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Another week brings more health care proposals, as incoming President Donald Trump and his pick for the head of the Department of Health and Human Services Robert F. Kennedy Jr. share plans to change up some establishments throughout the United States. From vaccine access to funding changes to firing staffers at the National Institutes of Health, it seems no area will be untouched by the new administration.
One major area of concern throughout the country is vaccines. Recently, Trump voiced distaste for school vaccine mandates and said he and Kennedy are going to have a “big discussion” about childhood vaccination programs. Kennedy has long been known as an anti-vaccine advocate who has repeated debunked claims linking autism and vaccination (which Trump has also echoed) and is now working with a lawyer who previously tried to revoke approval of the polio vaccine for children.
All of this could signal a change to the lifesaving routine vaccinations for children in the United States. While no one knows exactly what will play out in the coming months, experts have thoughts on what an end to longstanding vaccine programs and mandates could mean if they happen. Here’s what they say:
If childhood vaccine programs disappear, we’d likely see an increase in infectious disease outbreaks in time.
“First of all, we have to understand that this is the worst-case scenario, and I think it is unlikely,” said Dr. William Schaffner, a professor of preventive medicine in the department of health policy at Vanderbilt University Medical Center in Nashville. “But should the general support in its various sources for the childhood immunization program be diminished or end, what would happen is we would have a growing population of under- and unvaccinated children growing up in the United States.”
If you look back to the late 1960s when there was not large support for childhood vaccinations and there weren’t school vaccine mandates, roughly 60% of children were vaccinated. While more than half of children were vaccinated, it wasn’t enough to keep infectious diseases from spreading.
“You would have a circumstance where there would be continuing outbreaks of these now bygone infectious diseases once again,” Schaffner said.
Many of these infectious diseases have been out of the public’s consciousness for decades.
“If we ask the average new mom ‘What’s diphtheria?’ or even maybe ‘What’s polio?’ they wouldn’t really be able to give us a comprehensive answer. Isn’t that wonderful? Because they’ve never experienced it. Their mother never experienced it. Their grandmothers never experienced it,” Schaffner said.
This is because these diseases were eliminated through vaccination. “So, this is something we need to protect, because these illnesses are still out in the world … and these germs don’t require passports to come back into this country,” he said. “Should these laws be rescinded and these [susceptible children] grow up, the first disease that we would see being imported is measles because it’s so highly contagious, but the others would take a longer time.”
This means, in the short term, it may look like nothing bad has happened after the elimination of vaccine programs — “it will take a little bit longer, but then when it hits, it will hit very hard,” Schaffner added.
It could be harder for people to access vaccines if they don’t have the financial resources.
“I don’t have a crystal ball … there are many things that could be possible here. Now, we hear people say that our vaccines are not going to be taken away, that people should have choice, but it’s hard to know if that’s actually what intent looks like,” said Dr. Yvonne Maldonado, a pediatric infectious disease professor at Stanford University in California. “Even if there was ‘choice,’ lack of access to vaccines could limit people’s choice.”
In the U.S., we currently have pretty easy access to lifesaving vaccines, whether through insurance or programs for people without private insurance like the Vaccines for Children program (VFC). The VFC has been around for decades and “makes access to vaccination equitable from the standpoint of the cost,” she noted. But if there are changes to the funds the government needs for a program like this, it could lead to major problems.
“If that was restricted, then only people who could afford to pay for vaccines could get them, and that would be a real tragedy because that would be a huge disparity,” Maldonado noted. “But, again, we don’t know what policies are going to look like going forward.”
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There are structural supports that protect some vaccine access.
Maldonado said that processes don’t move quickly enough for things to just be taken away at once.
“Products that have been vetted for for a long time and have been produced for a long time … I’m hoping they don’t just disappear. Given that there’s so many structures in place that regulate what we can provide for people, it would be really a shame, and it’s hard for me to envision that things would just be taken away,” Maldonado said.
Schaffner doesn’t think the country’s childhood vaccination program would completely cease because of some structural supports.
“Congress would actually have to rescind that legislation, and I don’t think that will be popular in any congressperson’s district,” he said. “The American Academy of Pediatrics and the American Academy of Family Physicians strongly support vaccination, and they will still continue to support that, and I think the private insurance programs in this country will continue to support vaccinations.”
Vaccine mandates are another major discussion, Schaffner noted. In the U.S., children are required to get vaccinations to enter school and daycare — although there are exemptions, such as religious and medical.
Vaccine mandates “are not federal laws, they were instituted in each of the individual 50 states,” Schaffner said.
“Since these laws were passed in every state, that meant they had to go through the House of Representatives and the state Senate of each of these states,” he continued. “There were legislative bodies that debated whether children should be protected against these diseases … these laws, in their variations across the 50 states, passed and they were signed into law by governors representing the entire political spectrum in the United States.”
“So there was then, and I hope now, a continuing support for obliging us to do this,” Schaffner said.
These laws have made illnesses that used to plague children and their families dramatically lower in the U.S.
“Those laws have moved our vaccination rates for children higher than the vaccination rates in any other country in the world, and as a consequence, we have eliminated a whole array of illnesses that plague children and their families,” he added.
Routine vaccinations prevent millions of deaths in children throughout the world every year.
“It’s estimated that around the world, routine vaccines probably prevent, at a minimum, 3 million deaths a year in children,” said Maldonado. “And in the U.S., they probably prevent about 30,000 or more deaths a year.”
“Stopping vaccinations would really be a huge step back in terms of keeping children healthy and alive,” Maldonado added.
In the meantime, there are ways to protect your family’s health.
If you’re worried about the future of vaccines, first, try not to panic. It’s impossible to know what’s going to happen until it happens, and there are certain supports in place that help protect vaccine access.
Nonetheless, there are things you can do to stay healthy. You can start by talking to your doctor and your children’s doctor to make sure everyone is up-to-date on all recommended vaccinations, Schaffner advised. If you have questions about vaccinations and overall health, don’t be afraid to talk to your physician, Maldonado said.
“Your medical provider is there to answer your questions and to make sure that you are healthy and that your family is healthy,” Maldonado explained. “We in the medical community are constantly working to provide up-to-date information to providers and to patients [and] the public about what needs to be done to stay healthy. Not just for vaccines, but just in general.”
There are also lots of scary vaccine-related headlines and videos on social media. If you come across something that gives you pause, don’t be afraid to message your doctor about it. They’ll be able to explain what’s going on and if there’s really cause for concern.
“Social media is not a source of research and peer-reviewed information, so I would be very cautious,” Maldonado said.
You can also look to resources like the American Academy of Pediatrics, which is an independent society that represents 67,000 pediatricians throughout the country. “They have a … publicly facing website, which is called healthychildren.org, and that is available to everyone to read, and there’s lots of resources there, tool kits and slides and all kinds of information,” Maldonado noted. The Centers for Disease Control and Prevention’s website is also a helpful resource.
And stay in the loop about the vaccination updates in your state.
Beyond caring for your family, you can pay attention to what’s happening with your state legislature.
“Try to influence the legislation that is introduced regarding mandates and to make sure that your state health department still continues to promote vaccination,” Schaffner said.
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Vaccine mandates aren’t being issued in far-away Washington, he noted. “This is close to home, each in our own state … it’s remarkable that these are state laws that are in place and they can be altered locally. So this is something you can do with legislators who are in your state Capitol.”
“I think we just need to be aware that we have to be the caregivers of our families and our communities,” Maldonado said.