President Donald Trump this week nominated a former deputy surgeon general who has expressed support for vaccines to lead the Centers for Disease Control and Prevention. Considered a more traditional fit for the job, Erica Schwartz would be the agency’s fourth leader in roughly a year, should she be confirmed by the Senate.
And Health and Human Services Secretary Robert F. Kennedy Jr. appeared on Capitol Hill this week in the first of several hearings discussing Trump’s budget request for the department. But the topics up for discussion deviated quite a bit from the subject of federal funding, with lawmakers raising issues of Medicaid fraud, measles outbreaks, the hepatitis B vaccine, peptides, unaccompanied minors, and much, much more.
This week’s panelists are Mary Agnes Carey of 麻豆女优 Health News, Anna Edney of Bloomberg News, Emmarie Huetteman of 麻豆女优 Health News, and Joanne Kenen of the Johns Hopkins University Bloomberg School of Public Health and Politico Magazine.
Panelists
Among the takeaways from this week’s episode:
- Trump on Thursday named four officials to the CDC’s leadership team. Schwartz, whom he picked as director, is a physician and Navy officer who served as a deputy surgeon general during Trump’s first term. She has voiced support for vaccines and played a key role in the covid-19 pandemic response.
- RFK Jr. testified before three committees of the House of Representatives this week on the president’s budget request for HHS. While the hearings touched on a wide variety of topics, notable moments included a slight softening of Kennedy’s stance on the measles vaccine, including the acknowledgment that being immunized is safer than having measles 鈥 although he also stood by the decision to remove the recommendation for the newborn dose of the hepatitis B vaccine.
- New studies on the use of acetaminophen during pregnancy and the effects of water fluoridation on cognitive function refute Trump administration claims. And a White House meeting that brought together Trump, Kennedy, and other leaders of the Make America Healthy Again movement aimed to soothe concerns among supporters 鈥 yet there’s reason to believe the overture won’t completely mend fences between the Trump administration and the MAHA constituency ahead of the midterm elections.
Also this week, 麻豆女优 Health News’ Julie Rovner interviews Michelle Canero, an immigration attorney, about how the Trump administration’s policies affect the medical workforce.
Plus, for “extra credit,” the panelists suggest health policy stories they read (or wrote) this week that they think you should read, too:
鈥Mary Agnes Carey: Politico’s “,” by Alice Miranda Ollstein.
Joanne Kenen: The New York Times’ “,” by Teddy Rosenbluth.
Anna Edney: Bloomberg’s “,” by Anna Edney.
Emmarie Huetteman: 麻豆女优 Health News’ “Your New Therapist: Chatty, Leaky, and Hardly Human,” by Darius Tahir.
Also mentioned in this week’s podcast:
- JAMA Pediatrics’ “,” by Kira Philipsen Prahm, Pingnan Chen, Line Rode, et al.
- Proceedings of the National Academy of Sciences’ “,” by John Robert Warren, Gina Rumore, Kamil Sicinski, and Michal Engelman.
- 麻豆女优 Health News’ “Pennsylvania Town Faces Fallout From Trump’s Environmental Rule Rollback,” by Stephanie Armour and Maia Rosenfeld.
- The New York Times’ “,” by Sheryl Gay Stolberg.
- Wakely Consulting Group’s “,” by Michelle Anderson, Chia Yi Chin, and Michael Cohen.
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Mary Agnes Carey: Hello from 麻豆女优 Health News and WAMU radio in Washington, D.C. Welcome to What the Health? I’m Mary Agnes Carey, managing editor of 麻豆女优 Health News, filling in for Julie Rovner this week. And as always, I’m joined by some of the best and smartest health reporters covering Washington. We’re taping this week on Friday, April 17, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So here we go.
Today we’re joined via videoconference by Anna Edney of Bloomberg News.
Anna Edney: Hi, everybody.
Carey: Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine.
Joanne Kenen: Hi, everybody.
Carey: And my 麻豆女优 Health News colleague Emmarie Huetteman.
Emmarie Huetteman: Hey there.
Carey: Later in this episode, we’ll play Julie’s interview with immigration attorney Michelle Canero about the impact the Trump administration’s immigration policies are having on the medical workforce. But first, this week’s news 鈥 and there is plenty of it.
On Thursday, President [Donald] Trump nominated Dr. Erica Schwartz to lead the Centers for Disease Control and Prevention. Schwartz, a vaccine supporter, served as a deputy surgeon general in President Trump’s first term, and during the coronavirus pandemic she ran the federal government’s drive-through testing program. She’s also a Navy officer and a retired rear admiral in the Commissioned Corps of the U.S. Public Health Service. Her appointment requires Senate confirmation. President Trump also announced other changes to the agency’s top leadership: Sean Slovenski, a health care industry executive, as the agency’s deputy director and chief operating officer; Dr. Jennifer Shuford, health commissioner for Texas, as deputy director and chief medical officer, and Dr. Sara Brenner, who briefly served as acting commissioner of the FDA [Food and Drug Administration], as a senior counselor to Department of Health and Human Services Secretary Robert F Kennedy Jr. So we’ve discussed previously on the podcast several times that the CDC has lacked a permanent director for most of the president’s second term. Will Dr. Schwartz, if confirmed, and the other members of this new leadership team make the difference?
Huetteman: I think that we’ve seen a CDC that’s been in a protracted period of turmoil, and this is going to be an opportunity for maybe a shift in that. Dr. Schwartz would actually be the agency’s fourth leader in a little more than a year, and we’ve talked on the podcast about how naming someone who could fit the bill to lead the CDC was a difficult task facing the Trump administration. They needed someone who could support the MAHA [Make America Healthy Again] agenda while not embracing some of the more anti-vaccine views, and that person needed to be able to win Senate confirmation, which isn’t a given, even with this Republican-controlled Senate.
Edney: And I think we’ve seen that there have been some people already in the MAHA coalition that have come out and been upset about this pick. So I think what that shows is a calculated decision by the administration to, kind of, as they’ve been doing for this year, is kind of not focus on the vaccine part of Secretary Kennedy’s agenda and to, as Emmarie said, try to get someone that can get through Senate confirmation. We’ve already seen the surgeon general nominee be held up in the Senate because she was not as strong on vaccines as I think some would have liked to see when she had her confirmation hearing.
Kenen: So this happened late yesterday, and I’ve been traveling this week, but I did have a chance to talk to some public health people about her, and there was sort of this audible sigh of relief. The Senate is a very unpredictable place, and we live in very unpredictable times. At this point, my initial gut reaction is she’s got a pretty good chance of confirmation. The other thing, I think some of the other appointees, there’s a little bit more concern about, but what really matters is who is the face of the CDC, and she would be the face of the CDC. She would be in charge, and people like her. Also, this is an administration that has not had a lot of minorities, and she will be, she’s a Black woman. respected in her field. And that also is going to 鈥 she needs to be able to speak to all Americans about their health, and I think that people welcome that as well, both her credentials and her life experience. So, yeah, I think that MAHA is sort of in this funny moment now, because clearly Kennedy isn’t doing everything that people wanted or expected. And so we’ll sort of see how the 鈥 I think if he had his ideal CDC director, this, we can probably surmise that this would not, she would not be the first on his list. But there’s a certain amount of adaptation going on at the moment. So I think many, many people will be relieved to see somebody get through, confirmed pretty quickly. People can get held up for things that have absolutely nothing to do with the CDC or public health. The Senate has all sorts of peculiarities. But I think there’s probably going to be a desire to get this done pretty quickly.
Carey: All right. Well, we’ll see what happens, and we will go back to the MAHA folks a little bit later in the podcast. But right now I want to shift to Capitol Hill. Thursday was a very big day on the Hill for HHS Secretary Kennedy. He kicked off a series of appearances before Congress. This week he’s testifying before three House committees before he heads over to the Senate next week. This is the first time that the secretary has visited some of these House panels, and while the purpose of the latest congressional visit is to talk about President Trump’s HHS budget request, this also was the first time that a lot of lawmakers ever had an opportunity to talk to Kennedy, and what they asked him sometimes deviated, maybe quite a bit, from that subject of federal funding. The topics included Medicaid fraud, measles outbreaks, the birth-dose recommendation for the hepatitis B vaccine, peptides, unaccompanied minors, and more 鈥 actually, much more when you look at the hearings from yesterday, and I’m sure that will also happen with today’s session. What stood out to you about Kennedy’s testimony this week?
Edney: I think it was the mix of questions, and you sort of alluded to this, but they wanted, the members of Congress wanted to talk about so many things. And I feel like in the earlier hearing, which was in the House Ways and Means Committee, that it was, there was a lot of focus in the beginning on fraud, and that sort of surprised me, and then we saw maybe one or two questions on vaccines. And so I thought the mix of questions, the things that members were interested in, were really interesting. And it did 鈥 there were some fiery moments, but for his first time on the Hill in a while, for such a controversial Cabinet member, I thought they were pretty tame.
Kenen: Yeah, I watched a fair amount of the morning. I did not see the afternoon, but I read about the afternoon, and I totally agree with Anna’s take. This administration and Kennedy did what this administration has been doing. They blame all problems on [former president Joe] Biden and the prior administration. And to be fair, Democrats, when they’re in power, they, I don’t think they do it quite to this extreme, but Democrats spend, when they have the chance, they blame things on Republicans. So that’s sort of Washington as usual. The emphasis on fraud has been a hallmark of this administration, particularly in health and social services. And you’ve seen, of course, in the way they’ve gone after blue states in particular. And a lot of their justification for the changes in Medicaid that are coming in the coming year are supposedly because of massive fraud and they’re cracking down. It was not dominated by vaccines, and I was watching Kennedy’s face really carefully. When he was asked about the first child to die of measles in Texas last year, and a Democrat asked him could the vaccine have saved her life, and you could sort of see him just, you just sort of watch his facial expressions, and he knew he had to say this, and he came out with the word “possibly,” and, which is a change. And then in the afternoon 鈥 where I did not, as I said, I did not watch the afternoon, but I read about it 鈥 he was much more certain. He was much stronger about the measles vaccine and said it’s, the measles vaccine, is safer than measles, which is a big signal shift there.
Huetteman: It’s true, although I will point out, though, that he did stand by the decision to remove the recommendation for the birth dose of the hepatitis B vaccine when he was pressed on that. So it was, I agree it was a softening, I’d say. At least it wasn’t a dramatic turnaround from what he’d said or not said in the past. But for him, it was at least a softening.
Kenen: In the hepatitis B recommendation, he said that the biggest threat to infection was at, through birth, at, through the mother, and if you test the mother, the baby is not at risk. And that’s partially true, and that is a significant factor to eliminate risk. It doesn’t 鈥 it minimizes risk. It does not eliminate risk. Babies can and have been infected in the first weeks of life in other ways. The recommendation was not to totally eliminate that vaccine. It was to postpone it. But there’s, public health, still believe that, in general, many public health leaders would still say that the vaccine at birth is the better way of doing it.
Carey: The focus was, theoretically, on the budget request from the administration. Did the secretary shed any light on those priorities or their impacts? I was taken, I think in the afternoon hearing I read about various lawmakers, including Rosa DeLauro from Connecticut, who sort of just said: A CDC cut of 30%? We’re not gonna do that. And there were also some Republican members who jumped in to sort of say, I don’t think we’re going to do the cuts you envision. But did the secretary defend them? Did he bring any new clarity to them?
Edney: I don’t feel like I gained any new clarity on it. I think to bring it back to Budget 101, I guess, is like when the president, when the administration, sends down their budget, I think a lot of people already assume it’s dead on arrival. And maybe even though Kennedy is there to talk about the budget, it does become this broader hearing, because they don’t get him on the Hill that often and people go there to talk about all kinds of things, and I think that he probably knew that he didn’t have to defend it in the same way, because it’s not going to happen.
Carey: Sure. As they say, the president proposes and Congress disposes. But Joanne, you want to jump in?
Kenen: Yeah, there’s something significant about this administration, which is Congress has repeatedly authorized more money for various health programs and science programs, and the administration doesn’t spend it, so that there’s a different dynamic. Traditionally, yes, Congress 鈥 the president proposes, Congress legislates, and then people go off and spend money. That’s what people like to do. And in this case, when Congress has, in a bipartisan way, differed with the administration and restored funding, it hasn’t all gone, those dollars haven’t gone out the door. So the entire sort of checks-and-balances system has been askew in terms of funding. I agree with everybody here. I do not think that Congress is going to accept these extreme cuts across the board in health care and health policy, in public health and science and NIH [the National Institutes of Health] and everything, but I don’t know what they’re actually going to spend at the end of the day.
Carey: Emmarie, you wanted to jump in.
Huetteman: Yeah, there was one striking exchange to me where the secretary acknowledged he wasn’t happy with the cuts that were proposed. I think those were his words. But he pretty quickly added, and neither is President Trump, and he framed it as a matter of making hard decisions when faced with federal budget shortfalls.
Carey: All right. Well, we’ll keep watching this as it moves through Congress. Also during yesterday’s House Ways and Means hearing, some Democrats took issue with past statements from Secretary Kennedy and President Trump that linked Tylenol use during pregnancy to autism in children. released this week in JAMA Pediatrics found that the use of Tylenol by women during pregnancy was not associated with autism in their children. This nationwide study from Denmark followed more than one and a half million kids born between 1997 and 2002, including more than 31,000 who were exposed to Tylenol in the womb. in another medical journal examining community water fluoridation exposure from childhood to age 80 found no impact on IQ or brain function. Kennedy has claimed that fluoride in water has led to IQ loss in children. These studies clearly debunk medical claims that have gotten a lot of attention. Will these findings have an impact now?
Kenen: I think we’ve seen over and over and over again that there are people who are very deeply wedded to certain beliefs, and new science, new research, does not deter them from those beliefs. We also see some people who are sort of in the middle, who are uncertain, and new findings can shift their beliefs, right? And then, of course, there’s a lot of 鈥 these are not new studies. I mean these are new studies but they are not the first of their kind. The reason we’ve been using fluoride for, what, 60 years now in the water. Tylenol has been around a long time. So is it going to change everybody’s belief? No. Is it going to perhaps slow the push to ban fluoridation? Perhaps. But I just don’t think we know, because we’re sort of on these dual-reality tracks regarding a lot of science in this country, where once people sort of buy into disinformation, they’re very, it’s very hard to change 鈥 or misinformation 鈥 it’s hard to change people’s minds.
Edney: I do think, on the Tylenol front 鈥 I absolutely agree with what Joanne said overall. And I think on the Tylenol front that it’s possible that this study will give pediatricians something to give and talk about with parents that are asking. I think there still is some confusion among some people. It’s not a huge, I don’t think, widespread thing, but I think there are some new parents who are wondering. And if you are able to take this study that is published in 2026 鈥 it just happened, it was after Trump made his statements 鈥 I think maybe that would give them something to talk about with their patients.
Kenen: I agree with Anna. I think the Tylenol one is easier to change than some of the fluoridation stuff going on, partly because so many of us 鈥 and we should just say, it’s not just the Tylenol, the brand. It’s acetaminophen, which I’ve never pronounced right. I think those of us who have been pregnant, we’ve taken that in our life before and we don’t think of it as a big, dangerous, heavy prescription drug. I think we’ve, it’s something we feel comfortable with. And I think there’s also the counterinformation, which is, a fever in a pregnant woman can, a pregnant person can be dangerous to the fetus. So I think that one’s a little 鈥 and I don’t, also, I don’t think it’s as deep-rooted. The fluoridation stuff goes back decades, and the Tylenol thing is sort of new. And it might be, I’m not sure that the course of these arguments 鈥 I think that Tylenol is easier to counter than some other things, because partly just we do feel safe with it.
Carey: All right. We’re going to take a quick break. We’ll be right back.
We’re back and talking about how the Trump administration is managing the voters behind the Make America Healthy Again, or MAHA, movement, which helped President Trump win the 2024 election. My colleagues Stephanie Armour and Maia Rosenfeld wrote about the administration’s recent decision to give coke oven plants in the U.S. a one-year exemption from tougher environmental standards. And that was a move that angered some MAHA activists who wondered if the GOP is more beholden to industry than the MAHA agenda. President Trump, HHS Secretary Kennedy, and other top administration officials met recently at the White House with a group of MAHA leaders to calm concerns that the administration is moving too slowly on food policy changes, and they are concerned about the president’s recent support of the pesticide glyphosate. According to press reports, the MAHA folks seem to feel their concerns were heard during that session. But is this ongoing conflict between the president and this key political constituency, will it be one that keeps brewing as the midterm elections approach?
Edney: Yes, 100%. I think it will continue to brew. I think that meeting was thrown together so quickly that some members of the MAHA movement who were invited couldn’t even make it. So it wasn’t exactly a long-planned, seemingly deep desire to fix everything. But it was, as you’ve said, an effort to kind of hear them out and make them feel heard. No one that I’ve talked to has said everything is fixed now. It’s more of a to-be-determined We will see what the administration will do moving forward, if they will listen to any of our plans 鈥 which we will not share with you, by the way 鈥 to make us happy. And I think that that’s going to continue. There’s a rally planned in front of the Supreme Court on glyphosate later this month where a lot of those people will be, and so I think that they’re upset and they’re stirring up, that concern is only going to get stirred up more.
Carey: Emmarie.
Huetteman: It’s a small thing, but our fellow podcast panelist Sheryl Stolberg at The New York Times during this White House meeting where President Trump was meeting with MAHA leaders, one of the leaders made a joke about how this is not a group that’s going to be, quote, “Team Diet Coke,” and the president apparently took that as a cue to press that Diet Coke button he famously has on his desk and summon a server who apparently brought him a Diet Coke. Supporters of MAHA have been clear that they want not just for the Trump administration to promote policies supporting priorities like healthy eating and removing food dyes, but also they want them to rein in or end policies they don’t support. And that weed-killer executive order, that really was a big example of that. The MAHA constituency made it clear that they felt betrayed by that order, and they’re going to have to do some work to walk that back.
Carey: We’ll also see how, with their concerns about the new CDC director nominee, which they’re already voicing, we’ll see how that plays out.
Kenen: No, I just think that we are, as we mentioned at the beginning, we’re seeing cracks, right? We’re seeing 鈥 none of us are privy to any conversations that President Trump has had privately with Secretary Kennedy. But his, Secretary Kennedy’s, public statements have been a little different than they were a few months ago. There’s certainly been reports that he’s been told to soft-pedal vaccines and talk about some of the things that there’s more unanimity across ideological and party lines. Healthier food 鈥 there’s debate about how to, whether, there’s debate about how Kennedy defines healthier food. But in general, should we eat healthier? Yes, we should eat healthier. Should our kids get more exercise? Yes, our kids should get more exercise. Do we have too much chronic disease? Yes, we have too much chronic disease. So they’re sort of this, trying to move a little bit more, sort of this sort of top line, very hazier agreement. But at the same time, the people who are sort of really the core of MAHA, as Kennedy has sort of created it or led it, there’s cracks there.
Carey: All right, we’ll see. We’ll see where that goes. But let’s go ahead and move on to ACA enrollment. A found that 1 in 7 people who signed up for an Affordable Care Act plan failed to pay their first month’s premium. The analysis from Wakely consulting group found that nationally around 14% of those who enrolled in ACA plans didn’t pay their first bill for January coverage. Now we know the elimination of the enhanced ACA tax credits and higher premium costs led to lower enrollment in the ACA exchanges, with sign-ups for 2026 falling to 23 million from 24 million a year ago. But how do you interpret this finding that 14% of enrollees didn’t pay their January premium? Is it a sign of more trouble ahead?
Edney: I think it could be a sign of more trouble ahead. Some 鈥 what we’re seeing is sticker shock. And there may be some people who are trying to deal with that and won’t be able to as the months go on. And so, yeah, I think it could mean that even more drop out, and that means more people lose coverage and are uninsured.
Kenen: I think there was sort of a general, initial, misleading sigh of relief when in December, when the enrollment figures, the drop wasn’t as bad as some feared. But at the same time, people said: Wait a minute. This doesn’t really count. Signing up isn’t the same thing as staying covered. The drop in January was significant, we now know. And I agree with Anna. I think we don’t know how many more people will decide they can’t afford it. Or we don’t know whether the big drop is January. Probably a lot of it is, because you get that first bill. But can, will more people drop? Probably. We have no way of knowing how many. And it also depends on the economy, right? If more people lose jobs, right now it’s still pretty, kind of still pretty stable, but we don’t know what’s ahead. We don’t know what’s going to happen with the war. We don’t know many, many, many 鈥 we don’t know anything. So the future is mysterious. I would expect it to drop more. I don’t think, I don’t know whether this is the big drop or February will be just as bad. I suspect January will be the biggest. But who knows? It depends on other outside factors.
Huetteman: We’re also seeing a drop-off in the kind of coverage that people are choosing. That analysis that you referenced, Mac, showed that there was a 17% drop in silver plan membership, with most of those folks switching to bronze plans, which, in other words, that means they switch to plans that have lower monthly premiums but they have higher deductibles. And that means that when you get sick, you owe more, in some cases much more, before your insurance starts picking up the tab. And I think really what this means is people are more exposed to the high charges for medical services, bigger bills when you get sick. I think that
Kenen: I think that the Republicans were seen as having pushed back a lot of the health impacts of the so-called One Big Beautiful Bill and that it would be after the election. And I and others wrote: No, no, no, no, no. We’re going to see this playing out before the election. This is a really big political red flag, right? This is a lot more people becoming uninsured, which makes other people worried about their insurance and stability. So I think this is definitely going to 鈥 it may not be. There are other things going on in the world. Health care may not be the dominant theme in this year’s election. But yes, this is going to be, the off-year elections are going to be health care elections, like almost every one else has been for鈥
Carey: Oh yeah.
Kenen: 鈥攕ince the Garden of Eden, right?
Carey: Absolutely, it’s a perennial. All right, we’ll keep our eye on that. That’s this week’s news. Now we’re going to play Julie’s interview with immigration attorney Michelle can arrow, and then we’ll be back with our extra credits.
Julie Rovner: I am pleased to welcome to the podcast Michelle Canero. Michelle is an immigration attorney from Miami and a member of the board of Immigrants’ List, a bipartisan political action committee focused on immigration reform. Michelle, thanks for joining us.
Michelle Canero: Thank you for having me.
Rovner: So, we’ve talked a lot about immigration policy on this podcast over the past year, but I want to look at the big picture. How important to the U.S. health care system are people who originally come from other countries?
Canero: I think the statistics speak for themselves. One in three residency positions can’t be filled by American graduates alone. That means 33% of these residency positions are being filled by immigrant workers. Twenty-seven percent of physicians are foreign-born. Twenty percent of hospital workers are immigrants. And, at least in Florida, a large percentage of our home health care workers happen to be immigrants. And we depend on this population heavily in the health care sector.
Rovner: Now, we talk a lot about the Trump administration’s crackdown on illegal immigration, but we talk a little bit less about their sort of messing with the legal immigration system. And there’s a lot going on there, isn’t there?
Canero: There is. And I think that the campaign talking points were illegal immigration but what we’re actually seeing is a little more sinister. I think that the goal of leadership at the head of DHS [the Department of Homeland Security] and DOS [the State Department], or really Stephen Miller, is pushing something called reverse migration, which is really not about limiting illegal immigration but reducing the immigrant population in the United States. And I think that’s where the real concern is and why you’re seeing these policies that directly affect legal immigrants.
Rovner: We talk a lot about doctors and nurses and skilled, the top skilled, medical professionals who make up a large chunk of the United States health care workforce. We don’t talk as much about the sort of midlevel professional workers and the support staff. They’re also overwhelmingly immigrant, aren’t they?
Canero: Yeah, and whether it’s your IT- and technical-knowledge-based workers in hospitals who facilitate all the technology 鈥 we rely on an immigrant workforce for a lot of the technology sector. And then you’ve got research professionals. A lot of clinical researchers, medical researchers, are foreign-born. So it’s not just about the doctors. It’s also the critical staff that keep the hospitals operating. And I’m from Florida. For us, it’s the home health care workers. We have an aging population, and a large percentage of the home health care workers, particularly in Florida, happen to be Haitians on TPS [temporary protected status] or people with asylum work authorizations. And when we lose that, our aging population is left with no resources, because that’s not something AI or technology can fix. You can’t turn someone over in a bed with a robot yet, and we’re probably decades away from that.
Rovner: So what’s the last year been like for you and your clients?
Canero: I think it’s a lot of uncertainty. A lot of these policies are percolating, and we’re assuming that they’ll be resolved in litigation, but the damage is being done in real time. So we’re seeing hospitals turning away from hiring foreign workers, because of the H-1B penalty now. The suspension of J-1 processing created backlogs. These visa bans that affect 75 countries on certain visas and 39 countries on others. You’ve got thousands of health care workers that are stuck outside the U.S. So what’s happening, really, is that hospitals and medical providers are just shutting down, and they’re cutting back services, and that means that there are less available services and resources for the same population and the same demand. People are waiting longer for doctor’s appointments. People are finding that they’re not able to get to the specialist that they need to get to in time. And so for us as practitioners, I think, we’re trying to navigate as best we can, but we’re just seeing a lot of people, employers that traditionally would rely on our services, give up and foreign workers looking to go elsewhere.
Rovner: I noticed during the annual residency match in March that it worked out, I think, fairly well for most graduating medical students. But the big sort of sore thumb that stuck out were international medical graduates. That’s going to impact the pipeline going forward, isn’t it?
Canero: From what I understand, it takes like seven to 15 years to get to that level, and we just don’t have the student body to meet the demand of residency positions. From my understanding, there’s a gap between American graduates and the demand for residents that’s usually filled by foreign workers. And if we don’t have those foreign workers, those residency positions just don’t get filled. And that becomes more expensive for hospitals, and that transfers to our medical bills.
Rovner: And people assume that, Oh well this doesn’t impact me. But it really impacts all patients, doesn’t it? And I would think particularly those in rural areas, which are less desirable for U.S.-born and -trained medical professionals and tend to be overrepresented by immigrants.
Canero: Yeah, I think a lot of the J-1 doctors and H-1B doctors are what facilitate, are working at, our veterans hospitals and our rural medical facilities. And what’s ending up happening is the very same people that this administration touts to support their interests are being forced to travel farther for specialists, right? If there isn’t an endocrinologist in your area, you may have to drive 100 miles to go see that specialist, and you may forgo necessary medical care because of the inconvenience or the cost. And I think that’s hitting at our health.
Rovner: So you’re on the board of Immigrants’ List, which is working to change things politically. What’s one change that could really make a big difference in what we’re starting to see in terms of immigration and the health care workforce?
Canero: Well, asking Congress to actually do something. It’s been a problem for decades. So I don’t really know, but I think there’s a couple of things, whether it’s just policymakers supporting our fight against some of these illegal policy changes in courts, organizations supporting us with amicus briefs. For example, there’s a lot of lawsuits challenging these visa bans and these adjudicative holds and the H-1B fine. The more support that the plaintiffs in the litigation get, the more likely we are to resolve that through the court system. And then I hope that there’s enough pressure from hospitals and organizations that have real dollars that impact these elected officials to get them to start seeing, Hey, we need to pass reasonable immigration reform to address some of the loopholes that this administration is using to cause chaos in the system, right? They’re able to do this because we have a gap. We allow them to terminate TPS. We don’t have a structure to ensure that a community that’s been on TPS for 20 years gets grandfathered into some sort of more stable visa. We don’t have a system that precludes the administration from just putting a hold or a visa ban on nationalities. So it’s something that Congress is going to have to step up and do something about.
Rovner: What worries you most about sort of what’s going on with the immigration system and health care? What keeps you up at night? Obviously you, I know you work on more than just health care.
Canero: I think my concern is that the American people aren’t seeing what’s happening, or they’re sort of turning a blind eye to it, and by the time it starts to actually impact them and they start asking, Wait, wait, wait. Why is this happening? I don’t understand, it’s going to be too late. Because it’s not hitting their pocket, because it’s not their suffering at this point, they’re not standing up and saying, Hey, this needs to stop, at the level that we need, opposition, to make it stop. And by the time it does hit their pocket and it does affect them directly, I think, it’ll be a little too late. I think people will be scared off from coming here, people that we needed will be gone, and to reverse the system is going to take decades.
Rovner: Michelle Canero, thanks again.
Canero: No, you’re very welcome. Thank you for your time.
Carey: OK, we’re back. Now it’s time for our extra-credit segment, and that’s where we each recognize a story we read this week and we think that you should read it, too. Don’t worry if you miss it. We’ll post the links in our show notes. Joanne, why don’t you start us off this week?
Kenen: Well, this is by Teddy Rosenbluth in The New York Times. The headline is “” This is one of those stories where you know exactly how it’s going to end in the first paragraph, and yet it was so compellingly and beautifully written that you kept reading until the last word. It is, as the headline suggested, a young man who is an expert on AI and cognitive science named Ben Riley discovered that his father had been lying about a controllable, treatable form of leukemia. He had denied treatment, he’d refused treatment, he had ignored his oncologist because he was relying on AI. And as we all know, AI has its up moments and its down moments. And he was getting incorrect information, distrusted the diagnosis, refused treatment, getting sicker and sicker and sicker as the oncologist and the family got increasingly desperate. And the son, Ben Riley, had, like, skills. He knew how to find scientific evidence, and his father just would not believe it. And by the time his father finally consented to treatment, it was too late, and he did die. And his father was a neuroscientist, a retired neuroscientist, but he found a neuroscience rabbit hole.
Carey: That’s amazing. Anna, what’s your extra credit?
Edney: Mine, I’m highlighting a story that I wrote in Bloomberg called “.” And this is, I wanted to dive into this policy that the FDA had implemented. The commissioner has long talked about and felt that perimenopausal and menopausal women were not getting access to the treatments that maybe they really needed, because there had been sort of this two-decade-old study that had showed there were some safety issues regarding breast cancer and cardiovascular disease, but the issue being that those studies had looked at older forms of the medication and also at women who were much older than those who might benefit from taking it. And so they, the agency, asked the companies to remove those warning labels, at least the strongest ones. And what we’ve seen, why 鈥 I wanted to dive into the numbers specifically. Bloomberg has some prescription data that was able to help me out here and just look at when this started rising. You could see that the prescriptions started going up around 2021. I feel like a lot of influencers, a lot of celebrities, were talking about this. And then in 2024 to 2025 when the FDA started talking about this, it really just goes, the prescription numbers just go straight up on the scale. And so there were about 32 million prescriptions written last year, which is a huge increase. And I just dove into some of this, some of the companies, what kind of drugs there are out there, and talked to some women who are benefiting but also, because of this pop, experiencing shortages, because the companies aren’t quite keeping up with the products.
Carey: Wow, that sounds like an outstanding deep dive. Thank you. Emmarie.
Huetteman: Yeah, my extra credit is from my colleague at 麻豆女优 Health News who covers health technology. That’s Darius Tahir. The headline is “Your New Therapist: Chatty, Leaky, and Hardly Human.” The story looks at the proliferation of AI chatbot apps that offer mental health and emotional support, particularly the ones that market themselves as, quote-unquote, “therapy apps.” Darius counted 45 such apps in Apple’s App Store last month, and he uncovered in some cases that safety and privacy concerns existed, such as minimal age protections. Fifteen of the apps that he looked at said they could be downloaded by users who were only 4 years old. His story also explored the tension between the risks of sharing sensitive data and the interests of app developers and collecting that data for business purposes. It’s a good read. All right,
Carey: All right. Thanks so much. My extra credit is from Politico, and it’s written by Alice Miranda Olstein, and she’s a frequent guest here on What the Health? The headline is, quote, “,” close quote. The headline kind of says it all. Alice writes that Nebraska is racing to implement Medicaid work requirements by May 1, and that’s eight months ahead of the national deadline that was set by the One Big Beautiful Bill Act. Nebraska state officials plan to do this without hiring additional staff, even as other health departments in other states prepare to bring in dozens, if not hundreds, of new employees. Alice writes that advocates for people on Medicaid fear that this rush timeline and lack of new staff will cause many problems for Medicaid beneficiaries who are just trying to meet those new work requirements.
All right. That’s this week’s show. Thank you so much for listening. Thanks, as always, to our editor and panelist Emmarie Huetteman, to this week’s producer and engineer, Taylor Cook, and to my 麻豆女优 colleague Richard Ho, who provided technical assistance. A reminder: What the Health? is now available on WAMU platforms, the NPR app, and wherever you get your podcasts, as well as, of course, kffhealthnews.org. Also, as always, you can email us with your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, . Joanne, where can people find you these days?
Kenen: and , @joannekenen.
Carey: OK. Anna?
Edney: and and , @annaedney.
Carey: And Emmarie.
Huetteman: You can find me on .
Carey: We’ll be back in your feed next week. Until then, be healthy.
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LISTEN: After a federal judge blocked the Trump administration’s efforts to pare down childhood vaccine recommendations, plenty of questions remain 鈥 like how annual vaccines for the flu will get approved. 麻豆女优 Health News chief Washington correspondent Julie Rovner spoke with WAMU about how the decision is rippling through the public health system.
Big swings in federal vaccine policy are creating confusion for some parents and clinicians. A federal judge recently struck down Health and Human Services Secretary Robert F. Kennedy Jr.’s new, for all kids. But with the Trump administration likely to appeal, the situation is in flux. Meanwhile, cases of such as measles, mumps, and whooping cough continue to accumulate nationwide and in the Washington, D.C., area.
Julie Rovner, 麻豆女优 Health News chief Washington correspondent and host of the podcast What The Health?, appeared on WAMU’s “Health Hub” on April 1 to break down what’s changed, what hasn’t, and what’s still unclear.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/public-health/listen-wamu-health-hub-julie-rovner-explains-acip-vaccine-schedule-court-judge/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2177579&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The tensions risk fraying Kennedy’s dynamic MAHA coalition, potentially driving away critical supporters who helped fuel President Donald Trump’s 2024 election win.
The movement’s grassroots membership includes suburbanites, women, and independents who are generally newer entrants to the GOP and laser-focused on achieving certain results around the nation’s food supply and vaccines.
Promoting healthy foods tops their list and will be at the center of the White House’s pitch to voters during the midterm election cycle.
“President Trump’s mass appeal partly lies in his willingness to question our country’s broken status quo,” White House spokesperson Kush Desai said in a statement. “That includes food standards and nutrition guidelines that have helped fuel America’s chronic disease epidemic. Overhauling our food supply and nutrition standards to deliver on the MAHA agenda remains a key priority for both the President and his administration.”
At the same time, with most Americans , the White House has cooled on Kennedy’s aggressive policies to curb vaccines and MAHA’s interest in tamping down environmental chemicals that are linked to disease.
The result: Republicans are realizing just how demanding the MAHA vote can be. Moms Across America leader Zen Honeycutt warned that Republicans are facing their biggest setback yet with the MAHA movement, after Trump signed an executive order to support production of glyphosate, a herbicide the World Health Organization has .
“It has caused the biggest uproar in MAHA,” Honeycutt said during a CNN interview in late February.
A White House Warning
Trump’s top pollster, Tony Fabrizio, cautioned in December that an embrace of Kennedy’s anti-vaccine policies could cost politicians their jobs this year.
Eight in 10 MAHA voters and 86% of all voters believe vaccines save lives, his poll of 1,000 voters in 35 competitive districts found.
“In the districts that will decide the control of the House of Representatives next year, Republican and Democratic candidates who support eliminating long standing vaccine requirements will pay a price in the election,” on the poll stated.
The White House has since shaken up senior staffing at HHS, including removing from the deputy secretary role and his job as acting director of the Centers for Disease Control and Prevention, in which he curtailed the agency’s childhood vaccination recommendations. Ralph Abraham, a vaccine skeptic who as Louisiana’s surgeon general suspended its vaccination promotion program last year, stepped down as the CDC’s principal deputy director in late February.
, a doctor who said in congressional testimony that he doesn’t believe vaccines cause autism, is now running the CDC in addition to directing the National Institutes of Health.
Though Trump himself has frequently espoused doubts and mistruths about vaccines, polling around anti-vaccine policy has undoubtedly shaken the White House’s confidence during a tough midterm election year, said former , an Indiana Republican and retired doctor who left Congress last year.
Bucshon said Republicans can’t risk alienating voters, especially parents of young children who might be moved by Democratic attack ads on the topic at a time when hundreds of measles cases are popping up across the U.S.
“That’s the reason you’re seeing the White House get nervous about it,” Bucshon said. “This is just the political reality of it.”
Kennedy built some of his MAHA following with calls to end federal approval and recommendations for the covid vaccines during the pandemic. The Advisory Committee on Immunization Practices, a federal panel of outside experts who were handpicked by Kennedy to develop national vaccine recommendations, is expected to review and possibly withdraw its recommendation for covid shots. Its February meeting was postponed and is now scheduled for March 18-19, when the panel plans to discuss injuries from covid vaccines, HHS spokesperson Andrew Nixon confirmed on March 11.
“I’m not deaf to the calls that we need to get the covid vaccine mRNA products off the market. All I can say is stay tuned and wait for the upcoming ACIP meeting,” ACIP Vice Chair Robert Malone , a conservative account on the social platform X, before the meeting was postponed. “If the FDA won’t act, there are other entities that will.”
No Fury Like Scorned MAHA Moms
Bipartisan support is also extremely high — above 80% — for another core tenet of the MAHA agenda: eliminating the use of certain pesticides on crops.
But MAHA leaders were incensed when Trump issued a Feb. 18 promoting the production of glyphosate, a chemical used in weed killers sprayed on U.S. crops and which Kennedy has railed against and sued over because of its reported links to cancer.
“There’s gonna be ups and downs, and there is zero question that this week was a down,” Calley Means, a senior adviser to the health secretary and a former White House employee, told a MAHA rally in Austin, Texas, on Feb. 26. “I am not going to gaslight or sugarcoat it: This glyphosate thing was extremely disappointing. Bobby’s disappointed.”
Despite deep unhappiness from MAHA followers, Kennedy endorsed Trump’s executive order defending access to such pesticides.
“I support President Trump’s Executive Order to bring agricultural chemical production back to the United States and end our near-total reliance on adversarial nations,” Kennedy .
Without offering policy changes, Kennedy promised a future agricultural system that “is less dependent on harmful chemicals.”
White House officials are now trying to downplay the executive order.
“The President’s executive order was not an endorsement of any product or practice,” Desai said in a statement.
But that’s done little to dampen criticism from leading MAHA influencers who had hoped, with Kennedy’s influence in the administration, that the chemical would be banned.
Some Democrats see an opening.
of Maine earned cheers from MAHA loyalists for co-sponsoring legislation with Rep. Thomas Massie (R-Ky.) to undo the executive order.
“The Trump Admin. cannot keep paying lip service to while propping up Big Chemical like this and choosing corporate profits over Americans’ health,” .
, a prominent MAHA influencer who promotes healthy eating, responded on X with a “HELL YES.”
‘Eat Real Food’
The White House and Kennedy are refocusing their messaging to emphasize one of the most popular elements of the MAHA platform: food.
At the start of the year, Kennedy unveiled new dietary guidelines that emphasize vegetables, fruits, and meats while urging Americans to avoid ultraprocessed foods.
Kennedy has leaned into his new “Eat Real Food” campaign, launching a nationwide tour in January. Ahead of the late-February MAHA rally, he stopped at a barbecue joint in Austin where he took photos with stacks of smoked ribs and grilled sausages. Large “Eat Real Food” signs have been provided for crowds of supporters to hold up during major announcements at HHS’ headquarters this year.
Focusing on nutrition will please MAHA moms, suburban swing voters, and conservatives alike, said , a physician and former Republican representative from Texas.
“They keep them happy by talking about the food pyramid,” Burgess said. “That’s an area where there is broad, bipartisan support.”
Indeed, Fabrizio’s poll shows equal support — 95% — among respondents who voted for former Vice President Kamala Harris and those who voted for Trump for requiring labeling of harmful ingredients in ultraprocessed foods.
Trump is keenly aware that Kennedy’s MAHA movement is key to his political survival. At a Cabinet meeting in January, Kennedy rattled off a list of his agency’s efforts researching autism and tackling high drug prices.
Trump leaned in at the table.
“I read an article today where they think Bobby is going to be really great for the Republican Party in the midterms,” , “so I have to be very careful that Bobby likes us.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/elections/maha-make-america-healthy-again-vaccines-food-glyphosate-midterm-risk-opportunity/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2165377&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>Bill Cassidy offered jabs to thousands of inmates at Louisiana’s maximum-security prison in the early 2000s. A decade before that, he set up vaccine clinics in middle schools, a model as a success.
“He got that whole generation immunized in East Baton Rouge,” said Holley Galland, a retired doctor who worked with Cassidy vaccinating schoolchildren.
About the same time, a lawyer and environmental activist with a famous last name was starting to build the loyal anti-vaccine coalition that, two decades later, would move President Donald Trump to nominate him as the nation’s top health official.
Today, a year after now-Sen. Cassidy warily cast the vote that ensured Robert F. Kennedy Jr.’s ascension to that role, the Louisiana Republican’s life’s work — in medicine and in politics — is unraveling.
Newborn hepatitis B vaccination rates in the U.S. had plunged to 73% as of August, down 10 percentage points since a February 2023 high, published in JAMA last month. In December, the Centers for Disease Control and Prevention’s Advisory Committee for Immunization Practices — remade by Kennedy — voted to revoke a two-decade-old recommendation that all newborns get the shot.
The next month, Trump endorsed U.S. Rep. Julia Letlow, a Cassidy challenger in what’s shaping up to be a competitive Republican Senate primary. Letlow’s foray into politics began in 2021 when she took the seat won by her husband, left vacant after he died from covid.
麻豆女优 Health News made multiple requests for comment from Cassidy over three months. His staff declined to make him available for an interview or provide comment. Letlow’s campaign did not respond to requests for comment.
Rise of the Skeptics
As the May primary nears, some Louisiana doctors are worried they’ve begun a long trek down a dark road when it comes to vaccine-preventable diseases.
Last year, on the day Kennedy was sworn in a thousand miles away in Washington, Louisiana’s health department stopped promoting vaccines, halting its clinics and advertising. Its communications about an ongoing whooping cough outbreak in the state have nearly ceased. It took months for the state to announce last year that two infants had died from the illness. A Louisiana child’s death from the flu was confirmed this January, and a couple of cases of measles were reported last year.
Spokespeople for the Louisiana Department of Health did not respond to questions.
“It’s so hard to see children get sick from illnesses that they should have never gotten in the first place,” said Mikki Bouquet, a pediatrician in Baton Rouge. “You want to just scream into the void of this community over how they failed this child.”
As anti-vaccine forces have taken hold of the state and federal health departments, Cassidy has lamented the consequences.
“Families are getting sick and people are dying from vaccine-preventable deaths, and that tragedy needs to stop,” he last fall.
But while it is Cassidy’s duty as chairman of the Senate’s Health, Education, Labor, and Pensions Committee to conduct oversight of the health department, Kennedy has appeared before the committee just once since he was confirmed.
The secretary speaks at a “regular clip” with Cassidy, said Department of Health and Human Services spokesperson Andrew Nixon.
Kennedy’s department has elevated Louisiana vaccine skeptics. The state surgeon general who terminated Louisiana’s vaccine campaign, Ralph Abraham, was named deputy director of the CDC. (He left the role in February.) And Kennedy handpicked Evelyn Griffin, a Baton Rouge OB-GYN who later replaced Abraham as the state surgeon general, for an appointment to ACIP. Griffin the covid vaccine had dangerous side effects for young patients.
Research has shown that serious side effects from the vaccinations are rare and that the shots saved millions of lives during the pandemic.
Cassidy “has really not had an outspoken chorus of policy supporters” when it comes to inoculating people, said Michael Henderson, a professor of political communication at Louisiana State University. “There’s not a lot of political stakes in doing that in Louisiana if you’re a Republican.”
Louisiana Gov. Jeff Landry reprimanded Cassidy after the senator called for the state’s health department to ease access to covid shots.
“Why don’t you just leave a prescription for the dangerous Covid shot at your district office and anyone can swing by and get one!” the Republican in September.
On ‘Eggshells’ in the Exam Room
On a sunny February afternoon, as Carnival floats were readied to parade the streets of New Orleans, pediatrician Katie Brown approached a basement apartment on a well-child visit. Cowboy boot pendants dangled from her ears, and a pack of diapers were clutched tightly in her arms.
The patient, a toddler who waved at the sight of visitors, was up to date on her immunizations. But when Brown suggested a covid vaccine, the girl’s mother quickly declined, noting she had never gotten the shot either.
Many of Brown’s young patients — seen through Nest Health, which offers in-home visits covered by Louisiana’s Medicaid program — are current with their vaccines. Brown said home visits make parents more comfortable immunizing their children, but she’s still spending more time these days explaining what they’re getting in those shots.
“After covid vaccines, that’s when some people just decided, ‘I don’t know if I trust vaccines, period,’” she said.
Across the state, vaccination rates have declined since the pandemic, falling short of the levels scientists say are required to achieve herd immunity for some deadly diseases, including measles. About have had the recommended two doses of the measles, mumps, and rubella vaccine.
The New Orleans Health Department has tried to step up with a $100,000 immunization campaign of its own, with clinics and billboards, during this year’s flu season, said Jennifer Avegno, the department’s director.
But the state’s absence is felt. Other parishes across Louisiana have not taken similar action, leaving doctors largely on their own to promote immunizations.
“I’ll say that with certainty,” Avegno said. “It’s been a blow to not have a statewide coordination.”
A day after Brown’s home visit, a mother in Baton Rouge shook her head when Bouquet offered a flu shot for her 10-year-old daughter in an exam room.
In the waiting room, parents could thumb through a handmade book that offers scientific facts to counter fears about vaccines. A laminated guide placed in each exam room explained the benefits of each recommended immunization.
Bouquet said she’s experimenting with ways to educate parents about vaccines without seeming overbearing. She still hasn’t figured out a surefire formula. Some parents now shut down any vaccine talk, and she worries others skip scheduling appointments to avoid the topic entirely.
“We’re having to walk on eggshells a bit to determine how to get that trust back,” Bouquet said. “And maybe these discussions can come up in future visits.”
Pro-Vax, Pro-Anti-Vaxxer
Children’s Health Defense, the nonprofit that Kennedy helmed, worked to erode vaccine trust during the pandemic — falsely claiming, for instance, that covid shots cause organ damage and that polio vaccines were at fault for a rise in the disease. The organization also sued the federal government over the mRNA-based covid shots, hoping to get their emergency authorizations from the Food and Drug Administration revoked.
When Kennedy came before Cassidy’s committee in January 2025 as Trump’s nominee for health secretary, the senator-doctor saw risks if the prominent anti-vaccine lawyer was confirmed.
Cassidy described a time years ago when he loaded an 18-year-old onto a helicopter to get an emergency liver transplant. The young woman had acute hepatitis B, an incurable disease that is spread primarily through blood or bodily fluids and can lead to liver failure.
It was “the worst day of my medical career,” he said, addressing Kennedy at the witness table in front of him. “Because I thought, $50 of vaccines could have prevented this all.”
Cassidy started in politics in 2006 as a state senator, winning election to the U.S. House two years later. When he first ran for the U.S. Senate, in 2014, he charmed Louisiana voters with campaign ads showing him , talking about his work with Hurricane Katrina evacuees and patients at Baton Rouge’s public hospital.
But some Republicans soured on Cassidy after he voted to convict Trump on an article of impeachment charging him with inciting the Jan. 6, 2021, insurrection at the U.S. Capitol.
The impeachment vote has hampered Cassidy’s reelection bid this year in a state where Trump captured 60% of the vote in 2024.
“Cassidy has things that are associated with his name: the impeachment vote in 2021,” Henderson said.
Cassidy’s loyalty to Trump was tested again with Kennedy’s nomination. Cassidy said he endorsed Kennedy after extracting pledges that he wouldn’t tinker with the nation’s vaccination program.
But since taking office, Kennedy has largely ignored those promises, and Cassidy hasn’t publicly rebuked him.
Former Texas congressman Michael Burgess served for years with Cassidy in the House, where they were founding members of the GOP Doctors Caucus, started in 2009. He said Cassidy’s discomfort with some of Kennedy’s actions is palpable.
“You could hear some of the pain in Sen. Cassidy’s voice when he was addressing that the secretary wanted to drop the birth dose of hepatitis B,” Burgess said. “You got cases to nearly zero on hepatitis B. It was painful to him to think about taking this away from the population.”
Retired Baton Rouge nurse practitioner Elizabeth Britton has switched her party affiliation so she can vote in the closed Republican primary for Cassidy, with whom she vaccinated inmates decades ago.
She doesn’t quite understand the “mess” in Washington that resulted in the senator voting to confirm a vaccine critic.
Watching Kennedy and others promulgate doubts about shots she once administered has made her “profoundly sad” and “angry,” she said, but most of all worried.
“It puts a pit in my stomach, because I know the consequences of people not getting the vaccine,” she said.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/public-health/bill-cassidy-rfk-jr-confirmation-vaccines-hepatitis-b-hhs-senate-primary-louisiana/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2165304&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>One year after taking charge of the nation’s health department, Health and Human Services Secretary Robert F. Kennedy Jr. hasn’t held true to many of he made while appealing to U.S. senators concerned about the longtime anti-vaccine activist’s plans for the nation’s care.
Kennedy squeaked through a narrow Senate vote to be confirmed as head of the Department of Health and Human Services, only after making a number of public and private guarantees about how he would handle vaccine funding and recommendations as secretary.
Here’s a look at some of the promises Kennedy made during his confirmation process.
The Childhood Vaccine Schedule
In two hearings in January 2025, Kennedy repeatedly assured senators that he supported childhood vaccines, noting that all his children were vaccinated.
Sen. Elizabeth Warren (D-Mass.) about the money he’s made in the private sector from lawsuits against vaccine makers and accused him of planning to profit from potential future policies making it easier to sue.
“Kennedy can kill off access to vaccines and make millions of dollars while he does it,” Warren said during the Senate Finance Committee hearing. “Kids might die, but Robert Kennedy can keep cashing in.”
Warren’s statement prompted an assurance by Kennedy.
“Senator, I support vaccines,” he said. “I support the childhood schedule. I will do that.”
Days later, Sen. Bill Cassidy of Louisiana, chair of the Senate Health, Education, Labor, and Pensions Committee, declared Kennedy had pledged to maintain existing vaccine recommendations if confirmed. Cassidy, a physician specializing in liver diseases and a vocal supporter of vaccination, had questioned Kennedy sharply in a hearing about his views on shots.
“If confirmed, he will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ recommendations without changes,” Cassidy said during a speech on the Senate floor explaining his vote for Kennedy.
A few months after he was confirmed, Kennedy fired all the incumbent members of the vaccine advisory panel, known as ACIP, and appointed new members, including several who, like him, oppose some vaccines. The panel’s recommendations soon changed drastically.
Last month, the CDC removed its universal recommendations for children to receive seven immunizations, those protecting against respiratory syncytial virus, meningococcal disease, flu, covid, hepatitis A, hepatitis B, and rotavirus. The move followed a memorandum from the White House calling on the CDC to cull the schedule.
Now, those vaccines, which researchers estimate have prevented thousands of deaths and millions of illnesses, are recommended by the CDC only for children at high-risk of serious illness or after consultation between doctors and parents.
In response to questions about Kennedy’s actions on vaccines over the past year, HHS spokesperson Andrew Nixon said the secretary “continues to follow through on his commitments” to Cassidy.
“As part of those commitments, HHS accepted Chairman Cassidy’s numerous recommendations for key roles at the agency, retained particular language on the CDC website, and adopted ACIP recommendations,” Nixon added. “Secretary Kennedy talks to the chairman at a regular clip.”
Cassidy and his office have repeatedly rebuffed questions about whether Kennedy, since becoming secretary, has broken the commitments he made to the senator.
Vaccine Funding Axed
Weeks after Kennedy took over the federal health department, the CDC pulled back $11 billion in covid-era grants that local health departments were using to fund vaccination programs, among other initiatives.
That happened after Kennedy pledged during his confirmation hearings not to undermine vaccine funding.
Kennedy replied “Yes” when Cassidy asked him directly: “Do you commit that you will not work to impound, divert, or otherwise reduce any funding appropriated by Congress for the purpose of vaccination programs?”
A federal judge later ordered HHS to distribute the money.
The National Institutes of Health, part of HHS, also yanked dozens of research grants supporting studies of vaccine hesitancy last year. Kennedy, meanwhile, ordered the cancellation of a half-billion dollars’ worth of mRNA vaccine research in August.
A Discredited Theory About Autism
Cassidy said in his floor speech that he received a guarantee from Kennedy that the CDC’s website would not remove statements explaining that vaccines do not cause autism.
Technically, Kennedy kept his promise not to remove the statements. The website still says that vaccines do not cause autism.
But late last year, new statements sprung up on the same webpage, baselessly casting doubt on vaccine safety. “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism,” the now misleadingly reads.
The webpage also states that the public has largely ignored studies showing vaccines do cause autism.
That is false. Over decades of research, scientific studies have repeatedly concluded that there is no link between vaccines and autism.
A controversial 1998 study that captured global attention did link the measles, mumps, and rubella vaccine to autism. It was retracted for being fraudulent — though not until a decade after it was published, during which there were sharp declines in U.S. vaccination rates.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/health-industry/rfk-jr-robert-kennedy-vaccines-broken-promises-senators-cassidy/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2153482&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>“There are enough reports of it, enough interest in it, that we actually did 鈥 ivermectin, in particular 鈥 did engage in sort of a better preclinical study of its properties and its ability to kill cancer cells,” said Anthony Letai, a physician the Trump administration appointed as NCI director in September.
Letai did not cite new evidence that might have prompted the institute to research the effectiveness of the antiparasitic drug against cancer. The drug, largely used to treat people or animals for infections caused by parasites, is a popular dewormer for horses.
“We’ll probably have those results in a few months,” Letai said. “So we are taking it seriously.”
He spoke about ivermectin at a Jan. 30 event, “Reclaiming Science: The People’s NIH,” with National Institutes of Health Director Jay Bhattacharya and other senior agency officials at Washington, D.C.’s Willard Hotel. The MAHA Institute hosted the discussion, framed by the “Make America Healthy Again” agenda of Health and Human Services Secretary Robert F. Kennedy Jr. The National Cancer Institute is the largest of the NIH’s 27 branches.
During the covid pandemic, ivermectin’s popularity surged as fringe medical groups promoted it as an effective treatment. it isn’t effective against covid.
Ivermectin has become a symbol of resistance against the medical establishment among MAHA adherents and conservatives. Like-minded commentators and wellness and other online influencers have hyped 鈥 without evidence 鈥 ivermectin as a miracle cure for a host of diseases, including cancer. Trump officials have pointed to research on ivermectin as an example of the administration’s receptiveness to ideas the scientific establishment has rejected.
“If lots of people believe it and it’s moving public health, we as NIH have an obligation, again, to treat it seriously,” Bhattacharya said at the event. at Duke University, Bhattacharya recently said he wants the NIH to be “the research arm of MAHA.”
The decision by the world’s premier cancer research institute to study ivermectin as a cancer treatment has alarmed career scientists at the agency.
“I am shocked and appalled,” one NCI scientist said. “We are moving funds away from so much promising research in order to do a preclinical study based on nonscientific ideas. It’s absurd.”
麻豆女优 Health News granted the scientist and other NCI workers anonymity because they are not authorized to speak to the press and fear retaliation.
HHS and the National Cancer Institute did not answer 麻豆女优 Health News’ questions on the amount of money the cancer institute is spending on the study, who is carrying it out, and whether there was new evidence that prompted NCI to look into ivermectin as an anticancer therapy. Emily Hilliard, an HHS spokesperson, said NIH is dedicated to “rigorous, gold-standard research,” something the administration has repeatedly professed.
A preclinical study is an early phase of research conducted in a lab to test whether a drug or treatment may be useful and to assess potential harms. These studies take place before human clinical trials.
The scientist questioned whether there is enough initial evidence to warrant NCI’s spending of taxpayer funds to investigate the drug’s potential as a cancer treatment.
The FDA has approved ivermectin for certain uses in humans and animals. Tablets are used to treat conditions caused by parasitic worms, and the FDA has approved ivermectin lotions to treat lice and rosacea. Two scientists involved in its discovery , tied to the drug’s success in treating certain parasitic diseases.
The FDA that large doses of ivermectin can be dangerous. Overdoses can cause seizures, comas, or death.
Kennedy, supporters of the MAHA movement, and some conservative commentators have promoted the idea that the government and pharmaceutical companies quashed ivermectin and other inexpensive, off-patent drugs because they’re not profitable for the drug industry.
“FDA’s war on public health is about to end,” Kennedy wrote in an that has since gone viral. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”
Previous laboratory that ivermectin could have anticancer effects because it promotes cell death and inhibits the growth of tumor cells. “It actually has been studied both with NIH funds and outside of NIH funds,” Letai said.
However, there is no evidence that ivermectin is safe and effective in treating cancer in humans. from a small clinical trial that gave ivermectin to patients with one type of metastatic breast cancer, in combination with immunotherapy, found no significant benefit from the addition of ivermectin.
Some physicians are concerned that patients will delay or forgo effective cancer treatments, or be harmed in other ways, if they believe unfounded claims that ivermectin can treat their disease.
“Many, many, many things work in a test tube. Quite a few things work in a mouse or a monkey. It still doesn’t mean it’s going to work in people,” said Jeffery Edenfield, executive medical director of oncology for the South Carolina-based Prisma Health Cancer Institute.
Edenfield said cancer patients ask him about ivermectin “regularly,” mostly because of what they see on social media. He said he persuaded a patient to stop using it, and a colleague recently had a patient who decided “to forgo highly effective standard therapy in favor of ivermectin.”
“People come to the discussion having largely already made up their mind,” Edenfield said.
“We’re in this delicate time when there’s sort of a fundamental mistrust of medicine,” he added. “Some people are just not going to believe me. I just have to keep trying.”
by clinicians at Cincinnati Children’s Hospital Medical Center in Ohio detailed how an adolescent patient with metastatic bone cancer started taking ivermectin “after encountering social media posts touting its benefits.” The patient 鈥 who hadn’t been given a prescription by a clinician 鈥 experienced ivermectin-related neurotoxicity and had to seek emergency care because of nausea, fatigue, and other symptoms.
“We urge the pediatric oncology community to advocate for sensible health policy that prioritizes the well-being of our patients,” the clinicians wrote.
The lack of evidence about ivermectin and cancer hasn’t stopped celebrities and online influencers from promoting the notion that the drug is a cure-all. On a January 2025 episode of Joe Rogan’s podcast, actor Mel Gibson claimed that a combination of drugs that included ivermectin cured three friends with stage 4 cancer. The episode has been viewed more than 12 million times.
Lawmakers in a handful of states have made the drug available over the counter. And Florida 鈥 which, under Republican Gov. Ron DeSantis, has become a and the spread of public health misinformation 鈥 announced last fall that the state plans to fund research .
The Florida Department of Health did not respond to questions about that effort.
Letai, previously a Dana-Farber Cancer Institute oncologist, started at the National Cancer Institute after caused by Trump administration policies.
“What you’re hearing at the NIH now is an openness to ideas 鈥 even ideas that scientists would say, 鈥極h, there’s no way it could work’ 鈥 but nevertheless applying rigorous scientific methods to those ideas,” Bhattacharya said at the Jan. 30 event.
A second NCI scientist, who was granted anonymity due to fear of retaliation, said the notion that NIH was not open to investigating the value of off-label drugs in cancer is “ridiculous.”
“This is not a new idea they came up with,” the scientist said.
Letai didn’t elaborate on whether NCI scientists are conducting the research or if it has directed funding to an outside institution. Three-quarters of the cancer institute’s research dollars go to outside scientists.
He also aimed to temper expectations.
“At least on a population level,” Letai said, “it’s not going to be a cure-all for cancer.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/health-industry/ivermectin-cancer-treatment-nih-study-dewormer-offlabel-drug/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2152756&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>Republicans have hitched themselves to the “Make America Healthy Again” campaign, banking on its popularity to give them an electoral bounce. But the strategy carries risks.
Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist who rails against Big Pharma and ultraprocessed food, is the leader of the movement. And Americans’ .
Plus, polls show about reducing health care costs than MAHA priorities such as ending vaccine mandates and promoting raw milk.
Enhanced Affordable Care Act subsidies expired at the end of 2025, fueling a nationwide affordability debate. Roughly 24 million people buy coverage on the Affordable Care Act marketplaces, and many are now facing premium payments more than double what they faced last year.
After taking a political back seat in recent years, health care may dominate the 2026 election races.
Credits
This <a target="_blank" href="/health-care-costs/watch-video-make-america-healthy-again-maha-maga-rfk-explainer/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2152344&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>The daylong, invitation-only event in November featured a who’s who of MAHA luminaries. Vice President JD Vance attended, as did Health and Human Services Secretary Robert F. Kennedy Jr., the leader of the ad hoc movement whose members rail against vaccines, Big Pharma, and ultraprocessed food.
During a that organizers broadcasted online, Vance extolled MAHA’s impact on the Trump administration, calling it “a critical part of our success in Washington.”
The summit underscored just how closely Republicans have hitched themselves to the MAHA campaign, banking on its popularity to give them an electoral bounce in the midterms. But the strategy carries risks, because is cratering and polls show about reducing health care costs than MAHA priorities such as ending vaccine mandates and promoting raw milk.
“Polls show clearly MAHA issues are not the top issues for people,” said , a professor emeritus of health policy and political analysis at Harvard University. “The top health care voting issue is cost, and costs are actually rising.”
The disconnect was on display Nov. 12, the day of the , where attendees picked up swag bags and mingled amid the hotel’s blue-velvet couches and crystal chandeliers.
A few blocks away at the White House, President Donald Trump that day to reopen the federal government. The centered on disagreement over expiring Affordable Care Act subsidies, which Democrats wanted to extend and GOP congressional leadership declined to take up. The government went back to business and, in the midst of a political and legislative , those subsidies expired at the end of 2025. That has fueled the national affordability debate, as many of the roughly 24 million people who buy coverage on the health law’s marketplaces are now facing premium payments more than double what they faced last year. In January, with what has emerged as a key kitchen table issue.
Said Blendon: “MAHA is not lowering the cost.”
MAHA was mainstreamed as part of the political platform embraced by Kennedy, an environmental lawyer and anti-vaccine activist who ran for president in 2023 and 2024. When he suspended his campaign and endorsed Trump, Kennedy united MAHA with conservatives, marrying the “health freedom” movement with MAGA.
But the movement took root before then, during the covid pandemic, grounded in the idea that the U.S. is in the throes of a chronic disease epidemic caused by corruption in the food, medical, and pharmaceutical industries, as well as federal agencies. Some adherents also are skeptical of or opposed to vaccines.
“Covid was really eye-opening for people,” said Andrea Nazarenko, a psychologist and MAHA supporter who co-authored a . “They realized, 鈥榃ait a minute 鈥 the systems I trusted may not be as trustworthy as I thought.’ At its core, people are noticing the systems they relied on are failing them.”
MAHA has since emerged as an influential force for the GOP, gaining significant clout in a short time. Case in point: Early this month, Kennedy announced and updated , which were both part of the movement’s wish list and departures from existing frameworks.
In addition, members of Congress have founded a MAHA caucus. Lawmakers in Republican-led states are introducing or passing legislation to advance the MAHA agenda, including laws to restrict mRNA vaccines or in food. And food manufacturers including Nestle, General Mills, and Kraft Heinz have pledged to remove artificial dyes or additives.
Republicans see the MAHA constituency as critical in the 2026 midterm elections and beyond. Its supporters include desirable voting demographics 鈥 independents and some Democrats, many of whom are women, younger voters, or suburbanites. About 21% of independent voters and 8% of Democratic voters held a favorable or somewhat favorable view of MAHA as of early fall, according to by Change Research.
“I think one reason I won reelection was that I advocated for the covid-vaccine-injured and was an ally of Bobby Kennedy back then when he was being vilified,” Sen. Ron Johnson (R-Wis.) said. “People appreciated that. It’s about basic health.”
Republicans are counting on a MAHA bounce, and political analysts say they may need it. The party took a drubbing in November’s statewide races, and from 47% in early 2025 to 36% by December, according to Gallup polls. Those are ominous trends for the GOP, since the party with the presidency has lost ground in midterm House elections.
Meanwhile, cracks are starting to threaten the Make America Great Again coalition and the lockstep support Trump has enjoyed from Capitol Hill Republicans. While MAGA shows signs of weakening, MAHA is flourishing.
“Kennedy has ratified the Republican agenda around health and food,” said David Mansdoerfer, who served in HHS leadership during the first Trump administration. “We sound very much like the issues Democrats were into in the 1990s and 2000s. We’ve almost done a 180 and co-opted a topic under a Republican agenda.”
Kennedy is expected to soon check another item off MAHA’s list by pressing states to remove fluoride from the water supply, according to a source who asked to remain anonymous because he isn’t authorized to speak to the media.
But Republicans’ embrace of MAHA in the run-up to the November midterm elections could also cost them, political strategists say.
Polling shows popular support for MAHA initiatives such as ridding food of synthetic dyes, but voters are far less enthusiastic about Kennedy and his denouncements of vaccines and efforts to limit access to them. Almost 60% of adults disapprove of his work as head of HHS, according to by 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News.
And only 26% of registered voters support defunding mRNA vaccine research, according to a by left-leaning pollster Navigator Research. In the same poll, 3 in 4 reported feeling positively toward the measles vaccine.
Still, the Trump administration has its attack on vaccines. The Food and Drug Administration’s top vaccine official in November that the agency would overhaul vaccine regulation, asserting without evidence that at least 10 children had died from covid shots.
In December, a federal vaccine advisory panel handpicked by Kennedy voted to stop recommending routine vaccination of newborns against hepatitis B. Medical groups denounced the panel’s actions, saying the vaccine is safe and that the recommendation would lead to more infections with the virus, which causes serious liver damage.
Democrats see an opening. The Democratic Doctors Caucus, a group of medical doctors in Congress, condemning the federal advisory panel’s changed recommendation on the hepatitis B vaccine, calling it an attack on basic science. And Democratic Reps. Frank Pallone of New Jersey, Diana DeGette of Colorado, and Yvette Clarke of New York demanding data from the agency on the covid death claims.
Highlighting the risks of the Trump administration’s anti-vaccine initiatives is only part of Democrats’ game plan to counter Republicans’ alliance with MAHA.
Strategists describe three aims: Expose GOP policies that run counter to MAHA priorities; trumpet Democrats’ efforts to tackle health care costs; and highlight their own party’s work on such MAHA goals as cracking down on pesticide-makers.
“If people want to be healthier, they need affordable health care, and Democrats are the only ones pushing for affordable health care,” said , communications director for the House Majority PAC, a fundraising group that works to elect more Democrats.
Most notably, the strategy so far hasn’t really involved attacks on Kennedy or MAHA itself.
“If Democrats focus on attacking Kennedy, saying he’s crazy and he has a brain worm, some voters hear that as reinforcing the notion that Democrats are wedded to Big Pharma and Big Ag,” said , a senior adviser at the Center for Economic and Policy Research, a progressive nonprofit focused on economic policy.
So Democrats will talk about their continuing fight to address health care costs, such as with a possible retroactive fix to the now-expired ACA subsidies, or by Sen. Cory Booker (D-N.J.) to prevent pesticide manufacturers from getting legal immunity against health claims. And they plan to discuss Trump administration actions that seemingly run counter to the MAHA agenda, such as a decision by the Environmental Protection Agency to relax the of the carcinogen formaldehyde.
“Everything they’re doing actually makes people sicker with higher bills, dirtier air, and fewer people covered with insurance,” said , a Democratic strategist. “Democrats do need to take MAHA seriously and can’t brush it off. The core is to show Democrats are focused on health and health care and exposing what the Republican agenda means.”
For Republicans, the next batch of MAHA events and summits is already scheduled. After taking a political back seat in recent years, health care may dominate the 2026 election races.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/health-care-costs/maha-midterms-gop-strategy-health-rfk-vaccines-ultraprocessed-food/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2141937&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>Just three of those that the Centers for Disease Control and Prevention says it will no longer routinely recommend 鈥 against hepatitis A, hepatitis B, and rotavirus 鈥 have prevented nearly 2 million hospitalizations and 90,000 deaths in the past 30 years, according to .
Federal and private insurance .
Experts on childhood disease were baffled by the change, which the Department of Health and Human Services said followed “a scientific review of the underlying science.”
The vaccines are “held to a safety standard higher than any other medical intervention that we have,” said , a pediatric infectious disease specialist at the Children’s Hospital of Philadelphia. “The value of routine recommendations is that it really helps the public understand that this has been vetted upside down and backwards in every which way.”
Public health officials say the guidance puts the onus on parents to research each vaccine and its importance. Here’s what they prevent:
RSV. Respiratory syncytial virus is the most common cause of hospitalization for infants in the U.S. It spreads in fall and winter, producing cold-like symptoms and causing tens of thousands of hospitalizations and hundreds of deaths yearly.
Hepatitis A. Hepatitis A vaccination, recommended for all toddlers since 2006, has led to a more than 90% drop in the disease since 1996. The foodborne virus, which causes a wretched illness, still plagues adults, particularly people who are homeless or abuse drugs or alcohol, with reported in 2023.
Hepatitis B. The disease causes liver cancer, cirrhosis, and other serious illnesses and is particularly dangerous when contracted by babies and young children. The hepatitis B virus is transmitted through blood and other bodily fluids, even in microscopic amounts, and can survive on surfaces for a week. From 1990 to 2019, vaccination resulted in a 99% decline in reported cases of acute hepatitis B among children and teens. Liver cancer among American children also plummeted with universal childhood vaccination.
Rotavirus. Before routine administration of the current rotavirus vaccines began in 2006, 70,000 young children were hospitalized and 50 died yearly from the virus, known as “winter vomiting syndrome,” said Sean O’Leary, a University of Colorado pediatrician. “It was a miserable disease that we hardly see anymore.”
Meningococcal disease.聽About 600 to 1,000 U.S. cases of meningococcal disease聽are reported聽yearly, killing more than 10% of those it sickens and聽leaving聽1 in 5 survivors聽with a聽disability.聽
Flu. The virus has killed hundreds of children in recent years, though it tends to be much more severe in older adults.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/public-health/the-week-in-brief-cdc-childhood-vaccine-recommendations/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=2140541&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>More children would be hospitalized because of this preventable disease. Some would lose their hearing. Some would die. Measles is also expensive. A 鈥 not yet published in a scientific journal 鈥 estimates that the public health response to outbreaks with only a couple of cases costs about $244,000. When a patient requires hospital care, costs average $58,600 per case. The study’s estimates suggest that an outbreak the size of the one in West Texas earlier this year, with 762 cases and 99 hospitalizations, costs about $12.6 million.
America’s status hinges on whether the country’s main outbreaks this year stemmed from the big one in West Texas that officially began Jan. 20. If these outbreaks are linked, and go on through Jan. 20 of next year, the U.S. will no longer be among nations that have banished the disease.
“A lot of people worked very hard for a very long time to achieve elimination 鈥 years of figuring out how to make vaccines available, get good vaccine coverage, and have a rapid response to outbreaks to limit their spread,” said Paul Rota, a microbiologist who recently retired from a nearly 40-year career at the Centers for Disease Control and Prevention.
Instead of acting fast to prevent a measles comeback, Robert F. Kennedy Jr., a lawyer who founded an anti-vaccine organization before taking the helm at the Department of Health and Human Services, has undermined the ability of public health officials to prevent and contain outbreaks by eroding trust in vaccines. The measles vaccine is safe and effective: Only confirmed U.S. cases of measles this year have been in people who had received two doses.
Kennedy has fired experts on the vaccine advisory committee to the CDC and has said, without evidence, that vaccines may cause autism, brain swelling, and death. On Nov. 19, scientific information on a CDC webpage about vaccines and autism was replaced with false claims. Kennedy that he ordered the change.
“Do we want to go back into a prevaccine era where 500 kids die of measles each year?” asked Demetre Daskalakis, a former director of the CDC’s national immunization center, who resigned in protest of Kennedy’s actions in August. He and other scientists said the Trump administration appears to be occupied more with downplaying the resurgence of measles than with curbing the disease.
HHS spokesperson Andrew Nixon said in a statement that vaccination remains the most effective tool for preventing measles and that the “CDC and state and local health agencies continue to work together to assess transmission patterns and ensure an effective public health response.”
Looking for Links
CDC scientists are indeed tracking measles, alongside researchers at health departments and universities. To learn whether outbreaks are linked, they’re looking at the genomes of measles viruses, which contain all their genetic information. Genomic analyses could help reveal the origin of outbreaks and their true size, and alert officials to undetected spread.
Scientists have conducted genomic analyses of HIV, the flu, and covid for years, but it’s new for measles because the virus hasn’t been much of a problem in the U.S. for decades, said Samuel Scarpino, a public health specialist at Northeastern University in Boston. “It’s important to get a surveillance network into place so that we could scale up rapidly if and when we need it,” he said.
“We are working with the CDC and other states to determine whether what we’re seeing is one large outbreak with continued spread from state to state,” said Kelly Oakeson, a genomics researcher at the Utah Department of Health and Human Services.
At first glance, the ongoing outbreak in and , with 258 cases as of Dec. 1, seems linked to the one in Texas because they’re caused by the same strain of measles, D8-9171. But this strain is also spreading throughout Canada and Mexico, which means the outbreaks could have been sparked separately from people infected abroad. If that happened, this technicality could spare the U.S. from losing its status, Rota said. Being measles-free means the virus isn’t circulating in a country continuously year-round.
Canada lost its measles-elimination status in November because authorities couldn’t prove that various outbreaks from the D8-9171 strain were unrelated, said Daniel Salas, executive manager of the comprehensive immunization program at the Pan American Health Organization. The group, which works with the World Health Organization, includes health officials from countries in North, South, and Central America, and the Caribbean. It makes a call on measles elimination based on reports from scientists in the countries it represents.
Early next year, PAHO will hear from U.S. scientists. If their analyses suggest that measles has spread continuously for a year within the U.S., the organization’s director may revoke the country’s status as measles-free.
“We expect countries to be transparent about the information they have,” Salas said. “We will ask questions, like, 鈥楬ow did you determine your findings, and did you consider other angles?’”
In anticipation of PAHO’s assessment, Oakeson and other researchers are studying how closely the D8-9171 strains in Utah match others. Instead of looking at only a short snippet of genes that mark the strain, they’re analyzing the entire genome of the measles virus, about 16,000 genetic letters long. Genetic mutations occur naturally over time, and the accumulation of small changes can act like a clock, revealing how much time has ticked by between outbreaks. “This tells us the evolutionary history of samples,” Oakeson said.
For example, if one child directly infects another, the kids will have matching measles viruses. But measles viruses infecting people at the start of a large outbreak would be slightly different than those infecting people months later.
Although the Texas and Utah outbreaks are caused by the same strain, Oakeson said, “more fine-grained details are leading us to believe they aren’t super closely related.” To learn just how different they are from each other, scientists are comparing them with measles virus genomes from other states and countries.
Ideally scientists could pair genetic studies with shoe-leather investigations into how each outbreak started. However, many investigations have come up dry because the first people infected haven’t sought care or contacted health departments. As in West Texas, the outbreak in Utah and Arizona is concentrated in close-knit, undervaccinated communities that are leery of government authorities and mainstream medicine.
Researchers are also trying to learn how many measles cases have gone undetected. “Confirmed cases require testing, and in some communities, there’s a cost to going to the hospital to get tested: a tank of gas, finding a babysitter, missing work,” Andrew Pavia, an infectious disease doctor at the University of Utah, said. “If your kid has a measles rash but isn’t very sick, why would you bother?”
Subtle Surveillance
Pavia is part of a nationwide led by the CDC. A straightforward way to figure out how large an outbreak is would be through surveys, but that’s complicated when communities don’t trust public health workers.
“In a collaborative setting, we could administer questionnaires asking if anyone in a household had a rash and other measles symptoms,” Pavia said, “but the same issues that make it difficult to get people to quarantine and vaccinate make this hard.”
Instead, Pavia and other researchers are analyzing genomes. A lot of variation suggests an outbreak spread for weeks or months before it was detected, infecting many more people than known.
A less intrusive mode of surveillance is through wastewater. This year, the CDC and state health departments have launched efforts to test sewage from households and buildings for measles viruses that infected people shed. A found that this could function as an early warning system, alerting public health authorities to an outbreak before people show up in hospitals.
The quiet research of CDC scientists stands in stark contrast to its dearth of public-facing actions. The CDC hasn’t held a single press briefing on measles since President Donald Trump took office, and its last publication on measles in the agency’s Morbidity and Mortality Weekly Report was in April.
Rather than act fast to limit the size of the Texas outbreak, the Trump administration impeded the CDC’s ability to communicate quickly with Texas officials and slowed the release of federal emergency funds, according to investigations by 麻豆女优 Health News. Meanwhile Kennedy on vaccines .
Daskalakis said that as the outbreak in Texas worsened, his CDC team was met by silence when they asked to brief Kennedy and other HHS officials.
“Objectively they weren’t helping with the Texas outbreak, so if we lose elimination, maybe they’ll say, 鈥榃ho cares,’” Daskalakis said.
Nixon, the HHS spokesperson, said Kennedy responded strongly to the Texas outbreak by directing the CDC to help provide measles vaccines and medications to communities, expediting measles testing, and advising doctors and health officials. The U.S. retains its elimination status because there’s no evidence of continuous transmission for 12 months, he added.
“Preliminary genomic analysis suggests the Utah and Arizona cases are not directly linked to Texas,” the CDC’s acting director, Deputy HHS Secretary Jim O’Neill, .
Given Kennedy’s distortions of data on vitamin A, Tylenol, and autism, Daskalakis said the Trump administration may insist that outbreaks aren’t linked or that PAHO is wrong.
“It will be quite a stain on the Kennedy regime if he is the health secretary in the year we lose elimination status,” he said. “I think they will do everything they can to cast doubt on the scientific findings, even if it means throwing scientists under the bus.”
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