A top expert at the Centers for Disease Control and Prevention who was overseeing the process to update COVID-19 vaccine recommendations resigned on Tuesday.
The resignation, first reported by The Associated Press and confirmed by CBS News, comes just a week after health secretary and anti-vaccine advocate Robert F. Kennedy Jr. unilaterally revoked and altered some of the CDC’s recommendations for COVID-19 vaccines, restricting access to children and pregnant people. The resignation also comes three weeks before CDC’s experts and advisors are scheduled to meet to publicly evaluate data and discuss the recommendations for this season—a long-established process that was disrupted by Kennedy’s announcement.
The departing CDC official, Lakshmi Panagiotakopoulos, a pediatric infectious disease expert, was a co-leader of a working group on COVID-19 vaccines who advised experts on the CDC’s Advisory Committee on Immunization Practices (ACIP). She informed her ACIP colleagues of her resignation in an email on Tuesday.
“My career in public health and vaccinology started with a deep-seated desire to help the most vulnerable members of our population, and that is not something I am able to continue doing in this role,” Panagiotakopoulos wrote.
Unilateral changes
Previously, the CDC and ACIP recommended COVID-19 vaccines for everyone ages 6 months and up. Experts have emphasized that pregnant people in particular should get vaccinated, as pregnancy suppresses the immune system and puts pregnant people at high risk of severe COVID-19 and death. The American College of Obstetricians and Gynecologists states that “COVID-19 infection during pregnancy can be catastrophic.” Further, dozens of studies have found that the vaccines are safe and effective at protecting the pregnant person, the pregnancy, and newborns.
In practice, it is unclear how this change will affect access to the vaccines. Health insurers are required to cover vaccines on the CDC schedules. But, it’s yet to be seen if children will only be able to get vaccinated at their doctor’s office (rather than a pharmacy or vaccine clinic) or if additional consent forms would be required, etc. Uncertainty about the changes and requirements alone may lead to fewer children getting vaccinated.
In the adult immunization schedule, when viewed “by medical condition or other indication” (table 2), the COVID-19 vaccination recommendation for pregnancy is now shaded gray, meaning “no guidance/not applicable.” Hovering a cursor over the box brings up the recommendation to “Delay vaccination until after pregnancy if vaccine is indicated.” Previously, COVID-19 vaccines were recommended during pregnancy. The change makes it less likely that health insurers will cover the cost of vaccination during pregnancy.
The President of the American College of Obstetricians and Gynecologists (ACOG) put out a statement shortly after the Tuesday video, saying that the organization was “extremely disappointed” with Kennedy’s announcement.
“It is very clear that COVID-19 infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families,” ACOG President Steven Fleischman said.
Calling it a “practical question,” he asked, “If we were to change strains, can we assume that age-specific licensure won’t change for any of these [vaccine] products?” Currently, COVID-19 boosters are accessible to those aged 6 months and up.
Weir reiterated that there was no answer. Another FDA official, David Kaslow, chimed in to say only, “Rest assured that we’re engaging with the manufacturers on this topic.”
As a follow-up to that exchange, VRBPAC member and infectious disease expert Eric Rubin of Harvard, shot down the FDA’s plan to use randomized placebo-controlled trials for licensure for healthy children and adults. The plethora of observational data—aka real-world data—on the boosters shows clear efficacy, Rubin pointed out. That suggests that requiring people in a trial to take placebos despite the availability of a clearly effective treatment could be unethical.
It suggests “that a randomized controlled trial (RCT) has no equipoise right now, and that you cannot do one,” Rubin said. “I don’t think the RCT is feasible,” he added.
The selection
While the pushback and the questions lingered, the committee still had to select a strain. For now, omicron still reigns, and variants in the JN.1 lineage are still dominant. That is largely unchanged from last year, when vaccine makers were advised to target their seasonal shots against the JN.1 lineage generally, or KP.2, the leading variant in the JN.1 lineage at the time, specifically.
This year, advisors unanimously voted to stick with vaccines that target the JN.1 lineage, in line with recommendations from the World Health Organization. The question of targeting the JN.1 lineage was the only voting question the FDA tasked them with. But there was open discussion on a more specific recommendation. Given the regulatory uncertainty, advisors were divided on whether to stick with the JN.1 and KP.2 formulations from last year or recommend switching to the latest leading variant in the JN.1 family, LP.8.1.
Shortly after the meeting, the FDA announced that it would essentially leave it up to manufacturers; they could stick with JN.1 or KP.2 but, if feasible, switch to LP.8.1.
“The COVID-19 vaccines for use in the United States beginning in fall 2025 should be monovalent JN.1-lineage-based COVID-19 vaccines (2025–2026 Formula), preferentially using the LP.8.1 strain,” it said.
Under President Trump, the Food and Drug Administration may no longer approve seasonal COVID-19 vaccines updated for the virus variants circulating that year, according to recent statements by Trump administration officials.
Since the acute phase of the pandemic, vaccine manufacturers have been subtly updating COVID-19 shots annually to precisely target the molecular signatures of the newest virus variants, which continually evolve to evade our immune responses. So far, the FDA has treated these tweaked vaccines the same way it treats seasonal flu shots, which have long been updated annually to match currently circulating strains of flu viruses.
The FDA does not consider seasonal flu shots brand-new vaccines. Rather, they’re just slightly altered versions of the approved vaccines. As such, the regulator does not require companies to conduct lengthy, expensive vaccine trials to prove that each slightly changed version is safe and effective. If they did, generating annual vaccines would be virtually impossible. Each year, from late February to early March, the FDA, the Centers for Disease Control and Prevention, and the World Health Organization direct flu shot makers on what tweaks they should make to shots for the upcoming flu season. That gives manufacturers just enough time to develop tweaks and start manufacturing massive supplies of doses in time for the start of the flu season.
So far, COVID-19 vaccines have been treated the exact same way, save for the fact that the vaccines that use mRNA technology do not need as much lead time for manufacturing. In recent years, the FDA decided on formulations for annual COVID shots around June, with doses rolled out in the fall alongside flu shots.
However, this process is now in question based on statements from Trump administration officials. The statements come amid a delay in a decision on whether to approve the COVID-19 vaccine made by Novavax, which uses a protein-based technology, not mRNA. The FDA was supposed to decide whether to grant the vaccine full approval by April 1. To this point, the vaccine has been used under an emergency use authorization by the agency.
The cases in Kansas are likely part of the mushrooming outbreak that began in West Texas in late January. On March 13, Kansas reported a single measles case, the first the state had seen since 2018. The nine cases reported last week had ties to that original case.
Spreading infections and misinformation
On Wednesday, KDHE Communications Director Jill Bronaugh told Ars Technica over email that the department has found a genetic link between the first Kansas case and the cases in West Texas, which has similarly spread swiftly in under-vaccinated communities and also spilled over to New Mexico and Oklahoma.
“While genetic sequencing of the first Kansas case reported is consistent with an epidemiological link to the Texas and New Mexico outbreaks, the source of exposure is still unknown,” Bronaugh told Ars.
Bronaugh added that KDHE, along with local health departments, is continuing to work to track down people who may have been exposed to measles in affected counties.
In Texas, meanwhile, the latest outbreak count has hit 327 across 15 counties, mostly children and almost entirely unvaccinated. Forty cases have been hospitalized, and one death has been reported—a 6-year-old unvaccinated girl who had no underlying health conditions.
On Tuesday, The New York Times reported that as measles continues to spread, parents have continued to eschew vaccines and instead embraced “alternative” treatments, including vitamin A, which has been touted by anti-vaccine advocate and current US Health Secretary Robert F. Kennedy Jr. Vitamin A accumulates in the body and can be toxic with large doses or extended use. Texas doctors told the Times that they’ve now treated a handful of unvaccinated children who had been given so much vitamin A that they had signs of liver damage.
“I had a patient that was only sick a couple of days, four or five days, but had been taking it for like three weeks,” one doctor told the Times.
In New Mexico, cases are up to 43, with two hospitalizations and one death in an unvaccinated adult who did not seek medical care. In Oklahoma, officials have identified nine cases, with no hospitalizations or deaths so far.
Stat asked the HHS specifically about the Wild to Mild campaign as well as promotional campaigns for other vaccines, but an HHS spokesperson puzzlingly responded with a statement saying: “No, the CDC was not told to take down the flu vaccination campaign webpage,” which wasn’t what the outlet had asked about.
The statement went on to say: “Unfortunately, officials inside the CDC who are averse to Secretary Kennedy and President Trump’s agenda seem to be intentionally falsifying and misrepresenting guidance they receive.” NPR received the same statement.
Meanwhile on Thursday, The Washington Post reported that the HHS told the CDC to indefinitely postpone a meeting of its vaccine advisory committee (the Advisory Committee on Immunization Practices, or ACIP), which Kennedy has criticized. ACIP, comprised of independent experts, meets regularly to review and discuss vaccine safety and efficacy data and vote on recommendations.
ACIP was previously scheduled to meet February 26 to 28 to discuss a large number of vaccines, including those against meningitis, influenza, RSV, chikungunya, HPV, mpox, pneumococcal infections, Lyme disease, COVID-19, and CMV. An HHS spokesperson told the Post that the meeting was “postponed to accommodate public comment in advance of the meeting,” but there is no rescheduled date.
Leading medical experts and organizations, such as the American Medical Association, quickly sent a joint letter urging Kennedy to preserve the meeting. “Each ACIP meeting holds tremendous weight and relevance,” the letter states. ‘Infectious diseases are constantly evolving opponents; vaccines are among the best tools for constantly adapting and responding to the latest public health threats. … Making America healthy requires healthy discussion and timely, evidence-based decisions. This meeting should be no different.”
In an interview with Ars Technica last week, Zach Holbrooks, the executive director of the South Plains Public Health District (SPPHD), which includes Gaines, said that the area has a large religious community that has expressed vaccine hesitancy.
Additional cases likely
Pockets of the county have yet lower vaccination rates than the county-wide averages suggest. For instance, one independent public school district in Loop, in the northeast corner of Gaines, had a vaccination rate of 46 percent in the 2023–2024 school year.
Measles is one of the most infectious diseases known. The measles virus spreads through the air and can linger in the airspace of a room for up to two hours after an infected person has left. Ninety percent of unvaccinated people who are exposed will fall ill with the disease, which is marked by a very high fever and a telltale rash. Typically, 1 in 5 unvaccinated people with measles in the US end up hospitalized, and 1 in 20 develop pneumonia. Between 1 to 3 in 1,000 die of the infection. In rare cases, it can cause a fatal disease of the central nervous system called Subacute sclerosing panencephalitis later in life. Measles can also wipe out immune responses to other infections (a phenomenon known as immune amnesia), making people vulnerable to other infectious diseases.
“Due to the highly contagious nature of this disease, additional cases are likely to occur in Gaines County and the surrounding communities,” the state health department said.
While Gaines is remarkable for its low vaccination rate, vaccination coverage nationwide has slipped in recent years as vaccine misinformation and hesitancy have taken root. Overall, vaccination rates among US kindergartners have fallen from 95 percent in the 2019–2020 school year into the 92 percent range in the 2023–2024 school year. Vaccine exemptions, meanwhile, have hit an all-time high. Health experts expect to see more vaccine-preventable outbreaks, like the one in Gaines, as the trend continues.
As federal lawmakers prepare to decide whether anti-vaccine advocate Robert F. Kennedy Jr. should be the next secretary of the Department of Health and Human Services, pediatricians from around the country are making emotional pleas to protect and support lifesaving immunizations.
The American Academy of Pediatrics (AAP) has assembled nearly 200 stories and dozens of testimonials on the horrors of vaccine-preventable deaths and illnesses that pediatricians have encountered over their careers. The testimonials have been shared with two Senate committees that will hold hearings later this week: the Senate Committee on Finance and the Senate Committee on Health, Education, Labor, and Pensions (HELP).
“I remember that baby’s face to this day”
In a statement on Monday, AAP President Susan Kressly noted that the stories come from a wide range of pediatricians—from rural to urban and from small practices to large institutions. Some have recalled stories of patients who became ill with devastating diseases before vaccines were available to prevent them, while others shared more recent experiences as vaccine misinformation spread and vaccination rates slipped.
In one, a pediatrician from Raleigh, North Carolina, spoke of a baby in the 1990s with Streptococcuspneumoniae meningitis, a life-threatening disease. “I remember holding a baby dying of complications of pneumococcal meningitis at that time. I remember that baby’s face to this day—but, thanks to pneumococcal vaccination, have never had to relive that experience since,” the doctor said. The first pneumococcal vaccine for infants was licensed in the US in 2000.
A doctor in Portland, Maine, meanwhile, faced the same disease in a patient who was unvaccinated despite the availability of the vaccine. “As a resident, I cared for a young, unvaccinated child admitted to the pediatric intensive care unit with life-threatening Streptococcus pneumoniae meningitis. This devastating illness, once common, has become rare thanks to the widespread use of pneumococcal conjugate vaccines. However, this child was left vulnerable…and [their parents] now faced the anguish of watching their child fight for their life on a ventilator.”
Kressly emphasizes that “One unifying theme of these stories: vaccines allow children to grow up healthy and thrive. As senators consider nominees for federal healthcare agencies, we hope these testimonies will help paint a picture of just how important vaccinations are to children’s long-term health and wellbeing.”
Their investigative report—based on interviews with multiple health department employees who spoke on the condition of anonymity for fear of retaliation—revealed that employees were told of the startling policy change in meetings in October and November and that the policy would be implemented quietly and not put into writing.
Ars Technica has contacted the health department for comment and will update this post with any new information.
The health department provided a statement to NPR saying that it has been “reevaluating both the state’s public health priorities as well as our messaging around vaccine promotion, especially for COVID-19 and influenza.” The statement described the change as a move “away from one-size-fits-all paternalistic guidance” to a stance in which “immunization for any vaccine, along with practices like mask wearing and social distancing, are an individual’s personal choice.”
According to employees, the new policy cancelled standard fall flu vaccination events this year and affects every other aspect of the health department’s work, as NPR explained:
“Employees could not send out press releases, give interviews, hold vaccine events, give presentations or create social media posts encouraging the public to get the vaccines. They also could not put up signs at the department’s clinics that COVID, flu or mpox vaccines were available on site.”
“We’re really talking about deaths”
The change comes amid a dangerous swell of anti-vaccine sentiment and misinformation in Louisiana and across the country. President-elect Trump has picked Robert F. Kennedy Jr.—a high-profile anti-vaccine advocate and one of the most prolific spreaders of vaccine misinformation—to head the US Department of Health and Human Services.
Earlier this week, Robert F. Kennedy, Jr. used a Zoom call to tell his supporters that Donald Trump had promised him “control” of the Department of Health and Human Services (HHS), the federal agency that includes the Centers for Disease Control, Food and Drug Administration, National Institutes of Health, as well as the Department of Agriculture. Given Kennedy’s support for debunked anti-vaccine nonsense, this represents a potential public health nightmare.
A few days after, Howard Lutnick, a co-chair of Trump’s transition team, appeared on CNN to deny that RFK Jr. would be put in charge of HHS. But he followed that with a long rant in which he echoed Kennedy’s spurious claims about vaccines. This provides yet another indication of how anti-vaccine activism has become deeply enmeshed with Republican politics, to the point where it may be just as bad even if Kennedy isn’t appointed.
Trump as Kennedy’s route to power
Kennedy has a long history of misinformation regarding health, with a special focus on vaccines. This includes the extensively debunked suggestion that there is a correlation between vaccinations and autism incidence, and it extends to a general skepticism about vaccine safety. That’s mixed with conspiracy theories regarding collusion between federal regulators and pharmaceutical companies.
While there is no evidence for any of this, and some of it is clearly wrong, the conspiracies have real-world consequences. An anti-vaccine activist in Samoa, aided by a visit from RFK Jr., helped pave the way for a measles outbreak that shut down the government and ultimately led to over 80 deaths.
Kennedy has long been interested in getting access to the agencies that regulate vaccines and other interests of his, such as food safety, under the assumption they are hiding the data that would vindicate his views. And, long before his recent presidential run, he viewed Trump as the route to that access. Shortly before Trump’s inauguration in 2017, Kennedy claimed that he would be appointed to head a vaccine safety commission that Trump would supposedly create once in office. Nothing ever came of that, and it was never clear whether that was due to Trump lying to him, Kennedy exaggerating his significance, or Trump simply telling him what he wanted to hear at the time and never following up.
In the hearing, board member Jennifer Riebe (who voted to keep COVID-19 vaccinations available) worried about the potential of a slippery slope.
“My concern with this is the process because if this board and six county commissioners and one physician is going to make determinations on every single vaccine and pharmaceutical that we administer, I’m not comfortable with that,” she said, according to Boise State Public Radio. “It may be COVID now, maybe we’ll go down the same road with the measles vaccine or the shingles vaccine coverage.”
Board Chair Kelly Aberasturi, who also voted to keep the vaccines, argued that it should be a choice by individuals and their doctors, who sometimes refer their patients to the district for COVID shots. “So now, you’re telling me that I have the right to override that doctor? Because I know more than he does?” Aberasturi said.
“It has to do with the right of the individual to make that decision on their own. Not for me to dictate to them what they will do. Sorry, but this pisses me off,” he added.
According to Boise State Public Radio, the district had already received 50 COVID-19 vaccines at the time of the vote, which were slated to go to residents of a skilled nursing facility.
The situation in the southwest district may not be surprising given the state’s overall standing on vaccination: Idaho has the lowest kindergarten vaccination rates in the country, with coverage of key vaccinations sitting at around 79 percent to 80 percent, according to a recent analysis by the Centers for Disease Control and Prevention. The coverage is far lower than the 95 percent target set by health experts. That’s the level that would block vaccine-preventable diseases from readily spreading through a population. The target is out of reach for Idaho as a whole, which also has the highest vaccination exemption rate in the country, at 14.3 percent. Even if the state managed to vaccinate all non-exempt children, the coverage rate would only reach 85.7 percent, missing the 95 percent target by nearly 10 percentage points.
Enlarge/ A US child infected with measles during a 2024 outbreak. The child’s cheek shows the characteristic rash associated with this viral infection.
With one of the highest vaccine exemption rates in the country, Oregon is experiencing its largest measles outbreak in decades. This year’s count is now higher than anything seen since 2000, when the Centers for Disease Control and Prevention declared the highly contagious virus eliminated from the US.
Last month, when the outbreak tally was still in the 20s, health officials noted that it was nearing a state record set in 2019. There were 28 cases that year, which were linked to a large outbreak across the border in Washington state. But, with that record now surpassed, the state is in pre-elimination territory.
“Before 2019, you have to go all the way back to the early 1990s to see case counts this high,” Paul Cieslak, medical director for communicable diseases and immunization at Oregon Health Authority, said in a statement. “The reason is, we maintained very high vaccination rates and very high population levels of immunity. Unfortunately, we’ve seen an erosion in the percentage of people who are getting vaccinated against measles.”
Vaccination decline
In 2000, when measles was declared officially eliminated, only about 1 percent of kindergarteners in the state had exemptions from childhood vaccines, such as measles. But in the years since, Oregon has become one of the states with the highest exemption rates in the country. In the 2022–2023 school year, 8.2 percent of Oregon kindergarteners had exemptions from vaccinations, according to a CDC analysis published in November. Only Idaho had a higher rate, with 12.1 percent of kindergarteners exempt. Utah was a close third, with 8.1 percent, followed by Arizona (7.4 percent) and Wisconsin (7.2 percent).
Oregon’s exemption rate has risen since then, with the exemption rate now at 8.8 percent, according to the Oregon Health Authority. Any exemption rate above 5 percent is concerning. At that threshold, even if every non-exempt child is vaccinated, a state will not be able to achieve the target of 95 percent vaccine coverage expected to prevent sustained transmission of infectious diseases.
Health officials are directly linking the rise of non-medical exemptions to the current measles outbreak, which is centered in Clackamas, Marion, and Multnomah counties. All three are in the northwestern corner of the state, with Clackamas and Multnomah in the Portland area.
“In Clackamas County, as in other Oregon counties, pockets of unvaccinated people raise risk of infection in communities where they live,” Clackamas County Health Officer Sarah Present said. “That’s why the counties reach out to every case that’s been identified and try to determine exactly where they’ve been while infectious.”
Notorious virus
Measles is among the most infectious viruses known. It is notorious for its ability to stay aloft in indoor air for up to two hours after an infected person has been present. For unvaccinated people who are exposed, up to 9 out of 10 will end up falling ill. Those who become infected are contagious from about four days before developing the tell-tale rash and four days after it erupts. Other common symptoms of the infection include high fever, runny nose, cough, and conjunctivitis (pink eye). Many children become severely ill, requiring hospitalization.
In a small percentage of cases, measles can lead to severe complications, including pneumonia, encephalitis, and a progressive neurological disorder (subacute sclerosing panencephalitis), which develops five to 10 years after an initial infection. Additionally, measles is known to cause “immune amnesia.” That is, being infected with measles virus wipes out existing antibodies and immune responses to other germs, leaving people more vulnerable to other diseases.
So far this year, the US has logged 236 measles cases. Of those, 40 percent were in children under the age of 5, while 30 percent were in children and teens between the ages 5 and 19. Eighty-seven percent were either unvaccinated or had an unknown vaccination status. Forty-four percent (103 of 236) were hospitalized.
This year’s tally is already well ahead of the total for 2023, which reached just 59 cases. It is still significantly lower than the 1,274 cases seen in 2019, when the US nearly lost its elimination status.
