 in 20 people get pneumonia; 1 to 3 in 1,000 people get brain swelling known as encephalitis; and 1 in 1,000 people die.

The scope of the CHD messaging — including interviews with parents expressing vaccine skepticism — shows how so-called anti-vaxxers may be weaponizing tragedy to promote an agenda, said Kelsey Suter, a partner at Upswing, an opinion research and strategy firm that supports Democratic candidates and progressive causes. Suter has monitored online disinformation about vaccines since around the start of the pandemic for several clients.

“This group in particular has long cherry-picked individual stories and sort of held them up to represent a broader trend that doesn’t exist,” she said, noting that CHD has shared parent-centered videos in the past about purported vaccine injuries.

Kennedy who tried to distance himself from that record during his contentious to lead the country’s expansive health department. Before Kennedy’s longshot bid for the Democratic presidential nomination — which culminated in an independent candidacy and subsequent endorsement of Republican President Donald Trump — he was closely tied to the Children’s Health Defense.

The nonprofit, previously known as the World Mercury Project, says it aims to end “childhood health epidemics by eliminating toxic exposure.” Kennedy, also its former chief litigation counsel, took a leave from CHD in 2023 to run for office. During a Wednesday news conference, could play a role in autism — a framing that autism groups . (CHD has publicly linked vaccines to autism, .)

CHD’s messaging — which includes a standalone site for “news and views” and an accompanying newsletter — highlights an evolution of how misinformation and disinformation over vaccines is being directed at parents at a time when vaccination rates for kindergarteners . Parents are already targeted by social media influencer accounts about their children’s health and wellness. Some of that information is packaged in video that can be more widely shared than in previous eras of vaccine skepticism, a phenomenon that has existed since the development of the first vaccine more than 200 years ago.

Some of the misinformation circulating online is that measles was not a dangerous disease when it spread rampantly in the 60s. (In the decade before a vaccine was available in 1963, . Between 400 and 500 died and thousands were hospitalized each year at the time.)

“It’a this kind of broader lifestyle perspective that incorporates vaccine hesitancy and is being sort of packaged up and targeted for moms in particular, but parents generally,” Suter said.

The two-dose MMR vaccine is safe and . Side effects, which pediatricians share with parents when their children are vaccinated, can include a sore arm and mild rash. Medical professionals say the benefits of the vaccine far outweigh the risks of being unvaccinated.

“We’re not hiding the side effects, we’re just telling you what they are and we’re putting it in context,” said Dr. Kathryn Edwards, a longtime expert in infectious diseases who recently retired. “What is a more grave danger — to get infected with measles or to get the vaccine? And that is a really easy question. , it is much, much better to be immunized than to get the disease.”

The videos on “CHD.TV” run the gamut in terms of programming. In the video of the parents of the 6-year-old girl, they say their child had a fever, leading to a visit to a nearby hospital where her condition worsened. She died in February. Her siblings were also infected with measles, according to her parents, but they recovered. They credit treatments that medical experts say do not have a therapeutic role in treating or preventing measles infection. Still, Kennedy has defended the treatments for secondary symptoms.

In a separate video, staff speculated about whether the 8-year-old died from a different ailment related to her hospital stay — a sentiment also expressed by her father and . CHD staff also criticized the scope of hospital care that the girls received.

Abram Wagner is an assistant professor of epidemiology at the University of Michigan who studies vaccine hesitancy. He said building trust within a community that is hesitant about vaccines relies on messengers who are well-known members of that community. He said it can be potent for an anti-vaccine group to travel to these communities and highlight the personal stories of parents — including the narrative technique of imagery and voice through video — to emphasize an agenda because those parents are themselves potentially trusted messengers.

Wagner said it’s important for the public to take into account the framing of these interviews involving the parents of unvaccinated children. He noted they had experienced trauma — the loss of a child — and that makes them vulnerable in such settings. He also wondered about the social impact of losing a child in a close-knit community. Both families are members of a at the epicenter of the outbreak in West Texas.

It sets up hard work for the public health officials, including state officials, who go into these communities to counter anti-vaccine messaging, Wagner added. This week, a CDC official told a vaccine committee that federal officials were “scraping to find the resources and personnel needed to provide support to Texas and other jurisdictions” as it relates to the outbreaks.

“The issue is, how do you create trusted messengers and how do you develop that over time?” said Wagner.

Suter said she is not surprised that the MMR vaccine has been targeted in disinformation messaging, since falsely tied that vaccine to autism.

“The MMR vaccine was really the first modern vaccine to be targeted with this kind of disinformation questioning its safety,” she said.

Suter said that before the pandemic — which propelled distrust of COVID-19 vaccines — being against vaccines still included some left-wing partisan perspective that included “crunchy” mothers. But vaccine hesitancy is now rooted in a broader topic of distrust of government officials and of the health care system.

“Now, being anti-vaccine is not exclusively right-wing coded, but is much more integrated into right-wing politics than it used to be,” she said.

Edwards said Kennedy has opened a messaging vacuum on measles and the MMR vaccine that groups like CHD have filled. Edwards noted that when Kennedy was asked in late February about the growing measles outbreak that began in Texas, he said such outbreaks are “not unusual,” a description that . Kennedy later said that the decision to vaccinate “is a personal one” for parents — a framing that Edwards disagrees with.

“At that point, there should have been a strong message that vaccination should be done and will prevent disease,” she said. “The fact that there has been so much indecision and lack of clarity, in terms of what Secretary Kennedy has said and what he lets other people say, has really confused things. That has made families think that it’s appropriate not to vaccinate.”

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.”&�Բ�����; 

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.

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.”&�Բ�����;

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.”

The former independent presidential candidate has a complicated past as a member of a famous Democratic political dynasty that includes his uncle, former President John F. Kennedy, and his father, U.S. Sen. Robert Kennedy, both assassinated in his youth. He struggled with addiction, and an arrest for heroin possession in the 1980s led him to volunteer with the Natural Resources Defense Council to fulfill community service hours, which jump-started his career in . 

Then, about two decades ago, Kennedy became interested in vaccine conspiracy theories, including the disproven link between vaccines and autism, which has become a focal point of much of his work since. He has peddled other , including that Wi-Fi causes cancer, that chemicals in water can lead to children becoming transgender and that AIDS may not be caused by HIV. In 2021, he was named one of the of misinformation about COVID vaccines on social media. 

Doctors and advocates have expressed alarm about the impact he could have on the department, while some have applauded his more mainstream views, such as a focus on preventative care through healthy eating and exercise and a commitment to removing processed foods from .

His beliefs and proposals are particularly relevant for kids, amid heated debates around school vaccination policies and a in the percentage of kindergarteners who have gotten state-required vaccinations.

If confirmed by the Senate, Kennedy would take control of an agency with one of largest federal budgets — — that employs about 90,000 people across 13 agencies, including , (the latter pays for a host of for eligible children), the and the

To better understand the pediatric and school-based health care implications of some of Kennedy’s proposals, The 74’s Amanda Geduld spoke with Leana Wen, an emergency physician and contributing opinions columnist for . The parent of two school-aged kids is also a professor of health policy and management at George Washington University, a non-resident senior fellow at the and Baltimore’s former health commissioner.

Geduld then spoke with medical legal expert Richard H. Hughes IV about how likely Kennedy’s confirmation is and what kind of power he would wield if confirmed. Hughes is a professor at George Washington University’s law school, where he teaches a course on vaccine law, and a partner at the firm . He formerly worked as the vice president of public policy at Moderna — one of the co-producers of the first FDA-approved COVID-19 vaccines — guiding the company’s policy strategy during the pandemic.

These interviews have been edited for length and clarity.

The medical perspective

The 74: Kennedy has a long record of promoting and even before the pandemic had built a following through his anti-vaccine nonprofit group, . 

In the past few weeks, he’s backed off these assertions a bit, but I’m still wondering what impact his rhetoric around vaccines could have— especially around parents vaccinating their kids. Can you also speak to some of the science behind vaccinating kids in the first place and what impact that’s had on pediatric health care?

Leana Wen: I think it’s important for us to start with the facts and to talk about what happened before there were vaccines for a variety of diseases. In the decades past, prior to vaccines, we used to see children succumbing to diseases that we now do not see anymore. We used to see children becoming paralyzed from polio and their parents being too scared for them to interact with others and go to school. We used to see children with severe, lifelong problems — including with their brains and other organs — because of measles, mumps and other diseases that we now consider to be eliminated thanks to vaccines. 

And so I think part of why vaccine misinformation has caught on is that the current generation of Americans have not experienced how terrifying these diseases have been that vaccines prevent. And I would really hate for us to see these diseases return before people recognize how much vaccines are life saving. 

I think it’s also important for us to mention the facts. It’s a fact that in 1900, 30% of all deaths in America occurred in kids under 5. Now that number is 1.4%. Back in 1900, the three leading causes of death were all infectious diseases. Now they aren’t. Thanks to antibiotics, thanks to sanitation, also thanks to vaccines. 

There was done recently that was published in the journal The Lancet. The study found that vaccines against the 14 most common pathogens saved 154 million lives globally over the past five decades, and that these vaccines cut infant mortality by 40%. 

And so it’s really heartbreaking to hear anyone spread misinformation about vaccines, but certainly it would be extremely concerning from a public health standpoint, if the individual in charge of science and health in this country is the one spreading such falsehoods. This could have a huge impact on trust in vaccines. And unfortunately, that could reduce vaccine uptake and lead to the return of these diseases that we thought were eliminated.

Kennedy has proposed removing processed foods from and limiting the use of food dyes, saying that the U.S. obesity epidemic, as well as a rise in chronic diseases like diabetes, are the result of He recently called out the nutrition department, which he says is Can you talk a little bit about what impact the food that we see showing up in school lunches has on kids, and what we know about food dyes?

I want to focus on ultra-processed food. We know that ultra-processed foods are associated with a whole variety of health problems — certainly things like diabetes, obesity, other chronic diseases like that — but also with depression and early dementia and potentially behavioral developmental issues in children as well. 

Unfortunately, some studies show that as much as 70% of the diet that Americans consume come from ultra-processed foods — that the calories from these diets come from ultra-processed food. I think it would be great if we can start reducing or removing ultra-processed food from school lunches. There has been some research done on food dyes and other additives. Reducing these in school lunches would also be a positive step.

He’s also mentioned that the same way that a doctor can prescribe Ozempic to treat obesity, they should also be able to prescribe, say, and have that covered by health insurance policies. I’m wondering what that might look like for kids as well, and what role pediatricians might play.

I don’t think any pediatrician would disagree with the idea that we have to focus more on prevention — that promoting healthy lifestyle, increasing exercise, improving diet, these would all be excellent for the promotion of health and well-being in our children. 

To be clear, it’s not these ideas that Kennedy is promoting that the medical profession would have an issue with. It’s that mixed in with many of these good ideas, are our concerns about misinformation around vaccines and that traditionally have not been considered to be safe and effective. 

After Kennedy’s nomination, he wrote on on Jan. 20, “The Trump White House will advise all U.S. water systems to remove fluoride from public water.” Can you talk a little bit about the role of fluoride in drinking water — specifically for kids.

This is an area where re-examination of the current policy would be a good idea, because this is a nuanced and complicated issue. On the one hand, we know that fluoridating the water supply has reduced cavities in children, but that effect was seen the most before widespread use of fluoride toothpaste.

We also know that fluoride in large quantities has toxic effects, including on bone development, on teeth discoloration and potentially on the developing brain if consumed by the pregnant woman. And so the question then is, what is the amount of fluid that would be optimal for promoting both dental health and reducing other effects? …

I think these are all reasonable questions to be asking — again, though, using science as the basis and not approaching this as an activist who already has a preconception in mind.

Are there any other policy ideas that Kennedy has put forward that you have thought of as either welcome news and an exciting change or particularly concerning?

None of what we’re talking about here is new. I think we can divide the proposals by Kennedy into three categories. One are things that are good ideas. For example, removing ultra-processed lunch or ultra processed food from school lunches. 

The second category are things that deserve a re-examination, and depending on what we find, may or may not be a good idea. That includes the fluoridation.

And then the third area would be things that have been proven to be wrong. For example, misinformation around vaccines.

And so again, I think to your point, none of these things that have been brought up in the category of good ideas is new, but that’s how I would think about this.

The legal perspective

The 74: Speaking about Kennedy at a rally recently, Trump said, How accurate is that? Can he really go wild on health? What are some of the congressional stopgaps there, and how much power does Kennedy actually have to enact these proposed policies? 

Richard H. Hughes: I think we could break that down into sort of two parts: Is Trump going to make good on that promise? and How far will RFK go? 

I would say that President Trump is very intent on making good on that promise. He went through with the selection of RFK. If you look at the appointments across the board, the nominees he selected are very unconventional. He’s very intent on disruption. 

And if you look at the health appointees in particular, there is some consistency there, right? They all hold really unconventional views. They come from very unconventional backgrounds for these types of roles. There are some questions about the adequacy of some of their experience and qualifications for these roles. There is also some consistency across the nominees that this sort of unconventional, non-mainstream views on COVID and the COVID response, as well as this focus around infections versus chronic disease. A lot of them have said we think we should be focused on chronic disease. A lot of them have espoused misinformation about vaccines. 

In terms of the legal authority, Congress has given a lot of really sweeping power to the secretary. When Congress gives the authority to the executive branch to do something, and it does it really clearly, the executive branch has a lot of leeway … 

So I’ll just give you an example. A lot of the questions I’m getting are about vaccine recommendations and vaccine requirements. There is the (ACIP). That is a committee that is created by the secretary… 

There are all of these requirements for programs or payers to provide coverage of the vaccines that are recommended by the committee. And so there are really interesting questions about, well, if he stopped convening the committee, if he eliminated the committee, what impact would that have?

There’s a potential trickle down effect, because a lot of states actually either look to that committee to determine what their [vaccine] policy should be, or they just refer to the committee and require, say, you know, for school entry, they require vaccination in accordance with the schedule that’s determined by the ACIP. 

That’s sort of a very specific area … 

At the FDA, there’s a lot of room for someone to come in, introduce subjective views on science, and say, “Well, what do we mean by safety? What do we mean by efficacy? Your traditional randomized, controlled trial, that doesn’t tell me what I need to know…” [That] might be the view of somebody at the agency in this administration, and they might try to introduce alternative evidence, and they would have some latitude to do that.

Just turning a little bit more to vaccines, it sounds like whoever is running this agency and convening this committee has a lot of power to potentially help determine what vaccines are going to be covered by health insurance. Is that correct?

That’s right. Congress requires payers to cover vaccines that are recommended by that committee. If those recommendations are rescinded by the secretary, which the secretary has the authority to do, that really throws a lot into question there. 

Now I’m having a really healthy, friendly debate with one of my mentors over the legal challenges that one could bring to challenge that sort of decision. There are some potential checks on this in the courts, but it’s all going to be really circumstantial.

Thinking specifically about schools, you mentioned that folks look to this committee to help determine what vaccines are required for students. Can you explain a little bit about how that works? How might RFK’s policies impact that?

If you’re interested — it’s open access — I just wrote in this month’s issue of Health Affairs on the relationship between ACIP recommendations and state school requirements … 

But, this is the authority of the states, and it’s really interesting in a Republican administration to think about the federalism debate … and you’re going to see this tension play out in this administration over the role of the states and the federal government. 

And it’s going to play out in the arena of public health and around vaccine policy … The federal government can come in and play a really important role when you have a threat that, say, goes across state lines. But states have to be able to enact these measures to protect themselves, to protect their people. 

The Jacobson v. Massachusetts case recognized that states can require immunization. [In] 1922, [in] the case Zucht v. King — lesser known but very important case when we talk about school requirements — the Supreme Court came back and said that a school district was able to exclude a young girl from school when she wasn’t vaccinated, even though there was no active outbreak. 

And so that’s a really, really important case, because if you think about why we require kids to get vaccinated to go to school, it’s a decision that the state makes to impose these requirements so that we don’t have disease outbreaks. It’s the suppression of endemic disease. You take those requirements away, you weaken those requirements, you’re going to see outbreaks potentially. And we’ve seen that with measles outbreaks, where we weaken those policies. 

So it sounds to me less like RFK can put out a mandate that schools federally cannot require vaccines, but more that there could be a trickle-down effect of some of what he does at the federal level, and that might impact then state policies. Is that correct?

Well, yes, but this is something I’m thinking a lot about right now because there is this statute that some of us have looked at over time — — which is the old isolation and quarantine statute that allows, essentially, the CDC to come in and and impose certain measures when necessary to control communicable disease. 

And every semester, I ask students, “Would this actually allow the federal government to impose a vaccine mandate?” And we debate that endlessly, whether that language actually would allow it or not. 

And right now, I think that poses the question: there is preemption language in that statute, so could it potentially be used to set a policy that would undermine state requirements or weaken state requirements? And it’s just a really interesting academic question. I don’t know that realistically that’s something that RFK or the CDC would pursue, but I think we’re living in an era where everything’s on the table.

Well, all of that said, how likely is Kennedy to actually get confirmed? And could there be, from a policy or a legal standpoint, any roadblocks put up in his way?

Yeah, so I do think he’ll get confirmed. I think that what you have seen is President Trump came forward and put together a slate of nominees very rapidly. And all of the ways that you could say that President Trump is inconsistent, he has been very consistent with his health nominees — a lot of similarly held views, a lot of unconventional backgrounds. 

I think just if you look at the pool of appointments as a whole, there’s a lot to take aim at, whether it was Matt Gaetz, his AG nominee () or the selection of the defense secretary nominee (), there’s a lot to provide sort of political fog. And I think that in all of that noise you lose sight of the fact that RFK does not have really the ideal qualifications for the role [and] holds some views that are anti-science. 

And you look to the Senate and ask, “Well, is someone going to stand up and push back and say, ‘We’re not going to confirm this nominee because they lack the qualifications?’” … No one has come out and sort of put a stake in the ground and said, “We’re not going to confirm nominees who don’t meet these qualifications,” or “If they hold these views, there’s no way that they’re going to get a hearing.”&�Բ�����;

We just haven’t seen that. And so I do think they’ll get confirmed. I think President Trump expects loyalty from his party.