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A
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C
I'm JVL here with my bulwark colleague Jonathan Cohn, and we have news coming out of Robert F. Kennedy Jr's Department of Health and Human Services. They have rejiggered the vaccine schedule for American children. They are downgrading it from a recommendation of 17 vaccinations to 11 vaccinations. They're cutting out a bunch of things, leaving some in. Jonathan, this is all. I mean, it's slightly confusing and there are some nuances that we're going to get into, but the very bottom line is, as of now, the government is going to recommend fewer vaccines, which may make it harder for people to get their kids vaccinated to all the stuff that they would have gotten vaccinated a week ago from. Correct? Correct.
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B
Yes.
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C
I mean, I'll just tick off some of the ones here that are no longer covered. Rsv, which I remember the days before the RSV vaccine. Miserable meningococcal disease, Hep B, hep A. These things are, are now out, I think. Chickenpox and polio and MMR still in.
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B
Yay.
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C
Yay. You could still get Your measles vaccine. So I. Talk to me, Jonathan, was this, first of all, was this expected or is this a surprise?
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B
Yeah, no, it's totally expected. They've been building up to this for a while now. If you remember, back in early December, there was this big meeting of the advisory council that it's the official CDC committee of outside experts that makes recommendations to the CDC director about what America's vaccine schedule should look like. And at that meeting, and a member of that committee has been replaced. Right. It used to be all these very prominent outside experts, widely respected scientists. RFK Jr came in, he sacked all of them. He stacked the committee with people who in one way or another were sympathetic or had expressed sympathy to at least parts, if not all, of his anti vaccine agenda. And I do call it an anti vaccine agenda, even though he does not call it that. And there was a presentation there that said, hey, you know, we give all these vaccines, we give 17, you know, we recommend 17, and we shouldn't do that, it's too many. And they said, look, there's a country abroad, Denmark, that recommends only 10, 11, the way you count these varies on what method you use, but we'll go with 11 and we should do what they do. And it was then reported that they were gearing up to make the announcement right before Christmas. They held off on it. It wasn't clear. Sort of conflicting accounts both officially and unofficially. Was this a political move because Trump wanted to announce some other things on that same day? Were there legal concerns? Because, you know, about how this was being rolled out, what, you know, what was being changed? Because you can't just, despite what, how the Trump administration frequently acts, you can't just snap your fingers and change a policy like this. But I guess whatever legal concerns they thought they had, they've decided they have overcome. And so now we have this new set of recommendations.
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C
Yeah, it's just great. HHS also going to say that vaccinations against flu, the flu shot, COVID 19 and rotavirus, they are going to be now shared clinical decision making. Meaning that if you want to get those, you can't just like show up at your pharmacy to get them. You now have to go in, see your doctor and ask for it. One of my questions, Jonathan, is to what extent this is going to really restrict access. So obviously for the ones we just talked about, you are now going to have to go and seek out the vaccinations in a slightly more complicated way. The HHS said if as part of their announcement that the Insurers will continue to cover these vaccinations, but there's very little detail on this statement, as far as I can tell. How does the Department of Health and Human Services know what health insurance companies will or won't do?
- [05:28]
B
It's all very murky. And, you know, we're waiting to see more details on this. And you know, what it looks like where you live in getting these shots is going to depend a lot. I mean, it's actually. CDC doesn't make binding recommendations, right? I mean, they make these recommendations. It's states who make these sort of recommendations within states about what you get and what you can get. A pharmacy versus what, you know, you need to get a prescription for. And then insurers can make their own decisions. There are certain things that are required to cover. You know, there are various regulatory tools that HHS has for requiring certain kind of preventative medicine has to be covered without a. Without. Without cost sharing. So it's a little murky right now exactly what this is going to mean. And we're waiting, all of us, to see what details they come forth with and how this all shakes out. And we've seen in the past, like when they changed the recommendation from the COVID vaccine, they sort of announced and made it, you know, Kennedy made this very big, splashy announcement on video that they were sort of withdrawing it. And then it turned out, well, they weren't exactly withdrawing it then they changed the recommendation a few times. And the way it kind of shook out on the one hand was, you know, a lot of insurers said, hey, we're just going to keep doing what we were doing before. You know, a lot of states said, we're just going to keep recommending what we recommended before. We're just not going to listen to CDC or hhs. We don't even, you know, we're going to go with what we were doing before. But we also saw when that happened, not every state did that. And there were all kinds of reports right away, people trying to get their Covid vaccines and even people who fell within the groups that CDC had said, you should get the COVID vaccine because you were high risk. And they would go to the pharmacy, like so many people do now, to get your shot. And then the pharmacist would say, oh, you know, you can't get this unless you get an actual prescription. And it wasn't actually clear if that was the. That was actually true. There was just so much confusion going on. Right, that fewer people ended up getting the vaccine as A result.
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C
So a lot of this is going to depend, like so much else in American life where you live, because we are now breaking down in ways where fundamental rights and freedoms vary drastically based on whether or not you live in a red state or a blue state. That's great. Nothing bad has ever come of that. And I would say it does seem to me that the end goal here is not to let people opt out of vaccines. Right. Which is the thin end of the wedge for the anti vax movement. They were like, we just don't want to be told that we have to vaccinate our kids. You know, we don't want. We want our kids to be able to enroll in public schools without being vaccinated. And that sort of sounds like my body, my choice. But it does seem like the larger project is, no, we want to stop other people from getting vaccinated. And the part you and I talked about this offline, the thing which I keep coming back to is what malpractice insurers will allow providers to do. Because if you live in a state where the state will not recommend a vaccine and you are a provider, you know, malpractice insurance is phenomenally expensive. It's the single biggest cost for medical providers in their industry. Are those insurers going to allow providers to prescribe a vaccine which their state does not recommend? Will they be allowed to administer it? I mean, again, we just don't know what this is going to look like. And I. I don't know. Do you have any thoughts on this?
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B
Yeah. So I will say, first of all, the question of sort of private malpractice insurance and what those carriers tell their practicing physicians is a really interesting one. I don't know the answer. We haven't, you know, that's, that's sort of a. People haven't even started talking about that yet. It's absolutely a really good question to answer. You know, what we do know is that liability is a really important issue in vaccine production for the manufacturers. Right. And you know, you know, you know this history, but for a long time, you know, the vaccine makers were subject to any kind of, you know, the same kind of lawsuits as anyone. When. And there would be reports of vaccine injuries, people would go to jury trials and they got these very big awards, and it would frequently turn out later on that there really wasn't anything there. But it's, you know, it's not hard to make one of those cases in a courtroom. Now, every once in a while, you're going to get a Sympathetic jury, a sympathetic kid or something that's happened to them had nothing to do with the vaccine. But you know, jury's going to want to award money for it. So they created, as you know, they created, we created this vaccine liability system where basically it's like a no fault system where we basically say to the manufacturers, you know, anybody who has anything that could plausibly said to be a sort of consequence, you know, a side effect, you know, some kind of damage from a vaccine and you know, it's like any medication, occasionally there are going to be side effects, occasionally there are going to be serious consequences, health effects. You, if you're, you can show that you had that condition happen, you just file, you show it goes through a view and then you can just get paid right away. You don't have to go through a whole lawsuit. So it speeds up the process for you and you're guaranteed money and the vaccine makers don't have to kind of constantly labor under this specter of a giant judgment against them that's going to turn the whole business into something less profitable. And that's, that's something society has an interest in because, you know, make vaccines, you can make money lots of other ways and we don't want shortages. So this was the arrangement.
- [10:40]
C
We. And vaccines only work if they're broadly distributed. Like this is a classic public health thing, right, because we're talking about communicable diseases.
- [10:48]
B
It's a public good. You know, one of the possibilities that was raised and was raised by a lawyer who was an advisor to Kennedy, who's sort of the most famous critic of vaccination, who said that when vaccines come off the schedule, as several just did, right. That's what the decision does. We pull those vaccines off the schedule. It will be, he's, he thinks, he was making the argument that that means that they might not fall under this liability shield for manufacturers and we'd be back to a world where manufacturers were, you know, in that. Now, I don't know if he's right. There's some, it's a legal argument. I've heard lawyers who say, no, he's wrong about that. But you know, I've heard lawyers who say, yeah, he might have a case, who knows? But again, it adds to the unknowns here of threatening vaccine availability by threatening the supply. We wouldn't have enough vaccines, you know, and this has happened before. So it's not like a purely hypothetical. We could be in a situation where you want to get your kid inoculated, you know, you Know, against RSV or Hep B or whatever. And you can't because there aren't any vaccines in supply.
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C
I mean, while we're talking about, you know, ratchets turning in thin ends of wedges. Is this the beginning or is this the end? Is, is the anti vax project over now? They got what they wanted? Or do you think a year from now, two years from now, we're going to revisit, say mmr?
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B
Oh, I don't think this is over by any stretch. I mean they clearly, this is, this is, this is a big step they took and I think this was one they've been eyeing for a while. But there is more to come. You know, it could be anything from taking, you know, what we were just saying about that compensation program, that liability program, if they add autism to that, you know, they say if you have autism, your child has autism, you can apply for an injury reward under this system. That could bankrupt that whole program because there's just, you know, so many cases of autism out there. And just to be clear, anyone watching this, there's no link. You know, we've investigated this exhaustively and found no link between vaccines and autism. But you know, that would be something they could do. Just as one example. There is more to come. I mean, the, the idea that this is not about that, this is simply giving more choice. It doesn't hold up to even casual scrutiny. And you know, and remember, you know, people, you know, you know, they talk about, well, now it's going to be shared decision making. Well, it was always shared decision making, right? I mean, you could always go to your doctor and talk about it. And lots of people didn't get some of these newer vaccines. But this is about putting a thumb on the scale against vaccines with no scientific backing. And again, I just, you know, I'm a process guy, I care about this. You know, to me, the reason we have a cdc, the reason we have these scientific advisory committees, is that we want to make these decisions carefully and with deliberation in a transparent way and taking the best possible evidence out there. And that doesn't always lead to the right decision, but the process, I think is the right process. And that has been completely junked. This is not how this decision was made. This was basically some of Kennedy's hand picked people putting up this idea and then green lighting it. And it's just, it's very sad because there was a time when the CDC was the gold standard for these kinds of decisions. And now you have lots of people basically walking around saying, don't listen to the cdc, which is just a very tragic thing.
- [14:04]
C
This is my last question for you and I have a version of this conversation with basically all of our colleagues at the Bulwark which is how are we supposed to go back from this? So I mean, let's just pretend three years from now there's a new president, maybe it's a Democrat, maybe it's a Republican. And, but, but this person is a normal human being and they decide, hey, we gotta, we gotta undo all this stuff. This stuff is crazy town, we're not gonna. And they try to bring all the experts back to the cdc. They try to reinstate the vaccine recommendations. You can't have a rules based system which only exists like every four years, can you? Like at some point, if it is in constant flux like that and you know, it depends on what 40,000 voters in Wisconsin do every four years as to whether or not a system of vaccinations is recommended by the federal government. That just destroys the entire public health thing. I mean, do you see what I'm driving at here? Like it, yeah, you know, can you say like, oh, we can trust the CDC every four years? It's just, you know, then in the other times, that's when the rest of the world understands that you can't trust the CDC because the crazy people are in charge of it. Like if that's the arrangement then then you don't have a CDC to begin with. Really?
- [15:27]
B
I mean, yeah, no, no. You and I have talked about this online offline and I've been thinking about this because I actually think I owe you a slack message on this. You would hit me up on that. My not great answer. I'm not going to pretend this is the greatest answer in the world, is that you can rebuild it. Part of that though is really making sure this current period both seems and is thought of as an outlier. And I think that's why it's so important to pay attention to the. I mean this is, this is going to keep happening over the Next, however long RFK Jr. Is in charge of HHS and the Trump administration and the Republican Congress are willing to give him this much room. We're going to keep seeing decisions like this and I think to the extent that we write about them, we talk about them and we hold them up to scrutiny, we say, hey, this is not what a real scientific consensus would say. This is not what people who you can trust would say that makes it possible three years from now or whenever it is, that when you bring in, you know, a kind of a more sort of respected, more knowledgeable, more trustworthy group of people in charge. You can say, look, that was. We said all along, we told you that, that that's not how this is supposed to work. We're back to doing things the way they should be run. You need that to kind of keep that drum beat up so people understand this was something outside the lines. This was. This was the exception to the rule. And then, you know, beyond that, why.
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C
Would you be the exception? Why would this. And this is a very serious question as a political matter, why would this be the exception? We have a fairly large percentage of America that affirmatively wants this. And they have all coalesced in one political party. They used to be spread out across the spectrum so they would cancel each other out. Some were Democrats, some were Republicans. All the people want this for Republicans now. And so they are an important constituency within the party. Why would they not get what they want whenever they are in power?
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B
You know, I guess I am hopeful. Said hope, not expect. But I am hopeful that as people see the consequences of this, that more and more turn against it. And, yeah, you're going to have some percentage of the country that wants this, but if it's a small percentage and, you know, going down the road, we have voices, you know, political defeats for the party that stands for this, that maybe, you know, we snap out of this.
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C
John. Johnathan. A million people died from COVID 19 in the greatest public health failure in this nation's history. And three years later, this same country reelected the guy who did that failure. So I don't know, man, like anything that's like, well, people will see the bad outcomes and then we'll, you know, change course. Dude, I just don't see that. I don't think that's how America works.
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B
I guess I have more faith. I'm not going to pretend that I have good reason for that faith, but I'm a hopeless optimist, so I'm going to. We'll see where we are in a couple years.
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C
Guys. Thanks for sitting with us. I mean, spoiler. I'm going to wind up being right on this one. Hit. Like, hit. Subscribe. Follow us as we continue the rocket sled to hell. Hello, 2026. We're back with the Bulwark. Good luck, America. With Cargurus Discover, you can skip the filters and describe what you're looking for.
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C
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