Destruction from Within, Resistance from Without

It feels like everything is unraveling at once.

On August 5, 2025, the US Secretary of Health and Human Services (HHS), Robert F. Kennedy Jr, announced he was abruptly canceling $500 million in grants and contracts supporting mRNA vaccine research.¹ These platforms proved their worth during COVID-19, enabling record-fast vaccine development. With that capacity now eroded, our preparedness for the next pandemic is compromised.

Three days later, tragedy struck at CDC headquarters in Atlanta, Georgia: A gunman— convinced that a COVID-19 vaccine caused his ailments—fired more than 500 rounds at the building, killing a police officer.² In June, Kennedy dismissed the CDC’s Advisory Committee on Immunization Practices (ACIP), replacing experts with individuals ranging from underqualified to openly antivaccine. The justification of “conflicts of interest” is hollow; the result is a body stripped of credibility.² CDC Director Susan Monarez, was fired on August 28 after less than a month in office, reportedly for refusing to endorse new ACIP vaccine recommendations before the committee even convened.³ HHS then rewrote COVID-19 vaccine policy, limiting adult eligibility to those 65 years or older or with specific comorbidities and removing recommendations entirely for children and pregnant women. In many states, pharmacists can only administer vaccines endorsed by the CDC. Overnight, access to COVID-19 vaccines was cut off—not because of new science, but because of political fiat.³

At the state level, Florida’s governor and surgeon general announced the intent to phase out all childhood vaccine mandates, dismantling another safeguard.⁴ If you think it cannot get worse, it will. These changes will drive up rates of preventable illness and death, raise health care costs, and slow US innovation as other nations forge ahead with vaccine development. The toll will also be human: Fewer talented young people will see a future in public health, a field now portrayed as futile—or even dangerous. Still, there are sparks of resilience. As I wrote previously, professional societies must step up where government has abdicated. That is beginning to occur. The Infectious Diseases Society of America, traditionally cautious about political criticism, led a coalition of organizations calling for Kennedy’s removal and has already started drafting its own respiratory virus recommendations with partner groups.⁵ The American Academy of Family Physicians (AAFP) reaffirmed that all adults 18 years and older, pregnant women, and young children (aged 6 to 23 months, with risk-based vaccination for those aged 2 to 18 years) should receive COVID-19 vaccines.⁶ The American College of Obstetricians and Gynecologists (ACOG) echoed this guidance for pregnant women.⁷ These recommendations may seem immaterial compared with HHS guidance, but they already matter. Pharmacists provide the majority of adult vaccines in the US, but 16 states limit them to ACIP-endorsed vaccines.⁸ HHS’s rollback instantly restricted access in those jurisdictions. Some are now responding: New Jersey authorized COVID-19 vaccination by state standing order, and Pennsylvania broadened authority so pharmacists can follow recommendations from societies that include AAFP, ACOG, and the American Academy of Pediatrics.^8,9

This patchwork of state laws and societal guidance is far from efficient, but it may be the only way to preserve access until federal leadership is restored. The scientific community, professional societies, and even state legislatures are showing they will not sit idle while progress unravels. They reflect a refusal to abandon evidence-based medicine. If enough clinicians, scientists, and advocates act, the foundations of public health can endure this storm—and perhaps emerge stronger once society has been reminded of the consequences of vaccine-preventable disease.

References
1. Walsh J. RFK Jr. halts $500 million for mRNA vaccine research. August 6, 2025. Accessed September 12, 2025.
https://www.cbsnews.com/news/rfk-jr-halts-500-million-for-mrna-vaccine-research/
2. McFadden A, Mandavilli A, Keenan S, and Rojas R. What we know about the CDC shooting in Atlanta. New York Times. August 12, 2025. Accessed September 12, 2025.
https://www.nytimes.com/2025/08/10/us/cdc-shooting-atlanta.html
3. Monarez S. Robert F. Kennedy Jr., the CDC and Me. WSJ. September 4, 2025. Accessed September 12, 2025.
https://www.wsj.com/opinion/robert-f-kennedy-jr-the-cdc-and-me-b4ca2eaa?st=NZGRvY&reflink=desktopwebshare_permalink
4. Tan T, Parkinson J. Florida plans to end all vaccine mandates. ContagionLive. September 3, 2025. Accessed September 12, 2025.
https://www.contagionlive.com/view/florida-plans-to-end-all-vaccine-mandates
5. Tan T. FDA’s narrow COVID-19 vaccine label ignores science and puts millions of lives at risk. IDSA. August 27, 2025. Accessed September 12, 2025.
https://www.idsociety.org/news--publications-new/articles/2025/fdas-narrow-covid-19-vaccine-label-ignores-science-and-puts-millions-of-lives-at-risk/
6. O’Connell-Domenech A. Doctors group recommends COVID-19 vaccine for all adults in break with government. The Hill. September 9, 2025. Accessed September 12, 2025.
https://thehill.com/homenews/5493603-aafp-recommends-covid-vaccines/
7. ACOG releases updated maternal immunization guidance for COVID-19, influenza, and RSV. News release. ACOG. August 22, 2025. Accessed September 12, 2025.
https://www.acog.org/news/news-releases/2025/08/acog-releases-updated-maternal-immunization-guidance-covid-influenza-rsv
8. Dall C. Three states take steps to ensure COVID vaccine access. CIDRAP. September 4, 2025. Accessed September 16, 2025.
https://www.cidrap.umn.edu/covid-19/three-states-take-steps-ensure-covid-vaccine-access
9. State health department issues executive directive, standing order to ensure access to COVID-19 vaccines in New Jersey. News release. NJ Department of Health. September 9, 2025. Accessed September 12, 2025.
https://www.nj.gov/health/news/2025/approved/20250909a.shtml
10. After Governor Shapiro takes action to protect Pennsylvanians’ personal freedom and ensure access to health care, state board of pharmacy votes to protect vaccine access across PA. News release. Commonwealth of Pennsylvania. September 3, 2025. Accessed September 12, 2025.
https://www.pa.gov/governor/newsroom/2025-press-releases/state-board-of-pharmacy-votes-to-protect-vaccine-access-across-p