Experts are worried about how President-elect Trump’s nomination of Robert F. Kennedy as Health and Human Services secretary will affect vaccination rates for school children, which have been on the decline.
Schools have seen a drop in childhood vaccinations since the COVID-19 pandemic, when critics of the COVID-19 vaccines increased anti-vaccine sentiments in general.
Public health groups see vaccines as a huge bulwark against disease and fear Kennedy will only increase skepticism if he is confirmed.
“The reason we think Mr. Kennedy is the wrong guy for the Secretary of Health and Human Services is we do not think that somebody who has been the source of so much death and disability amongst the nation's children should have any seed of prominence in the health world,” said Georges Benjamin, the executive director of the American Public Health Association.
Trump has suggested he could at least consider ending some childhood vaccination programs.
“We're going to have a big discussion. The autism rate is at a level that nobody ever believed possible. If you look at things that are happening, there's something causing it,” Trump told Time magazine when asked about ending certain vaccines programs.
While autism diagnoses are on the rise, claims that vaccines cause autism have been debunked by the medical community. Health experts have explored other reasons for the increase in autism diagnosis, such as changes to diagnostic criteria.
Kennedy is a longtime vaccine skeptic who said back in 2023 that “there’s no vaccine that is safe and effective.” He also created an anti-vaccine group called the Children’s Health Defense.
Public health groups say a move against vaccines could be a danger for school children.
“Kids are coming together often for the first time in places like daycares and in schools and these are diseases that are spread when you get close to one another in any kind of setting,” Benjamin said.
“School is a very high-risk place for the spread of these diseases. So, as a way of protecting the public, both individually and broadly, we require kids to get vaccinated at school,” he added.
The U.S. began childhood vaccination programs in the 1970s due to outbreaks in schools. By the end of the 20th century, all but four states had vaccine mandates for students entering K-12.
“I mean, were school mandates to be eliminated, I think you would see major resurgences of these highly contagious, infectious diseases that are often transmitted in schools,” said Paul Offit, the director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia.
“And I fear that what's happened with COVID is that people feel that there was government overreach, and so there's pushback. And I think one of the places where there's pushback is school mandates,” Offit said.
In the 2023-24 school year, fewer than 93 percent of kindergarteners had all state required vaccines, down from 95 percent in the 2019-20 school year, according to data from the Centers for Disease Control and Prevention.
There are multiple reasons vaccinations are on the decline since COVID-19, such as some children missing their routine checkups due to the pandemic and also a general increase in vaccine skepticism.
There was “intentional misinformation and disinformation, which has led to what I consider to be just a tragic deterioration in trust of public health expertise, and that is really something that has compounded all of the challenges that were presented by the pandemic,” said Michael Cappello, professor of pediatric infectious diseases and chair of the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health.
“And so I think having leaders in important offices, particular Health and Human Services, the Centers for Disease Control, these positions really have an important pulpit from which to be able to provide reliable information to the public, and I would very strongly say that the people in those positions really should be, at this moment in time, really should be advocates for routine childhood vaccination rather than skeptics,” he added.
The 2023-24 school year also saw the highest exemption rates at 3.3 percent, up from 2.5 percent in the 2019-20 academic year. The increase in exemptions was mostly all for nonmedical reasons.
In 14 states in the past school year, school districts had higher than a 5 percent exemption rate, compared to only eight states before the pandemic.
“It is really imperative for schools to actually make sure they are enforcing the school requirements that are in place and making sure that if they find that there is a lower vaccination rate in their school … those schools should really take that seriously,” said Amy Pisani, CEO of Vaccinate Your Family, a nonpartisan organization that has worked with Democratic and Republican administrations.
Experts are concerned about conflicting messages coming from the federal government and the health community under the Trump administration, but emphasize local mandates and support are key to instilling confidence in vaccines.
“Vaccinations occur at the local level. The laws around vaccinations are determined at the local level. They're not determined at the federal level. Now, the Fed still sets some standards and gives some guidance and things like that. But at the end of the day, vaccination requirements are managed at the local level,” Cappello said.
“So to the extent that the schools can continue to work with their public health departments locally to encourage vaccination requirements, and the schools make sure kids are following the law, then there will be … we will not have the outbreaks that that we have predicted,” he said.
Some schools are ready to continue their path of abiding by state law and sharing the benefits of vaccines with parents.
“Even if the Feds decide to recommend or not to recommend” parents will make their own decisions, said Bebi Davis, principal of Princess Victoria Kaiulani Elementary School in Hawaii.
“For example, I know for myself, I consult with my physician first, right, my primary care to make sure I can get vaccinated for something. Because everybody has different health challenges,” Davis said.
“And some people cannot be vaccinated. And then some people have religious constraint and cannot be vaccinated,” she added.
The three exemptions from vaccine mandates are medical, religious and personal reasons.
All states allow exemptions for medical reasons, such as a student’s weakened immune system or allergies to a vaccine. Most states allow for religious exemptions but can require proof a family belongs to the religious organization. Only a little more than a dozen states allow students not to be vaccinated due to a family’s personal beliefs about vaccines.
“When Donald Trump says something like ‘maybe they don't need all these vaccines,’ which diseases would you like to see come back?” Offit said.
“I think the term is all politics is local. I think that's also true with public health, that all public health is, I think, is the state health departments and local health departments and school nurses,” Offit said.
“And everyone involved in carrying out the health and well-being of children should stand up and stand up hard and loud and clear that we need to protect these children, and the vaccines do offer that protection.”
