Making vaccines complicated again? A critical look at the new immunization schedule

In a move critics are already calling political theater, President Donald J. Trump, joined by senior administration officials including HHS Secretary Kennedy, announced an executive order recommending a new vaccine schedule.

Why Trump’s vaccine schedule may be more politics than medicine 

First and most critically, because a recommendation to separate the MMR vaccine is not a practical medical reality. There are currently no US-approved separate vaccines. Short of a new Operation Warp Speed, with all the concerns raised by President Trump’s most supportive patients, those new vaccines will not possibly be available for several years.

Second, the midterms are coming, and for various reasons, it is time to activate the base. What better raw meat than to find a new path to fulfilling his promise to reduce those “harmful” vaccines? The Courts found that RFK, Jr.’s approach was unlawful because he ignored the legal procedures for a vaccine schedule change. So how about a Presidential Executive Order, titled in the language of the federal government that obscures rather than enlightens, Delivering Gold Standard Childhood Vaccine Recommendations for Americans? A cursory glance suggests that the executive order will meet the same legal fate as Kennedy’s attempt. It is, as with many of President Trump’s statements on health, more sizzle than steak; we still await a definition of ultra-processed foods, a definitive answer on autism, and what about those pesticides and microplastics?

President Trump, pro-vaccine?

One of best indications that we're watching politics, not science, drive the new schedule is the President's previous statements about vaccines and treatments for COVID-19.

“And then I see the disinfectant [bleach], where it knocks it out in a minute... And is there a way we can do something like that, by injection inside or almost a cleaning? ...It sounds interesting to me. “

When challenged, the President said he was being sarcastic, although a review of the video tape shows little sarcasm and much musing. Consider his decision to exercise his medical freedom to go “off-label.”

“I happen to be taking it [Ivermectin],” Trump said during a roundtable event at the White House. “A lot of good things have come out. You’d be surprised at how many people are taking it, especially the front-line workers.”

The President, it seems, was, as the saying goes, a bit ahead of his skis. No study found Ivermectin efficacious [1]. Of course, when faced with COVID itself, reality comes crashing through. President Trump took the COVID vaccine and both boosters. And as with a variable percentage of fully vaccinated Americans, he was hospitalized; he didn’t reach for the bleach or the Ivermectin; he went “on-label” big time, with the antibodies and the antivirals. As that linked report begins, 

“If you get sick with Covid-19, don't expect to get the same treatment as President Donald Trump.” 

What would the new childhood vaccine guidance mean in practice? 

Here is a question we might ask Vice President Vance that will help influence our health. His newborn son is rapidly approaching two months of age. Which vaccines will he be getting? Are you down with the new guidance: will hepatitis B and rotavirus protection be given or not?

I’ve written in the past about the vaccine schedule and the Danish model that is currently being offered as a Presidential recommendation. Perhaps, like his previous musings, this can be dismissed when the reality of measles comes closer to home. 

I will show you mine: the scientific evidence for the current vaccine schedule

I stand with the science as applied by the current vaccine schedule. ACSH stands there too. If you believe another schedule would be better, I am open to hearing the scientific arguments. 

• As a clinician, I am very familiar with how my patients do and do not follow recommendations, and what makes it easier for them to get healthier. Separating a vaccine into one to three doses, one to three visits, and one to three co-payments, even if it were possible (which it currently is not), fosters inconvenience and creates an artificial obstacle to accessing care. Just like prior authorizations do. 

“Receipt of combination vaccine was associated with an increased likelihood of completing all recommended vaccinations at 24 months, receiving all vaccinations at age-appropriate times and less than 7 months under vaccinated.”

• When to act is often as important as what you do. Treating when you are most vulnerable is preventive medicine. 

“Concentrations of passively acquired antibodies decreased rapidly within the first 6 months of life.” Measles, mumps and rubella all reach their lowest levels at 9 to 12 months of age."

• There is no evidence supporting president Trump’s statement, “Large amounts of vaccine, large amounts of like vats of vaccine are currently pumped into your child’s body.” Presidential hyperbole or a whisper of safety concerns?

“Several studies demonstrated that MMRV [mumps, measles, rubella, and varicella] and Men C [meningococcal C] conjugate vaccines can be administered concomitantly without a negative impact on the safety and immunogenicity of either vaccines, inducing highly immunogenic responses.”

Vaccine policy: evidence or political theater? 

In the end, this is less a debate about Denmark, MMR, or the number of needles than about whether vaccine policy will be driven by evidence or political theater. The current schedule is not sacred, and if better evidence supports changing it, change it. But adding visits and barriers without evidence of greater safety is not medical freedom; it makes prevention harder. Combination vaccines improve completion; timing matters because maternal protection fades; and simultaneous vaccination has not been shown to compromise safety or immune response. If President Trump and his advisers want a different schedule, show us the science. I’ve shown you mine. 

[1] Here is a video synopsis of the study