Darwin's Our Take 8.17.26: Trump tries again to revise federal childhood vaccination recommendations

For the second time in less than three months, President Donald Trump on Aug. 10 issued an Executive Order regarding a revised childhood and adolescent immunization schedule his administration is seeking to implement.  

The revised schedule, released in a memo by various agencies under the Department of Health and Human Services on Jan. 5, would decrease the number of diseases targeted by routine childhood vaccinations from 17 to 11, while decreasing the number of routine, or “consensus,” vaccinations from 13 to seven.

Under the revised schedule, the Centers for Disease Control and Prevention would not universally recommend the following vaccinations for all children: COVID-19, hepatitis A, hepatitis B, influenza, meningococcal disease, respiratory syncytial virus, and rotavirus. Instead, these vaccinations would be recommended only for high-risk groups or through shared clinical decision making.

In March, a district court granted a request by the American Academy of Pediatrics and other plaintiffs for a preliminary injunction blocking implementation of the revised immunization schedule while their lawsuit is ongoing.

The most recent EO goes further than the one signed in late May. In the new EO, the Trump administration calls for swapping out the combined measles, mumps, and rubella vaccine for “single-disease shots” when available.

Currently, only the combined vaccine is approved by the FDA. Vaccines for the separate diseases are available in other countries but would need to undergo testing before being approved for use in the U.S.

Among other actions the new EO calls for, it advises states to review the federal recommendations and consider updating their laws accordingly. States, not the federal government, determine which vaccinations are required for school enrollment.

The EO also gives a federal panel under HHS, referred to as the Task Force on Safer Childhood Vaccines, the power to assess the timing and sequencing of core childhood vaccines and to adjust the federal vaccine schedule. In effect, this task force — which, KFF noted, consists of federal officials rather than independent experts — could circumvent the authority of the CDC and its Advisory Committee on Immunization Practices.  

At the official signing of the EO last Monday, Trump and HHS Secretary Robert Kennedy Jr. repeated debunked claims about a potentially causal relationship between vaccines and autism.

OUR TAKE: As happened earlier this year when the revised immunization recommendations were released and when Trump signed the first EO in response to the court-ordered injunction, medical organizations such as the American Academy of Pediatrics (AAP) and various public health experts issued statements in which they cautioned against changing the CDC’s established childhood vaccine schedule.

Regarding the comments Trump and Kennedy made about the possible connection between vaccines and autism, Alycia Halladay, chief science officer at the Autism Science Foundation, said in a press release:

“No environmental factor has been better-studied as a potential cause of autism than vaccines. That includes vaccine ingredients as well as the body’s response to the vaccines. All this research has determined that there is no link between autism and vaccines.  

“This is consistent across multiple studies, repeated in different countries around the world, including those mentioned in today’s press conference. Separating vaccines into multiple visits has also never been shown to prevent autism.”

Dr. Andrew Racine, AAP’s president, had this to say:

“Dozens of studies involving millions of people show there is no link between vaccines and autism, and yet federal leaders continue to promote this outdated, disproven idea to scare families.

“The only purpose of this announcement is to sow confusion so that more people doubt the importance of vaccines. Delaying or skipping shots is risky, especially as measles continues to spread and children go back to school.”

Dr. Jan Carney, president of the American College of Physicians, said in a prepared statement:

“This executive order is part of a troubling pattern by the administration to attempt to unilaterally change vaccine guidance, particularly for children, rather than relying on the transparent, scientific review that has guided the U.S. childhood vaccine schedule for decades.

“If implemented, the changes could increase costs to patients and families, including additional copays while also placing a greater burden on families needing to schedule multiple appointments for a multiple-dose MMR vaccine.”

Even Sen. Bill Cassidy, who’s a physician and the senator who provided a crucial vote to confirm Kennedy as the head of HHS last year, posted the following on social media:

“This executive order is wrong. The President does not have the expertise to make these changes. Vaccines are overwhelmingly safe. Vaccines are effective. Vaccines DO NOT cause autism.

“Breaking up vaccines will mean children have to get more shots to get the same protection, not fewer shots. It will increase hesitancy and make children less safe.

“Parents should listen to their child’s pediatrician about vaccines rather than listening to an inaccurate executive order. This is so wrong.”

We, of course, concur with the experts. Neither Trump nor Kennedy has any formal medical training. They should not be weighing in on medical policies that affect millions of people.

It’s unclear whether the EO will stand up in court; undoubtedly, it will be contested. But that won’t keep Trump and Kennedy from continuing their efforts to undermine public trust in vaccines.  

Editor’s note: I address the backstory of these claims and the research refuting them in this week’s Health Care Rounds podcast. We decided to address the EO here rather than add a comment to the podcast, which had been recorded prior to the announcement. -JM

Health Care Rounds Mailbag: Vaccines, Autism, and the CDC

A few weeks ago we conducted a survey of Our Take readers that included both listeners to our podcast and those who don’t (the latter group, we assume, was interested enough to complete a survey). We asked for questions you would like John to answer, and we got some great ones, including today’s question about vaccines and the long-debunked link between the MMR vaccine and autism spectrum disorder. In this first mailbag episode, John reviews the evidence, calls out the "revised" CDC website, and provides his thoughts on the cost of misinformation and disinformation — and what to do about it. Find it on Spotify, Apple, or your favorite podcast platform.

What else you need to know

Employers are migrating away from the Big Three pharmacy benefit managers, according to a recent survey released by the National Alliance of Healthcare Purchaser Coalitions. The percentage of employers using one of the three largest PBMs — CVS Caremark, Cigna’s Express Scripts, or UnitedHealth Group’s Optum Rx — decreased from 63.4% in 2025 to 54.3% in 2026.

Of those still using one of these PBMs, 55.7% said they are considering changing to a different PBM within the next three years. By comparison, just 31.1% of employers who use a PBM other than one of the Big Three indicated they might switch PBMs in the next few years.

Of the 408 employers surveyed, 27 reported switching PBMs in the past year, and only seven of those who changed PBMs are using one of the Big Three. The migration away from the largest PBMs was most pronounced among employers with fewer than 1,000 workers: Nearly 70% of these employers said they used a Big Three PBM in 2025, compared with just 44% in 2026.

While large employers (those with at least 10,000 workers) have been less likely to contract with a PBM other than one of the Big Three, the survey indicated that these employers have the most interest in switching to a different PBM within the next three years. The survey report suggested that the scale of making such a decision could be a reason large employers have not yet acted on their interest in switching PBMs.

Twelve health systems and Aidoc have launched an initiative “to harness AI to improve the safety, quality, and speed of diagnosis.” The group, dubbed the Diagnostic AI Consortium, consists of some of the nation’s leading health systems, including Advocate, Mercy, Northwell, Northwestern Medicine, Sutter Health, and University Hospitals of Cleveland. Collectively, the 12 health systems provide care for nearly 20 million patients each year.

Diagnostic AI differs from other uses of AI in healthcare because it needs to detect subtle clinical signs across a variety of collected data, including imaging, pathology, and lab results, as well as electronic medical records, the group explained in a news release. This means AI has to be “purpose-built for clinical decision-making, rigorously validated in clinical practice, FDA-cleared, and designed to improve measurable patient outcomes,” the group noted, adding that AI performance has to be continuously monitored for drift and bias.

“[These] health systems holding themselves to shared standards for how diagnostic AI is evaluated and governed is how we earn the right to scale it, and how we shorten the time from scan to diagnosis for every patient,” said Elad Walach, CEO and co-founder of Aidoc, an AI healthcare company with corporate headquarters in Tel Aviv, Israel, and New York City. The group expects to share its initial results next year.

Oracle Health’s AI-powered patient portal is now generally available in the U.S., the company announced last week. The portal integrates directly with Oracle’s electronic health record. Patients can use the portal to receive health summaries that might include highlights of recent provider visits, key medical conditions, medications, and steps they need to take, such as completing labs, follow-up visits, and screenings. They can also use it to schedule appointments and get answers to questions they may have about their health and medical records. Oracle noted that the portal has built-in guardrails that prevent it from offering diagnoses, medical advice, or treatment recommendations. A company spokesperson said existing Oracle customers may have the portal included in their current contracts, or it can be purchased separately, Healthcare Dive reported.

Jazz Pharmaceuticals has agreed to acquire Actio Biosciences, a privately held biotech company based in San Diego, for $820 million up front and potentially another $500 million in milestone payments. Actio’s lead candidate, ABS-1230, is a potential first-in-class precision therapy. It’s being developed as a treatment for KCNT1-related epilepsy, a rare genetic epilepsy that typically emerges during infancy and often presents with a “profound seizure burden,” the companies said in a press release. There are no FDA-approved treatments for this form of epilepsy.

The boards of both companies have approved the acquisition, which is expected to close in the fourth quarter if customary closing conditions are satisfied. At that time, under the terms of the definitive agreement, Actio will spin out a new privately held entity with certain employees and assets other than ABS-1230. The new company will focus on genetic rare neurological diseases and be funded by existing investors. Jazz will receive a minority stake, along with certain related rights.  

The FDA approved Replimune’s Tudriqev (vusolimogene oderparepvec-wtpg) in combination with Bristol-Myers Squibb’s Opdivo (nivolumab) for adults with advanced, refractory melanoma. Tudriqev, an engineered oncolytic virus based on a modified herpes simplex virus type 1, was previously rejected twice by the FDA. The agency’s latest decision to grant an approval under the accelerated approval pathway means Replimune will need to conduct at least one confirmatory trial; such a trial is underway.

What we’re reading

The Value Opportunity from Artificial Intelligence in U.S. Health Care Spending. NEJM Catalyst, 7.22.26 (abstract available, subscription required for full article)

Medicare Accountable Care Organizations: Clinical Performance for Patients With Heart Failure. AJMC, August 2026

Hospital Price Transparency After Five Years: The Next Challenge Is Incentives, Not Disclosure. Health Affairs, 8.14.26