You want to know what’s a term that will be forever tarnished? “Gold standard.” If I never hear the term “gold standard science” ever again, it will be too soon. Like the tacky gold that now adorns every nook and cranny of the once-classy White House, the term “gold standard” has been used too many times by this administration to try to convey improvement, while ultimately just making something worse.
On Monday, I started receiving texts and emails from people sounding the alarm about the executive order that Trump was considering, which would remake the childhood vaccine schedule. Right around 2pm Eastern time, the Washington Post broke the news that they had obtained the draft executive order “that would upend decades of federal guidance on which vaccines are administered to children and call for states to reconsider school vaccine requirements,” and that Trump was expected to sign it as soon as Monday.
Not even 40 minutes later, someone sent another email with the full text of the executive order. I read through it and at first assumed it was just a leaked version of the draft. But within 30 minutes, my phone lit up with a NY Times alert: Trump Signs Executive Order Calling for Fewer Childhood Vaccines. That’s when I realized that “as soon as Monday” meant “as early as today.”
Well. Much panic ensued on social media and in my poor email inbox. I was getting ready to post my finished Substack post about RFK Jr.’s shameful visit to CDC on Friday, and for a moment considered kicking that post down the road and burning another few hours writing this post instead, trying to be timely.
But after I took a breath or two, I came to the conclusion that What in the Health?! has never really been about breaking news, it’s been about helping others understand what’s really happening in public health these swirly, stressful, confusing days. And in many ways, what happened at CDC on Friday is much more important than this executive order. They want us to be running around, chasing every shiny object—and they sit around devising cheap gold shiny objects to toss in the air, just to tire us out. But we have important things to do. I see it as an act of resistance to take a beat and suppress the urge to chase them.
So here we are. Just about a week after the executive order “Delivering Gold-Standard Childhood Vaccine Recommendations for Americans.” Where do we stand?
Basically where we stood before.
The executive order’s own summary of what it is designed to do is this:
“Taking further action to reaffirm that it is the policy of the United States that the core childhood vaccine recommendations should be aligned with scientific evidence and best practices from peer, developed countries while preserving access to vaccines currently available to Americans. Further, it is the policy of my Administration that Federal programs and funding should support maximal parental choice over childhood vaccines, consistent with the Federal Government’s constitutional and statutory obligations and the fundamental principles of personal autonomy and informed consent.”
Translation: We want to make sure Americans can access vaccines aligned with scientific evidence, and parents should have the ability to choose which vaccines their children receive.
Well, this is already true. No change. The only exception is that a few states (California, New York, Connecticut, and Maine) have regulations that say no children can attend public or private kindergarten without having certain vaccines, and only medical reasons (aka allergies to the vaccines themselves) are an allowable exemption. I’ll talk about that more below.
The executive order goes on to say:
“It is hereby declared that the United States recognizes Gold Standard Childhood Vaccine Recommendations informed by the three distinct categories of childhood immunization recommendations identified in the scientific assessment, as specified below:
(i) immunizations recommended for all children: measles, mumps, rubella (MMR), diphtheria, tetanus, pertussis, polio, Hib, pneumococcal disease, HPV, and varicella;
(ii) immunizations recommended for certain high-risk groups or populations: respiratory syncytial virus (RSV) monoclonal antibodies, hepatitis A, hepatitis B, meningococcal B, meningococcal ACWY, and dengue; and
(iii) immunizations based on shared clinical decision-making: hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19.”
Translation: We’re trying to change the vaccine schedule by executive order. We tried to do it another way, and a judge said it wasn’t legal. So we’re trying this way instead.
Except it doesn’t work that way. If you live in California, Connecticut, Maine, or New York, nothing has changed. And if you live somewhere else, nothing has changed. You should still follow the American Academy of Pediatrics recommended schedule, in conversation with your own family’s pediatrician. Do what’s right for you. This executive order has no power over you.
Side note: I am fascinated that the two childhood vaccines that are most controversial in the MAHA space—the MMR and the HPV vaccine—are both on the “recommended for all children” list in this executive order. RFK Jr. cannot be happy about that. (They are both extremely safe and life-saving vaccines according to regular old science, and your kids should definitely get them.) Oh, and the dengue vaccine listed at the end of category 2? It is not currently available in the US outside of Puerto Rico.
It also says:
“The Secretary of HHS, through the HHS Task Force on Safer Childhood Vaccines, shall, within 90 days of the date of this order, present plans to the President through the Assistant to the President for Domestic Policy to, to the extent appropriate and consistent with applicable law:
(a) offer options to administer core childhood vaccines, starting with MMR, as single vaccines rather than combination products/doses, including by working with the private sector and other countries as appropriate, while guaranteeing continued availability of combination vaccines and those vaccines recommended for shared clinical decision-making”
Translation: RFK Jr. has 3 months to present a plan for offering MMR as separate shots.
This will take years of research and development, since right now there ARE no licensed vaccines for measles, mumps and rubella to be administered separately in the US. For vaccines in the US you need to license both the vaccine itself and the factory that produces it. Those don’t exist, and the effort required for vaccine manufacturers to complete clinical trials or license factories for this purpose is extensive. Who is going to rush to do this? No one.
The only other option is to push the FDA to allow individual vaccines from other countries, which would mean American kids going to multiple different doctors appointments to get multiple injections of vaccines made in either China, India, Indonesia, or Japan, instead of a single vaccine made by a US company, offered over two doses (two visits). Trump said outright at the press conference where he signed the executive order, “At 1 year, you should have five separate visits for vaccines rather than getting them all in the same day.” So instead of two doctor’s visits with one shot each, they think it’s better for new parents to bring their babies and toddlers to the doctor five separate times, for five separate shots granting the same protection. Why?? There is no scientific evidence to support this. Trump also said in the press conference: “Together, there could be a possibility they’re quite lethal, and separately, it looks like they are not at all lethal, but just very effective.” This is simply a lie. There is zero evidence to suggest this. Zero. Even those countries with licensed single disease vaccines don’t use them – like India’s monovalent measles vaccine, given at 9 months, which is followed by an MMR or MR vaccine at 12-24 months for full protection. China also uses an MMR vaccine, despite existence of a monovalent mumps vaccine. So….my prediction is this will be much like when there was a big announcement that RFK Jr. was going to find the cause of autism in only 5 months. Five months later they had to do something, so there was a pronouncement that probably it was Tylenol. Except the science didn’t back it up, and all that ensued was unnecessary confusion and fear by pregnant people and their doctors.
And finally, the big threat:
“The Attorney General shall take appropriate measures to further meritorious legal actions challenging State laws that conflict with States’ constitutional and Federal statutory obligations related to parental authority, religious freedom, disability accommodations, and equal protection under the law, including, to the extent applicable under Federal law, States’ obligations to provide religious and medical exemptions from childhood and adolescent immunization requirements.”
Translation: We’re thumping our chests and hoping the DOJ will find some way to address this issue, but honestly there might not be a path forward because we can only address areas where states are violating federal statutes or the Constitution. We’ll see what we can do.
Lots of people are reading this section of the EO and saying “Great! Religious exemptions are back. Too bad California, good try but you were just overruled.” They’re simply wrong. As Dr. Joel Gator—someone who self-describes as “someone who strongly believes parents should have more choice when it comes to vaccines”—says, “The entire legal dispute is over whether states like New York and California are actually violating federal law by refusing to provide religious exemptions. You cannot solve the question by putting the question into an executive order. It is a little like writing, ‘Anyone who legally owes me $10 million should immediately pay me $10 million.’ Great. I strongly support this policy. Now comes the slightly more difficult part of establishing who legally owes me $10 million.”
Closing thoughts
Stephen Miller also piped up at the signing, saying about the childhood vaccination schedule: “Nobody has studied it. Nobody’s looked at it. Nobody’s thought about it.” I don’t know about you, but when Stephen Miller says something I usually assume it’s either a lie or some manipulative way to be terrible to other people. This is certainly a ridiculous lie. The current childhood vaccine schedule has involved decades of research, where people with qualifications substantially better than Stephen Miller, Donald Trump, or RFK Jr. have studied, looked at, and thought about these issues extensively. To say otherwise is frankly absurd.
RFK Jr’s own CDC has a page that provides a lot of details on the safety of the MMR vaccine, demonstrating the years and years of people studying this very thing. And yes, this page talks about the very rare but possible chance of life-threatening reactions to the vaccine. That scares a lot of people, mostly because our human brains aren’t very good at comparing risk levels between two things. There is non-zero risk from the vaccine. But there is a much more than zero risk from the infections you can get if unvaccinated. If you’re interested in understanding this better for yourself, Unbiased Science has just released an outstanding free and interactive tool that allows you to compare the risk of the vaccine to the risk of no vaccine. I strongly encourage you to check it out, here.
In case you are too busy to click the link, I’ll give you just one screenshot:
But seriously, check it out for yourself.
One last thought?
At her confirmation hearing in July, Sen. Bernie Sanders (I-Vt.) said to (now) CDC Director Erica Schwartz, “If confirmed, will you commit that you will report to Congress if you receive directives from Secretary Kennedy or any other individual in the Trump administration to implement policies that are unscientific and could harm the health and well-being of the American people?” And she replied, “Senator, I do not believe that the President or the Secretary would ever do what you just mentioned.”
It was 5 days after she was confirmed as CDC Director that this was dropped in her lap. How will she respond is anyone’s guess – but we’ll learn a lot from this test of Dr. Erica Schwartz’s integrity, and how this will all play out.