Turmoil at the Centers for Disease Control and Prevention (CDC) and states’ beginning to take more control of their own vaccine decisions threaten to fracture the once-national consensus around immunization, setting the stage for a reorganization of the way vaccination recommendations work across the United States.
As NBC News reports, the moves together point toward an increasingly stark divide emerging in the United States around vaccinations, with some Republican-led states starting to roll back or eliminate mandates while Democrat-led states split from the CDC to come up with their own vaccination guidance.
States Forming their own Vaccine Guidance
Last week, California, Oregon and Washington announced they are forming a public health alliance to provide “credible information” about vaccine safety in response to the recent firing of CDC Director Susan Monarez, the resignations of top scientists that followed her ousting and the Food and Drug Administration’s new controversial guidelines for who should get Covid shots.
Last week, New Mexico’s Health Department announced it was ordering pharmacies to “remove potential barriers and ensure access to COVID-19 vaccines.” Colorado did the same Wednesday. On the same day, Florida’s surgeon general, Dr. Joseph Ladapo, moved to eliminate vaccination mandates entirely across the state, including in public schools. Other states have also weighed rolling back vaccination mandates, most notably Texas, where dozens of anti-mandate bills have been introduced in the Legislature.
Vaccine Misinformation Continues to Run Rampant
The split comes as once-fringe and long-debunked claims about the health risks of vaccinations have found mainstream appeal and been embraced by the Trump administration. “Repeatedly hearing that vaccines cause autism or that an mRNA vaccine will alter your DNA can erode public trust,” said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco, referring to two of the most common pieces of vaccine misinformation.
For decades, the federal government, in close collaboration with infectious disease experts, has crafted guidelines for who should receive vaccinations and when. States and medical organizations used the guidelines to administer shots to millions of people, and insurance companies relied on them to determine payment. The recommendations were based on clinical studies and aimed to minimize both individual and societal risk.
But as vaccine hesitancy has skyrocketed in the wake of the Covid-19 pandemic and online misinformation campaigns, vaccination mandates have become a political flashpoint. Distrust in vaccines has created a rift that threatens to split the country into two distinct zones, delineated not by borders or geography but by state governments’ stances on the medical establishment’s right to dictate who must get a jab and who gets a pass.
In an op-ed Tuesday in The Wall Street Journal, Health and Human Services Secretary Robert F. Kennedy Jr. described “cloth masks on toddlers, arbitrary 6-foot distancing, boosters for healthy children, prolonged school closings, economy-crushing lockdowns, and the suppression of low-cost therapeutics in favor of experimental and ineffective drugs” as “irrational” policies that had a “devastating” toll on Americans.
Lockdowns and school closures certainly had economic and mental health drawbacks, and data suggests that vaccinated and unvaccinated people may transmit the virus at similar rates because they have comparable viral loads — or amounts of virus in their respiratory tracts — according to a 2022 paper in The Lancet Infectious Diseases.
Vaccines Were Key in Tamping Down Covid-19 Pandemic
However, the vaccines were proven effective at reducing hospitalizations and the number of severe Covid cases, two factors that overwhelmed health care systems early in the pandemic and precipitated lockdowns in the United States and around the world.
Once Covid vaccines became available at the end of 2020, following intense investment by the first Trump administration, states started to ease lockdowns and social distancing rules.
What didn’t let up — and still hasn’t — was the fear around the purported dangers of the new Covid shots, which were developed using a new type of vaccine technology, known as mRNA, that was at once revolutionary but difficult to understand.
The novelty compounded the uncertainties about the long-term health repercussions of a previously unknown virus and the pervasive feelings of loss the pandemic created, including loss of personal freedoms. That created the perfect conditions for divisiveness over vaccinations, Chin-Hong said, and the Covid shots became an easy scapegoat. “The vaccine is something you could focus on, instead of a general feeling of loss,” he said.
Kennedy, among the highest-profile figures of the once-small anti-vaccine movement, was confirmed as HHS secretary as he struck a more moderate tone on vaccines, which he has since abandoned.
Kennedy’s Changes and Firings at CDC
In June, Kennedy gutted a 17-person independent vaccine advisory committee at the CDC. He replaced the members with a group that included vaccine skeptics and people critical of the Covid vaccines. In early August, he also cut $500 million in mRNA vaccine contracts.
After the FDA approved a new version of the Covid vaccine in May, Kennedy announced that the CDC would recommend that doctors administer the shots only to adults ages 65 and above, as well as people with certain pre-existing conditions. Previously, Covid vaccinations were recommended more widely.
Following that change, the American Academy of Pediatrics took the unusual step of issuing its own vaccination recommendations — the first time in 30 years its guidelines were significantly different from the federal government’s.
“It is going to be somewhat confusing. But our opinion is we need to make the right choices for children to protect them,” Dr. James Campbell, vice chair of the academy’s infectious diseases committee, told NBC News.
Country has a Growing Vaccine Divide
That might have been the first visual fracture in the country’s growing vaccine divide.
The governors of California, Oregon and Washington are following in those footsteps, saying they are working to provide unified recommendations to “ensure residents remain protected by science, not politics.” They warned that there will be severe consequences if the CDC becomes “a political tool that increasingly peddles ideology instead of science.”
“President Trump’s mass firing of CDC doctors and scientists — and his blatant politicization of the agency — is a direct assault on the health and safety of the American people,” the statement said.
HHS criticized Democratic-run states in a statement for pandemic policies that “eroded the American people’s trust in public health agencies.” It also defended the Advisory Committee on Immunization Practices. “ACIP remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and Gold Standard Science, not the failed politics of the pandemic,” the statement said.
The news release announcing the West Coast Health Alliance on Wednesday criticized the CDC’s dismantling, saying there is an absence of consistent, science-based federal leadership in public health. It said the alliance’s shared principles will be finalized “in the coming weeks.”
Without clarity from the federal government, individual states may begin to craft their own public health orders. New Mexico’s Health Department announced last week that it was ordering pharmacies to “remove potential barriers and ensure access to COVID-19 vaccines” after some pharmacies said they couldn’t administer the new versions of the Covid shots until the CDC advisory panel met and issued its official guidance.
Insurance Companies Could Change Coverage based on New CDC Guidelines
Kennedy and his allies argue the public can still receive the COVID inoculation if desired, but they skirt over issues of convenience, insurance coverage and cost. Health insurance companies had been covering the cost of shots recommended by the CDC, and it’s not clear what they’ll pay for now that the eligibility is more restrictive.
Insurance companies, which look to the federal government for guidance about what’s covered by health plans, will also be figuring out the changing landscape in coming months. Vaccines recommended by the Advisory Committee on Immunization Practices are generally free because of provisions in the Affordable Care Act, also known as Obamacare, and the Inflation Reduction Act of 2022.
Tina Stow, a spokesperson for the health insurance industry group AHIP, said in a statement that the organization was reviewing the FDA announcement and would monitor upcoming recommendations from the CDC “on considerations around coverage,” alongside its members. “Individual health plans and plan sponsors will be prepared to make coverage decisions informed by science, the latest medical evidence and data,” she said. “This process will be evidence-based, evaluate multiple sources of data, including but not limited to ACIP, and will be informed by customer needs.”
Coverage decisions for vaccinations can also hinge on recommendations from medical organizations like the American Association of Pediatrics.
In the Wake of CDC Director Firing, Directors Resign and Speak Out
More chaos unfolded at the CDC in recent days after the White House said it was firing Monarez as its director after she refused to resign. Attorneys for Monarez said she “refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts” and “chose protecting the public over serving a political agenda.”
Her dismissal sparked a mass exodus of top CDC officials. As ABC News reports, seven former directors and two former acting directors — whose tenures stretch back to the administration of former President Jimmy Carter — published an op-ed in The New York Times on Monday, just days after the ousting of the CDC’s new director Dr. Susan Monarez.
Sources told ABC News that Kennedy and Stefanie Spear, his principal deputy chief of staff, called on Monarez to support changes to COVID vaccine policy and the firings of high-level staff, which Monarez would not commit to. The directors said Monarez’s removal is the latest in a series of actions that could have a “wide-ranging impact” on “America’s health security.”
“During our respective C.D.C. tenures, we did not always agree with our leaders, but they never gave us reason to doubt that they would rely on data-driven insights for our protection, or that they would support public health workers,” they wrote.
“What we are seeing taking place in the Department of Health and Human Services, and at CDC in particular, is not businesses as usual,” he told ABC News. “There are always changes, different policy priorities when administration changes. But what we’re seeing under the leadership of Secretary Robert F. Kennedy [Jr.] is something different altogether.”
“He has come into his role as Secretary of Health and Human Services with a strong agenda that is centered on dismantling our vaccine system in America and limiting people’s access to these life-saving, health-preserving interventions,” Besser added.
They urged Congress to “exercise its oversight authority” over HHS and called on state and local governments and philanthropic givers to fill in the gaps where possible.
Kennedy defended his decisions, including gutting the CDC, in his own guest essay Tuesday in The Wall Street Journal. He accused the CDC of squandering public trust for decades. He wrote that the organization should focus on infectious diseases — its original mission — and that other programs focused on chronic diseases, such as diabetes or heart conditions, should be moved away from the CDC.
Public is Confused – “Will I Have Access?”
As an infectious disease specialist, Dr. Daniel Griffin hears frequent concerns from patients about whether they’ll be able to get the new COVID vaccines. Even his relatives are worried. As USA Today reports, Griffin, who does clinical work in Long Island, New York, said his sister-in-law is in her 40s and quite wary of long COVID, the enduring, debilitating health issues that have afflicted millions of Americans who contracted the coronavirus.
“She was worried about, ‘If I don’t get vaccinated now, will I have access in the fall?’’’ he said. “The other was, ‘If I get vaccinated now, will they not let me get vaccinated in the fall and say you’re only allowed one a year?’ A lot of people have been making decisions out of fear that they’re going to lose access to vaccines.’’
Currently, immunizations to protect healthy children and pregnant women are no longer recommended, despite protestations from medical organizations such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, among others.
AAP said kids ages 6 through 23 months “are at the highest risk for severe COVID-19’’ and should be vaccinated. ACOG pointed out COVID infections during pregnancy have been linked with “an increased risk of severe disease, adverse pregnancy outcomes and maternal death.’’
The new guidelines come at a time when COVID cases, emergency room visits and hospitalizations have been rising nationally, according to data from the Centers for Disease Control and Prevention, though not at alarming rates and certainly nowhere near the heights of the pandemic in its first two years. “COVID-19 activity is increasing in many areas of the country,’’ the CDC, also under the HHS umbrella, said on its website Aug. 29.
Dr. Jesse Goodman, a former chief scientific officer for the FDA and now an attending physician for infectious diseases at Georgetown University, said Americans “get confused by all these different messages’’ on vaccines. “I’m really worried there will be people who are not vaccinated because of access or cost issues or because they’ve had doubts,’’ he said, “and some of those people are going to get hurt, and some are going to die.’’
Holly Micheletos, a family therapist in San Francisco, said she has grown frustrated by the lack of information about the COVID vaccine from the Trump administration. In previous years, Micheletos said, the government would spread the word when a new vaccine formulation was available and she would see signs posted at drug stores. “You would know it was time to get the new booster or whatnot,’’ she said. “Now I don’t see any communication, and I don’t even know who needs it anymore. Over 65 only? I literally feel like I’m being discouraged to get it, and I want it.’’
“The (FDA) decision does not affect access to these vaccines,’’ HHS spokesman Andrew Nixon said via e-mail. “These vaccines remain available to those who choose them in consultation with their health care provider.’’ Those consultations could present an obstacle for people who don’t have the time, means or perhaps even a regular provider to get the vaccine prescribed.
And that’s precisely the objective of the new limitations, say critics of Kennedy’s leadership at HHS, noting his long history of positions that defy established science. “The spirit is really to not let people have the vaccines,’’ Griffin said. “They’ve created a climate of fear around giving people a wonderful intervention in vaccination.’’
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