Last November, Robert F. Kennedy Jr. said that, as secretary of health and human services, he would not “take away anybody’s vaccines.” If you believed him, you were duped.

The longtime anti-vaccine crusader remains intent on vilifying lifesaving immunizations and promoting the lie that the shots cause autism and all manner of other conditions. Maybe it’s his long history of profiting off vaccine controversy, his convoluted distrust of germ theory, or a eugenicist ideology. But whatever his motivation, four months into Kennedy’s term leading the federal department that oversees the CDC, NIH, and FDA, he has made several policy changes, proclamations, and decisions that directly imperil Americans’ ability to access and afford routine vaccinations.

Most recently, in accordance with the larger trend of Donald Trump’s administration axing experienced, well-vetted advisors in favor of unqualified sycophants, Kennedy fired 17 people from the federal committee responsible for making vaccine recommendations. He replaced them almost entirely with close associates that echo his scientifically dubious and medically dangerous beliefs, or with those who seem to lack the relevant knowledge for the role. “Today, we are taking a bold step in restoring public trust by totally reconstituting the Advisory Committee for Immunization Practices (ACIP). A clean sweep is necessary to reestablish public confidence in vaccine science,” he wrote on X — while acting to undermine medical experts’ trust in federal health agencies. 

Physicians, epidemiologists, and public health advocates are disturbed by what’s unfolded so far and fear what’s yet to come. Some patients seeking covid vaccinations have now reportedly been turned away, mobile vaccine clinics are being forced to restrict or end operations, and research that could have cured cancer and prevented HIV infections has lost its funding, setting science back decades. Moving forward, it’s unclear if routine childhood vaccinations will remain free to families, if pharma companies will continue to invest in vaccine development in the face of expensive new requirements, and if vaccination will remain a viable choice for many. 

When Kennedy gutted the ACIP, the group of independent, unpaid experts tasked with making vaccine recommendations to the CDC, on June 9th, he claimed he was doing so because of “conflicts of interest” among the members. The committee has existed since 1964 and has never before been considered explicitly partisan, explains Sean O’Leary, a professor of pediatrics and infectious disease at the University of Colorado. “These are not political appointees,” he says. It is entirely “unprecedented,” a word O’Leary used repeatedly, that a new administration would fire all voting committee members.

Kennedy announced eight new ACIP members to replace the 17 who were fired just two days later, in another post on X. In every prior case, ACIP appointees have been nominated and evaluated in a transparent, rigorous process over the course of months and often years, says Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University. The 17 terminated members were initially selected for ACIP because of their qualifications and lack of compromising conflicts, she says. Kennedy’s new appointments weren’t. At least half of the new ACIP appointees are outspoken in their controversial or outright anti-vax views. 

ACIP’s decisions directly determine insurance and Medicaid coverage for vaccines. If this new group were to change federal immunization recommendations, then those shots could go from free to prohibitively expensive. Without proper federal support, many doctors’ offices might stop carrying certain vaccines altogether. In Kennedy’s announcement of his committee picks, he wrote that the group “will review safety and efficacy data for the current schedule,” signaling a major revision is to come. 

The appointees include Vicky Pebsworth, a nurse who sits on the board of the National Vaccine Information Center (NVIC), a group with a long history of advocating against vaccine requirements in schools. NVIC is also known for promoting conspiracy theories and spreading misinformation about vaccine risk, for instance, by presenting raw data from the Vaccine Adverse Event Reporting System without noting that these stats are unverified and that many initially reported injuries and issues are not legitimately related to immunization. 

There’s also Robert Malone, previously an mRNA vaccine researcher and now a health influencer with a Substack who makes regular appearances on conservative talk shows, where he promotes claims like covid vaccines cause AIDS and lies about measles deaths. Then there’s Martin Kulldorff, who has railed against childhood covid shots and co-authored the Great Barrington Declaration in October 2020, which called for a “herd immunity” approach to covid, eschewing preventative measures. The declaration was roundly rejected as dangerous by dozens of epidemiologists. Both Malone and Kulldorff have served as paid expert witnesses against drugmaker Merck in vaccine-related trials. 

Retsef Levi, an operations management professor at MIT, is also among those appointed. He has no direct science or medical background, and has claimed — against scientific evidence — that mRNA shots are unsafe and ineffective. Two of the remaining appointees include an emergency room doctor and a psychiatrist and neuroscientist who studies the health impacts of dietary fat intake. Neither seems to have much experience in epidemiology, vaccine science, or infectious disease policy.  

“You could think about it like taking the National Transportation Safety Board or even air traffic controllers, firing all of them, and replacing them with people who don’t really know what they’re doing, who don’t really believe in flying airplanes,” says O’Leary. 

The changeover “meets my worst expectations,” says Paul Offit, a vaccine scientist, virologist, and professor of pediatrics at the Children’s Hospital of Philadelphia. “ACIP has now taken a giant step backward.” Just one of the appointees appears fit to serve, in Offit’s view: Cody Meissner, a Dartmouth pediatrics professor who has been an ACIP member before. Yet, even in his prior time on ACIP, Meissner had a tendency to go against the grain and to promote fewer infectious disease interventions. He endorsed the Great Barrington Declaration and voted against covid vaccinations for children, notes Offit. 

“My biggest fear is that what this is really about is preventing Americans from getting the vaccines they want,” says Nuzzo. 

Immunizations recommended by ACIP, through the CDC childhood or adult vaccine schedules, are required to be fully covered by private insurers, as mandated by language in the 2010 Affordable Care Act. The Vaccines for Children (VCF) program, which covers the cost of immunizations for children who are uninsured, underinsured, Medicaid-eligible, or Native American, also bases its coverage on ACIP recommendations. Over half of all American children qualify for the VFC program. 

If ACIP were to remove vaccines from the schedule, it’s very possible payers (including the VCF program) would stop covering them, all sources told The Verge. “Those recommendations determine who gets access to vaccines,” Nuzzo explains. A single vaccine dose can cost well over $100, and then there’s service fees and costs for storage. “You go to a pediatrician’s office, you get four shots, you’re going to get hit with an $800 or $1,000 bill,” says Ashish Jha, a physician and dean of public health at Brown University and former White House covid-19 response coordinator under Joe Biden. “Before we had certainty” routine immunizations would be free, says Jha. “Now we don’t.” If families can’t shell out, children will go unvaccinated. Some will get sick. Some will make others sick. Some will be disabled. Some killed. We could reenter a time where hospitals have to dedicate entire wings to polio wards.  

“My fear, and I don’t say this lightly — it’s devastating — is that this is going to cost lives. Children are going to suffer,” says O’Leary. Measles outbreaks corresponding to locally low vaccination rates are “just the canary in the coal mine,” he notes, because measles is especially contagious. Other diseases that are less easily spread but more often fatal, like whooping cough, diphtheria, and pneumococcal infections, would resurge too if vaccination rates fell. 

Before the ACIP upheaval, Kennedy had already made it clear he wasn’t going to let science get in the way of HHS decision-making. At the end of May, he unilaterally altered CDC vaccination schedules without consulting ACIP at all, and in direct contradiction to the CDC’s own research. He axed the existing recommendation that pregnant people receive covid-19 shots and also proclaimed that the vaccine was no longer recommended for children. In a slightly defiant move, the CDC kept the covid shot on the childhood immunization schedule, but shifted it from a clear recommendation to a decision to be made via “shared clinical decision making.” Yet even that small change left insurer and VFC program coverage for kids up in the air, O’Leary says. And pregnant people are facing new difficulties as they attempt to get vaccinated, says Richard Hughes IV, an attorney and vaccine law instructor at George Washington University. “I’ve already heard of confusion in the pharmacy setting over whether a pregnant person can or cannot access vaccines … and of a patient being turned away,” he tells The Verge. 

Also in May, Kennedy announced that placebo-controlled clinical trials would be required for “all new vaccines,” including routinely updated shots like the covid immunization and potentially even the seasonal flu shot. But mandating annual placebo trials would be impractical, costing tens of millions of additional dollars from manufacturers every year, Hughes says. “It could discourage smaller manufacturers from making those investments,” meaning less effective, or simply far fewer, vaccines available in the future. 

Plus, it’s roundly considered unethical to conduct a placebo trial for an intervention that is known to be safe and relatively effective in protecting against a dangerous illness. “You can’t knowingly give [a] placebo to somebody when you have a vaccine that works,” Offit says. “I can’t imagine any institutional review board would ever allow that to go through,” he adds. Just after the announcement, Moderna withdrew its application for a combined flu and covid vaccine. Separately, HHS has canceled its own existing contracts, including with Moderna for the development of a new bird flu vaccine, leaving us less prepared for the next possible pandemic. 

In the background, massive funding cuts implemented with no notice (most notably, the early termination of $11.4 billion in pandemic-era grants) and waves of layoffs have left federal, state, and local agencies far less equipped to actually manage, administer, and deliver the public health initiatives they’re supposed to offer — including immunization programs, says Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials (NACCHO). 

Her organization is made up of more than 3,300 local health departments across the country, which overall receive about 50 percent of their funds from the federal government. NACCHO has been tracking the effects of funding cuts nationwide. Tremmel shared two spreadsheets with The Verge, each containing over 100 entries, cataloging resource losses at local health agencies and the outcomes. Many departments describe reductions in mobile or school vaccination programs and ending or cutting back on disease contact tracing and monitoring. Some specifically note that their ability to respond to measles outbreaks was hampered. It’s been “an abrupt and chaotic end” to many programs, Freeman says, and she expects it to get worse. “There’s much more to come,” she says. Unable to detect new outbreaks early, track ongoing ones, or provide people with accessible immunizations, disease will spread faster and farther. States can fill some gaps, but not all, and the local agencies tasked with containing illness will struggle to keep up. 

Cuts at NIH have additionally left ongoing vaccine research completely unfunded. Scientists are euthanizing lab animals and shutting down projects that have been in progress for years, says Nuzzo. So far, studies that have lost federal support include work to produce an HIV vaccine, cancer vaccine research, and those related to examining public health communication and vaccine hesitancy. 

“It’s hard to say which will be more damaging: the destruction of funding for new vaccines or the destruction of funding for public health efforts to get vaccines delivered to patients,” says a recently terminated ACIP member and public health researcher who requested anonymity out of fear of reprisal from the government. 

Vaccines are a lifesaving technology that’s shaped modern society. Immunizations prevented 32 million hospitalizations among US children born between 1994 and 2023. They’ve also saved hospitals, governments, and families trillions of dollars over just a couple of decades, according to a 2024 CDC report.

“What we’re seeing is a broader dismantling of the vaccine infrastructure in our country that we have built up over 50 years — really in many ways since the early days of the polio vaccine. We have open, transparent discussions. We have recommendations. We have programs that get vaccines into peoples’ arms. All of that is very quickly being dismantled,” Jha says. “It’s going to take us years to rebuild.”

Avian influenza is “evolving in ways we haven’t seen before,” says Martha Nelson, a computational biologist and staff scientist researching pathogen evolution at the National Institutes of Health — one of many scientists who have been monitoring the global H5N1 outbreak. Bird flu “is adapting to mammals, and it continues to show new tricks,” Nelson tells The Verge. The virus is spreading widely in domestic and wild animals, while exact transmission routes remain unclear. Confirmed human cases are rising, particularly among farmworkers.

More than two years into the US outbreak, we’re stuck with H5N1 for the long haul. The risk that it mutates to spread readily from person to person and that we could find ourselves in the middle of another pandemic is entrenched. As the Trump administration hacks away at scientific institutions and rapid federal changes impede the flow of information, the threat looms especially large. To mitigate those chances, animal agriculture, wildlife management, trade policy, and even cat owners may have to adapt to manage the virus on multiple fronts — indefinitely. 

The Centers for Disease Control and Prevention (CDC), along with many virologists and epidemiologists outside the agency, continue to describe the threat that the virus poses to the public as low. Yet the likelihood of an H5N1 human pandemic “is growing,” says Nelson.  

The vast majority of the 70 confirmed human cases in the US have been mild. But since last November, at least four people have been hospitalized with H5N1 in North America (three in the US and one in Canada). In January, one person died in Louisiana after contracting the virus from a backyard poultry flock. 

Until recently, Nelson and other bird flu experts held out hope that, with some basic interventions, the H5N1 outbreak among cows and poultry would burn itself out and that cases among wild animals might fade away, as they did during a brief 2014-2015 outbreak. But the latest events prove that isn’t likely. “It’s hard to imagine a scenario where it’s no longer a pandemic threat,” Nelson says. 

Since the virus was first detected in cows in March 2024, almost 1,000 dairy herds have been infected. Despite that spread, scientists saw a silver lining: for nearly the whole year, all of those cases were infections of a viral genotype called B3.13, believed to have entered the cattle population from a single spillover event in Texas, wherein a cow caught the virus from a wild bird. “We thought this was a one-off: one bird to one cow, and we wouldn’t see that again,” says Peter Halfmann, a virologist at the University of Wisconsin-Madison’s Influenza Research Institute. 

Yet the more severe human cases are concurrent with the spread of a recently mutated, potentially more dangerous version of the virus called the D1.1 genotype. D1.1. is now circulating among wild birds and poultry, and it has spilled over into dairy cows at least twice in 2025, according milk testing data from the Agriculture Department. With D1.1, Halfmann explains that the threshold for cross-species transfer is “much lower than we previously thought.” 

Bird flu infections have also been confirmed among rats and mice near farms. Many other wild mammals, including fox, deer, and skunks are testing positive for the virus, but rodents are a particular concern given their notorious propensity to infest human dwellings and act as vectors of disease, says Meghan Davis, an epidemiologist and veterinarian at Johns Hopkins University. “When you have one of these classic reservoir hosts with highly pathogenic avian influenza, it gives you pause,” she says. “If this host could set up to be a reservoir, what implications would that have for our control strategies?” 

It’s not yet known if mice or rats transmit the virus onward or are simply dead ends. However, research into 2023 H5N1 outbreaks among marine mammals and lab experiments in ferrets suggest that H5N1 can spread from mammal to mammal in certain cases. And at least one recent study of rats found the virus replicates in their respiratory tract, priming the rodents to shed it. 

The good news is that there’s still been no confirmed instances of human-to-human transmission, and no human case clusters without clear ties to farmwork. These two things would signal a significant uptick in pandemic risk, Nelson says, and there’s no guarantee either will occur. 

The bad news is that there’s ample opportunity for H5N1 to make that leap, says Seema Lakdawala, an epidemiologist studying avian influenza at Emory University. According to her, with multiple species acting as wild reservoirs, eradication is effectively impossible. “I think it’s endemic,” she says. And a December 2024 study, published in Science, concluded that just a single mutation could make the currently circulating H5N1 virus readily transmissible between humans. “What we’re allowing this virus to do is like 1,000 shots on goal,” Lakdawala says. 

H5N1 has been around for decades. The virus first evolved in waterfowl like ducks and geese, but it has long been transmissible among many other types of birds including seabirds and songbirds. It was initially isolated following an outbreak in Scottish chickens in 1959. The first human infections and deaths occurred during a 1997 outbreak in Hong Kong. In the years since, public health authorities have contained periodic outbreaks as they’ve happened, and the worst case hasn’t materialized yet. 

Now, though, “we’re in a whole new ballgame,” says Michael T. Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “If you look at the last 80 years, we’ve never seen anything like this with H5.” 

Natasha Bagdasarian, an epidemiologist and the chief medical executive in Michigan, has been at the forefront of the state’s much-lauded multipronged response to the H5N1 outbreak. Last spring, she was hopeful that the spread could be stamped out through thoughtful communication with farmworkers and disease-monitoring strategies in just a handful of states. Less than a year on, despite the fact that new cases in Michigan dairies have stalled, that optimism is gone. “At this point, I would say there is absolutely no chance of containment, and we now have to think about mitigation and monitoring.” 

With a virus like rabies, wildlife managers will sometimes disperse an oral vaccine through food to control local outbreaks among animals. With H5N1, Andrew Pekosz, a virologist at Johns Hopkins University, says that’s not a viable option. It’s in too many different species across too large of an area. Even if we had some readily dispersible bait that all of these animals were attracted to, there is no oral H5N1 vaccine to use. In lieu of that far-fetched hypothetical, Pekosz says mitigation means doubling down on reducing risk at the interfaces between wildlife, domestic animals, and humans. 

Backyard poultry and pets — especially cats — are vulnerable to the virus and worrying potential transmission sources to the public, says Davis. Health officials have confirmed dozens of infections in domestic cats, most recently in New York City.

In February, the CDC published, deleted, then rereleased an unsettling report describing two instances where indoor cats in the households of dairy workers fell ill with bird flu. Out of five cats, three got sick and two died. Some people in the households, including those who had no direct exposure to farm animals or raw milk, also showed symptoms of illness. Despite layers of safety precautions, H5N1 found its way in and potentially spread from cow to human, human to cat, clothes to cat, cat to cat, or cat to human. The web of possible transmissions and infections remains unclear and unconfirmed. 

Davis advocates for pets to be included in viral surveillance efforts. In the interim, pet owners should keep track of H5N1 reports in their area, be sure to always supervise pets outside, and avoid feeding animals raw milk or meat products. Those with backyard chickens or other fowl should implement hygiene measures, in accordance with federal and local guidelines.

Yet, for now, the biggest locus of prevention over the long term remains farms. Michigan and other states, like California — where the virus has hit about 70 percent of dairies — should commit to increased and constant surveillance on farms, coupled with immediate interventions upon detection, Lakdawala says, adding, “But I think it’s going to be really hard. I don’t know if the farmers are ready for something like that.”

The USDA began requiring states to submit samples of raw milk for H5N1 testing last December, but that doesn’t identify individual infected cows or stop the virus from spreading among an entire herd or farm. To reduce overall human exposure to H5N1, and minimize the chances the virus makes a significant jump from cows to humans or spills back into wildlife, we need to be testing individual cows on affected farms, Lakdawala says. Such a regimen would also help scientists better understand the virus, offering a window into the number of sick cows and how the flu is spreading. The current prevailing belief is that most transmission between cows occurs via contaminated milking equipment, yet it’s important to monitor for evidence of other forms of spread, she explains, because that would mean a significant change in the virus and a rise in risk. 

Biosecurity efforts on farms should also be ramped up and sustained, Pekosz says. The types of flock containment measures that have been deployed for poultry need to be strengthened and translated to dairy cattle, he explains. “For most of the poultry industry, there is no such thing as free-range chickens.” On many farms, birds are held in closed facilities, and all people and equipment entering undergo a disinfection process: changing clothes and sanitizing boots. “A cow isn’t a bird, but the same principles can be applied,” he says. 

Many states have already advised or mandated farms to institute new biosecurity protocols, including sanitizing vehicles and equipment, preventing contact between wildlife and farmed animals, restricting animal transport, and recommending protective equipment like masks and face shields to workers. Yet major challenges remain, says Tim Boring, director of the Michigan Department of Agriculture and Rural Development. “The prospect of completely segregating out wildlife from dairy farms would certainly be a daunting task,” he says, adding that it would also be an expensive one.

More wildlife testing could help farms defray costs by catching new viral mutations and trends of local spread even earlier, Pekosz says. With sufficient wildlife monitoring, farmers could hold off on the most intensive defense strategies unless and until nearby wild animals test positive. 

Though a wildlife vaccination campaign isn’t feasible, the USDA is investigating the use of avian flu vaccines in poultry and cows. Despite some countries already vaccinating poultry, the US has so far avoided the practice as many trade partners ban imports of vaccinated birds. Moving forward, global trade agreements will likely require renegotiation. 

It’s a good sign that the US is seriously considering vaccines, Halfmann says, but he warns that any vaccination effort will require sustained investment to be effective. “We can’t have one season where we vaccinate and then stop. This is a long-term endeavor that we’re going to have to go through that’s going to cost money and require buy-in from farmers. It’s a lot of hurdles.” 

An animal vaccine would need to be regularly assessed and updated to keep pace with viral mutations, just like the seasonal human flu has historically been, he explains. Given that the Food and Drug Administration is now helmed by prominent anti-vaxxer Robert F. Kennedy Jr. and that the agency recently canceled a meeting for the seasonal flu vaccine selection process without explanation, Halfmann is skeptical that the federal government is up to the task. 

He’s not the only one. While the virus is evolving quickly, so are US regulatory agencies. Lakdawala says there are fewer updates on federal efforts around H5N1. Until recently, Davis participated in regular small group briefings with the CDC, where governmental and nongovernmental experts would share data and insights on the virus. Now, she says those meetings have completely stopped. “What’s been most concerning to me is the lack of communication,” she says. “The backbone of outbreak response is communication.”

Without up-to-date information, virologists, epidemiologists, and state public health officials are left in the dark, with little to guide their science or policy. At the same time, research institutions are facing real and threatened major budget cuts and are enacting extensive layoffs. 

“We are flirting with a massive global pandemic that could be equal to or greater than COVID-19,” Nelson says; yet, all the knowledge and tools we built during the pandemic aren’t being harnessed. It feels, she adds, like “watching a train wreck in slow motion.”