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Following a year of chaos around childhood vaccines, the medical community finally got a win in mid-March when a judge temporarily stayed a number of controversial decisions made by a federal vaccine advisory committee and essentially halted its ability to meet at all.
The ruling came about nine months after the American Academy of Pediatrics and other groups filed a lawsuit against longtime vaccine skeptic, Health and Human Services Secretary Robert Kennedy Jr., and the department he leads, which includes the Centers for Disease Control and Prevention. In it, the plaintiffs argued that Kennedy Jr.’s advisory committee appointments — and the panel’s subsequent votes to roll back childhood vaccine recommendations — were unlawful.
David Hill, a pediatrician who has been practicing for over 30 years, serves as a spokesperson for the AAP. He recently told The 74 that while he and his colleagues are “very happy” with this latest development, “we’re also all still holding our breaths.”
“This is one moment in a lengthy process,” he added. “It is an encouraging moment, but I don’t think any of us are under the impression that this is over yet.”
Most of Hill’s work centers around hospitalized children and newborn care, which means he is often the first pediatrician a family meets and the one parents talk to about vaccinating their kids. He recently started practicing in Seattle after spending years working in North Carolina, where he served a widely diverse group of patients.
The families he works with, he said, have “vastly different socioeconomic backgrounds and value systems and understandings of health,” which has given him a unique perspective into on-the-ground impacts of shifting vaccine policies.
While not new to public discourse, vaccine skepticism has significantly swelled and gained greater footing since Kennedy Jr. took the helm of the nation’s health care system last February. Following his appointment, he swiftly fired all 17 members of the Advisory Committee on Immunization Practices, also known as ACIP, replacing them with hastily hand-picked advisors who largely shared his views on vaccines.
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The committee has since voted to overturn a recommendation that all newborns receive the hepatitis B vaccine; change policies surrounding the measles, mumps, rubella and varicella (chickenpox) combination vaccine; and roll back recommendations around 2025’s COVID- 19 booster. Then, this January, officials announced a plan to overhaul the U.S. childhood vaccine schedule, significantly reducing the number of shots routinely recommended for all kids — all amid already falling vaccine rates, measles outbreaks and the return of a deadly bacterial disease known as Hib. The AAP and other groups were also cut off from their long-standing liaison roles.
It was in response to all of these decisions that the AAP, a trusted source of information for pediatricians and families for nearly a century, began boycotting ACIP meetings, released a competing vaccination schedule, filed their lawsuit and effectively severed ties with the committee.
March’s preliminary injunction halts the changes to the pediatric immunization schedule, and stays Kennedy Jr. ‘s 13 appointments to the committee, essentially rendering it unable to meet. All votes made by the now-stayed ACIP appointments are also overturned — at least temporarily.
When asked to comment, HHS spokesperson Andrew Nixon said this week that the department looked forward to the judge’s decision being overturned, but would not say whether it had filed an appeal.
The 74’s Amanda Geduld recently spoke with Hill about his organization’s lawsuit and how childhood vaccine sentiments have shifted over the past three decades. The impacts he’s seen in his own practice are particularly illuminating.
This interview has been edited for length and clarity.
What is the most common question that parents ask you about vaccinating their newborns? Is there one vaccine they’re particularly concerned about?
I have the most experience in my current role with the first hepatitis B vaccine, but I think it is a fantastic model for the questions that we get about other vaccines. For example, I recently admitted a child at the hospital with an infection and breathing difficulty at age 2 who had not yet been vaccinated against Haemophilus influenza B (Hib) and pneumococcal pneumonia.
And we had to think about this child very differently, because these are complications of viral illnesses that used to be absolutely horrendous — with meningitis, aggressive pneumonia, severe ear infections, infections of the bone around the ear or behind the ear. And really, because of the effectiveness of the vaccines against these illnesses, we have been lulled into not worrying about them very much anymore. And so we had to make sure that the team was aware that this was a possibility — these complications with this baby.
But most often I’m talking about hepatitis B, and usually I’m the one who begins with the questions, and I say, “Hey, I noticed that your child has not had the hepatitis B vaccine we usually give. Do you mind sharing with me your thoughts about that?”
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How have those conversations shifted, if at all, over the past three decades that you’ve been practicing medicine?
Well, they used to be vanishingly rare. And not a “never” event, but a rare enough event that if it occurred, it was remarkable. It might be the first thing I would tell my wife when I came home that evening, or something I would comment to my colleagues about when I went into the office. “You’ll never believe this, but we had a patient turn down [the] hepatitis B vaccine today.”
And that is because there was a widely shared understanding that this was an important intervention to keep children healthy for the rest of their lives, and that it was an extraordinarily low-risk intervention with a very high degree of reward.
And it wasn’t a never event. It’s always been there, but it was remarkable. It was unusual, and the script has flipped to the extent now that when I’m first reviewing a newborn’s chart before I go into the room, I actually breathe a sigh of relief when I see that they have gotten their vaccine, because a really significant proportion of my patients — especially just in the last five or six months — have decided that they are going to delay it or maybe not get it at all.
How much of that do you attribute to this current administration and to Robert F. Kennedy Jr.’s leadership of HHS?
I think that there’s a very apropos chicken-and-egg question here. The wellness industry has put an enormous amount of money and effort into undermining confidence in traditional medicine, and that, of course, allows them to expand their market. It’s a market which is extraordinarily profitable.
But if patients have trust in traditional medicine, then they’re less likely to purchase those products or to go to those providers. So there has been a decades-long effort — in terms of marketing, in terms of influence — that has been well funded and extraordinarily successful.
It certainly did not start with the election of Donald J. Trump, either the first time or the second time. It definitely was accelerated by the success of a number of proponents of these efforts to achieve power within the United States government, to achieve federal power.
And as much as people distrust the government, they really do listen to what the government says. So when the message coming from the Centers for Disease Control and Prevention or from the Department of Health and Human Services, are messages undermining confidence in traditional medicine — whether we like it or not — that really does have a bearing on the decisions that people make.
Last July, the AAP sued HHS and Kennedy Jr. over vaccine policies. Then, in March, a judge issued a stay, which essentially means that a lot of the votes that ACIP made are overturned — at least for now. One of those involves the Hep B vaccine birth dose. Can you talk a little bit about the initial decision that was made by ACIP to delay that birth dose, and how you saw that impacting patients on the ground?
I think the really good news for those of us in public health and those of us striving for child health is that the initial decisions made by the ACIP — the ones that were recently stayed by the court — had not yet come to affect what vaccines were available to children. And so the stay has also not changed that, because payers were still paying for the vaccines, suppliers were still supplying them, manufacturers were still making them, hospitals and offices were still stocking them.
So I think it’s very good news that we had not yet seen our worst case scenario of some of these vaccines becoming unavailable or unaffordable. We, on the ground, are very happy to see a court agreeing with our professional opinion that there was no scientific basis for making these changes, and yet I think we’re also all still holding our breaths, because this is not done. There will be appeals. This is one moment in a lengthy process. It is an encouraging moment, but I don’t think any of us are under the impression that this is over yet.
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You mentioned that the judge’s ruling luckily came before some of the worst case scenarios were able to play out. But are you aware of any pediatricians on the ground who had started shifting any of their practices based on ACIP votes?
I am not. I am quite involved in the American Academy of Pediatrics, and listen to a lot of lines of communication. And I think we were all trained to follow the best evidence. And the American Academy of Pediatrics, and scores of other medical organizations, endorsed an evidence-based vaccine schedule that was very similar to the prior vaccine schedule, and that is, as far as I know, what all of my colleagues were referring to.
If the judge had not issued this preliminary injunction, do you think providers on the ground ultimately would have shifted their practices to match the new ACIP guidelines? Or would they have stuck to the evidence-based practices regardless?
You know, I have great confidence that my colleagues would have continued to follow the evidence wherever it leads. I think the fear would have been that some other barriers to following that evidence might have arisen — in terms of reimbursement, manufacturing, liability — that would have made it more difficult for us to do what we know is right for children.
I would imagine that the majority of parents across the country are not keeping super close tabs on this lawsuit or tuning into ACIP meetings, but they are reading the headlines, and they’re seeing these rulings go back and forth and practices being implemented and then rolled back. I’m wondering what impact that back-and-forth messaging is having on parents. Is that leading to confusion?
Oh, I know that it is leading to massive confusion. When you look at a marketing campaign, as this has been, people don’t have to be convinced that a message like this is correct, they just have to have some doubt. And so the fact that these conflicting announcements or decisions are sowing doubt is really enough to dramatically change the landscape that we are looking at at this point in terms of communicating with parents, in terms of following the best practices for public health and in terms of protecting children.
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So what is your big takeaway of the judge’s latest ruling then? What impact will this stay have for parents and providers on the ground?
I think the most important shift that I’ve seen — and as a professional medical communicator, it is a shift that I welcome — is that pediatricians and health care providers as a whole, and scientists and public health officials are coming to terms with a new understanding of how critical our communication is. And it is across the board revolutionizing the way that we communicate, both individually and in public.
Can you talk a little bit about how that communication is revolutionizing, specifically when you’re talking to patients and parents of patients?
Yeah, absolutely. My dad is still a practicing pediatrician at age 84, and throughout his career he could count on the fact that he was the doctor being enough for most people. He walks in the room in a white coat with years of experience and an absolutely spectacular education at the best institutions the country has to offer, and has a wall of diplomas behind him, and people will be like, “OK, you know a thing.” It’s just like when I walk onto my airplane and I see the pilot with all the gold bars on his epaulet. I’m like, “Oh, this guy probably knows how to fly an airplane. I’m going to take my seat.”
The relationship between doctors and patients and doctors and the public has changed in a way that I don’t think is going to change back. No matter what happens, we can’t just sit down in the chair and say, “Hey, I’m the doctor. Here’s what you need to do. Trust me, I studied, I know some stuff.” Patients are really demanding — and appropriately so — that we show first that we care and that we can listen and that their value system, their understanding, their goals for their child’s health are the most important thing in that room — that we are servants who can bring our knowledge to bear to further this family’s goals for their child. …
My mentor for many years, Dr. Tom Blackstone in Wilmington, North Carolina, used to sit me down early in my career and say, “Davey, they don’t care how much you know until they know how much you care.” And those are the very wise words of someone who’s been doing this for a long time, and I think those are words we all have to live by.
I love that — that’s a beautiful sentiment. Well you talked about how there have been shifts in medicine you don’t necessarily foresee going back. I’m going to ask you to look into a crystal ball here, if you will, and tell me if you foresee this moment as a shift in policy moving forward.
In other words, might this be a time the administration moves away from the attacks on vaccine policy and perhaps more towards other elements of the MAHA movement, like nutrition? Or is this stay merely a brief pause before the vaccine battle continues?
I would tend more toward the brief pause, and I would be thrilled if MAHA acted aggressively on some of their [other] priorities. There is more common ground between the stated priorities of the MAHA movement and the priorities of pediatricians. We would love to see kids get more fresh, healthy food in their diets. We would love to see aggressive measures taken to reduce pollutants in the water, in the air, in farming practices. We would love to see efforts toward increasing family activity and generating safe green spaces for exercise and play really put at the forefront of policy.
I think, in a very sincere way, there are a ton of common goals that pediatricians and the MAHA movement share. I am disappointed that on many of these fronts, it appears that this administration is actually taking steps backwards rather than forwards. Taking steps to allow greater degrees of pollution that we know harm children; taking steps to allow greater use of chemicals in farming; taking steps to decrease the availability of fresh, healthy food in schools, for example.
And people have done this — there are forums where pediatricians and MAHA advocates sit down and find that they agree on a lot. So I think we would love to see any of those priorities move to the forefront of the movement. … The attack on vaccines, unfortunately, is very much an attack on public health, and so I think we are still waiting to see what the next steps are going to be before we relax.
The AAP has always been a highly trusted organization and leading authority on children’s health, but I would imagine that role has been pretty seriously magnified over the past year or so with this shift in leadership. Can you talk a little bit about what that feels like from inside the organization and how that’s impacted some of your public-facing actions?
Past administrations have certainly cooperated in more concert with the American Academy of Pediatrics, regardless of whether the leadership was Republican or Democratic. We are a nonpartisan organization, and we have enjoyed close working relationships with pretty much every administration. I believe it is unprecedented since we began working with the ACIP to terminate that relationship. So that certainly would appear to be a flash point.
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However, as a pediatrician of a certain age, I also recall that this is very much in continuity with the American Academy of Pediatrics taking positions in favor of child health that were at times quite unpopular with the public. We were out there early talking about tobacco-free spaces and tobacco-free homes. Those of us who are old enough to remember when people smoked in restaurants and airports and pretty much anywhere they wanted to also recall that there was a tremendous backlash on that.
When the American Academy of Pediatrics came out in favor of taking lead out of gasoline and paint that was dramatically unpopular. The fuel industry and the paint industry, the builders, really protested quite loudly against that. Even car seats, bike helmets, things that we all take for granted as public safety measures — like who would not have their baby in a car seat right now? — were incredibly controversial when they began, and the American Academy of Pediatrics always stood up for child health and safety first and understood that if children’s health was benefited, eventually the public would understand. …
So to some extent, we are just following in the footsteps of those who came before us, and I certainly hope that when I’m not working anymore, there will be another generation to continue in that path, because it’s the right path.
Is there anything I haven’t asked about — having to do with this current administration and vaccine policy — that you think is important for readers to understand, given the news of the past couple of weeks?
I think first of all, that the public is wise enough to see where these attacks on vaccines could lead, and to make good decisions regarding child health moving forward. I don’t think we’re going to be having the same conversation in 10 years, or even five years, because as we see measles sweep through certain states, we’re also seeing people in those states recognize what a danger it is. And part of what we’re seeing is parents asking if they can have their babies vaccinated against measles at six months of age, which they can, it just doesn’t keep them from needing the next two vaccines.
I think that the public is really very intelligent, and that people are already waking up to what these changes mean for public health, and I think for the most part, they don’t like it. One truism that I’ve witnessed as a pediatrician throughout my career is that parents love their children. They want the best for their children. Everybody holds their baby, imagining what that little being is going to turn into, how they’re going to grow, what they’re going to accomplish, and knowing that, I know that societally, we are going to ultimately make good choices, because that’s what it means to love our children.
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