For two decades, Washington, D.C., pediatrician Lanre Falusi has counseled parents about vaccine safety, side effects and timing. But this year, she said, the conversations have changed.
"For the first time, I'm having parents of newborns ask me if their baby will still be able to get vaccines," Falusi said.
Throughout the U.S., pediatricians say anxious parents are concerned about access to routine childhood immunizations.
That's especially true for those with children covered by Medicaid, the government insurance program for low-income families and people with disabilities. Medicaid covers 4 in 10 children in the United States.
"It really became an issue when RFK Jr. stepped into the role of HHS secretary," said Deborah Greenhouse, a pediatrician in South Carolina.
The concern accelerated after the shake-up of a key Centers for Disease Control and Prevention vaccine advisory body in June, raising fears that millions of American families could soon have to pay out of pocket for shots now covered by their health insurance.
Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, removed all 17 members of the CDC's Advisory Committee on Immunization Practices (ACIP), the panel responsible for recommending which shots are included in the nation's adult and childhood immunization schedules.
Kennedy replaced the panelists with new members aligned with his views, prompting alarm among medical professionals and public health experts.
Insurance uncertainty worries parents
"People should be worried about what's going to happen to the availability of vaccines for children," said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, a national health information nonprofit that includes KFF Health News.
Under the Affordable Care Act, health insurers are required to cover all ACIP-recommended vaccines.
States and other jurisdictions use the childhood vaccine schedule to set immunization requirements for schoolchildren.
ACIP's recommendations also determine which vaccines get covered by the Vaccines for Children Program, a CDC-funded initiative that provides free immunizations to low-income and uninsured children. Half of children in the U.S. are eligible for the VFC Program.
If the new ACIP members withdraw support for a particular vaccine and the CDC director agrees, Tolbert said, the consequences would be immediate.
"It would automatically affect what is covered and therefore which vaccines are available to children on Medicaid," she said.
Health insurance companies have not yet said how they would alter coverage, but Tolbert said such a move would open the door for private insurers to refuse to cover the vaccine.
Pediatricians worry about a future where parents might have to choose: pay hundreds of dollars out of pocket for shots or leave their kids unprotected.
The health insurance industry group AHIP said that health plans "continue to follow federal requirements related to coverage of ACIP-recommended vaccines and will continue to support broad access to critical preventive services, including immunizations."
Pediatricians say news about President Donald Trump's new budget law, which is expected to reduce Medicaid spending by about $1 trillion over the next decade, has also prompted questions from parents.
While parents may be worried about losing their Medicaid, the law doesn't mention vaccines or change eligibility or benefits for children's Medicaid, Tolbert said.
But less federal funding means states will have to make decisions about who is covered and which services are offered.
To raise the revenue needed to pay for Medicaid, states could raise taxes; move money earmarked for other spending, such as education or corrections; or, more likely, reduce Medicaid spending.
"And they may do that by cutting eligibility for optional populations or by cutting services that are optional, or by reducing payments to providers in the form of provider rates," Tolbert said. "It's unclear how this will play out, and it will likely look different across all states."
In May, Kennedy announced in a post on X that the CDC is no longer recommending the COVID-19 vaccine for healthy children and pregnant women. The move prompted a lawsuit by the American Academy of Pediatrics and other physician groups that seeks to freeze Kennedy's directive.
And in June, the new ACIP members appointed by Kennedy voted to recommend that adults and children no longer receive flu vaccines with thimerosal, a preservative rarely used in some flu vaccines. Anti-vaccine activists, including Kennedy, have rallied against thimerosal for decades, alleging links to autism despite no evidence of any association.
"There is no cause for concern," Department of Health and Human Services spokesperson Emily Hilliard said in a statement. "As Secretary Kennedy has stated, no one will be denied access to a licensed vaccine if they choose to receive one."
"When the ACIP committee met last month, they reaffirmed that flu vaccines will remain accessible and covered, and they emphasized safety by ensuring these vaccines are mercury-free," Hilliard wrote.
"The Vaccines for Children (VFC) program continues to provide COVID-19 vaccines at no cost for eligible children when the parent, provider, and patient decide vaccination is appropriate. Medicaid will continue to reimburse the administration fee."
But the possibility that a vaccine could be restricted or no longer covered by insurance is already changing how parents approach immunization.
In Falusi's practice, parents are scheduling appointments to coincide precisely with their child's eligibility, sometimes making appointments the same week as their birthdays.
Doctors warn that fewer kids may get shots if cost shifts to families
Melissa Mason, a pediatrician in Albuquerque, N.M., has treated some patients who got measles during the multistate outbreak that started in neighboring Texas.
She's concerned that any new limitations on access or reimbursement for childhood vaccines could lead to even more preventable illnesses and deaths.
Nationally, there have been more than 1,300 measles cases since January, including three deaths, according to the CDC. "We're seeing this outbreak because vaccination rates are too low and it allows measles to spread in the community," Mason said.
Children and teens account for 66% of national measles cases. Mason has begun offering the measles vaccine to infants as young as 6 months old, a full six months earlier than standard practice, though still within federal guidelines.
Last year, overall kindergarten vaccination rates fell in the United States. At the same time, the number of children with a school vaccination exemption continued to rise.
Pertussis, or whooping cough — another disease that can be deadly to young children — is spreading. As of July 5, more than 15,100 cases had been identified in U.S. residents this year, according to the CDC.
Mason said pertussis is especially dangerous to babies too young to receive the vaccine.
For now, pediatricians are trying to maintain a sense of urgency without inciting panic.
In Columbia, S.C., Greenhouse used to offer families a flexible age range for routine vaccinations.
"I'm not saying that anymore," the pediatrician said.
She now urges parents to get their children vaccinated as soon as they are eligible.
She described anxious parents asking whether the HPV vaccine, which helps prevent cervical cancer, can be administered to children younger than the recommended age of 9.
"I actually had two parents today ask if their 7- or 8-year-olds could get the HPV shot," Greenhouse said. "I had to tell them it's not allowed."
With the vaccine requiring multiple doses months apart, Greenhouse fears time may run out for families to get the series covered by insurance. If they have to pay out of pocket, she's afraid some families may choose not to get the second dose. A second dose could cost about $300 if no longer covered by insurance.
"I cannot be 100% sure what the future looks like for some of these vaccines," Greenhouse said. "I can tell you it's a very scary place to be."
Kennedy's newly appointed vaccine advisory committee is expected to hold its next public meeting as soon as August.
This story comes from NPR's health reporting partnership KFF Health News, a national newsroom that produces in-depth journalism about health issues. It's one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
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