The incoming Trump administration has health experts worried about reductions to vaccine access and affordability.
Their concerns stem partly from longtime anti-vaccine advocate Robert F. Kennedy Jr.’s potential involvement in health agencies like the Department of Health and Human Services and the Centers for Disease Control and Prevention. Experts’ fears have also been prompted by recommendations in the Heritage Foundation’s Project 2025 agenda, which include a large-scale reorganization of the CDC that would drastically limit its power to make public health recommendations.
Experts say any change in vaccine access could have severe consequences on a number of public health fronts.
“It concerns me if there is a loud voice in an administration that is undermining people’s trust in our vaccine system … because when you undermine that trust, then people may make decisions based on incomplete or incorrect information that is dangerous to their health,” said Richard Besser, former CDC acting director.
One possibility experts worry about is the Trump administration making changes to the CDC’s Advisory Committee on Immunization Practices — or ACIP, which produces recommendations on vaccine schedules. Their concern is those changes could force patients to pay out of pocket for vaccines again. The CDC did not respond to a request for comment.
Under the Affordable Care Act, most private health insurance plans and Medicaid ACA expansion programs must cover the cost of immunizations without requiring a co-pay — but this only applies to vaccines that the ACIP recommends. The Inflation Reduction Act added the same coverage to Medicare Part D prescription drug plans, eliminating cost-sharing and deductibles for more recommended adult vaccines, including RSV and shingles immunizations.
The cost of medical treatment can be a major factor in someone’s decision whether or not to seek care: A 2022 KFF survey found that one-quarter of American adults had skipped or postponed health care they needed in the past 12 months because of the cost.
Even a relatively small co-pay can dissuade people from receiving a vaccine and making it free can radically increase the number of people who get it. After the IRA made the shingles vaccine free for those with Medicare part D coverage, shingles vaccinations dispensed via part D increased by 46%.
“Taking away a benefit is really hard to do,” Besser said. “People rely on it.”
Some health policy experts are concerned that the ACIP could see drastic changes in its membership — which currently includes chairs of medical schools and professors of public health and medicine — and scope to reflect the new administration priorities.
“They might think differently about the kinds of voices they want to have around the table,” said Jason Schwartz, an associate professor at the Yale School of Public Health, about the Trump administration.
The Trump campaign did not respond to a request for comment. But Del Bigtree, a former spokesperson for the Kennedy campaign and close associate of Kennedy’s, told Reuters that Kennedy had been asked to recommend potential appointees to the agencies that regulate health.
“President Trump is keenly interested in the selections that Bobby Kennedy thinks would get the job done,” said Bigtree, adding that Kennedy will recommend scientists and doctors who “don’t have any conflicts of interest with the pharmaceutical industry when it comes to the departments that are going to be dealing with drugs and vaccines.”
Some associates of Kennedy’s whose names have been floated for possible health agency appointments include Casey Means, a physician, chronic disease entrepreneur and author, and Marty A. Makary, a doctor who worked with the first Trump administration on health care policy.
Both have also promoted vaccine skepticism. Means has questioned the effectiveness of hepatitis vaccines (the CDC recommends that all newborns receive a first dose of the hepatitis B vaccine immediately following birth), and Makary has voiced concerns about COVID-19 vaccines (though he has also said that he would recommend the COVID-19 vaccine to pregnant women). Neither Means nor Makary responded to a request for comment.
Any increase to the cost of vaccinations would both exacerbate health inequities, since minority communities are more likely to have greater numbers of Medicare users, as well as widespread harm to public health caused by reduced vaccination rates overall, said Kathleen Hoke, the director of the Legal Resource Center for Public Health Policy at the University of Maryland School of Law.
“You don’t keep measles inside your house,” Hoke said.
Other vaccine access programs could also be threatened by changes to the ACIP’s recommendations, including the CDC’s Vaccines for Children program, which was created by Congress in the ’90s in response to a measles epidemic and provides vaccines to children whose parents cannot afford to pay for them. A recent resurgence of measles outbreaks can be attributed in part to falling vaccination rates, according to the CDC.
Another possible challenge to the ACIP and the CDC’s ability to make vaccine recommendations could come via Project 2025, the conservative agenda for a second Trump administration produced by The Heritage Foundation. The plan includes a proposal to end the CDC’s ability to make recommendations on public health policy, arguing that it is an “inescapably political function.”
“The CDC can and should make assessments as to the health costs and benefits of health interventions, but it has limited to no capacity to measure the social costs or benefits they may entail,” the plan states. “The CDC has no business making such inherently political (and often unconstitutional) assessments and should be required by law to stay in its lane.”
But being able to make public health recommendations is a central tenet of the CDC’s mandate to protect public health, Besser said.
“Most clinicians don’t have the time or expertise to come up with their own independent assessments [on vaccines]. They count on our government,” Besser said. “It’s a central part of a democracy, having a strong, functional public health system to provide those recommendations.”
Other ongoing infectious disease threats include H5N1, mpox, measles and COVID-19 — all of which have FDA-approved vaccines. But the dissemination of those vaccines is contingent on the CDC being able to work with public health data and make recommendations on how to respond to outbreaks. Experts warn that disrupting that workflow could have serious consequences for future infectious disease threats.
“Fundamentally, the way CDC engages with public health departments means that if you were to try to separate and change the streams of communication and data, you would create immense confusion and inefficiencies responding to any emerging threat,” one public health official said.
The official pointed to the CDC response to the ongoing H5N1 outbreak in animals. The CDC recently updated its guidance for farmworkers and livestock owners who could be exposed to the virus.
“All of that is done by seeing the data, talking with public health departments, talking with our public health partners on what we see and how we should think about protecting Americans because of the data. If you separate that, you have two agencies on an island with no direction or steer or understanding of how to make any decisions,” the official said.
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Margaret Manto is a NOTUS reporter and an Allbritton Journalism Institute fellow.