RFK Jr.‘s mass firing of the government's vaccine experts, explained

Vox

a day ago

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.'
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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.