Part 2: Vaccine Chaos Reigns.

What in the Health? July 14, 2025

It’s time for installment 2 of What in the Health?! has been going on the last few weeks. (If you missed Installment 1: The Big Ugly Bill is now law you can read that here.)

2. Vaccine chaos is the name of the game.

I already wrote earlier about how the Advisory Committee on Immunization Practices (ACIP) was suddenly dismissed via X (sigh) and then replaced with people who were mostly unqualified, or actively and proudly anti-vax. What’s happened since then? Oh, so much.

• The ACIP had their first meeting. Just hours before, one of the 8 appointees, Dr. Michael Ross, resigned. (This is the person whom RFK Jr. claimed in his announcement on X was “a Clinical Professor of Obstetrics and Gynecology at George Washington University and Virginia Commonwealth University,” even though he hadn’t worked at either of those places for at least 4 years.) Apparently some red flags came up during the “financial holdings review” done in the days between their appointment and the meeting. No one is saying exactly what that means, but presumably he owns stock or has some other financial interest he was not willing to divest from in order to be on the committee. Cool, great start.

• Until this meeting, presentations at ACIP have either been by CDC scientists with expertise on vaccines, or are by external presenters but are fact-checked by CDC and approved prior to the meeting—usually days or weeks in advance. This time, Lynn Redwood—a former leader of Children’s Health Defense, RFK Jr’s anti-vax advocacy group—presented on thimerosal in flu vaccines. The presentation had not been fact-checked by CDC. It had a ton of cherry-picked data and a number of fake citations. Unfortunately, that didn’t matter. While the ACIP ultimately voted to recommend flu shots this fall for all Americans over 6 months of age, they are not recommending flu shots with thimerosal, even though a large quantity of actual scientific evidence says it is safe, and this means 4-7% of existing flu shots will now be wasted. (Also, thimerosal hasn’t been used in routine childhood vaccines for over 20 years, because there were people who were concerned about it, and it was deemed better to just remove it to maintain public confidence.)

• The ACIP members did not vote on COVID-19 vaccines for the fall. It was removed from the agenda at the last minute, with no explanation provided. So who will be able to get them, and whose vaccines will be covered by insurance, even if they’re accessible? Still an unknown, even though the usual point of this summer meeting of ACIP is to resolve this for fall. Since the future is unclear, some states and nonprofit organizations are forming new committees of experts to try to make local or regional recommendations that can safeguard vaccine access, even if federal support for this dries up. However, the Alliance of Community Health Plans and AHIP (a national association of health insurance providers) released a statement that they were committed to covering fall vaccines, and encouraging Americans to talk to their health care providers about vaccines. When Wired reached out to health insurance providers for comment, Blue Shield of California went on record saying that they would cover all routine vaccinations, regardless of what ACIP recommends or RFK Jr. says patients should do. Hopefully more insurance providers will follow suit.

• Seven days ago, 6 major professional medical societies and an anonymous pregnant patient filed suit against RFK Jr. and HHS for unilaterally changing COVID-19 vaccine recommendations for children and pregnant people. The president of the Infectious Diseases Society of America said it well: “The Infectious Diseases Society of America will fight to ensure that all individuals of every age have access to life-saving vaccines. We will not stand by while a single federal official unilaterally and effectively strips Americans of their choice to vaccinate with actions that thoroughly disregard overwhelming scientific evidence and decades of established federal processes.”

• Five days ago, you might have seen headlines that Moderna was granted full approval for its Spikevax COVID-19 vaccine for children aged 6 months to 11 years old. (Hey, maybe it’s not going to be so bad under RFK Jr! Maybe he’s not going to be pushing to limit vaccinations after all. </sarcasm>) The problem is that when FDA made this decision, Moderna published a press release called “Moderna Receives Full U.S. FDA Approval for COVID-19 Vaccine, Spikevax, in Children Aged 6 Months Through 11 Years at Increased Risk for COVID-19 Disease.” Unfortunately, the mainstream media that amplified this story far and wide seem to have largely missed the last 6 words, which are very important here. Instead of granting “full approval” for all children ages 6 months and older, the FDA limited its approval of this pediatric COVID-19 vaccine to children who are known to have at least one high-risk underlying medical condition. This is important, because last year 54% of children ages 6-23 months who were so sick from COVID-19 that they needed to be hospitalized had no known underlying medical conditions. (Ironically, the slide this data point comes from was presented at the ACIP meeting on June 25. It’s slide 23, here.) Think about this. In 2024, more than half of young children who were sick enough with COVID to be hospitalized are now, thanks to this administration, not eligible to get vaccinated with this new pediatric vaccine. You don’t have to be a pediatrician or even a parent to understand that many very young children haven’t yet been identified as having some sort of underlying medical condition that puts them at risk. The way these things get identified is because something bad happens with their health, making medical providers go searching for an underlying cause. Something bad like…hospitalization for COVID-19??? This is how prevention is supposed to work. Vaccines are some of the best prevention tools we have. Or…had.

To close out this installment, I have one word of warning: it looks like what happened with ACIP might be repeating itself again with the U.S. Prevention Services Task Force, better known as USPSTF, as we speak. Just like with ACIP, it’s starting with a long-scheduled meeting being abruptly cancelled, with no explanation. People have been wondering if this might happen. And why? (Besides the generally dystopian and anti-health times we’re living in?) It’s because of a recent decision by the Supreme Court, which was surprisingly good if you care about public health, with one important caveat. Kennedy v. Braidwood Management was a case that challenged the constitutionality of the Affordable Care Act requirement that Medicaid expansion programs and most private insurers had to cover preventive services without deductibles or co-pays. Specifically, the statute requires insurers to cover “evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force.”

The case was brought by individuals and a business who objected to the fact that, per this provision, insurers had to cover HIV pre-exposure prophylaxis, or PrEP. The USPSTF recommends PrEP for “persons who are at increased risk of HIV acquisition.” The people who filed the suit said that paying for people to access PrEP was in conflict with their religious convictions because it would “encourage and facilitate homosexual behavior.” (Wow, 1982 anyone?) But the implications were potentially huge, affecting everything from cancer screening to folic acid for pregnant people. The plaintiffs posed a specific argument: It wasn’t constitutional for Congress to assign the USPSTF the authority to determine what services insurers must cover. The Fifth Circuit Court of Appeals agreed, finding that under the ACA the USPSTF members were principal “officers of the United States,” and this required to be appointed by the president and confirmed by the Senate. As these things go, it was appealed to the Supreme Court, who agreed to hear the case and decide again on that specific question.

What the Supreme Court ruled on June 27 was that USPSTF members were in fact “inferior officers,” and therefore may be appointed by the Secretary of HHS and do not need to be confirmed by the Senate. Specifically, the majority opinion states, “The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect. So Task Force members are supervised and directed by the Secretary, who in turn answers to the President.” Overall, this felt like a huge win for public health folks, who by definition believe in prevention. It means that the ACA’s requirement that preventive services recommended by the USPSTF is constitutional, and these types of services—including PrEP, but also hepatitis C screening, colonoscopies to screen for colorectal cancer, TB screening, and more—remain available without cost-sharing for almost everyone in the US. But right away, public health folks reading the opinion looked at the rationale quoted above with a wary eye. The Supreme Court explicitly said that RFK Jr. has oversight of the entire USPSTF, and can remove them all at will. Meaning, he can do what he did with ACIP: gut the task force entirely, and replace the members with basically whomever he wants. Expertise may no longer be as important as loyalty to the whims and (often mistaken) beliefs of the Secretary of HHS. And if a reformed USPSTF changes the recommendations to align with those whims, and not science, then Americans might lose access to many of those preventive services after all. Only time will tell.