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For decades, countries around the world have held up the United States’s rigorous approach to vaccine policy as a global ideal. But in Robert F. Kennedy Jr.’s Department of Health and Human Services, many of the officials responsible for vaccine policy disagree. For the best immunization policy, they argue, the U.S. should look to Europe.

Marty Makary, the new FDA commissioner, and Vinay Prasad, the new head of the agency’s center for regulating vaccines, have criticized the nation’s COVID-19-vaccine policy for recommending the shots more broadly than many European countries do. Tracy Beth Høeg, a new adviser at the FDA, has frequently compared the U.S.’s childhood vaccination schedule unfavorably with the more pared-down one in Denmark, and advocated for “stopping unnecessary vaccines.” (Prasad, citing Høeg, has made the same points.) And the new chair of the CDC’s Advisory Committee on Immunization Practices, Martin Kulldorff—whom Kennedy handpicked to serve on the panel, after dismissing its entire previous roster—announced in June that ACIP would be scrutinizing the current U.S. immunization schedule because it exceeds “what children in most other developed nations receive.”

This group has argued that the trimness of many European schedules—especially Denmark’s—implies that the benefits of the U.S.’s roster of shots may not outweigh the risks, even though experts discussed and debated exactly that question when devising the guidance. But broadly speaking, the reasons behind the discrepancies they’re referencing “have nothing to do with safety,” David Salisbury, the former director of immunization of the U.K.’s Department of Health, told me. Rather, they’re driven by the factors that shape any national policy: demographics, budget, the nature of local threats. Every country has a slightly different approach to vaccination because every country is different, Rebecca Grais, the executive director of the Pasteur Network and a member of the WHO’s immunization-advisory group, told me.

One of the most important considerations for a country’s approach to vaccines is also one of the most obvious: which diseases its people need to be protected from. The U.S., for instance, recommends the hepatitis A vaccine for babies because cases of the contagious liver disease continue to be more common here than in many other high-income countries. And conversely, this country doesn’t recommend some vaccine doses that other nations do. The U.K., for example, routinely vaccinates against meningococcal disease far earlier, and with more overall shots, than the U.S. does—starting in infancy, rather than in adolescence—because meningitis rates have been higher there for years. Using that same logic, countries have also modified prior recommendations based on emerging evidence—including, for instance, swapping the oral polio vaccine for the safer inactivated polio vaccine in the year 2000.

Vaccines are expensive, and countries with publicly funded insurance consider those costs differently than the U.S. does. Under U.K. law, for instance, the National Health Service must cover any vaccine that has been officially recommended for use by its Joint Committee on Vaccination and Immunisation, or JCVI—essentially, its ACIP. So that committee weights the cost effectiveness of a vaccine more heavily and more explicitly than ACIP does, and will recommend only a product that meets a certain threshold, Mark Jit, an epidemiologist at NYU, who previously worked at the London School of Hygiene & Tropical Medicine, told me. Price also influences what vaccines are ultimately available. In 2023, JCVI recommended (as ACIP has) two options for protecting babies against RSV; unlike in the U.S., though, the NHS bought only one of them from manufacturers, presumably “because the price they gave the government was cheaper,” Andrew Pollard, the director of the Oxford Vaccine Group, the current JCVI chair, and a former member of the World Health Organization’s advisory group on immunizations, told me. (The prices that the U.K. government pays for vaccines are generally confidential.)

[Read: The neo-anti-vaxxers are in power now]

The nature of a country’s health-care system can influence vaccine policy in other ways too. In the U.S. system of private health care, health-equity gaps are massive, and access to care is uneven, even for one person across their lifetime. Many Americans bounce from health-care provider to provider—if they are engaged with the medical system at all—and must navigate the coverage quirks of their insurer. In this environment, a more comprehensive vaccination strategy is, essentially, plugging up a very porous safety net. Broad, simple recommendations for vaccines help ensure that a minimal number of high-risk people slip through. “We’re trying to close gaps we couldn’t close in any other way,” Grace Lee, a pediatrician and a former chair of ACIP, told me.

The U.S. strategy has worked reasonably well for the U.S. Universal flu-vaccine recommendations (not common in Europe) lower the burden of respiratory disease in the winter, including for health-care workers. Hepatitis B vaccines for every newborn (rather than, like in many European countries, for only high-risk ones) help ensure that infants are protected even if their mother misses an opportunity to test for the virus. More generally, broad recommendations for vaccination can also mitigate the impacts of outbreaks in a country where obesity, heart disease, and diabetes—all chronic conditions that can exacerbate a course of infectious illness—affect large swaths of the population. American vaccine experts also emphasize the importance of the community-wide benefits of shots, which can reduce transmission from children to elderly grandparents or decrease the amount of time that parents have to take off of work. Those considerations carry far more weight for many public-health experts and policy makers in a country with patchy insurance coverage and inconsistent paid sick leave.

The current leadership of HHS thinks differently: Kennedy, in particular, has emphasized individual choice about vaccines over community benefit. And some officials believe that a better childhood immunization schedule would have fewer shots on it, and more closely resemble Denmark’s, notably one of the most minimalist among high-income countries. Whereas the U.S. vaccination schedule guards against 18 diseases, Denmark’s targets just 10—the ones that the nation’s health authorities have deemed the most severe and life-threatening, Anders Hviid, an epidemiologist at Statens Serum Institut, in Copenhagen, told me. All vaccines in Denmark are also voluntary.

But “I don’t think it’s fair to look at Denmark and say, ‘Look how they’re doing it, that should be a model for our country,’” Hviid told me. “You cannot compare the Danish situation and health-care system to the situation in the U.S.”

Denmark, like the U.K., relies on publicly funded health care. The small, wealthy country also has relatively narrow gaps in socioeconomic status, and maintains extremely equitable access to care. The national attitude toward federal authorities also includes a high degree of confidence, Hviid told me. Even with fully voluntary vaccination, the country has consistently maintained high rates of vaccine uptake, comparable with rates in the U.S., where public schools require shots. And even those factors don’t necessarily add up to a minimalist schedule: Other Nordic countries with similar characteristics vaccinate their children more often, against more diseases.

At least some of Kennedy’s allies seem to have been influenced not just by Denmark’s more limited vaccine schedule but specifically by the work of Christine Stabell Benn, a researcher at the University of Southern Denmark, who has dedicated much of her career to studying vaccine side effects. Like Kennedy and many of his allies, Benn is skeptical of the benefits of vaccination: “It’s not very clear that the more vaccines you get, the healthier you are,” she told me. Along with Kulldorff, Høeg, and National Institutes of Health Director Jay Bhattacharya, Benn served on a committee convened in 2022 by Florida Governor Ron DeSantis that cast COVID-19 vaccines as poorly vetted and risky. She and Høeg have appeared together on podcasts and co-written blogs about vaccine safety; Kulldroff also recently cited her work in an op-ed that praised one Danish approach to multidose vaccines, noting that evaluating that evidence “may or may not lead to a change in the CDC-recommended vaccine schedule.” When justifying his cuts to Gavi—the world’s largest immunization program—Kennedy referenced a controversial and widely criticized 2017 study co-authored by Benn and her husband, Peter Aaby, an anthropologist, that claimed that a diphtheria, tetanus, and pertussis vaccine was increasing mortality among children in Guinea-Bissau. (Benn wrote on LinkedIn that cutting Gavi funding “may have major negative impact on overall child survival,” but also noted that “it is reasonable to request that WHO and GAVI consider the best science available.”)

[Read: The U.S. is going backwards on vaccines, very fast]

Several of the researchers I spoke with described Benn, with varying degrees of politeness, as a contrarian who has cherry-picked evidence, relied on shaky data, and conducted biased studies. Her research scrutinizing vaccine side effects—arguing, for instance, that vaccines not made from live microbes can come with substantial detriments—has been contradicted by other studies, spanning years of research and scientific consensus. (In a 2019 TEDx talk, she acknowledged that other vaccine researchers have disagreed with her findings, and expressed frustration over her difficulties publicizing them.) When we spoke, Benn argued that the U.S. would be the ideal venue for an experiment in which different regions of the country were randomly assigned to different immunization schedules to test their relative merits—a proposal that Prasad has floated as well, and that several researchers have criticized as unethical. Benn said she would prefer to see it done in a country that would withdraw vaccines that had previously been recommended, rather than add new ones. In a later email, she defended her work and described herself as “a strong advocate for evidence-based vaccination policies,” adding that “it is strange if that is perceived as controversial.”

When I asked her whether anyone currently at HHS, or affiliated with it, had consulted her or her work to make vaccine decisions, she declined to answer. Kulldorff wrote in an email that “Christine Stabell Benn is one of the world’s leading vaccine scientists” but did not answer my questions about Benn’s involvement in shaping his recommendations. HHS did not respond to a request for comment.

What unites Benn with Robert F. Kennedy Jr. and his top officials is that, across their statements, they suggest that the U.S. is pushing too many vaccines on its children. But the question of whether or not the U.S. may be “overvaccinating” is the wrong one to ask, Jake Scott, an infectious-disease physician at Stanford, told me. Rather, Scott said, the more important question is: “Given our specific disease burden and public-health goals, are we effectively protecting the most vulnerable people? Based on overwhelming evidence? The answer is yes.”

[Read: RFK Jr. is barely even pretending anymore]

That’s not to say that the U.S. schedule should never change, or that what one country learns about a vaccine should not inform another’s choices. Data have accumulated—including from a large clinical trial in Costa Rica—to suggest that the HPV vaccine, for instance, may be powerful enough that only a single dose, rather than two, is necessary to confer decades of protection. (Based on that growing evidence, the prior roster of ACIP was considering recommending fewer HPV doses.) But largely, “I’m not sure if there’s a lot in the U.S. schedule to complain about,” Pollard, the JCVI chair, told me. On the contrary, other nations have taken plenty of their cues from America: The U.K., for instance, is expected to add the chickenpox shot to its list of recommended vaccines by early next year, Pollard told me, based in part on reassuring data from the U.S. that the benefits outweigh the risks. The U.S. does recommend more shots than many other countries do. But the U.S. regimen also, by definition, guards against more diseases than those of many other countries do—making it a standout course of protection, unparalleled elsewhere.

*Illustration by Jonelle Afurong / The Atlantic. Source: Aleksandr Zubkov / Getty; Anna Efetova / Getty; Smith Collection / Gado / Getty; BBC Archive / Getty; Child and Adolescent Immunization Schedule by Age / CDC

Every summer, there is a brief window—call it August—when the produce is exquisite. The cherries are at their best, as are the peaches, plums, and nectarines. The watermelon is sweet. The eggplants are glossy. The corn is pristine. And the tomatoes! The tomatoes are unparalleled. There’s a reason tomatoes are synonymous with summer, staple of home gardens and farmers’ markets alike. Giant, honking beefsteaks and sprightly Sungolds are begging to be transformed into salads and gazpachos, tossed with pasta and sliced into sandwiches, or eaten raw by the fistful. Enjoy them while you can.

Come fall, tomato season will be over just as quickly as it began. Yes, you can obtain sliceable red orbs in virtually any supermarket, at any time of year, anywhere in the United States. But they are pale imitations of dripping August heirlooms. Out-of-season tomatoes—notoriously pale, mealy, and bland—tend to be tomatoes in name only. They can be serviceable, dutifully filling out a Greek salad; they can valiantly garnish a taco and add heft to a grilled-cheese sandwich. At the very least, they contribute general wetness and a sense of virtue to a meal. Flavor? Not so much.

This year, of all years, it’s worth indulging in the bounties of high tomato season. The bloodless tomatoes waiting for us in the fall are mostly imported from Mexico, and as with so many other goods these days, they are now stuck in the middle of President Donald Trump’s trade war. This week, the White House imposed 17 percent tariffs on Mexican tomatoes. In all likelihood, that will mean higher prices for grocery-store tomatoes, Tim Richards, an agricultural economist at Arizona State University, told me. This will not make them better in terms of color, texture, or flavor—but it will make them cost more.

[Read: America has never been so desperate for tomato season]

Grumbling about grim winter tomatoes is a long-standing national hobby, and at the same time, their existence is a small miracle. You can eat a BLT in the snow or a Caprese salad for Valentine’s Day with no effort at all. In August 1943, before Americans could get fresh tomatoes year-round, New York City Mayor Fiorello La Guardia encouraged housewives to brace for winter by canning as many tomatoes as they could. “They are in your city’s markets and I want to see every woman can them while they are at this low price,” he announced. They wouldn’t have to do it for long. By the 1960s, “just about every supermarket and corner store in America was selling Florida tomatoes from October to June,” the author William Alexander wrote in Ten Tomatoes That Changed the World. They were visually perfect but tasted like Styrofoam, which is in many ways what they were supposed to be: durable, pest-resistant, long-lasting, and cheap. Tomatoes are famously fragile and quick to rot, so they are often picked while still green, and then gassed with ethylene. It turns them red, giving the appearance of ripeness but not the corresponding flavor. In recent years, the situation has somewhat improved: Instead of focusing exclusively on looks and durability, horticulturalists have turned their attention to maximizing flavor.

There is another reason year-round tomatoes have improved: Mexico. “Most of the nice-looking, really tasty tomatoes in the market are Mexican,” Richards said. That includes small varieties such as cherry tomatoes, grape tomatoes, and cocktail tomatoes, or, as he classified them, “those little snacking tomatoes in the plastic things.” Mexico manages to produce this steady stream of year-round, pretty-good tomatoes by growing them primarily in greenhouses, which Richards said is the best possible way to produce North American tomatoes at scale. Even in winter, tomatoes sheltered from the elements can be left to ripen on the vine, which helps improve the taste.

All of which is to say that an America without easy access to imported Mexican tomatoes looks bleak. Like all of Trump’s tariffs, the point of taxing Mexican tomatoes is to help producers here in the U.S. Thirty years ago, 80 percent of the country’s fresh tomatoes were grown in America. Now the share is more like 30 percent, and sliding. America could produce enough tomatoes to stock grocery stores year-round—Florida still grows a lot of them—but doing that just doesn’t make a lot of sense. “It’s not cost-effective,” Luis Ribera, an agricultural economist at Texas A&M University, told me. “We cannot supply year-round tomatoes at the prices that we have.” Unlike Mexico, Florida mainly grows its tomatoes outside, despite the fact that it is ill-suited to outdoor tomato growing in pretty much all ways: The soil is inhospitable. The humidity is an incubator for disease. There are regular hurricanes. “From a purely botanical and horticultural perspective,” the food journalist Barry Estabrook wrote in Tomatoland, “you would have to be an idiot to attempt to commercially grow tomatoes in a place like Florida.”

[Read: Who invented the cherry tomato?]

Exactly what the tariffs will mean for grocery prices is hard to say. Tomatoes will be taxed when they cross the border, so importers and distributors will directly pay the costs. But eventually, the increase will likely trickle down to the supermarket. The story of tariffs, Ribera said, is that “the lion’s share is paid by consumers.” In the short term, Richards estimated that price hikes will depend a lot on the variety of tomato, with romas hardest hit. “That’s the one we rely on most from Mexico,” he said. Beefsteaks, he added, will face a smaller increase.

Compared with some of the other drastic tariffs that Trump imposed, a 17 percent price bump on Mexican tomatoes hardly portends the tomato-pocalypse. Last year, the average import price of Mexican tomatoes was about 74 cents a pound. If the entire 17 percent increase is passed on to consumers, we’d be looking at an additional 13 cents—enough to notice, but not enough for a critical mass of people to forgo romas altogether. Here’s the other thing: People want tomatoes, and they want them now. “We don’t want to wait for things to be in season,” Ribera said, and we aren’t about to start.

For all of the many problems with out-of-season tomatoes, Americans keep eating them. It was true when winter tomatoes were a novelty: “I don’t know why housewives feel they have to have tomatoes,” one baffled supplier told The New York Times in 1954. But they did, and people still do. Season to season, our national tomato consumption fluctuates relatively little, the grocery-industry analyst Phil Lempert told me. Every burger joint in America needs tomatoes—not the best tomatoes, but tomatoes that exist. There is a whole genre of recipes about how to make the most of out-of-season tomatoes. A lesser tomato, of course, is better than no tomato at all.

Mark and David Geier were a father-and-son team of researchers who operated on the fringes of the scientific establishment. They were known for promoting a controversial treatment for autism, and for publishing papers on the purported harms of vaccines that experts dismissed as junk science. In 2004, the CDC accused them of violating research protocols. In 2012, the state of Maryland sanctioned them. And in 2025, Health and Human Services Secretary Robert F. Kennedy Jr. tapped one of them to investigate alleged wrongdoing in a crucial CDC database.

For years, Kennedy has claimed that the database, which tracks adverse reactions to immunizations and is known as the Vaccine Safety Datalink, once contained vital information about vaccine safety—and that this information has been withheld from the public, scrubbed from the record, or otherwise manipulated. He wants David Geier to investigate it because he and his late father, a physician, studied it in the early 2000s, after they applied through a CDC program that allows researchers outside the government to access certain data sets.

When the Geiers were first allowed into this trove of millions of anonymized health records, they were supposed to be carrying out a safety study of the DTaP vaccine. But the CDC found that they were instead conducting unauthorized analyses to hunt for a link between the vaccine and autism, and risked breaching patients’ confidentiality in the process; the agency revoked their access. (At the time, the Geiers disputed the charge that they had endangered anyone’s personal information, writing in a 2004 letter to an institutional-review-board administrator that they held the “utmost regard” for patient confidentiality.) Even after they were ousted, the Geiers used information they’d apparently held on to from that database to publish a series of scientific papers advancing the widely discredited theory that thimerosal, a mercury-based preservative once common in childhood vaccines, is linked to autism, among other conditions.

[Read: The U.S. is going backwards on vaccines, very fast]

Researchers in the field have long criticized the Geiers’ methodology as sloppy, and noted that their conclusions are at odds with those of numerous higher-quality studies. Since March, when The Washington Post reported that David Geier had been brought into the Department of Health and Human Services, his and his father’s work has come under renewed scrutiny. One scientist found that several of their papers—based on information from the very CDC database that Kennedy has tasked Geier with investigating—contain a statistical error so fundamental that it casts doubt on Geier’s abilities and intentions in assessing data. That scientist and another I spoke with couldn’t believe that some of Geier’s work had ever been published in the first place.

David Geier is currently listed as a senior data analyst in HHS’s staff directory, though what exactly he’s doing for the department is unclear. The Wall Street Journal has reported that Geier is using his new position to continue his search for a link between thimerosal-containing vaccines and autism. New York magazine floated the possibility that he will attempt to repeat a study from the early 2000s that anti-vaccine activists cite as proof that inoculations harm developing brains. Kennedy has denied that Geier is running the agency’s project to find out what causes autism, and testified that he has instead been hired by a contractor to determine whether information disappeared from the database. (Mark Geier died in March, and David Geier did not respond to interview requests. Reached for comment, an HHS spokesperson pointed to a lengthy X post by Kennedy in which he defends Geier’s record and notes his “extensive background as a research scientist.”)

Under any other administration, Geier’s history would almost certainly have disqualified him from any role at HHS. In the mid-2000s, after Mark Geier had established a profitable sideline of testifying as an expert witness in lawsuits that alleged injury from vaccines, the father and son claimed to have discovered a method of treating autism. What they touted as a miracle drug was Lupron, a testosterone-suppressing medication used in many cases of premature puberty. They ran a laboratory out of the basement of their Maryland home and administered the drug to children based on their unfounded theory, advertising their supposed breakthrough on the autism-conference circuit. In 2012, Mark, a physician, was stripped of his license, and David was sanctioned for practicing medicine without one. (The Geiers sued the Maryland Board of Physicians in 2012 for releasing information about medications Mark Geier had prescribed to family members. They were awarded a total of nearly $5 million for the invasion of their privacy and attorneys’ fees, but that judgment was reversed after a different court ruled that Maryland Board of Physicians members were immune from such claims.)

[Read: RFK Jr.’s autism time machine]

The Geiers’ work is well known among autism researchers, though not well respected. “They were seen as not representing the best of autism science,” Craig Newschaffer, a Penn State scientist who has studied how genetics and environmental factors contribute to autism, told me, putting it more gently than others I spoke with. Marie McCormick met the Geiers when she chaired a 2004 review of immunization safety by the Institute of Medicine (now known as the National Academy of Medicine), a nonprofit group that advises the federal government. McCormick, now an emeritus professor at Harvard’s School of Public Health, recalled that the Geiers’ presentation had “really made no sense”: It was a slideshow of vaccine vials with labels indicating that they contained mercury, but it didn’t have much else in the way of evidence. The committee’s report identified a host of “serious methodological flaws” in the Geiers’ research, such as a failure to explain how they had sorted their subjects into groups.

The Geiers’ work from the 2010s likewise has such glaring flaws that the experts I spoke with were baffled as to how the studies had been published at all. Jeffrey Morris, a biostatistics professor at the University of Pennsylvania, recently examined a series of papers on which the Geiers were authors that used data from the Vaccine Safety Datalink. One representative 2017 study purportedly showed that the hepatitis B vaccine was associated with an increased risk of autism.

Morris quickly noticed that the paper’s approach rendered its findings meaningless. It compared a group of children with autism to a control group of children without the diagnosis, to see how vaccination rates differed between the two. But these groups of children also differed in another crucial way: The children diagnosed with autism were born during the eight-year span from 1991 to 1998, whereas the control group—children not diagnosed with autism—were born in 1991 or 1992.

That’s more than a minor inconsistency. In 1991, the CDC’s vaccine-advisory committee recommended that all infants in the United States receive the hepatitis B vaccine, and so the percentage of vaccinated children rose steadily throughout the decade, from fewer than 10 percent to approximately 90 percent. That meant that babies born later in the ’90s (who were overrepresented in the autism group) were very likely to have gotten the shot, whereas those born earlier in the decade (who were overrepresented in the control group) were not. By picking a control group in which relatively few kids would have been vaccinated, and an autistic population in which most were, the Geiers made finding a connection between immunization and autism inevitable.

[Read: The conversations doctors are having about vaccination now]

Using this approach, you could blame the vaccine for all manner of maladies. According to Morris, the Geiers did exactly that in at least nine papers, published from 2015 to 2018, that used data from the vaccine-safety database. One of their studies linked hep-B vaccination to childhood obesity. Others showed an association with tic disorders, emotional disturbance, and premature puberty, among other conditions, some of which rose during the ’90s and early 2000s at least in part because of new diagnostic criteria and increased awareness. That likely also explains why autism rates began to climb significantly in the ’90s.

Many flawed scientific papers include a regrettable but understandable oversight, Morris told me, but the Geiers employed “an absolutely invalid design that biases things so enormously that you could throw out the results of all these papers.” Newschaffer reviewed Morris’s critique and told me he doesn’t believe that a study with such a serious problem should have been published in the first place. “I would characterize that as a ‘miss’ in the peer review,” he said. (I also contacted Dirk Schaumlöffel, the editor in chief of the Journal of Trace Elements in Medicine and Biology, which published the Geiers’ paper connecting the hep-B vaccine to autism. He took issue with Morris’s “polemical allegations” and defended the paper, noting that it “does not argue against vaccination, but merely questions the role of thimerosal.” He told me that he would prefer that the matter be debated in the pages of his journal.)

If David Geier were merely an independent researcher publishing in lesser-known journals, his errors, although egregious, would be of little more than academic concern. But his influence on Kennedy runs deep. In 2005, Kennedy highlighted the Geiers’ research in an essay outlining how he’d come to believe that thimerosal-containing vaccines could cause autism. He wrote about them again that year in “Deadly Immunity,” an article—eventually retracted by both Salon and Rolling Stone after multiple corrections and intense criticism—that alleged that government health agencies had covered up evidence indicating that thimerosal in vaccines was to blame for the rise in autism rates. In his 2014 book, Thimerosal: Let the Science Speak, Kennedy cites the Geiers dozens of times, portraying them as determined truth-tellers battling uncooperative government agencies—the very ones Kennedy has now been appointed to oversee.

[Read: The neo-anti-vaxxers are in power now]

Thanks to Kennedy, Geier seemingly is being handed the keys to the same database he’s proved himself unfit to study. People who are familiar with Geier’s history worry that he’ll use his position on the inside not to defend the truth but to resurrect thoroughly debunked claims, twisting the data to support what he and Kennedy have long believed.