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The number of changes to vaccine policy in the United States in recent weeks is dizzying — and we’ve just hit Code Red.
The federal government has sown confusion by changing recommendations for Covid-19 vaccines, ending contracts for mRNA technology research and firing the entire congressionally authorized panel that guides the Centers for Disease Control and Prevention’s vaccine decisions.
Robert F. Kennedy Jr., the secretary of health, is a longtime vaccine conspirator. Though he most likely couldn’t unilaterally revoke vaccine licenses or rewrite the children’s vaccination schedule, there has been concern that he will spur an insidious unraveling of vaccine infrastructure, starting with his destruction on Monday of the C.D.C.’s Advisory Committee on Immunization Practices.
With so much happening, it can be difficult to know what’s truly concerning and what changes are probably fine — or even worthwhile. As an expert in vaccines and public health, I’m looking at the shifting landscape like this:
What keeps me up at night
1. The firing of the A.C.I.P. members: The ousting of all 17 members is a warning of what might be coming. The committee has served for decades as the C.D.C.’s independent scientific body on immunization. Removing its entire membership in one day, under the guise of restoring “public trust,” destroys the firewall between science and politics. There’s no clear plan for its new makeup, but all signs point to a committee aligned with Mr. Kennedy’s longstanding antagonism toward vaccines — and unlike him, a reconstituted committee will be in a position to more directly rearrange, alter or dismantle the national vaccine schedule as it sees fit.
2. Canceling mRNA vaccine development: Mr. Kennedy’s Department of Health and Human Services recently canceled a $766 million contract with the pharmaceutical company Moderna to develop next-generation mRNA flu vaccines that use the same technology that made the Covid-19 vaccines so effective. This is despite promising early data on the effectiveness of the company’s bird flu vaccine, and an urgent need for more pandemic response tools. This is not fiscal prudence. It’s sabotage of a platform that helped end the worst of the Covid pandemic and remains our best defense should a deadlier one emerge.
3. Politicizing autism research: Mr. Kennedy has appointed the longtime vaccine critic David Geier to lead a government study on autism. Mr. Geier, who has been disciplined for practicing medicine without a license, has promoted debunked links between vaccines and autism. The mission of this research isn’t scientific discovery; it’s laundering fringe ideas through federal legitimacy.
What’s off-track
4. Rescinding Covid vaccine guidance for pregnant women: Mr. Kennedy recently called for an end to federal recommendations for Covid vaccination during pregnancy, despite strong evidence that the vaccines offer important protection for pregnant women and, crucially, the infants who received their protective antibodies. This decision seemed to contradict the fact that just days earlier Food and Drug Administration leaders seemed to reaffirm that pregnancy remains a high-risk condition warranting vaccination, in a policy-defining article outlining the agency’s Covid strategy.
5. Sidestepping the F.D.A.’s vaccine panel: That same F.D.A. vaccine policy article, published without public input and without consultation with the Vaccines and Related Biological Products Advisory Committee, the F.D.A.’s own advisory committee, introduced a sweeping shift, announcing that future Covid vaccines for healthy children and adults must be tested in clinical trials against a placebo. The advisory committee exists to ensure independent oversight. Bypassing it weakens transparency. Even if the new trial requirement has merit, and I believe it does, sidelining the committee on policy developments sets a troubling precedent. Will this committee be on the chopping block next?
What’s worth considering
6. Getting more data for Covid vaccine recommendations: Not all recent federal vaccine changes are misguided. The F.D.A.’s new policy for placebo-controlled clinical trials was announced in an unconventional way. But it was at least done transparently, in a high-profile New England Journal of Medicine article. That may not be the ideal venue for policy rollout, but it invites broad scientific scrutiny.
Nearly all Americans now have substantial immunity to Covid-19 owing to infection, vaccination or both. The risk has changed markedly. For high-risk groups, including pregnant women, vaccines remain essential. But for lower-risk groups, the data shows that the benefit of Covid boosters is becoming more modest and short-lived, and that deserves to be re-evaluated with new study approaches to inform future vaccine approvals and licensure.
Rethinking Covid boosters for all also puts the United States more in line with peer nations. Britain, Germany and Australia now prioritize boosters for high-risk groups. Smarter studies are how we improve. This is a chance for the F.D.A. to lead.
What comes next
When once-reliable guidance is muddied by conspiracy thinking, the risks to vaccines and the health of Americans increase. This is a precarious moment for vaccine policy — the damage may not be obvious until it’s too late.
Soon, Americans may face a grim choice: Turn away from our public health institutions and look abroad for guidance, or continue to look to American public health agencies, though potentially compromised, out of habit or exhaustion. If that happens, what was once fringe will have become normalized.
The consequences will not be theoretical. They will be viral: a resurgence of dangerous infectious diseases.
Vaccines are among the most powerful public health tools ever developed. But their strength depends on whether we use them wisely. The scientific method has no allegiance to ideology. Vaccine policy shouldn’t, either.
To reclaim science, it may take politics. Only voting power, and a public willing to speak up for evidence over ideology, can undo the hijacking of public health. If science is to guide us again, the first step is choosing leaders who will let it.
Michael Mina is a former professor at Harvard T.H. Chan School of Public Health and Harvard Medical School. He has spent decades studying the long-term immunological and population health consequences of both infections and vaccines.
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