What the administration’s new vaccine order actually changes
Vaccines are one of those subjects that raise everyone’s blood pressure, so whether you’re a flag-waving MAGA type, a coastal liberal elite, or somewhere considerably further left: unclench and please keep your panties appropriately unbunched. This is an article about evidence, consent, education, and scientific curiosity.
On Aug. 10, President Trump signed an executive order establishing new federal categories for childhood vaccinations. The administration describes the order as a change to bring the country closer to practices in peer countries and give parents more discretion. Medical organizations, including the American Academy of Pediatrics, American Medical Association, and over 200 others have argued that some changes, particularly separating vaccines and spacing them over more visits, are not supported by existing evidence.
In this article, we’ll get into what all of this means, what exactly changed, and our ideas of evidence and consent.
An immunization exposes the immune system to a harmless form or component of a disease-causing agent, or instructions for making one of its antigens, along with ingredients that may help strengthen the immune response (aluminum salts, MF59, CpG 1018, MPL, QS-21), and ingredients to preserve and stabilize the vaccine.
The department of Health and Human Services’ new framework puts immunizations into two different categories: more narrowly recommended ones and others.
The U.S. recommends 11 vaccines for all children including measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, pneumococcal disease, HPV, and varicella.
THE FEDERAL administration vaccine recommendations drop from 17 or 18 to 11.
Others that include hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19 are in a different category; either higher-risk, shared clinical decision making, or both. This means the vaccine is recommended for people who are deemed “higher risk” (such as those with immunocompromised conditions), or, if there’s no default recommendation either way, the parent and provider weigh the benefits versus risks and engage in “shared clinical decision making.”
In short, instead of stating that “every child should get this immunization,” it becomes more like, “the parent and clinician should decide whether this particular child is likely to benefit.”
The order also calls for separated measles, mumps, and rubella vaccines. It says that immunizations should be administered at separate medical visits for children and recommends more research into vaccine timing, safety monitoring, and alternatives to aluminum-containing adjuvants, Moreover, it pushes states to reconsider vaccine requirements.
The assessment performed by the HHS preceding this new order found that the U.S. was recommending vaccines (17 to 18) against more diseases than other countries examined and argues that a core schedule of vaccines would be a wise international development. In Sweden, vaccination is voluntary and free and recommended for 11 diseases. Denmark immunizes for 10 diseases in its standard program. The UK routinely vaccinates for approximately 15 diseases. While it is true that other countries may recommend vaccinations against fewer diseases, this doesn’t mean that’s objectively a good or bad decision. Simply measuring vaccine counts won’t tell us why a country vaccinates, or if it’s a good/bad idea. It could be due to an overly aggressive or overly liberal vaccine schedule, or simply different public health calculations based on what the common disease risks are in that country. In other words, if Denmark or Germany recommend fewer childhood vaccines than the U.S., does that show that America vaccinates too much or simply that different countries make different public-health calculations?
This brings me to the issue of the title. The new order is called the “Gold Standard Childhood Vaccine Recommendations.” I urge my readers to consider what should count as gold-standard evidence? Clinical trials before authorization? Safety surveillance in the market? Efficacy? Transparent consideration of known adverse events? Comparison of vaccinated and unvaccinated groups? What is your definition of enough research to show benefits versus risks? And what kind of research? I leave this question unanswered, for the reader to consider.
The useful debate isn’t whether parents should trust vaccines or question vaccines. It’s what standard of evidence we should demand when recommending them and what standard we should demand before withdrawing those recommendations. If there is one take home message I’d like to end with it is that public health and bodily autonomy do not have to be in opposition; you can believe vaccines produce enormous collective benefits while also believing informed consent and autonomy deserve serious respect and a place in medicine. Perhaps the healthiest relationship with medicine is neither blind trust nor blanket distrust, but informed participation.
If you have any questions, please feel free to reach out to me by email: pcd1130@gmail.com.
Category: People
