The Trump administration will slash routine vaccine recommendations during childhood from 17 to 11 jabs – the biggest change to vaccines yet under the purview of longtime vaccine critic Robert F Kennedy Jr.
The changes, which US health officials announced on Monday afternoon and are effective immediately, will erode trust and reduce access to vaccines while allowing infectious diseases to spread, experts said.
“The goal of this administration is to basically make vaccines optional,” said Paul Offit, an infectious diseases physician at Children’s Hospital of Philadelphia and a former member of the advisory committee on vaccines for the US Food and Drug Administration (FDA). “And we’re paying the price.”
The CDC will now recommend one dose of the HPV vaccine instead of two.
The vaccines for high-risk individuals only – a group that was not defined or clarified in the announcement – now include the shots to prevent hepatitis A, RSV, hepatitis B, dengue, meningococcal ACWY, and meningococcus B.
The vaccines now under shared clinical decision-making include rotavirus, Covid-19, influenza, meningococcal disease, hepatitis A and hepatitis B, according to an unpublished announcement obtained by the Guardian.
The changes are a “systematic attempt” by health officials “to erode public confidence in childhood vaccines”, said Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine.
“Their longer range goal is to make vaccines unavailable by making impossible demands on the vaccine producers,” like breaking up the components of the measles, mumps and rubella (MMR) into separate shots or casting doubt on the safe and effective components, like aluminum adjuvants, in other childhood immunizations, Hotez said.
Virologist James Alwine, a member of Defend Public Health’s Coordinating Committee, said in a statement: “Kennedy’s decision will harm and kill children, like all of his anti-vaccination decisions will.
“Viruses and bacteria that were under control are being set free on our most vulnerable. It may take one or two years for the tragic consequences to become clear, but this is like asking farmers in North Dakota to grow pineapples. It won’t work and can’t end well,” he said.
Some of the previously recommended vaccines will now only be available for “high-risk” individuals, while others are to be designated as “shared clinical decision-making,” which are usually only available with a doctor’s recommendation.
The revised vaccine schedule will look similar to that of Denmark’s, though there are a few differences.
“Because this is coming from HHS, the public, who is only so hooked into this, will say that ‘maybe these aren’t such a big deal. I can reasonably choose not to get a vaccine, and it’s burdensome to get a vaccine, so great,’” Offit said. “Now we’ll just see this continue to worsen.”
The US is on the cusp of losing its measles elimination status amid the biggest outbreak in three decades. There have been more tetanus cases in the past year than more than in a decade, and more pertussis deaths than the US has seen in years.
Nearly 300 children died from the flu last year, and several more have died this flu season.
The fact that Kennedy is changing the recommendation for the flu vaccine “in the midst of a very bad flu season tells you who he is, which is someone who is so virulently anti-vaccine that he’s willing to ignore all the harm that is occurring around him”, Offit said.
Donald Trump in December ordered changes to the immunization schedule to be more like peer countries. Trump directed Kennedy and the CDC to review vaccine recommendations from “peer, developed countries” and “update the United States core childhood vaccine schedule to align with such scientific evidence and best practices” from them.”
This move, experts note, puts the US out of step with other nations which routinely recommend the shots.
The announcement could open up the US government for lawsuits from parents who are no longer able to access the vaccines, said Dorit Reiss, a vaccine law expert at UC Law San Francisco.
The decision was not made in a transparent way, she said, and the advisory committee on immunizations hasn’t been consulted. The change will likely bring confusion among providers and parents, Reiss added: “The fact that we’ll see some providers follow this in some way will decrease vaccine coverage.”
Officials say the vaccines would still be covered by key programs such as Vaccines for Children, a federal program that provides vaccines to more than half of all kids in the US. Continuing to cover the program makes it less likely that parents will sue on the grounds of being affected by an arbitrary and capricious decision, Reiss said.
Previously, officials have said that vaccines under shared clinical decision-making would also still qualify for the National Vaccine Injury Compensation Program (VICP), which settles claims for rare but major side effects from most vaccines.
But Offit doubted that Kennedy would follow through on that promise.
“I don’t believe him,” he said. “I think that his goal ultimately is to shake up the Vaccine Injury Compensation Program so he can continue to make himself and his personal injury lawyer friends richer.”
Reiss noted that there is “legal uncertainty on whether vaccines that are under shared clinical decision making are covered by VICP”. She believes vaccines could not be removed from the compensation program without going through the usual rule-making process.
“But Kennedy isn’t necessarily law-abiding on this, so he might try to do it anyway,” she said, before noting that a change like that could force vaccine makers from the US market and significantly decrease access to shots.
Reiss also said she’s worried about “political pressure on states to remove recommended vaccines from school mandates”. The federal government has never mandated vaccines for any children. Instead, those decisions are made at the state and local level. Officials could pressure states to change their school vaccine recommendations now that they are not fully recommended by US health agencies.
“There’s a number of funding sources that they could tie to remove school vaccine mandates if you want federal funding,” Reiss said.
