Medical News

As far as sticker price goes, the recommended vaccines for kids in the United States do not come cheap. The hepatitis-B shot, given within the first hours of life, can be purchased for about $30. The rotavirus vaccine costs $102 to $147 a dose. A full course of the vaccine that protects against pneumonia and meningitis runs about $1,000.

Virtually all children receive these shots for free. The federal government legally requires most insurance to cover the roughly 30 different shots for kids, without a co-pay. Kids who are on Medicaid or who don’t have insurance coverage can get free shots as well, thanks to a CDC program known as Vaccines for Children. Among public-health experts, VFC, as it’s commonly known, is widely seen as an unmitigated success. After the program was created in 1994, “disease went down, and life was a lot simpler for the families,” Anne Schuchat, a former top CDC official, told me. Roughly half of American children are eligible to receive vaccines through VFC.

That ease and simplicity may be about to change. This week, the CDC’s Advisory Committee on Immunization Practices (ACIP)—which guides America’s vaccine policy—convened for just the second time since Robert F. Kennedy Jr. fired the entire panel and appointed new members, some of whom lack vaccine expertise or have expressed anti-vaccine views (or both). The meeting was chaotic, contentious, and plagued by indecision. But the votes it got through are starting to point toward a shifting, more fractured landscape for kids’ access to vaccines.   

Yesterday, ACIP voted to remove the joint measles-mumps-rubella-varicella (MMRV) vaccine from the childhood-immunization schedule for children under 4, and instead recommended that kids get two separate shots: one for measles, mumps, and rubella, and another for varicella. This morning, the panel also voted to remove the combination shot from the VFC program. Both votes were motivated by a concern about the safety of the vaccine, including an elevated risk of febrile seizures. (As the CDC’s website points out, these seizures can be stressful for families, though most children fully recover.)

The effect of the move away from the combination vaccine will be limited, because most children in America already receive the separate shots. However, one group would bear the brunt of the changes more than others: children on VFC. Some parents opt for the convenience of a single shot, and those who are covered by private insurance may still be able to get it. Although private insurers will no longer be required to cover the joint MMRV vaccine free of charge, they are already pledging to continue with business as usual: On Tuesday, AHIP, a lobbying group that represents the health-insurance industry, announced that its members will continue to cover shots under the pre-ACIP vaccine schedule until the end of 2026. (A spokesperson for AHIP declined to comment on what happens after that.) Parents could, hypothetically, also pay for these vaccines out of pocket. The disproportionately poor children covered by VFC do not have the same kind of wiggle room. What shots they can get for free from the program, and when, are directly tied to ACIP’s recommendations. (A Department of Health and Human Services spokesperson told me that the move will not increase vaccine inequality but did not explain further.)

Mainly, the changes that ACIP is currently considering would create inconveniences for poor families—more trips to the doctor, more needle pricks. But as my colleagues Tom Bartlett and Katherine J. Wu wrote yesterday, the change to the MMRV policy, while minor, can send the message that vaccines are dispensable. The committee also discussed delaying when kids should get the hepatitis-B shot but ultimately decided to table an anticipated vote on whether they would recommend the delay. (Kennedy has intimated that the hepatitis-B vaccine may cause autism, despite the lack of data showing a link between the two.) If the hepatitis-B vaccine or another shot is removed entirely from the schedule, that will immediately hit kids served by VFC.

Beyond potentially serious disparities, more alterations to childhood vaccines would likely cause more confusion. Kennedy’s recent changes to COVID-vaccine policy, which narrowed the approval for COVID shots so that they are recommended only for people over 65 or who have certain underlying conditions, left many Americans unsure about if and how they could get one. (Today, ACIP also voted that every person should consult with a clinician before receiving a COVID shot.) Americans who rely on VFC may soon have to similarly figure out what shots they can get, and where. The confusion over COVID shots “is a small glimpse of what may happen” if ACIP moves forward with changes to the childhood-vaccine schedule, Schuchat told me.

In the event that a vaccine is removed from the schedule, the experts I spoke with remain hopeful that some entity, such as a state health department, a community health center, or philanthropy, would step in to provide uninsured kids with free shots. But who or what, besides the federal government, could provide vaccines at the necessary scale is an open question. “It’s going to require some sort of extraordinary effort to provide that access,” Richard Hughes IV, a professorial lecturer in law at the George Washington University Law School, told me. VFC works so well not only because it provides vaccines free of charge but also because it is designed to ensure that doctors always have a supply of vaccines on hand—the CDC purchases vaccines and then provides them for free to doctors, who then dole them out to children in need.

Medicaid could still provide some backstop for the poorest children, experts told me, but a likely scenario seems to be a system in which private insurers continue to cover vaccines, while poor children are left behind. Such a scenario is “the definition of a health-care disparity,” Christoph Diasio, a pediatrician in North Carolina, told me.

America has seen this type of vaccine inequity before. Beginning in 1989, measles tore through several cities—including Los Angeles, Houston, and Chicago—precisely because many low-income children were unable to access the vaccine. “A big part of the problem was, kids were in the doctor’s office, but because they weren’t insured, the doctors were referring the family to the health department,” Schuchat told me. “That extra visit was something that was not easy for parents to find the time to get to.” Researchers estimated that nonwhite preschoolers were seven to 10 times more likely to contract the virus than white children. It was this outbreak that led to the formation of the VFC program in the first place.

In his time as secretary of Health and Human Services, Kennedy has claimed that reforms to Medicaid would improve the program, despite projections from the Congressional Budget Office that the change would kick millions off of the safety-net program. He has decimated minority-health offices in his department in the name of government efficiency. And he has said that vaccine changes will be made in line with the latest science, despite overwhelming evidence to the contrary. Now, in the name of following the science, Kennedy is on the cusp of creating a two-tiered vaccine system.

As far as sticker price goes, the recommended vaccines for kids in the United States do not come cheap. The hepatitis-B shot, given within the first hours of life, can be purchased for about $30. The rotavirus vaccine costs $102 to $147 a dose. A full course of the vaccine that protects against pneumonia and meningitis runs about $1,000.

Virtually all children receive these shots for free. The federal government legally requires most insurance to cover the roughly 30 different shots for kids, without a co-pay. Kids who are on Medicaid or who don’t have insurance coverage can get free shots as well, thanks to a CDC program known as Vaccines for Children. Among public-health experts, VFC, as it’s commonly known, is widely seen as an unmitigated success. After the program was created in 1994, “disease went down, and life was a lot simpler for the families,” Anne Schuchat, a former top CDC official, told me. Roughly half of American children are eligible to receive vaccines through VFC.

That ease and simplicity may be about to change. This week, the CDC’s Advisory Committee on Immunization Practices (ACIP)—which guides America’s vaccine policy—convened for just the second time since Robert F. Kennedy Jr. fired the entire panel and appointed new members, some of whom lack vaccine expertise or have expressed anti-vaccine views (or both). The meeting was chaotic, contentious, and plagued by indecision. But the votes it got through are starting to point toward a shifting, more fractured landscape for kids’ access to vaccines.   

Yesterday, ACIP voted to remove the joint measles-mumps-rubella-varicella (MMRV) vaccine from the childhood-immunization schedule for children under 4, and instead recommended that kids get two separate shots: one for measles, mumps, and rubella, and another for varicella. This morning, the panel also voted to remove the combination shot from the VFC program. Both votes were motivated by a concern about the safety of the vaccine, including an elevated risk of febrile seizures. (As the CDC’s website points out, these seizures can be stressful for families, though most children fully recover.)

The effect of the move away from the combination vaccine will be limited, because most children in America already receive the separate shots. However, one group would bear the brunt of the changes more than others: children on VFC. Some parents opt for the convenience of a single shot, and those who are covered by private insurance may still be able to get it. Although private insurers will no longer be required to cover the joint MMRV vaccine free of charge, they are already pledging to continue with business as usual: On Tuesday, AHIP, a lobbying group that represents the health-insurance industry, announced that its members will continue to cover shots under the pre-ACIP vaccine schedule until the end of 2026. (A spokesperson for AHIP declined to comment on what happens after that.) Parents could, hypothetically, also pay for these vaccines out of pocket. The disproportionately poor children covered by VFC do not have the same kind of wiggle room. What shots they can get for free from the program, and when, are directly tied to ACIP’s recommendations. (A Department of Health and Human Services spokesperson told me that the move will not increase vaccine inequality but did not explain further.)

Mainly, the changes that ACIP is currently considering would create inconveniences for poor families—more trips to the doctor, more needle pricks. But as my colleagues Tom Bartlett and Katherine J. Wu wrote yesterday, the change to the MMRV policy, while minor, can send the message that vaccines are dispensable. The committee also discussed delaying when kids should get the hepatitis-B shot but ultimately decided to table an anticipated vote on whether they would recommend the delay. (Kennedy has intimated that the hepatitis-B vaccine may cause autism, despite the lack of data showing a link between the two.) If the hepatitis-B vaccine or another shot is removed entirely from the schedule, that will immediately hit kids served by VFC.

Beyond potentially serious disparities, more alterations to childhood vaccines would likely cause more confusion. Kennedy’s recent changes to COVID-vaccine policy, which narrowed the approval for COVID shots so that they are recommended only for people over 65 or who have certain underlying conditions, left many Americans unsure about if and how they could get one. (Today, ACIP also voted that every person should consult with a clinician before receiving a COVID shot.) Americans who rely on VFC may soon have to similarly figure out what shots they can get, and where. The confusion over COVID shots “is a small glimpse of what may happen” if ACIP moves forward with changes to the childhood-vaccine schedule, Schuchat told me.

In the event that a vaccine is removed from the schedule, the experts I spoke with remain hopeful that some entity, such as a state health department, a community health center, or philanthropy, would step in to provide uninsured kids with free shots. But who or what, besides the federal government, could provide vaccines at the necessary scale is an open question. “It’s going to require some sort of extraordinary effort to provide that access,” Richard Hughes IV, a professorial lecturer in law at the George Washington University Law School, told me. VFC works so well not only because it provides vaccines free of charge but also because it is designed to ensure that doctors always have a supply of vaccines on hand—the CDC purchases vaccines and then provides them for free to doctors, who then dole them out to children in need.

Medicaid could still provide some backstop for the poorest children, experts told me, but a likely scenario seems to be a system in which private insurers continue to cover vaccines, while poor children are left behind. Such a scenario is “the definition of a health-care disparity,” Christoph Diasio, a pediatrician in North Carolina, told me.

America has seen this type of vaccine inequity before. Beginning in 1989, measles tore through several cities—including Los Angeles, Houston, and Chicago—precisely because many low-income children were unable to access the vaccine. “A big part of the problem was, kids were in the doctor’s office, but because they weren’t insured, the doctors were referring the family to the health department,” Schuchat told me. “That extra visit was something that was not easy for parents to find the time to get to.” Researchers estimated that nonwhite preschoolers were seven to 10 times more likely to contract the virus than white children. It was this outbreak that led to the formation of the VFC program in the first place.

In his time as secretary of Health and Human Services, Kennedy has claimed that reforms to Medicaid would improve the program, despite projections from the Congressional Budget Office that the change would kick millions off of the safety-net program. He has decimated minority-health offices in his department in the name of government efficiency. And he has said that vaccine changes will be made in line with the latest science, despite overwhelming evidence to the contrary. Now, in the name of following the science, Kennedy is on the cusp of creating a two-tiered vaccine system.

The world’s market for vaccines, as it exists today, depends on the United States. The U.S. has poured immense resources into the design and development of vaccines, and has paid far higher prices for doses than most other nations can afford. The federal government has issued broad vaccine recommendations, generating strong, consistent demand. “That’s a predictable market,” Richard Hughes IV, a public-health-law expert and the former vice president of public policy at Moderna, told me. It’s also a huge one. Seth Berkley, the former CEO of Gavi, which supports the immunization of about half the world’s children, told me that the U.S. accounts for 35 to 40 percent of global vaccine revenue at a minimum, more than all of Europe combined.

But since the start of this year, when Robert F. Kennedy Jr.—one of the nation’s most prominent anti-vaccine activists—took charge of the Department of Health and Human Services, the federal government has signaled that it is no longer a reliable partner in the business of vaccines. The Trump administration has fired vaccine experts, tightened vaccine regulatory policies, restricted vaccine recommendations, and spread misinformation about vaccines’ harms. It has halted its funding of Gavi. It has canceled hundreds of contracts for vaccine research across multiple agencies. “Even before the change in policies that are being implemented now, vaccines were a difficult business,” Andrew W. Lo, an economist at MIT, told me. “It’s just become that much harder.”

In response, companies are paring back. Multiple vaccine makers suffering from the American government’s recent attacks have announced layoffs or a demerger of their vaccine division, as their stocks fall. These include Moderna, which HHS recently stripped of more than $700 million in grant funding for its pandemic-flu shots. Also among them is the Australian biotechnology company CSL, which sells two flu vaccines to the U.S. that contain thimerosal, a mercury-based preservative that Kennedy’s handpicked CDC vaccine-advisory panel recently recommended against, despite decades of evidence showing the additive is safe. (Last month, CSL noted that a recent dip in flu-vaccine uptake in the U.S. had put “competitive pressure” on its vaccine profit margin; a CSL spokesperson told me in an email that the company expects American vaccination rates to recover. Moderna declined to comment.) More instability is likely ahead. The CDC’s vaccine advisory panel meets again today and could vote to restrict guidance for several immunizations, including ones that protect infants against measles, mumps, rubella, chicken pox, and hepatitis B.

When reached for comment, an HHS spokesperson wrote over email that “Secretary Kennedy serves the American people, not the interests of Big Pharma,” adding that the department was “not limiting access to vaccines, but rather returning focus to the doctor-patient relationship.”

Legitimate critiques can be made of the pharmaceutical industry’s incentives and pricing strategies. But from a financial standpoint, vaccines have always been a bit of an underdog for pharmaceutical companies. As preventative products, designed for healthy people, they’re held to an especially high safety standard—a requirement that reliably drives up the expenses of development and testing—and they need to be widely accessible, which puts pressure on manufacturers to keep their price tags low. Individual vaccines are also used, at most, a few times over a lifetime—another cap on potential revenue. What’s more, “it’s very hard to charge money for something that patients don’t immediately need,” Lo told me: They might clamor for a new heart medication or cancer drug, but persuading healthy people to inject a foreign substance into their body can be trickier. Throughout the past half century, the vaccine industry has also been threatened repeatedly by lawsuits over potential vaccine side effects.

To their makers, then, vaccines are a big risk for a potentially low reward. That makes the market for them one of the most fragile in the pharmaceutical industry, Rajeev Venkayya, the former head of Takeda Pharmaceuticals’ vaccine unit, told me. Those realities have driven plenty of vaccine makers out of the market, experts told me—whether via mergers, bankruptcy, or strategic decisions to focus on other products. In 1967, 26 companies produced vaccines for the U.S.; by the mid-2000s, fewer than half a dozen were left—and the nation was staring down shortages of nine of the 12 childhood vaccines recommended at the time.  

In the two decades since, the industry has rallied, Berkley told me, especially as profitable “blockbuster” vaccines, including pneumococcal vaccines, HPV vaccines, and, most recently, COVID-19 vaccines, have grown into billion-dollar markets or more in the United States. The U.S.’s deep pockets helped—as Berkley pointed out, the federal government pays about 20 times what Gavi does for pneumococcal vaccines—but so did federal policies that have increased incentives and lowered risks for manufacturers. And when the public’s trust in vaccines has been threatened, often the government has emphasized that American immunizations have been well vetted and urged the public to continue getting them, Jesse Goodman, who served as the FDA’s chief scientist until 2014, told me.

Now the Trump administration is doing essentially the opposite—most dramatically, so far, for COVID vaccines. Trump’s FDA has limited who can access the shots and made seeking approval for new versions more difficult. The CDC has also muted its COVID-vaccine guidance. Every expert I spoke with for this story expected more changes to the regulatory pipeline that all vaccines must pass though. And the people Kennedy has chosen to oversee vaccine policy and sit on the CDC’s vaccine-advisory commitee—COVID contrarians and vocally anti-vaccine researchers—are making the U.S. a highly unappealing market for all vaccine makers, experts told me.

Without clear, strong recommendations, demand will likely be uneven, making it difficult for manufacturers to estimate how much product to make; without vaccine experts using evidence to advise the government, companies can’t trust that the clinical-trial data they produce, vouching for vaccine safety and performance, will be fairly or accurately assessed. Across the National Institutes of Health and the Biomedical Advanced Research and Development Authority, Trump officials have also defunded billions of dollars’ worth of vaccine-related grants. That includes half a billion specifically for mRNA-based vaccines—jeopardizing the development of future immunizations, including those designed to protect against pandemic flus. And new roadblocks in the approval process will hinder companies trying to bring products to market, making the up-front costs of research, development, and testing that much bigger a gamble. “All of this creates more chaos and uncertainty for vaccine manufacturers,” Grace Lee, a pediatrician and a former chair of ACIP, told me. “Why would you take these additional risks, where it is not clear from week to week what will happen?”

Large, long-established pharmaceutical companies with wide-ranging drug portfolios will likely have the resources to weather a dip in demand. But smaller biotechnology companies, which already tend to operate on thin margins, “will get out of the business,” Lo told me—which, in turn, will likely discourage other vaccine-focused companies from starting up. Venture capitalists have taken note of the circumstances: “The sense right now is that the market’s going to be unstable,” Berkley told me. “This is not the time to invest heavily in new or better products.”

The Trump administration could also nudge companies to exit the vaccine business by making them more vulnerable to legal risk. Most immediately, Kennedy could rescind a pandemic-era declaration that has protected COVID-vaccine manufacturers from excessive liability. He has also announced his intention to amend the Vaccine Injury Compensation Program, which experts worry could take the U.S. back to a time when lawsuits nearly destroyed the vaccine market. Congress established the VICP in the 1980s, after a flood of litigation against the makers of a pertussis vaccine persuaded all but one company supplying the U.S. to stop selling it. (The lawsuits were spurred in part by since-debunked claims that the vaccine caused permanent brain damage.) Today, the program simultaneously acknowledges the rare but very real side effects of vaccines, and gives vaccine makers an important liability shield. Funded by a tax on manufacturers, it offers compensation for certain vaccine injuries that are already backed by evidence; other claims are heard in a kind of vaccine court. Major alterations to the program, Anna Kirkland, the author of the book Vaccine Court, told me, would require Congress to act. Still, some experts told me they fear that Kennedy could push for autism to be added to the list of compensable vaccine injuries, as part of his effort to advance the debunked narrative that vaccines cause the condition. That change could flood the program with claims, rapidly drain it, and give manufacturers another reason to pull away from making vaccines.

The exit of even just a handful of manufacturers from the U.S. market could mean shortages of certain vaccines, on disastrously quick timelines. In 2004, for instance, the U.S. lost half of its supply of seasonal flu vaccine after one of the country’s two flu-shot manufacturers at the time, Chiron, temporarily shut down one of its factories because of potential contamination. Several vaccines on the American childhood immunization schedule still rely on only one or two manufacturers, Goodman told me. Among them are the shots that guard against HPV, varicella, and rotavirus.

A wind-down in vaccine manufacturing for the U.S. wouldn’t just invite outbreaks of known diseases. The country would also be exceptionally ill-equipped to respond to the next pandemic. Manufacturers managed to debut the world’s first COVID-19 vaccines in less than a year—a record—because the government was eager to fund their development and because companies could trust that the government would buy them. That mRNA vaccines would arrive first was never a foregone conclusion, either; Operation Warp Speed succeeded in part because federal agencies offered resources to a wide range of vaccine companies. Several of the experts I spoke with agreed: If a new pandemic were to ignite in the current climate, “Operation Warp Speed Part 2 would not operate at warp speed,” Lo said.

If the U.S. vaccine market shrinks, it can rebound, as it has before. But the amount of time that will take, experts told me, will depend heavily on just how thoroughly vaccine infrastructure is dismantled. Already, the scale of destruction is unlike any they have ever seen before. Perhaps, if the world is fortunate, demand and supply will rebound within a couple of years, Goodman said. But if manufacturers go out of business, if factories close, if some vaccines have their licenses entirely stripped, rebuilding could take decades. For now, most Americans continue to strongly support vaccination. But if Kennedy and the rest of the Trump administration succeed in draining the U.S. of its vaccine supply, Americans could soon be forced into a position where they cannot access immunizations—no matter how badly they may want them.

Three months into its tenure, Robert F. Kennedy Jr.’s handpicked vaccine advisory committee has taken down one of its easiest targets.

Today, its members voted to limit the national guidance for a childhood vaccine that has helped protect infants against some of the most dangerous and fast-spreading viral diseases in the United States. If the CDC adopts the committee’s advice, the agency will no longer recommend the combination measles-mumps-rubella-varicella (MMRV) vaccine for kids younger than 4, defaulting their first dose of protection against MMR and chickenpox to two separate shots. The committee also discussed shifting the recommended timing for the first dose of the hepatitis-B vaccine from birth to at least one month old, unless the mother tested positive for the virus during pregnancy. It plans to vote on that question tomorrow.

These vaccines are among the most vulnerable to being challenged, on the grounds that they appear more risky or seem less necessary than the rest of the immunizations the CDC recommends. Some other high-income countries, for instance, do not recommend the hepatitis-B vaccine universally at birth; MMRV vaccines have been linked to an increased risk of certain side effects in children under 2.

Helen Chu, an infectious-disease specialist at the University of Washington, told us she sees no reason to alter the current recommendations for these vaccines. But she can imagine how they fit into a broader strategy: “If you were going to pick, these are good ones to pick off first.” (Chu was a member of the vaccine advisory panel, known formally as the Advisory Committee on Immunization Practices, or ACIP, until Kennedy abruptly dismissed her in June along with the other 16 sitting members.)

This seems to be an agenda of Kennedy’s own design. In the past, ACIP has considered changes in guidance prompted by evidence—a new shot being brought to market, the release of new data on a vaccine’s effectiveness or safety. Now Kennedy himself is driving much of what the committee discusses, including today’s deliberations on hepatitis B and MMRV, Demetre Daskalakis, the former director of the CDC’s National Center for Immunization and Respiratory Diseases, told us. “Those were dictated topics,” he said. (A spokesperson for the Department of Health and Human Services told us via email that Susan Monarez, the most recent CDC director, approved the agenda before she was fired last month.)

Going after these relatively weak spots in the national immunization schedule makes it that much easier for Kennedy’s ACIP to cast other vaccines as dispensable. To Margot Savoy, a senior vice president at the American Academy of Family Physicians, this looks like “a very calculated approach.” (The AAFP is one of several professional medical societies that recently published vaccine recommendations that openly diverge from the CDC’s in response to Kennedy’s overhaul of U.S. vaccine policy.) Many of Kennedy’s initial attacks against immunizations have focused on COVID vaccines, capitalizing on lingering and highly politicized resentment over pandemic-era policies. And in June, at the first meeting of Kennedy’s newly reconstituted ACIP, the committee voted to drop its recommendations for flu vaccines containing the mercury-based preservative thimerosal—a decision that played on decades-old fears, fueled by anti-vaccine activists, that the compound can cause harm, despite years of evidence showing that it doesn’t.

Those early decisions were relatively limited in their impact. Last flu season, less than 5 percent of flu vaccines in the U.S. contained thimerosal. COVID-vaccine uptake had already been declining for years and was never very high among children; the previous iteration of ACIP was already considering paring back some of the recommendations for COVID vaccines before Kennedy fired all sitting members. But those restrictions also paved the path for this week’s votes, which could delay protection for millions of children in the years to come.

Compared with MMR and varicella vaccines that are administered separately, MMRV vaccines do have a higher risk of febrile seizures (which, while frightening to watch, usually resolve on their own and don’t generally carry long-term risks). The CDC once recommended MMRV over separate shots, but as the data on seizures emerged, the agency shifted its guidance to prefer giving the first dose of the MMR and varicella vaccines separately. Several ACIP members suggested today that the vaccine and its side effects were still poorly understood, and that safety issues would crater trust in vaccines overall.

But the experts we spoke with pushed back on that notion. The CDC previously kept MMRV as an option in part to offer more choices for families—especially ones that don’t interact regularly with the health-care system or prefer fewer injections. Edwin Asturias, a pediatrician at the Colorado School of Public Health and one of the ACIP members Kennedy dismissed in June, told us. Each year, about 10 percent of families opt to give MMRV as their child’s first dose, a spokesperson for the pharmaceutical company Merck, which manufactures the vaccine, told us. Removing that option, experts said, could dissuade some families from vaccinating their children against those viruses at all. The committee did vote to preserve MMRV’s status in the Vaccines for Children program, which offers shots to millions of families that can’t afford them—but the conflict between today’s votes adds substantial confusion into how to immunize children against these four viruses.

In making the argument for delaying the first dose of the hepatitis-B vaccine—which Kennedy has refused to say doesn’t cause autism, despite numerous studies showing no association—the committee built a more multifaceted case. Its members spent hours today casting doubt on the vaccine’s safety, despite being shown again and again strong evidence that it’s one of the safest shots made today. “I’m just not sure I see the data that suggests: Where is the benefit?” Retsef Levi, one of the ACIP members, said. “I’m not sure I see the impact of universal vaccination, and definitely not on day zero of life.” Martin Kulldorff, the committee’s chair, pushed CDC officials presenting at the meeting to compare the U.S. vaccination schedule with those of other developed nations that don’t recommend a universal birth dose.

But Adam Langer, a CDC official who presented background information about hepatitis-B shots at the meeting, pointed out that those nations tend to have universal health care and screen more than 90 percent of pregnant women for hepatitis B. In the U.S., prenatal care is spottier, especially early in pregnancy, when testing is typically done, Asturias noted. And the people most likely to miss out on prenatal care tend to be the ones at highest risk of having the virus; about 12 to 16 percent of pregnant women are never tested at all. Babies can also contract the highly infectious pathogen shortly after birth from family members, caregivers, children, and even surfaces. Once the virus takes hold in a newborn, it has a high chance of going on to cause liver damage, cancer, or even death.

Researchers credit the guidance to give all infants the vaccine, issued in 1991, with decreasing rates of acute hepatitis-B infection among young children by 99 percent. Delaying the first dose of the vaccine by even a month, experts told us, would risk the health of vulnerable infants and potentially reduce rates of hepatitis-vaccine uptake overall, because it would rely on families receiving the shot at the pediatrician—if they have one—rather than by default at the hospital. “I have not seen any data that says that there is any benefit to the infant of waiting a month,” Langer said during the meeting, “but there are a number of potential harms.”

The committee made its choice about MMRV at breakneck speed. In advance of meetings, ACIP has typically assembled work groups that would evaluate the evidence on vaccines, then share their analyses with their colleagues and the public. Major decisions would not be made without an assessment of the benefits and risks of each option. All of that has gone out the window. Experts from professional societies, in the past invited to advise committee members, have been barred from participating in work groups; five committee members were added to ACIP just days before today’s meeting. At a Senate hearing yesterday, Debra Houry, who resigned recently as the CDC’s chief medical officer, told senators that she was discouraged by a senior adviser at the agency from providing data or asking questions about changes to the hepatitis-B recommendation. (Kulldorff did, at the last minute, announce that the hepatitis-B vote would be delayed until tomorrow, citing a “slight discrepancy” in the proposed voting questions.)

This ACIP, experts pointed out, seems uninterested in discussing vaccines’ benefits. Instead, it has been building the case that many vaccines pose excessive risk, and that the U.S. is pushing far more of them than are necessary. The intention seems to be to “cast the previous committee as less concerned about safety than they are,” Kelly Moore, a former ACIP member and the president of Immunize.org, a nonprofit supporting immunization, told us. They appear to be suggesting that the CDC has saddled the public with an unsafe, bloated vaccine schedule that Kennedy’s chosen cohort will now fix.

These early shifts—less COVID vaccination; fewer options for flu, MMR, and chickenpox vaccines; and, perhaps soon, delays to the hepatitis-B schedule—may seem benign enough. But that may be part of the point. Kennedy and his allies are testing the waters, but they’re also accustoming the public both to the idea of fewer vaccines and to the routine of doubting vetted immunizations. The more logical their early choices seem, the more reasonably Americans might assume the ones that follow are too. “By the time people realize we’re in a bad way, we’re going to be so far in a bad way, we won’t be able to get back out,” Savoy told us. Whether vaccine infrastructure disappears by erosion or rapid demolition, the end result will be the same: a nation far less protected than it once was and could still be.

Americans across the political spectrum are aligned on at least one belief, albeit for different reasons: The CDC is a mess. In a poll conducted this summer by The Washington Post and KFF, a nonpartisan health-policy organization, Democrats and Republicans alike expressed low confidence that the agency could be trusted to make independent decisions based on scientific fact. Robert F. Kennedy Jr., as the head of Health and Human Services, has described the CDC as dysfunctional and politicized; according to the former CDC director Susan Monarez, he has also disparaged the agency’s workers as child murderers. Meanwhile, public-health experts—a group that has historically worked in tandem with the CDC—now question the agency’s credibility with Kennedy in charge. “You can’t trust anything that comes out of the CDC,” Michael Osterholm, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy, told me.

Today, Monarez testified before a Senate committee that Kennedy fired her after less than a month in her role because she refused to accept his vaccine policy. According to Monarez, Kennedy demanded “blanket approval” of all recommendations made by the agency’s Advisory Committee on Immunization Practices, which Kennedy dismantled in June and has since remade in his own anti-vaccine image. Over the next two days, the group is scheduled to discuss vaccines for COVID, hepatitis B, and other diseases. According to a Washington Post report, at the meeting, Trump-administration officials also plan to use a database of unverified vaccine-injury reports to link COVID shots to the deaths of 25 children.

The Department of Health and Human Services and the CDC did not respond to requests for comment for this article. Kennedy has previously claimed that he fired Monarez because she told him she was not trustworthy. And in response to the Post report, Kennedy’s spokesperson said, “Any recommendations on updated COVID-19 vaccines will be based on gold standard science and deliberated transparently at ACIP.”

If the CDC is no longer the reliable source of health guidance it once was, Americans must find reliable information elsewhere. (Even Americans who don’t regularly seek out the agency’s advice generally receive it through their doctors and local officials.) Physicians, researchers, and public-health experts I spoke with told me that academic and public-health institutions can be trustworthy sources but also that no existing institution in the United States is equipped to replace the CDC. Kennedy has long encouraged Americans to do their own research on health matters and especially on vaccines; now we have no choice but to follow his advice.

Some public-health experts I spoke with emphasized that the CDC can no longer be trusted specifically on vaccination. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told me that the agency’s vaccine-credibility problems lie with ACIP. Ashish Jha, the dean of Brown University’s School of Public Health and the Biden administration’s COVID czar, agreed. “Whatever ACIP recommends, it is not coming from expertise and an understanding of the scientific process,” he told me.

[Read: What it’s like to work inside a broken CDC]

To some extent, Americans don’t have much of a choice about whether to follow the CDC’s guidance. It determines, for instance, what vaccines are administered through a federal program called Vaccines for Children that offers free shots to more than half of American kids. Some state governments have updated their policies in response to the vaccine chaos the federal government has inflicted in recent weeks, but many states still follow CDC recommendations to shape school vaccine requirements and regulations on insurance coverage.

When Americans do need vaccine advice, Jha said, most turn to their health-care providers, who themselves generally go to the CDC for information. Physicians “used to have a single place to look, and now we don’t,” Offit said. All of the experts I spoke with agreed that, as an alternative, professional medical organizations are among the most trustworthy sources for vaccine information right now. For many years, these groups have released guidance on vaccination, largely intended for health-care providers, based on the latest science. “The difference today is that they just don’t align with the federal government,” Katelyn Jetelina, who writes the public-health newsletter Your Local Epidemiologist, told me. The American Academy of Pediatrics and the American College of Obstetrics and Gynecology, for instance, recently published their own guidelines contradicting the CDC’s stance on vaccination for children and during pregnancy, respectively.

Medical organizations form their recommendations based on their review of the scientific evidence, not the CDC’s, Jennifer Kates, a public-health expert at KFF, told me. According to other experts I spoke with, additional trustworthy sources include the American Academy of Family Physicians, the American College of Physicians, and the Infectious Diseases Society of America. These groups can be trusted because they review updated scientific evidence every year, Jetelina said. Their leaders are also, crucially, not appointed by politicians.

[Read: A massive vaccine experiment]

Science organizations are also working to interpret the latest evidence for providers and policy makers. Multiple experts applauded Osterholm’s Vaccine Integrity Project, which describes itself as “dedicated to safeguarding vaccine use in the U.S. so that it remains grounded in the best available science.” Caitlin Rivers, a professor at Johns Hopkins Bloomberg School of Public Health, recommends Immunize.org, a nonprofit that gears similar advice toward health-care providers. The Pandemic Center at Brown University publishes a weekly tracking report on infectious diseases. During the recent measles outbreak centered in Texas, the Pandemic Center’s data contradicted Kennedy’s assertions that the crisis was subsiding, Jennifer Nuzzo, the director of the Pandemic Center, told me.

All of these sources provide good information, but they also offer slightly different takes on the available research and data. In the past, the CDC helped unify varying scientific interpretations, incorporating them into consensus guidance. “You really can’t replicate that, not in any academic institution, not any state health department, not in any professional society,” Tom Frieden, a former CDC director who is now the president and CEO of the global-health nonprofit Resolve to Save Lives, told me. Without sound input from the agency, the vaccine-information landscape is fragmented—which, Jetelina told me, will likely accelerate the atomization of American vaccine policies, behaviors, and beliefs. Already, state-level vaccine recommendations are diverging along political lines. After the CDC changed its recommendations to restrict eligibility for annual COVID shots, more than a dozen blue states began changing their vaccine policies to expand access. Meanwhile, Florida and Idaho have attempted to cancel schools’ vaccine mandates. In Louisiana, the health department has forbidden its employees from promoting “mass vaccination.”

The divided vaccine-information landscape will make it even harder for doctors and everyone else to sort fact from fiction. Some of the advice physicians receive from medical societies is already at odds with what the CDC recommends. “It’s going to create real conflict for them about what they should do,” Jha said. Ultimately, politics may determine who providers end up trusting, Offit said. Jetelina worries that the mixed messages, combined with Kennedy’s anti-vaccine signaling, will decrease confidence in vaccines. An obstetrician I interviewed recently told me she has already observed a rise in vaccine hesitancy among her pregnant patients since the CDC stopped recommending COVID vaccines for them.

[Read: Moms are losing options to protect newborns from COVID]

The experts I spoke with agreed that as long as Kennedy oversees the CDC, its trustworthiness is at stake. The continued gutting of its staff—and their replacement with non-experts—will further weaken its ability to vet and publish science-based guidance. Americans have long valued medical autonomy. But we’re now getting a sense of what happens when it’s all we have.

In 2022, Florida weathered a bad outbreak of meningococcal disease, a type of fast-moving bacterial infection that can become fatal after entering the bloodstream or the lining of the brain and spinal cord. As the number of ill people climbed into the dozens, public-health officials scrambled to address clusters of cases, including one among college and university students. Campuses are primed for outbreaks: The bacteria spread through the kind of intimate or prolonged contact that’s rampant on campuses, where people are “kissing and sharing drinks, being in close quarters in dorm rooms and parties,” Sarah Nosal, the president-elect of the American Academy of Family Physicians, told me. College attendance is considered its own risk factor for infection, and many states—including Florida—require the meningococcal vaccine for students living on campus.  

Soon, though, Florida’s policy may change. Earlier this month, the state’s surgeon general, Joseph Ladapo, announced his intention to end all vaccine mandates: “Every last one of them is wrong,” he said. Some vaccine rules—including the one applying to the meningococcal vaccine—are written into the state’s laws, but Ladapo has said his office will partner with Governor Ron DeSantis’s to push for necessary changes.

A canceled mandate alone may do little to change the risk of meningococcal outbreaks on Florida’s college campuses. The CDC still recommends these vaccines for preteens and teenagers, and currently almost all American kids in that age group get at least one dose. But Florida’s rebellion against vaccine mandates is part of a larger erosion of the immunization status quo, as childhood-vaccination rates in the United States decline, Robert F. Kennedy Jr.’s Department of Health and Human Services chips away at long-standing vaccine policy, and more families seek exemptions from state requirements.

These changes won’t affect only young children, who are supposed to get numerous shots in their first 15 months of life. If vaccination rates fall—due to changing federal recommendations, states eliminating mandates, increasing anti-vaccine sentiment, or some combination of all of the above—middle schools, high schools, and college campuses may also become particular breeding grounds for once-controlled illnesses.

Nosal’s youngest child is still in college, so the idea of outbreaks on campuses hits close to home: If her child got a preventable illness because she hadn’t been encouraged to vaccinate them against it, or because campus-vaccination rates were too low to squash transmission, she’d be devastated, she told me. (The AAFP in September broke with federal guidance by recommending COVID-19 shots for all children, adults, and pregnant people.)

Meningococcal disease (which includes meningitis) is a very real concern for teenagers and young adults in a less vaccinated world. “You can be fine one minute and dead four hours later,” Paul Offit, who directs the Vaccine Education Center at Children’s Hospital of Philadelphia, told me. Thanks in no small part to vaccination, meningococcal disease is rare in the United States. But it’s been on the rise since 2021—last year’s count of 503 confirmed and probable cases was the highest recorded since 2013—and the ages of 16 to 23 are a risky time for contracting these infections, relatively speaking. The CDC currently recommends that kids get their first meningococcal vaccine at age 11 or 12, then another when they’re 16; only about 60 percent of kids in the U.S. get both doses by the time they’re 17. Even fewer get a separate vaccine that targets a meningococcal subtype responsible for many cases among teens and young adults. (The CDC does not routinely recommend this shot for teens without special risk factors for infection, instead leaving the choice up to patients and their doctors.)

In recent years, the CDC’s Advisory Committee on Immunization Practices, the expert group that shapes the agency’s national vaccine recommendations, has considered dropping its recommendation for a first dose administered at age 11 or 12, since meningococcal infections are rare among preteens. Some experts have argued that axing that dose could set off a dangerous domino effect. Sarah Schaffer DeRoo, a primary-care pediatrician with Children’s National Hospital who has studied meningococcal disease and vaccination among college students, told me she worries that any disruption to established recommendations could cause confusion and contribute to further drops in vaccination rates, and more unvaccinated students means more chances for these infections to take root.

That consideration predated Kennedy—who recently dismissed all sitting members of ACIP and installed a variety of vaccine skeptics in their place—and the rejiggered committee may not implement it. (“Looking ahead, the new ACIP will continue to evaluate the latest gold-standard science before making future updates,” an HHS spokesperson said in a statement.) But Kennedy’s HHS has already shown willingness to reduce the number of immunizations children receive, such as by removing COVID-19 shots from the vaccine schedule for healthy kids.

If the committee continues to wind back vaccine recommendations, adolescents and teens could also be affected by vaccination decisions made on behalf of much younger people, Walter Orenstein, who formerly ran the United States Immunization Program, told me. Herd immunity only holds when protection is so high throughout an entire population that contagious illnesses are virtually unable to spread. If childhood-vaccination rates plummet, giving pathogens new targets in unprotected babies and young children, outbreaks won’t necessarily stay contained to those age groups. People of all ages—particularly those who are immunocompromised or under-vaccinated, but also some who are just plain unlucky—are bound to get sick too.

“If we stopped all vaccinations today, we won’t have huge outbreaks tomorrow,” Orenstein said. It would take time for the susceptible population to grow. But over time, largely forgotten illnesses could reestablish a foothold. If measles-mumps-rubella vaccination declined by 10 percent, for instance, the U.S. could see more than 11 million measles cases over the next 25 years, according to a 2025 modeling study. (Even at current vaccination rates, the disease may again become endemic and result in about 850,000 cases over the next 25 years, the study projected.)

Older kids and young adults would not be spared. Despite measles’ reputation as a childhood disease, about one-third of the cases recorded in the U.S. so far this year were among people 20 and older. And at least 8 percent of people sickened by measles this year had gotten one or more doses of the MMR vaccine—living proof that vaccinated people are also at risk when illnesses are given room to maneuver.

“This is what I call the new epidemiology of measles,” Michael Osterholm, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy, told me. The fact that adults are already catching measles suggests outbreaks could easily emerge in high schools and on college campuses, particularly if vaccine coverage wanes—the last thing any school wants, given the disease’s extreme contagiousness.

Mumps is another concern, Offit added. It spreads best among people in close contact, such as students. Immunity can also wane over time, even among people who get vaccinated, which raises the chance of campus clusters. Across the board, if vaccination rates fall, “we’re going to be spending a lot more time dealing with outbreaks,” Osterholm predicted. “We’re going to have an increasing number of cases and, unfortunately, an increasing number of deaths among kids” of all ages.

To forgo vaccinations proven to prevent deadly and debilitating diseases is to accept the possibility of these grim outcomes—which parents haven’t had to think about for decades, as mass immunization has invisibly done its job. “That is the choice we’re making,” Nosal said. “We just don’t completely understand that choice because we haven’t seen it.” At least not yet.

Since Robert F. Kennedy Jr. pushed out the CDC’s director and three other senior officials resigned in protest, public-health experts—including a former CDC director, a renowned vaccine expert, and at least one departing official—have broadcast an unprecedented loss of faith in the agency. The public, they say, should no longer trust the advice the CDC gives.

That message has put CDC staffers left behind in an awkward position. Nine current and former employees told me they appreciated the need to sound the alarm about Kennedy tampering with the agency’s vaccine-evaluation machinery. But a blanket warning about the CDC implicates more than the agency’s vaccine recommendations; it casts doubt on the ongoing work of the rank and file across the agency.

The reality of what’s unfolding inside the CDC is more complicated than widespread meddling, according to the employees I spoke with. And that makes navigating the information coming out of the agency even more of a challenge for everyone on the outside.

So far, “it’s where data meets vaccine policy that this administration is causing the biggest reputational damage,” Fiona Havers, a vaccine-policy expert who led the CDC’s studies of COVID and RSV hospitalizations before resigning from the agency in June, told me. Earlier this year, Kennedy fired all 17 members of the agency’s Advisory Committee for Immunization Practices and replaced them with his own handpicked alternatives, many of whom have long histories of spreading vaccine misinformation. Havers told me that HHS personnel outside the CDC have also started reviewing some agency materials before they’re published; this process has led to changes to scientists’ language involving vaccinations and treatments for measles and RSV, Havers said.

I asked HHS to comment on whether the review policy for such materials has changed, but the department’s communications director, Andrew Nixon, declined to answer that question. “Secretary Kennedy has been clear: the CDC has been broken for a long time,” Nixon wrote in an email. “Restoring it as the world’s most trusted guardian of public health will take sustained reform and more personnel changes.”

The administration has interfered with work in other politically sensitive fields. Earlier this year, when President Donald Trump issued executive orders refuting the existence of gender and disavowing diversity, equity, and inclusion, CDC staff withdrew papers submitted to journals and removed and edited data on certain populations from select data sets. They also changed protocols for research involving these populations, current and former employees told me. (A number of workers I spoke with for this story asked to remain anonymous due to fear of professional retaliation.)

[Read: ‘This is not how we do science, ever’]

When it comes to publicly accessible material, the CDC’s website may be particularly prone to including misleading information, because on any of the site’s pages with no named authors, “there’s no way to verify that that came directly from a scientist and wasn’t tampered with,” a current employee who has worked in noninfectious-disease epidemiology at the CDC for about a decade told me. That said, most pre-2025 guidance documents on the CDC’s website are likely reliable, as is newer guidance on less politicized topics (for example, the Yellow Book website that provides information about travel medicine), a subject-matter expert who staffs one of the agency’s many disease-specific hotlines told me.

The bulk of the data removed and edited earlier this year will be restored following a legal settlement this month. Jennifer Layden, who led data-modernization efforts as director of the agency’s Office of Public Health Data, Surveillance, and Technology before resigning in August, told me that the agency’s data sets otherwise remained largely unaltered. “We are working extremely hard to protect the data,” a senior official still at the agency told me. Other significant parts of the CDC’s work are basically fine, according to current and former employees I spoke with. Much of it is invisible to the general public, which may help keep it safe from political interference. For example, since January, disease experts scattered throughout the agency have answered more than 1,500 calls from providers caring for patients with malaria, parasitic diseases, free-living amoebas, diphtheria, and botulism, according to numbers from the CDC. The agency’s epidemiologists also continue to assist state, local, and tribal health departments when they’re faced with particularly challenging outbreaks, such as the rabies infections that have turned up in unusually high numbers this year. (This past winter’s measles outbreak was arguably an exception: CDC researchers didn’t arrive in Lubbock, Texas, until a child had already died in nearby Seminole.) The subject-matter expert I spoke with, who takes calls from clinicians and health departments nationwide, told me that their work had not been interfered with, perhaps in part because the infections they advise on are so rare.

CDC scientists often write technical articles for publication both in the agency’s own journals and in external peer-reviewed journals. Submission numbers, at least to the agency’s journals, have been down in recent months: Fewer scientists are available to write the articles due to staff scarcity in the wake of layoffs, and some research is newly off-limits under Trump’s executive orders. Still, several epidemiologists told me that agency scientists’ published work about subjects other than vaccine-preventable disease—on overdoses and vector-borne diseases, for example—remains their own. I heard several times that an awful lot of people at the CDC would quit before they’d put their name on scientific material that they’d been forced to fabricate.

Across the board, however, departments are under strain as the administration strips away the CDC’s resources. Since Trump withdrew the U.S. from the World Health Organization in January, the CDC’s global-health experts have been largely unable to receive the timeliest information about disease trends worldwide, and they’ve been prevented from collaborating on infections and conditions that easily traverse borders, according to several global-health epidemiologists still employed by the CDC. “We look like idiots,” an epidemiologist in the agency’s Global Health Center told me. Early in the year, the Trump administration, guided by Elon Musk and his team at the Department of Government Efficiency, clawed back $11 billion in funding from the CDC and took a chain saw to its staffing. A recent analysis of HHS worker departures by ProPublica found that anywhere from 4 to 20 percent of staff across several CDC centers and offices was forced out as part of a so-called reduction in force, or RIF. According to ProPublica, the real losses are likely much higher, as the analysis does not include the more than 1,100 workers who have received layoff notices but remain on administrative leave.

[Read: ‘It feels like the CDC is over’]

Workers have so far been able to cover for absent colleagues and funding, but that could change if months turn into years, or if the agency’s budget is cut as much as proposed 2026 budgets suggest it will be. After about a third of Layden’s staff was laid off, she told me, she felt she couldn’t be effective in her role. Workers left behind in these scenarios “can still provide the guidance and the direction and support” to the health departments and other partners they serve, but “they may not have enough bandwidth to do it as well, or help as many states,” she said.

Kennedy seems poised to bend the CDC further to his will. In a recent Wall Street Journal op-ed, he wrote that the agency has “squandered public trust” and allowed its core purpose to be “corroded” (and that his leadership will restore the CDC’s reputation). Two days later, in a hearing before the Senate Finance Committee, he said the CDC needed to be purged of “officials with conflicts of interest and catastrophically bad judgment and political agendas.” The CDC’s new acting director is Jim O’Neill, Kennedy’s deputy at HHS, who has no medical or scientific training and a history of spreading COVID-related misinformation and conspiracy theories. (In an emailed statement, the HHS spokesperson Gregory Angelo cited O’Neill’s previous tenure at HHS during the aughts, and described him as “a proven leader with a deep understanding of HHS and its many divisions.”) Kennedy has not yet given any indication of who might be tapped to replace the director he ousted. “If the administration appoints an ideologically driven leader, we’re at higher risk for political interference in other areas of CDC,” the Global Health Center epidemiologist told me.

In making broad statements about the CDC’s credibility, public-health experts—who overwhelmingly oppose Kennedy’s anti-vaccine agenda—risk playing into his hands. “I absolutely understand why they are saying what they are saying,” the noninfectious-disease epidemiologist said about the CDC’s current critics. “My fear is that we’re going to throw the baby out with the bathwater.” No other entity gathers nationwide data on health trends like CDC does; before this year, it was unparalleled as a reservoir of public-health expertise. If clinicians and public-health officials don’t trust that they’ll get good advice when they call for help with unusual cases, the risk that small outbreaks will become big ones, and that more people will die, rises. If researchers lose faith in the agency’s data on health trends, or if the general public doesn’t believe what’s published on the CDC website, people have few other options to turn to for reliable, centralized information on crucial health matters.

[Read: RFK Jr.’s victory lap]

The continuing exodus from the CDC also poses a numbers problem. Multiple employees I spoke with said that, for now, if nobody has noisily quit the agency over something it’s made or done, that product is likely trustworthy. “I don’t think at this point we’re going to tolerate pressure in silence,” a medical epidemiologist who has been at the CDC for a decade told me. But what happens when everyone who can noisily quit already has? The agency might exist in name, but its reputation may be ruined for good.

At 38 weeks pregnant with her second child, Hannah Robb has no time to waste on red tape. Yet she’s lost hours in her struggle to figure out whether and when she can get a COVID booster. Her doctor said she could—and should, she told me. According to her doctor, she wouldn’t need a prescription; according to her local New York City Walgreens, she would. When Robb finally arrived at her appointment at the pharmacy, prescription in hand, she wasn’t sure whether the shot, which can cost $250 out of pocket, would be covered by insurance; so far, no one has billed her, so she assumes it was. “It’s hard to know what’s right and what’s wrong until you show up to the pharmacy and see what they’ll do,” Robb told me.

Similar scenes are playing out at drugstores across the country. The Trump administration’s recent swerves in COVID-vaccine policy have left many Americans—including pharmacists and physicians—confused about where the shot will be available, who is eligible to receive it, and who will be covered by insurance. Pregnancy raises the stakes of that confusion: Pregnant women face an elevated risk of becoming severely ill from COVID, as do newborns, who cannot be immunized against the coronavirus before they’re six months old. The federal government’s guidance on pregnancy and COVID vaccines is now so tangled that Jennifer Lincoln, a board-certified ob-gyn in Oregon, told me that people have asked her whether they should hide the fact that they’re pregnant to more easily receive a shot.

Previously, the COVID-vaccine approval process went something like this: The FDA reviewed the safety and efficacy of updated versions of the shots, then approved them for certain groups of people. Next, the CDC translated the FDA’s guidance into public-health recommendations, on which individual states based their own immunization policies. Although states ultimately determine who is eligible and whether a prescription is necessary, the Affordable Care Act requires insurers to cover any vaccine the agency recommends. Annual COVID shots have, until now, been recommended by the CDC for all adults, including pregnant women, and have thus been covered by insurance.

The process this year has taken a wildly different trajectory. In May, the FDA announced that it would narrow eligibility for annual COVID vaccines to only adults over 65 and people with certain high-risk conditions, including pregnancy. Days later, Health and Human Services Secretary Robert F. Kennedy Jr. announced that the CDC would no longer recommend COVID vaccines for healthy children or healthy pregnant women, claiming, inaccurately, that no evidence supports the use of the booster in children. The CDC clarified that healthy children could get the vaccine after consulting with their doctor, and last month, the FDA approved three updated COVID vaccines that healthy children can receive (again, after a medical consult). But neither agency has offered any new guidance about pregnancy and COVID vaccination since then. (The Department of Health and Human Services, which oversees both the CDC and the FDA, did not respond to a request for comment.)

The chaos has left pharmacies in a bind. At the beginning of this year, roughly half of states based their policies on the CDC’s recommendations, Brigid Groves, the American Pharmacists Association’s vice president of professional affairs, told me. (Other states, she said, incorporate the guidance of the FDA, the state health department, and other groups that issue vaccine recommendations.) According to Groves, after the CDC changed its recommendations, pharmacists in those states lost the authority to vaccinate pregnant people. Even in states whose policy deviates from the CDC, each pharmacy can set its own boundaries on who can be vaccinated, and individual pharmacists may fear liability for vaccinating pregnant customers, Groves said. Last month, CVS stopped offering COVID vaccines entirely in three states. A CVS spokesperson told me that COVID vaccination has resumed in the three states where it was paused, and that people must attest to their eligibility when scheduling an appointment.

[Read: A massive vaccine experiment]

Doctors are unhappy with the confusion. Last month, the American College of Obstetricians and Gynecologists (ACOG) reaffirmed its stance that women should get a COVID vaccine or booster while pregnant, trying to get pregnant, postpartum, or lactating. “To act like they’re not high-risk just by virtue of being pregnant shows no actual understanding of data and science,” Lincoln said. Pediatricians are concerned too. The COVID vaccine “protects both the mom and the baby” because the mother’s antibodies are passed to the fetus, says James Campbell, a pediatrics professor at the University of Maryland who is also the vice chair of the American Academy of Pediatrics’ committee on infectious diseases. According to the CDC, newborns have a higher COVID-related hospitalization rate than that of any other age group besides people 75 and older. “The younger the child, the more likely that they’re going to be hospitalized,” Campbell told me.

A long-awaited meeting of the Advisory Committee on Immunization Practices—the group that informs the CDC’s recommendations, which Kennedy recently repopulated with several members who are hostile to vaccination—may clarify later this week where pregnant women stand. But in the meantime, states in favor of offering the vaccines are taking matters into their own hands. In recent weeks, 16 states have moved to expand access to COVID vaccines, some by granting state health departments the authority to set vaccine policies or allowing pharmacists to defer to medical organizations such as ACOG rather than the CDC. Massachusetts became the first state to require insurers to pay for all vaccines recommended by the state health department, regardless of CDC guidance. Several West Coast states have allied to develop joint vaccine recommendations; some states in New England appear to be doing the same. Jennifer Kates, a public-health expert at KFF, a nonpartisan health-policy organization, told me she expects more blue states to follow suit.

Policy is far from the only factor that will determine whether Americans—pregnant or otherwise—receive their COVID shots this fall. COVID vaccines have never been particularly popular among pregnant women; since 2023, uptake has hovered below 15 percent. People tend to be more anxious about what they put into their body during pregnancy, especially vaccines, Lincoln said. One 2024 study found that mothers worried that getting a COVID shot while pregnant would endanger their baby; a 2023 KFF poll found that a quarter of American adults thought COVID vaccines had “definitely or probably” been proved to cause infertility. Today, copious evidence shows that vaccination protects both mother and child. But fears about the safety of getting the shot during pregnancy have been stoked by politicians and public figures airing anti-vaccine talking points on the national stage. “I hear an increase in vaccine hesitancy in my clinic every week,” Anne Waldrop, an ob-gyn and a clinical professor focusing on maternal fetal medicine at Stanford, told me. Meanwhile, Kennedy has reportedly asked health officials to compile data linking COVID vaccines to poor pregnancy outcomes—a measure that seems destined to provoke even greater anxiety. (HHS responded to the report by restating its commitment to transparency, and the White House reiterated its support for Kennedy’s leadership.)

[Read: Why RFK Jr.’s anti-vaccine campaign is working]

When health care becomes complicated, the standard response is to ask your doctor for advice. Yet even some providers aren’t offering straight answers. Francesca Cohen, who is 37 weeks pregnant, told me that her obstetrician never recommended that she get a COVID booster. “I live in Austin, Texas. I assume they have a mix of perspectives in their patient base,” she said. When Cohen brought up the vaccine, her provider shared ACOG’s guidance and said that the choice was up to her. Cohen is still deciding.

*Illustration sources: How Wee Choon / Getty; Grace Cary / Getty; Sergey Ryumin / Getty (edited)

When Connecticut legalized recreational marijuana in 2021, the state’s lieutenant governor, Susan Bysiewicz, boasted that the new law was “crafted to repair the wounds left by the War on Drugs.” The move followed the same rationale that had motivated legalization in 18 other states: fewer resources exhausted on policing a drug that legalization advocates view as largely unharmful, fewer lives derailed by what they argue to be excessive lockups. In a sense, the plan worked: Possession arrests have fallen precipitously in the years since. But as Connecticut’s number of legal neighborhood weed shops has grown, so too has a problem that the state, like others that have eased marijuana laws, was seemingly ill-prepared to deal with: the rise of illegal marijuana shops.

Such shops are largely indistinguishable from state-sanctioned ones. They look the same and operate in the same neighborhoods, but they’ve never gone through the required licensing process to become a seller. (Beyond asking for paperwork, you’d be unlikely to know if you were shopping in an illegal store.) And they have become a headache for local law-enforcement agencies that want to crack down. “This is an epidemic within the state of Connecticut,” Ryan Evarts, a sergeant at the Norwalk Police Department, told me. The problem has become so pronounced that some states, including Connecticut, have recently passed laws giving law enforcement greater powers to police these shops.

The result has been a strange new inversion: states with some of the loosest marijuana restrictions in the nation arresting and charging sellers of a drug that was made legal at least in part to move away from such charges. Since the beginning of last year, Connecticut has arrested dozens for selling pot out of illegal shops. From April to June 2025, California, supposedly a bastion of recreational cannabis, arrested 93 people for illegally selling, growing, and distributing weed, according to the state’s Department of Cannabis Control—the largest number of weed arrests in a three-month period since the state legalized the drug. Similar arrests have also been made within the past year in Illinois; Arizona; New Jersey; New York; Ohio; Washington, D.C.; and Washington State. It’s not just the owners of smoke shops who have been targeted—so have rank-and-file employees, according to news reports.

[Read: The GOP’s tipping point on weed]

There is a justifiable public-health rationale for going after these shops. In most states, legal weed must be independently tested for contaminants, such as lead and cadmium. Illegal products may not undergo such testing, in turn putting consumers at increased risk of long-term health complications, such as cancer. Some of these stores are also allowing cannabis to land in the hands of children, which is particularly concerning given research showing that cannabis can harm the developing brain. Multiple smoke shops in Connecticut that were raided had been caught selling products to minors.

Illegal sales of cannabis are bad for the states financially, too. Officials have invested time and money into setting up legal cannabis programs; by levying taxes on legal marijuana sales, states have turned recreational cannabis into a windfall. California expects to bring in more than $700 million in tax revenue from marijuana this year alone. States have a clear reason to crack down: Illegal weed sales might go untaxed. And if businesses can continue selling cannabis under the table, it dilutes the incentive for shops to go through the often long and arduous process of getting a cannabis-retailer license.

Police officers have also warned that some illegal cannabis shops are involved in and potentially funding other, more criminal enterprises. Police found guns and other drugs—including hallucinogenic mushrooms, fentanyl, and crack cocaine—during several recent arrests in Connecticut, according to press reports. In California, where the governor has created a task force on illegal cannabis, recent busts are part of a larger effort to disrupt criminal groups, including “Chinese organized crime,” Kevin McInerney, a commander at the Department of Cannabis Control, told me. McInerney did not cite any examples of operations explicitly tied to Chinese organized crime, but last year, ProPublica reported that America’s illegal cannabis market is dominated by “Chinese mobsters who roam from state to state, harvesting drugs and cash and overwhelming law enforcement with their resources and elusiveness.”

But not everyone is enthusiastic about using police to regulate the cannabis black market. “You can’t arrest your way out of problems like illicit markets,” Daniel Nagin, a criminology expert at Carnegie Mellon University, told me. “Targeted arrest strategies are effective only in a limited set of circumstances, like going after known high-rate offenders.”

Drug-policy advocates I spoke with emphasized that some operators of illegal weed shops may not have the resources to secure a coveted place in the legal market. A license to operate a cannabis shop in Connecticut can run up to $25,000, not including additional fees. Owners also must have measures in place to ensure that cannabis is not stolen or diverted, including programs to track each piece of cannabis that enters and leaves their store, as well as more traditional security systems, such as video-surveillance systems and a silent alarm.

If the problem is merely too few legal cannabis shops, the solution may seem simple, at least among those who argue that recreational marijuana should be legal: a loosening of the rules around cannabis licensing. “The solution isn’t to crack down harder, but to create more inclusive pathways into the legal market and to decriminalize cannabis at all levels,” Adrian Rocha, the director of policy for the Last Prisoner Project, a criminal-justice-reform group focused on drug policy, told me. For those who still break the law, other enforcement measures—such as fines—should solve the problem, Maritza Perez Medina, the director of federal affairs at the Drug Policy Alliance, told me.

But such arguments for how to deal with the problem of illegal weed fall flat. Los Angeles still has a problem with illegal dispensaries, even though the city has more than three times the number of legal dispensaries serving about the same population as Connecticut. And fines and other regulatory tools have time and again proved ineffective in stopping illegal behavior. Some shops in Connecticut, for example, have been busted more than once for selling illegal cannabis products. Even shutting down dispensaries doesn’t always fix these problems: When New York City closed an illegal smoke shop in the Bronx, it simply reopened next door.

Regardless of who is selling black-market weed and what their motivations are, if illegal sales continue to grow, they have the potential to put the legalization movement in jeopardy. Even in states that have already enacted law changes, one could imagine residents—and politicians—getting so sick of hearing about lawless cannabis shops, including those with guns and who are selling to kids, that they question the merits of legalization more generally. Throwing people in jail may not be ideal. But so far, no one has quite figured out a better plan.

Pesticides once appeared to be a clear target for Robert F. Kennedy Jr.’s desire to “make America healthy again.” Before becoming the health secretary, he described Monsanto, the maker of the glyphosate-based herbicide Roundup, as “enemy of every admirable American value,” and vowed to “ban the worst agricultural chemicals already banned in other countries.” Since he came to power, many of Kennedy’s fans have waited eagerly for him to do just that.

Kennedy has yet to satisfy them: In the latest MAHA action plan on children’s health, released last week, pesticides appear only briefly on a laundry list of vague ideas. The plan says that the government should fund research on how farmers could use less of them, and that the government “will work to ensure that the public has awareness and confidence” in the EPA’s existing pesticide-review process, which it called “robust.”

Unlike Kennedy’s concerns about vaccines, his concerns about pesticides have echoed those found in a body of legitimate research. Studies have found associations between exposure to some herbicides and pesticides and cancer, hormone disruption, and other acute and chronic health conditions. These include neurodevelopmental impacts in children, such as autism—which Kennedy has also promised to tackle.

Right now his department’s promised report on what has caused rates of autism to rise over recent decades is expected to highlight Tylenol use, whether during pregnancy or, as my colleague Tom Bartlett reported, based on Kennedy’s correspondence with a fringe researcher, in early childhood. Researchers generally point to a change in diagnostic criteria as the primary reason rates have spiked so dramatically. They also consider autism a complex condition that does not appear to have a single cause: Studies suggest that genetics play a bigger role than environmental factors in determining a person’s risk, though both seem likely to contribute and may work in concert. A serious effort from the government to understand its causes would require investment in long-term, large-cohort, and detailed studies that might cast light on the contribution of many environmental factors, including pesticides.

Several studies have found neurological impacts associated with pesticides. UC Davis’s MIND Institute put out a study in 2014 that found autism risk was much higher among children whose mothers had lived near agricultural-pesticide areas while pregnant. A 2017 paper found that zip codes that conducted aerial spraying for mosquitoes—a pesticide—had comparatively higher rates of autism than zip codes that didn’t. Others have linked pesticides to a range of behavioral and cognitive impairment in children.

Rebecca Schmidt, a molecular epidemiologist and professor at UC Davis, has been researching potential risk factors for autism as part of the school’s long-term MARBLES study of mothers and children. Schmidt and her colleagues study families with at least one child already diagnosed with the condition—to see what environmental and biological factors may raise the risk of subsequent children being diagnosed. (Younger siblings of a child with autism have on average a 20 percent chance of also having it.) Her own research, she told me, has not seen as dramatic of results for pesticides as the 2014 paper—which she also worked on—reported, though other labs have found associations of their own between prenatal pesticide exposure and autism.

These studies, like most studies that assess environmental exposures, typically cannot determine causality between agricultural-pesticide exposure and autism risk. Investigating links between pesticides and health outcomes is challenging; researchers can look at geographic proximity to sprayed fields, but drilling down to find out how much pesticide actually ended up in a person’s body requires herculean diagnostic efforts, such as frequent urine sampling. And the conclusions drawn from these studies can only point to associations between certain exposures and the likelihood of developing the condition: Showing direct causality would involve willingly exposing pregnant mothers and infants to pesticides and seeing what happens, which scientists cannot do, for obvious reasons. But based on what she knows now, Schmidt told me, “pesticides are probably not a good exposure for any pregnant person, or even children,” since their brains are still developing.

In investigating autism causes, Kennedy could also consider another environmental factor: air pollution. Breathing air pollution does have robust evidence linking it to neurodevelopmental effects in children, including autism. The Trump administration’s policy changes since January have predominantly tipped the country toward more air pollution, not less, while its climate-policy rollbacks will contribute even further to the burden of air pollution from wildfires. Meanwhile, some evidence also suggests a link between flame-retardant exposure and behavioral-developmental problems in children. Other studies have found possible links between pre- and postnatal exposure to PFAS, or “forever chemicals,” and autism.

All of this means that following the science would give Kennedy many places to look. “We’ve been working on this for over a decade,” Schmidt told me. “Every time we do a study, it raises new questions. And so it’s a complex picture that takes time to tease apart.” Designing and completing strong studies of any of these factors is challenging and costly. If the federal government did want to put its resources toward finding the causes of autism, Kennedy would do well to increase funding for large, national studies that follow people for years.

The latest MAHA plan does say that the National Institutes of Health, along with other agencies, will develop a way to evaluate “cumulative exposure,” or the impact of the cocktail of chemicals Americans are regularly interacting with—including pesticides. It does not say how that research will be funded or which of the tens of thousands of in-use chemicals the agencies would focus on.

Since taking office, Kennedy has mostly avoided even rhetorically linking specific environmental exposures to health concerns. An earlier MAHA report had more to say on pesticides, but The New York Times and Politico reported that Republican lawmakers as well as the farm lobby expressed concern about its potential impact on farmers. At a Senate hearing, Kennedy said that there are “a million farmers who rely on glyphosate” and told lawmakers that “we are not going to do anything to jeopardize that business model.” At a Heritage Foundation event last month, Kennedy’s senior adviser, Calley Means, said on a panel that corn and soybean farmers are not the “enemy,” but rather that the “deep state” is. (Corn and soy are two of the most heavily sprayed crops.) In response to a request for comment, HHS pointed me to last week’s MAHA plan, as well as the EPA’s work to evaluate environmental risks while phasing out animal testing.

This shift has raised the ire of some of Kennedy’s most ardent fans. Zen Honeycutt, the founder of the advocacy group Moms Across America who has been a major Kennedy supporter, said shortly after the MAHA plan was unveiled last week that her vote for the Republican Party is not guaranteed: “We will be actively campaigning to get people into office coming in the midterms that will protect our children, and we are not beholden to political parties.” In a statement later that day, she said that eliminating specific mentions of glyphosate and atrazine, another widely used pesticide that appeared in the first report and has concerning health implications, is “a tactic to appease the pesticide companies.”

Some of Kennedy’s defenders rightly point out that he is not in charge of the EPA, which regulates pesticides, or the U.S. Department of Agriculture, which oversees farming policies. Even if he cannot regulate pesticides himself, he is in charge of the National Institutes of Health, “and the NIH can study the causes of the effects of these chemicals on Americans. Those studies can drive the marketplace and policy change,” Vani Hari, a food activist, MAHA influencer, and vocal supporter of Kennedy, told me. (In particular, she wants to see the United States, as some other countries have, eliminate the practice of spraying glyphosate on crop fields right before harvest, which farmers do to dry out the crops.) Kennedy understands the threat these chemicals pose, she told me: “When there is an opportunity to add influence, he will. He’s not afraid to speak up.”

I asked whether she would be disappointed if the forthcoming autism report doesn’t mention pesticides and instead focuses on Tylenol and folate deficiencies. She told me she doubted that the autism report would overlook pesticides. “I don’t see that even happening,” she said. Yet in his few months in office, Kennedy has had many chances to let science guide him and has let them pass—on the health benefits of seed oils, the safety of abortion pills, children’s mental-health screening, and, most notably, vaccine policy. This may be one more.