RFK JR and Trump Could Pull the COVID-19 Vaccine

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SENATE HEARING: Susan Monarez, the former head of the Centers for Disease Control and Prevention, testified in a closely watched hearing of the Senate Committee on Health, Education, Labor and Pensions (HELP) weeks after she was fired. The hearing kicked off with statements from Chairman Bill Cassidy, R-La., who is a physician, and Sen. Bernie Sanders, I-Vt.

CLASHES WITH RFK JR.: Monarez testified about a tense meeting she had with Health and Human Services Secretary Robert F. Kennedy Jr. on vaccines. Monarez told senators that Kennedy tried to pressure her to preapprove vaccine recommendations from a committee that contains anti-vaccine activists. At a Senate hearing this month, Kennedy said she was lying.

CDC ATTACKS: Monarez told senators that Kennedy became "very upset" when she told him she wouldn't go along with his requests on vaccine approvals and that he attacked the CDC as "corrupt" and claimed employees were responsible for "killing children."

MORE CDC TURMOIL:Debra Houry, the CDC’s former chief medical officer, is also testifying about her decision to quit her job after Monarez's departure. Houry warned of the long-term consequences of undermining public health.

A closely watched advisory panel to the CDC voted Thursday to tweak recommendations for a measles vaccine that includes protection against the varicella, or chickenpox, virus.

The new guidance from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) suggests the vaccine, called MMRV, shouldn’t be recommended for children under age 4 because of a small risk for febrile seizures in that age group. The seizures can be prompted by fevers associated with viruses or, sometimes, vaccines. They usually last for a few minutes and, while they are scary for parents to witness, are generally harmless, doctors say.

The panelists voted 8-3 in favor of the change. One member, Dr. Robert Malone, abstained because of a conflict of interest.

Doctors have known about the increased risk of febrile seizures in young children for years. It’s why the CDC already suggests that younger kids get the varicella vaccine separately, unless a parent or a caregiver prefers the MMRV shot.

The combination shot was developed to cut down on the number of vaccines babies receive at age 1 and to increase the chances kids will get all of their vaccinations. But about 85% of parents opt to give their children the stand-alone measles, mumps and rubella vaccine and a separate varicella shot, according to data presented at Thursday’s meeting.

Thursday’s vote doesn’t change the fact that kids should get vaccinated for measles, mumps and rubella twice — once at 12 to 15 months and again at 4 to 6 years. Varicella vaccines can be given at the same doctor’s visit.

The ACIP didn’t weigh in on combination vaccines for the second dose, so kids ages 4 and up can still get them if their parents prefer. There is no evidence of an increased risk of febrile seizure in this older age group.

The committee’s recommendation isn’t final. Acting CDC Director Jim O’Neill will have the last say over whether to adopt the changes, and it’s unclear when he could sign off. (Health Secretary Robert F. Kennedy Jr. appointed O’Neill in late August after he ousted Susan Monarez.)

The Department of Health and Human Services said in a statement Thursday evening that it “will examine all insurance coverage implications following today’s ACIP recommendation, prior to a final decision on adoption by the Acting Director.”

Many public health experts have expressed concern about the motives behind Thursday’s discussion and vote in light of recent changes to the ACIP.

Ahead of the meeting, ACIP Chair Martin Kulldorff asked the CDC to re-analyze data about the risk of febrile seizures after MMRV vaccinations. But the CDC’s presentation Thursday didn’t reveal anything new. Rather, it pointed to what doctors have long understood — there is a small increased risk of febrile seizures in young children after the first MMRV dose but no increased risk in older kids.

“The real question isn’t whether MMRV’s small seizure risk justifies offering separate shots — we already do that. It’s why a new committee appointed by Kennedy is revisiting a policy that’s been working well for two decades,” Dr. Jake Scott, a clinical associate professor of infectious diseases and geographic medicine at the Stanford University School of Medicine, said in an earlier interview.

“This feels like using a known, disclosed, managed risk to undermine confidence in the entire schedule,” Scott said.

ACIP member Robert Malone said the committee took up the subject Thursday because “a significant population” in the United States has concerns about vaccine policy.

The ACIP will vote Friday on a recommendation to delay the first dose of the hepatitis B vaccine until a child is at least 1 month old. Typically, the first dose is given within 24 hours of birth. The committee will also discuss this fall’s updated Covid shots.

The Centers for Disease Control and Prevention on Monday updated its Covid vaccine guidance to recommend Covid shots for people 65 and older and only after they consult a doctor or pharmacist.

A press release from the agency said acting CDC Director Jim O’Neill signed off on the recommendations of an agency advisory panel last week, capping months of confusion and concern about this season’s Covid vaccine. Earlier this year, Health Secretary Robert F. Kennedy Jr. fired all 17 members of the influential vaccine panel, replacing them with his own picks, many of whom have spoken out against Covid vaccines.

The CDC’s sign-off on Monday does not mean people younger than 65 are barred from getting a Covid vaccine — they still can do so, after consulting with a doctor or pharmacist.

Adding in this so-called shared clinical decision-making essentially “puts up one more little barrier” to getting the shot, said Dr. Yvonne Maldonado, a professor of global health and infectious diseases at Stanford University. “It’s kind of a vague term that says you should have your doctor or your provider or pharmacist tell you what the risks and benefits are before you get the vaccine.”

The CDC said that the vaccine panel's recommendations for people under 65 found the most benefit for someone at increased risk for severe Covid due to underlying conditions. The benefit of vaccination was lowest for people under 65 who aren't at increased risk for severe Covid.

But how easy it is to get a Covid shot may depend on where you live.

In previous years, states have generally mirrored the CDC’s vaccine guidance, particularly that of the vaccine advisory panel, called the Advisory Committee on Immunization Practices, ACIP, which had been considered one of the foremost authorities on vaccinations.

Prior to the CDC’s announcement, 26 states (mostly blue states with Democratic governors) had already set their own Covid shot guidance to keep access as broad as possible, according to KFF, a nonpartisan health policy research group.

The result is a complex hodgepodge of Covid vaccine policies nationwide.

“We now have had a breakdown in consensus between the federal government and the states as to how to manage Covid immunization,” said Dr. Ofer Levy, director of the Precision Vaccines Program at Boston Children’s Hospital. “We are facing an unprecedentedly complicated landscape.”

Illinois, Maryland and Washington, D.C., for example, officially recommend universal Covid vaccination for everyone 6 months and older. Other states, like California, Michigan and Minnesota, recommend the shots for everyone 3 years and old.

“Viruses don’t respect state borders,” Levy said. “From the perspective of protecting the public against infectious diseases, the last thing you would want as a strategy is to protect different states differently. It’s confusing, it’s inconsistent, and it leaves certain people vulnerable.”

What’s more, some doctors’ offices might not have any incentive to stock the vaccine since the CDC’s recommendation focuses on older adults. Last season, 23% of adults and 13% of children got the Covid vaccine, according to the CDC.

“There’s all kinds of ways where people who want the vaccine might not be able to get it because of all of these little obstacles that are put in place, even though, in theory, anybody 6 months and older should be able to get them,” said Maldonado, who is also a pediatrician.

In a statement, Amy Thibault, a spokesperson for CVS Health, said its pharmacies would be ready to administer Covid shots for people ages 5 and older as soon as the CDC signed off.

Walgreens starts Covid vaccines at age 3. A spokesperson for Walgreens said in an email that the pharmacy chain “will offer the 2025-2026 COVID-19 vaccines at locations nationwide” without a prescription.

Do I need a Covid shot?
While a summer uptick in cases appears to have peaked in most areas of the country, according to CDC surveillance, every year since the Covid pandemic started in 2020 has also had a winter wave.

Like the flu shot, the Covid vaccine doesn't necessarily stop a person from getting infected with the virus. But it does reduce the chances of severe illness, hospitalization or death.

Pfizer and Moderna’s updated Covid shots target the LP.8.1 variant, which was the dominant strain in the U.S. earlier this year but has been overtaken by newer variants. Novavax’s updated Covid shot targets an even older strain, called JN.1.

As of Sept. 27, LP.8.1 accounts for just 3% of all new Covid cases, according to the CDC. A strain called XFG is now dominant, accounting for at least 85% of new Covid cases. All are descendants of the omicron variant, which emerged in late 2021.

Research presented by Moderna and Pfizer at an FDA advisory committee meeting in May found that the updated shot generated a modestly stronger immune response to the strains circulating at that time than last year’s Covid shots.

It typically takes a few weeks after the Covid vaccine for immunity to build.

Is the Covid shot free?
Most people with insurance who want a Covid vaccine should be able to get it free this year.

Ahead of the CDC’s advisory committee meeting, AHIP, a health insurance industry trade group, said that private plans will continue to cover all CDC-recommended vaccines that were recommended as of Sept. 1, meaning its previous Covid shot recommendation for everyone 6 months and older still applies.

Medicare, Medicaid and other government health programs will continue to cover the shots at no cost, according to an HHS spokesperson

Acting CDC Director Jim O’Neill on Monday called on vaccine manufacturers to develop separate shots for measles, mumps and rubella instead of the current vaccine, which combines the three.

O’Neill wrote in a post on X that manufacturers should replace the MMR vaccine with “safe monovalent vaccines,” which only target one virus. His statement referenced a recent comment from President Donald Trump, who advised people last month on Truth Social to “break up the MMR shot into three totally separate shots.”

However, no monovalent vaccines for measles, mumps or rubella are approved in the U.S., and the Centers for Disease Control and Prevention says there is no published scientific evidence that shows a benefit to separating the combined vaccine. It is not clear whether the change O'Neill is calling for is possible or likely to come about.

Andrew Nixon, a spokesperson for the Department of Health and Human Services, said “standalone vaccinations can potentially reduce the risk of side effects and can maximize parental choice in childhood immunizations.” He did not offer evidence for his statement about side effects.

The measles, mumps and rubella vaccine has been available as a combination shot since 1971, in part to reduce the number of injections that children receive, given that the three are administered at the same ages.

Breaking up the MMR vaccine, a two-dose regimen in which the first shot is recommended at 12 to 15 months and the second at 4 to 6 years, would mean that children would receive six injections instead of two.

It’s unclear where Trump’s advice came from. The White House is not responsible for setting vaccine or drug use recommendations.

At a White House event on Sept. 22, the president expressed a preference for individual over combined shots while at the same time decrying the number of vaccines that kids receive, saying that “too many different things are going into that baby at too big a number.”

“The MMR, I think, should be taken separately,” Trump said. “This is based on what I feel. ... It seems to be that when you mix them, there could be a problem. So there’s no downside in taking them separately.”

Merck, the pharmaceutical company that has manufactured the MMR vaccine since 1971, said in a statement that use of individual vaccines “increases the number of injections for the individual and may result in delayed or missed immunizations.”

At the same time, the company added, “evidence suggests that use of combination vaccines improves childhood vaccination outcomes, increasing both completion (receipt of all recommended doses) and compliance (age-appropriate administration) rates.”

The U.S. has recorded more measles cases this year than in any other since 2000, when the country eliminated the disease.