Field: Vaccine fatigue has caused flu vaccination rates to fall slightly
Emily Field, Barclays head of European pharma research, discusses RFK Jr.'s call to overhaul the CDC vaccine panel, vaccine skepticism, and the impact on stocks like Merck amid new RSV vaccine approvals.
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Vox
an hour ago
- Vox
RFK Jr.‘s mass firing of the government's vaccine experts, explained
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. For the past 60 years, a committee of independent experts has advised the federal government on vaccine policy, providing guidance on which shots people should get and when. Government public health officials have almost always followed the panel's recommendations, all but making it the final word on public health policy in the US for most of its existence. And over those decades, the United States has made tremendous health gains over that time through mass vaccination campaigns. But on Monday, Health Secretary Robert F. Kennedy Jr. fired every sitting member of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), a move that stunned doctors and scientists across the country. And it means that the CDC's days as the clear and unchallenged authority on US vaccine policy appear numbered. 'Up until today, ACIP recommendations were the gold standard for what insurers should pay for, what providers should recommend, and what the public should look to,' Noel Brewer, a health behavior professor at the University of North Carolina, who was a member of the panel until this week, told the Associated Press. 'It's unclear what the future holds.' Today, Explained Understand the world with a daily explainer plus the most compelling stories of the day, compiled by news editor Sean Collins. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. New committee members will be announced at some point, but as of Tuesday morning, even top US senators did not know who the replacements would be. The panel is supposed to hold one of its periodic public meetings in late June to discuss the Covid-19 vaccine, as well as shots for RSV and HPV, among others. This is a watershed moment in US public health, one that seems sure to sow confusion among patients and health care providers. The deepening divide between Kennedy's Make American Healthy Again (MAHA) movement and mainstream medicine could make it harder for people who want vaccines to get them, while encouraging more doubt about the value and safety of shots among the general public. Here's what you need to know. Why is Kennedy doing this? The vaccine advisory committee was first convened by the surgeon general in 1964, but it is not enshrined in federal law. That means that Kennedy — as the top official at the US Department of Health and Human Services, which contains the CDC — can change its membership or dissolve the panel entirely if he so desires. Kennedy framed his decision to clear out the members as necessary to restore public trust in the government's vaccine recommendations. In a Wall Street Journal op-ed, Kennedy asserted the committee 'has been plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine.' As health secretary, he has made overhauling vaccine policy a centerpiece of his agenda, both through his rhetoric and policy. Over the past few months, while the worst measles outbreak in 30 years has spread through the US, Kennedy has equivocated in public comments on the value of the measles vaccine, which doctors say is far and away the best tool to combat the disease. He directed an anti-vaccine researcher to scour federal data for evidence of a vaccine-autism link. His department's recent MAHA report on childhood chronic disease named vaccines as one example of how the US overmedicalizes its children and exposes them to artificial agents that could do harm to their body. Then in late May, Kennedy oversaw a revision of the federal government's Covid-19 vaccine guidance, limiting the shots to elderly people and those who are immunocompromised. He ended the recommendation that pregnant women and kids get a Covid vaccine shot, even though studies have shown they help confer immunity to infants, who are at a higher risk from the virus and cannot be vaccinated until they are 6 months old. The move plainly circumvented ACIP's accepted role in setting vaccine policy, presaging this week's mass firing. Whatever his intentions, Kennedy's gutting of the federal vaccine committee seems likely to sow even more distrust — and certainly more confusion. People are reasonably left to wonder whether they can trust forthcoming CDC guidance on vaccines, and just what vaccines they'll be able to get. How will I know which vaccines to get? In the past, ACIP would typically meet a few times a year to discuss any additions or changes to the country's vaccine schedule. Their recommendations have usually been adopted without alterations by the CDC director, and then became the standard for state and local health departments across the country. Importantly, most health plans are required to cover any shots that the committee recommends. Now there is far more uncertainty. Will doctors follow the CDC guidance, even if it changes under a new advisory panel staffed by Kennedy loyalists, or will they stick with the earlier vaccine schedule? Will health insurance plans cover the cost of a vaccine that professional medical organizations support but the CDC does not? Once-unthinkable questions could soon be something doctors and patients must deal with every day. Some doctors already believed, before the firings at ACIP, that the CDC was no longer trustworthy under Kennedy's leadership; his unilateral change to the Covid vaccine guidance in May was enough to convince them. In a media call last week, experts from the Infectious Disease Society of America urged patients and providers in the short term to consult with professional medical societies — not the CDC — on vaccine recommendations. They considered those groups, as well as guidance from European health authorities, the best substitutes we currently have for information on vaccines if the CDC's recommendations can no longer be taken at face value. 'It's been a confusing several days, confusing last two weeks, and I'm not sure that confusion is going to be abated in the near future,' John Lynch, an infectious disease doctor at the University of Washington, said on the call. 'These are evidence-based guidelines developed by experts in the field using transparent methods and published publicly,' Lynch said. Kennedy, in explaining his change to the Covid vaccine guidelines, said he wanted to encourage shared decision-making between providers and their patients. The CDC guidance would be only one consideration in the decision whether to vaccinate, rather than a firm recommendation. The doctors from the IDSA said that such conversations are already to be considered best practice among physicians — and noted Kennedy's undermining of trust in the federal vaccine policy would now make them more important. 'I would just emphasize the need to have a good source of information when this situation occurs. If indeed shared decision making is going to occur, we always do our research,' Dr. Flor Muñoz-Rivas at Baylor College of Medicine said. 'But go to the proper sources.' What are the long-term risks? There is a lot we don't know right now: Who will be named to the new panel? Will they change existing vaccine recommendations? Will they approve new ones? But the experts warned that Kennedy's rhetoric alone risks undermining people's confidence in vaccinations. 'All health care decisions are shared decision-making; this is not a special concept that's only rolled out for conversations like vaccination,' Lynch said on the IDSA call. 'As an infectious disease doctor, when I talk to a patient about treatment or diagnostics, it is a conversation. It is shared decision-making.' Kennedy has quickly disrupted decades of public health consensus. Anyone who watched the sometimes contentious ACIP meetings during the pandemic saw the members grappling with genuinely vexing questions about who should be prioritized for vaccination in a public health emergency. The pandemic featured rare examples of Biden CDC director Rochelle Walensky overruling the panel in certain cases in which the experts actually recommended against more vaccinations. (Walensky said she overrode the guidance to align the CDC with a separate recommendation from the FDA's advisory committee, and cited the narrow 9-6 vote against the recommendation.) Those scenes should have helped dispel the notion that they were acting as a rubber-stamp for any new shot Big Pharma produced. But the nation's top health official is now telling Americans that they should never have trusted the ACIP, which risks pushing more people to skip routine immunization. Shortly after the country declared measles eradicated in 2000, 94 percent of adults said childhood immunizations were extremely or very important. But that consensus has since weakened: 69 percent of Americans said the same in 2024. If changing opinion leads to declining vaccination rates, diseases that we successfully stamped out through vaccines to rebound — which is exactly what we are seeing now with measles. The US is experiencing its highest number of measles cases since the 1990s, nearing 1,200 as of this writing. One outbreak that accounts for most of those cases took off in a small Texas community where vaccination rates had fallen far below the 95-percent threshold that is considered necessary to stop the virus's spread. Other knock on effects could hurt Americans who still want to get vaccinated. Pharma companies, the target of so much of Kennedy's criticism, could decide to stop pursuing new vaccines if they believe the federal government will limit access as much as possible, shrinking the world's biggest pharmaceutical market. Vaccines are not big moneymakers for drug companies, and they have often relied on the US government's support to develop new ones. Kennedy, however, has canceled major vaccine development contracts during his first few months as health secretary, including a $700 million contract with Moderna, one of two companies that produced the mRNA Covid vaccines, to work on a universal flu shot. Kennedy has quickly disrupted decades of public health consensus. For now, the best reaction is, oddly enough, for patients and providers to take him at his word when he says people should not take medical advice from him — and make their own decisions in collaboration with their doctors.
Medscape
an hour ago
- Medscape
Real Life Simulations: Mass Casualty Training in Med School
Anyone who watched television show The Pitt on Max knows how overwhelming a mass casualty event can be for a hospital. Preparation is key, and accredited hospitals are required to hold training exercises. But these incidents don't only affect physicians in the Emergency Department. The random nature of mass shootings, natural disasters, multi-car pileups, building collapses, and the like means an all-hands-on-deck situation could happen at any time. An increasing number of medical schools see the value in preparing their students early. 'Unfortunately this is where the world is going. We need to rely on ourselves because help may not be coming,' said Jeffrey Pearl, MD, associate dean of professional health education at the University of Texas (UT) at Tyler School of Medicine. 'In the end, the first line is going to be one of us picking someone out of the rubble from a tornado and putting a tourniquet on.' Unfortunately this is where the world is going. We need to rely on ourselves because help may not be coming. More than 20 years ago, the Associations of American Medical Colleges and the CDC issued a joint report recommending disaster-related training for medical students. It's still a relatively rare offering — by 2021, only seven allopathic medical schools in the US mentioned disaster response training in their course catalogs. But just 2 years later, that number had more than doubled. Roughly 10% of allopathic medical schools now offer it, as do a number of osteopathic medical schools. 'I think the best part is, it gives you perspective as to what goes on out in the field,' said Joshua Goodman, a rising fourth-year medical student at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. He's participated in the school's annual training day more than once. 'Even in non-MCI situations, you might wonder why the patient is being brought in in this condition. Why didn't they do this? Why didn't they do that? This gives you a better understanding of what it's really like out there, so you know what to expect and can act on it.' Different Approaches to the Same Concept In order to prepare their students for an unpredictable future, medical schools take a variety of tacks. At some schools, all students undergo this training. At others, it's voluntary. Scenarios include bus bombings, school shootings, landslides, and the like. Often, they're location-specific, like the New York City subway car used in Hofstra's training, done at the local fire training academy. 'They fill it with smoke, and have students come in to rescue patients,' said Thomas Kwiatkowski, MD, assistant dean for simulation and professor of emergency medicine and science education at Hofstra. 'Some victims speak a different language, which is typical for New York City. It really challenges the students.' The variations don't stop there: At both UT Tyler and Hofstra, all first-year medical students complete a full emergency medical technician course. It concludes with a mass casualty simulation, which provides the chance to really practice the skills they've just learned. 'We didn't just want them to ride along in an ambulance,' Kwiatkowski said. 'That's not going to provide anything more than observation. I wanted a true clinical experience.' A presentation on FEMA's National Incident Management System kicks off the day at Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio. Students then move on to training with emergency equipment like cervical collars and backboards. But the bulk of the day is spent at the local fire department's training center for a hands-on simulation. Training at Perelman School of Medicine, University of Pennsylvania, Philadelphia, is part of a popular 2-week elective in wilderness and disaster medicine. Medical students learn to handle scenarios including avalanches, dirty bombs, and chemical weapons. At Idaho College of Osteopathic Medicine, Meridian, Idaho, training has included a simulated music festival gone awry as well as a multi-vehicle accident. College of Osteopathic Medicine, University of New England, Portland, Maine, has held four annual mock events. Last year's program focused on the lessons learned in the 2023 mass shooting in nearby Lewiston. Investing in Realism Limited research has been done to show exactly how realistic simulations should be, but there is some that suggests the more accurately a scenario reflects real life, the more students can benefit from it. Depending on a medical school's budget, things can get quite realistic, indeed. For many, it includes going off-site to a training ground, where students must triage realistic victims even as they experience the chaos of an actual event. 'When they walk into a burn tower knowing that there's been an explosion, and they hear people screaming out and they can't see much, it's an environment that probably causes their heart rate to go up a little bit, perhaps their respiratory rate to go up a little bit,' said William Burke, DO, dean of Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio. 'I think those types of situations help you better understand, as an individual, how you might respond in real life.' William Burke, DO For the simulations' victims, most schools use a combination of mannequins and volunteers — either locals or other medical students. Often, moulage artists are brought in to apply special-effects makeup. At UT Tyler, a relatively new school, Pearl had a sizable budget to design the mass casualty training program. Faculty works with campus and local law enforcement, fire department and emergency medical services, and even the Federal Bureau of Investigation to make the event feel as real as possible for students. High-tech wound simulation includes three-dimensional printed shrapnel mounted on silicone patches that are easily applied to volunteers' bodies; bleeding systems that pump fake blood; two cut suits of repairable skin with organs that bleed — which can be operated on while actors wear them; and several mannequins with realistic injuries. A significant amount of effort goes into creating thoughtful, plausible scenarios. A school shooting is part of the simulation at Hofstra. 'The way they set it up is hyper realistic, in that you have real police officers acting, there's a lot of yelling, it's dark, there's a lot of banging on doors. It's frankly a little bit scary,' Goodman, the medical student, said. 'You really do feel like you're in a school and you have to hide but you also have to triage: Who can we get out? How are we going to get them out? Is it safe to open the door?' Decisions Under Pressure Whatever the scenario, the goal in all these simulations is the same: To help medical students learn to make life-or-death decisions quickly, under extreme circumstances. 'The first minute or two, they're a little shell shocked. After that, it's like watching your children grow up,' Pearl said. 'These are first- and second-year med students, and they're rocking and rolling.' Thomas Kwiatkowski, MD During the exercises, they must triage victims into color-coded categories. Yes, just like in The Pitt : Green goes to the walking wounded, those who need minimal help. Yellow indicates a more serious injury, but not immediately life-threatening. Red means a victim has severe injuries, but with a high potential for survival. Victims designated with a black mark are either deceased or have injuries incompatible with life. 'It's very difficult when you have to make that decision,' Kwiatkowski said. 'There are a couple of maneuvers that people do before they can decide to make someone black, but sometimes you can have someone who's talking to you, and you know that you can't save them. That's an important experience for students.' Other ethical considerations also play out. During some simulations, for instance, a school shooter is still active. Students must decide how to help children while staying safe themselves, or if and when it's worth it to risk their own lives. At Ohio University, one situation involves a bombing. Unbeknownst to the students, the bomber is among the victims. 'Students are turning victims over and see the person playing the bomber has another bomb underneath them,' Burke said. 'It helps them understand the ethics of the situation: Do you treat them the same? The answer is yes, you take care of everybody. When you ask those questions, students are thinking about things in ways they've never had to before.'
Axios
an hour ago
- Axios
Vaccine board purge stokes talk of CDC alternatives
By gutting the expert panel that's advised the government on vaccine policy for more than 60 years, Health Secretary Robert F. Kennedy Jr. earned the condemnation of virtually every medical society, as well as former public health officials and local practitioners. What became immediately clear is that no outside group can immediately step in and fill the vacuum if the public won't trust the reconstituted Advisory Committee on Immunization Practices. The big picture: The distress and lack of organization apparent in health circles on Tuesday was a sign that a new independent body that could act as a "shadow CDC" to truth-squad the Trump administration isn't close to materializing. "We are clearly working on it and we think it's very important, but I don't think anyone has an answer yet," said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, who's behind one ad hoc effort. "Right now, we're in such uncharted territory." The medical establishment has floated ideas such as state-appointed boards or medical specialty associations serving as clearinghouses for information on vaccine safety and efficacy for clinicians. California Gov. Gavin Newsom (D) during the pandemic created a state entity to review the safety of federally approved COVID-19 vaccines before distributing them to the public. But it would be difficult to replicate the professional clout of ACIP, whose recommendations can influence whether insurers cover vaccines. That would leave Kennedy's handpicked successors controlling the narrative — a prospect many researchers and physicians think will bring a radical departure from ACIP's evidence-based deliberations on safety and efficacy. Friction point: Kennedy and other Trump health officials' assertions that ACIP has been a rubber stamp for vaccines have infuriated public health officials, who say the physicians, infectious disease experts and researchers constituted a vital body of nongovernmental health leaders who took their jobs seriously. Panel members were carefully vetted for conflicts and had their professional credentials scrutinized. Discussions took place in a high-profile public forum that would be difficult, if not impossible, to replicate. "Many of us can provide a read of the science, and we can convene formally or informally to create consensus around vaccine recommendations," said Megan Ranney, dean of the Yale School of Public Health. "But I suspect that it won't be sufficient for insurers, for Medicaid, for the Vaccines for Children program, and it's unclear how pediatricians and primary care physicians and pharmacies across the country are going to be able to respond," she said. The other side: Kennedy wrote on X Tuesday night that he would announce new ACIP members in the coming days. "None of these individuals will be ideological anti-vaxxers. They will be highly credentialed physicians and scientists," Kennedy wrote. He added he would detail instances of "historical corruption at ACIP to help the public understand why this clean sweep was necessary. "Kennedy cited the panel's "stubborn unwillingness to demand adequate safety trials before recommending new vaccines for our children" as the most "outrageous example." What to watch: All eyes are on the new appointees for the board, including their scientific backgrounds, track records when it comes to defending vaccines and any potential conflicts of interest. HHS has indicated it has every intention of moving forward with ACIP's next meeting, scheduled for June 25-27. The agenda includes recommendation votes for COVID–19, HPV, influenza, meningococcal and RSV vaccines. "If nothing else, I think [the committee] may have trouble functioning because you've just lost a whole lot of institutional memory," said Adam Ratner, a member of the American Academy of Pediatrics' Committee on Infectious Diseases. "That agenda has the committee voting on real things that matter to real people, and I don't know how they're possibly going to do that in any kind of way that is based on science or evidence," he said.
