What We Know About RFK’s Announcement to Reduce Access to the COVID Vaccine

If you wanted to get a COVID vaccine during pregnancy, to protect yourself and your future baby from the virus, that may soon be difficult to impossible. According to a short video posted on X, U.S. Department of Health and Human Services secretary Robert F. Kennedy, Jr, who is also a noted anti-vaccine activist, said that the COVID-19 vaccine “has been removed” from the list of vaccines recommended in pregnancy, as well as the list of vaccines recommended for healthy children. This announcement sidesteps the usual regulatory process, and it’s not clear exactly what will happen next—but here’s what we know. 

The announcement may not be entirely valid

RFK, Jr made the announcement in a video where he stood alongside the NIH director Jay Bhattacharya and FDA commissioner Marty Makary. Notably, nobody from the CDC was present. The FDA approves vaccines, but it’s the CDC that is in charge of recommendations. (It is not clear who the CDC’s acting director actually is, or whether there is one.) 

Normally, the CDC has an advisory panel called ACIP (the Advisory Committee for Immunization Practices) that reviews scientific evidence to make recommendations for vaccines. They’ll vote on whether a given vaccine should be recommended for everybody in a group of people. Their decisions are then passed to CDC leadership, who make the final call as to whether the vaccine gets officially recommended for that group. 

Vaccines are not usually added or removed to the recommended list by the CDC without consulting with ACIP, and they definitely aren’t usually added or removed by tweeting a video. 

Dorit Reiss, a law professor who specializes in vaccine policy, posted on LinkedIn that the announcement may not be legally valid if it’s not immediately followed by supporting documentation. She says: “Under administrative law, to avoid being found arbitrary and capricious, an agency's decision has to meet certain criteria, including explaining the agency's fact finding, a connection between the facts and the decisions, etc. A one minute video on Twitter doesn't quite get you there.” 

So far, the CDC’s web page on vaccines recommended in pregnancy still says that “A pregnant woman should get vaccinated against whooping cough, flu, COVID-19, and respiratory syncytial virus (RSV).” The adult and child vaccine schedules still include COVID vaccines.

Strangely, this move on behalf of the CDC contradicts the one we reported about recently from the FDA. The FDA plans to require extra steps (possibly unethical and/or impractical ones) to approve new COVID vaccines for healthy children and adults. But these steps don’t apply to people who are at high risk for complications of COVID. The FDA’s policy announcement included a list of those high risk health conditions—which includes pregnancy.

Why it matters which vaccines are “recommended”

Recommending a vaccine doesn’t just mean expressing an opinion; the Affordable Care Act requires that vaccines recommended by ACIP must be covered by most private insurance and Medicaid expansion plans without any cost sharing. That means no deductible and no copay—so these vaccines must be free to you out of pocket if you fall into a group of people for whom they are recommended. 

The recommended vaccines include all the standard childhood vaccines, plus your seasonal flu shot, and other vaccines that are recommended for adults, for people who are pregnant, and so on. The full schedules are here. If you’ve gotten a COVID shot, a flu shot, a tetanus shot, a shingles shot—the shot’s inclusion on this list is why you were able to (probably) get it for free.

So taking a vaccine off the recommended list means that it could be prohibitively expensive. GoodRX, which keeps tabs on pharmacy prices, reports that COVID shots may cost $200 or more out of pocket, plus any applicable administration fee that the provider might charge.

Taking a vaccine off the recommended list may also mean it won’t be covered by the Vaccines for Children program, which provides free vaccines to children who don’t have coverage for them through health insurance.

Whether or not the vaccine actually gets taken off the list, the recent HHS announcement has another impact: The American College of Obstetricians and Gynecologists said in a statement that “Following this announcement, we are worried about our patients in the future, who may be less likely to choose vaccination during pregnancy despite the clear and definitive evidence demonstrating its benefit.” 

The ACOG statement also pointed out a few ways in which removing the vaccines from the recommended list is not “common sense and good science,” as the HHS announcement claimed. ACOG writes: “As ob-gyns who treat patients every day, we have seen firsthand how dangerous COVID infection can be during pregnancy and for newborns who depend on maternal antibodies from the vaccine for protection. We also understand that despite the change in recommendations from HHS, the science has not changed. It is very clear that COVID infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families.”

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