‘Uncharted territory’: uncertainty as US vaccine guidance falls apart under Trump | Trump administration
Many vaccines have lost a recommendation from the US Centers for Disease Control and Prevention (CDC) after a judge struck down changes made by the Trump administration that could affect access to vaccines in some states. As long as the vaccine committee is stopped, no new vaccine recommendations will be made.
Access to existing vaccines and future development of new vaccines have been increasingly called into question during the second Trump administration, as the now-stalled Advisory Committee on Immunization Practices (ACIP) made controversial recommendations and health officials made unilateral changes to routine vaccinations that would have long-term and global consequences.
Current annual flu and Covid vaccine recommendations are no longer available, and a new vaccine recommendation to protect babies against RSV (respiratory syncytial virus) is also pending. Even as spikes in respiratory viruses are expected, it is unclear whether new vaccines will be recommended in the coming months.
“We could see delays in vaccine updates,” said Jen Kates, senior vice president and director of the Global and Public Health Policy Program at KFF, a nonprofit health policy organization. “We are entering fairly uncharted territory.”
Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services (HHS) and long-time anti-vaxxer. America’s vaccine landscape has been thrown into greater turmoil after hand-picked vaccine advisors by a judge overturned essentially every decision made by the .
US district court judge Brian Murphy ruled to halt the vaccine changes after the American Academy of Pediatrics (AAP) filed a lawsuit challenging the decisions made by both ACIP and direct health officials. Although new vaccine recommendations were not objected to in the case, the postponement appears to include these as well.
“Everything has been thrown out,” said Sarah DesPres, a former adviser to the HHS secretary of public health and science during the Biden administration and an advisor to nonprofits on vaccines.
In addition to recommendations for the latest season’s flu and Covid vaccines, recommendations for Merck’s RSV monoclonal antibodies also ended midway through the RSV season; however, another RSV vaccine, Beyfortus, is still recommended for infants.
Some insurance providers in question DesPres stated that they will continue to cover all recommended vaccines as of September 2025, “but this is a new proposal”, so it is unclear whether insurers will cover it.
The turmoil also has implications for vaccines in development, such as Moderna’s new flu vaccine and Pfizer’s new Lyme vaccine, which has shown promising results in trials.
Although the U.S. Food and Drug Administration (FDA) hasn’t made a decision on Moderna’s new flu vaccine (after initially rejecting the application outright), vaccine advisors generally review data before approval in case they need to make a quick recommendation. Typically, the ACIP working group on the flu vaccine would already be reviewing Moderna’s confidential data, DesPres said.
If the new flu vaccine is approved by the FDA but not recommended by the CDC or ACIP, it’s unclear whether insurance companies (also known as payers) will cover it.
“I don’t know how payers will react to this,” DesPres said.
Professional organizations have bridged this gap to make vaccine recommendations based on publicly available data; However, data on vaccines that are not yet on the market are generally shared confidentially with ACIP.
“When you’re talking about a new vaccine, it becomes a little more challenging because you’re not going to have a lot of data on it,” DesPres said.
There are also questions about whether pharmacists can administer Covid and flu vaccines without current advice. Pharmacists and providers are protected from liability to administer Covid vaccines under the Preparedness Act; however, the vaccines must be recommended by ACIP, so they may not be able to continue administering Covid vaccines with the Preparedness Act protections.
The same obstacle does not exist for the flu vaccine.
“I think the public will have access to flu vaccines, at least existing flu vaccines, as long as payers are willing to pay for it and professional societies can make recommendations,” DesPres said.
‘Confusion has increased’
Approximately 29 states and Washington, D.C., have moved to separate their vaccination processes from the ACIP following the committee’s controversial decisions to end recommendations for certain routine childhood vaccines.
But other states still have laws that adhere to CDC or ACIP recommendations; This means providers and pharmacists cannot administer flu or Covid vaccines. Residents of these states may face difficulties accessing them both now and when the formulations are updated in the fall.
“There’s a lot of uncertainty about this,” Kates said. “We don’t have the answers right now.”
Without a functional ACIP, new recommendations cannot be made for vaccines that are updated each year or for new vaccines coming out of production.
There is no approved or acting director of the CDC who can make recommendations without the committee’s input. Kennedy has the legal authority to sign the recommendations as HHS secretary, but the AAP lawsuit challenged officials’ ability to make unilateral decisions on vaccines.
“Potentially Kennedy could make the recommendation, but it would have to meet what was stated in the court decision,” Kates said.
Health authorities may also ignore the stay. “This administration has certainly done that in other cases where the judge ruled one way and continued to pursue that behavior. So there’s a lot of different ways to go about it,” Kates added.
Last week, the CDC issued a new charter for the ACIP, increasing the committee’s focus on potential vaccine side effects and adding new areas of expertise for members. It has also brought in liaison groups such as the Association of American Physicians and Surgeons, Physicians for Informed Consent, and the Independent Medical Alliance, which have challenged scientific evidence, especially regarding vaccines.
The new statute is unlikely to address the judge’s concerns about the way counselors are selected and hired. Even if the administration brings in new consultants to avoid legal complications, this process can take months.
For annual respiratory vaccines such as flu and Covid, ACIP generally meets in June and makes recommendations published by August.
In some ways, the damage has already been done, Kates said. Polls already show declining trust in the CDC, and confusion abounds about which vaccines are safe and recommended.
“Increased distrust, increased confusion among the public and among parents – this has happened. The genie is not going back in the bottle,” Kates said. “In a sense, it is too late because the events of the past year have contributed to this growing climate of confusion and mistrust.”
Kates added that the loss of trust caused by continued misinformation from authorities could lead to serious long-term consequences. “If there were to be some sort of public health emergency at some point, it would be quite challenging for more and more people to not trust the federal government to make recommendations about what to do.”
DesPres said it was clear that the administration was “undermining confidence in vaccines and creating confusion.” “The confusion is actually part of a broader strategy to undermine trust.” He said the moves also make it difficult for vaccine developers to offer new vaccines to the public by “creating an uncertain environment.”
DesPres said the role trusted independent advisors play in evaluating vaccine safety and effectiveness is an integral part of the process: “We need a functioning ACIP to provide recommendations that providers, patients and the public can trust.” But he said it’s unclear when ACIP will work properly again.
