With two extraordinary moves, Health Secretary Robert F. Kennedy Jr. has upended the certainty that American children will always have cost-free access to lifesaving vaccines.
For decades, a little-known scientific panel at the Centers for Disease Control and Prevention has recommended which shots Americans should get and when. The group’s endorsement means insurance companies must cover the costs and helps states decide which vaccines to mandate for school-age children.
The panel, the Advisory Committee on Immunization Practices, also determines which shots are provided for free through the Vaccines for Children program, which serves about half of the children in the United States.
On Monday, Mr. Kennedy, long a vaccine skeptic, fired all 17 members of A.C.I.P., claiming that the group was rife with conflicts of interest and that a clean sweep was needed to restore public trust. Mr. Kennedy also reassigned C.D.C. staff scientists who oversee the panel’s work and vet its members.
On X, he promised not to replace the panel’s experts with “ideological anti-vaxxers.” On Wednesday, Mr. Kennedy named eight new members, at least half of whom have expressed skepticism of certain vaccines. Only one was a widely recognized expert in vaccines.
For years, Mr. Kennedy has argued that American children receive too many shots and has falsely claimed that vaccines are not tested in placebo-controlled studies. Critics fear he is now setting the stage for a rollback of federal recommendations.
“I’m very, very worried about young children in this country,” said Dr. Helen Chu, professor of medicine at the University of Washington and one of the committee members who was fired. If the panel’s new members “don’t believe in vaccines, then I think it puts us in a very dangerous place.”
Richard H. Hughes IV, who teaches vaccine law at George Washington University, predicted that the new committee would move to pare back the childhood vaccination schedule “relatively quickly.”
The Department of Health and Human Services did not respond to a request for comment.
“All of these individuals are committed to evidence-based medicine, gold-standard science, and common sense,” Mr. Kennedy said in a message on X. “They have each committed to demanding definitive safety and efficacy data before making any new vaccine recommendations.”
He also acknowledged that the panel would “review safety and efficacy data for the current schedule as well.”
The upheaval arrives as measles infections approach the highest level in decades; whooping cough has risen significantly, too, compared with this time last year. Steep cuts to global immunization programs also make it more likely that infectious diseases, like polio, may reach American shores.
Alarmed, members of the House Committee on Oversight and Government Reform have asked Mr. Kennedy to provide all communications and documents related to the dismissal of the committee and a “detailed description of the rationale for removing each individual” by June 24, according to a letter obtained by The New York Times.
The American Medical Association called for an immediate reversal of the purge and resolved to “identify and evaluate” alternative sources of advice on vaccines.
It is unclear whether Mr. Kennedy will appoint more members — there is no required minimum — before the next scheduled meeting at the end of June. And no one can say whether or how the decisions of the reshaped panel may diverge from current recommendations.
But any softening of federal recommendations regarding vaccination would ripple through the nation in unpredictable ways. Access to the shots eventually may depend on where you live, which insurance policy you hold and which doctor you see, experts said.
“That obviously is going to decrease the number of people who are protected with these vaccines,” said Dr. Mysheika Roberts, the health commissioner of Columbus, Ohio. “I am concerned about what that means about herd immunity, what that means about outbreaks and infections.”
Under the Affordable Care Act, insurance companies are required to cover the cost of any vaccine recommended by the A.C.I.P. Losing that endorsement means that some insurance companies may choose not to pay for immunizations.
Nor could those shots be offered for free through the Vaccines for Children program. The measles vaccine can cost up to $250 and the four-dose polio series up to $340.
“You’d essentially have a two-tier system where people who have cash at hand can purchase their own vaccines if they’re not recommended, and those who don’t have the money may have to go without,” said Dr. Yvonne Maldonado, a pediatrician at Stanford University and one of the fired panelists.
The panel could take a more measured approach, perhaps advising that a doctor’s sign-off should be required for some immunizations. The vaccines program would still cover it, but reimbursement from private insurers would be more difficult to enforce, Mr. Hughes said.
The Vaccines for Children program was created after a measles epidemic from 1989 to 1991 led to tens of thousands of cases and hundreds of deaths. More than half of the infected children were unvaccinated even though many had seen a doctor, because they could not afford the shots, according to the C.D.C.
Cutting back on free access to immunizations “is not a strategy to even think about — only vaccinating potentially the half of the population that has health insurance,” Dr. Chu said. If measles continues to resurge, for example, even vaccinated people will be at risk, she said.
Vaccinations are not profitable for clinics, and reduced demand could mean that fewer places bother to offer the shots. “In places where you know there’s a large anti-vax sentiment, there may not be financial incentive, or any incentive, to keep those vaccines in stock,” she said.
A.C.I.P. makes recommendations for immunizations. But the authority to mandate them rests with the states.
Even if the federal government walked away from some recommendations, most, if not all, states are likely to maintain the current mandates for school-age children, said Claire Hannan, executive director of the Association of Immunization Managers, which represents state and local officials.
“Even where legislators are chipping away at requirements and mandates, there’s a commitment to protect children,” she said.
Still, she added, “our members are very confused.”
Now some scientists are considering establishing alternatives to federal guidance on vaccines. “The new A.C.I.P. cannot be trusted to oversee unbiased and scientifically sound vaccine policy development,” said Michael Osterholm, an epidemiologist at the University of Minnesota.
He and other experts have formed a new group, called the Vaccine Integrity Project, to offer science-based advice on immunization.
Members of the A.C.I.P. are usually vetted thoroughly. It took more than four months for Dr. Roberts, who was set to join the panel in July, to be accepted, and several more weeks to fill out at least 50 forms, including disclosures of conflict of interest. The committee’s members typically rotate in staggered four-year terms to ensure some continuity and institutional memory.
Mina Zadeh, a C.D.C. scientist, has been named to oversee the committee, but the rest of her team has not been set up. Staff members who lead the committee’s work groups may meet with her “starting early next week,” according to a recording of an internal meeting obtained by The Times.
But the panel’s next meeting is scheduled to begin June 25. Dr. Adam Ratner, a pediatric infectious diseases physician and expert on vaccine policy, said he worried that the new members could not be prepared on such short notice and without the help of previous members or C.D.C. personnel.
“This raises the question of whether the goal here is for A.C.I.P. to be able to do its job,” he added. “Kennedy has accused the prior committee members of conflicts of interest and for rubber-stamping things, but I think that’s exactly what we’re looking at with this group.”
Reed Abelson and Emily Anthes contributed reporting.
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
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