of those infected so far are vaccinated. The remaining patients are either unvaccinated or their vaccine status is unknown. 

Robert F. Kennedy Jr., the newly confirmed head of the U.S. Department of Health and Human Services, has a long history of around vaccines, including the one for measles. He recently put vaccine advisory meetings — where a panel of experts establish a vaccine schedule used to inform state policies — on indefinite and wields power over how organizations within HHS, such as the Centers for Disease Control and Prevention, respond to such crises. 

Earlier this month, his anti-vaccine organization, Children’s Health Defense, put out a blaming the Texas outbreak on the vaccines themselves, arguing, “The real issue is not a failure to vaccinate but a failing vaccine.”

“As measles outbreaks continue to surface, the mainstream media is now using them as a political weapon, attempting to blame … Secretary Robert F. Kennedy Jr. for so-called ‘anti-vaccine rhetoric,’” the statement read. “His warnings about vaccine-induced injuries and failures are validated by the very outbreaks being reported today.”

Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, a Texas-based education advocacy organization that promotes childhood and adult immunization, said she is “just absolutely flabbergasted that there is intentionality to put blame on the vaccine when that is not where anybody should be spending their time or their effort. Our effort should be supporting families, making sure they’ve got the right information and supporting helping our public sector partners so we can try to get to the end of this crisis sooner rather than later.”

“CDC is aware of the death of one child in Texas from measles, and our thoughts are with the family,” Andrew Nixon, director of communications at HHS, wrote in a statement to �鶹��Ʒ. “CDC continues to provide technical assistance, laboratory support, and vaccines as needed to the Texas Department of State Health Services and New Mexico Department of Health, which are leading the response to this outbreak.”

There are now also at least nine reported cases in neighboring  

Kennedy that he’s following updates on the outbreak, which he noted was mainly in the Mennonite community. Despite the confirmed death of a child, Kennedy appeared to downplay the spread, saying, “It’s not unusual. We have measles outbreaks every year.”

Measles were declared eliminated in the United States in but there’s been a resurgence of cases as vaccination rates have dropped.

Mary Koslap-Petraco, a pediatric nurse practitioner who treats underserved children in New York state, said that when she heard about the child’s death Wednesday morning, “Quite frankly, I broke down in tears. This was [99%] preventable.”  

She placed much of the onus on the anti-vaccination movement, saying they planted “seeds of distrust” that ultimately scared parents.

“I know this family only wanted the best for this child,” she said, “and I’m really sorry that they weren’t able to encounter someone who could help them through this misinformation that they’re hearing to feel comfortable enough to vaccinate their child.”

‘Primed for something like this to happen’ 

Measles is a highly contagious which can be serious and sometimes fatal in children. If one person has it, up to 9 out of 10 people nearby will become infected if they , though spread is preventable through the measles, mumps and rubella vaccine, which is safe and about . The infection is often marked by a high fever, sore throat and rash; more severe complications can include pneumonia and swelling of the brain.

In a statement Wednesday, the Texas Department of State Health Services said the best way to prevent measles is through the vaccine. The department  it was “working with local health departments to investigate cases, provide immunizations where needed, and keep the public informed.”

Texas is one of 18 states that allow school-aged children to of vaccine requirements for medical, religious or “personal belief” reasons.

The majority of measles cases so far are in Gaines County, a small, rural county in West Texas, with one of the state’s highest vaccine exemptions rates: up from just over 4% a decade ago. And the actual number of unvaccinated kids in the county is likely significantly higher, because there’s no data for the many children who are homeschooled, according to reporting from the

Some of the initial cases appeared to be connected to . 

To be exempted for “reasons of conscience,” a parent or legal guardian has to submit a form to the school. Under certain circumstances — like an official emergency or epidemic — these students might not be allowed to go to school.

None of the four public school districts serving Gaines County immediately responded to a request for comment. The county’s small Loop Independent School District of K-12 students had a conscientious exemption for immunizations in 2023-24. The statewide vaccine exemption rate is 2%.

“We know based on a ton of research that these kinds of exemptions cluster,” Lakshmanan said. “They cluster geographically, they cluster in schools, they cluster in neighborhoods, they cluster in faith-based communities. Sadly we are seeing the practical reality of this type of loophole … when we start to see high exemption rates, we are bound and we are primed for something like this to happen.”

Kindergarten measles vaccination rates in Texas generally have fallen to below 95% since the pandemic, though they still remain just above national averages, according to a recent data analysis from  

A number of Texas parents who previously had not vaccinated their children are now changing course. “We’ve vaccinated multiple kids that have never been vaccinated before, some from families that didn’t believe in vaccines,” Katherine Wells, director of public health for Lubbock’s health department, told

Yet, as the outbreak spreads, Texas lawmakers are preparing to consider bills that would further loosen exemption requirements.

“Now is not the time to be playing a game of roulette with children’s lives or Texans’ lives and even contemplate making the exemption process easier,” Lakshmanan said.

Kate Gould said the classroom became a dangerous place for her son after took over the Douglas County school board and the district removed masking requirements.

After a prolonged back-and-forth, involving a pulmonologist and a special education attorney, district leaders finally agreed to an accommodation for his classroom, mandating masks. But mere weeks later, the superintendent was fired and, under new leadership, the district again removed the masking accommodation without consulting doctors or Gould, she told �鶹��Ʒ in a recent interview. 

Now, almost four years later, Gould and her family live in Southern California — where they moved during the pandemic for its masking and eventual COVID vaccine requirements — and they and other parents, advocates and health experts are gearing up for what could be the next front of the school culture wars: a broader attack on school vaccine mandates by the incoming Trump administration.

Currently, all 50 states have vaccine requirements for children entering child care and schools. But with Robert F. Kennedy Jr. — who has peddled baseless conspiracy theories and “There’s no vaccine that is safe and effective” — potentially at the helm of the Department of Health and Human Services, advocates and parents are right to fear a rollback of requirements, enforcements and funding, according to interviews with about a dozen experts. 

“The anti-vax warriors have made it inside the castle walls,” said Richard Hughes, a George Washington University law professor who teaches a course on vaccine law.

Kennedy’s legitimization and the different levers he could pull, experts told �鶹��Ʒ, could have an immense impact on vaccination rates and the spread of preventable, contagious diseases in school-aged kids.

If confirmed by the Senate, Kennedy would take control of an agency with a budget and 90,000 employees spread across 13 agencies, including the and the . Dave Weldon, nominated by President-elect Donald Trump to head the CDC, has also endorsed debunked theories, and some chronic diseases.

Kennedy, whose nomination faces from health professionals and scientists and questioning by , did not respond to requests for comment. He has said he would not take away vaccines but look to make more of their safety and efficacy data available. 

“We don’t know what he’s going to do,” John Swartzberg, a professor at the University of California Berkeley’s School of Public Health told �鶹��Ʒ. “But if he tries to carry out the things that he’s publicly stated — not just recently but over a long, long time — then the implications for our children in school are dire.”

While most school vaccine requirements come from states, the recommendations they’re based on begin with federal agencies, such as the CDC, and enforcement is often left up to local districts. This leaves room for both federal influence and “a hodgepodge of enforcement,” said Northe Saunders, executive director of the pro-vaccine , who sees battles around school vaccination mandates playing out at the federal, state and school board levels.

Experts agreed the federal government is highly unlikely to attempt to take vaccines off the market or categorically ban mandates, and most don’t anticipate individual states will do away with their long-standing requirements.

But James Hodge, a public health law expert at Arizona State University’s Sandra Day O’Connor College of Law, pointed out, “You don’t actually have to pull the vaccine for people to stop using it. You have to raise doubts about it.”

That can happen by planting seeds of misinformation, he said, or by starting to require that vaccines be assessed differently for approval or federal funding. Any slight dropoff in parents vaccinating their kids entering schools or day care can result in disease outbreaks, an outcome Hodge said he expects to see over the next year or so. Such declines are

As secretary, Kennedy could delay FDA vaccine development and influence the selection of CDC advisory committee members who make the vaccine recommendations that states then use to determine their requirements. Programs that provide free vaccines for kids could also see their funding cut.

“There’s short-term threats in terms of funding and what’s going to be available for state immunization programs,” Saunders said, “[and then] there’s long-term threats about immunization policy and what the future of the immunization landscape in the country can hold.”

Even in Democratically controlled California, Gould, the mom whose son has cystic fibrosis, said she’s concerned about shifts in vaccine rhetoric, particularly at the school board level. 

“I think what I have learned from my experience in Douglas County, Colorado, is that when these individuals take over majorities on school boards, it really affects everyone … Despite the fact that we are a highly educated, very liberal, coastal section of Southern California, you definitely have people that are trying to make inroads — and these are people who are anti-science.”

Are vaccines the new critical race theory?

Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons. Most states also have religious exemptions, and 20 have some form of personal , leaving a varied landscape. 

School vaccine mandates have been around for , and while some pushback has always existed, it wasn’t until COVID that there was a real spike in vaccine hesitancy, according to Kate King, president of the and a school nurse in Ohio.

The source of the skepticism has shifted, too: “Rarely have we seen the federal government behind those debates in a way that this next administration could be,” said ASU’s Hodge.

Randi Weingarten, president of the American Federation of Teachers, sees the potential “unraveling of decades and generations of protective vaccines.”

“RFK believes he knows more than the totality of any science that has come before him,” she said. 

For a vaccine to get approved, it must first go through an advisory committee at the FDA. Another committee at the CDC then develops recommendations for vaccine schedules, which state legislators rely on to determine their school policies. Kennedy would have an enormous impact on who serves on these committees, and he could stack them with anti-vaccine advocates.

Kennedy could also request a review of all vaccines that have been previously approved by the FDA and subject them to new requirements. 

Many vaccines are paid for by the federal government. If Congress — under HHS’s direction or on their own — were to begin pulling that money, some of the most vulnerable children across the country could lose access to immunization. Trump has threatened to requiring vaccines for students. 

“The moment you start tacking on any price tag to a vaccination — any price tag whatsoever, even fairly minimal — you do see vaccination rates go down,” said Hodge.

Beyond policy actions, experts warned of the power of rhetoric. “We still rely — even under legal mandates that exist at the state level — on public acceptance of vaccines,” Hodge added, so for vaccine rates to remain high, so too must the public trust. The mere presence of a federal official who is skeptical and — at times outright hostile — towards vaccines gives the opposition more credibility.

Since the enforcement of these policies is typically left up to the district level, some advocates are anticipating increased pressure on school board members to take anti-vaccine positions. 

“The real tension is if a school board decides that they don’t want to support these [vaccine mandate] policies,” said Hughes, the GW law professor. “They can’t change the policies, but they might say, ‘We don’t support these policies. Not in our school district. No way, no how.’”

He said he’s already seen some groups use vaccines as a wedge issue, much like the debate over critical race theory — an academic framework used to examine systematic racism — that convulsed school boards a few years ago.

In , public health workers were recently forbidden from promoting COVID, flu and mpox — previously known as monkeypox — shots, according to a recent NPR investigation. And a regional public health department in Idaho is no longer providing COVID vaccines to residents in six counties after a by its board. 

There’s money in anti-vax anxiety

The anti-vaccination movement is not new. It can be traced back as far as the 18th century with Edward Jenner’s discovery of the smallpox vaccine. Because it was made from cowpox, people at the time were afraid that if they got the vaccine, they’d turn into a cow, said Swartzberg, the public health professor who has taught a course on the anti-vax movement for over a decade. 

“There’s always been opposition to vaccination because it’s the idea of the word inoculate, — meaning putting into you something foreign — and that scares people,” Swartzberg said. “I understand that. That’s where emotion has to be countered with data.” 

The group of people so stringently anti-vaccination that they refuse them is small but vocal, he said. Over the past few years, though, “something has dramatically changed in our society,” and the voices behind the movement have shifted from expressing personal fears to looking to monetize the fears of others. 

For example, Joseph Mercola, deemed one of the — the 12 people responsible for sharing the majority of anti-vax messaging on social media — made substantial sums of money by peddling far-fetched health claims and then as alternative treatments. Kennedy also appeared on the “Disinformation Dozen” list.

Others sell merchandise, books and tickets to events, offer exclusive paid content on platforms like Patreon, have sponsored content and display affiliate marketing links to anti-vaccine products.

“It’s turned into an incredibly lucrative field for anti-vaxxers, and what’s really facilitated this has been the internet and the lack of any monitoring of the internet for misinformation and disinformation,” Swartzberg said.

Just last week, Meta, the owner of Facebook, Instagram and WhatsApp, d that it will end its fact-checking program on social media posts. 

Using social media and other mechanisms, the anti-vax movement has targeted fairly insular groups around the United States with misinformation, he added. These include New York’s and the y in Minnesota, both of which have seen recent measles outbreaks. 

While the image of vaccine skeptical parents is often one of young, white “,” Keri Rodrigues, president of the National Parents Union, also pointed to “well-earned” trepidation among Black and Latino parents. 

Historically, she noted, significant harm has been done to Black communities through the weaponization of medical trials, and families of color have had particularly negative experiences with the health care system —

During the pandemic, Children’s Health Defense, Kennedy’s anti-vaccine advocacy organization, seemed to tap into this distrust when it put out targeting Black Americans with disproven vaccine claims.��

Gould, the California mom, said if she were still living in more conservative Douglas County she’d fear that people would “believe the disinformation [and] stop vaccinating their children. For kids with chronic illnesses — or like my son, a life-limiting illness — that has massive consequences. It has life-or-death consequences.”

The former independent presidential candidate has a complicated past as a member of a famous Democratic political dynasty that includes his uncle, former President John F. Kennedy, and his father, U.S. Sen. Robert Kennedy, both assassinated in his youth. He struggled with addiction, and an arrest for heroin possession in the 1980s led him to volunteer with the Natural Resources Defense Council to fulfill community service hours, which jump-started his career in . 

Then, about two decades ago, Kennedy became interested in vaccine conspiracy theories, including the disproven link between vaccines and autism, which has become a focal point of much of his work since. He has peddled other , including that Wi-Fi causes cancer, that chemicals in water can lead to children becoming transgender and that AIDS may not be caused by HIV. In 2021, he was named one of the of misinformation about COVID vaccines on social media. 

Doctors and advocates have expressed alarm about the impact he could have on the department, while some have applauded his more mainstream views, such as a focus on preventative care through healthy eating and exercise and a commitment to removing processed foods from .

His beliefs and proposals are particularly relevant for kids, amid heated debates around school vaccination policies and a in the percentage of kindergarteners who have gotten state-required vaccinations.

If confirmed by the Senate, Kennedy would take control of an agency with one of largest federal budgets — — that employs about 90,000 people across 13 agencies, including , (the latter pays for a host of for eligible children), the and the

To better understand the pediatric and school-based health care implications of some of Kennedy’s proposals, �鶹��Ʒ’s Amanda Geduld spoke with Leana Wen, an emergency physician and contributing opinions columnist for . The parent of two school-aged kids is also a professor of health policy and management at George Washington University, a non-resident senior fellow at the and Baltimore’s former health commissioner.

Geduld then spoke with medical legal expert Richard H. Hughes IV about how likely Kennedy’s confirmation is and what kind of power he would wield if confirmed. Hughes is a professor at George Washington University’s law school, where he teaches a course on vaccine law, and a partner at the firm . He formerly worked as the vice president of public policy at Moderna — one of the co-producers of the first FDA-approved COVID-19 vaccines — guiding the company’s policy strategy during the pandemic.

These interviews have been edited for length and clarity.

The medical perspective

�鶹��Ʒ: Kennedy has a long record of promoting and even before the pandemic had built a following through his anti-vaccine nonprofit group, . 

In the past few weeks, he’s backed off these assertions a bit, but I’m still wondering what impact his rhetoric around vaccines could have— especially around parents vaccinating their kids. Can you also speak to some of the science behind vaccinating kids in the first place and what impact that’s had on pediatric health care?

Leana Wen: I think it’s important for us to start with the facts and to talk about what happened before there were vaccines for a variety of diseases. In the decades past, prior to vaccines, we used to see children succumbing to diseases that we now do not see anymore. We used to see children becoming paralyzed from polio and their parents being too scared for them to interact with others and go to school. We used to see children with severe, lifelong problems — including with their brains and other organs — because of measles, mumps and other diseases that we now consider to be eliminated thanks to vaccines. 

And so I think part of why vaccine misinformation has caught on is that the current generation of Americans have not experienced how terrifying these diseases have been that vaccines prevent. And I would really hate for us to see these diseases return before people recognize how much vaccines are life saving. 

I think it’s also important for us to mention the facts. It’s a fact that in 1900, 30% of all deaths in America occurred in kids under 5. Now that number is 1.4%. Back in 1900, the three leading causes of death were all infectious diseases. Now they aren’t. Thanks to antibiotics, thanks to sanitation, also thanks to vaccines. 

There was done recently that was published in the journal The Lancet. The study found that vaccines against the 14 most common pathogens saved 154 million lives globally over the past five decades, and that these vaccines cut infant mortality by 40%. 

And so it’s really heartbreaking to hear anyone spread misinformation about vaccines, but certainly it would be extremely concerning from a public health standpoint, if the individual in charge of science and health in this country is the one spreading such falsehoods. This could have a huge impact on trust in vaccines. And unfortunately, that could reduce vaccine uptake and lead to the return of these diseases that we thought were eliminated.

Kennedy has proposed removing processed foods from and limiting the use of food dyes, saying that the U.S. obesity epidemic, as well as a rise in chronic diseases like diabetes, are the result of He recently called out the nutrition department, which he says is Can you talk a little bit about what impact the food that we see showing up in school lunches has on kids, and what we know about food dyes?

I want to focus on ultra-processed food. We know that ultra-processed foods are associated with a whole variety of health problems — certainly things like diabetes, obesity, other chronic diseases like that — but also with depression and early dementia and potentially behavioral developmental issues in children as well. 

Unfortunately, some studies show that as much as 70% of the diet that Americans consume come from ultra-processed foods — that the calories from these diets come from ultra-processed food. I think it would be great if we can start reducing or removing ultra-processed food from school lunches. There has been some research done on food dyes and other additives. Reducing these in school lunches would also be a positive step.

He’s also mentioned that the same way that a doctor can prescribe Ozempic to treat obesity, they should also be able to prescribe, say, and have that covered by health insurance policies. I’m wondering what that might look like for kids as well, and what role pediatricians might play.

I don’t think any pediatrician would disagree with the idea that we have to focus more on prevention — that promoting healthy lifestyle, increasing exercise, improving diet, these would all be excellent for the promotion of health and well-being in our children. 

To be clear, it’s not these ideas that Kennedy is promoting that the medical profession would have an issue with. It’s that mixed in with many of these good ideas, are our concerns about misinformation around vaccines and that traditionally have not been considered to be safe and effective. 

After Kennedy’s nomination, he wrote on on Jan. 20, “The Trump White House will advise all U.S. water systems to remove fluoride from public water.” Can you talk a little bit about the role of fluoride in drinking water — specifically for kids.

This is an area where re-examination of the current policy would be a good idea, because this is a nuanced and complicated issue. On the one hand, we know that fluoridating the water supply has reduced cavities in children, but that effect was seen the most before widespread use of fluoride toothpaste.

We also know that fluoride in large quantities has toxic effects, including on bone development, on teeth discoloration and potentially on the developing brain if consumed by the pregnant woman. And so the question then is, what is the amount of fluid that would be optimal for promoting both dental health and reducing other effects? …

I think these are all reasonable questions to be asking — again, though, using science as the basis and not approaching this as an activist who already has a preconception in mind.

Are there any other policy ideas that Kennedy has put forward that you have thought of as either welcome news and an exciting change or particularly concerning?

None of what we’re talking about here is new. I think we can divide the proposals by Kennedy into three categories. One are things that are good ideas. For example, removing ultra-processed lunch or ultra processed food from school lunches. 

The second category are things that deserve a re-examination, and depending on what we find, may or may not be a good idea. That includes the fluoridation.

And then the third area would be things that have been proven to be wrong. For example, misinformation around vaccines.

And so again, I think to your point, none of these things that have been brought up in the category of good ideas is new, but that’s how I would think about this.

The legal perspective

�鶹��Ʒ: Speaking about Kennedy at a rally recently, Trump said, How accurate is that? Can he really go wild on health? What are some of the congressional stopgaps there, and how much power does Kennedy actually have to enact these proposed policies? 

Richard H. Hughes: I think we could break that down into sort of two parts: Is Trump going to make good on that promise? and How far will RFK go? 

I would say that President Trump is very intent on making good on that promise. He went through with the selection of RFK. If you look at the appointments across the board, the nominees he selected are very unconventional. He’s very intent on disruption. 

And if you look at the health appointees in particular, there is some consistency there, right? They all hold really unconventional views. They come from very unconventional backgrounds for these types of roles. There are some questions about the adequacy of some of their experience and qualifications for these roles. There is also some consistency across the nominees that this sort of unconventional, non-mainstream views on COVID and the COVID response, as well as this focus around infections versus chronic disease. A lot of them have said we think we should be focused on chronic disease. A lot of them have espoused misinformation about vaccines. 

In terms of the legal authority, Congress has given a lot of really sweeping power to the secretary. When Congress gives the authority to the executive branch to do something, and it does it really clearly, the executive branch has a lot of leeway … 

So I’ll just give you an example. A lot of the questions I’m getting are about vaccine recommendations and vaccine requirements. There is the (ACIP). That is a committee that is created by the secretary… 

There are all of these requirements for programs or payers to provide coverage of the vaccines that are recommended by the committee. And so there are really interesting questions about, well, if he stopped convening the committee, if he eliminated the committee, what impact would that have?

There’s a potential trickle down effect, because a lot of states actually either look to that committee to determine what their [vaccine] policy should be, or they just refer to the committee and require, say, you know, for school entry, they require vaccination in accordance with the schedule that’s determined by the ACIP. 

That’s sort of a very specific area … 

At the FDA, there’s a lot of room for someone to come in, introduce subjective views on science, and say, “Well, what do we mean by safety? What do we mean by efficacy? Your traditional randomized, controlled trial, that doesn’t tell me what I need to know…” [That] might be the view of somebody at the agency in this administration, and they might try to introduce alternative evidence, and they would have some latitude to do that.

Just turning a little bit more to vaccines, it sounds like whoever is running this agency and convening this committee has a lot of power to potentially help determine what vaccines are going to be covered by health insurance. Is that correct?

That’s right. Congress requires payers to cover vaccines that are recommended by that committee. If those recommendations are rescinded by the secretary, which the secretary has the authority to do, that really throws a lot into question there. 

Now I’m having a really healthy, friendly debate with one of my mentors over the legal challenges that one could bring to challenge that sort of decision. There are some potential checks on this in the courts, but it’s all going to be really circumstantial.

Thinking specifically about schools, you mentioned that folks look to this committee to help determine what vaccines are required for students. Can you explain a little bit about how that works? How might RFK’s policies impact that?

If you’re interested — it’s open access — I just wrote in this month’s issue of Health Affairs on the relationship between ACIP recommendations and state school requirements … 

But, this is the authority of the states, and it’s really interesting in a Republican administration to think about the federalism debate … and you’re going to see this tension play out in this administration over the role of the states and the federal government. 

And it’s going to play out in the arena of public health and around vaccine policy … The federal government can come in and play a really important role when you have a threat that, say, goes across state lines. But states have to be able to enact these measures to protect themselves, to protect their people. 

The Jacobson v. Massachusetts case recognized that states can require immunization. [In] 1922, [in] the case Zucht v. King — lesser known but very important case when we talk about school requirements — the Supreme Court came back and said that a school district was able to exclude a young girl from school when she wasn’t vaccinated, even though there was no active outbreak. 

And so that’s a really, really important case, because if you think about why we require kids to get vaccinated to go to school, it’s a decision that the state makes to impose these requirements so that we don’t have disease outbreaks. It’s the suppression of endemic disease. You take those requirements away, you weaken those requirements, you’re going to see outbreaks potentially. And we’ve seen that with measles outbreaks, where we weaken those policies. 

So it sounds to me less like RFK can put out a mandate that schools federally cannot require vaccines, but more that there could be a trickle-down effect of some of what he does at the federal level, and that might impact then state policies. Is that correct?

Well, yes, but this is something I’m thinking a lot about right now because there is this statute that some of us have looked at over time — — which is the old isolation and quarantine statute that allows, essentially, the CDC to come in and and impose certain measures when necessary to control communicable disease. 

And every semester, I ask students, “Would this actually allow the federal government to impose a vaccine mandate?” And we debate that endlessly, whether that language actually would allow it or not. 

And right now, I think that poses the question: there is preemption language in that statute, so could it potentially be used to set a policy that would undermine state requirements or weaken state requirements? And it’s just a really interesting academic question. I don’t know that realistically that’s something that RFK or the CDC would pursue, but I think we’re living in an era where everything’s on the table.

Well, all of that said, how likely is Kennedy to actually get confirmed? And could there be, from a policy or a legal standpoint, any roadblocks put up in his way?

Yeah, so I do think he’ll get confirmed. I think that what you have seen is President Trump came forward and put together a slate of nominees very rapidly. And all of the ways that you could say that President Trump is inconsistent, he has been very consistent with his health nominees — a lot of similarly held views, a lot of unconventional backgrounds. 

I think just if you look at the pool of appointments as a whole, there’s a lot to take aim at, whether it was Matt Gaetz, his AG nominee () or the selection of the defense secretary nominee (), there’s a lot to provide sort of political fog. And I think that in all of that noise you lose sight of the fact that RFK does not have really the ideal qualifications for the role [and] holds some views that are anti-science. 

And you look to the Senate and ask, “Well, is someone going to stand up and push back and say, ‘We’re not going to confirm this nominee because they lack the qualifications?’” … No one has come out and sort of put a stake in the ground and said, “We’re not going to confirm nominees who don’t meet these qualifications,” or “If they hold these views, there’s no way that they’re going to get a hearing.” 

We just haven’t seen that. And so I do think they’ll get confirmed. I think President Trump expects loyalty from his party. 

It’s a major boost in efficacy compared to data from Moderna, which announced in March that its two-dose regimen is 51% protective in toddlers 6 months to 2 years old and 37% protective in youngsters 3 to 6 years old.��

Researchers believe both vaccines offer a strong defense against severe illness and hospitalization in the age group.

The U.S. Food and Drug Administration on Monday its vaccine advisory committee will meet June 15 to review Moderna’s and Pfizer-BioNTech’s emergency use authorization requests for kids ages 6 months to 5 years old and 6 months to 4 years old, respectively. Pfizer and BioNTech have not yet submitted an EUA request, but plan to do so by the end of the week, BioNTech CEO Ugur Sahin said in a .

The agency’s advisory committee will make a recommendation on whether to approve the shots at the end of the meeting, which the FDA typically follows. Many experts hope the agency will greenlight shots soon after the mid-June meeting.

“I have some optimism that this will go well at [the] FDA advisory meeting and we might begin immunizing under 5 beginning next month,” Peter Hotez, co-director of Texas Children’s Hospital’s Center for Vaccine Development, wrote on .

Children under 5 years old remain the last Americans without access to COVID vaccines, and parents are eager to protect their children, especially as cases once again rise, said Atlanta-based pediatrician Jennifer Shu.��

On Monday, as the Pfizer news was announced, multiple parents of young children asked whether they could get their kids on a waiting list for the forthcoming vaccines.

“I assure them that we will make availability for everyone who wants [the shots],” said Shu, explaining that her practice has received ample pediatric vaccine supply every time they have placed an order. “I don’t think that access is going to be an issue.”

The news from Pfizer and BioNTech comes on the heels of a months-long saga that has repeatedly raised the hopes of parents anxious to vaccinate their toddlers against COVID only to later send them crashing down. In late February, Pfizer-BioNTech first submitted a request asking the FDA to grant emergency authorization for a two-dose regimen of their vaccine for children 6 months to 4 years old, only to then withdraw the application just five days later.��

Then in April, when Moderna was on the verge of submitting its EUA application for the age group, that the FDA might postpone the review process until Pfizer’s shots were also ready, a reveal that angered many parents and spurred a congressional letter asking the agency to explain the reported delay. The announcement of the June 15 committee meeting appears to confirm those speculations of a simultaneous review.

The trial results released Monday clarified what experts have hinted at since February — that Pfizer’s two-dose regimen never offered the full intended protectiveness for young children.

“It was always a three-dose vaccine,” said Hotez.

The news comes as reported U.S. coronavirus cases are up 53% since two weeks ago and youth infections are also rising, though less steeply. With the increased prevalence of at-home testing, those numbers may fail to capture the full scope of new case totals, said Shu.

During the winter’s massive Omicron surge, children under 5 were hospitalized with the virus at five times the rate they were during the Delta surge, a from the Centers for Disease Control and Prevention recently found. And in February, the agency’s data revealed that kids under 18 had been infected by the virus.

Still, repeat infections remain a threat, and can happen of each other. Children who have not yet been vaccinated are more likely to get sick and, in turn, more likely to experience severe outcomes than immunized peers, said Shu.

“The kids who are ending up in the hospital are more likely not to be vaccinated,” she told �鶹��Ʒ.

Just 28% of children 5 to 11 years old and 58% of youth 12 to 17 years old have received two vaccine doses, rates that have remained nearly stagnant for months.

Aside from recommending that kids roll up their sleeves as soon as they’re eligible, the pediatrician believes schools should consider reinstating universal face-covering rules while infections multiply. While a few schools and districts have made that jump, the vast majority continue to keep masks optional, though some have upped their language recommending masks.��

Shu, however, knows of some children who have chosen to mask up at school as they’ve watched their peers get sick. It’s prom and graduation season, the pediatrician noted, and young people don’t want to miss out.

“If you miss some of these things, you can’t make them up,” said Shu.

Children under 5 years old may be eligible for coronavirus shots as soon as the end of February — much earlier than previously expected.

On Tuesday, Pfizer and BioNTech that they requested the Food and Drug Administration authorize a two-dose regimen of their vaccine for children under 5. Meanwhile, the companies will continue to research the efficacy of a third shot.

In December, disappointing trial data showing that two smaller doses were safe for youngsters but, in children ages 2 to 4, threatened to extend the timetable before which young children would be eligible for COVID vaccines. But the FDA urged Pfizer-BioNTech to submit their initial trial data so that regulators could begin the review process, then to later submit numbers on a third shot once those become available, The Washington Post . Results from the study of a three-dose regimen are expected to arrive in late March at the earliest.

“If they get the two-dose approved, then they can get going. And by the time the first round of two-dose people are ready to boost … if they have a third dose approved, then they’ll get through this course,” explained Benjamin Linas, professor of medicine at Boston University. “But if they wait until they have all the data for the three-dose course, then they won’t even be able to get started.”

Even if three shots prove to be the optimal vaccination level for the age group, the Massachusetts doctor reassures parents that two doses provide far more protection than zero.

“Absolutely, it should give families some peace of mind having their children two-dose vaccinated,” he told �鶹��Ʒ.

The news may bring some long-awaited relief to parents of children under 5 for whom the Omicron surge has been particularly frightening and stressful between spikes in and widespread .

“As a parent of a 3-year-old, this news does feel like light at the end of (the) tunnel,” said Jorge Burmicky, assistant professor at Howard University, in a sharing The Washington Post story.

But nationwide, rates of pediatric vaccination remain low. As of Jan. 26, just 20 percent of children ages 5 to 11 were fully immunized, while 55 percent of those ages 12 to 17, who have been eligible for shots for longer, had received two doses, according to data published by the .

As of November, nearly a third of parents of children ages 5 to 11 said they would “wait and see” before immunizing their kids in the most recent poll administered by the on parents’ vaccine attitudes.

For this decision around immunizations for children 6 months to 4 years old, Linas believes federal agencies must be upfront about the expected authorization process. Without clear messaging that young kids may ultimately need to receive three shots — but that the initial authorization of a two-shot regime allows youngsters to safely get started — he worries the eventual pivot could erode some parents’ faith in the shots. 

“If you don’t talk about it … it just creates this opportunity for misinformation, lack of trust, and then people shut down,” he said. “This is all about trust right now.”

Early Monday morning, a steady stream of Brooklyn families showed up at one neighborhood pharmacy for childrens’ COVID vaccines — even as hundreds of other New York City kids confronted uncertainty and long lines at school sites.

At Neergaard Pharmacy in Park Slope, Heath Griffths, 5, was soon 10 micrograms of Pfizer vaccine richer — departing for a happily delayed school day equipped with a stuffed bear from the pharmacy shop.

Elsewhere in the city, in lines hundreds deep. On the opening day for school-based vaccine pop-up sites, operated by the city and Department of Education, many were turned away as demand overwhelmed supply.

Line an ave deep for kids shots…but no one here to give the shots! H and h was supposed to be here at 630 for a 7 start. Now 730 and a line 100+ deep

— Jason Barnett (@barnettjason)

On 5th Avenue in Park Slope on Monday, Neergaard began its first official day of vaccinating kids, administering about 200 doses, preparing to offer hundreds of vaccines to 5- to 11-year-olds this week.

Vaccines have been a staple for Neergaard, an independent Brooklyn institution .  

About 15 minutes into a child’s screams from a fear of needles, one pharmacist told �鶹��Ʒ families choose them for their “more personalized touch — people come in and feel like they’re comforted.” He added, “that kid’s been here a long time.” 

Pharmacists had a deep bag of tricks: “Are you a righty or a lefty?” and “count down from 10 with me” were repeated throughout the morning to help calm kids’ anxieties about the dreaded needles.  

One Neergaard pharmacist said over the last two weeks, the shop has seen droves of parents walk in, seeking shots ever since the Centers for Disease Control and Prevention news broke. Appointment sign-ups for 5- to 11-year-olds almost crashed Neergard’s website. 

“I definitely prefer to go here than a place far away … this felt a lot better,” Ava, 10, told �鶹��Ʒ after receiving her vaccine.

Meanwhile, as he waited to get his shot, Heath Griffiths silently looked to his mother, Rachel. Confident and on a mission, Heath never took off his scooter helmet. Time was of the essence — he didn’t want to miss any more school than he had to at P.S. 282 on nearby 6th Avenue.

For the Griffiths, the pediatric vaccine means indoor playdates and family visits are back on the table. Once Heath and his 8-year-old brother finish their sequences, the Griffiths will fly to Arizona for the first time since the pandemic began.

“We’re following the CDC guidance and are really excited. I hope everyone decides to do it,” Rachel Griffiths said, adding that the excitement’s been constant since authorization was announced on Nov. 2. Dancing erupted in their kitchen when Heath and his brother learned the news. 

Excitement was an understatement for Neergaard regulars Luke and Parker Trautmann, 10 and 8 years old, respectively. “Relieved,” they jointly agreed. 

“Right when the message came out that kids can be vaccinated, she was on the case,” Parker said of his mom, Amanda.

When first-week, city-run appointment slots filled up, Amanda looked to pharmacies. She said her boys needed the in-person connections vaccines afforded, and the sooner the better. 

And Ava’s mother, Allison, said what was on a lot of parents’ minds: 

“We just hope that a lot of kids are going to be protected,” she said, looking forward to the days when visiting friends and family will “feel a little bit safer, for us and for them.” 

“Happy, excited,” she said, throwing her arms up to celebrate.

Her 5-year old sister, Mayari, who also got the shot, jumped in a circle to show off her “happy vaccine dance” outside the Brooklyn Children’s Museum, where both siblings got immunized.

Then the sisters, hand in hand with their father, skipped down the street back to their car.

Days after Rochelle Walensky, director of the Centers for Disease Control and Prevention, gave the final sign-off late Tuesday night to Pfizer-BioNTech’s pediatric coronavirus vaccine for use in children ages 5 to 11, shots are now rolling out and kids are — gleefully — pushing up their sleeves.

The Brooklyn Children’s Museum, located in the borough’s Crown Heights neighborhood, is one of to offer pediatric shots. Before the site’s 9 a.m opening, a modest line of roughly a dozen parents and children gathered by the front doors. A larger crowd came for shots afterschool on Thursday, when the museum first had doses available for the age group.

“It’s emotional,” said Kira Halevy, who was bringing her 6- and 8-year-old boys to get immunized. The pandemic has taken up about a quarter of her younger son’s lifetime, and the family jumped at the first opportunity to vaccinate their kids. 

“We’ve been waiting for this,” she said.

Leading up to the shots, her family used the event as a real-world lesson in biology and medicine, explaining the mechanics of the doses.

“The first shot tells your body what corona is,” recited Zeke, Halevy’s older son. “The second shot is telling your body how to fight it.” 

In New York City, nearly ages 12 to 17 have been vaccinated, well above the national rate reported by the American Academy of Pediatrics for that group. 

Now with shots available for the younger age group, a speedy and thorough rollout could significantly lower COVID’s hospitalization and death toll in the U.S. over the coming months and dull the impact of future variants, according to recent . Polling indicates, however, that nationwide will “definitely not” vaccinate their kids and others will “wait and see.” 

But the early-bird crowd on Friday was gung-ho.

“I was literally jumping up and down,” said Jenna Sternbach, describing the feeling when she received the email telling her she could sign her 11-year-old daughter Adlai up for a vaccine appointment. Now, having received the first dose and with a second soon to come, Adlai will soon be able to play soccer without a mask, which she looks forward to. 

The elder Halevy son, Zeke, can see himself very soon back at his friends’ houses, trading  Pokemon cards, he said.

And Wesley Francois, 15, who has been eligible for vaccines since the spring but was finally persuaded to receive the shot by a requirement for his basketball team, was excited to soon be able to ease up on masking.

“I’ll be a little more free,” he told �鶹��Ʒ.

Plus, the pain was only a 1 on a scale of 1 to 5, Mateo Vasquez, 7, estimated after his shot.

The nation’s largest school district is doing its part to encourage the vaccination effort. On Monday, New York City officials are setting up pop-up vaccine clinics at across the five boroughs.

Efforts to boost accessibility to the shots is key, said pediatrician Maria Molina, who practices in Manhattan and the Bronx.

“Now that we have a vaccine,” she told �鶹��Ʒ, “we have to make sure that every child has the same opportunity to get it.”

That extends to cultural factors as well, she noted. “I not only share the language of my patients, but I share the culture,” said Molina, who immigrated to the U.S. from the Dominican Republic and is now a member of SOMOS Community Care, a network of city health providers from diverse linguistic backgrounds. “It’s coming from someone who looks similar to them.”

The city has extended its for new vaccine recipients to youngsters as well, including those who receive shots at school. After first doses, families will receive an email explaining how to select between a prepaid $100 debit card, tickets to sporting events  or other perks.

“We really want kids to take advantage, families to take advantage of that,” said Mayor Bill de Blasio.

Young folks told �鶹��Ʒ that they had wide-ranging plans for their newfound cash: some planning to save or donate it to school fundraisers sending holiday gifts abroad, others are planning to splurge on the aforementioned Pokemon cards or Heelys sneakers, which come with wheels in the sole.

The mayor has not stipulated whether there is a student vaccination threshold at which schools would drop universal masking rules for the classroom — a move made by at least a dozen major districts across the country in recent weeks, with mixed opinions from health experts.

Parents at the Brooklyn Children’s Museum vaccination site on Friday said that they would prefer schools wait to scrap mask mandates until vaccination rates reach as many as 90 percent of students. 

“We’d rather have any form of protection,” said Kira Halevy.

Elsewhere in the U.S., Chicago Public Schools announced Thursday that it will cancel school Friday, Nov. 12 for the nation’s first “” in an effort to boost immunization rates.

It’s an “opportunity for parents and guardians to take their children five years of age and older to get vaccinated at their pediatrician’s office, at a healthcare provider, or at a CPS school-based site or community vaccination event,” schools CEO Pedro Martinez wrote to parents.

For those wary of vaccination, other effective safety measures against the virus may soon be on the way. Pfizer announced Friday that their new antiviral pill cuts the risk of COVID hospitalization or death by in vulnerable adults. That development, alongside President Joe Biden’s recently announced vaccine mandate deadlines for large workplaces, led Pfizer board member Scott Gottlieb to tell CNBC on Friday that the pandemic “” by early January. Other health experts have their doubts, citing the possibility of new mutations of the virus.

Back in Brooklyn, Winona Winkel, 9, got her first vaccine dose Friday and is already counting the days to her second. 

“Then I can hug my friends,” she said. 

Centers for Disease Control and Prevention Director Dr. Rochelle Walensky on Tuesday evening the unanimous vote of a CDC vaccine advisory panel recommending Pfizer-BioNTech’s pediatric coronavirus vaccine for use in children ages 5 to 11. Her sign-off means shots can begin Wednesday for some 28 million children in this younger age group. The CDC approval comes after the Food and Drug Administration on Friday for emergency use in 5- to 11-year-olds. Children’s hospitals and pediatrician’s offices across the country told CNN that they have and would be ready to administer shots to children as soon as they got the green light. “As a mom, I encourage parents with questions to talk to their pediatrician, school nurse or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated,” Walenksy said.

Members of a federal advisory panel voted overwhelmingly Tuesday evening to recommend the authorization of a pediatric dose of Pfizer-BioNTech’s coronavirus vaccine for children ages 5 to 11, setting in motion a process that could make shots available for the age group by next week.

The 17-0 vote, with one abstention, represents a key step toward vaccine access for approximately 28 million U.S. children — and means that virtually all K-12 students could soon be eligible for shots.

The Food and Drug Administration panel endorsed giving children one-third the dosage for adults in two shots spaced three weeks apart. The group’s vote is non-binding, but the FDA typically in the days after a decision, according to The New York Times.

Next, the Centers for Disease Control and Prevention has Nov. 2 and 3 meetings scheduled for their own panel of experts to weigh in on the matter, after which emergency use authorization could soon be issued.

FDA committee members cast their votes after considering the efficacy data of the Pfizer-BioNTech shots and the cumulative toll of COVID-19 on children and families.

Shots for kids were 91 percent effective at preventing infection, the pharmaceutical companies’ trial showed. Only three out of over 3,000 inoculated children experienced breakthrough infections, compared to over a dozen who had received the placebo.

Immunity and side effects for 5- to 11-year-olds were comparable to those produced by the larger dose in 16- to 25-year-old patients, the data showed. No new safety problems or cases of heart inflammation were observed in the trial. Israeli studies have found myocarditis to occur in less than , so it’s possible the condition would have been too rare to have been detected in the main study.

However, even in worst-case scenarios where adverse cases run on the high side of what officials expect, the benefits of shots for kids still supersede the potential dangers, according to modeling presented by Hong Yang, senior advisor at the FDA’s Office of Biostatistics and Epidemiology.

“The benefits clearly outweigh the risks,” she said.

Over the course of the pandemic, nearly 2 million children between the ages of 5 and 11 have fallen ill with the virus, 8,300 have been hospitalized, and close to 100 have died, making COVID-19 one of the top 10 causes of death among the age group, said Peter Marks, who heads the FDA division that oversees vaccine approvals.

In addition to preventing cases and hospitalizations, minimizing learning disruptions was a key consideration for advisory committee members. 

Since August, over 1 million K-12 students have been affected by school closures due to COVID, Dr. Fiona Havers, a viral diseases specialist at the CDC told committee members during the Tuesday hearing.

“The school closures and the disruption has been enormous,” said the FDA’s Jeanette Lee. “We have to weigh that against the benefits we would see [from] the vaccine.”

Randi Weingarten, president of the American Federation for Teachers, celebrated the panel’s recommendation as a win for school safety.

“This is huge news in our ongoing effort to keep our kids safe from COVID-19. For nearly two years, parents have been living in fear, worried that their child could get sick at school, day care, or in daily life, but now they finally have FDA-approved protection to add to the long list of vaccines we use to keep our children protected from transmissible diseases,” she said in a statement. “Educators, school staff and healthcare professionals are eager to work together with parents to help get America’s kids vaccinated in the places they trust, including public schools and community centers.”

At least one committee member, Cody Meissner, who ultimately voted to recommend the vaccine for authorization, expressed hesitation about how greenlighting shots for 5- to 11-year-olds may play out for school policy. 

“I’m just worried that if we say yes, that the states are going to mandate administration of this vaccine to children in order to go to school and I do not agree with that. I think that would be an error at this time,” he said during the Tuesday hearing.

Vaccine mandates have become a flashpoint in the ongoing culture wars now consuming school boards nationally. Only a handful of school districts, mostly in California, have enacted coronavirus vaccine requirements for eligible students. The Golden State’s two largest school systems, Los Angeles and San Diego, are currently defending their policies in court. 

California is also the only state to mandate shots for eligible students, though the policy will .

A third of parents with children ages 5 to 11 said they would get their child vaccinated “right away” once they were eligible, according to a Sept. 30 , while a third said they would “wait and see” and a quarter said they would “definitely not” vaccinate their younger children. A by ​​the COVID-19 Vaccine Education and Equity Project reported that two-thirds of parents with children in the age group said they would immunize them once the shots are authorized.

When shots do ultimately roll out for children, vials will be colored differently to avoid confusion with the more potent adult formula, said William Gruber, senior vice president of Pfizer Vaccine Clinical Research and Development.

Immediately after the FDA panel’s vote, Ashish Jha, dean of the Brown University School of Public Health, .

“They got it right,” he said.

In many cases, CDC numbers clash with locally reported vaccination rates, an analysis from �鶹��Ʒ reveals, including multiple instances of double-digit gaps between local and federal counts. In some counties, the agency’s data indicate that the share of 12- to 17-year-olds who have received at least one vaccine dose is impossibly high — 101 percent in Miami-Dade County, Florida, and 104 percent in San Francisco County, California, for example.

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The lack of clarity takes on heightened significance as the country another swath of the K-12 population, with coronavirus shots for children ages 5 to 11 currently under review by the U.S. Food and Drug Administration and expected as soon as early November.

Inaccuracies in CDC data could have implications for the nationwide understanding of vaccine uptake among young people. The youth COVID immunization rate calculated by the , for example, is based on CDC numbers.

“Our method is to clearly state the source of our data,” Suk-fong Tang, senior database analyst for the AAP, told �鶹��Ʒ. But due to time limitations and the vast quantity of information, she said, “it is not possible at this time to validate everything that we use.”

“We work with [CDC] data with the faith that the data really captures the large trends,” the AAP expert continued. “It may not be, you know, accurate down to the single-digit counts.”

While the CDC does not publish youth immunization data directly, it releases vaccination rates and raw counts for those over 12 and those over 18 by county. Using those numbers, �鶹��Ʒ calculated the rate of inoculation for 12- to 17-year-olds via a method that Tang confirmed produced a “highly similar” youth vaccination figure as the AAP. (Click to see the math.) Those rates frequently deviated from local reports, indicating possible flaws in the federal agency’s vaccination counts, population counts, or both.

For example, CDC data downloaded by �鶹��Ʒ Sept. 30 indicate that in Queens County, New York, 86 percent of teens have received at least one vaccine dose, while NYC Health said the county’s figure was actually 74 percent. In an especially extreme case, federal data for Coconino County, Arizona, indicate a 93 percent one-dose vaccination rate for 12- to 17-year-olds, while Coconino Health and Human Services reported a 57 percent rate.

Coconino County officials explained the gap in an email to �鶹��Ʒ, saying they use a “more enhanced data cleaning process” than the state or the CDC.

Other areas such as Fairfax County, Virginia; Marin County, California; and Howard County, Maryland, reported youth vaccination rates that closely aligned with federal counts, differing by under 5 percentage points.

The CDC did not respond to the discrepancies identified by �鶹��Ʒ, and did not provide comment when asked for the reasons behind them, despite over a half-dozen requests made over more than a two-week span. The agency did send a link to information on its vaccination data reporting protocols, which that their population counts are based on the Census Bureau’s 2019 estimates, meaning that their percentages could be inaccurate if individuals moved counties in the last two years.��

Population shifts may not completely account for the discrepancies. Outside experts also said issues such as or delays in reporting data upstream to the federal government could contribute to inaccuracies.��

‘Flying blind’

Data woes have plagued the CDC throughout the pandemic, said Ali Mokdad, who, after years monitoring vaccine coverage at the federal agency, is now a professor of epidemiology at the University of Washington.��

“We’re flying blind,” he said, pointing out that U.S. decisions around Pfizer booster shots were based on data from Israel and Qatar, where vaccination numbers are collected in a more standardized fashion, due to a dearth of reliable U.S. data.��

From the CDC’s decision to for breakthrough infections to their for vaccinated individuals, the agency has come under fire at multiple points throughout the pandemic.��

In past months, the epidemiology professor said, many Americans received by crossing state lines or lying about their vaccination status thanks to lax immunization tracking. “We don’t know [exactly how many people are] vaccinated or not, and what types of vaccines they have received and when.”

That can become a life-or-death problem, said Mokdad. “When you know how many people are vaccinated, you know what immunity you have in your community,” he explained. “[But if you don’t] know how many people are vaccinated … you can’t get a handle on how many people are susceptible in your own community and then that will sustain a surge.”

In instances where local vaccination numbers are above CDC counts, it’s possible that states have been slow to report their most recent immunization data, Emily Pond, a researcher for the Johns Hopkins University , told �鶹��Ʒ — she calls that glitch “data lag.” Where the CDC count is higher, Pond explained, federal overseers may have access to vaccination counts that local departments of health do not, such as coronavirus immunizations that occurred at army bases or on tribal lands through the Indian Health Service.

In Navajo County, Arizona, for example, Assistant County Manager Bryan Layton said via email, “We openly acknowledge the inherent challenges of tracking and reporting case data and vaccine rates in a rural county that is home to 3 different sovereign tribal entities: the White Mountain Apache Tribe, the Hopi, and the Navajo Nation …. The Navajo Nation … uses a series of service areas that do not necessarily conform to county or state jurisdictions.”

Still, local reports in Navajo County say of residents under 20 years old have received at least one dose of the vaccine, compared to CDC numbers that put the rate for 12- to 17-year-olds at 98 percent — a gap that likely can’t be fully explained by Indian Health Service data absent at the local level.

“I have a red flag when any [vaccination rate] is above, like, 90 percent,” said Pond. Differences between CDC and local figures, she said, can be rather common.��

‘A lot of moving parts’

To get a better sense of the frequency of discrepancies between local and CDC vaccination rates, �鶹��Ʒ queried a random sample of 10 U.S. counties, a small sliver of the over 2,600 in the full dataset and separate from the analysis of the counties with the highest reported rates. Seven returned data for comparison against federal numbers, some using slightly different age boundaries for youth vaccination than �鶹��Ʒ’s 12- to 17-year-old range.

Out of those seven counties, three had rates that diverged from CDC numbers by more than 5 percentage points. Hood River County, Oregon, reported that 72 percent of youth ages 12 to 17 had received at least one dose of the coronavirus vaccine while the CDC reported an 80 percent figure. Sullivan County, Pennsylvania, reported a 23 percent rate for youth ages 12 to 19 compared to a 30 percent 12- to 17-year-old rate from the CDC. And Schoolcraft County, Michigan, reported that 32 percent of youth ages 12 to 15 and 47 percent of youth ages 16 to 19 had received at least one dose, compared to a 13 percent CDC rate for youth ages 12 to 17. Both Sullivan and Schoolcraft counties have populations under 10,000, meaning small inaccuracies could have an outsized impact on their vaccination percentages.

The inconsistencies don’t surprise Michael Kurilla, director of the National Center for Advancing Translational Sciences at the National Institutes of Health. The U.S. has a decentralized health care system, he pointed out, meaning that providers can’t easily share data. For example, someone sick with COVID who leaves the hospital too early and re-admits to another facility could easily be counted as two cases, said Kurilla.

Further, the reporting systems themselves are often antiquated, the NIH expert explained.

“Some places are still paper based, some are using fax to transmit information,” he told �鶹��Ʒ, adding — only half joking — that it wouldn’t surprise him if some local health agencies still used floppy disks.

On top of technological woes, the many different settings offering COVID-19 shots can compound reporting challenges, explained Phil Chan, medical director for the Rhode Island Department of Health. It’s easy to document doses at state-run vaccination clinics, he said, but vaccinations delivered at doctor’s offices or pharmacies can be harder to track.

“It’s a lot of moving parts,” he told �鶹��Ʒ. “The devil’s really in the details.”

When those details are mishandled, inaccuracies in the data arise. In mid-September, the CDC adjusted their report of the share of people 12 and older in West Virginia who had received at least one dose of the coronavirus vaccine , after discovering that they had double-counted certain data streams for over three months.

On the flip side, increased data transparency may well translate into increased accuracy. In Maine — the only U.S. state to publicly report student and staff COVID vaccination data for school districts, according to the University of Washington’s Center on Reinventing Public Education — reported by the state for each of its 16 counties align closely with federal numbers.

“We need to be transparent, you need to show exactly what you do,” said Mokdad, the UW epidemiologist who spent two decades at the CDC.

He wishes his former employer would be more forthcoming about its raw numbers and any possible shortcomings in its data pipeline. In his own COVID research, Mokdad said, he relies on infection counts from the Johns Hopkins tracker, because he finds it more reliable than the federal numbers.

“There is a big problem at CDC right now,” said the epidemiologist. Mokdad himself was involved in a high-profile incident in 2004 where he co-authored a CDC paper that the number of annual deaths caused by obesity. The health expert said he left the centers in 2008 for unrelated reasons and on good terms with all his co-workers.

“I criticize CDC because I love CDC,” he said.