U.S. Vaccine Guidance Is a Mess

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In January, the Trump administration attempted to fundamentally change the way the United States handles childhood immunizations. Following a memo from the Department of Health and Human Services, the CDC updated its vaccine schedule to recommend that some shots no longer be given to all children. A federal court undid the effort in March. In an executive order in May, Donald Trump called on states to adopt the narrower schedule anyway. On Monday, Trump issued a new executive order on the same subject, focused on lowering the number of vaccines that the government recommends for all children. As I wrote earlier this week, this White House has a habit of doubling down when it doesn’t get its way. But only states have the power to put these proposals into practice—and many state policy makers, concerned that the White House is contradicting existing research, aren’t keen to follow its guidance.

According to the new executive order, preventive shots for hepatitis A, hepatitis B, dengue, and other diseases should be recommended for “high-risk” groups only. The order also calls to split up vaccinations for measles, mumps, and rubella—the two-dose MMR shot that has been a standard recommendation for U.S. children for decades—into three separate stages, and directs the attorney general to pursue legal action against states that don’t respect “parental authority, religious freedom, disability accommodations, and equal protection under the law.” (The order says it will align U.S. policy with the best practices of other countries, such as Denmark, but the experts I spoke with highlighted that what works in one country won’t necessarily work in another.)

The mandate may not have any legal authority to compel states to change their guidelines in the near term, although the invocation of the attorney general suggests that litigation may be on the horizon. And the single-disease vaccines that the executive order encourages aren’t yet available in the U.S. But this week’s order risks creating even more uncertainty about vaccines than already exists. “If you set out to write a policy that confuses people, it would look a lot like this one,” Jake Scott, an infectious-disease specialist at Stanford, told me.

Between the policy priorities of the Trump administration and the guidance of public-health experts, Americans have been stuck in a state of vaccine whiplash. When the American Academy of Pediatrics broke with the government earlier this year over its proposed vaccine schedule, the chair of the organization’s committee on infectious diseases told reporters that the recommendations are a “strong departure from the medical evidence and no longer offer the optimal way to prevent illness in children.” Some state lawmakers have been fighting over how best to adapt to the CDC’s changing guidelines; Kansas’s GOP-dominated legislature tried to bring the state’s vaccine rules into alignment with the CDC’s, only for its Democratic governor to veto the effort in April. And many other states have publicly said that they will reject the guidelines.

Secretary of Health and Human Services Robert F. Kennedy Jr., who has questioned vaccines’ safety in the past, has been driving the discussions of the CDC’s vaccine advisory committee, as my colleagues Tom Bartlett and Katherine J. Wu reported. And although the secretary has moved away from explicit anti-vax rhetoric in recent months (following a reported White House push for health officials to stick to messages with broad public support), vaccine skepticism clearly lingers within the administration. During the press conference for Monday’s executive order, Trump suggested that the MMR vaccine could be “quite lethal.” There is no evidence for this. Measles, though, can kill: Last year, the U.S. saw its first deaths from measles in a decade.

Rethinking MMR at this moment poses extreme logistical challenges. Even if pharmaceutical companies opted to invest the time and money to introduce these shots to the American market, splitting up the doses would create new problems for caregivers. “We are essentially tripling the operational labor required of the parent or guardian (who must now schedule three separate appointments for their child),” Maimuna Majumder, a Harvard epidemiologist, told me in an email, which is “all but guaranteed to result in missed vaccines.”

In the meantime, the executive order risks misinforming Americans who are already unsure of how they feel about vaccination. The Kaiser Family Foundation released a study in June suggesting that about a third of American adults fall into a “mixed middle group” of vaccine skepticism—they believe some myths and reject others. My colleague Nick Florko, who covers public health, told me that these are the people most likely to be swayed by the administration’s latest push: “Those are the folks that might see this and think, Okay, maybe my belief that I want to delay this vaccine is well founded because the federal guidance now says that we should do that.” Under the White House’s rubric, the Americans who most need clear guidance are those who stand to lose.

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Evening Read

Three black and white images showing a soldier in a military vehicle, a crime scene, and César Gastélum. — Illustration by Anna Ruch / The Atlantic. Sources: Ivan Medina / AFP / Getty; Kevin Sieff; YouTube / César Gastélum.

What I Saw In Sinaloa

By Kevin Sieff

Last Tuesday night, I was eating sushi with a Mexican police chief in downtown Culiacán, a city that had momentarily flickered back to life amid a bloody cartel turf war. At the table next to us was a birthday party. The police chief ordered a salmon roll. Through the window, I could see groups of families and friends walking on the sidewalk, past car dealerships and strip malls, after months of self-imposed lockdown.

Among them were three influencers who pulled up to a KFC down the street. They were dressed as food-delivery workers, carrying insulated bags on their backs, joking with one another and livestreaming everything with their phones. César Gastélum, the group’s front man, had become famous for such innocuous pranks. Even as thousands were murdered by the cartels, Gastélum, a stocky, bearded 24-year-old, posted videos of himself dancing in pajamas, dressing as a priest, sipping iced coffee. He had more than 700,000 followers on TikTok.

Read the full article.