Vaccine policy changes in the USA

What could the latest changes in the States mean for vaccine access and uptake?

Firstly, apologies for the huge gap in writing a post. There are things I have wanted to write about but work has been rather pressurised so been hard to find headspace or time. However, the ongoing and developing situation in the States is something I wanted to comment on and specifically the recent announcements regarding vaccine mandates.

Within a few hours of RFKJr being sworn in as Trump’s health secretary, Trump ordered an end to funding for schools and colleges that require Covid vaccines. But, what will these changes mean for infection prevention?

What are Vaccine Mandates?

Vaccine mandates are a way to try and make people get vaccinations by for example fining those who refuse or excluding them from certain roles or places such as educational institutions. Mandates have been used in a number of countries to try and tackle a variety of infections - often to try to increase the level and/or speed of vaccination programs in response to a health crisis or need. For example, the US was amongst the countries bringing in vaccine mandates for Covid19 in schools, colleges and some professions like the army or healthcare. In 2020, Germany made measles vaccines mandatory for schools and childcare attendance following serious measles outbreaks.

Data does suggest that vaccine mandates do work to increase vaccine access and coverage. However, another study found no correlation between mandates and rates of childhood vaccination. Arguments for mandates are generally strongest in countries where vaccine confidence is lower or when countries are facing a surge in infections and significant pressure on healthcare provision. Arguments against mandates often centre on vaccines being forced, removing freedom of choice and creating antagonistic attitudes to vaccines. The reality is that often there are many exemptions from vaccines whether it be for religious reasons or medical reasons. For example, some people are allergic to egg components that are used in some flu vaccines. In the USA, some states even allow exemption based on personal reasons. As such, mandatory vaccines are not necessarily all that mandatory. Removal of vaccines mandates also doesn’t necessarily mean vaccines are not advised or available so the change in policy in the States may not be as frightening as it first seems. I personally have quite mixed feelings about mandates- I am very much pro-vaccine but I do worry about the mistrust that mandates may unintentionally incur as a result of mandates.

Vaccine Trust

This takes us back to what is happening in the States right now. Vaccine mistrust is increasing across the globe, fuelled in large part by misinformation and disinformation. A notable study made by the Center for Countering Digital Hate found that just 12 individuals -also known as the Disinformation Dozen- were responsible for 65% of Covid-19 misinformation circulating on social media. Guess who one of the most active spreaders of disinformation was? If you look at the table taken from the study I have highlighted the second name from the top-RFKJr - Trump’s recently appointed health secretary.

Not only has RFKJr sown extensive vaccine disinformation, he has made a profit from doing so! He made over $20,000 per week as chairman of his Children’s Health Defense “non-profit” in 2023. He also stood to make vast sums from his role in the court case that aims to sue Merck for the vaccine against HPV known as Gardasil. It is alleged that he took action beyond just sowing doubt about the safety and efficacy of the vaccine and helped build a case. HPV is tightly linked with the development of cervical cancer and the vaccine has resulted in a dramatic decline in cervical cancer mortality. Whether he continues to be a part of the team pursuing this case now is not clear.

We know that rhetoric regarding vaccines really matters for vaccine uptake. I worry that a man who has sown such extensive mistrust and has NO scientific OR medical qualifications is now in charge of health decisions for an entire nation. The fact that the likes of Musk and his social media site also spread vaccine disinformation adds to my disquiet.

My nervousness regarding vaccine access and trust has not been assuaged as within a few hours of Kennedy’s role being formalised, Louisiana announced it was ending mass vaccinations campaigns. The Louisiana surgeon general has ordered its staff to stop engaging in media campaigns and encouraging vaccines. To be clear you can still get vaccines there but there will be NO large drives such as winter flu campaigns or information circulated. This essentially will make it hard to find out anything about vaccines. This is despite the state having had a lot of flu this winter.

I really fear that the actions of Louisiana may be the first of several such measures and the continued rhetoric around vaccines will cause more and more distrust and a further fall in vaccine confidence. That American scientists are being muzzled at a time and science budgets slashed when they are so needed is also very worrying. Apologies this post is so gloomy!

So what can we do? For those seeking accurate science information, I urge you to consider the reliability of the sources and whether the people involved stand to make money out of their actions (many proponents of disinformation and woo woo health practices do). There are also good sources still of vaccines information including organisations such as the British Society for Immunology who have made accessible resources. I also recommend feeds like Your Local Epidemiologist , Ground Truths and of course (although I am biased) Independent SAGE.

Take care !