A Health and Human Services Department under vaccine skeptic Robert F. Kennedy Jr. could pull several different levers that result in weakened school vaccination requirements, even though those are set by states.
Even if the incoming Trump administration doesn’t make concrete policy moves aimed at weakening vaccination requirements or discouraging vaccines, Kennedy and other health officials aligned with the incoming president have the bully pulpit to further undermine confidence in vaccines at a time when immunization rates have been slipping, said Dr. Georges Benjamin, the executive director of the American Public Health Association.
“He can begin as secretary speaking negatively about vaccines, creating vaccine doubt, empowering people who are skeptics,” he said.
President-elect Donald Trump on Nov. 14 announced Kennedy, who has a long history of making false statements about the safety and efficacy of vaccines, as his pick to serve as secretary of HHS—the mammoth federal agency that’s in charge of the nation’s public health infrastructure.
If he’s confirmed by the Senate—or if Trump makes a recess appointment to the post without Senate confirmation—Kennedy would lead the federal department that includes two key agencies that deal with vaccines: the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration.
The CDC develops the immunization recommendations and schedules that physicians follow, and to which most states align their school vaccination requirements. The FDA approves and regulates the vaccines themselves.
Both agencies have vaccine advisory committees: the CDC’s advisory panel plays a key role in developing immunization-related recommendations, which the CDC director can then choose to adopt. The FDA’s panel reviews data on vaccine safety and effectiveness.
Kennedy would have a strong hand in influencing the makeup of those committees, and could exert some leverage through changes to recommended childhood immunization schedules.
The HHS secretary chooses members of the CDC advisory committee as their terms expire while the FDA commissioner—a presidential appointee subject to Senate confirmation—selects the members of that agency’s advisory committee. The committees include doctors, public health experts, and specialists in a range of related scientific fields.
“At the end of the day, the people that get appointed to those jobs are influenced by the secretary,” Benjamin said.
Appointments to those key committees and policy changes—even if they stem from executive orders—would take some time, Benjamin said, but Kennedy would immediately have the federal government’s bully pulpit to potentially seed vaccine doubt.
He can begin as secretary speaking negatively about vaccines, creating vaccine doubt, empowering people who are skeptics.
And such messaging can filter down to state and local governments.
“There are opportunities to incentivize local elected officials, just by word of mouth, to begin changing things,” Benjamin said. “Those are problems because they begin to create doubt. You’ll begin to see patients, parents, beginning to question the efficacy or the safety or, more importantly, the need for vaccines.”
Childhood vaccinations have already declined
Already, childhood vaccinations have fallen in recent years and have yet to rebound from a pandemic dip.
Immunization rates were lower for children born in 2020 and 2021 than in 2018 and 2019, according to CDC researchers. In addition, the share of kindergarten students up to date on recommended immunizations sat at 93 percent in the 2022-23 school year, down from the 95 percent level it had remained at for about a decade.
There’s also been a greater push by states in recent years to broaden exemptions to school vaccination requirements, making it easier for families to claim religious or philosophical cause to skip shots.
Measles cases surged worldwide in 2023, reaching 10.3 million, the CDC reported Thursday, with the increase the result of insufficient numbers of children getting the two-dose vaccination.
Trump’s transition team didn’t respond to a request for comment on the incoming administration’s plans for school vaccination requirements. A spokesperson for Kennedy has told the Washington Post that the HHS secretary-designate isn’t anti-vaccine.
In accepting Trump’s appointment, Kennedy wrote on X that he “will provide Americans with transparency and access to all the data so they can make informed choices for themselves and their families.”
Schools have a long tradition of conditioning admission on immunizations
Schools have a long tradition as a lynchpin in America’s public health infrastructure. The first schools to require that incoming students be vaccinated did so in the 1850s to prevent the spread of smallpox, according to the Mayo Clinic.
The Supreme Court upheld such requirements in a 1922 case, Zucht v. King, in which an unvaccinated student challenged a school vaccination rule in San Antonio, Texas.
Today, all 50 states require that children entering child care, pre-kindergarten, and K-12 schools be immunized against polio; chickenpox; measles, mumps, and rubella; and diptheria, tetanus, and pertussis (whooping cough), according to the Immunization Action Coalition. Some have requirements for vaccinations against Hepatitis A and B, influenza, and human papillomavirus.
In addition to playing a key role in infectious disease prevention, schools in recent decades have also taken on a bigger role in preventing chronic diseases such as obesity. Many have removed soft drinks from vending machines and now routinely measure students’ body mass index, said Richard Hughes IV, a lecturer at the George Washington University School of Law and a health lawyer.
“RFK Jr., his whole philosophy about public health is that we need to focus more on chronic disease and less on infectious disease, and that doesn’t really square with the principles of public health,” said Hughes, who is also a former public policy director for the vaccine developer Moderna and previously served on the Arkansas State Board of Health as an appointee of former Republican Gov. Mike Huckabee. “Over the last few decades, public health is increasingly focused on chronic disease, but not at the expense of infectious disease.”
While vaccination requirements have long been the purview of individual states, there are provisions of federal law the Trump administration could use to influence vaccine policy in its desired direction, Hughes said.
The CDC has authority under the Public Health Services Act, a 1944 law, to “control communicable diseases,” and the law also has a clause allowing the federal government to preempt any state law that “conflicts with an exercise of federal authority under this section.”
“It’s really more of a question than a definitive answer as to whether the federal government could just simply set its own vaccine policies and force the states to comply with those,” Hughes said.
Such a move would likely prompt litigation over the delineation of state and federal authority, he said.
Short of using that direct mechanism, the federal government has leverage to influence state vaccine policies through the grant funding it distributes to build up state and local immunization programs.
Under the section of the law that authorizes those grants, Hughes said, “CDC has wide latitude in how it gives out that money and the conditions that it sets.” That language raises the specter of new conditions that might involve the adoption of revised vaccine schedules or broadened exemptions from vaccine requirements.
However, not all states would likely agree to those conditions, potentially setting up vaccine rules and practices that vary widely by geography.
“You really don’t want to have physicians in one community practicing differently than physicians in another community right across the state line, right across a county line,” Benjamin said. “You don’t want that to occur.”
