If the Senate confirms Robert F. Kennedy Jr. — a vaccine skeptic — to lead the Department of Health and Human Services, he would control an influential group of federal vaccine advisors.
Editor’s Note: This article was published ahead of Robert F. Kennedy Jr.’s confirmation hearings this week as President Trump’s nominee for secretary of the Department of Health and Human Services. Our podcast episode on Kennedy’s power over federal vaccine advisors includes updates from his appearance before the Senate Finance Committee. Kennedy, who testified that he supports vaccines, was met with sharp questions from Democrats, who pointed to his record of vaccine skepticism.
Robert F. Kennedy Jr. has long criticized an obscure and powerful federal vaccine committee. If senators confirm him to lead the Department of Health and Human Services, he would control it.
Kenndy is scheduled to meet with senators this week for confirmation hearings, where his vaccine views are expected to come under scrutiny.
The Advisory Committee on Immunization Practices — an influential group of clinicians and scientists — recommends who should get vaccines to the Centers for Disease Control and Prevention, the nation’s public health agency.
ACIP widely shapes public health practices, pharmaceutical development and how doctors treat patients. ACIP makes recommendations to the CDC, which almost always endorses the committee’s decisions.
“It is the most important policy making body with respect to vaccines in the United States,” said attorney Richard Hughes IV, who teaches at George Washington University and advises vaccine manufacturers.
Experts in public health said they fear Kennedy, if confirmed by the U.S. Senate, would appoint advisors who share his vaccine skepticism and who could weaken the committee’s recommendations, jeopardizing public health.
The HHS Secretary is authorized to remove or add members at will. That power, lawyers and public health officials say, amounts to one of the most significant levers the secretary has over immunization policy in the U.S.
That’s because the committee’s reach extends into American lives in ways that are often imperceptible.
The committee approves free vaccines for half the nation’s children. States look to ACIP recommendations to guide their school vaccination requirements. Federal laws require health insurers to pick up the entire bill for ACIP-recommended vaccines for most Americans with private health insurance, Medicare’s Part D prescription drug benefit and adults in Medicaid.
Control of the committee matters to the nation’s health, said Dorit Reiss, a law professor at the University of California, San Francisco, who studies vaccine policy.
“What we could see is more outbreaks of preventable disease as vaccine rates decline,” she said.
Press officers for Kennedy and President Trump didn’t respond to requests for comment.
Kennedy has previously criticized the advisory committee, whose members are independent scientists and physicians, as beholden to pharmaceutical companies. ACIP members must disclose potential financial conflicts each year and cannot discuss or vote on vaccines where they have personal financial interests.
ACIP’s job
It is common in the U.S. for scientists to advise agencies across the government on technical and practical policy questions. In the CDC alone, at least 20 groups advise policymakers on research into everything from lead exposure to breast cancer prevention.
Vaccine experts outside the government have consulted with policymakers for decades. ACIP emerged in the 1960s.
The committee’s principal job is to evaluate who should get vaccinated. That’s trickier to do than it may seem. First, members must answer several key questions: Who is at risk from an infection? Do the vaccine’s benefits outweigh its risks?
Members scour research and data to find answers. Most of their time is spent in smaller work groups, which also draw in specialists from the CDC, universities and medical societies. The work is intensive and can span months.
Drexel University Professor Sarah Long remembers one ACIP group that forced her to squeeze in an extra 40 hours of meetings over more than six months while holding down her day job teaching and treating patients. She was one of at least 94 people to pitch in.
Once finished, the full committee deliberates findings and votes at public hearings. Decisions are published, and the members list the evidence they considered as they weighed a vaccine’s benefits and harms, among other factors.
Experts brace for vaccine rollbacks
Public health officials and drug developers said they are bracing for the possibility the Trump administration could roll back vaccine recommendations.
Kennedy has said in recent interviews that he doesn’t want to take away vaccines, but has said people should have a choice and would make information available to make that decision.
Kennedy could deliver on the promise by naming ACIP committee members who favor more relaxed guidance.
ACIP recommendations fall into two broad categories: vaccines you should get and vaccines you might want to get, based on your risk.
Few vaccines carry the softer recommendation, known as shared clinical decision-making. Research shows it is more time consuming and confusing for physicians to follow.
Vaccine use may also drop with more relaxed guidance. In 2014, for example, the committee said older adults should get a pneumococcal vaccine manufactured by Pfizer. They voted in 2019 to soften that guidance, telling seniors to instead consider the option by talking with their doctors. Use of the vaccine fell, Pfizer told its inventors in financial statements. Pfizer declined to comment.
When the committee issues softer recommendations, it’s based on an analysis of evidence. Reiss from UCSF said she is concerned Kennedy could instead appoint members who prefer softer guidance on principle.
If that happened, Reiss said it would strike a blow to confidence in the committee for many. “The basis of its influence is trust,” she said.
ACIP decisions can influence investment in vaccine development
Doctors and public health officials aren’t the only ones closely tracking whether the new administration will weaken vaccine policy. Drugmakers have a lot riding on these recommendations.
The vaccine market is already limited. People usually need vaccines just once – or once a year – unlike drugs for chronic diseases that people take daily. Weaker recommendations from ACIP could mean fewer people taking vaccines, which makes investors nervous.
If that funding dries up, we could see fewer new vaccines hit the market or it could take them longer to get there.
For example, Danish drug company MinervaX recently completed the second stage two clinical trials to treat group B streptococcus, a life-threatening infection in newborns. It causes an estimated 90,000 infant deaths worldwide each year.
Currently, doctors prescribe mothers antibiotics before birth to protect newborns from infections, but a vaccine has been a top global public health priority for years.
MinervaX is backed by several investors, who are necessary to finance the multimillion dollar cost of clinical trials.
MinervaX’s CEO Per Fischer said his company will need even more capital to continue. He fears raising money will get harder if Kennedy is confirmed. “I think people are sort of applying this wait and see kind of approach and then hoping it’s not going to be as bad.”
Funding for kids vaccines potentially at risk
The committee’s most direct power over immunization may be its control over billions of federal dollars to buy vaccines.
ACIP decides which vaccines to buy under the Vaccines for Children program, and the federal funding is guaranteed. Congress created the program after deadly measles outbreaks more than 30 years ago.
The epidemic, which ended in 1991, sent thousands of children to hospitals and killed 123 people. Some children who became ill had seen doctors, but were unvaccinated because their families couldn’t afford shots. Doctors had referred parents to free clinics for shots. The extra step became a barrier.
As a fix, Congress set up the Vaccines for Children to pay for immunizations that doctors give vulnerable children. It worked. Referrals to free clinics dropped. Measles vaccination rates increased.
About half the nation’s children are eligible for vaccines under the program, which, in 2023, spent $5.2 billion.
Some state public health officials are concerned appointments under Kennedy will shrink the program.
In Hawaii, 56% of children receive free vaccines. Doctors order about $19 million of children’s vaccines under the program, according to the state.
Ron Balajadia, who oversees the program for Hawaii’s Health Department, said the agency is in early meetings with lawmakers on new state funding to fill in gaps should ACIP begin to cut back the program under Kennedy.
He fears what may happen to the state’s children if Hawaii loses ground on immunization rates should money for vaccines disappear.
Balajadia has seen the toll of outbreaks firsthand. Early in his career, he responded to an outbreak of whooping cough, on islands in the Pacific.
He anchored one day on a small island in the Pacific Ocean. He was met by a distressed mother and local health care worker holding a baby in spasms. The infant was vomiting and blue.
Balajadia could do nothing. “It haunted me, in the way that I wanted to help, but I couldn’t.”
Balajadia worries that handing Kennedy control over funding for children’s vaccines would threaten to undermine a hard-won public health lesson: Research shows policies that make vaccines low-cost or free help push up public protection against diseases to levels that, largely, prevent outbreaks.
“That’s the part that I fear the most,” he said, “is if we have another outbreak.”
Episode Transcript and Resources
Episode Transcript
Dan Gorenstein (DG): Robert F. Kennedy Jr. is back in Washington this week.
He’s meeting with the Senate, hoping to convince members he should become the nation’s next health secretary.
Robert F. Kennedy Jr. I’m humbled to be sitting here today as President Trump’s nominee to oversee the U.S. Department of Health and Human Services.
DG: During his hearing with the Senate Finance Committee yesterday, Kennedy’s views on vaccines came under sharp questioning and criticism from Democrats.
Sen. Ron Wyden: He has made it his life’s work to sow doubt…
Sen. Michael Bennet: …pedalling in half truths, pedaling in false statements…
Sen. Bernie Sanders: Are you supportive of these onesies?
RFK JR.: I’m supportive of vaccines.
Sen. Elizabeth Warren: …Mr. Kennedy it’s just a really simple question…
DG: Kennedy testified he supports vaccines and good science.
RFK JR: I support the measles vaccine. I support the polio vaccine. I will do nothing as HHS Secretary that makes it difficult or discourages people from taking either of those vaccines.
DG: Kennedy’s pledge – to not make it difficult or discourage people from taking the measles or polio vaccine did little to assure his critics.
Sen. Maggie Hassan: I am extremely concerned that, as secretary, you would be able to halt critical vaccine research and to exploit parents’ natural worries by advising them not to vaccinate their children. This will lead to more children getting sick and some will even die.
DG: What worries some senators and many public health officials is how much power Kennedy would have to shape vaccine policy as the nation’s health secretary.
It turns out one of the most important levers he would have is control of an obscure committee whose influence shapes how doctors treat their patients, public health practices and even has the power to move markets.
Today, the most powerful committee you’ve never heard of, and the control Kennedy would wield as HHS Secretary.
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DG: Joining us to talk about this committee and its influence over vaccines is Tradeoffs reporter and producer Melanie Evans.
Hi Melanie.
Melanie Evans: Hey Dan.
DG: OK. So before we talk about Kennedy, let’s first focus on this committee.
It’s called the Advisory Committee on Immunization Practices. In a sentence, Melanie, what does it do?
ME: Well, Dan, this is a group that, for the most part, makes recommendations about who should get vaccines to the Centers for Disease Control and Prevention.
DG: Ok, and to be clear this committee, which goes by the acronym ACIP, is made up of clinicians and scientists who advise the CDC.
I mean the CDC ultimately has to sign off on those recommendations, right?
So, how much power does the committee actually have?
ME: Fair point. I talked to lawyers, public health officials and vaccine developers about this, Dan. Richard Hughes IV, an attorney who represents drug makers, summed up what I heard.
Richard Hughes IV: “It is the most important policy making body with respect to vaccines in the United States.”
ME: ACIP’s influence, Dan, is pretty broad.
Doctors follow its recommendations. Their decisions guide school vaccine mandates, health insurance coverage. People told me ACIP even sways drug development.
DG: Why do so many people put so much faith into this obscure little committee?
ME: Sure. I can answer your question in a few ways.
First, this committee is influential because – over the last sixty years – many doctors and public health experts have developed a high level of confidence in its decisions.
Dorit Reiss: The ACIP is one of the most important points in the vaccine world because it’s such a trusted body.
ME: That’s University of California, San Francisco professor Dorit Reiss.
Dorit ticked off a whole list of why this body is so trusted.
And it starts with that the members have a lot of expertise
Reiss: Second, the recommendations are very detailed, very fact-heavy. So the content of the recommendations is heavily science-based. And third, transparency ACIP meets in public. Their recommendations are also public. They’re published. But the meetings themselves are also recorded and heard. So there’s no it’s not a behind-closed-doors organization.”
ME: But more than transparency, Dan, what the committee is doing is hard work.
You’ve got these 19 scientists and doctors whose job is to basically keep tabs on all the research and data about diseases and vaccines, which of course, keeps changing.
And for the people who do it, it’s basically a second job.
Take Sarah Long. She served on the committee for about three years.
Sarah says she squeezed in roughly 40 hours of meetings over several months to consider a single vaccine. Her day job, by the way, is pediatric infectious disease doctor and professor.
Dr. Sarah Long: “Having grown up in Alaska was probably helpful. You know, you just did a lot of things. If you wanted to go skating, you went and swept off a glacier (laugh).”
DG: That’s intense.
ME: Skating on a glacier? Or the workload?
DG: Both. One definitely sounds harder.
ME: Sarah was one of 94 people who worked on this one recommendation.
A thing I learned, Dan, interviewing people like Sarah is that their commitment to the work is real.
They are so devoted to it because they understand the stakes. Dr. Paul Offit from the Children’s Hospital of Philadelphia has also been on the committee.
Dr. Paul Offit: You’re taking the responsibility for this country’s children often, and your heart is in your throat all the time because you’re so worried that you might miss something because these products are given to healthy people, including healthy young children.”
DG: Alright. So, you’re really starting to paint a picture for me, Melanie, why this committee is so influential.
You’ve got a bunch of vaccine experts who get together combing through evidence and data – trying to figure out the best vaccine recommendations.
They’ve been doing this work since the 1960’s and all their work is out in the open.
ME: That’s why there’s so much trust in the committee, Dan. And the CDC almost always approves their recommendations which touch many of us.
DG: How’s that?
ME: Well, a few things.
One, their policies are followed by lots of doctors when they give vaccines to patients.
States look to ACIP to know which vaccines students need for school.
And finally, federal law requires most health insurers to make ACIP-recommended vaccines free. They pick up the entire bill.
DG: Wow. This committee really has a wide reach, Melanie.
ME: Yeah, Dan, its influence touches lots of us in ways either directly or indirectly. I definitely didn’t realize that when I started my reporting.
But I’ve saved perhaps ACIP’s most direct power for last: it makes critical decisions for the Vaccines for Children program. And before you ask me what the Vaccines for Children program is, Dan, it’s basically a blank check from the feds to states and doctors to buy vaccines for vulnerable children.
DG: How many kids does it serve, Melanie? How big is this?
ME: Right. About half the nation’s children are eligible for these free vaccines. And Congress gave ACIP the power to choose which vaccines will be included. If ACIP approves a vaccine, federal funding is guaranteed. If not, no money.
DG: This is why lots of public health folks are nervous if RFK Jr. is confirmed.
Given his anti-vaccine comments – many that have been totally debunked – through ACIP he could end up with a lot of power over vaccine policy.
When we come back, how Kennedy could change the committee and public health officials begin drawing up plan B’s.
MIDROLL
DG: Welcome back.
Melanie, before the break you walked us through the broad reach these vaccine advisors to the CDC have.
Let’s talk now about what power the HHS Secretary has – whoever that is – over this advisory committee.
ME: Sure. It’s pretty straightforward. The ACIP is what is known as a discretionary committee. That just means it exists because HHS says so.
DG: So, does that mean the HHS Secretary can shut it down?
ME: Yes, and in fact, the agency has to agree every two years to let the ACIP continue.
Now, Kennedy has questioned the committee’s integrity. He alleges its members are in the pocket of drugmakers.
To be clear, the ACIP has ethics rules that say members must disclose any financial conflicts and sit out votes where they have personal financial interests.
Kennedy may distrust the committee, but people I spoke to said he probably won’t go so far as to end it.
DG: What did they think was more likely to happen?
ME: So, the Secretary can appoint people. The folks I talked to said Kennedy could fill those seats with people who share what has been called his vaccine cynicism.
Right now, there are four open seats. Another four members have terms that end in June. Adding eight new members, to a committee of 19, who are vaccine skeptics could be disruptive.
DG: Doing some quick math, here, eight seats on a board of 19 falls short of a majority.
ME: Good work, Dan. But, here’s the thing. The Secretary also has the power to remove existing members. I spoke to public health and legal experts who think this is possible.
DG: Ok, so, and I know this is entering the world of speculation, but if Kennedy stacked the committee, what could happen?
Or, at least, what are the people you interviewed afraid could happen?
ME: Ok, so ACIP recommendations fall into two broad categories: vaccines you should get and vaccines you might want to get, based on your health. And, the committee has the power to roll back strong recommendations – vaccines you should get – in favor of softer ones – vaccines you might want to get.
DG: Got it.
ME: These softer recommendations can be time-consuming in practice, right, doctors and patients talking it out. It can be confusing for physicians – ‘should I give my patient the vaccine, or not?’ A CDC study found, no surprise, softer recommendations are a challenge to follow.
DG: Makes sense.
ME: And quick anecdote, Dan. In 2019, the committee switched to a soft recommendation for older adults for a vaccine that treats a serious bacterial infection called pneumococcal disease.
Fewer older adults got the vaccine, which was the point. And the drug maker, Pfizer, said sales dropped.
Now, people told me they fear Kennedy could name members who would switch more vaccines to softer recommendations, even when a strong recommendation is warranted.
That, obviously, could lead to fewer people getting vaccinated.
This is how Kennedy could make good when he says, people should have a choice to get vaccinated and information to make that choice.
DG: Right because Kennedy has been saying he wants people to have access to vaccines if they want them.
And the softer “you might want to get this” recommendation doesn’t take anything away, but it does make it less likely people will get their shots.
ME: Yes, people worry we could see more preventable diseases in the United States as vaccine use drops off.
DG: How realistic is this concern, Melanie?
ME: Obviously, we won’t know unless Kennedy becomes secretary. I did contact staff for Kennedy and President Trump, but didn’t hear back.
But people are taking this risk seriously.
Credit analysts warned investors the market for vaccines could shrink.
And if that happens – we are likely going to see fewer new vaccines or, at least, they will take longer to reach the market.
Here’s a great example. The Danish company, MinervaX, is developing a vaccine that’s been on the public health wish list for a long time; it’s to treat an infection that causes an estimated 90,000 infant deaths globally each year.
CEO Per Fischer says his company needs more money to fund the third phase of clinical trials, but if Kennedy is confirmed, he believes it will be harder to raise that money.
Per Fischer: “I think people are sort of applying this wait-and-see kind of approach and then hoping it’s not going to be as bad.”
DG: Can you explain a bit more, Melanie, why are people in the industry anxious?
ME: Sure. Private investors play a huge role in paying for the upfront costs.
DG: Like the third phase of clinical trials.
ME: Exactly. And they do that in hopes there’s a hefty return at the end.
But the market for vaccines is already limited. In most cases, we take vaccines once, maybe once a year. The money comes from the fact that many people who can get vaccinated actually do. With weaker vaccine recommendations from ACIP that pool gets smaller.
DG: And so the concern is a smaller payday means it’s harder for drugs like MinervaX’s to raise money.
ME: Yes, and, arguably worse than investors and the company losing out, we all lose out on the public health upside in this instance the chance to reduce infant mortality.
Per Fischer told me he’s concerned about what could happen in the short-term, but is grimly confident in the long-term demand for vaccines.
PF: “Ultimately I believe that if you start killing childhood vaccinations broadly, and, and parents start noticing that their infants become sick with measles and other, you know, serious childhood diseases then ultimately, I believe that, that science will prevail and that people will actually ultimately understand that vaccines are good.”
DG: So, Melanie, investors and drug makers are bracing for what might be coming. I know you’ve also talked to public health officials who are relying on funding through the Vaccines for Children program. What are they saying?
ME: Right. I talked to Ron Balajadia from the Hawaii Department of Health.
About 56% of the state’s children are eligible for free vaccines. He said that’s not cheap. Hawaii gets around $19 million from the feds.
He says the Health Department is in early talks with Hawaii lawmakers about coming up with a backup plan, in case ACIP cuts funding.
Ron Balajadia: And how can the, the state government afford that? It would be one question and can it afford it? We’re still looking through that, we’re still trying to understand better what that looks like, because it’s going to be a lot of money.
DG: I’m really curious, what’s the mood right now?
ME: Ron says he’s been talking to counterparts around the country and lots of people are worried, kind of on pins and needles.
For Ron in particular, he’s seen firsthand what happens when there are outbreaks that impact kids and it’s scary.
About 20 years ago the CDC sent him to the Federated States of Micronesia to help stop the spread of whooping cough, also known as pertussis.
RB: “I went to a very small island in, in the Pacific, and I got off a boat.”
ME: He was met by a distressed mother and local healthcare worker holding a baby.
RB: “I would say maybe seven, eight months old, that was blue and trying to cough, but was throwing up and was coughing at the same time with spasms of pertussis.”
ME: The healthcare worker asked him to help. Ron tried to make sure the child didn’t choke as it vomited.
RB: “And there really isn’t anything we could have done. We didn’t have any medical equipment at the time.”
ME: He still remembers that moment, Dan, about two decades later.
RB: “It haunted me in the way that I wanted to help, but I couldn’t.”
ME: The child ultimately survived, but Ron said illness could have been avoided if the baby had had access to the vaccine.
After my reporting for this story, Dan, this is a vivid example of what public health officials see is at stake.
DG: That – if Kennedy is confirmed – we could end up in a situation where there’s a lot of suffering needlessly?
ME: That’s right.
You remember we were talking about the pneumococcal vaccine?
DG: Yeah, the one ACIP gave a soft recommendation to – that led to the downturn in people who took it.
ME: Right. Well, that was a decision the committee made after carefully reviewing the evidence.
The people I talked to said they’re worried Kennedy will appoint people who will make decisions, regardless of evidence.
DG: And if he does that, not only does he undermine the trust ACIP has built up over the last five decades. He’s also undermining basic science, which could lead to the kind of suffering Ron saw with the whooping cough.
ME: Yep. That’s the real worry here, Dan.
DG: Melanie Evans, thanks so much for your reporting on this story. I know you will continue to watch this closely.
ME: You’re welcome.
DG: From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, this is Tradeoffs.
Reporting for this episode is supported in part by West Health
Episode Resources
Additional Reporting and Research on RFK Jr. and Vaccines:
- How America’s Fire Wall Against Disease Starts to Fail (Katherine J. Wu, The Atlantic, 1/22/2025)
- Trump Team Sidelines RFK Jr.’s Antivaccine Aides (Liz Essley Whyte, The Wall Street Journal, 1/14/2025)
- Legal Underpinnings of the Great Vaccine Debate of 2025 (James G. Hodge, Social Science Research Network, 1/6/2025)
- Trump’s CDC pick wouldn’t let go of false theory that vaccines cause autism (Lena H. Sun, Fenit Nirappil and Aaron Schaffer; The Washington Post; 12/15/2024)
- How Measles, Whooping Cough, and Worse Could Roar Back on RFK Jr.’s Watch (Arthur Allen, KFF Health News, 12/6/2024)
- What Could RFK Jr. Do As Head of HHS? We Asked Someone Who’s Done the Job (Dan Gorenstein, Tradeoffs, 11/21/2024)
- U.S. advisory panel stops short of broad recommendations for two common vaccines (Helen Branswell, STAT, 6/26/2019)
Episode Credits
Guests:
- Ron Balajadia, Hawaii Department of Health immunization branch chief
- Dorit Reiss, University of California, San Francisco, professor of public health law
- Dr. Sarah Long, former member of the Advisory Committee on Immunization Practices and Drexel University, professor of pediatric infectious disease
- Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
- Richard Hughes IV, attorney with Epstein Becker Green
- Per Fischer, CEO, MinervaX
The Tradeoffs theme song was composed by Ty Citerman. Additional music this episode from Blue Dot Sessions and Epidemic Sound.
Additional thanks toJames Hodge, Michelle Fiscus, Anne Schuchat and Glenn Rockman.
This episode was produced by Melanie Evans, edited by Dan Gorenstein and mixed by Andrew Parrella and Cedric Wilson.